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TRIBAL SELF-DETERMINATION
ISSUE
Under Self-Determination, Tribes have three options for receiving their health care: (1) directly from the Indian Health Service (IHS), (2) through contracting with the IHS to have the administrative control, operation, and funding for health programs transferred to American Indian and Alaska Native tribal governments, or (3) through compacting with the IHS and assuming even greater control and autonomy for the provision of their own health care services.
BACKGROUND
President Nixon was instrumental in promoting the policy and legislation for Tribal Self-Determination, and in 1975, President Ford signed into law the Indian Self-Determination and Education Assistance Act (ISDEAA), P.L. 93-638. This landmark legislation recognized the primacy of the government-to-government relationship between the United States and sovereign Tribal Nations. The Act provides Tribes with the option of either assuming from the IHS the administration and operation of health services and programs in their communities (Title I, Title V) or remaining within the IHS-administered direct care health system. Subsequent amendments to the ISDEAA have only strengthened the federal policy of Self-Determination for Indian people. In 1992, the ISDEAA was further amended to authorize a Tribal Self-Governance Demonstration Project in the IHS, which enabled selected Tribes to explore Self- Governance management and health-delivery initiatives. In 1996, tribal leaders and representatives participated with federal agencies in a negotiated rulemaking process that resulted in a Final Rule to implement the 1988 and 1994 amendments (Title I) to the ISDEAA. On August 18, 2000, the ISDEAA was amended by P.L. 106-260, which provided for further self-governance by Indian Tribes. This authorized a permanent Tribal-Self-Governance Program (TSGP) in the IHS and required that implementing regulations be developed through a negotiated rulemaking process. On May 17, 2002, the Federal Register promulgated the Tribal Self-Governance Amendments of 2000 Final Rule to implement amendments (Title V) to the ISDEAA.
SITUATION
At present, over 54% of the IHS budget authority appropriation is administered by Tribes under the authority of the ISDEAA, as amended. The TSGP alone accounts for 32% of the IHS budget, which provides for 38% of total IHS users. Each year, additional IHS programs are assumed by Tribes under the authority of this Act.
As of December of 2007, a total of 73 government-to-government Compacts encompassing 94 Funding Agreements have been negotiated. This represents 323 Tribes participating in the TSGP, or 57% of federally recognized Tribes that are compacted with the United States through the Indian Health Service under Self-Governance authority.
OPTIONS/PLANS
The IHS will continue to support and promote tribal self-determination.
ADDITIONAL INFORMATION
For referral to the appropriate spokesperson, contact the IHS Public Affairs Staff at 301-443-3593.
January 2008