On April 3, 2023 the Department of Veterans Affairs (VA) announced that American Indian and Alaska Native (AI/AN) veterans are exempt from copay requirements for urgent care or healthcare provided by VA. Under this new policy, the VA will reimburse copays paid on or after January 5, 2022, and it will waive future copays for AI/AN veterans. VA Secretary Denis McDonough stated “American Indian and Alaska Native Veterans deserve access to world-class health care for their courageous service to our nation. By eliminating copays, we are making VA health care more affordable and accessible — which will lead to better health outcomes for these heroes.” For years, the National Council of Urban Indian Health (NCUIH) has worked to remove copayment barriers for AI/AN veterans at the VA and recently provided comments to the VA’s Proposed Rule on the Copayment Exemption for AI/AN Veterans and was successful in getting the agency to remove a proposed cap on the amount of urgent care visits which qualify for the exemption. This is a significant victory that will directly impact the level of access to health care for AI/AN veterans. Current eligibility for the copay exemption is available to AI/AN Veterans who met the definition of “Indian” or “urban Indian” under the Indian Health Care Improvement Act.
The copay exemption is a significant step to upholding the federal government’s trust responsibility to “maintain and improve the health of the Indians.” AI/ANs serve in the military at one of the highest rates of any group in the United States and many Native veterans receive healthcare from the Veterans Health Administration, an agency within VA, in addition to utilizing IHS, Tribal, and UIO facilities. Unfortunately, AI/AN veterans generally have a higher prevalence of mental health disorders compared with White veterans, and among all veterans, the prevalence of suicidal ideation is highest for those reporting a diagnosis of depression, anxiety, or post-traumatic stress disorder. Further, an estimated 86.2 percent of AI/AN veterans that live in urban areas generally have higher unemployment, lower education attainment, lower income, higher VA-service connected disability, and generally live in poorer housing conditions than non-Native veterans also living in urban areas.
NCUIH continuously advocates for Native veterans living in urban areas to ensure that they have access to the high-quality, culturally competent care the country owes to them for their military service and as a result of federal trust responsibility. In February 2023 NCUIH submitted comments to the VA regarding the copay exemption proposed rule and expressed VA copayments have historically represented a significant barrier to AI/AN veterans’ ability to access the healthcare this Nation owes them through VA facilities. NCUIH further recommended VA utilize self-attestation in determining eligibility for copay exemptions, VA cover all urgent care visits needed by Indian or urban Indian veterans, VA make clear that the copay exemption exists because of the trust responsibility, and VA host an Urban Confer and Tribal Consultation on the copay exemption. NCUIH appreciates the VA’s commitment to ensuring quality health care is more accessible for Indian and urban Indian veterans.