February 24, 1998
 

Dear Tribal Leader/Indian Organization Official:

You will find enclosed a copy of a "Dear State Official" letter that provides guidance to States on the Children’s Health Insurance Program (CHIP). This program, created under the new Title XXI of the Social Security Act, will expand health coverage to uninsured children whose families earn too much for Medicaid but too little to afford to purchase private health insurance. Under this new Federal/State program, a State may choose to create or expand new child health insurance programs, expand its Medicaid program, or create a combination of both.

This "Dear State Official" letter sets out the Department of Health and Human Services guidance on meaningful consultation with American Indian and Alaska Native (AI/AN) Tribes and Indian organizations. It requests that the State official responsible for the CHIP program (1) consult with AI/AN Tribes and Indian organizations in that State on development and implementation of the CHIP plan, and (2) use State flexibility with certain limited administrative funds to improve outreach efforts and to establish health services initiatives to benefit Indian children.

Our request that States consult with Tribes and Indian organizations is intended to supplement, not replace, Federal consultation. We recognize that the Department’s consultation policy, and the Presidential directive to Executive Branch Agencies upon which that policy is based, call for consultation between the Federal level and AI/AN Tribes on a government-to-government basis. Because States have considerable flexibility on CHIP policy and operational matters under the new law, we believe it is also important to encourage consultation on the State level. CHIP presents an opportunity for Tribes and Indian organizations to have input on this important new program which can be very beneficial to Indian children and families most at risk.

We would like to commend NCAI, NIHB, and the Western Governors Association work group for their efforts on Indian issues in CHIP. We hope that the outreach efforts, health services initiatives, and other aspects of the CHIP program contribute to developing ongoing consultation between States and Indian Tribes and organizations. This partnership will help better achieve the CHIP goal of providing access to health care for all vulnerable children. A list of specific contact people for American Indian and Alaska Native issues is included on the attachment to the "Dear State Official" letter. They, along with HCFA and HRSA Regional Office CHIP staff (list also enclosed) are available to assist you with the consultation process and with efforts to use CHIP funding to assist American Indian and Alaska Native children.

Sincerely,