Indian Health Service (IHS) Director's Corner Blog IHS Director's updates on important issues affecting the Indian Health Service. en-us 2017 Budget for IHS Proposed Tuesday, February 9, 2016 ]]> Today, I joined HHS Secretary Sylvia Mathews Burwell and leaders of the agencies of HHS to announce the President's proposed budget for fiscal year 2017. The amount proposed for IHS for fiscal year 2017 is $5.2 billion, which represents a $377.9 million increase over the fiscal year 2016 level.

This budget accurately reflects the challenges the Indian health system faces in providing comprehensive health care and public health services in some of the most remote parts of our country. As IHS responds to an expanded mission - from an increasing patient population to new requirements for health information technology to the federal government's commitment to honor the sovereign rights of tribes by fully funding Contract Support Costs - these resources are necessary to raise the physical, mental, social and spiritual health of American Indians and Alaska Natives to the highest level.

The budget proposes additional investments in behavioral health and programs for Native youth. This would enable IHS to expand successful substance abuse and domestic violence prevention programs needed in the communities we serve. The budget also responds critical infrastructure needs for health care facilities. Among other increases, it provides $103 million for sanitation facilities construction for 190,000 homes and $33 million to fully staff five new state-of-the-art facilities.

Read more about the details in our IHS press release, budget in brief [PDF] Exit Disclaimer: You Are Leaving and budget summary [PDF - 121 KB].

Robert G. McSwain, a member of the North Fork Rancheria of Mono Indians of California, is the Principal Deputy Director for the Indian Health Service (IHS). Mr. McSwain most recently served as the Acting Director for the IHS, and has more than 30 years of experience in Tribal health care.

ACA and Tax Season: What You Need to Know Monday, February 8, 2016 ]]> Although open enrollment for the Affordable Care Act's Health Insurance Marketplace Exit Disclaimer: You Are Leaving ended on January 31, members of federally recognized tribes and Alaska Native Claims Settlement Act Corporation shareholders can enroll in Marketplace coverage any time of the year.

The Indian Health Service is still actively engaging in outreach and enrollment events across Indian Country, but now we're shifting the focus to tax season and what tribal members need to know. The tax forms can be confusing and sometimes a little frustrating, but it's important to file the correct forms with the correct information about your health care coverage.

If you had coverage through the Health Insurance Marketplace in 2015 and used premium tax credits Exit Disclaimer: You Are Leaving to lower the monthly payments, you must file a federal income tax return for 2015. Here are some helpful tips:

  • The Marketplace will send you Form 1095-A Exit Disclaimer: You Are Leaving, Health Insurance Marketplace Statement, by early February.
  • Use the information on the 1095-A Form to complete Form 8962 Exit Disclaimer: You Are Leaving, Premium Tax Credit.
  • Form 8962 will figure out if you used the right amount of tax credit during the year.

If you had employer-based insurance or any other type of coverage outside of the Marketplace, you will not receive a 1095-A form, but may get a 1095-B or 1095-C or no form at all.

If you didn't have any coverage in 2015, you must pay a penalty or claim an exemption. The penalty for 2015 is $325 per adult or 2 percent of your household income, whichever is higher.

However, members of federally recognized tribes or those eligible to receive services from an Indian Health Service, tribal or urban Indian health program may claim an exemption from the penalty Exit Disclaimer: You Are Leaving The exemption should be claimed on a federal income tax return using IRS Form 8965 [PDF - 82 KB].

If you already applied for and received an Exemption Certificate Number (ECN), then use this number to complete Part I of IRS Form 8965. If you did not already obtain an ECN you can still claim the exemption using IRS Form 8965 by entering code "E" in Part III of the form.

You will need to submit this form every year that you file a federal income tax return and are requesting an exemption, even if you have an ECN. You don't need to apply for an exemption if you are not filing a federal income tax return.

Please know there are trained assisters in every state to help you at no cost. You should never be asked to pay for services or help to apply for Marketplace coverage. You can find help at your local Indian Health Service, tribal or urban Indian health program or you can find a free, trained local assister through the Marketplace Exit Disclaimer: You Are Leaving

Be wary of scams. Remember to never give your financial information, like banking, credit card or account numbers to someone who calls or comes to your home uninvited, even if they say they are from the Marketplace. Double check any information that is confusing or sounds suspicious. Check out to verify information or call the Marketplace at 1-800-318-2596.

