1. Distribution of Tribes by Size
Tribal enrollment is highly concentrated among a relatively small number of large tribes. This graphic shows the distribution of federally recognized tribes by enrolled-citizen population and illustrates why aggregate measures of the American Indian population can obscure substantial differences among Tribal communities.
2. How We Count AI/AN Population
Different population definitions produce very different estimates of the American Indian and Alaska Native population. This graphic compares enrollment, Census, IHS, and other population measures and explains why the choice of population definition matters when measuring health needs, coverage, and Indian health financing.
3. Estimating Funding Equity
This graphic presents the broader Indian health financing picture by comparing current federal funding with estimated health care needs. It examines the relationship between IHS funding, population and utilization, projected requirements, and the resources needed to move toward greater funding equity.
Growing Importance of Medicaid
4. Medicaid Enrollment Trends for AI/AN People
This graphic traces Medicaid enrollment among American Indian and Alaska Native people from 2013 through 2023. It documents substantial enrollment growth and changes in Medicaid coverage while highlighting the importance of reliable population and enrollment data for understanding Medicaid’s role in Indian health financing.
What Would It Take to Achieve Health Equity?
5. User Need Estimates: Two Methods
This graphic compares two methods for estimating health care need among AI/AN people. The comparison demonstrates how population definitions and methodological choices affect estimates of need and, ultimately, estimates of the resources required to achieve health equity.
6. Medicare and Medicaid: Enrollment Gains in Medicare and Dual Eligibles
6. Medicare and Medicaid: Enrollment Gains in Medicare and Dual Eligibles
This graphic moves from overall enrollment to the intersection of Medicare and Medicaid. It examines the growth of Medicare enrollment and the increasing number of AI/AN people who qualify for both programs.
7. Medicare Among AI/AN People in the IHS-Access Population
This analysis quantifies the Medicare population within the IHS-access population and estimates associated Medicare spending. It demonstrates that Medicare represents a substantial source of health care financing alongside IHS and Tribal resources.
8. Dual Eligibles: Where Medicare and Medicaid Meet in Indian Health
Dual-eligible AI/AN people qualify for both Medicare and Medicaid and represent an important part of the IHS-access population. This analysis examines their numbers, coverage, and associated spending, showing how the two programs together contribute substantial resources to Indian health care.
9. How Medicaid Works Differently in Indian Country
Medicaid plays a distinctive role in Indian Country because American Indian and Alaska Native people may receive care through IHS, Tribal health programs, Medicaid, or combinations of these systems. This graphic explains how Medicaid financing, eligibility, federal policy, and Tribal health systems interact—and why Medicaid is an important component of Indian health financing.
10. Methods: How We Measure and Analyze Indian Health Financing
This graphic summarizes the methodological framework used throughout the Indian Health Financing research. It brings together population data, Medicaid and Medicare enrollment, CMS and IHS administrative data, federal spending, health system measures, and other sources to examine how resources flow through the Indian health system and how financing relates to access and performance.
PrC Has Not Kept Pace with INflation
11. Purchased/Referred Care (PRC): Does Not Keep Up With Inflation
Purchased/Referred Care is a critical component of the Indian health system, providing access to services that cannot be delivered directly by IHS or Tribal facilities. This analysis compares PRC funding with the growth in health care costs and demonstrates the widening gap between available resources and the cost of purchased care over time.
12. Indian Health System: Access Has Grown, But Capacity Has Not Kept Pace
The Indian health system has expanded access through increased facilities, services, Medicaid coverage, and other investments. However, growth in demand and enrollment has often outpaced the system’s capacity to provide care. This graphic examines that gap and highlights the continuing need for investments in facilities, workforce, infrastructure, and sustainable health financing.
13, Key Definitions of AIAN Population with Estimates and Administrative Data
