Eligibility for Services

Eligibility for care at Choctaw Nation Health Service facilities is a difficult topic, often determined by an individual’s unique circumstances. Each of our facilities have patient registration staff trained to address any questions or concerns you may have regarding eligibility for services. In general, Choctaw Nation Health Services Authority (CNHSA) provides health care services at the Choctaw Nation Health Care Center and outlying clinics according to the following guidelines:

Native Americans

A Native American with a CDIB card (Certificate Degree of Indian Blood), a Membership card, or letter of descendancy from a federally recognized tribe is eligible for services as described in the following guidelines. Verification of social security number is required. If 18 or older, a photo ID is also required.

Please note: In order to be eligible for Choctaw Referred Care (CRC) the patient must show proof of residency in Atoka, Choctaw, Haskell, Latimer, Leflore, McCurtain, Pittsburg, Pushmataha or Bryan counties of Oklahoma. Residency must be for a time period of 180 days or more. Proof of residency consists of the following: tax returns, Oklahoma driver’s license, vehicle registrations, utility bills, bank statements, school enrollment, and physical address (no P.O. Box). The burden of proof is on the patient.

Natural Children

Natural Children, under the age of 19 years, of an eligible parent are eligible for services.

If a child has his/her own CDIB, required documentation is the same as for an eligible adult. If a child does not have his/her own CDIB, eligibility will be determined through the Parents ONLY. A copy of the parent(s) CDIB, the child’s birth certificate and social security card must be provided. Grandparents, other relatives or friends may verify the child’s eligibility by providing the aforementioned documents in addition to a letter from either parent authorizing medical care for the child. In certain instances, as determined by the Administrator, care may be rendered without producing a CDIB. Individuals will be required to provide documentation by their next visit. Failure to comply will result in billing for services rendered and ineligibility for further care. In all cases, after the age of one (1) year, either a social security card or a copy of the parent’s must be in the chart to provide services.

Adopted, Step, and Foster Children

An adopted child, stepchild, foster child, legal ward or orphan under the age of 19 years of an eligible parent is eligible for services (except Diabetes Wellness Center). A stepchild is required to live in the home of the Native and recertification is required once per year. The following documents must be provided to document eligibility:

1. Marriage License of parent

2. Birth Certificate of child

3. CDIB, membership card or letter of descendancy of eligible parent

4. Proof of dependency (i.e., divorce papers, tax forms, adoption papers, custody agreement, court orders)

5. Eligible parent MUST come in and complete an affidavit of acknowledgement of dependency form once a year.

6. CNHSA does not recognize common law marriages. Stepchildren from these circumstances are not eligible for care.

Non-Eligible Spouses

Non-eligible spouses are eligible for limited services on a fee basis (Must have a third Party Payer). Non-eligible spouses can use Laboratory services, Radiology, Surgery Clinic, Women’s Clinic, Family Practice, Emergency/ Urgent Care, and In-Patient Services ONLY. Non-eligible spouses can be seen at Talihina Hospital ONLY.

Non-eligible spouses are responsible for deductibles and paying the remaining balance after the third Party Payer has billed. The following documents must be provided to determine eligibility:

1. Marriage License

2. CDIB, membership card or letter of descendancy on eligible spouse

3. Proof of Insurance: Medicare, Medicaid, or Private Insurance card

4. In the event of eligible spouse’s death, services will continue until the non-eligible spouse remarries 5. Non-eligible spouses can be seen at the Choctaw Nation Health Care Center in Talihina ONLY.

Non-Eligible Spouses Pregnant with an Eligible Child Non-eligible spouses pregnant with an eligible child:

ALL services related to pregnancy (to be determined by Physician). The following document must be provided to determine eligibility:

1. Marriage License

2. CDIB, Membership card, or letter of descendancy

3. Proof of pregnancy (positive test from Health Department)

Please note: If individuals are not married, paternity papers must be completed at the hospital during the first prenatal visit. The eligible party must be present for signature. Individuals must submit photo ID with signature.

Non-eligible spouses will be eligible for services at Talihina Hospital ONLY (with the exception of prescriptions related to pregnancy, as determined by physician, which will be available at any outlying clinic) until released by the provider (six weeks post partum).

NOTE: If a step-child and/or non-eligible dependent presents herself as being pregnant, the patient will be eligible for services related to pregnancy until six weeks post-partum.

After step-child and/or non-eligible dependent has delivered, that individual becomes emancipated (Emancipated is considered as being an adult).

The child born at Choctaw Nation Health Care Center to the step-child and/or non-eligible dependent (mother) will receive care for six weeks post-partum.

Non-Eligible- Emergent Care

Choctaw Nation Health Care Center will assess/treat any emergency with potential loss of life or limb (Choctaw Nation Health Care Center complies with all laws governing emergency services). Non-eligible patients presenting with a non-emergent complaint will be assessed to determine the necessity to treat (An attempt will be made to stabilize the patient prior to transfer to another facility). In questionable cases, the administrator on call will make the determination concerning admission. These individuals will be required to pay for the Episode of Care.

A supply of medications will not be dispensed. If the provider determines a medical necessity and an alternate source for obtaining medication is unavailable, the provider may give a one (1)-time dose or a one day dosage to start initial treatment.

Non-Eligible Employees (refer to Human Resources’ Non-Eligible Employee Policy)

Active Duty Non-Indian Members of the Armed Services Including Spouses and Dependents- This includes Commissioned Corp. Active duty non-Indian members for the Armed Services are eligible for all services except Diabetes Wellness Center, Choctaw Referred Care and Pharmacy on a fee basis.

Non-eligible spouses and dependents (under age 18) of non-Indian Active Duty members of the Armed Services are eligible for Laboratory, Radiology, Emergency/Urgent Care ONLY on a fee basis.

Acute Infectious Disease Non-Indian family members dwelling in the house of an eligible where an acute infectious disease has been diagnosed will be assessed/treated for the disease.

If you or a loved one falls into any of these categories and wants to be seen at a Choctaw Nation facility, please call Patient Registration at your nearest clinic for more information or to schedule an appointment.