Tribal Self-Governance Program
Introduction
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 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 72 Self-Governance Tribal Compacts and 93 Funding Agreements representing 322 Tribes, providing health services to over 57% of the American Indians and Alaska Natives.
The History of Self-Governance
The provision of health services to federally recognized American Indians and Alaska Natives 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 Indian Health Service (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 American Indians and Alaska Natives, and its goal is to raise their health status to the highest level possible.
In Fiscal Year 1992, the 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 Public Law (P.L.) 100-472. Through enactment of P.L. 102-573, the Indian Health Care Amendments of 1992, authority to fund the Tribal Self-Governance Demonstration Project (TSGDP) was extended to IHS and the Office of Tribal Self-Governance was established. Through 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 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 2007 approximately $1.082 billion will be transferred to support 114 Compacts.
Accomplishments
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 supports a system of care implemented at the local level by Tribal governments through their Compacts and Funding Agreements. This provides for the administration and management of the health programs to be placed in the hands of Tribal governments, thus, enabling the flexibility to tailor health programs to meet the diverse and unique needs of each Tribe.
Significant improvements have been made in the administration of Tribal health programs. Results show growth in the quality, quantity and accessibility of services provided to the service population. This makes evident the effective and efficient use of federal funds in addressing the local health needs of American Indians and Alaska Natives.
The TSGP promotes improved program and fiscal accountability such 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.
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