Putting Native Vets to Work, IHS Launches Veterans Hiring Initiative



Indian Health Service Release


The Indian Health Service (IHS) has launched a Veterans Hiring Initiative with the goal of increasing veteran new hires from 6 percent to 9 percent over the next two years. Veterans hired by the agency would increase by 50 percent with this initiative.

The IHS will recruit veterans by setting hiring goals, engaging in active outreach, and using existing and new partnerships to create additional career opportunities. Earlier this year, the IHS and the Department of Veterans Affairs (VA) signed a Memorandum of Understanding to assist veterans in finding employment and help achieve President Obama’s National Strategy to Hire More Veterans.

As part of its Veterans Hiring Initiative, the IHS will collaborate with the VA on federal recruitment events targeting veterans. Additionally, the IHS will partner with the Department of Defense on recruitment of separating active duty service members through the Transition Assistance Program and through marketing and media outreach campaigns. The IHS will also partner with tribes in recruitment outreach efforts targeted at tribal members who are active duty or veterans. Finally, the IHS is developing its own nationwide public service announcement radio and print campaign customized to markets with large populations of military personnel.

RELATED: Veteran Affairs Expanding Access and Visibility for Native Vets

The agency website will be updated with more resources and information for veteran candidates, and the IHS will post recruitment information on the Native American Veterans website hosted by the VA. The IHS will also be interviewing veterans who have successfully transitioned from the military to the IHS or tribal positions and post these stories on IHS and partner organization websites.

The IHS, an agency in the U.S. Department of Health and Human Services, provides a comprehensive health service delivery system for approximately 2.1 million American Indians and Alaska Natives who are members of federally recognized tribes.


Read more at http://indiancountrytodaymedianetwork.com/2014/07/01/putting-native-vets-work-ihs-launches-veterans-hiring-initiative-155585

Cherokee veterans gain care options

New agreement links tribal service to VA health system

By Anita Reding, Muskogee Phoenix Staff Writer

Cherokee Nation Secretary of State Chuck Hoskin Jr., left, and Principal Chief Bill John Baker sign the reimbursement agreement Friday. Next to Baker is James Floyd, the director of the Jack C. Montgomery VA Medical Center. Watching from behind are Gayla Stewart, left, the victim witness coordinator for the regional U.S. Attorney’s Office; Dr. Ricky Robinson, the director of the Cherokee Veterans Center; Vickie Hanvey, the Cherokee Nation self-governance administrator; Jacque Secondine Hensley, the Native American liaison for Gov. Mary Fallin; Connie Davis, the executive director of Cherokee Nation Health Services; Tribal Council Speaker Tina Glory-Jordan; Deputy Chief S. Joe Crittenden; and John Alley and Bunner Gray, Indian health liaisons for the VA center.

Cherokee Nation Secretary of State Chuck Hoskin Jr., left, and Principal Chief Bill John Baker sign the reimbursement agreement Friday. Next to Baker is James Floyd, the director of the Jack C. Montgomery VA Medical Center. Watching from behind are Gayla Stewart, left, the victim witness coordinator for the regional U.S. Attorney’s Office; Dr. Ricky Robinson, the director of the Cherokee Veterans Center; Vickie Hanvey, the Cherokee Nation self-governance administrator; Jacque Secondine Hensley, the Native American liaison for Gov. Mary Fallin; Connie Davis, the executive director of Cherokee Nation Health Services; Tribal Council Speaker Tina Glory-Jordan; Deputy Chief S. Joe Crittenden; and John Alley and Bunner Gray, Indian health liaisons for the VA center.

TAHLEQUAH — Veterans who are members of the Cherokee Nation can now choose from several locations to receive health care.

Cherokee Nation Principal Chief Bill John Baker signed a reimbursement agreement with the U.S. Department of Veterans Affairs on Friday.

The Cherokee Nation is one of several tribes that have contracts with the VA, said James Floyd, director of the Jack C. Montgomery VA Medical Center in Muskogee.

