Eligibility
- CNHSA Eligibility Guidelines
NATIVE AMERICANS
A Native American with a CDIB card, a Membership card, or letter of descendancy from a federally recognized tribe is eligible for services as described in the following guidelines. Social security card is required. If 18 or older, a Photo ID is also required.
Please Note: In order to be eligible for Choctaw Referred Care, 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, State birth certificate is required and social security card required. (Required by age one)
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, State birth certificate and social security card required. (Required by age one) Grandparents, other relatives or friends may verify the child's eligibility by providing the aforementioned documents in addition to the 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.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.- Marriage License of parent
- Birth Certificate of child
- CDIB, membership card or letter of descendancy of eligible parent
- Proof of dependency (i.e., divorce papers, tax forms, adoption papers, custody agreement, court orders, minor child affidavit) Note: school records can show address where child lives
- Eligible parent MUST come in and complete an affidavit of acknowledgement of dependency form once a year. (stepchild) (if signed outside the facility must be notarized)
- Choctaw Nation Health Services Authority 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. (With Insurance) (Must have a third (3rd) 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 (3rd) Party Payer has been billed.
The following documents must be provided to determine eligibility:- Marriage License
- CDIB, membership card, or letter of descendancy on eligible spouse
- Proof of Insurance: Medicare, Medicaid, or Private Insurance card
- Current Photo ID
- In the event of the eligible spouse's death, services will continue until the non-eligible spouse remarries
- 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 documents must be provided to determine eligibility:- Marriage License
- CDIB, membership card, or letter of descendancy
- Proof of pregnancy (positive test from Health Department)
- Current Photo ID
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 picture ID with signature. This includes all types of paternity such as Denial of Paternity.
Non-eligible spouse 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 provider. Patient will be seen up to six weeks post-partum for medical care related to pregnancy. If the condition continues after the pregnancy, care can be established with an outside provider.
Note:
If a stepchild and/or non-eligible dependent presents herself as being pregnant, the patient will be eligible for all services related to pregnancy until six weeks post-partum.After a stepchild and/or non-eligible dependent has delivered then that individual becomes emancipated. (Emancipated is considered as being an adult.)
The child born at Choctaw Nation Health Care Center to the stepchild and/or non-eligible dependent (mother) will receive care for six weeks post-partum.
NON-ELIGIBLE EMERGENT CARE
CNHCC will assess/treat any emergency with potential loss of life or limb (CNHCC 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 (SEE NON-ELIGIBLE EMPLOYEE POLICY IN HR SECTION)
ACTIVE DUTY NON-INDIAN MEMBERS OF THE ARMED SERVICES INCLUDING SPOUSES AND DEPENDENTS- THIS INCLUDES COMMISSIONED CORP.
Active duty non-Indian member 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 or Urgent Care only on a fee basis. Talihina onlyACUTE INFECTIOUS DISEASE
Non-Indian family member dwelling in the house of an eligible where an acute infectious disease has been diagnosed will be assessed/treated for the disease.SPECIALITY SERVICES
All patients seen by specialty services provided in house must meet the following guidelines:- BIOLOGIC MEDICATIONS 3-year resident – Limited to CRC/Choctaw only (Living in 10 ½ counties) for at least three (3) years.
- CARDIOLOGY-18 y/o+; Echo 18+; Holter Monitor 18+- Limited to CRC Only (Any tribe living in 9 counties) Limited to CRC/Choctaw only (Living in 10 ½ counties) for at least three (3) years.
- DENTAL PEDIATRIC <8 y/o – Limited to CRC/Choctaw only (Living in 10 ½ counties) for at least 3 years. Children must be 8 years old and under.
- DERMATOLOGY – CDIB holders, Direct (Any tribe living anywhere) Any patient with consult and non-eligible spouse with third party payer.
- EEG – Limited to CRC/Choctaw only (Living in 10 ½ counties), Ordered by Neurologist.
- Endocrinology- CDIB holders, Direct (Any tribe living anywhere), Includes pediatric and FNA.
