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HHS FY 2018 Budget in Brief - IHS


Indian Health ServicesIndian Health Service (IHS)

The mission of the Indian Health Service is to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.

A doctor prepares to draw blood.

IHS Budget Overview

(Dollars in millions)

Services 2016 2017 /1 2018 2018
+/- 2017
Clinical Services: 3,237 3,231 3,253 +22
Purchased/Referred Care (non-add) 914 912 914 +2
Preventive Health 156 155 157 +2
Contract Support Costs 718 717 718 +1
Tribal Management/Self-Governance 8 8 5 -3
Urban Health 45 45 45 --
Indian Health Professions 48 48 43 -5
Direct Operations 72 72 72 --
Subtotal, Services 4,284 4,276 4,292 +16

 

Facilities 2016 2017 /1 2018 2018
+/- 2017
Health Care Facilities Construction 105 105 100 -5
Sanitation Facilities Construction 99 99 75 -24
Facilities and Environmental Health Support 223 222 192 -30
Maintenance and Improvement 74 73 60 -13
Medical Equipment 23 23 20 -3
Subtotal, Facilities 523 522 447 -75
Total, Budget Authority 4,808 4,798 4,739 -59

 

Funds From Other Sources 2016 2017 /1 2018 2018
+/- 2017
Health Insurance Collections 1,194 1,194 1,194 --
Rental of Staff Quarters 9 9 9 --
Diabetes Grants 150 147 150 +3
Total, Program Level 6,160 6,148 6,091 -56
         
Full-time Equivalents 15,059 15,096 15,096 --

Table Footnotes

1/  Reflects the annualized level of the Continuing Resolution that ended April 28, 2017, including the across the board reduction, the 21st Century Cures Act, and directed transfers.

The mission of the Indian Health Service is to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.

As part of the unique Government-to-Government relationship between the Federal Government and Tribal Governments, the Indian Health Service (IHS) provides health care to members of more than 567 Federally-recognized Tribes.

The Fiscal Year (FY) 2018 Budget requests $6.1 billion for IHS, which is $56 million below the FY 2017 Continuing Resolution.  The FY 2018 Budget prioritizes funding the delivery of health care services to American Indians and Alaska Natives across Indian Country. 

Prioritizing Health Care Services

IHS provides comprehensive healthcare services through a network of over 679 hospitals, clinics, and health stations on or near Indian reservations.  The Budget reflects the high priority commitment to Indian Country, protecting direct health care investments in the context of an 18 percent reduction to the overall HHS discretionary budget.  The FY 2018 Budget provides $3.3 billion for clinical services, which is an increase of $22 million above the FY 2017 Continuing Resolution—restoring funding for direct health care services to FY 2016 levels.  Direct health care services include outpatient and inpatient care in hospitals and clinics, behavioral health services, and dental health services.  In FY 2018, IHS estimates that they will serve approximately 2.2 million American Indians and Alaska Natives.

IHS User Population by Area

Purchased/Referred Care
The Purchased/Referred Care program is a high priority for American Indians and Alaska Natives because it provides, through contracts with hospitals and other health care providers, the critical health care services that IHS and tribally-managed facilities are otherwise unable to provide.  The Budget provides $914 million for Purchased/Referred Costs—an increase of $2 million above the FY 2017 Continuing Resolution—to support medical care for catastrophic injuries, specialized care, and other critical care services.

Behavioral Health
While Tribes battle several chronic health problems, high rates of alcohol and substance abuse, mental health disorders, suicide, and chronic diseases are particular scourges that have had a tragic impact on American Indian and Alaska Native communities.  The FY 2018 Budget requests a total of $288 million for Mental Health and Alcohol and Substance Abuse to support ongoing efforts to meet these persistent behavioral health challenges in Indian Country.  This represents an increase of $1 million above the FY 2017 Continuing Resolution.

Preventive Health Services
In FY 2018, the Budget provides $157 million for preventive health services, which is an increase of $2 million above the FY 2017 Continuing Resolution.  IHS, in partnership with Tribes, uses evidence-based practices at the local level to reduce the incidence of preventable disease, and increase the health of individuals, families, and communities across Indian Country.  Programs such as public health nursing, health education, and community health representatives deliver culturally appropriate services to American Indian and Alaska Natives and serve as a link to accessing care for many who live in rural and isolated communities.

Staffing for Newly Opened Facilities
The Budget request includes funding to support the staffing of two newly opened facilities.  In FY 2018, IHS will support staffing in two Joint Venture projects, the Choctaw Nation Regional Medical Center in Oklahoma and the Flandreau Health Center in South Dakota.  Under Joint Venture agreements, IHS partners with Tribal entities to provide funds for staffing, equipping, and operating a facility while participating Tribes cover the design and construction costs associated with the new facility.  These funds will allow the new facilities to expand the provision of health care in areas where the existing capacity is overextended, while balancing the need to maintain existing services across the country.