The contract allows the tribe to be reimbursed by the VA for services rendered to Native American veterans using Cherokee Nation health centers for primary care. The contract also allows the Cherokee Nation and the VA to share patient information and charts. The VA will provide medication for veterans.

Now that the contract has been signed with the Cherokee Nation, veterans’ care can be tied to the VA system, Floyd said.

The contract will make it possible for veterans with the Cherokee Nation to receive vital services and not have to travel as far as they have been, said Baker.

“I think it’s a win, win, win for the veterans, for the Cherokee Nation and for the VA hospital,” Baker said.

The agreement with the Cherokee Nation provides health care at W.W. Hastings Hospital and eight clinics. The Cherokee Nation also is planning to build a hospital in Bartlesville, Baker said.

The initial users who can benefit from the contract total 4,500, and that number could easily increase by 1,000, Floyd said.

There are 37,000 users at the Muskogee medical center, and Native Americans are the second highest population group, he said.

“This helps us to grow as a system and to grow from within the tribe as well,” Floyd said.

Some veterans who are members of the Cherokee Nation have not used services at the VA, and this offers them an opportunity to be a part of the VA, he said.

“We are excited to partner with the Cherokee Nation in providing health care to our American Indian veterans,” Floyd said. “This agreement will allow for better coordination of care, allows tribes and IHS (Indian Health Service) to expand care for their users, shortens wait times for medical care and increases access at VA facilities for all veterans.”

Debra Wilson of Briggs is a member of an advisory committee with the VA. Many Native American veterans will be more comfortable receiving medical care at Cherokee Nation facilities, she said.

“This is something we have looked forward to for a really long time,” said Wilson, one of several veterans who witnessed the signing of the agreement.

Don Stroud of Tahlequah said he uses the Cherokee Nation Health System, and the funding that will be provided by the contract will benefit the veterans initially, “but it’s also going to impact the care that’s available for all the patients in the health system.”

“The less money spent on us, the more money available to treat that next little kid that comes in and needs the care, or the next one of our elders that comes in and needs some medication,” he said.

The funds will be there to help them because another source of funding will be available, which will equal things out, he said.

Tribes and federal government begin settling decades-long contract disputes


Norma Thomas, a resident of Owyhee on the Duck Valley Indian Reservation, talks with David Simons, a doctor at the Shoshone-Paiute Tribes Owyhee Community Health Facility in Nevada on Nov. 25, 2013. (Darin Oswald for The Washington Post)

Norma Thomas, a resident of Owyhee on the Duck Valley Indian Reservation, talks with David Simons, a doctor at the Shoshone-Paiute Tribes Owyhee Community Health Facility in Nevada on Nov. 25, 2013. (Darin Oswald for The Washington Post)

By Kimberly Kindy

The Washington Post May 1, 2014

After decades of underfunding hundreds of contracts with Native Americans, the federal government over the past several months has reached settlement agreements on 146 claims, totalling $275 million, government records show.

The settlements for health and social service contracts represent about 10 percent of all outstanding tribal claims with the federal Indian Health Service. The unpaid contract expenses were the subject of two U.S. Supreme Court rulings, the latest in June 2012, in which both IHS and the Bureau of Indian Affairs (BIA) were ordered to pay outstanding claims on the self-determination contracts.

The disputed contracts have their origins in the 1975 Indian Self-Determination Act, which gives tribes the option of receiving federal funding to run their own education, public safety and health-care programs. Those services — which were promised in perpetuity in tribal treaties — historically were delivered by the IHS and BIA.

The unpaid claims are for “contract support costs,” which include travel expenses, legal and accounting fees, insurance costs and workers’ compensation fees. Such costs typically account for between 10 to 20 percent of the value of a contract.

“The federal government has a trust responsibility to provide health care for this nation’s First Peoples and it’s about time it steps up to pay legal and contractual obligations to those tribes that choose to take over this responsibility through self-governance contracts and compacts,” Sen. Mark Begich (D-Alaska) said in a prepared statement.

Through letters and public hearings, Begich and several other members of Congress have pressured IHS and BIA to resolve past unpaid claims since the last Supreme Court ruling nearly two years ago.

