Indian Health Services (IHS) Overview

Overview

Indian Health 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. There may be a limitation on the amount of time IHS or the tribal clinic will continue to provide services to a child not listed on a CDIB card. This limitation could vary among tribes;
3. Tribal ID card / Certificate of Citizenship, or;
4. A letter issued by the tribe confirming eligibility of the parent and/or child. The Bureau of Indian Affairs (BIA) does not necessarily issue CDIB cards for all tribes. There are some tribes outside of Oklahoma with other types of documents to denote Indian descent.

Verifying and Documenting Child(ren)’s Access to IHS

Make sure the entry is easily identifiable, such as having a tagline on the first line of the entry. The auditors need to be able to determine the documentation exists in the file showing the child is eligible for IHS. This may include:

Proof of Indian Descent

• The child’s name does not have to appear on the documentation;
• There must be additional documentation linking the child to the parent if the child’s name does not appear; and
• 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 Confirmation

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

Once IHS Health Care Coverage is Verified

If CSS has verified that IHS is available and if it is 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 health care coverage in addition to IHS if coverage is available and the custodial person (CP) requests it.

Employer Services Center

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).

Example 1
District office sends ESC copy of CDIB card with the non-custodial parent’s (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.

Result:
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.

Result:
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.

IHS FAQs

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 (BP) regardless of who is the custodian is.

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 health care coverage and/or cash medical (CM) support.

What should be included in the child support order when there is no documentation of HIS, 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.