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Documenting Child’s Access to Indian Health Services

CSS must document proof of the child(ren) being covered by Indian Health Services (IHS).

Proof of Indian Descent

  1. The child’s name does not have to appear on the documentation
  2. There must be additional documentation linking the child to the parent if the child’s name does not appear
  3. Documents accepted are
    • Certificate of Degree of Indian Blood (CDIB) Card of a parent
    • Tribal ID card
    • Card issued by Bureau of Indian Affairs (BIA), or
    • A letter issued by the tribe confirming eligibility

Tribe Confirms Eligibility

Tribe  confirms IHS eligibility through letter, statement, or e-mail documented in the file.

Once Coverage is Verified

If CSS has verified that IHS is available and accessible, or the parents agree to exceed the 60 mile requirement, CSS can consider the IHS sufficient to meet the medical support requirement. If IHS is provided, cash medical should not be ordered. The court can order insurance in addition to IHS if insurance is available and custodial person (CP) requests it.


The CS Specialist should send a copy of the documentation of IHS eligibility to the Employer Services Center (ESC) with the request that POLA or CPOLA be updated.   The CS Specialist must indicate the name of the child covered by IHS and the tribal member through whom benefits are provided (NCP, CP, BP or Other).  If the information provided to ESC only indicates the parent is a tribal member but does not indicate the child is covered, the ESC will enter the information on the parent, but will not link the coverage to the child. This means the district office will not receive credit for obtaining coverage for the children if the case is audited. In addition, the Office of Child Support Enforcement (OCSE) 157 report would not indicate coverage is being “provided as ordered” for this child.

Example 1

District office sends ESC copy of CDIB card with NCP name on it, plus indicates there is an order establishing the NCP is the father of the child. District office requests ESC to add coverage for both the father and the child.


ESC updates POLA to show both father and child have IHS coverage.

Example 2

District office sends ESC copy of CDIB card with NCP name on it, but provides no other instruction.


ESC updates POLA to show father has IHS coverage, but does not update POLA to show that the child has IHS coverage. If the case is  audited, the conclusion will be that the office gets NO ACTION for medical support enforcement for this child.