The slices of pie that is funding for IHS have been shrinking for several reasons, one is that increases, when there were increases, were offset by the cost of medical inflation and as is pointed out in this article, demographics, population increases. A second reason, is recent cases where Tribes have successfully sued IHS for their fair share of Contract Support Costs, that is the actual costs of administrating programs contracted by Tribes. Whereas, before the lawsuits, IHS paid a percentage of the actual Contract Support. The problem is that Congress did not appropriate any additional funds to pay for actual Contract Support Costs and the Courts did find that just because Congress did not provide enough funds, that this did not eliminate or reduce IHS’s obligation and responsibility to pay those costs to Tribes. Additionally, under the Bush administration, funding for Urban Indian Health programs were cut (about $32,000,000) with the rational being that there were Community Health Centers funded programs that could provide those services to Urban Indian Populations. Never mind the fact that over 60% of eligible Native Americans live in Urban areas, and that less then 2% of the IHS budget went to Urban programs. Congress did restore those Urban Health line items, but did not allocate additional funds to cover them, so the pie shrank. The notion of Community Health Centers has been around for a while and there are some Tribes who have taken advantage of those funds and have had their clinics designated as such. There are also some Urban Indian Health programs that receives such funding. Accepting such funding and designation does not come without pitfalls, notably a requirement to provide services to anyone who comes to the facility who meets income eligibility requirements. Tribes and Urban programs have to be very careful to provide Community Health Services to everyone and IHS funded services only to IHS eligible patients, (unless there is a special agreement signed with IHS). I agree with Mark that there will be tough times ahead for IHS and Tribal programs with this new era of contraction.
Friday, September 23, 2011 - 17:37