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Indian Healthcare Improvement Act

The Indian Health Care Improvement Act (IHCIA), the cornerstone legal authority for the provision of health care to American Indians and Alaska Natives, was made permanent when President Obama signed the bill on March 23, as part of the Patient Protection and Affordable Care Act. The authorization of appropriations for the IHCIA had expired in 2000, and while various versions of the bill were considered by Congress since then, the act now has no expiration date. The Indian Health Care Improvement Act of 1976 (25 U.S.C 1601, et seq.) and the Snyder Act of 1921 (25 U.S.C 13) comprise the basic legislative authority for the Indian Health Service. Listed below are these Acts along with several other Acts which give Congress appropriations for the Indian Health Service.

Learn more about the Indian Healthcare Improvement Act.

Snyder Act

Provides authority for the expenditure of such funds as Congress may appropriate for the benefit, care and assistance to Indians throughout the United States. Originally utilized by the Bureau of Indian Affairs at the Department of the Interior. At the date of enactment health care services were provided through this agency until 1955. This Act was never superseded, authority only transferred and expanded.

Learn more about the Snyder Act [PDF-60KB]

Indian Health Care Improvement Act - Public Law 94-437

The act implements the Federal responsibility for the care and education of the Indian people by improving the services and facilities of Federal Indian health programs and encouraging maximum participation of Indians in such programs. This Act expanded the Snyder Act authority. The Act became known as the “437” Act.

Learn more about The Indian Health Care Improvement Act (See section entitled "437" as Codified in 1996, for the statutory language)

Transfer Act

Authorized the transfer of maintenance and operation of hospital and health facilities for Indians to the Public Health Service. This Transfer Act also encompassed all services related to the delivery of health care to Indian people. This was the beginning of specific directives on how such health care services were to be provided. i.e., through the construction of facilities.

Learn more about the Transfer Act [PDF-39KB]

Indian Health Facilities Act

Authorized funding for the construction of Indian health facilities to be used to assist in the construction of non-Federal community hospitals which service Indian and non-Indian patients. Such funding required consent of tribe.

Indian Sanitation Facilities Act of July 31, 1959 (Public Law 86-121)

This Act expanded both the Snyder Act and the Transfer Act to include, as part of the health care services to be provided to Indians, the provision of sanitation facilities and services. The Act includes authority to construct facilities and acquire land for sanitation purposes.

Learn more about the Indian Health Facilities Act [PDF-26KB]

Self Determination Act

Congress recognized the importance of tribal decision-making in tribal affairs and the primacy of the nation-to-nation relationship between the United States and Tribes through the passage of the Indian Self-Determination and Education Assistance Act (ISDEAA) (Public Law 93-638) in 1975. Subsequent amendments to the ISDEAA strengthened the federal policies supporting tribal self-determination and self-governance. In 1992, Congress amended the ISDEAA to authorize a Tribal Self-Governance Demonstration Project within the IHS, giving federally-recognized Tribes the option of entering into self-governance compacts to gain more autonomy in the management and delivery of their health care programs. By 2000, Congress permanently authorized the IHS Tribal Self-Governance Program by creating Title V of the ISDEAA through Public Law 106-260.

Learn more by visiting the IHS Fact Sheet on Tribal Self Governance and the Office of Tribal Self Governance websites.

Special Diabetes Program for Indians Act

In response to the diabetes epidemic in American Indian and Alaska Native people, Congress established the Special Diabetes Program for Indians through the Balanced Budget Act of 1997.

Learn more by visiting the Special Diabetes Program for Indians (SDPI) website and viewing Indian Special Diabetes Program Act, 42 USC 254c-3 [PDF-77KB]

Alaska Native and American Indian Direct Reimbursement Act

This Act amended the IHCIA to make permanent the demonstration program that allows for direct billing of Medicare, Medicaid, and other third party payers, and to expand the eligibility under such program to other tribes and tribal organizations.

Learn more about the Alaska Native and American Indian Direct Reimbursement Act, Public Law 106-417 [PDF-117KB]

Tribal Law and Order Act (Public Law 111-211)

The Act helps reduce the prevalence of violent crime in Indian Country and to combat sexual and domestic violence against American Indian and Alaska Native women. The Act also expands the number of federal agencies that are required to coordinate efforts on alcohol and substance abuse issues.

Violence Against Women Act (Public Law 113-4)

This Act extends the 1994 Violence Against Women Act, authorizing grants to state and local authorities for programs to address domestic and sexual violence. The reauthorization includes a provision that would allow tribal courts to prosecute non-American Indians accused of domestic violence on tribal lands.