The Navajo Nation wants to become the 51st Medicaid state. The Affordable Care Act has allowed them to study the idea.

The Navajo Nation stretches across three states -- Arizona, New Mexico and Utah. According to some Navajo health officials that means their medical services, funds and policies become fragmented. So the tribe would like to be seen as a separate state when it comes to Medicaid reimbursements from the federal government.

Eric Henley is the Chief Medical Officer for North Country HealthCare in Flagstaff. They serve a lot of Medicaid and uninsured patients, many of them Navajo. Henley says taking on the bureaucratic burdens of Medicaid paperwork is not easy.

"It’s complicated," Henley said. "You have to manage the money, decide what codes. You have to pay bills based on certain codes. You have to negotiate rates. You know not a walk in the park."

The tribe is finalizing its Medicaid feasibility study. It goes to Congress for approval in March.