Tribal Government Relations


 Tribal Partnership Action Plan 

OHCA SFY 2017 Tribal Government Relations Annual Report & Consultation Summary 

Bimonthly Tribal Consultation Agendas 

 OK TMAM - Tribal Medicaid Administrative Match

Tribal Government Relations Resources

Tribal Amendment (Transportation Agreement)

100 Percent FMAP Preface & Addendum

I/T/U Resources

I/T/U Public Notices

More Information

Tribal Government Relations Purpose and Core Functions

The OHCA Tribal Relations Unit performs American Indian liaison services between OHCA and Centers for Medicare & Medicaid Services, Indian Health Service and the tribes of Oklahoma for state and national level issues including American Indian work groups, policy development and compliance, tribal consultation, payment issues and elimination of health disparities. The goals of the OHCA Tribal Relations Unit are to develop and implement a service delivery model within the current Medicaid program (SoonerCare in Oklahoma) which increases access to SoonerCare services for American Indians.

Unique Relationship

Since tribal governments are considered “domestic dependent nations” by the federal government they have a unique and distinct relationship with the federal and state governments. The federal government has entered into enduring agreements (treaties) with tribes that create certain responsibilities for the federal government including providing health care for tribal members.

In recognition of the federal trust responsibility for American Indian health care, Congress stipulated that a 100 percent federal medical assistance percentage to states would apply for SoonerCare services delivered to American Indians and Alaska Natives through Indian Health Service facilities and tribal-operated facilities.

Health Disparities

American Indians and Alaska Natives have significantly worse health status compared to the rest of the national population. Factors such as high poverty rates, lower education levels, inadequate housing, and insufficient transportation contribute to disproportionately high rates for health disparities.

Tribal Health Facilities in Oklahoma

In Oklahoma there are three types of Indian Health facilities: facilities operated by IHS and facilities operated by Tribes and Urban Indian clinics. IHS is the federal agency responsible for providing health services to most American Indians and Alaska Natives. There are approximately 50 American Indian health care facilities in Oklahoma (including hospitals and clinics.)

American Indian Citizenship

American Indians and Alaska Natives retain citizenship not only with the United States, and the state of their residence, but their tribal government as well. As citizens of each government American Indians and Alaska Natives are eligible for services and enjoy certain inherent rights; they are members of tribes that have a unique relationship with the United States government and utilize a distinctive health care delivery system. IHS is a service that is available, not required, for American Indian people who can verify their ancestry. Verification of ancestry is documented by a Certificate of Degree of Indian Blood which is issued by the Bureau of Indian Affairs.


Unlike SoonerCare, Indian Health is not an entitlement program. Instead, this provision of health care to American Indians and Alaska Natives falls under the federal trust responsibility that recognizes the debt owed to American Indian tribal governments. Eligibility for care at IHS, Urban Indian and Tribal facilities is usually determined under federal statute and regulation and depends largely (but not exclusively) upon membership in a federally-recognized tribe.

As a matter of law, American Indians who meet SoonerCare eligibility standards are entitled to SoonerCare coverage. This applies to American Indians as it does to other American citizens. SoonerCare reimburses Indian Health providers for covered services provided to American Indian SoonerCare Members. When an American Indian SoonerCare member is eligible for services through multiple payers such as Medicare, SoonerCare and Indian Health, Indian Health is always the payer of last resort.

OHCA SoonerCare Tribal Consultation

In order to carry out agency activities, OHCA has developed a mechanism for ongoing communications with Oklahoma’s tribal governments, health providers, health facilities, governmental officials, and other stakeholders. 

OHCA will hold an annual tribal consultation meeting to maximize partnerships with tribal governments and improve services to American Indian SoonerCare members and providers.

Given the number of tribal governments and the substantial tribal population in Oklahoma, it is imperative that OHCA seek the input of tribal governments during the OHCA decision making and priority setting process to improve the health status of all Oklahomans. Such collaboration can be achieved through the implementation of open, continuous, and meaningful consultation, which leads to information exchange, mutual understanding, and informed decision-making.