American Indian/Alaska Native

Find information about Apple Health (Medicaid) coverage for American Indian and Alaska Native populations.

Apple Health options

Under the Affordable Care Act, American Indians and Alaska Natives have a range of options for health care and health care coverage. Learn more about these options.

As an American Indian or Alaska Native on Apple Health, you can:

  • Enroll in an Apple Health managed care plan, or
  • Receive Apple Health coverage without a managed care plan.

There are advantages and disadvantages to each, depending on your individual circumstances. Tribal health clinic and urban Indian clinic staff are very familiar with these options and can help you make this choice.

You can also:

Changes to behavioral health coverage

Beginning on July 1, 2017, if you identify as American Indian or Alaska Native and are on Apple Health you will be able to choose your coverage for behavioral health services. Currently, there is not a choice – you are automatically enrolled in your local Behavioral Health Organization (BHO) for mental health services and in the Apple Health fee-for-service program for substance use disorder treatment services. With this change, you will be able to choose your Apple Health coverage for behavioral health services, just like for physical health services.

Note: If you are eligible to receive care at an Indian Health Service (IHS) facility, Tribal health program, or urban Indian health program, this change will not affect your ability to receive care at those programs but they may be able to help you make your choice.

Behavioral health services coverage choices starting July 1, 2017

The following chart compares the choices you have now for behavior health services coverage with the choices you will have starting July 1, 2017.

  What choices do I have today for behavioral health services coverage? What coverage choices do I have starting July 1, 2017?

Some mental health services (for example depression or autism)

When you choose your Apple Health coverage, this is your coverage for any mental health services that are not covered by the BHO (see below), either:

  • Apple Health Managed Care through either Amerigroup, Community Health Plan of Washington, Coordinated Care, Molina, or United HealthCare;
  • Apple Health coverage without a managed care plan.

This will not change on July 1, 2017. You will continue to be able to choose your Apple Health coverage, either:

  • Apple Health Managed Care through either Amerigroup, Community Health Plan of Washington, Coordinated Care, Molina, or United HealthCare;
  • Apple Health coverage without a managed care plan.

Specialized mental health services

You are automatically covered by your local Behavioral Health Organization (BHO).

For specialized mental health services and all substance use disorder treatment, you will be able to choose either:

  • Your local Behavioral Health Organization (BHO);
  • Apple Health coverage without a managed care plan.

What do I need to do?

You will need to decide if you want your Apple Health coverage for behavioral health services from:

  1. Your local Behavioral Health Organization  (BHO), or
  2. Apple Health fee-for-service.
If you choose: Then:
Your local Behavioral Health Organization (BHO)

Your mental health and substance use disorder treatment services will be managed by the BHO.

  • If you are currently receiving specialized mental health services, your treatment will not be affected.
  • If you are currently in substance use disorder treatment, you may want to check first with your provider to confirm that you can continue treatment without interruption.
Apple Health fee-for-service (“Apple Health coverage without a managed care plan”)

You will be able to seek specialized mental health services and substance use disorder treatment services directly from a provider. You will want to make sure that the provider is participating in Apple Health fee-for-service.

  • If you are currently receiving specialized mental health services, you may want to check first with your provider to confirm that you can continue treatment without interruption.
  • If you are currently receiving substance use disorder treatment, your treatment will not be affected.

Note: If you do not make a choice, you will be automatically enrolled in the Apple Health fee-for-service program.

The following chart compares the choices you have now for behavior health services coverage with the choices you will have starting July 1, 2017.

  What choices do I have today for mental health services coverage? What coverage choices do I have starting July 1, 2017?

Specialized Mental Health services and Substance Use Disorder Treatment Services

When you choose your Apple Health coverage:

  • If you choose Apple Health Managed Care (either Community Health Plan of Washington or Molina), your behavioral health services are covered by the plan you choose;
  • If you choose Apple Health coverage without a managed care plan, your behavioral health services are still covered by either Community Health Plan of Washington or Molina. In other words, you cannot access mental health or substance use disorder treatment providers directly through the Apple Health fee-for-service program.

For all physical health, mental health, and substance use disorder treatment services, you will be able to choose your Apple Health coverage, either:

  • Apple Health Managed Care through either Community Health Plan of Washington or Molina;
  • Apple Health coverage without a managed care plan (also known as “ProviderOne” or “Apple Health fee-for-service”).

What do I need to do?

You will need to decide if you want your Apple Health coverage for physical health, specialized mental health services, and substance use disorder treatment services from:

  1. One of the Apple Health fully integrated managed care plans, or
  2. Apple Health fee-for-service.

If you choose:

Then:

One of the Apple Health fully integrated managed care plans

Your physical health, specialized mental health services, and substance use disorder treatment services will be managed by the managed care plan.

  • If you are currently in physical health treatment and:
    • You are covered by Apple Health Fully Integrated Managed Care, your treatment will not be affected.
    • You are covered by Apple Health fee-for-service, you may want to check first with your provider to confirm that you can continue treatment without interruption.
  • If you are currently receiving specialized mental health services or substance use disorder treatment, your treatment will not be affected.

Apple Health fee-for-service (also known as “ProviderOne” or “Apple Health coverage without a managed care plan”)

You will be able to seek physical health, specialized mental health services, and substance use disorder treatment services directly from a provider. You will want to make sure that the provider is participating in Apple Health fee-for-service.

  • If you are currently in physical health treatment and:
    • You are covered by Apple Health Fully Integrated Managed Care, you may want to check first with your provider to confirm that you can continue treatment without interruption.
    • You are covered by Apple Health fee-for-service, your treatment will not be affected.
  • If you are currently receiving specialized mental health services or substance use disorder treatment, you may want to check first with your provider to confirm that you can continue treatment without interruption.

Note: If you currently have one of the Apple Health Fully Integrated Managed Care plans and you want to keep this coverage, you do not need to do anything. If you do not make a choice, you will be automatically enrolled in the Apple Health fee-for-service program.

Can I choose my behavioral health coverage after July 1, 2017?

Yes, you can change your selection at any time, but the change will not take effect until the first day of the following month. If you are connected or partnered with a Tribal Assister through a Tribal or UIHP, please contact them for assistance.

The Health Care Authority can also assist you with opting into or out of a Behavioral Health Organization or Washington Apple Health managed care and answer your questions by calling 1-800-562-3022.

Indian health care providers

You can always go to tribal and urban Indian clinics, whether you have Apple Health or not, and you won't have to pay any out-of-pocket costs. You can sign up with the clinic as your primary care provider, whether you're enrolled in an Apple Health managed care plan or you receive Apple Health coverage without a managed care plan. If a tribal or urban Indian clinic can't provide the services you need, they will refer you to a specialist.

Find a tribal clinic or urban Indian clinic near you.