- Endodontic >14 y/o- Limited to CRC/Choctaw only (Living in 10 ½ counties)
- ENT Talihina (incl Surgery) 2 y/o+- Limited to CRC Only (Any tribe living in 9 counties) Limited to CRC/Choctaw only (Living in 10 ½ counties)
- ENT- Durant- CDIB holders, Direct (Any tribe living anywhere
- GASTROINTESTINAL – CDIB holders, Direct (Any tribe living anywhere) Limited to CRC only (Any tribe living in 9 counties) Limited to CRC/Choctaw Only (Living in 10 ½ counties)
- NEUROLOGY – Limited to CRC/Choctaw Only (Living in 10 ½ counties), will see patients aged 2 and over. (For migraines, must have two (2) failed therapies. Will see for any other serious neurological issue).
- OPHTHALMOLOGY CATARACT SERVICES – Limited to CRC/Choctaw only (Living in 10 ½ counties)
Exception: IN HOUSE cataract surgery only, NOT CRC
- Must be Choctaw
- CDIB must have been issued in Oklahoma. This includes Mississippi Band, as long as issued in OK.
- They Do Not have to live in the counties.
- May or May does not have 3rd party.
- May also qualify for cataract surgery regardless of Tribe, if being treated by Dr. Fransen (retina Clinic), and he requires extraction to continue his treatment/care.
- ORTHO MID-LEVEL – Limited to CRC only (Any tribe living in 9 counties)
- ORTHOPEDIC SURGEON – Limited to CRC/Choctaw only (Living in 10 ½ counties) can be Mississippi Choctaw if Oklahoma CDIB.
- PT-EMG/NCVS- Limited to CRC/Choctaw only (Living in 10 ½ counties)
- PULMONARY 16 y/o+- Limited to CRC only (Any tribe living in 9 counties), Limited to CRC/Choctaw Only (Living in 10 ½ counties)
- RHEUMATOLOGY – Durant Only >18- Limited to CRC/Choctaw Only (Living in 10 ½ counties) No patients under age 18.
- SLEEP LAB – Limited to CRC/Choctaw Only (Living in 10 ½ counties) Age 15 and up is for non-diabetic and age 10-15 must be diabetic.
NON-SPECIALTY SERVICES
- 24 Hour Event Monitors - CDIB holders, Direct (Any tribe living anywhere)
- 30 Day Event Monitors - Limited to CRC only (Any tribe living in 9 counties)
- ACC- CDIB holders, Direct (Any tribe living anywhere)
- Audiology-Hearing Test/Exam) - CDIB holders, Direct (Any tribe living anywhere
- Audiology-Hearing Aids/Batteries - Limited to CRC/Choctaw Only (Living in 10 ½ counties)
- Behavioral Health - CDIB holders, Direct (Any tribe living anywhere), Non-Eligible Pregnant with an Eligible child up to 6 wks. post-partum (pregnancy related) Crisis only, Talihina only. Non- Eligible Health Care Employee & omission Corp. (Bariatric) with Insurance.
- Chi Hullo Li (Female) - CDIB holders, Direct (Any tribe living anywhere)
- Choctaw Referred Care (CRC) - Limited to CRC only (Any tribe living in 9 counties)
- Community Health Nurse - CDIB holders, Direct (Any tribe living anywhere) (Imm). Limited to CRC only (Any tribe living in 9 counties) (NB)
- Dental - CDIB holders, Direct (Any tribe living anywhere)
- De-Sat Monitors - CDIB holders, Direct (Any tribe living anywhere)
- Diabetic Educator - CDIB holders, Direct (Any tribe living anywhere)
- Dietician - CDIB holders, Direct (Any tribe living anywhere)
- DWC - CDIB holders, Direct (Any tribe living anywhere)
- Emergency/Urgent Care - CDIB holders, Direct (Any tribe living anywhere), Limited to CRC only (Any tribe living in 9 counties), Limited to CRC/Choctaw Only (Living in 10 ½ counties), Non-Eligible Pregnant with an Eligible child up to 6 wks. post-partum (pregnancy related, Talihina only), Non-eligible spouse with insurance Talihina only, . Non- Eligible Health Care Employee & omission Corp. with Insurance, Non-eligible Health care Employee Spouses and dependent children with insurance.
- Employee Health (All Employees) Spouses and children - Non-eligible Health Care Employee spouse and Dependent children, ALL CNO Employees. Insurance not required.
- Eye clinic (Includes retina) - CDIB holders, Direct (Any tribe living anywhere)
- Family Practice - Direct (Any tribe living anywhere), Limited to CRC only (Any tribe living in 9 counties), Limited to CRC/Choctaw Only (Living in 10 ½ counties), Non-Eligible Pregnant with an Eligible child up to 6 wks. post-partum (pregnancy related, Talihina only), Non-eligible spouse with insurance Talihina only, . Non- Eligible Health Care Employee & omission Corp. with Insurance, Non-eligible Health care Employee Spouses and dependent children with insurance.