IHS is working through thousands of disputed claims in more than 200 lawsuits filed by tribes, which are being individually negotiated. BIA is dealing with a single class-action lawsuit, which includes unpaid claims for hundreds of tribes, which has not yet been resolved.

The largest IHS settlement of $96 million went to Southcentral Foundation in Anchorage. The organization operates several health-care facilities, including a portion of the Alaska Native Medical Center, and serves more than 60,000 Alaska Natives and American Indians.

Llloyd Miller, an attorney in the Supreme Court cases, who is also representing 55 tribes in the settlement talks, said progress is being made, but at the current pace it would take IHS another three years to resolve all outstanding claims.

“It’s an enormous breakthrough because, over the past two years, little in the way of settlements have been achieved,” Miller said. “The challenge for the agency is to resolve the remaining 90 percent in a coherent time frame.”

In February, both agencies committed for the first time in decades to fully fund the self-determination contracts in their 2014 revised budgets. The revisions followed a Washington Post article in December that detailed the administration’s plans to impose spending caps on the contracts, despite two U.S. Supreme Court rulings ordering the government to fully compensate the tribes.

Federal contractors have carefully monitored the case because they worried that if federal agencies were able to not pay contract support costs for tribes, it could set a dangerous precedent for non-tribal service contracts with federal agencies.

In a friend-of-the-court brief to the Supreme Court in 2012, the U.S. Chamber of Commerce said: “The government’s position would have the effect of making contracts illusory by giving it a broad right to refuse payment at the stated price for services rendered.”

Advocates vow to revive Navajo junk-food tax

By Felicia Fonseca, Associated Press

FLAGSTAFF, Ariz. (AP) – Facing a high prevalence of diabetes, many American Indian tribes are returning to their roots with community and home gardens, cooking classes that incorporate traditional foods, and running programs to encourage healthy lifestyles.

The latest effort on the Navajo Nation, the country’s largest reservation, is to use the tax system to spur people to ditch junk food.

A proposed 2 percent sales tax on chips, cookies and sodas failed Tuesday in a Tribal Council vote. But the measure still has widespread support, and advocates plan to revive it, with the hope of making the tribe one of the first governments to enact a junk-food tax.

Elected officials across the U.S. have taken aim at sugary drinks with proposed bans, size limits, tax hikes and warning labels, though their efforts have not gained widespread traction. In Mexico, lawmakers approved a junk food tax and a tax on soft drinks last year as part of that government’s campaign to fight obesity.

Navajo President Ben Shelly earlier this year vetoed measures to establish a junk-food tax and eliminate the tax on fresh fruit and vegetables. At Tuesday’s meeting, tribal lawmakers overturned the veto on the tax cut, but a vote to secure the junk-food tax fell short. Lawmakers voted 13-7 in favor of it, but the tax needed 16 votes to pass.

The Dine Community Advocacy Alliance, which led the effort, said it plans to revise the proposal and bring it before lawmakers again during the summer legislative session.

“We’re going to keep moving on it,’’ group member Gloria Begay said. “It’s not so much the tax money – it’s the message. The message being, ‘Let’s look at our health and make healthier choices.’ We have to go out and do more education awareness.’’

Shelly said he supports the proposal’s intent but questioned how the higher tax on snacks high in fat, sugar and salt would be enacted and regulated. Supporters say the tax is another tool in their fight for the health of the people.

“If we can encourage our people to make healthier choices and work on the prevention side, we increase the life span of our children, we improve their quality of life,’’ said professional golfer Notah Begay III, who is among supporters.

American Indians and Alaska Natives as a whole have the highest age-adjusted prevalence of diabetes among U.S. racial and ethnic groups, according to the American Diabetes Association. They are more than twice as likely as non-Hispanic whites to have the disease that was the fourth leading cause of death in the Navajo area from 2003 to 2005, according to the Indian Health Service.

Native children ages 10 to 19 are nine times as likely to be diagnosed with Type 2 diabetes, the IHS said.

