Free Healthcare for American Indians and Alaska Natives: The Indian Health Service

The federal government has a trust responsibility to provide healthcare services to American Indians and Alaska Natives (AI/AN)—a legal obligation rooted in treaties, federal statutes, and the unique government-to-government relationship between the United States and tribal nations. The Indian Health Service (IHS) fulfills this obligation through a comprehensive healthcare delivery system that serves approximately 2.7 million American Indians and Alaska Natives across 37 states.

IHS healthcare is provided at no cost to eligible individuals. There are no premiums, no deductibles, no copays, and no coinsurance at IHS and tribally operated facilities. This includes primary care, emergency care, dental services, behavioral and mental health care, substance abuse treatment, pharmacy services, laboratory and imaging services, public health nursing, preventive care, immunizations, prenatal and obstetric care, and health education. For a population that experiences some of the most significant health disparities in the nation, IHS represents an essential—and for many, the only—source of healthcare.

The IHS system is not a single monolithic entity. It operates through three interconnected components known as the “I/T/U” system: IHS-operated facilities (federal), tribally operated programs (tribal), and Urban Indian Health Programs (urban). Together, these components operate 46 hospitals, over 350 health centers, clinics, and health stations, and 41 urban Indian health programs, spanning from rural Alaska villages to major metropolitan areas.

Opportunity Snapshot

Services Available Through IHS

Primary and Preventive Care

IHS facilities provide comprehensive primary care services including annual wellness exams, chronic disease management (diabetes, hypertension, heart disease, asthma), acute illness care, immunizations, cancer screenings, laboratory and imaging services, and health education. Preventive care is a particular emphasis given the high rates of chronic disease in AI/AN populations—IHS operates robust diabetes prevention and management programs, cardiovascular health initiatives, and community health education campaigns.

The Special Diabetes Program for Indians (SDPI), for example, has invested over $150 million annually in diabetes treatment and prevention across Indian Country, contributing to a 54% decrease in end-stage renal disease due to diabetes among AI/AN people since the program began.

Dental Care

Dental services at IHS facilities include diagnostic and preventive care (exams, cleanings, fluoride treatments, sealants), restorative care (fillings, crowns, root canals), oral surgery (extractions, biopsies), emergency dental care, prosthetics (dentures, partials), and in some facilities, orthodontic services. Access to dental care varies by facility and location, with some areas experiencing significant wait times for non-emergency services due to workforce shortages.

Behavioral Health

Mental health and substance abuse services include individual and group therapy, psychiatric evaluation and medication management, crisis intervention, substance abuse assessment and treatment (including medication-assisted treatment for opioid use disorder), traditional healing practices integrated with Western medicine, and prevention programs targeting suicide, substance abuse, and domestic violence. IHS has placed particular emphasis on behavioral health in recent years, recognizing the role of historical trauma, adverse childhood experiences, and social determinants of health in the mental health challenges facing AI/AN communities.

Pharmacy Services

IHS pharmacies dispense prescription medications at no cost to eligible patients. The formulary includes medications for chronic diseases, acute conditions, mental health, and preventive care. IHS leverages federal pricing (similar to the 340B program) to obtain medications at significantly reduced costs, passing those savings directly to patients.

Emergency Services

IHS hospitals and some larger health centers operate emergency departments that provide emergency medical care around the clock. For facilities without emergency departments, IHS covers the cost of emergency services at non-IHS facilities through its Purchased/Referred Care (PRC) program, subject to eligibility and funding availability.

Maternal and Child Health

Prenatal care, obstetric services (including delivery at IHS hospitals), postpartum care, well-child visits, pediatric care, developmental screening, and reproductive health services. Some IHS facilities offer midwifery services and incorporate traditional birthing practices alongside modern obstetric care.

Purchased/Referred Care (PRC)

When a service you need is not available at your local IHS facility, the Purchased/Referred Care program (formerly called Contract Health Services) can pay for care at outside providers—specialists, hospitals, and other facilities that are not part of the IHS system. PRC is subject to availability of funds, medical priority, and residency in a designated PRC delivery area. Referrals must be pre-authorized except in emergency situations.

PRC is an important component of the IHS system because many IHS facilities, particularly in rural areas, do not offer the full range of specialty services. Cardiology, oncology, orthopedic surgery, and other specialties often require referral to outside providers, with PRC covering the cost for eligible patients.

Who Is Eligible

IHS eligibility is based on American Indian or Alaska Native status, not on income:

Members of federally recognized tribes: If you are an enrolled member of any of the 574 federally recognized tribal nations in the United States, you are eligible for IHS services.

Persons of Indian descent: Even if you are not an enrolled member of a tribe, you may be eligible if you can document that you are of Indian descent—typically defined as a descendant of a member of a federally recognized tribe. Documentation requirements vary by facility and may include tribal enrollment cards, Certificates of Degree of Indian Blood (CDIB), or other acceptable evidence.