- Imaging (excluding MRI) - Direct (Any tribe living anywhere), Limited to CRC only (Any tribe living in 9 counties), Limited to CRC/Choctaw Only (Living in 10 ½ counties), Non-Eligible Pregnant with an Eligible child up to 6 wks. post-partum (pregnancy related, Talihina only), non-eligible spouse with insurance Talihina only, Non- Eligible Health Care Employee & Commission Corp. with Insurance, Non-eligible Health care Employee Spouses and dependent children with insurance.
- In-Patient Services - Direct (Any tribe living anywhere), Limited to CRC only (Any tribe living in 9 counties), Limited to CRC/Choctaw Only (Living in 10 ½ counties), Non-Eligible Pregnant with an Eligible child up to 6 wks. post-partum (pregnancy related, Talihina only), Non-eligible spouse with insurance Talihina only, . Non- Eligible Health Care Employee & omission Corp. with Insurance, Non-eligible Health care Employee Spouses and dependent children with insurance.
- Laboratory - Direct (Any tribe living anywhere), Limited to CRC only (Any tribe living in 9 counties), Limited to CRC/Choctaw Only (Living in 10 ½ counties), Non-Eligible Pregnant with an Eligible child up to 6 wks. post-partum (pregnancy related, Talihina only), non-eligible spouse with insurance Talihina only, Non- Eligible Health Care Employee & omission Corp. with Insurance, Non-eligible Health care Employee Spouses and dependent children with insurance.
- MRI - CDIB holders, Direct (Any tribe living anywhere), Non- Eligible Health Care Employee & Commission Corp. with Insurance, Non-eligible Health care Employee Spouses and dependent children with insurance.
- Nutrition Therapy Counseling - CDIB holders, Direct (Any tribe living anywhere),. Non- Eligible Health Care Employee & omission Corp. (Bariatric) with Insurance.
- Nutrition Therapy Supplement - Limited to CRC only (Any tribe living in 9 counties
- OB - Direct (Any tribe living anywhere), Limited to CRC only (Any tribe living in 9 counties), Limited to CRC/Choctaw Only (Living in 10 ½ counties), Non-Eligible Pregnant with an Eligible child up to 6 wks. post-partum (pregnancy related, Talihina only), Non-eligible spouse with insurance Talihina only, . Non- Eligible Health Care Employee & omission Corp. with Insurance, Non-eligible Health care Employee Spouses and dependent children with insurance.
- OMT (osteopathic manipulation therapy) - CDIB holders, Direct (Any tribe living anywhere)
- Ophthalmology-Retinal - CDIB holders, Direct (Any tribe living anywhere)
- OR - Direct (Any tribe living anywhere), Limited to CRC only (Any tribe living in 9 counties), Limited to CRC/Choctaw Only (Living in 10 ½ counties), Non-Eligible Pregnant with an Eligible child up to 6 wks. post-partum (pregnancy related, Talihina only), non-eligible spouse with insurance Talihina only, Non- Eligible Health Care Employee & omission Corp. with Insurance, Non-eligible Health care Employee Spouses and dependent children with insurance.
- OT - CDIB holders, Direct (Any tribe living anywhere)
- Pediatric - Direct (Any tribe living anywhere), Limited to CRC only (Any tribe living in 9 counties), Limited to CRC/Choctaw Only (Living in 10 ½ counties), Non-Eligible Pregnant with an Eligible child up to 6 wks. post-partum (pregnancy related, Talihina only), non-eligible spouse with insurance Talihina only, Non- Eligible Health Care Employee & omission Corp. with Insurance, Non-eligible Health care Employee Spouses and dependent children with insurance.
- Pharmacy - CDIB holders, Direct (Any tribe living anywhere), Non-Eligible Pregnant with an Eligible child up to 6 wks. post-partum (pregnancy related, Talihina only)
- Physical Therapy - CDIB holders, Direct (Any tribe living anywhere), Non-Eligible Pregnant with an Eligible child up to 6 wks. post-partum (pregnancy related, Talihina only, Breast program), non-eligible spouse with insurance Talihina only, Non- Eligible Health Care Employee & omission Corp. with Insurance, Non-eligible Health care Employee Spouses and dependent children with insurance. Talihina only.
