What the Indian Health Service Is

The Indian Health Service (IHS) is a federal agency that provides health care to enrolled members of federally recognized American Indian and Alaska Native tribes. IHS does not work like a typical insurance program — it is a direct health care system run by the U.S. Department of Interior. If you are a tribal member, you may receive medical services through IHS clinics, hospitals, and health programs without paying premiums or copays, though some services may have small fees depending on your income.

IHS operates in every state but is concentrated in the West, Southwest, and Alaska. The agency runs about 600 health facilities ranging from small clinics to full hospitals. Some tribes also run their own health systems using IHS funding through a process called tribal self-information, which means the tribe contracts with IHS to manage its own health care instead of IHS running it directly.

Key Takeaways

  • IHS serves enrolled members of federally recognized tribes and provides medical care through clinics and hospitals rather than through insurance.
  • You must be an enrolled tribal member to use IHS services, and enrollment requirements are set by each individual tribe.
  • IHS covers primary care, emergency care, dental, mental health, and some specialty services, though availability varies by location.
  • Some tribes run their own health systems using IHS funding, so the experience and services available depend on which tribe and which facility you use.
  • IHS also funds public health programs, maternal health, substance abuse treatment, and diabetes prevention in tribal communities.

Who Can Use IHS Services

To use IHS, you must be an enrolled member of a federally recognized American Indian or Alaska Native tribe. Enrollment is not automatic — each tribe maintains its own membership roll and sets its own enrollment requirements. Some tribes require a certain blood quantum (a percentage of tribal ancestry), while others use different criteria. You will need to contact your tribe's enrollment office to find out what documentation you need and whether you meet their requirements.

If you are already enrolled, you can use IHS services at any IHS facility in the country, though you may get faster service and more complete records at facilities in your home region. If you are not yet enrolled but believe you have tribal ancestry, start by contacting your tribe's enrollment department — they can tell you what proof of ancestry they need and how long the enrollment process takes.

What Services IHS Covers

IHS provides a range of health services at no cost or low cost to enrolled tribal members. These include primary care (routine doctor visits), emergency care, hospital stays, dental care, mental health counseling, substance abuse treatment, maternal and child health services, and some specialty care. The specific services available depend on which IHS facility you visit — a small rural clinic may not offer specialty services that a larger IHS hospital can provide.

IHS also funds public health programs run by tribes themselves, such as diabetes prevention, nutrition programs, health education, and disease screening. Many tribes use IHS funding to run community health worker programs that bring care and education to people in remote areas. If you need a service that your local IHS facility does not offer, staff can refer you to another IHS facility or, in some cases, to a non-IHS provider, though the referral process and coverage vary.

How to Find and Use an IHS Facility

The IHS website has a facility locator tool where you can search by state or tribe to find clinics and hospitals near you. When you visit an IHS facility for the first time, bring your tribal enrollment card or enrollment documentation, a photo ID, and proof of address. The facility will create a medical record for you and ask about your health history and current medications.

Most IHS facilities operate on a first-come, first-served basis for routine care, though some now use appointment systems. If you need emergency care, go to the nearest IHS emergency room or hospital. If the nearest IHS facility is far away, some tribes have agreements with local non-IHS hospitals and clinics to provide care to tribal members, and IHS will cover those visits.

Costs and Fees

IHS services are free or very low cost for enrolled tribal members. Most routine care has no copay. Some facilities charge small fees based on your income — if you earn below a certain threshold, you pay nothing, and fees increase as income rises. Emergency care and hospital stays are covered. Prescription medications are usually free or very low cost at IHS pharmacies.

If you receive care at a non-IHS facility through an IHS referral, IHS will cover that care, though the amount and process depend on the agreement between IHS and that facility. If you go to a non-IHS provider without a referral, IHS will not cover it. Some tribal members also have other insurance (Medicare, Medicaid, private insurance), and IHS can coordinate with that insurance to cover costs.

IHS and Other Insurance

If you have Medicare, Medicaid, or private insurance in addition to IHS coverage, you can use either system. Many tribal members use IHS as their primary care source and use other insurance for specialty care or when IHS cannot provide a service. If you have Medicaid, you can use both IHS and Medicaid-covered providers. IHS will not bill your other insurance unless you ask them to, but billing your insurance can sometimes help IHS cover costs for services they provide.

If you are may be able to access for Medicaid, you should still enroll because Medicaid can cover services that IHS does not provide or cannot cover. The process for enrolling in Medicaid is separate from IHS and is handled by your state's Medicaid program, not by IHS.

Tribal Self-information and Tribal 638 Programs

Some tribes have chosen to run their own health systems using IHS funding through contracts called Tribal Self-information Act agreements or 638 contracts (named after the law that created them). When a tribe does this, the tribe hires its own staff, sets its own policies, and manages its own budget, though IHS still provides funding. From a patient's perspective, the experience is usually similar — you still show your tribal enrollment card and receive care — but the tribe may offer different services or have different hours than a direct IHS facility.

If your tribe runs its own health system, contact your tribe's health department directly for information about services, hours, and how to register. If your tribe does not run its own system, IHS runs the facilities in your area.

Frequently Asked Questions

Do I have to be a certain blood quantum to use IHS?

No. Blood quantum requirements vary by tribe — some tribes require a certain percentage of tribal ancestry, while others do not. Your tribe's enrollment office sets the requirement, not IHS. Contact your tribe to find out what they require.

Can I use IHS if I live far away from an IHS facility?

Yes. IHS can refer you to local providers and cover those visits, though the process and coverage depend on your location and your tribe's agreements. Call your nearest IHS facility or your tribe's health department to ask about options in your area.

What if I need a specialist that IHS does not have?

IHS can refer you to a specialist outside the IHS system, and IHS will cover that care. The referral process and wait times vary by facility. Ask your primary care provider at IHS to make the referral and confirm that it will be covered before you schedule the appointment.

Do I lose IHS coverage if I move to a different state?

No. Your tribal enrollment is valid everywhere, and you can use IHS services at any IHS facility in any state. You may have better access to records and faster service at facilities in your home region, but you are not limited to one location.

Can IHS bill my Medicare or Medicaid?

Yes, if you ask them to. IHS can coordinate with your other insurance to cover costs, though they are not required to do so. Ask the billing department at your IHS facility whether billing your insurance would help cover services.