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CMS Division of Tribal Affairs 

Important Information for our Tribal partners 


CMS Seeks Comments on Draft Letter to Issuers

CMS has issued a draft letter that provides sub-regulatory guidance to issuers of qualified health plans (QHPs) seeking to be certified or recertified for offer through a Federally-facilitated Marketplace (FFM). The information in the draft letter will help issuers apply for certification for plan years beginning in 2016 and understand FFM consumer support and oversight functions.

The Draft 2016 Letter to Issuers includes:

•       key dates in the FFM certification and recertification process

•       standards that will be used to evaluate QHPs for certification

•       oversight procedures

•       consumer support policies and programs, and

•       tribal support.

Of particular interest to the disability community is how the letter addresses meaningful access to effective communications for people with disabilities and people with limited English proficiency. The letter also includes examples of discriminatory benefit design, including formularies.

CMS welcomes comments on this proposed guidance. To the extent that this guidance summarizes policies proposed through other rulemaking processes that have not yet been finalized, such as the rulemaking process for the 2016 Payment Notice proposed rule, stakeholders should comment on those underlying policies through the ongoing rulemaking processes, and not through the comment process for this letter. Please send comments on other aspects of this letter to by January 12, 2015.

Click here for the Draft Letter to Issuers.

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CMS awards $3.9 million to improve access to quality health care services for American Indian and Alaska Native Children

The Centers for Medicare & Medicaid Services (CMS) awarded $3.9 million for outreach and enrollment efforts aimed at American Indian and Alaska Native children eligible for Medicaid and the Children’s Health Insurance Program (CHIP). The grant awards will fund activities to engage schools and tribal agencies in Medicaid and CHIP outreach and enrollment activities.

CMS awarded grant funds to health programs operated by the Indian Health Services, tribes, tribal organizations and urban Indian organizations located in seven states: Alaska, Arizona, California, Mississippi, Montana, New Mexico and Oklahoma.

“We are very pleased to support efforts that help eligible American Indian and Alaska Native children gain access to affordable health coverage,” said Director of the Center for Medicaid and CHIP Services Cindy Mann. “More people with health coverage also benefits local health care facilities, allowing them to offer more services and improve health care for the whole community.”

Several grantees will receive funds to conduct activities focused on helping eligible teens enroll in coverage. Grantees will work to ensure that eligible children retain coverage for as long as they qualify and will help guide families through the application process for Medicaid and CHIP.

Since 2009, the United States has made substantial progress toward reducing the number of children who remain uninsured, and toward providing health coverage to all children who are eligible for Medicaid and CHIP. Despite this significant progress, serious health coverage disparities persist, particularly for American Indian and Alaska Native children. Research shows that eligible American Indian and Alaska Native children are less likely to participate in Medicaid and CHIP and more likely to be uninsured compared with all children.

These awards, authorized under the Children’s Health Insurance Program Reauthorization Act of 2009 and extended by the Affordable Care Act, will help ensure American Indian and Alaska Native children have opportunities to get quality health care services which may not be available through their local Indian health care provider.

In states with expanded Medicaid, more parents and other adults in the family could be eligible for health coverage than in the past and can apply at any time.

For more information and a complete summary of the current American Indian and Alaska Native Connecting Kids to Coverage Outreach and Enrollment grants, visit

NEW Resource: Information and Tips for Assisters: Working with American Indians/Alaska Natives (AI/AN)

We posted a new resource to our Technical Assistance Resources pageInformation and Tips for Assisters: Working with American Indians/Alaska Natives provides background information about existing and new options for AI/ANs related to affordable health coverage. The Marketplace provides certain protections specifically for AI/ANs. The tip sheet highlights these protections, how assisters can help AI/ANs submit their documentation to support Marketplace applications, and other resources.

A new question and answer (Q&A) regarding the Special Enrollment Period for American Indian and Alaska Native families has been posted on

The Q&A explains that for those families that apply through the Federal-facilitated Marketplace, if one family member on the application is eligible for the Special Enrollment Period (SEP), all family members who apply on the same Marketplace application would be eligible for the SEP if otherwise eligible to enroll in a QHP.  The Q&A explains that for those who enroll in a state based marketplace, you will need to contact your state regarding whether this policy applies. 

To read the Q&A, please visit or