2. American Indians

Section 1902(xx)(9)(A)(ii)(II) of the Act defines as specified excluded individuals an individual “who: (aa) is an Indian or Urban Indian (as such terms are defined in paragraphs (13) and (28) of section 4 of the Indian Health Care Improvement Act; (bb) is a California Indian described in section 809(a) of such Act; or (cc) has otherwise been determined eligible as an Indian for the Indian Health Service under regulations issued by the Secretary.” CMS has previously issued regulations that define “Indian” to implement various protections for individual Indians, Indian tribes, and tribal organizations as it relates to Medicaid premiums and cost sharing, as required by sections 1916(j), 1916A(b)(3)(A)(vii), and 1916A(b)(3)(B)(x) of the Act. [ 46 ] The existing definition at § 447.51 incorporates each of the specific groups listed in section 1902(xx)(9)(A)(ii)(II)(aa) through (cc) of the Act; therefore, we adopt the existing definition of “Indian” at § 447.51 for the community engagement exclusion at the new § 435.554(c)(2). In other places throughout this IFC, we refer to this population as American Indians. We believe adopting this definition will promote alignment with existing Medicaid protections for American Indians and will allow States to use existing data used for cost sharing to effectuate this community engagement exclusion. Notably, unlike other exclusions which may change from month to month or be time-limited, States will not be required to (and may not) reverify someone's status as an American Indian for exclusion from the community engagement requirement.