For more information, visit the IHS Affordable Care Act website or the Marketplace Tribal Resources website Exit Disclaimer: You Are Leaving

Raho Ortiz is the Director of the Division of Business Enhancement in the Office of Resource Access and Partnerships with the Indian Health Service. He provides national oversight and guidance for IHS business offices and provides the IHS with advice regarding reimbursement policy and procedures for Medicare, Medicaid and Marketplace health plans. He is Navajo and Acoma Pueblo.

First Steps into Fitness Thursday, February 4, 2016 ]]> Healthcare providers encourage active lifestyles, particularly for diabetic patients who should include regular exercise as an essential part of their diabetes management. We know that incorporating exercise into our daily schedule can help achieve overall weight loss, lower blood sugar and help the body accept insulin more efficiently. We also know that getting started can be intimidating.

Luckily, the patients at the Red Lake Hospital in Red Lake, Minnesota, have access to a free fitness center on weekdays. Yet a lot of patients with Type 2 diabetes have told me that they are reluctant to use the fitness center. They say they fear being judged, feel they don't have the appropriate attire, or they don't know how to use the equipment. That is a lot of obstacles, both physically and mentally, to overcome.

To help reduce the fear and inhibitions of attempting a new activity, it helps to have someone with you. So to help my diabetic patients, I have introduced the concept of going to the fitness center with them as part of our appointments.

One patient, 51-year-old Terri Desjarlait, of the Bad River Band of the Lake Superior Tribe of Chippewa Indians in Wisconsin, who is a seamstress and makes traditional regalia, was first diagnosed with diabetes six years ago. Terri had never used a treadmill or elliptical machine. She had all of the typical fears. We went over to the fitness center together, and I introduced her to the staff, showed her around and helped her get started on the treadmill and with other equipment. After that initial visit, we met a couple of other times at the fitness center, walked together and talked about healthy lifestyles and physical activity.

On her own, she started going to the fitness center most days of the week, and worked her way up from walking for five minutes to 30 minutes. She was excited to see her blood sugars improving, and her energy levels increase. She also found an additional benefit: exercise can lift your spirits and make you feel good.

The buddy system is a great way to increase your daily exercise goals, keep each other motivated and on the path to better health.

The next time you go for a walk, invite a friend. Even with a simple walk, every step makes a difference!

CDR Kailee Fretland, PharmD, BCPS, NCPS is a clinical pharmacist at Red Lake Hospital in Red Lake, Minnesota. She provides clinical pharmacy services to help patients meet their diabetes, high blood pressure and cholesterol health goals. Fretland is a descendant of the White Earth Chippewa tribe in Minnesota.

Patient information is being used with permission.

CEO Supports Urban Indian Community in Detroit Wednesday, February 3, 2016 ]]> The Urban Indian community in Detroit enjoys the services of the American Indian Health and Family Services clinic, and Chief Executive Officer Ashley Tuomi makes sure the needs of both the clients and employees are covered.

For many of the employees, this is their home. Ms. Tuomi makes sure this is an environment where the clients come in and feel at home, too. The people they serve are part of the community. They are friends, family and fellow tribal members.

Ashley Tuomi, chief executive officer, American Indian Health and Family Services of Detroit
Ashley Tuomi, chief executive officer, American Indian Health and Family Services of Detroit

As a member of the Confederated Tribes of Grand Ronde in Oregon, Ms. Tuomi takes pride in helping the Urban Indian community. The American Indian Health and Family Services clinic offers a number of services, including outpatient medical and behavioral health, nutrition and child birth classes, traditional healing including sweat lodge, youth and gardening programs along with cooking and exercise classes.

The Indian Health Service and the Substance Abuse and Mental Health Services Administration are the clinic's biggest funders. They also receive funding from the state, the Inter-Tribal Council of Michigan and third-party revenue.

Ms. Tuomi is also a certified Affordable Care Act Navigator through the Centers for Medicare and Medicaid Services Navigator Grant. The clinic received funding for two years to educate American Indians and other minorities living in southeast Michigan on their health insurance options and enroll them through the Affordable Care Act's Health Insurance Marketplace.

"Our third-party revenue definitely increased and we saw the uninsured rate greatly decreasing," Ms. Tuomi said. "We did a lot of training with Tribes and participated in many enrollment events across the state. We helped nearly 2,000 individuals enroll in health plans in the last two years. That's an amazing number."

In May, Ms. Tuomi will officially become the Board President for the National Council of Urban Indian Health. She joined the organization as a regional representative.