The proposed Navajo Nation tax wouldn’t have added significantly to the price of junk food, but buying food on the reservation presents obstacles that don’t exist in most of urban America. The reservation is a vast 27,000 square miles with few grocery stores and a population with an unemployment rate of around 50 percent. Thousands of people live without electricity and have no way of storing perishable food items for too long.

“They have a tendency to purchase what’s available, and it’s not always the best food,’’ said Leslie Wheelock, director of tribal relations for the U.S. Department of Agriculture.

Wheelock said the diabetes issue in tribal communities is one that has been overlooked in the past or not taken as seriously as it could be. It has roots in the federal government taking over American Indian lands and introducing food that tribal members weren’t used to, she said.

To help remedy that, the USDA runs a program that distributes nutritional food to 276 tribes. Grants from the agency have gone toward gardening lessons for children within the Seneca Nation of Indians in New York, culturally relevant exercise programs for the Spirit Lake Tribe in North Dakota and food demonstrations using fresh fruit and vegetables on the Zuni reservations in New Mexico.

The Dine Community Advocacy Alliance estimated a junk-food tax would result in at least $1 million a year in revenue that could go toward wellness centers, community parks, walking trails and picnic grounds in Navajo communities in Utah, New Mexico and Arizona. It would have expired at the end of 2018.

No other sales tax on the Navajo Nation specifically targets the spending habits of consumers. Alcohol is sold in a few places on the reservation but isn’t taxed. Retailers and distributors pay a tobacco tax.

Opponents of the junk food tax argued it would burden customers and drive revenue off the reservation. Mike Gardner, executive director of the Arizona Beverage Association, said the lack of specifics in the legislation as to what exactly would be taxed could mean fruit juice and nutritional shakes could be lumped in the same category as sodas.

“I don’t think they mean that, but that’s what will happen,’’ Gardner said. “It’s a little loose, a little vague. It’s going to create problems for retailers and … it doesn’t solve the problem.’’

Are you exempt from the Affordable Care Act because you are a citizen of a federally recognized tribe?


February 10 2014

Written by LCDR Amy Eden, Muscogee (Creek) Nation, Department of Health


The Affordable Health Care Act Health Care Coverage for the American Indian and Alaska Native

OKMULGEE, Okla. – Health Insurance coverage has not always been a familiar term within Indian Health Country.  The unfamiliarity could be linked back to treaties made in 1787 between federally recognized Tribes and the United States Government.  The treaties obligated the United States Government to provide health care services to Tribal members at no cost to the patient, in exchange for land that belonged to the Tribes.  Due to this obligation, there was no apparent reason for an American Indian or Alaska Native to purchase any additional health insurance coverage.

Over the years, Indian Health has significantly grown along with the rest of the health care industry; and unfortunately the U.S government has not always been able to provide the appropriate amount of funding that is needed.  In 1998, the Indian Health Care Improvement Act, P.1.94-437, authorized the Indian Health Service, Tribal Health and Urban Indian Health, (I/T/U) the ability to bill and collect third party reimbursement for the services provided to the patient.  This reimbursement from insurance companies has created a dependable, sustainable revenue stream, which is directly placed back into the Muscogee (Creek) Nation health care system; which helps pay for additional equipment and services for the patient population.

Since ITU’s have had the ability to bill, they highly encourage their patient load to apply for health care Insurance coverage.   Although, before now, due to either the high financial expense or a pre-existing condition, the percentage of patients that carry health insurance coverage has been minimal in comparison to the patient population.

The Affordable Health Care Act also known as Obama Care, is a law that is intended to reform the health care industry as we know it.  It provides the American population affordable options when purchasing a health care coverage plan.  It also provides the American Indian/Alaska Native population the option of using a health care coverage plan rather than using the Contract Health Service; which could potentially run low on funding and not be available to cover health care service charges, which would mean that the charges would then become the patients’ responsibility.

