Self-Governance is fundamentally designed to provide Tribal governments with more control and decision-making authority over the Federal financial resources provided for the benefit of the Indian people. More importantly, Self-Governance fosters the shaping of a “new partnership” between Indian Tribes and the United States in their government-to-government relationships. Self-Governance provides, administratively, the opportunity for Tribal governments to exercise their sovereignty with minimal Federal intrusion and involvement.
The IHS and tribal programs provide health services to approximately 1.5 million American Indians and Alaska Natives who belong to 556 federally recognized tribes in 35 states. There are currently 61 self-governance tribal compacts and 81 funding agreements representing 285 tribes, providing health services to over 51.1% of the American Indian and Alaska Native tribes.
The History of Self-Governance
The provision of health services to federally recognized Indians grew out of a special relationship between the federal government and Indian tribes. This government-to-government relationship is based on Article I, Section 8, of the United States Constitution, and has been given form and substance by numerous treaties, laws, Supreme Court decisions, and Executive Orders. The IHS, an agency of the U.S. Public Health Service within the Department of Health and Human Services, is the principal federal health care provider and health advocate for Indian people, and its goal is to raise their health status to the highest level possible.
In FY 1992, the Indian Health Service (IHS) was instructed by Congress to initiate planning activities with tribal governments with approved Department of Interior self-governance compacts for the development of a Self-Governance Demonstration Project as authorized by P.L. 100-472. Through the enactment of P.L. 102-573, the Indian Health Care Amendments of 1992, the authority to fund the Tribal Self-Governance Demonstration Project (TSGDP) was extended to IHS, and the Office of Tribal Self-Governance was established. Through the enactment of P.L. 106-260, the Tribal Self-Governance Amendments of 2000, permanent authority was given to Title V, Tribal Self-Governance. Since 1993, the IHS, in conjunction with Tribal representatives, has been engaged in a process to develop methodologies for the identification of Tribal Shares for all Tribes. Tribal shares are those funds historically held at the Headquarters and Area organizational levels of the IHS. In FY 2003 approximately $794 million will be transferred to support 81 compacts.
Tribes participating in the Tribal Self-Governance Program (TSGP) report that the program has had a significant positive impact on the health and well-being of their constituents. The TSGP puts the administration and management of the health programs in the hands of tribal governments and provides them the flexibility to tailor their health program to meet the diverse and unique needs of their constituents. Significant improvements have been made in the administration of Tribal health programs and the quality, quantity, and accessibility of services provided to the service population. Thus federal funds are more effectively and efficiently used in addressing the local health needs of American Indians and Alaska Natives. The TSGP also promotes the improved program and fiscal accountability in that tribal governments and health administrators are held directly accountable by and to their service population. A study conducted by the National Indian Health Board confirmed the significant positive impact that Self-Governance has had on Tribal health programs and their constituents.