"I have a passion for Urban Indian health. There are a lot of great things happening in the Urban Indian health program community. The programs are making changes every day, not just with funding but also with recognition," Tuomi said. "As CEO of an Urban Indian health program and part of NCUIH, we appreciate the time the Indian Health Service takes to confer with us."

It's clear that Ms. Tuomi is making great strides to improve the health care access to urban Indian communities.

Keith Longie, an enrolled member of the Turtle Mountain Band of Chippewa Indians, is the Director of the Bemidji Area office of the Indian Health Service. Mr. Longie is responsible for providing leadership to the Bemidji Area and overseeing the delivery of health care to American Indians and Alaska Natives in Minnesota, Michigan, Wisconsin and Illinois.

IHS Announces the 4-in-1 Grant Opportunity to Enhance Health Services in Urban Areas Tuesday, February 2, 2016 ]]> The Indian Health Service, Office of Urban Indian Health Programs and Division of Grants Management, will soon begin accepting new, competitive grant applications for the FY 2016 4-in-1 Grant Program. To be eligible to apply under this announcement, applicants must currently have a Title V Indian Health Care Improvement Act (IHCIA) contract with the IHS in place. Funding level available to an organization is based on specific criteria in the Indian Health Care Improvement Act to include size of urban Indian population, accessibility to and utilization of other health resources available to that population and identification of need for services.

The FY 2016 competing, continuation cycle of 4-in-1 grant funding, approximately $8.3M, will be used to promote urban Indian organizations' successful implementation of IHS priorities. Additionally, funding will be used to meet objectives for Government Performance and Results Act and the Government Performance and Results Modernization Act reporting; collaborative activities with the Veterans Health Administration; and four health programs that make health services more accessible to American Indians and Alaska Natives living in urban areas.

The four healthcare areas include:

  • Health Promotion and Disease Prevention Services
  • Immunizations
  • Alcohol and Substance Abuse Services
  • Mental Health Prevention and Treatment Services

These programs are integral components of the IHS improvement in patient care initiative and the strategic objectives focused on improving safety, quality, affordability and accessibility of health care.

Prior to the 1950s, most American Indians and Alaska Natives (AI/AN) resided on reservations, in nearby rural towns or in Tribal jurisdictional areas such as Oklahoma. In the era of the 1950s and 1960s, the federal government passed legislation to terminate its legal obligations to the Indian Tribes, resulting in policies and programs to assimilate Indian people into mainstream American society and the relocation of over 160,000 AIAN to selected urban centers across the country. Today, a majority of AI/ANs reside off-reservation. In response to efforts of urban Indian community leaders, Congress appropriated funds to study unmet urban Indian health needs. The findings of this study documented cultural, economic and access barriers to health care and resulted in Congressional appropriations under the Snyder Act to support emerging urban Indian clinics in several Bureau of Indian Affairs relocation cities including Chicago, Denver and San Francisco.

The IHCIA, permanently reauthorized by Congress in 2010, is considered health care reform legislation to improve the health and well-being of all AI/AN, including urban Indians. Title V specific funding is authorized for the development of programs for AI/AN residing in urban areas. Since passage of this legislation, amendments to Title V provided resources for urban Indian health programs in the areas of primary care services, alcohol abuse services, mental health services, HIV, immunizations and health promotion and disease prevention services.

For additional information about the Office of Urban Indian Health programs, visit

Sherriann Moore, an enrolled member of the Rosebud "Sicangu" Lakota Tribe in South Dakota, is the Acting Director of the Office of Urban Indian Health Programs. The IHS Office of Urban Indian Health Program supports contracts and grants to programs funded under Title V of the Indian Health Care Improvement Act.

Contract Support Cost Workgroup Meeting - January 14-15, 2016 Thursday, January 21, 2016 ]]> I was pleased to join the Indian Health Service Contract Support Cost Workgroup meeting on January 14-15 in Washington, D.C., to discuss updating and implementing a new policy in 2016. Nearly 40 committee members, federal partners and technical advisors attended the meeting.

IHS Principal Deputy Director Robert McSwain referred to the Dear Tribal Leader Letter [PDF - 172 KB] dated January 7, 2016, announcing the initiation of consultation on the CSC policy. The Workgroup will meet several times over the next two months to draft a revised policy that will be available for your review and comment in the first quarter of 2016.

The CSC Workgroup plans to meet in Washington, D.C., on January 29 after the IHS Tribal Self-Governance Advisory Committee Quarterly Meeting, and again on February 10-11 during the United South and Eastern Tribes Impact Week.