There are special provisions for the American Indian and the Alaska Native population when they enroll in health insurance coverage through the marketplace, such as;

  • No out of pocket costs like deductibles, copayments and coinsurance if the income is around $70,650 for a family of 4 ($88,320 in Alaska).
  • Can enroll in Marketplace health insurance any month, not just during the yearly open enrollment period.
  • Can begin and continue to receive health care services at any Indian Health Service including Tribal Health or Urban Indian Health Facilities.
  • Can get services from any providers listed on the Marketplace Insurance Plan
  • The Affordable Health Care coverage plans can be found on a web based portal called the Marketplace.  There are four ways to apply for a Marketplace health care coverage;
  • On-line at www.healthcare.gov
  • Telephone at 1-800-318-2596; available 24 hours a day 7 days a week

Can download and print the application at www.healthcare.gov and mail to

Health Insurance Marketplace
Dept. of Health and Human Services
465 Industrial Blvd.
London, KY 40750-0001


Although the Affordable Health Care Act provides affordable health care coverage, there are still some that prefer not to enroll into a health care coverage. For the American Indian/Alaska Native population there is an exemption from having to obtain health care coverage, it is based upon Tribal citizenship. There are two ways that a Federally Recognized American Indian can file for exemption.

Claim the exemptions when you fill out your 2014 federal tax return, which is due by April 15, 2015 (make sure you have your CDIB or your Tribal Citizenship Card available, they need the information from one or the other)

Fill out an exemption application in the Health Insurance Marketplace (if you would like to fill this application out, you can download it from www.healthcare.gov, or you can call Amy Eden at (918)756-4333 ext. 315 and request an application be mailed to you)

The State Recognized American Indian population is required to file for this exemption only by filling out the application; they do not have the option of waiting until they file their 2014 Income Taxes.

If there is anyone that would like assistance with filling out the exemption application or just have any questions in general, you can contact any of the Patient Benefit Coordinators at any of the Muscogee (Creek) Nation health facilities.  You can also contact LCDR Amy Eden at (918)756-4333 ext. 315.

Get your exemption form HERE.


IHS Confused Whether Indian Diabetes Funding Faces Another Sequestration


Rob Capriccioso

1/16/14 ICTMN.com

For the second year in a row, Indian Health Service (IHS) leadership is confused how federal sequestration will impact its budget, leading to questions of responsibility and competency from Native-focused health officials.

The latest confusion centers on how the Special Diabetes Program for Indians (SDPI), a program created in 1997 by Congress for the prevention and treatment of diabetes in American Indian and Alaska Natives, will be affected under the new federal budget deal. The December congressional arrangement alleviates sequestration on many so-called discretionary Indian-focused programs, but it leaves cuts in place for some mandatory programs.

SDPI last year was classified as mandatory under White House Office of Management and Budget (OMB) rules, so the program received a 2 percent cut, translating to $3 million. That reduction was able to be absorbed by IHS through an internal reshuffling of funds, according to agency officials last year.

This year, under the budget deal hammered out for 2014 by Democratic and Republicans congressional negotiators in December, mandatory programs would be subject to the same cut. As of December 24, 2013, IHS officials believed that SDPI would face the same cut as last year, and agency leadership was communicating that information to Indian health officials and to the press. An IHS spokeswoman told Indian Country Today Media Network by e-mail on December 24 that “SDPI has been sequestered by 2 percent again as other mandatory health programs.” A question at that time left unanswered was whether IHS would be able to absorb the $3 million shortfall, as it had in 2013.

Fast forward to mid-January, with IHS now telling Indian health officials that it doesn’t know if SDPI will be subject to sequestration in 2014. They also told Indian health officials on January 15 that the agency does not know when they would have more information on this issue.

When asked by ICTMN again on January 16 if SDPI would be subject to sequestration and if so whether IHS would be able to administratively pick up the slack as it did last year, Dianne Dawson, a spokeswoman for IHS, said that the Office of Management and Budget (OMB) should be contacted for details on the 2014 budget.

OMB has not responded to requests for comment, but one thing is for sure: IHS leadership is no stranger to accusations of not knowing how federal sequestration affects their budget. Yvette Roubideaux, acting director of the agency, told Indian health officials at various tribal meetings and in letters throughout 2011 and early 2012 that “the worst-case scenario would be a 2 percent decrease from current funding levels” for IHS under sequestration, rather than the 9 percent that was forecasted for most federal agencies if the sequester went into effect. But that information was a misreading of the law, according to OMB, and IHS ended up being subject to higher levels of sequestration.

