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Tribal Self Goverance

The majority of Tribes have compacted or substantially contracted their health programs (nearly all have at least one contracted PFSA), but a large percentage (over 30%) of AI/ANs still receive their health care from IHS health programs. 

List of Self-Governance Tribes.

How does a Direct Service Tribe compact its health program?

The first step is to explore the option of either a contract or compact and decide if the Tribe wants to proceed or leave IHS administration of its health programs unchanged.

IHS

The Indian Health Service is the main partner to a Tribe considering a new or expanded level of Self-Governace.

Tribes begin by contacting their IHS Area Office to begin the planning process.  Funding may be secured by applying for a Tribal Self-Governance Planning Cooperative Agreement or a Tribal Management Grant.

Tribes are not required to utilize IHS funds for planning and can use other sources.

NOTE:
Contract Support Costs

One reason Tribes became reluctant to compact was the lack of full funding of their contract support costs.  Court decisions and action by Congress has greatly improved the funding for CSC.  This is the reason for a renewed interest in compacting.

The Process to Compact:  IHS Office of Self-Governance

The Office of Self-Governance web pages contain most of the information needed to understand and begin the process.

IHS statement:

To be eligible for the TSGP, a Tribe must (1) successfully complete a planning phase, (2) request participation in the TSGP byTribal resolution or other official action by the governing body of the Tribe, and (3) demonstrate financial stability and financial management capability by providing evidence that, for the three years prior to participation in the TSGP, the Tribe has had no uncorrected significant and material audit exceptions in the required annual audit of the Tribe’s Self-Determination Contracts or Self-Governance Funding Agreements with any Federal agency.

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