CSC Workgroup Chairman Andrew Joseph, Jr. and Workgroup member Rob Demaray from the Phoenix Area.
CSC Workgroup Chairman Andrew Joseph, Jr. and Workgroup member Rob Demaray from the Phoenix Area.

Our staff is diligently working on this policy, and rest assured, we will not rollout a policy without tribal leader input. So, I encourage you all to play an active role providing feedback.

Please visit the IHS website often for updates. In addition, the IHS will provide updates at national Indian organization and committee meetings, such as the National Congress of American Indians, National Indian Health Board, the IHS Direct Service Tribes Advisory Committee and the Tribal Self-Governance Advisory Committee.

IHS Holds National Kickoff Meeting for New Awardees in Behavioral Health Tuesday, January 19, 2016 ]]> On January 14-15, 2016, IHS held its national kickoff meeting for the new cohort of Methamphetamine and Suicide Prevention Initiative (MSPI) and Domestic Violence Prevention Initiative (DVPI) awardees. In late 2015, IHS made 118 MSPI funding awards totaling more than $13 million and 56 DVPI awards totaling more than $7 million. The in-person meeting, held in Denver, Colorado, addressed critical technical and programmatic issues to help set up for success these awardees and their projects.

Over 250 people attended, representing Tribal, federal, and Urban Indian programs across the country. Headquarters staff from the IHS Division of Behavioral Health, Division of Grants Management and Division of Planning, Evaluation and Research offered workshops on various topics. Sessions included:

  • Operating a Grant Program
  • Trauma Informed Care
  • Methamphetamine Use Prevention
  • Community Assessment/Strategic Planning
  • Suicide Prevention
  • Domestic Violence and Sexual Violence Prevention

In addition to these workshops, attendees also met with technical assistance providers from the National Indian Health Board Exit Disclaimer: You Are Leaving, National Council of Urban Indian Health Exit Disclaimer: You Are Leaving and the various Urban Exit Disclaimer: You Are Leaving and Tribal Epidemiology Centers. These tailored sessions offered awardees the opportunity to access pertinent information and resources on data collection, planning and evaluation.

"We know that a lot of work remains to be done to comprehensively address the critical behavioral health issues across American Indian and Alaska Native communities," said Dr. Beverly Cotton, director of the Division of Behavioral Health. "With these awards, Tribes are able to promote culturally relevant programs that improve the effectiveness of prevention, intervention and treatment of substance use, suicide and domestic and sexual violence."

We and our IHS colleagues are excited to facilitate this new era of grants for the MSPI and DVPI programs. One thing that will help is that each participant received a resource kit of presentations and materials shared during the two-day meeting. We are sure to have many stories of success and accomplishment to highlight in the months to come.

Ms. Solimon serves as project officer for MSPI and DVPI awards and is an enrolled member of the Pueblo of Laguna, New Mexico. LCDR Sean K. Bennett is a United States Public Health Service Officer who serves as the lead for Zero Suicide at IHS and also supports IHS MSPI and DVPI.

The Success of the Affordable Care Act at the Pawnee Indian Health Center Thursday, January 14, 2016 ]]> Pasia Morrison, a young stay-at-home mother, had been experiencing a series of health problems. She learned that she has gastrointestinal disorders, which resulted in multiple hospital stays and several visits to specialists. The cost of one corrective surgery is $100,000 including a six-day hospital recovery time. Fortunately, as a patient of the Pawnee Indian Health Clinic, a federally-operated facility in the Oklahoma City Area Indian Health Service, IHS was able to help.

Alyssa Goodfox, a Patient Benefits Coordinator at the Pawnee Indian Health Service, helped Ms. Morrison research available plans through the Affordable Care Act's Health Insurance Marketplace. Ms. Morrison enrolled in a suitable insurance plan, and as a tribal member, is exempt from out-of-pocket costs. The affordable and flexible plan was just what she needed to obtain a higher level of care for the surgical procedures.

"I saw Ms. Morrison during a normal annual patient screening. She shared with me all her health conditions and concern about not being able to get on her husband's coverage because it wasn't affordable. I used a premium calculator tool on to give her an idea of what her costs may be. We set up an account in March and she was enrolled in a plan in April," said Ms. Goodfox.

Ms. Morrison enrolled in a zero cost-sharing plan with no out of pockets costs and a premium of about $118 a month. It's through the ACA coverage, that Ms. Morrison was able to have multiple surgeries with inpatient stays and follow up appointments with the gastroenterologist without any co-pays or deductibles.