RELATED: A Miscalculation on the Sequester Has Already Harmed Indian Health

Indian health officials were outraged that Roubideaux had fed them wrong information, and they said it cost them the ability to prepare tribal budgets to help make up for the greater shortfall. They were also concerned with OMB’s interpretations of the law.

Questions over this issue and others involving lacking tribal consultation, transparency and funding issues have caused Democratic senators to hold up Roubideaux’ re-nomination to her director position. She has been reduced to acting capacity, which has reduced morale in the agency, according to Indian-focused officials who have discussed the situation with IHS staff.

RELATED: 6 New Year Nomination Battles for Obama’s Native-Focused Nominees

Given the new confusion surrounding the SDPI program and sequestration in 2014, Indian health officials are again angry with IHS leadership and are demanding clarification.

“I am not sure what IHS is doing anymore; we have hardly any transparency when it comes to IHS budget issues with this director and administration,” said Jim Roberts, a policy analyst with the Northwest Portland Indian Health Board, when asked about the SDPI situation in December. “I’ve never seen budget and administrative transparency worse in the history of the agency despite its mantra and their espousal that this is their priority.”

From Roberts’ own reading of the law, he says that if Congress does its job and stays within the allocation caps reached under the December budget deal, there should not be a two percent reduction to the general IHS appropraition.

National Indian Health Board officials say they are investigating the situation with the agency.

IHS and the Notah Begay III Foundation form partnership to address obesity in Native youth

Source: Indian Health Service

The Indian Health Service (IHS) and the Notah Begay III Foundation (NB3F) are collaborating on activities aimed at preventing childhood obesity in American Indian and Alaska Native youth. The partnership will include sharing best practices in implementation of community-based activities directed at addressing childhood obesity in Indian Country.

The collaboration, initiated Nov. 12, 2013, was developed in support of the Let’s Move! In Indian Country (LMIC) program, which is part of First Lady Michelle Obama’s Let’s Move! initiative. The LMIC seeks to advance the work tribal leaders and community members are doing to improve the health of Native youth.

“Today’s partnership is an important step towards helping Native American youth lead healthier lives,” said Sam Kass, executive director of Let’s Move! and White House senior policy advisor on nutrition. “With the LMIC, we’ve seen tribal leaders engage their communities by creating food policy councils and reintroducing sports like lacrosse into schools, but we know there is more work to be done to ensure all our children have the healthy futures they deserve.”

Obesity is a significant problem in Native communities. It is a risk factor for many chronic diseases, such as diabetes, cardiovascular disease, and cancer, which are among the leading causes of death for American Indians and Alaska Natives.

“Tribal leaders have asked us to focus more on prevention efforts, especially with our youth,” said Dr. Yvette Roubideaux, acting director of the IHS. “Our new partnership with the NB3F gives us an opportunity to identify and share best practices from all of our prevention efforts, including the successful activities and outcomes of our Special Diabetes Program for Indians grantees, to help in the fight against childhood obesity in the communities we serve. We are excited to partner with them as they establish a new national center focused on these issues.”

With a mission centered on reducing the incidence of type 2 diabetes and childhood obesity among Native American children, NB3F has developed community-driven, scalable, and replicable prevention models that have seen statistically significant outcomes among child participants in the areas of reduced body mass index or BMI (a measure of weight proportionate to a person’s height), increased self-confidence and endurance, and enhanced understanding of nutrition knowledge. In August of this year, NB3F launched a national initiative, Native Strong: Healthy Kids, Healthy Futures that functions as a national center focused on strategic grant making, research and mapping, capacity building, and advocacy to combat type 2 diabetes and obesity among Native American children.

“This unprecedented partnership between the Obama administration, the IHS, and the NB3F demonstrates the critical importance of leveraging partnerships and resources to tackle the health crisis facing Native American children,” said NB3F founder Notah Begay III. “With 1 out of 2 Native American children expected to develop type 2 diabetes in their lifetime, it is vital that effective strategies and best practices are accessible for all Native communities, so together we can turn the tide on childhood obesity and type 2 diabetes.”

