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TRIBAL SELF-GOVERNANCE

ISSUE

Indian Tribes obtain health care for their members from the federal government through direct services, contracts, or compacts. Specifically, Tribes can choose to: (1) receive health care services directly from the Indian Health Service (IHS), (2) contract with the IHS to assume control over administration and funding for individual programs and services the IHS would otherwise provide (referred to as “Self-Determination Contracts”), or (3) compact with the IHS to assume control over health care programs the IHS would otherwise provide (referred to as “Self-Governance Compacts”). Self-Governance affords Tribes the most flexibility to tailor health care services to the needs of their communities.

BACKGROUND

In 1975, President Ford signed into law the Indian Self-Determination and Education Assistance Act (ISDEAA) (Public Law 93-638). This landmark legislation recognizes the primacy of the government-to-government relationship between the United States and Indian Tribes and the importance of Indian Tribes exercising decision-making authority over their own affairs. Subsequent amendments to the ISDEAA strengthened the federal policy of Tribal Self-Determination and led the way towards Self-Governance. In 1992, Congress amended the ISDEAA to authorize a Tribal Self-Governance Demonstration Project within the IHS, which enabled a small group of Tribes to enter into Self-Governance Compacts with the IHS and gain more autonomy in the management and delivery of tribal health care programs. In 2000, Congress passed P.L. 106-260, the Tribal Self-Governance Amendments of 2000, authorizing a permanent Tribal-Self-Governance program in the IHS under Title V of the ISDEAA. On May 17, 2002, the Department of Health and Human Services promulgated its final regulations to implement Title V.

SITUATION

As of February 2009, the IHS has negotiated a total of 75 Self-Governance Compacts and 96 funding agreements with Indian tribal governments and tribal organizations.  Currently, 328 Tribes participate in these 75 compacts with the IHS.  The Tribes involved in Self-Governance represent 58% of the 562 federally-recognized Indian Tribes in the United States today.

Self-Governance Tribes currently control nearly $1.15 billion of the IHS budget of approximately $3.58 billion, or about 32% of the total IHS FY 2009 budget appropriation.  Tribal Self-Governance programs served 550,646 of the 1,483,423 users (37%) of Indian health care programs in 2008.  Each year, Tribes assume additional IHS programs under the authority of Title V of the ISDEAA.

OPTIONS/PLANS

The IHS will continue to support and promote Tribal Self-Governance.

ADDITIONAL INFORMATION

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

January 2009