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Affordable Care Act Offers Behavioral Health Services for Natives

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Access to health care coverage that includes services for mental health and substance use disorders is critical for everyone. This is especially true for the American Indian and Alaska Native (AI/AN) community, which face some significant behavioral health challenges. 

According to a 2013 report by the Substance Abuse and Mental Health Services Administration, the rate of substance dependence or abuse among AI/ANs aged 12 or older was higher than any other population group. In the United States, among adolescents ages 12 to 17, Native youth have the highest lifetime prevalence of major depressive episodes. In addition, suicide is the second leading cause of death—2.5 times the national rate—for Native male youth in the 15 to 24 year old age group. Access to prevention and treatment is critical for these communities. 

The Health Insurance Marketplace provides many American Indians and Alaska Natives access to health coverage, including coverage for mental health and substance use disorder treatment that they did not have before. During this time, we urge you to talk with your friends, family, loved ones and community members and encourage everyone you know to get covered.

Open enrollment for the marketplace for all Americans runs until Feb. 15, and many American Indians and Alaska Natives are also able to enroll year round. Even if you already receive care from an Indian Health Service (IHS), tribal, or urban clinic or hospital, you and your loved ones can benefit from coverage under the Affordable Care Act, so it is important to enroll now.

The services that are available through Medicaid or the marketplace can be a valuable addition to services you receive at your IHS, tribal, or urban clinic or hospital. Enrolling in Medicaid or a private health insurance plan through the marketplace may offer you access to additional providers and services, including mental health and substance use programs. 

Americans who enroll in the marketplace may be eligible for tax credits to help them pay the cost of their monthly insurance premiums. The law also provides special protections exclusively for American Indians and Alaska Natives. Families with income under 300 percent of the federal poverty level (about $71,000 for a family of four in 2014, $89,000 in Alaska) and who are also eligible for the tax credit will not have any out-of-pocket costs like co-pays, coinsurance, or deductibles for services covered by their marketplace health plan.

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Members of federally recognized tribes are eligible for monthly special enrollment periods. And, regardless of income, tribal members who enroll in a marketplace health plan will not have any out-of-pocket costs when they get services from an Indian health care provider or from another provider if they have a referral from an Indian health care provider. In addition, IHS, tribal, and urban clinics or hospitals will be able to get reimbursed for services provided to someone with health care coverage, allowing them to serve more people in need.

The law also improves private health coverage outside of the marketplace. Most health plans must cover preventive care benefits such as depression screening and provide help for alcohol misuse. And young adults can remain enrolled on a parent’s private health plan up to age 26. This is particularly helpful for those young adults who have experienced mental health or substance use issues as an adolescent or young adult.

Now is an ideal time for tribes, federal, state, and local governments and community nonprofits to work together to help American Indian and Alaska Native families sign up for better health care coverage.

What can you do to help your family and community get covered? Go to to find out more about health care coverage. Talk to your family, friends, classmates and neighbors about getting covered. Reach out to state, local, and tribal officials and community organizations to voice your opinions about health care needs in your community. Spread the word on Twitter and Facebook. 

We hope that you will consider joining the millions of Americans who are benefiting from new and expanded health coverage under the Affordable Care Act. Learn more at

Pamela S. Hyde, J.D., is the Administrator for Substance Abuse and Mental Health Services Administration, and Mirtha Beadle is the Director of SAMHSA’s Office of Tribal Affairs and Policy.