Why do Health Directors seldom serve longer than 5 years?
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Determining Eligibility is a major cause of friction for directors.
Where does the potential eligible reside one of the main conflicts since it determines eligibility for PRC paid services.
What are the basic eligibility guidelines?
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Direct Care Eligibility (Part 2 Chapter 1 of IHS Manual). This only gets you started and combined with Jan 10, 2000 letter leaves room for uncertainty.
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Who is an Indian?
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Does residence matter?
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Otherwise ineligble
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The Service may provide health services under this subsection to individuals who are not eligible for health services provided by the Service under any other provision of law in order to—
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(1) achieve stability in a medical emergency;
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(2) prevent the spread of a communicable disease or otherwise deal with a public health hazard;
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(3) provide care to non-Indian women pregnant with an eligible Indian’s child for the duration of the pregnancy through postpartum; or
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(4) provide care to immediate family members of an eligible individual if such care is directly related to the treatment of the eligible individual.
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Direct Care Services
In a January 10, 2000 letter to all Tribal Leaders, the Director of the Indian Health Service (IHS) reaffirmed how the IHS interprets and defines eligibility for health care services provided by the IHS and tribal governments, stating:
…the IHS is required to maintain services to Indian people based on the guidelines found in the current eligibility criteria at 42 Code of Federal Regulations (CFR), subpart A-G (1986). This regulation requires the IHS to serve all persons of Indian descent, regardless of tribal affiliation, who belong to the local Indian community. Therefore, we provide services to any persons of Indian descent who seek treatment at an IHS facility. We do not require a finding that they "belong to" the local Indian community. The eligibility regulation does not require a particular degree of Indian ancestry and does not define the term "Indian community." Therefore, the regulation has been construed liberally to include anyone who can reasonably be regarded as an Indian regardless of degree of Indian ancestry or tribal affiliation. When resources are insufficient to handle the volume of services required, priorities must be established based on relative medical need and access to resources other than the IHS-funded resources. Under section 105(g) of the Indian Self Determination and Education Assistance Act, tribes operating IHS health care programs through a Public Law 93-638 contract/compact must:
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Adhere to departmental regulations the same as the IHS would if it were operating the same health care program or facility;
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Serve the same population the Secretary of Health and Human Services would have served;
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Provide services to any eligible American Indian/Alaska Native who presents himself/herself at the tribal facility; and
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State in its compact or contract if services are limited to a specific segment of the population.