“Health Insurance Premium Tax Credit” (IRS REG-131491-10)

NIHB Supplemental Submission - Definition of IndianMedicaid cost-sharing exemptions in § 5006 of the American Reinvestment and RecoveryAct (―ARRA‖). 18 Section 447.50 is a comprehensive and inclusive definition that isconsistent with the IHCIA, the ISDEAA and the IRS definitions of ―Indian‖ referenced in theACA. It is also consistent with the Federal trust obligation to provide health care to Indiansand with the Snyder Act, which provides fundamental authorization for Federal health careprograms to meet the needs of AI/ANs. Tracking the definition from § 447.50 in the ACAregulations would promote coordination of ACA programs with Medicaid. It would also beconsistent with HHS administration of health care programs for Indians. Finally, it is writtenclearly and comprehensively so that a layperson can read it and understand whether or not anindividual is an ―Indian.‖Reliance on § 447.50 to implement the various definitions of Indian under the ACAhas been endorsed by the National Congress of American Indians (―NCAI‖), the NationalIndian Health Board, the Tribal Technical Advisory Group to CMS (―TTAG‖), and theTribal Self-Governance Advisory Committee (―TSGAC‖), among others. 193. The Definitions of “Indian” in the ACA Are Not Limited to Members ofFederally-Recognized Indian Tribes.The current NPRMs have set out interpretations of the definitions of ―Indian‖ that arenarrower than the statutory provisions upon which they rely and are therefore incorrect. 20 The(A) Is a member of a tribe, band, or other organized group ofIndians, including those tribes, bands, or groups terminated since 1940 and thoserecognized now or in the future by the State in which they reside, or who is adescendant, in the first or second degree, of any such member;(B) Is an Eskimo or Aleut or other Alaska Native;(C) Is considered by the Secretary of the Interior to be an Indianfor any purpose; or(D) Is determined to be an Indian underregulations promulgated by the Secretary;(iii) Is considered by the Secretary of the Interior to be anIndian for any purpose; or(iv) Is considered by the Secretary of Health and HumanServices to be an Indian for purposes of eligibility for Indian healthcare services, including as a California Indian, Eskimo, Aleut, orother Alaska Native.‖18Pub. L. 111-5.19NCAI Res. # ABQ-10-080, November 2010, NIHB Res. 10-01, October 2010; TTAGOctober 2010; and TSGAC February 2011.2076 Fed. Reg. 41884 (―Section 4 of the IHCIA defines ‗‗Indian‘‘ as a member of a Federallyrecognizedtribe.") and 51205 (―For purposes of determining eligibility for cost-sharing provisions, wepropose to codify the definition of ―Indian‖ to mean any individual defined in section 4(d) of theIndian Self-Determination and Education Assistance Act . . . , in accordance with section 1402(d)(1) ofNational Indian Health Board Page 5 of 24 October 31, 2011