About the Indian Health Service: The IHS provides a comprehensive health service delivery system for approximately 2.1 million American Indians and Alaska Natives who are members of federally recognized Tribes. The IHS is the principal federal health care provider and health advocate for American Indians and Alaska Natives, and its mission is to raise their health status to the highest level. For more information about the IHS, visit www.ihs.gov

About the Notah Begay III Foundation: In 2005, Notah Begay III established the Notah Begay III Foundation (NB3F), a 502c3 non-profit organization to address the profound health and wellness issues impacting Native American children and to empower them to realize their potential as tomorrow’s leaders. The mission of NB3F is to reduce the incidences of childhood obesity and type 2 diabetes and advance the lives of Native American children through physical activity and wellness programming. To this end, NB3F develops community-driven, sustainable, evidence-based, and innovative wellness programs designed by Native Americans for Native American children that promote physical fitness, wellness, and leadership development. For more information on Notah Begay III and NB3F, visit: www.nb3foundation.org.

IHS prepares for Affordable Care Act implementation

Source: Native American Times

On Aug. 13-15, the Indian Health Service held an Indian Health Partnerships Conference in Denver to train key health system staff on Affordable Care Act implementation requirements, including the new Health Insurance Marketplace, and the impact on the provision of health care services to American Indian and Alaska Native people.

“The theme of this conference, ‘Partnerships 2013: Accessing Health Care through the Affordable Care Act,’ exemplifies the Agency’s commitment to ensuring that we are well prepared for the future of health care and the new opportunities available to federal, tribal, and urban beneficiaries,” said Dr. Yvette Roubideaux, acting director of the IHS.

For American Indians and Alaska Natives, the ACA will help address health disparities, increase access to affordable health coverage, and invest in prevention and wellness. The ACA will offer many uninsured American Indians and Alaska Natives an opportunity to purchase quality, affordable health insurance coverage or to enroll in Medicaid or the Children’s Health Insurance Program through the health insurance market. By filling out one simple application, many will learn that they qualify for financial assistance either through tax credits to purchase coverage in the market, reductions in cost-sharing that will reduce or eliminate out-of-pocket costs, or through enrollment in CHIP or Medicaid, if their state expands eligibility. Natives will also have access to enrollment periods outside the yearly open enrollment period and can continue to get services from tribal health programs, urban Indian health programs, or IHS if they enroll in a health insurance plan through the market.

Starting Oct. 1, a market will be open in every state, providing millions of Americans and small businesses with “one-stop shopping” for affordable health insurance coverage that can begin as soon as Jan. 1. The Indian Health Partnerships Conference provided an opportunity to encourage both members of tribal communities and health care professionals working with tribes to educate others about coverage opportunities.

First IHS facility designated as a Level III Trauma Center

Source: Indian Health Service

Gallup Indian Medical Center (GIMC) in Gallup, New Mexico, is the first Indian Health Service (IHS) facility to be designated as a Level III Indian Health Service. The designation means GIMC has the staff, training, equipment, supplies, and policies to provide trauma care to injured patients and improve outcomes for survival.

The designation, which became official on June 19, 2013, also ensures GIMC is continuously working to evaluate and improve on the care that is provided through an established trauma performance improvement process. GIMC also has an active Injury Prevention Program through its district Office of Environmental Health, an additional priority for all trauma centers. The program operates an injury surveillance system that enables the development of community-based injury prevention programs.

To obtain the Level III Trauma Center designation, GIMC collaborated with regional organizations, emergency medical services, and the state of New Mexico to review each trauma case and examine the appropriateness and timeliness of care provided. GIMC has agreements with the University of New Mexico in Albuquerque, N.M., and trauma centers in Phoenix, Arizona, to ensure patients can be quickly transferred when a higher level of care is needed.

