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Frequently Asked Questions

A: IHCIA has specific requirements for the overall expansion of CHAP:

  1. IHS must establish the policy that creates the program
  2. For specific aides within the program, state authorization is required (e.g.: dental health aides)


  1. IHCIA specifies that the CHAP program may not use aides to fill vacancies for a dentist
  2. In the expansion efforts, resources to Alaska CHAP (both funding and human capital) may not be reduced)
  3. Cannot authorize the use of Dental Health Aide Therapists in states that do not authorize its use in State law.


  • Title I ISDEAA: Redesign with IHS approval and rebudget
  • Title V ISDEAA: Redesign and rebudget

A: It depends. The regulations can be found in:

  • ISDEAA Title I - 25 C.F.R. 900, Subpart M – Federal Tort Claims Act Coverage Provisions
  • ISDEAA Title V- 25 § C.F.R. 137.220

A: The program requires Federal Appropriations. At this time, IHS CHAP activities are currently unfunded. At this point, IHS intention is to first develop the policy, but is continuing to work with Tribes through the budget consultation process.

A:The Community Health Aide Program (CHAP) and CHR Program have key differences.

  • Legislative Authority- CHAP is authorized under 25 USC § 1616 a-d while the CHR Program is authorized under IHCIA PL. 100-713.
  • Funding Sources- The Alaska CHAP is funded through the hospital and health clinics (H&HC) line item in the IHS budget and CHRs are funded through a specific CHR line item.
  • Scopes of Work- While the “community health” portion of the names are similar, the scope of work for a Community Health Aide and Community Health Representative are vastly different. CHAs are mid-level medical providers who can provide basic medical attention and can connect a patient to clinical care. CHRs provide health promotion, promotion, and outreach to community members.

A: IHCIA specifies that in order to operate programs such as dental health aides, states must authorize their use through state legislation.

A: The states that currently authorize the use of DHATs are:

  • Alaska
  • Washington
  • Oregon (through a pilot project, at select locations)
  • Minnesota
  • Maine
  • Vermont
  • Arizona
  • Michigan
  • New Mexico
  • Montana
  • Idaho
  • Nevada
  • Connecticut

A: IHCIA provisions state that the nationalization of CHAP is for Tribes and Tribal organizations; therefore, CHAP expansion would not apply to Urban Indian Organizations.