Federal healthcare programs Policy Term Definition

Any plan or program that provides health benefits, whether directly, through insurance, or otherwise, which is funded directly, in whole or part, by the United States Government (other than the health insurance program under Chapter 89 of Title 5 of the United Sates Code – the Federal Employees Health Benefit Program); or any state healthcare program, as defined in 42 U.S.C 1320a-7(h).

Federal healthcare programs include, at a minimum, the following:

  • Medicare Program, Parts A & B (Title XVIII of the Social Security Act); (but not Medicare managed care plans)
  • Medicaid (Title XIX of the Social Security Act); (but not Medicaid managed care plans)
  • Federal Prison Hospitals (prisoners);
  • Indian Health Service;
  • OWCP (workers’ compensation for federal employees);
  • Public Health Service;
  • Railroad Retirement Board;
  • The Black Lung Program;
  • TRICARE/CHAMPUS/Department of Defense healthcare programs (Chapter 55 of Title 10, United States Code); and
  • Veterans Administration (VA).