"Every agency that serves American Indians and Alaska Natives must answer these questions in order to fuel the decision-making process: How much will it cost? How many people are served? And, by the way, who is an Indian?

None of the answers are easy. The demand for federal services is growing as resources shrink. And in the health care arena the key to sustainable funding is Medicare and Medicaid (including the Children’s Health Insurance Program) where definitions are complicated by multiple factors.

Consider eligibility: More than 560 tribal communities with members living on or near reservations or spread out in urban areas. Each tribe defines its membership but that data is rarely collected for use in health statistics because it’s often privately held. The U.S. Census allows each individual to define his or her own status by checking a box. (Some 5 million by this count.)

The Indian Health Service has another definition that adds descendants of enrolled members to the mix. And it collects data through its area offices, not states. Many IHS boundaries and reservations cross state lines, further confusing the data.

Medicaid collects some American Indian Alaska Native statistics when it’s identified as a single race, excluding those who are multiracial or also consider themselves Hispanic. And, coming soon, there will be new rules from the Internal Revenue Service as part of the Patient Protection and Affordable Care Act because of the American Indian exemption from insurance mandates (as well as a new definition for urban Indians).

The Office of Management and Budget has yet another definition of American Indian and Alaska Native, one that is supposed to be the federal standard."

Get the Story:
The data story: How much? How many? And, by the way, who’s an Indian? (Mark Trahant 8/9)

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