FAQ for American Indians

• Adult American Indians and their adult household members with income up to 133% of the federal poverty guidelines (FPG) are eligible for Medical Assistance. Their children are eligible for Medical Assistance up to 283% FPG.
• Medical Assistance is a premium-free program for all qualified participants.
• American Indians and Alaska Natives do not have Medical Assistance cost sharing if they currently receive or have ever received care from an I/T/U provider or a referral from an I/T/U to a non-Indian provider. Any non-Indian household members will be responsible for cost sharing.
• American Indians who qualify for Medical Assistance and live on a reservation are excluded from mandatory enrollment in managed care and will be covered on a fee-for-service basis. However, they may choose to enroll in managed care on an individual basis regardless of residence on a reservation. American Indians who enroll in managed care Medical Assistance, whether or not they live on a reservation, have direct access to I/T/U facilities, even if the provider is not in network.

• Adult American Indians, Alaska Natives and their adult household members with income up to 200% of the federal poverty guidelines are eligible for MinnesotaCare.
• American Indians, Alaska Natives and their household members are not required to pay MinnesotaCare premiums.
• American Indians who are members of a federally recognized tribe are not subject to cost sharing for any covered services, regardless of where they receive care.
• American Indians do not have MinnesotaCare cost sharing if they receive care at I/T/U facilities or if they have a referral from an I/T/U facility when they receive covered services from other health care providers. This is true regardless of whether the person is a member of a federally recognized tribe.
• Non-Indian members of American Indian households are not required to pay MinnesotaCare premiums, but are responsible for cost sharing.
• American Indians and Alaska Natives eligible for MinnesotaCare must enroll in a managed care plan.

Yes. Access to coverage through your employer does not bar your family members from enrolling in coverage through MNsure. Family members who have access to employer-sponsored coverage might be eligible for premium tax credits if the employer-sponsored plan does not meet the minimum value or affordability test provided in the ACA.

Yes. Generally, loss of employer-sponsored coverage is a qualifying life event for a special enrollment period. See more information on life events here.

Yes. If you are not eligible for Medicare and are over 65 years of age, you might be able to purchase coverage through MNsure. For questions related to Medicare eligibility and your coverage options, contact Minnesota Aging Pathways at 800-333-2433.

No. Gaming per capita payments are taxable and must be included in your MAGI.

Many American Indians in Minnesota are covered by Contract Health Services/Purchased or Referred Care (CHS/PRC) through their IHS/tribal health care program. All rules regarding referrals must be followed for payment to be made. Those American Indians who do not have access to CHS/PRC will be financially responsible for services they receive unless they are insured through either a public or a private health care plan.

Certain categories of income are treated differently depending on which program you are eligible for. For purposes of Medical Assistance and MinnesotaCare, the following categories of income may be excluded from an Indian's MAGI:

• Distributions from Alaska Native Claims Settlement Act (ANCSA) Corporations and Settlement Trusts
• Distributions from trust/reservation property
• Income from property and rights related to hunting, fishing and natural resources
• Income from the sale and use of cultural/subsistence property
• Student financial assistance provided by the Bureau of Indian Affairs and/or a tribe
• Income that falls within the IRS General Welfare Doctrine
• Any other Indian income that is non-taxable according to federal law or IRS guidance

Yes. Though non-tribal members are not eligible for this monthly SEP on their own, effective October 1, 2015, MNsure allows family members who apply for coverage with a qualifying tribal member to take advantage of the monthly SEP along with the qualifying tribal member. If you, as a qualifying tribal member, choose to enroll in a qualified health plan or change plans using the monthly SEP, then your family members can enroll in or change plans as well.

Effective October 1, 2015, MNsure allows family members who apply for coverage with a qualifying tribal member to enroll in or change QHP in any month that the qualifying tribal member exercises the monthly SEP by enrolling in or changing QHPs. Remember, during open enrollment all household members can enroll or change plans for the coming coverage year.

No. In order to continue your 100% CSR benefit you cannot enroll a non-tribal member on your plan. You can enroll your non-tribal dependent in their own QHP and they can still receive any CSR benefit they may qualify for themselves. Please call the MNsure Contact Center for more information about this option.

Mixed-tax households have complicated eligibility determinations that need to be carefully considered. Spouses and children of mixed-tax households might benefit from various levels of public assistance. Questions may be directed to navigators or certified application counselors who are familiar with American Indian issues, or to the American Indian specialist at the MNsure Contact Center.

No, Starting January 1, 2019, the requirement to have health insurance ("individual mandate") is no longer in effect.

Up until this date, members of federally recognized tribes and AI/ANs and their descendants who are eligible to receive health care at an IHS/tribal facility were exempt from this requirement.

Yes. An exemption from the shared responsibility rule does not prevent AI/ANs from enrolling in a qualified health plan through MNsure, Medical Assistance, or MinnesotaCare, and they might qualify for certain protections under Medical Assistance or MinnesotaCare, or might qualify for tax credits and cost-sharing reductions, if eligible. (Note that the shared responsibility rule is no longer in effect starting 2019, therefore, you will not need to apply for an exemption for 2019 coverage.)

You may be eligible for special benefits through Medical Assistance and/or MinnesotaCare if you qualify for one of these programs.

Yes. If you enroll in a plan that does not list your I/T/U clinic as a provider, you can continue to go to your local Indian health provider. Tell your clinic about your insurance and show them your insurance card.

If you have a limited cost-sharing plan, then you need to get a referral from your Indian health clinic so you will not have to pay co-pays or deductibles when you go somewhere else. If you have a zero cost-sharing plan, you do not need a referral from your Indian health clinic, and you may go to any provider without having co-pays or deductibles.