On July 12, 2013, U.S. Department of Health and Human Services Secretary Kathleen Sebelius and IHS Acting Director Dr. Yvette Roubideaux visited GIMC and toured the emergency department and the Traditional Medicine Program. This tour was part of a recent trip by the Secretary to the Navajo Nation to meet with tribes and discuss the Affordable Care Act. During her visit, Secretary Sebelius viewed first-hand the great work of the GIMC staff to advance the mission of the agency. The designation of GIMC as a Level III Trauma Center will continue to improve services for patients in the Navajo Nation and surrounding rural communities.

While IHS is the primary health care system that American Indians and Alaska Natives use in their communities, the new Health Insurance Marketplaces and expansion of Medicaid services mean more choices for health care coverage, additional resources, and more services for both individuals and communities. Now more than ever, IHS is focused on providing access to quality health care for American Indians and Alaska Natives. Designations like this demonstrate IHS’s commitment to meeting this goal.

The Evolution Of U.S. Tribal Healthcare Centers

July 15, 2013 by Kristin D. Zeit

Healthcare Design Magazine



In the early 1990s, James Childers attended the groundbreaking of the Redbird Smith Health Clinic in Sallisaw, Okla., five miles north of the little town where he lived. Redbird Smith was the first clinic built from the ground up by the Cherokee Nation and—Childers was surprised to see—it was a huge improvement over the typical Indian clinics he was used to.

As an architect, Childers had been doing healthcare projects primarily with the Sisters of Mercy system since 1980. He’d never pursued any government- or publically funded healthcare projects—but the Redbird Smith project got him thinking.

“The architect for that clinic was out of New Mexico,” Childers says. “And that’s what caught my attention. I thought, there’s no need for them to be going to Albuquerque to do clinics in Oklahoma.”

The building, staffing, and maintenance of healthcare facilities for federally recognized Native American tribes have fallen under the jurisdiction of Indian Health Service (IHS) since that department was established in 1955. Traditionally, these IHS clinics haven’t exactly been design-driven, nor have they been particularly reflective of the cultures they serve. Built to meet strict federal guidelines that could be easily replicated from site to site, most of these clinics “were just boxes,” Childers says. “They’re just very functional government buildings.”

Over the past two decades, however, tribes have begun investing more and more money earned through their businesses in improving healthcare for its members. Fueled by joint ventures between the tribes and IHS, healthcare facilities are getting the attention they deserve, with bigger footprints (to better serve the number of patients and house more varied services); thoughtful innovations based on wellness research; and culturally significant touches to celebrate the rich histories of the tribes and provide a positive community resource.

Since 1992, Childers (a member of the Cherokee Nation himself) has been a prolific contributor to these new facilities. Of the 19 joint venture projects between IHS and tribes across the country, Childers has designed seven of them—all publicly bid and awarded separately by each tribe.

Healthcare Design spoke with Childers about the legacy he’s building, as well as the process behind designing facilities that proudly demonstrate the tribal values and cultural wealth of a historically underserved population.

Healthcare Design: Your first tribal project was the Wilma P. Mankiller Clinic in Stilwell, Okla., in 1992. How did you approach that job?
James Childers:  That was an Indian Health Service facility. And as we went through the IHS program, we figured out that what it produced was the typical Indian clinic you might walk into anywhere: too small, overcrowded, no waiting room, no people amenities. Indian Health Service did a fantastic job of getting the most out of its square footage, but there were really no provisions for waiting areas.

We’re in a very rural area here in Oklahoma; these people might drive 40-50 miles for healthcare. And when they did, they brought Grandpa and Grandma and the kids. Everybody came. As a result, you’d go into these clinics and the corridors would just be lined with people.

The IHS design guidelines dictated that you be within 10 percent of their square footage limitations. So what we ended up doing was reducing the square footage in the mechanical rooms. By selecting the right kind of systems and putting a lot of this equipment on the roof instead of on the floor, I ended up under their program on total square footage.

So what they allowed me to do—after many meetings and discussions—was to take that additional square footage and put it into circulation. We increased the widths of corridors and increased the size of waiting rooms. This was all an effort to get Indian healthcare environments compatible with private care.

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