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BUDGET PLANNING WITH TRIBES

ISSUE

The annual budget request of the Indian Health Service (IHS), an agency in the Department of Health and Human Services (HHS), is the result of a budget formulation and consultation process that involves IHS and tribal Indian health program representatives and providers from the local to the national level. This process ensures that the budget is relevant to the health needs and priorities of American Indian and Alaska Native (AI/AN) people.

BACKGROUND

The IHS budget request is improved and strengthened with the participation of tribal leaders and health program representatives in its development. The process begins at the local level, where budget priorities are established based on the health priorities of the local community. The tribal leadership and program staff of the 12 IHS Areas (regions) develop and submit budget recommendations for an agency budget request for a given fiscal year, which are consolidated into a national set of budget and health priorities by representatives from each of the 12 IHS Areas. These priorities are presented to HHS by representatives of the tribal budget workgroup. The tribal priorities are instrumental in informing senior officials of other HHS agencies of the health needs of the AI/AN population so that they have the opportunity to include those priorities in their individual budget requests to HHS.

SITUATION

The IHS and Tribes evaluate the budget formulation process to ensure it remains relevant and effective. As a result, the process is steadily improving and is responsive to changes in tribal leadership and IHS and tribal emerging and shifting health priorities. The IHS and Tribes have identified two items for focused attention:

• The tribal partners in the development of the budget request are not directly involved in the budget process once the request is submitted to HHS and the Office of Management and Budget. Because of the government-to-government relationship with Tribes and the established consultation policies of the IHS and HHS, it would be a reasonable business practice to have tribal leadership involved throughout the budget formulation decision-making process.

• The tribal leadership is requesting an exemption from rescissions. Between FY 2003 and FY 2009 the IHS appropriation has been subject to rescissions amounting to $196 million. Given the unique mission of the IHS as a direct service provider in comparison to other HHS agencies, a funding rescission to IHS translates into a reduction of health care services for American Indians and Alaska Natives. Medicare and Medicaid were not subject to such rescissions.

OPTIONS/PLANS

The IHS will continue to refine the budget formulation process.

ADDITIONAL INFORMATION

For referral to the appropriate spokesperson, contact the IHS Public Affairs Staff at 301-443-3593.

June 2009