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:

• Adhere to departmental regulations the same as the IHS would if it were operating the same health care program or facility;
• Serve the same population the Secretary of Health and Human Services would have served;
• Provide services to any eligible American Indian/Alaska Native who presents himself/herself at the tribal facility; and
• State in its compact or contract if services are limited to a specific segment of the population.

This definition only applies to programs and services funded by the IHS. In California most tribally operated health programs have multiple funding sources. In some cases, the IHS is not even the primary funding source. Most tribal programs augment their IHS funding with grants from others sources, both public and private, as well as funds generated from other tribal enterprises. Therefore, it is possible that certain services within the tribal health care system may not be equally available to all patients. In some cases, this funding source may be the State of California. State funding results in two unique conditions: (1) patients may be charged fees for services; and (2) programs using state funds must also serve non-Indians. You will need to consult the local program if you have questions.