About Us

The Indian Health Service (IHS) California Area Office (CAO) supports health services for American Indians and Alaska Natives (AI/AN) in California, which has the largest AI/AN population in the United States. The 2020 U.S. Census reported 631,016 AI/AN residents in California.

The California Area IHS works with 104 of the state’s 109 federally recognized tribes. Tribal health systems include 34 tribal health programs operating 102 ambulatory clinics and 62 dental clinics under the Indian Self-Determination and Education Assistance Act. Additionally, nine urban Indian health programs operate under the Indian Health Care Improvement Act.

In FY 2024, California tribal health programs reported:

199,589 registered users (all AI/AN patients ever seen at tribal facilities)
86,244 active users (patients who received care in the previous three years)

Unlike other IHS regions, none of California’s current tribal facilities were previously operated by IHS. Due to the large geographic dispersion and relatively small tribal populations, building and sustaining a full-service IHS hospital with emergency and maternity services is generally not feasible.

Instead, tribal health programs rely heavily on partnerships with private and public hospitals for inpatient and emergency care. Some tribal physicians maintain hospital privileges to follow patients during hospitalization. When specialty or hospital care is needed, patients are referred through Purchased/Referred Care (PRC) or other funding sources.

Most tribal programs do not maintain on-site laboratory, pharmacy, or radiology services, so these services are typically purchased from private-sector providers using PRC funds or tribal resources.