Deep Dive: Indian Exemption
Alaska Primary Care Association
Alaska Outreach & Enrollment Fall Training
September 17, 2014
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Overview
 What is the Indian Exemption?
 Who needs to complete the Indian Exemption?
 Indian Exemption vs. Hardship Exemption
 Indian Exemption Processing & Challenges
 Group Activity
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What is the Indian Exemption?
Under the Affordable Care Act (ACA) everyone must
have some form of credible health care coverage, or
1. Qualify for an exemption (there are many types)
2. Face a tax penalty (shared responsibility payment)
Any AN/AI who does not have health care coverage, an
exemption, or faces a tax penalty will CONTINUE to
receive the same care and services at their tribal
clinic or local health care facility.
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Who Needs to Complete the Indian
Exemption?
Anyone who DOES NOT have any form of health care
coverage:
- Medicare (lifetime)
- VA Health Benefits (lifetime)
- Medicaid/Denali KidCare
- Private/Employer’s Insurance
- Coverage through the Marketplace/Healthcare.gov
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Who Needs to Complete the Indian
Exemption?
However, we recommend everyone who does not have
lifetime health care coverage to apply!
Why?
- Less worry if you lose your coverage.
- It’s a lifetime exemption.
- Won’t face a tax penalty!
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Tax Penalty
Individuals must have health care coverage by 2014, have
an exemption, or face a tax penalty.
2014: $95 per adult and $47.50 per child
- Up to $285 for a family
Or 1% of family income, whichever is greater.
2016: $695 per adult and $347.50 per child
- Up to $2,085 for a family
Or 2.5% of family income, whichever is greater.
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Alaska Natives/American
Indians
Alaska Native and American Indian people are exempt
from the requirement to purchase insurance.
Eligibility for the exemption requires:
– Enrollment in a Federally Recognized Tribe,
– Alaska Native Claims Settlement Act (ANCSA) shareholder
status (village or regional),
– Certificate of Indian Blood, or
– Eligibility to receive services from an Indian Health Service (IHS)
facility/Tribal health care provider.
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2 Categories of AN/AI
Exemptions
Depending on documentation type, AN/AIs will either
receive an:
1. Indian Exemption
2. Hardship Exemption
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Indian Exemption
For AN/AIs who ...
1) Enrolled member of Federally- Recognized Tribe
2) Shareholder in a Alaska Native Corporation
3) CIB with Tribe/ANCSA Enrollee Number
Lifetime exemption
Eligible to receive special provisions for AN/AI’s
- Monthly enrollment option
- No cost sharing (income 100% - 300% FPL) – Family of 4 - $89,460
Exemption can be applied for by paper application or when filing taxes.
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Documentation Type for Indian
Exemption
Documentation Type for Indian
Exemption
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Hardship Exemption
For AN/AIs who …
1) Certificate of Indian Blood (with no tribal or ANCSA enrollment
number)
2) Eligible to receive service from a Tribal Health Facility/IHS with no
tribal or corporation enrollment
Lifetime exemption
NOT eligible to receive special provisions for AN/AI’s
- Must use open enrollment period
- Not eligible for cost sharing
Exemption can only be applied for with the paper application.
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Documentation Type for Hardship
Exemption
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Documentation Type for Hardship
Exemption
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How to Complete the Application
Based on tax household size.
All members of the tax household , even if they are nonNative need to be included; however they will not receive
an AN/AI exemption, only under certain circumstances.
Again, those with lifetime health benefits DO NOT need to
apply.
Applications are mailed to the Exemption Processing Center.
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Step 1: Tell Us About Yourself
Completed by the head of
household or single individual.
Can be non-Native or Native
person.
Step 2(a)
For those enrolled in a
Federally Recognized Tribe,
ANCSA Shareholder, or CIB
with Tribe/ANCSA
Enrollment Number.
*The person in Step 1 ALSO
needs to fill out a Step 2
form.
* 1-7 MUST be completed,
unless the person does not
need exemption, end at 6.
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Step 2(b)
For those who have a CIB, but
NO Enrollee Number/Tribe
name OR those who have a
letter stating they are eligible
to receive IHS services.
* Must go through ALL
questions 1-11.
10. Enter Date of Birth or the day person became
eligible to receive services from tribal health
facility.
11. N/A or put in date if there is an end date for
the individual.
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Step 3 & 4: Complete the Form
The person listed on Step 1 will
sign and date the application.
Applications are mailed to the
address in Step 4.
Navigators and assistors are not
allowed to mail the exemption for
applicants.
What to Expect
Receive a letter from the processing center.
Each person will receive a determination of the type of
exemption: Indian, Hardship, or none.
Each person who is eligible for an exemption will
receive a Exemption Certificate Number (ECN).
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Common Issues Reported
1. People haven’t received their exemption letter(s) back
2. Hardship Exemption issued instead of the Indian
Exemption
3. No ECN issued OR some family members receive an
ECN, some don’t
4. Two different letters with two sets of numbers
5. Not accepting NANA Shareholder Cards (reportedly
no longer an issue)
How to Assist Customers for Each Error
1. People haven’t received their exemption
letter(s) back
- Currently working on applications sent in late December
2013 –March 2014
2. Hardship Exemption issued instead of the
Indian Exemption
- DO NOT file an appeal. Use the ECN for now – IRS will not
differentiate.