"There was a sense of relief when Ms. Morrison realized what her private insurance covered. She became acclimated to her plan and empowered to take care of her own health care," Ms. Goodfox added. "As a Patient Benefits Coordinator, I make sure to provide every patient with all their coverage options and the benefits of having private coverage. It opens up a wider provider network, opens doors and creates convenience."

The Affordable Care Act waives deductibles, copayments and coinsurance for members of federally recognized Tribes and Alaska Native Claims Settlement Act (ANCSA) Corporation shareholders with incomes between 100 and 300 percent of the federal poverty level. Tribal members, no matter what income level, are exempt from out-of-pocket payments if they receives services directly from and Indian health care provider or through the Purchased/Referred Care program.

Tribal members and ANCSA shareholders can also enroll in a Marketplace plan any time of the year, and can change plans up to once a month. With less than a month left in the current open enrollment period, now is a great time for people of Indian descent or who are eligible to receive services from IHS to enroll in health coverage.
This is only one of many other success stories due to the Affordable Care Act. Since its implementation, an additional 54 million Americans are covered and have access to wellness and preventive services.

Ms. Morrison still receives services at the Pawnee Indian Health Center and uses her insurance. Ms. Goodfox added that "The clinic is always here for you, but we encourage you to do it for yourself. It's a win-win situation. They win. We win. Everyone wins."

The Affordable Care Act is working for our tribal members and communities. Success stories can be found at almost every Service Unit. Set up an appointment with a Patient Benefits Coordinator, assister or Navigator to learn more about the Marketplace plan options. There is also at least one Certified Application Counselor at each IHS-operated facility that can help with the enrollment process. Finding the right plan brings security and peace of mind. Get covered today.

Deadlines for IHS Scholarship Applications are Fast Approaching Tuesday, January 12, 2016 ]]> The IHS Scholarship Program application cycle for the 2016 - 2017 academic year is now open. If you know a student who is seeking a career with a true purpose and mission, one willing to commit to working in Indian health communities where they can truly make a difference, we encourage you to direct their attention to this information on applying for an IHS scholarship.

Current scholarship recipients seeking to extend their scholarship support for the 2016 - 17 academic year must submit their online application and supporting documentation by February 28, 2016. New applicants seeking an IHS scholarship must submit their online application and supporting documentation by March 28, 2016. Please direct interested students to the IHS Scholarship Program website at where they can complete the application process.

Since IHS began providing scholarships to American Indian and Alaska Native students to pursue health profession careers in 1978, the program has grown to support, educate and place health care professionals within medically underserved Indian health programs throughout the continental United States and Alaska. We encourage students interested in pursuing a health career to join the nearly 7,000 American Indian and Alaska Native students who've already participated in the IHS Scholarship Program.

IHS offers three scholarship opportunities to American Indian and Alaska Native students at multiple levels of their college education. Whether they are enrolled in preparatory or prerequisite courses; matriculating toward a bachelor's degree in pre-medicine, pre-dentistry and other programs; or enrolled in undergraduate- and graduate-level courses that will lead to a health profession degree, our scholarships support their educational pursuits toward a meaningful career as a full-time clinician at an Indian health facility.

Please help us encourage interested health care students to apply for this unique scholastic opportunity which will benefit their career and increase the quality of care to our Native patients and communities.

Robert E. Pittman is a member of the Yankton Sioux Tribe and is the Acting Director for the IHS Scholarship Program and the Director of the Division of Health Professions Support in the Office of Human Resources. The Office of Human Resources is responsible for the coordination of recruitment and retention for the Indian Health Service.

Changes to the IHS RPMS Software Update release cycle Monday, January 11, 2016 ]]> The IHS constantly strives for improvement in the care we provide. This quest for improvement extends into the Information Technology products and services which we provide as well.

As part our quest for improvement, we are announcing a change from our previous RPMS Software update release practice. Beginning in 2016, the IHS Office of Information Technology has changed to a quarterly software release schedule as a departure from our past practice which was more centered on an Ad Hoc release schedule.

Establishing a software update release cycle is vital because it announces a timetable for when stakeholders can expect to get some functionality. It also creates a routine around which all teams at headquarters, Area Office and facility can align. Establishing a regular release schedule is considered an industry "best practice" and is part of a larger effort to improve our interaction with RPMS users and RPMS systems administrators, which we believe will make distributing and using RPMS software easier and provide a more consistent experience.

CDR Mark Rives is the Chief Information Officer for the Indian Health Service. He holds a Doctor of Science degree in Information Systems and Communications as well as a Master degree in Computer Information Systems.