IHS Eligibility
The Indian Health Service (IHS) provides some primary care and selected health services to American Indians and eligible non-Indians. If you are eligible, you should not have to pay for any healthcare services that you receive at an IHS or Tribal facility.
You are eligible to use the IHS if you are:
- Enrolled in a federally-recognized Tribe, nation, band, or Pueblo. See the IHS Eligibility page for a full description of how eligibility as an American Indian or Alaska Native is determined. If your membership card has an expiration date, then you must provide proof of renewal.
- An eligible non-Indian, including:
- Children, up to 18 years of age, who live with an eligible American Indian, whether legally or adopted.
- Women who are pregnant with children of eligible American Indians, during pregnancy and post-partum.
- People living within a region determined to be a public health hazard that requires intervention or quarantine.
- See the IHS website for a full description of non-Indian eligibility.
If you are not sure whether you are eligible or how to establish your eligibility, contact the Patient Registration office at your local IHS or Tribal clinic. Visit the IHS Find Health Care page to locate the nearest one.
IHS Facilities
Albuquerque Area facilities include:
- Acoma-Canoncito-Laguna Service Unit
- Albuquerque Indian Health Center
- Albuquerque Indian Dental Clinic
- Jicarilla Service Unit
- Mescalero Service Unit
- New Sunrise Regional Treatment Center
- Santa Ana Health Center
- Santa Fe Service Unit, which serves San Felipe, Cochiti, Santo Domingo, Tesuque, Pojoaque, Nambe, San Ildefonso, Santa Clara and Ohkay Owingee Pueblos, with clinics in located in Santa Clara, Cochiti and San Felipe Pueblos.
- Taos-Picuris Service Unit
- Ute Mountain Ute Service Unit
- Zia Health Clinic
- Zuni Comprehensive Health Center
Navajo Area facilities include:
- Chinle Comprehensive Healthcare Facility
- Crownpoint Healthcare Facility
- Dzilth-Na-O-Dith-Hle Health Center
- Fort Defiance Indian Hospital
- Four Corners Regional Health Center
- Gallup Indian Medical Center
- Inscription House Health Center
- Kayenta Health Center
- Pinon Health Center
- Shiprock-Northern Navajo Medical Center
- Tohatchi Healthcare Center
- Tsaile Health Center
- Tuba City Regional Healthcare Corporation
- Winslow Indian Healthcare Center
Purchased/Referred Care (PRC)
PRC Eligibility
The Purchased/Referred Care (PRC) program, formerly called Contract Health Services, pays private healthcare providers for care that is not available from your local IHS or Tribal clinic, or in case of an emergency.
To be eligible for PRC, you must be:
- Eligible to use the IHS and,
- Live on or near an Indian reservation within a Contract Health Service Delivery areaThe federally designated area within which you must live to receive Purchased Referred Care services. It is usually a reservation or a county containing all or part of a reservation. (CHSDA), which is in any county that includes all or part of a reservation or shares a boundary with a reservation.
You are only eligible for PRC within your CHSDA. If you are a full-time student, traveling, or temporarily employed outside your CHSDA, you are still eligible for PRC at your permanent residence. If you are already receiving PRC-authorized services and leave your CHSDA for any other reason, you are still eligible for PRC for 180 days.
If you are unsure whether you are eligible for PRC, visit the IHS Find Health Care page to locate the facility nearest you and contact their Patient Registration office.
Using PRC
For non-emergency services, your IHS provider must make a referralA referral is an order from your doctor for you to see another kind of doctor or get a medical service. You often need a referral for your health plan to cover the care. for care from a non-IHS provider. Without a referral, PRC will not cover the cost. The care must be deemed “medically necessaryThis refers to care or equipment that your doctor has prescribed to treat an illness or condition.” by your IHS provider and you must not be able to get it from an IHS facility. See the Authorization for Purchased Referred Care chapter in the IHS Indian Health Manual to learn more about how the PRC determines medical care payment.
If you receive emergency medical care at a non-IHS facility or at an IHS facility outside of your CHSDA, you must notify PRC within 72 hours and PRC must deem the care to have been medically necessary to cover the cost of your care. If you are age 65 or older, or you are physically or mentally disabled, you have up to 30 days to notify PRC of emergency care received at a non-IHS facility.
For more information about PRC, visit the PRC Program Directory to find the number for your local program.
Priorities for Covered Services
The IHS and PRC are not entitlement programs, meaning that they only receive a limited amount of money from the federal government. For this reason, PRC may not have enough money to pay for all the medical care that Tribal members need, and must establish priorities for covered services. The IHS has an obligation to notify Tribal communities of these priorities. See the Tribal Budget Consultation page on the IHS website to learn more about this process.
Health Insurance and IHS
You do not have to have health insuranceA type of insurance that pays for some or all of your medical expenses.
to get services at your local Indian Health Service (IHS) or Tribal clinic. However, all clinics will urge you to enroll in a health insurance plan. Because the IHS has a limited amount of money, it is a good idea to have health insurance to make sure that you can get all the care you need. If you have health insurance, make sure to notify all your healthcare providers, including the IHS.