The Medicaid and CHIP Payment and Access Commission (MACPAC) is a nonpartisan agency in the legislative branch that analyzes policy and makes recommendations to federal and state-level policymakers. In this report, MACPAC provides an overview of the federal government’s role in providing health care to American Indians and Alaska Natives (AI/AN), including the structure of the Indian Health Service and the special Medicaid rules and protections that apply to AI/AN beneficiaries and Indian health providers.