Skip to Main Content

Tribal Consultation

On November 5, 2009, President Obama issued a Presidential Memorandum requiring all agencies to engage in regular and meaningful consultation and collaboration with Tribal officials. Tribal Consultation is an enhanced form of communication that emphasizes trust, respect, and shared responsibility. It is an open and free exchange of information and opinion among parties, which leads to mutual understanding and comprehension. To establish and maintain a positive government-to-government relationship, communication and consultation must occur on an ongoing basis so that Tribes have an opportunity to provide meaningful and timely input on issues that may have a substantial direct effect on them.

On November 17, 2011, the Centers for Medicare and Medicaid Services (CMS) finalized an agency specific Tribal Consultation Policy to establish a clear, concise and mutually acceptable process through which consultation can take place between CMS and Tribes. Consistent with the CMS Tribal Consultation Policy, CMS seeks the guidance of Tribal leaders on the delivery of health care for American Indians/Alaska Natives (AI/AN) served by the Marketplace, Medicare, Medicaid, Children's Health Insurance Program (CHIP), or any other health care program funded by CMS.

As part of a periodic review of the Policy and through Tribal consultation, CMS issued a revised CMS Tribal Consultation Policy effective December 10, 2015. This revised policy includes a new section eight that incorporates the State/Tribal consultation requirements for State Medicaid agencies to obtain the advice and input from Indian health care providers and Tribes prior to changes in the Medicaid programs having Tribal implications.

A copy of the CMS Tribal Consultation Policy, Dear Tribal Leader Letters related to the CMS Tribal Consultation Policy, and more information about CMS Tribal Consultation can be downloaded by clicking the links below.

Tribal Technical Advisory Group (TTAG)

In September 2003, CMS established the TTAG comprised of representatives of Tribal Governments and national Indian organizations based in Washington DC. The TTAG was codified by statute in the American Recovery and Reinvestment Act in 2009, under which representatives from a National Urban Indian Organization and the Indian Health Services were added. The TTAG serves as an advisory body to CMS, providing expertise on policies, guidelines, and programmatic issues affecting the delivery of health care for AI/ANs served through programs funded in whole or part by CMS. Interaction by CMS with the TTAG does not substitute for Tribal consultation, but assists CMS to make consultation more effective including advising on the type of consultation needed on particular issues. The TTAG plays an integral role in the CMS consultation process by providing technical assistance on complex issues faced by Tribal Governments. For more information on TTAG please visit: