Health Governance for Tribal Health Systems

In 1975, Congress passed the Indian Self-Determination and Education Assistance Act (P.L. 93-638). It was a significant law, which affects the provision of health services to the American Indian and Alaska Native (AI/AN) tribes.

The Act authorized tribes to assume the management and control of health care programs from Indian Health Service (IHS) and to increase flexibility in health care program development and services for communities.

The Act grants tribes the option to contract, then compact with IHS to deliver health services using pre-existing IHS resources, third party reimbursements, grants, and other sources.

Today, tribal health systems operating under the Self-Determination Act provide greater and expanded services to their community, and as a result are eligible for grants and other types of funding not available to federal agencies like IHS.

Due to the increased participation under ISDEAA, “638 Tribal Health Systems” are able to provide more services in their communities than they were able to under IHS control.


Advantages of Self-Determination of Health Care at the Local Level

Health care delivery systems that fall under the Self-Governance category, tribes manage their hospitals and clinics through compacting permitted under ISDEAA.

Tribal Health Systems on the Navajo Nation engage in 638 contracting or compacting permitted under the Indian Self-Determination Act of 1975. Tribal health facilities that choose to have IHS manage the hospitals and clinics, however may manage some other components of their health system. For example, a Tribal Health Program can contract for the management of Community Health Representative program funds, alcohol and substance abuse prevention and treatment funds, emergency medical services and other programs that are not directly managed under the hospital or clinic organizational chart.

A tribe’s choice to have IHS manage its health care programs is a form of self-determination and an expression of the tribe’s sovereign right to make this decision. However, self-determination under 638 contracting or compacting has several advantages, including the following: eligibility for grants, contract support costs, more local control, and ability to lobby without restrictions.

  • Increase flexibility in health care program development
  • Eligibility for Grants
  • Contract Support Costs
  • More Local Control
  • Ability to Lobby