---
kind: "section"
citation: "25 U.S.C. § 1680c"
title: "25"
title_heading: "Indians"
number: "1680c"
heading: "Health services for ineligible persons"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/25/1680c"
units:
  - "Chapter 18 — Indian Health Care"
  - "Subchapter VI — Miscellaneous"
---

# §1680c. Health services for ineligible persons

- (a) **Children—** Any individual who—
  - (1) has not attained 19 years of age;
  - (2) is the natural or adopted child, stepchild, foster child, legal ward, or orphan of an eligible [Indian](/usc/25/1603.md?p=13); and
  - (3) is not otherwise eligible for health [services](/usc/25/1603.md?p=18) provided by the [Service](/usc/25/1603.md?p=18),

  shall be eligible for all health [services](/usc/25/1603.md?p=18) provided by the [Service](/usc/25/1603.md?p=18) on the same basis and subject to the same rules that apply to eligible [Indians](/usc/25/1603.md?p=13) until such individual attains 19 years of age. The existing and potential health needs of all such individuals shall be taken into consideration by the [Service](/usc/25/1603.md?p=18) in determining the need for, or the allocation of, the health resources of the [Service](/usc/25/1603.md?p=18). If such an individual has been determined to be legally incompetent prior to attaining 19 years of age, such individual shall remain eligible for such [services](/usc/25/1603.md?p=18) until 1 year after the date of a determination of competency.