How to Assist Customers for Each
Error
3. No exemption certificate number (ECN) issued
OR some family members get an ECN, some don’t
- File another application for the family member ONLY, make a
copy of the letter, and write a cover page
4. Two different letters with two sets of numbers
-
Keep both documents, but pick one ECN to use. Will not be
corrected at this time.
Exemption Processing Centers
Different from the Health Insurance Marketplace
No way to follow up on exemptions by calling 1-800-318-2596
Processing:
1. Application gets scanned into system within secure facility
2. Staff go through background check
3. Staff not allowed to have cell phones/personal electronics,
access to internet, or ability to copy information
The Exemption Processing Center
Consumer’s Caller ID may read
the following:
-
Health Insurance MP; or
606-260-4191 (Kentucky); or
479-877-3203 (Arkansas); or
636-698-6320 (Missouri); or
580-354-7707 (Oklahoma).
No way to call back the
exemption processors*
The exemption processing
centers are calling people
–To confirm personal
information such as
• Last four digits of social
security number(s)
• Names
• Date of birth
- AN/AI script authorized &
released by CMS
How You Can Help!
Keep track of each Indian Exemption Issue
- Each person’s name
- Each person’s date of birth
- Community
- Issue type
- Email list to: nancy.goetschius@cms.hhs.gov
Nancy Goetschius, Tribal Contact at CCIIO & CMS &
CC’ srhaggitt@anthc.org.
Questions?
Thank You!
Shannon Haggitt
Alaska Native Tribal Health Consortium
4141 Ambassador Drive, 2nd Floor
Anchorage, Alaska 99508
907-729-2873
srhaggitt@anthc.org
www.anthctoday.org/aca
Group Activity
Each group has a different scenario.
Fill out the Indian Exemption based on the scenario.
Report back
- How many applications?
- Who?
- What type of exemption? Why?
- What questions?
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Scenario 1
Jack P. Frost (06/15/88) is not married and files his taxes as
“Single.”
He lives with his girlfriend, Gerty Heath (02/19/89).
Neither Jack nor Gerty are Alaska Native or American Indian.
Jack claims two dependents on his taxes;
– Christofer A. Frost (11/4/10), his son from a previous marriage, who is
Alaska Native, and who is a member of a federally recognized tribe.
– Hermione J. Frost (12/20/12), Jack’s daughter with Gerty, who is not Alaska
Native or American Indian.
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Scenario 2
John (1/5/82) and Delta Dawn (8/20/84) are married and file their taxes as
“Married Filing Jointly.”
John is not Alaska Native or American Indian.
Delta is Alaska Native and a member of a federally recognized tribe.
The couple has two dependents;
– Raine Dawn (9/17/08), their daughter, and a member of a federally
recognized tribe.
– Candice Smyth (3/23/10), John’s niece of whom he and Delta have
legal custody and is not Alaska Native or American Indian.
According to the custody agreement made on 8/15/10 John’s niece is
eligible to receive health care through Indian Health Services until she
turns 18.
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Scenario 3
Jack (11/22/88) and Jill (8/8/88) Hill are married.
They file their taxes as “Married Filing Jointly.”
They currently have no dependents.
Jack is Alaska Native, but Jill is not.
Jack is a member of a federally recognized tribe.
Jill is pregnant and is due 2/29/15.
Jill is eligible for health care through the local Indian Health Services
through the end of her pregnancy.
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Scenario 4
Betty Brown (3/8/70) is the mother of Jason Brown (4/27/96) and
Justice Brown (9/5/00).
Jason lives with his mother and sister, but has a full-time job and
plans on filing his own taxes next year.
Betty Brown is a shareholder of an Alaska Native Corporation.
Jason and Justice both have a Certificate of Indian Blood, stating
they are descendants. Neither is enrolled in a tribe or corporation.
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Scenario 5
David Davidson (6/6/68) and Margie Davidson (4/4/70) are married and file their
taxes as “Married Filing Jointly.”
David receives VA Health Benefits and Margie has no insurance.
Both David and Margie are members of a federally recognized tribe.
Their daughter, Janet Davidson (9/10/90) and their granddaughter, Morgan Hunter
(12/24/12) live with them.
Janet is currently working and files her own taxes and claims Morgan as a
dependent.
Janet has no insurance and Morgan has Denali KidCare.
Janet is a member of a federally recognized tribe and Morgan has a Certificate of
Indian Blood from the BIA and it states her tribe’s name and enrollment
number.
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Scenario 6
John Deere (1/28/1982) and Jessica Anderson (5/8/1984) are a nonmarried couple, who have one child Jackson Deere (8/14/09)
John works and has employer’s insurance and Jessica only works parttime and doesn’t meet the income guidelines to file taxes. John claims
Jackson on his taxes.
Neither Jessica nor Jackson has health care coverage.
John is not Alaska Native or American Indian. Jessica and Jackson are
members of a federally recognized tribe.
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