Established in 1954, the Indian Health Services (IHS), an agency within the Department of Health and Human Services (DHHS), is responsible for providing healthcare to American Indian / Alaskan Native (AI/AN) peoples in the United States. While all eligible AI/AN may receive health care at any of the IHS operated federal facilities within the network of hospitals and clinics, some federally recognized tribes also operate independent hospitals and clinics for their members.
Tribes / Tribal Organizations can choose to evoke Self-Governance and take control over the management of specific federal programs identified as part of the Indian Self-Determination and Education Assistance Act (ISDEAA). Examples include education programs, natural resource management programs, healthcare programs, etc. Self-Governance increases a tribe’s control over specific resource allocation and better aligns those resources with tribal goals. The process to be recognized as Self-Governing and receive the correlating federal funds resources involves a formal application to the relevant federal agency, negotiation of the programs to be transferred including accountability mechanisms such as mutually agreed benchmarks, formal execution of the Self-Governance Compact, and ongoing monitoring from the federal agency. To date, it is estimated at least 50% of all federally recognized tribes participate in at least one Self-Governance Compact.
For healthcare programs, tribal representatives negotiate directly with IHS representatives about the scope of services the tribe would like to directly manage. Self-Governance Compacts are intentionally flexible and unique to each tribe. The Self-Governance Compacts allow the tribe to make the best healthcare service choices for their members. Within the agreement, tribes specify healthcare delivery methods for their members including choosing to continue utilization of IHS facilities, establishing their own facilities to provide direct healthcare services, or varying combinations of these two options. Tribes may also choose only to on-board specific programs highly relevant to their community members such as diabetes care, mental health services, nursing care, etc.
Part of the Self-Governance Compact includes a delineation on the allocation of federal funds the Tribe will receive. IHS is required to provide the same amount of funding to the tribe that IHS would require if it provided similar healthcare services. After the Supreme Court’s decision in 2024, IHS now must also provide federal funds to cover the costs associated with the tribe’s administration of its healthcare programs as well. The removal of this financial burden and the receipt of these funds may spur additional tribes to consider Self-Governance Compacts for healthcare programs.
The IHS network of hospitals and clinics serves an essential purpose to the AI/NA community. Further collaboration with tribally-controlled healthcare facilities and/or programs creates a more comprehensive healthcare landscape and better set of services to this community. Because of the wide range of flexible engagement models between IHS and the tribal communities, pharmaceutical and medical device manufactures often find this healthcare system disjointed or fragmented. However, there is close operating unity between IHS and tribes choosing Self-Governance. Understanding how a specific product fits within this landscape through the acquisition of relevant data and market research will best ensure a return on this market.