INDIAN HEALTH SERVICE
Indian Health Services (IHS), an agency of the Dept. of Health and Human Services, is the principal provider for federal health care service to Federally recognized American Indian Tribes and Alaska Native Corporations. The Snyder Act of 1921 authorizes Congress to appropriate annual Federal funds, ‘for the relief of distress and conservation of health and for the employment of physicians for Indian tribes throughout the United States’.
The US Congress FY2003 budget appropriates $3.5 billion dollars, providing 60% of the health care needs of the 1.5 million eligible American Indians and Alaska Natives, which is a 3.3% increase in FY2002 $2.9 billion dollars budget.
IHS provides a quality pharmaceutical, medical, surgery and emergency care delivery system to ensure the availability and accessibility for eligible American Indians and Alaska Natives. Eligibility for IHS health care is determined by ‘varying’ Federal tribal enrollment ‘Blood Quantum or Blood Degree’ requirements. IHS is not a benefits package, an entitlement or an insurance program such as Medicare/Medicaid.
The government locks people into their own tribal reservation areas because they are not able to access medical care through IHS outside their respective areas.
With Medicare and Medicaid, as long as you qualified, and the facility is qualified, you can be treated where you want. With IHS, you have to go to one of the IHS facilities. You can’t go somewhere else and get reimbursed. An emergency situation is the exception to the rule, and then the treatment falls under indigent care. There are two types of services: 1) direct health care is provided by an IHS facility; 2) contracted health services (CHS) are services the IHS is unable to provide in its own facilities. A hospital or clinic can, under contract with the IHS, provide health care service to eligible Indians, e.g. an enrolled member in a Federally recognized tribe or a member of a Native Tribe or Group under Federal supervision living on or near their home reservations, tax-exempt land or own restricted property. A non-Indian woman ‘pregnant with an eligible Indians child’ receives IHS health care services during pregnancy to postpartum; a patient must reside in the designated IHS or CHS contracted geographical health care service areas. IHS cannot always guarantee the availability of funding, which means some CHS services must be prioritized. Some tribally operated hospitals or clinics restrict services to members of their own tribe, being a member of a Federally recognized tribe does not guarantee medical care at a tribally operated hospital or clinic. Some physicians and/or medical facilities have discussed and/or are experimenting with the idea of combining modern medical practice and the traditional healing arts
A lot of Native Americans qualify for both Medicare and Medicaid, but they had no transportation so they had no access to facilities]
Other Federal tribe enrollment requirements are biological native parents, enrolled members of a Federal recognized tribe, and/or if the child’s blood quantum satisfies tribal requirements, which vary from tribe to tribe, from as little as 1/64th to 50% ‘blood degree’. The Certificate of Degree of Indian Blood, the CDIB or ‘white’ card, is issued by the Dept. of the Interior (BIA) and an applicant who satisfies the BIA document requirements with a ‘blood degree’ percentage to a documented ancestor on the Federal Registry, not to a particular tribe, receives a Department of the Interior (DOI) number. Having a percentage of Indian blood or a CDIB card does not guarantee tribal enrollment; a tribes ‘citizenship’ application requirements must be satisfied. {Reference 17}
In 1954, the ‘Termination and Relocation’ phase of the Indian Reorganization Act of 1934, arbitrarily and legally removed 61 former ‘Federally’ recognized Tribes (legal self-governing community’s of people). With the stroke of a pen the US government removed many eligible American Indians from existence with no government-to-government voice in a court-at-law and/or other benefits such as Indian Health Service. These former 61 Tribal populations are not counted among the 1.5 million population of the current BIA Federal recognized ‘Indian’ census