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  • Writer's pictureEligibilityOneᵀᴹ

Medicaid Expansion: Indian Health Service Facilities, American Indians, & Alaska Natives

Medicaid expansion can improve healthcare access for the American Indian and Alaska Native (AI/AN) community in many ways, including by providing health coverage to a larger portion of the population and by increasing third-party revenue for Indian Health Service (IHS) facilities.

Expanding Health Coverage for AI/AN People

As of 2019, an estimated 19.1% of American Indian and Alaska Native people in the U.S. were uninsured.1

Inadequate health coverage is a significant barrier to healthcare access and often causes patients to delay or avoid medical care altogether.

In states that expand Medicaid, more people qualify for Medicaid based on income; so, more members of the AI/AN community become eligible for Medicaid coverage and may no longer be uninsured. This helps remove a major obstacle to healthcare access and enables many AI/AN people to obtain care from other providers in addition to their IHS facility.


Increasing Third-Party Revenue for IHS Facilities

After states were given the option to expand their Medicaid programs beginning in 2014, third-party collections for federally operated IHS facilities increased by 51% from 2013 to 2018.2

During that same timeframe, the percentage of patients at these facilities who reported having health insurance increased by an average of 14 percent, with facilities located in states that expanded Medicaid seeing the biggest increases.2

An increase in third-party revenue in the form of payments from patients’ Medicaid and private health insurance coverage made it possible for IHS facilities to expand their on-site services and lower the need for patients to use the Purchased/Referred Care (PRC) program, while also allowing for an extension in the complexity of services delivered off-site through PRC.2

If your IHS facility is in a state that is or will be expanding Medicaid, you can also expect a boost in third-party revenue as a result. This money can be used toward adding more providers and specialty services, purchasing medical equipment, facility maintenance, and more, all of which will greatly enhance the quality and accessibility of care for your AI/AN community.


Best Practices for Optimizing Self-Pay Conversions & Third-Party Revenue

A patient eligibility and enrollment service can ensure that as many of your patients as possible gain coverage under Medicaid expansion by:

  1. Helping patients apply for Medicaid – Eligibility professionals have the resources and expertise to help patients correctly and more efficiently complete their Medicaid applications.

  2. Screening patients before discharge – Patients may not realize they qualify for Medicaid, and those who are screened for eligibility and engaged before they leave your facility will be much more likely to follow through with the Medicaid application process.

  3. Meeting with patients one-on-one and in person – Face-to-face and personalized engagement with patients results in higher self-pay conversion rates than attempts to assist patients via email and phone alone.


EligibilityOne: Helping IHS Facilities Maximize the Benefits of Medicaid Expansion

Our Patient Advocates work on site to help patients enroll in Medicaid and other health plans or financial assistance programs. By finding alternative funding sources for patients’ medical costs and helping them apply, we can increase your third-party revenue and improve patients’ access to care.

Our services are free to patients and provide a guaranteed ROI for our clients thanks to our performance-based pricing model. We are only paid once we’ve successfully helped you collect reimbursement.

EligibilityOne delivers more self-pay conversions through one-on-one interaction with patients, a pre-discharge screening rate of 90 percent, expanded on-site hours and home visits, advanced technology and screening software, and our expertly trained, compassionate staff who are changing patients’ lives every day.

Contact us to learn more about how we can increase Medicaid enrollment at your IHS facility and help you maximize the benefits of Medicaid expansion.



1 United States Census Bureau. “Selected Characteristics of Health Insurance Coverage in the United States.” (2019). Retrieved from

2 GAO (United States Government Accountability Office). “GAO-19-612 Highlights, Indian Health Service: Facilities Reported Expanding Services Following Increases in Health Insurance Coverage and Collections.” (2019). Retrieved from



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