The Department of Health and Human Services has issued a final regulation that aims to ensure all Indians, regardless of tribal membership, can benefit from the Affordable Care Act.

The regulation, which will be published in the Federal Register on July 1, acknowledges that the law defines "Indian" as a member of a federally recognized tribe or a shareholder in an Alaska Native corporation.

"HHS does not have the legal authority to modify through regulation the statutory definitions of 'Indian' as referenced in the Affordable Care Act. There is no administrative flexibility to align these definitions," the notice of the regulation states.

The definition excludes American Indians and Alaska Natives who are otherwise covered by the Indian Health Care Improvement Act. However, the regulation includes a new provision that will bring these Indian and Native descendants under the ACA.

“The administration is taking steps to honor our historical commitment to the rights of American Indians and Alaska Natives and ensure that individuals protected under the Indian Health Care Improvement Act benefit from the special provisions in the Affordable Care Act,” Secretary Kathleen Sebelius said in a press release. “Today, we continue to fulfill our responsibility to consult and work with tribal communities.”

The regulation creates a new "hardship exception" that will apply to Indian and Native descendants who are eligible to receive services through Indian Health Service, a tribally-operated facility or an urban Indian clinic. This means they won't get penalized with a tax bill for not carrying insurance.

“We appreciate our tribal partners who advocated to ensure that all American Indians and Alaska Natives eligible for IHS can receive an exemption from the penalty for not having insurance coverage,” IHS Director Yvette Roubideaux said in the press release

Forthcoming Federal Register Notice:
Patient Protection and Affordable Care Act; Exchange Functions: Eligibility for Exemptions; Miscellaneous Minimum Essential Coverage Provisions (To Be Published on July 1, 2013)

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