- (b) **Spouses—** Any spouse of an eligible [Indian](/usc/25/1603.md?p=13) who is not an [Indian](/usc/25/1603.md?p=13), or who is of [Indian](/usc/25/1603.md?p=13) descent but is not otherwise eligible for the health [services](/usc/25/1603.md?p=18) provided by the [Service](/usc/25/1603.md?p=18), shall be eligible for such health [services](/usc/25/1603.md?p=18) if all such spouses or spouses who are married to members of each [Indian tribe](/usc/25/1603.md?p=14) being served are made eligible, as a class, by an appropriate resolution of the governing body of the [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) providing such [services](/usc/25/1603.md?p=18). The health needs of persons made eligible under this paragraph shall not be taken into consideration by the [Service](/usc/25/1603.md?p=18) in determining the need for, or allocation of, its health resources.
- (c) **Health facilities providing health services—**
  - (1) **In general—** The [Secretary](/usc/25/1603.md?p=17) is authorized to provide health [services](/usc/25/1603.md?p=18) under this subsection through health facilities operated directly by the [Service](/usc/25/1603.md?p=18) to individuals who reside within the [Service unit](/usc/25/1603.md?p=20) and who are not otherwise eligible for such health [services](/usc/25/1603.md?p=18) if—
    - (A) the [Indian tribes](/usc/25/1603.md?p=14) served by such [Service unit](/usc/25/1603.md?p=20) requests such provision of health [services](/usc/25/1603.md?p=18) to such individuals, and
    - (B) the [Secretary](/usc/25/1603.md?p=17) and the served [Indian tribes](/usc/25/1603.md?p=14) have jointly determined that the provision of such health [services](/usc/25/1603.md?p=18) will not result in a denial or diminution of health [services](/usc/25/1603.md?p=18) to eligible [Indians](/usc/25/1603.md?p=13).
  - (2) **ISDEAA programs—** In the case of health facilities operated under a contract or compact entered into under the [Indian](/usc/25/1603.md?p=13) Self-Determination and Education Assistance Act ([25 U.S.C. 450](/usc/25/450.md) et seq.),[^1] the governing body of the [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) providing health [services](/usc/25/1603.md?p=18) under such contract or compact is authorized to determine whether health [services](/usc/25/1603.md?p=18) should be provided under such contract or compact to individuals who are not eligible for such health [services](/usc/25/1603.md?p=18) under any other subsection of this section or under any other provision of law. In making such determinations, the governing body of the [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) shall take into account the consideration described in [paragraph (1)(B)](#c-1-B). Any [services](/usc/25/1603.md?p=18) provided by the [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) pursuant to a determination made under this subparagraph shall be deemed to be provided under the agreement entered into by the [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) under the [Indian](/usc/25/1603.md?p=13) Self-Determination and Education Assistance Act. The provisions of section 314 of Public Law 101–512 (104 Stat. 1959), as amended by section 308 of Public Law 103–138 (107 Stat. 1416), shall apply to any [services](/usc/25/1603.md?p=18) provided by the [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) pursuant to a determination made under this subparagraph.
  - (3) **Payment for services—**
    - (A) **In general—** Persons receiving health [services](/usc/25/1603.md?p=18) provided by the [Service](/usc/25/1603.md?p=18) under this subsection shall be liable for payment of such health [services](/usc/25/1603.md?p=18) under a schedule of charges prescribed by the [Secretary](/usc/25/1603.md?p=17) which, in the judgment of the [Secretary](/usc/25/1603.md?p=17), results in reimbursement in an amount not less than the actual cost of providing the health [services](/usc/25/1603.md?p=18). Notwithstanding [section 1621f of this title](/usc/25/1621f.md) or any other provision of law, amounts collected under this subsection, including Medicare, Medicaid, or children’s health insurance program reimbursements under titles XVIII, XIX, and XXI of the Social Security Act [[42 U.S.C. 1395](/usc/42/1395.md) et seq., 1396 et seq., 1397aa et seq.], shall be credited to the account of the program providing the [service](/usc/25/1603.md?p=18) and shall be used for the purposes listed in [section 1641(d)(2) of this title](/usc/25/1641.md?p=d-2) and amounts collected under this subsection shall be available for expenditure within such program.
    - (B) **Indigent people—** Health [services](/usc/25/1603.md?p=18) may be provided by the [Secretary](/usc/25/1603.md?p=17) through the [Service](/usc/25/1603.md?p=18) under this subsection to an indigent individual who would not be otherwise eligible for such health [services](/usc/25/1603.md?p=18) but for the provisions of [paragraph (1)](#c-1) only if an agreement has been entered into with a State or local government under which the State or local government agrees to reimburse the [Service](/usc/25/1603.md?p=18) for the expenses incurred by the [Service](/usc/25/1603.md?p=18) in providing such health [services](/usc/25/1603.md?p=18) to such indigent individual.
  - (4) **Revocation of consent for services—**
    - (A) **Single tribe service area—** In the case of a [Service Area](/usc/25/1603.md?p=19) which serves only 1 [Indian tribe](/usc/25/1603.md?p=14), the authority of the [Secretary](/usc/25/1603.md?p=17) to provide health [services](/usc/25/1603.md?p=18) under [paragraph (1)](#c-1) shall terminate at the end of the fiscal year succeeding the fiscal year in which the governing body of the [Indian tribe](/usc/25/1603.md?p=14) revokes its concurrence to the provision of such health [services](/usc/25/1603.md?p=18).
    - (B) **Multitribal service area—** In the case of a multitribal [Service Area](/usc/25/1603.md?p=19), the authority of the [Secretary](/usc/25/1603.md?p=17) to provide health [services](/usc/25/1603.md?p=18) under [paragraph (1)](#c-1) shall terminate at the end of the fiscal year succeeding the fiscal year in which at least 51 percent of the number of [Indian tribes](/usc/25/1603.md?p=14) in the [Service Area](/usc/25/1603.md?p=19) revoke their concurrence to the provisions of such health [services](/usc/25/1603.md?p=18).
- (d) **Other services—** The [Service](/usc/25/1603.md?p=18) may provide health [services](/usc/25/1603.md?p=18) under this subsection to individuals who are not eligible for health [services](/usc/25/1603.md?p=18) provided by the [Service](/usc/25/1603.md?p=18) under any other provision of law in order to—
  - (1) achieve stability in a medical emergency;
  - (2) prevent the spread of a communicable disease or otherwise deal with a public health hazard;
  - (3) provide care to non-[Indian](/usc/25/1603.md?p=13) women pregnant with an eligible [Indian](/usc/25/1603.md?p=13)’s child for the duration of the pregnancy through postpartum; or
  - (4) provide care to immediate family members of an eligible individual if such care is directly related to the treatment of the eligible individual.
- (e) **Hospital privileges for practitioners—**
  - (1) **In general—** Hospital privileges in health facilities operated and maintained by the [Service](/usc/25/1603.md?p=18) or operated under a contract or compact pursuant to the [Indian](/usc/25/1603.md?p=13) Self-Determination and Education Assistance Act ([25 U.S.C. 450](/usc/25/450.md) et seq.)[^1] may be extended to non-[Service](/usc/25/1603.md?p=18) health care practitioners who provide [services](/usc/25/1603.md?p=18) to individuals described in subsection [(a)](#a), [(b)](#b), [(c)](#c), or [(d)](#d). Such non-[Service](/usc/25/1603.md?p=18) health care practitioners may, as part of the privileging process, be designated as employees of the Federal Government for purposes of section 1346(b) and [chapter 171](/usc/28/chptVI/ch171.md) of title 28 (relating to Federal tort claims) only with respect to acts or omissions which occur in the course of providing [services](/usc/25/1603.md?p=18) to eligible individuals as a part of the conditions under which such hospital privileges are extended.
  - (2) **Definition—** For purposes of this subsection, the term “non-[Service](/usc/25/1603.md?p=18) health care practitioner” means a practitioner who is not—
    - (A) an employee of the [Service](/usc/25/1603.md?p=18); or
    - (B) an employee of an [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26) operating a contract or compact under the [Indian](/usc/25/1603.md?p=13) Self-Determination and Education Assistance Act ([25 U.S.C. 450](/usc/25/450.md) et seq.)[^1] or an individual who provides health care [services](/usc/25/1603.md?p=18) pursuant to a personal [services](/usc/25/1603.md?p=18) contract with such [Indian tribe](/usc/25/1603.md?p=14) or [tribal organization](/usc/25/1603.md?p=26).
- (f) **Eligible Indian—** For purposes of this section, the term “eligible [Indian](/usc/25/1603.md?p=13)” means any [Indian](/usc/25/1603.md?p=13) who is eligible for health [services](/usc/25/1603.md?p=18) provided by the [Service](/usc/25/1603.md?p=18) without regard to the provisions of this section.

