BATON ROUGE – New Medicaid rules requiring recipients to work and reverify coverage every six months will disproportionately affect the 85% of Native Americans living in Louisiana, tribal leaders and Indigenous experts say.

While the 4,000 Native Americans belonging to four tribes officially recognized by the federal government under longstanding covenants are not affected by the new Medicaid rules, roughly 24,000 members of 11 state-recognized tribes will be subject to the new regulations.

“Instead of investing the time and the energy to think of more efficient and impactful ways to create the infrastructure around the problem, the common decision has just been to run away from the problem,” said Devon Parfait, chief of the state-recognized Grand Cayou Dulac tribe.

The four federally recognized Native American tribes in Louisiana, which will be exempt from the new work requirements and more frequent reenrollment rules, are the Chitimacha Tribe of Louisiana (based in Charenton), the Coushatta Tribe of Louisiana (Elton/Kinder), the Jena Band of Choctaw Indians (Jena), and the Tunica-Biloxi Indian Tribe of Louisiana (Marksville).

Federal recognition indicates that the U.S. government acknowledges the tribe as a sovereign nation, meaning the tribe has the right to govern itself under its own laws and access federal funding and resources not available to state-recognized counterparts.

State-recognized Native American tribes in Louisiana lack the established federal relationship with the government and the benefits it provides.

“You (only) get state recognition, and even that's hard to come by,” said Shirrell Parfait-Dardar, a tribal elder from the state-recognized Grand Cayou Dulac tribe. “And, even when they get it to you, it's a mess."

Federal status is granted only to tribes that can prove continuous political authority and historical presence in an area. This is a lengthy process that many tribes in Louisiana have attempted for decades, but without success. Only 11 other states, including Alabama, have state-recognized tribes.

To be considered an American Indian for the purpose of federal law, a person must be enrolled in a federally recognized tribe. State recognition, while meaningful within Louisiana, does not coincide with sovereignty or federal rights. That means that state tribes are ineligible for the more robust healthcare protections given to the federal tribes.

Federally recognized tribes are exempt from the Medicaid cuts because Alaska Sen. Lisa Murkowski pushed to protect the tribal health care systems. She would not vote for the One Big Beautiful Bill Act, which contained the Medicaid changes, without protecting the 227 federal tribes within her state. There are no state tribes in Alaska.

Murkowski and other tribal leaders argued that the changes would violate federal treaty obligations and harm the communities that rely so heavily on Medicaid to fill in the gaps of the Indian Health Service funding.

Where are the Indian Health Service locations in Louisiana?
According to Indian Health Services, Louisiana relies on the tribally operated health programs on the four tribal lands that provide for the immediate care of its members. The four programs differ in the types of services they offer and to whom they offer services.

Since these programs are located inside tribal lands that are long distances from coastal Native American communities, access may be difficult, leaders say. For example, all of the state tribes located in Lafourche Parish would have to drive to Charenton to receive care from the Chitimacha Health Clinic, the closest center, 98 minutes away.

Parfait-Dardar, tribal elder of the Grand Cayou Dulac tribe, said state tribes have access to the four Indian Health Service centers, but that the process is “just as complicated as Medicaid.”

At-risk communities without a safety net
Under the new Medicaid rules, adults must meet new work requirements and reverify coverage every six months instead of yearly. That may winnow the Medicaid rolls, but the new rules may force state-recognized tribes to carry the full burden of these cuts, despite a documented history of health disparities.

Around 60% of all Native Americans in Louisiana – both state-recognized and federal – rely on Medicaid, according to the National Council of Urban Indian Health. By contrast, about one-third of the state’s overall population uses Medicaid.

Losing Medicaid can mean losing access entirely. Private insurance rates can be unaffordable for many in these communities, considering many are on a fixed income and are elderly.

“That $400 a month can turn into several thousand depending on the costs,” said Chief Parfait.“People are just going to go without health care. Instead of going to the doctor and getting their needs met early, it festers into a much worse problem that costs even more later.”

Ongoing health issues will increase
Chronic diseases, including diabetes, liver disease and heart disease, are significantly higher in Native American populations.

Robert Caldwell, a professor of Indigenous Studies at the University at Buffalo and a member of the Choctaw Apache community of Ybarb, said state-recognized tribes face significant poverty challenges.

“Those challenges are amplified because the state-recognized tribes often can't access direct aid because of their lack of federal recognition,” Caldwell said.

Without federal protections, tribal leaders say families will face almost impossible budgetary decisions.

"It's going to be either food or insurance, and I’m picking food,” tribal elder Parfait-Dardar said.

What do their lives look like right now?
With many state tribes in Louisiana living in coastal areas, they face unique issues in contrast to their federal counterparts.

Many of the federal tribes remain inland, away from the coast and are less likely to be forced to move to other areas due to hurricanes and land loss.

Many state tribes have been pushed down to the bayou, where they are forced to fortify their roofs or elevate their houses, if they have the choice.

“We have homes that are still on the ground, like mine,” tribal elder Parfait-Dardar said. “There is no way that I could afford to have it elevated.”

With homes on the ground and medical clinics miles away, these communities are at risk of being washed away.

What health services do they use right now?
Louisiana’s state-recognized tribes, many located in Terrebonne, Lafourche and St. Mary parishes, live in some of the state's highest poverty areas. The roads flood constantly, their houses are exposed to every hurricane, and their clinics are typically understaffed – if they exist at all, experts say.

“So, we typically rely on rural health clinics,” Caldwell, the University of Buffalo professor, said. “In that way, we are more similar to other impoverished communities of color than federally recognized tribes.”

What happens now?
For now, Louisiana state-recognized tribes are preparing for a wave of disenrollment that may reshape the health of their communities for years.

The path forward would require the unity of both state and federal tribes to fight for access to all.