- Podiatry - All ages- CDIB holders, Direct (Any tribe living anywhere)
- Recovery Center - (Male)- CDIB holders, Direct (Any tribe living anywhere)
- Respiratory Therapy - Direct (Any tribe living anywhere), Limited to CRC only (Any tribe living in 9 counties), Limited to CRC/Choctaw Only (Living in 10 ½ counties), Non-Eligible Pregnant with an Eligible child up to 6 wks. post-partum (pregnancy related, Talihina only), non-eligible spouse with insurance Talihina only, Non- Eligible Health Care Employee & omission Corp. with Insurance, Non-eligible Health care Employee Spouses and dependent children with insurance.
- Social Service - Direct (Any tribe living anywhere), Limited to CRC only (Any tribe living in 9 counties), Limited to CRC/Choctaw Only (Living in 10 ½ counties), Non-Eligible Pregnant with an Eligible child up to 6 wks. post-partum (pregnancy related, Talihina only), non-eligible spouse with insurance Talihina only, Non- Eligible Health Care Employee & omission Corp. with Insurance, Non-eligible Health care Employee Spouses and dependent children with insurance.
- Specialty Transport - CDIB holders, Direct (Any tribe living anywhere)
- Speech Therapy - CDIB holders, Direct (Any tribe living anywhere)
- Surgery - Direct (Any tribe living anywhere), Limited to CRC only (Any tribe living in 9 counties), Limited to CRC/Choctaw Only (Living in 10 ½ counties), Non-Eligible Pregnant with an Eligible child up to 6 wks. post-partum (pregnancy related, Talihina only), non-eligible spouse with insurance Talihina only, Non- Eligible Health Care Employee & omission Corp. with Insurance, Non-eligible Health care Employee Spouses and dependent children with insurance.
- Talihina Community Clinic - Direct (Any tribe living anywhere), Limited to CRC only (Any tribe living in 9 counties), Limited to CRC/Choctaw Only (Living in 10 ½ counties), Non-Eligible Pregnant with an Eligible child up to 6 wks. post-partum (pregnancy related, Talihina only), non-eligible spouse with insurance Talihina only, Non- Eligible Health Care Employee & omission Corp. with Insurance, Non-eligible Health care Employee Spouses and dependent children with insurance.
- Women's Health - Direct (Any tribe living anywhere), Limited to CRC only (Any tribe living in 9 counties), Limited to CRC/Choctaw Only (Living in 10 ½ counties), Non-Eligible Pregnant with an Eligible child up to 6 wks. post-partum (pregnancy related, Talihina only), non-eligible spouse with insurance Talihina only, Non- Eligible Health Care Employee & omission Corp. with Insurance, Non-eligible Health care Employee Spouses and dependent children with insurance.
- Must reside within the Choctaw Nation Service Area
- Must be at least 15 years old or 10 years old if diabetic
- Must have a medical chart with a CNHSA health facility or:
- CDIB, letter of descendancy, or tribal membership card from a federally recognized tribe
- Social security card
- Photo identification card (driver's license)
- Current insurance information such as Medicare, Medicaid, or Private Insurance
- For children under 19 years of age, the following documents are required:
- Child's CDIB or a copy of either parent's CDIB
- State issued birth certificate or hospital birth record issued by an Indian Health Service or tribal facility
CNHSA Eligibility Guidelines
Revised April 2016 with updates February 2020, July 2020, November 2020, April 2021, April 2022. The Choctaw Nation Health Services Authority (CNHSA) will provide health care services at the Choctaw Nation Health Care Center, Talihina, and all field Clinics according to the following guidelines:
Please note: The eligibility guidelines change frequently. As the guidelines are updated, Leadership, Executive Medical Staff and Governing Board will be presented with a cover sheet of amendments. Annually, the eligibility guidelines will be presented to these respective committees for approval.
How to Apply
Schedule an appointment with a Choctaw Nation Family Practice doctor to determine if a sleep study is needed. Please call 918-567-7000 or 800-349-7026 for additional information.
Additional Information
Over 100 million Americans suffer from sleep disorders, yet very few people know the symptoms or the serious, potentially life-threatening dangers of some of these conditions. Beyond an occasional night when it is difficult to fall asleep, sleep disorders can affect health and well-being more than most people realize.