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FAQs for Establishing Medical Support through Indian Health Services

Establishing Medical Support when the Father is a Tribal Member

During the establishment process, if the noncustodial parent (NCP) is a tribal member and does not dispute paternity and has agreed to the amount of child support, the medical support required might be eligible to the child through Indian Health Services (IHS). If the custodial parent (CP) agrees and knows how to access IHS, and neither parent is requesting other insurance be required, the next step is providing documentation that the child is eligible for IHS.

What documentation does IHS need in order to provide medical services?

IHS requires “proof of Indian descent” to access their services. A child can be of “Indian descent” even if the child has insufficient blood quantum to be a tribal member. “Indian descent” can be shown by providing one of the following:

  1. Certificate of Degree of Indian Blood (CDIB) card for the child
  2. Certificate of Degree of Indian Blood (CDIB) Card of a parent
    • The child’s name does not have to appear on this card.
  3. Tribal ID card / Certificate of Citizenship
  4. A letter issued by the tribe confirming eligibility of the parent and/or child

IMPORTANT NOTE: If there is no document with the child’s name, the child’s birth certificate, showing his/her relationship to the person who is listed on the tribal documentation must be included to establish Indian descent.

Is a CDIB card with father’s name on it plus the Order Establishing Paternity sufficient to show the linkage between the parent and the child to document that IHS is available?

For the purposes of completing the child support order, CSS can accept the CDIB card with the father’s name on it to indicate the child is of Indian descent. However, this may not be sufficient for the tribe to enroll the child.

Can the child qualify for IHS through the mother’s tribal membership?

The child may qualify for IHS through either biological parent regardless of who is the custodian.

What if the parent or custodian indicates they have attempted to use IHS for the child but they could not access the services based on the father’s CDIB card and an Order Establishing Paternity?

CSS would request the tribal parent to provide sufficient documentation for the child to be able to access IHS. If the parent fails to do so, CSS should request the court to order insurance and/or cash medical support.

What should be included in the child support order when there is no documentation of Indian Health Services but the parties indicate the child is eligible?

If there is no documentation of Indian Health Services for the child but the parties indicate the child is eligible, CSS treats the case as if IHS is not being offered to the child. A medical support order providing for insurance or cash medical support should be entered with a possible future review date. However, documentation of IHS eligibility must be provided prior to the review date. If no IHS documentation is provided, the prior medical support order remains in effect.