Non-Indian family members: In some cases, non-Indian spouses, parents, or guardians of eligible AI/AN individuals may receive limited services at IHS facilities, particularly when the services relate to the health of an eligible AI/AN person (such as prenatal care for a non-Indian mother carrying an AI/AN child). Policies vary by facility.

Urban Indian Health Programs: Urban Indian Health Programs (UIHPs) serve AI/AN people living in urban areas who may not live near an IHS or tribal facility. The 41 UIHPs across the country provide varying levels of services, from comprehensive primary care to referral and outreach. Eligibility for UIHP services follows IHS eligibility guidelines.

No income test: Unlike most federal healthcare programs, IHS does not apply an income or means test. Services are available based on AI/AN status regardless of household income, employment status, or insurance coverage.

Insurance status does not matter: You can use IHS services whether you have private insurance, Medicaid, Medicare, TRICARE, VA benefits, or no insurance at all. If you do have insurance, IHS may bill your insurer as a way to generate additional revenue for the facility (these “third-party collections” are a significant funding source for IHS), but you will not be charged for any remaining balance.

How to Register and Access Care

Step 1: Determine your nearest IHS facility. Use the IHS facility locator at ihs.gov/findhealthcare to find IHS-operated, tribally operated, and urban Indian health facilities near you. Facilities are concentrated in states with large AI/AN populations, including Alaska, Arizona, New Mexico, Oklahoma, Montana, South Dakota, Minnesota, and Washington, among others.

Step 2: Contact the facility. Call the facility to ask about registration requirements, services offered, appointment availability, and what documents to bring for your first visit.

Step 3: Register as a patient. At your first visit, you will complete a registration process that verifies your eligibility. Bring your tribal enrollment card or Certificate of Degree of Indian Blood (CDIB), a government-issued photo ID, insurance cards (if applicable), and information about your medical history. If you do not have tribal enrollment documentation, ask the facility about alternative ways to verify eligibility.

Step 4: Schedule and receive care. Once registered, you can schedule appointments for the services you need. Many facilities offer same-day or walk-in appointments for urgent needs.

Step 5: Understand the PRC process. If you need specialty care that is not available at your IHS facility, ask your primary care provider about a Purchased/Referred Care referral. PRC referrals must be authorized in advance (except in emergencies) and are subject to funding availability and medical priority guidelines.

Challenges and Important Context

While IHS provides an essential healthcare safety net for AI/AN communities, it is important to understand some ongoing challenges:

Funding limitations: IHS has been historically underfunded relative to the healthcare needs of the population it serves. Per capita healthcare spending for IHS beneficiaries is significantly lower than for Medicaid, Medicare, VA, or federal employee health benefits. This funding gap translates to longer wait times, limited specialty services, and facility shortages in some areas.

Geographic access: Many IHS facilities are located in remote, rural areas where AI/AN communities have historically resided. For AI/AN people who have moved to urban areas, the nearest IHS facility may be hours away. Urban Indian Health Programs help address this gap but do not offer the full range of IHS services in all locations.

Workforce shortages: Recruiting and retaining healthcare professionals in rural and remote IHS locations is an ongoing challenge. Physician, dentist, and nursing vacancies affect service availability at some facilities. IHS operates loan repayment and scholarship programs to attract providers, but shortages persist.

Enroll in other coverage too: While IHS is free, enrolling in Medicaid, Medicare, or private insurance provides important benefits. Insurance coverage gives you access to a broader range of providers (including specialists not available at IHS facilities), helps fund your IHS facility through third-party billing collections, and provides a safety net for care received outside the IHS system. IHS staff can help you enroll in insurance programs.

Frequently Asked Questions

Do I have to live on a reservation to use IHS? No. While many IHS facilities are located on or near reservations, you can access IHS services at any IHS or tribal facility where you meet eligibility requirements. Urban Indian Health Programs serve AI/AN people in cities.

Is IHS the same as Medicaid? No. IHS is a direct healthcare delivery system—it operates hospitals and clinics. Medicaid is a health insurance program. You can be enrolled in Medicaid and also receive care at IHS facilities.

Can my non-Native children receive care at IHS? If your children are eligible (through tribal enrollment or documented Indian descent), they can receive IHS care. Policies regarding children of mixed heritage vary—check with your facility.

What if there is no IHS facility near me? If you live far from an IHS facility, check whether there is an Urban Indian Health Program in your area. You may also be eligible for Purchased/Referred Care coverage at non-IHS providers if you live within a PRC delivery area.

Does IHS cover prescriptions? Yes. IHS pharmacies dispense medications at no cost to eligible patients.

How to Get Started

1. Use the IHS facility locator at ihs.gov/findhealthcare
2. Call the IHS Patient Information Line for assistance
3. Contact your tribal health department for tribally operated healthcare options
4. Search for Urban Indian Health Programs at ihs.gov/urban
5. Bring your tribal enrollment card or CDIB when you register

Healthcare is a right grounded in the treaty and trust relationship between the United States and tribal nations. The Indian Health Service exists to honor that commitment. If you are an American Indian or Alaska Native, comprehensive healthcare at no cost is available to you—take advantage of it.