## Footnotes

[^1]: See References in Text note below.

## Source credit

(Pub. L. 94–437, title VIII, § 813, formerly title VII, § 713, as added Pub. L. 100–713, title VII, § 707(a), Nov. 23, 1988, 102 Stat. 4829; renumbered title VIII, § 813, and amended Pub. L. 102–573, title VII, § 701(a), (b), title IX, § 902(8), Oct. 29, 1992, 106 Stat. 4572, 4592; Pub. L. 111–148, title X, § 10221(a), Mar. 23, 2010, 124 Stat. 935.)

## Notes

### Editorial Notes

### References in Text

The Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.), referred to in subsecs. (c)(2) and (e), is Pub. L. 93–638, Jan. 4, 1975, 88 Stat. 2203, which was classified principally to subchapter II (§ 450 et seq.) of chapter 14 of this title prior to editorial reclassification as chapter 46 (§ 5301 et seq.) of this title. For complete classification of this Act to the Code, see Short Title note set out under section 5301 of this title and Tables.

Section 314 of Public Law 101–512, referred to in subsec. (c)(2), is set out as a note under section 5321 of this title.

The Social Security Act, referred to in subsec. (c)(3)(A), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Titles XVIII, XIX, and XXI of the Act are classified generally to subchapters XVIII (§ 1395 et seq.), XIX (§ 1396 et seq.), and XXI (§ 1397aa et seq.), respectively, of chapter 7 of Title 42, The Public Health and Welfare. For complete classification of this Act to the Code, see section 1305 of Title 42 and Tables.

### Codification

Amendment by Pub. L. 111–148 is based on section 194 of title I of S. 1790, One Hundred Eleventh Congress, as reported by the Committee on Indian Affairs of the Senate in Dec. 2009, which was enacted into law by section 10221(a) of Pub. L. 111–148.

### Amendments

2010—Pub. L. 111–148 amended section generally. Prior to amendment, section related to health services for ineligible persons and consisted of subsecs. (a) to (e).

1992—Subsec. (b)(2)(A). Pub. L. 102–573, § 902(8), substituted “section 1642(a) of this title” for “section 402(c) of this Act”.