Tribes told to explore health funding options

WEDNESDAY, FEBRUARY 5, 2003

Citing a limited budget, the head of the Indian Health Service (IHS) urged tribes on Tuesday to bolster their health care systems with a broader range of federal funds.

Dr. Charles Grim, interim IHS director, spoke at a meeting of the United South and Eastern Tribes (USET). He described his agency's fiscal year 2004 budget request of $2.9 billion, a 2.6 percent increase over current levels, as "austere."

"Between '03 and '04, we are looking at some very difficult budget years," Grim told conference attendees.

With that in mind, tribes should look to other federal programs, Grim said. He cited a recent internal study that showed tribal governments are eligible for more than 40 programs that typically apply to state and local governments.

"There's a lot of money in the Health and Human Services," he said, referring to the department that oversees IHS.

On Monday, the Bush administration said it would spend more money on Indian Country in three major areas: diabetes grants, sanitation construction and contract health services. Grim and Michael Tiger, the Nashville area IHS director, said these would bring benefits to USET tribes. Tiger in particular noted that Eastern area tribes have a higher rate of inadequate safe water and waste disposal systems than other parts of the country.

Of the three areas, USET leaders were most concerned about contract health services. The IHS uses the money to purchase care from non-IHS providers, upon which tribes, especially those without local IHS facilities, as is the case in some areas in the East, rely.

Eddie Tullis, chairman of the Poarch Creek Tribe of Alabama, called for a fair distribution formula of the funds. Grim said he will be making a decision soon and promised to "do no harm" when the money is finally released. Congress, he said, might provide direction on how to distribute the money in the current 2003 and upcoming appropriations bills.

Beyond the IHS-only funds, Grim and Tiger pointed to other areas within the department. The Substance Abuse and Mental Health Services Administration (SAMSHA), for example, provides grants to combat substance abuse and treat mental illnesses.

Bio-terrorism was also brought up. In an interview, Grim confirmed that Indian Country will not receive its own smallpox funds. He said tribes and the IHS will have to turn to a pot of money -- $3.6 billion, according to HHS Secretary Tommy Thompson -- being provided to states.

"We're being tied in at the local level," he said. "We are still working at the national level to see if it might be more appropriate for those moneys and the programs to come directly through the IHS for Indian Country."

The HHS request for 2004 is $537.6 billion, a 7 percent increase that comes mostly from mandatory Medicare and Medicaid expenses. Total discretionary funding is $65 billion, which includes the bio-terrorism money.

Relevant Documents:
HHS Budget | HHS Secretary Tommy Thompson | HHS Budget [from OMB]

Relevant Links:
Indian Health Service - http://www.ihs.gov
Department of Health and Human Services - http://www.hhs.gov