Special Diabetes Program for Indians
The Budget requests $150 million in mandatory funding for the Special Diabetes Program for Indians, an increase of $3 million above the FY 2017 Continuing Resolution.  Diabetes health outcomes have improved significantly in American Indian and Alaska Native communities since the inception of the Special Diabetes Program for Indians, which provides grants for evidence-based diabetes treatment and prevention services across Indian Country.  One of the most important achievements has been an eight percent reduction in the average blood sugar level of American Indian and Alaska Natives with diagnosed diabetes between 1997 and 2015.  Improved blood sugar control reduces complications from diabetes.

Health Insurance Reimbursements
The FY 2018 Budget request for IHS estimates $1.2 billion in health insurance reimbursements from third party collections.  The collection of health insurance reimbursements for the provision of care to people covered by Medicare, Medicaid, the Veterans Health Administration, as well as by private insurance, allows IHS and contracting or compacting Tribes to expand the provision of health care services, purchase new medical equipment, maintain and improve buildings, and meet accreditation standards. 

Other Programs
To prioritize health services and staffing for new facilities, the Budget reduces funding for Self-Governance and Indian Health Professions and discontinues the Tribal Management Grant Program.

The FY 2018 Budget requests $5 million for Self-Governance, which is $1 million below the FY 2017 Continuing Resolution. 

The Indian Health Professions program funds efforts to recruit and retain health professionals to provide high-quality primary care and clinical preventive services to American Indian and Alaska Native communities.  The Budget provides a total of $43 million for Indian Health Professions, which is $5 million below the FY 2017 Continuing Resolution.  This funding level will maintain funding for current scholarship and loan payments.

Facilities and Construction

The FY 2018 Budget request includes a reduction of $75 million below the FY 2017 Continuing Resolution in facilities improvements and construction costs, for a total of $447 million in FY 2018, to prioritize funding for direct health care services to American Indians and Alaska Natives as well as staffing costs for newly opened health care facilities.

Health Care Facilities Construction
In FY 2018, the Budget provides $100 million for Health Care Facilities Construction, which is $5 million below the FY 2017 Continuing Resolution.  The Budget requests $100 million for the on-going construction of the following three facilities:  the Alamo Health Center in New Mexico; the Rapid City Health Center in South Dakota; and the Dilkon Alternative Rural Health Center in Arizona.

Sanitation Facilities Construction
The Sanitation Facilities Construction Program supports construction projects that ensure access to safe drinking water and waste disposal across Indian Country.  The Sanitation Facilities Construction program has had much success in disease prevention by ensuring that Tribal communities have access to safe drinking water and waste disposal.  The Budget requests $75 million for these activities—$24 million below the FY 2017 Continuing Resolution—to maintain IHS’s agreement to fund staffing in joint venture agreements and to ensure direct patient care services are funded.

Other Facilities Improvement and Construction Programs
The FY 2018 Budget reduces funding for Maintenance and Improvement, Facilities, and Environmental Health Support and Equipment. The Budget requests $60 million for Maintenance and Improvement, which is $13 million below the FY 2017 Continuing Resolution.  These funds are the primary source of funding to maintain, repair, and improve existing IHS and Tribal health care facilities.  The Budget requests $192 million for the Facilities and Environmental Health Support program, which is $30 million below the FY 2017 Continuing Resolution.  This program supports an extensive array of real property, as well as community and institutional environmental health, injury prevention, and sanitation facilities construction services.  The Budget also includes $20 million for Equipment, which is $3 million below the FY 2017 Continuing Resolution. The Budget will allow IHS to maintain its responsibility and commitment to patient care services as well as joint venture agreements with Tribes.

Furthering Indian Self-Determination

Under the Indian Self-Determination and Education Assistance Act of 1975, Tribes and Tribal organizations can take over the operation of Indian Health Service programs.  IHS recognizes the importance of their partnerships with Tribes and also understands that Tribes and Tribal organizations are the most knowledgeable about the needs in their communities. More than 60 percent of the IHS budget is administered directly by Tribes.

Contract Support Costs
Contract support costs funding supports certain operational costs of Tribes and Tribal organizations administering health care service programs under self-determination contracts and self-governance compacts.  The Budget fully funds contract support costs at an estimated $718 million, and continues the use of an indefinite appropriation.   The indefinite appropriation allows IHS to guarantee full funding of contract support costs while protecting funding for direct service Tribes.

Content created by Office of Budget (OB)
Content last reviewed on May 23, 2017