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Indian Health Service The Federal Health Program for American Indians and Alaska Natives

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President Signs Fiscal Year 2006 Budget for Indian Health Service

The Indian Health Service (IHS) will have approximately $3.9 billion available in fiscal year (FY) 2006 to administer health care programs for American Indian and Alaska Native people. This is an increase of approximately $100 million, or about 2.7 percent, over fiscal 2005.

Approximately $3.1 billion of the funding comes from the FY 2006 IHS budget appropriation recently signed by President Bush, which includes an increase of approximately $91 million, or about 3 percent, over the FY 2005 budget appropriation. The remaining funding for the agency includes $6 million from staff quarters rentals; $648 million from private health insurance and Medicare/Medicare collections; and $150 million through the Special Diabetes Program for Indians congressional appropriation.

An estimated 1.8 million American Indians and Alaska Natives will be eligible for IHS services in 2006, a 1.6 percent increase over 2005. The FY 2006 budget increase will help provide health care services for an additional 29,000 people who are expected to seek IHS services in FY 2006, cover increased pay costs for the Federal and Tribal employees who provide these services, and respond to the rising cost of providing these services. Funds will go primarily to Clinical Services (operation of hospitals and clinics, and purchase of medical care), and to other IHS programs that are providing additional services and support functions.

The IHS is the agency of the Department of Health and Human Services (HHS) with primary responsibility for providing health care services to American Indians and Alaska Natives. The FY 2006 appropriated budget increase reflects the impact of the HHS policy of consulting with Tribes on budget decisions affecting their members, as well as the continuing Federal Government commitment to provide health service resources to members of federally recognized Tribes.

The budget includes an additional $32 million toward covering increased Federal employee pay costs and to allow tribally run health programs to provide comparable pay raises to their staffs.

A total of $38 million is included for health care facility construction. This amount will complete funding of staff quarters in Ft. Belknap, Mont.; begin construction of a replacement hospital in Barrow, Alaska; complete the design and initiate construction of a health center in Kayenta, Ariz.; complete the design of a health center in San Carlos, Ariz.; and begin the construction of an ambulatory care center supporting the Phoenix Indian Medical Center. In addition, $2 million is provided for dental units and $7 million to fund construction projects under the Small Ambulatory facilities program.

An additional $35 million is included to add staffing for six newly constructed health care facilities, which include Red Mesa, Ariz.; Sisseton, S.D.; Pinon, Ariz.; Idabel, Okla.; Coweta, Okla.; and St. Paul, Alaska. Tribes financed construction of two of these facilities, the Idabel and Coweta facilities, through the Joint Venture Program, saving the Federal Government $22 million in construction costs.

The FY 2006 appropriation includes $93 million for sanitation construction – an increase of $1.3 million, or 1.4 percent, over FY 2005, to provide safe water and waste disposal systems to an estimated 20,000 Indian homes. Approximately 88 percent of American Indian and Alaska Native homes have been provided safe and reliable water since the inception of the IHS sanitation construction program. The IHS credits its sanitation constructions program with playing a key role in long-term reductions in infant mortality, gastroenteritis, and other environmentally related diseases.

Tribes continue to increase the number of IHS programs they operate under the authority of the Indian Self- Determination and Education Assistance Act (Public Law 93-638, as amended). In FY 2006, Tribes will administer an estimated $1.6 billion, or approximately 53 percent, of the total IHS budget appropriation. To enable Tribes to develop the administrative infrastructure necessary to successfully manage these programs, the budget includes approximately $267 million for contract support costs, an increase of $3.7 million over FY 2005. The additional funds will be provided to Tribes and Tribal organizations to support continued contracting and compacting under P.L. 93-638, as amended.

The appropriation includes an additional $24 million for contract health service (CHS) costs, for a total of approximately $523 million. The IHS uses CHS funds to supplement the care provided in its own facilities by purchasing medical care from hospitals and health providers. These CHS funds pay for specialty care, including most types of surgery, and are used to purchase medical care for Tribes that do not have an IHS facility nearby.

While most IHS services are provided on or near reservations, approximately 1 percent of the budget is used to provide services to Indian people living in urban areas. The IHS 2006 budget provides $33 million to help support 34 Urban Indian health organizations that provide service in cities with large numbers of Indian people. Services provided vary from outreach, referral, and case management to comprehensive care, including ambulatory medical care; dental services; community education; alcohol and substance abuse prevention, treatment, and counseling; mental health counseling; and social services.

The budget includes $150 million for diabetes prevention and treatment grants. Through the Special Diabetes Program for Indians, the IHS has awarded $650 million in grants over the past 5 years to over 300 Tribes and Indian organizations to support diabetes prevention and disease management at the local level. This program has substantially increased the availability of services such as basic clinical exams, newer treatment medications and therapies, laboratory tests to assess diabetes control and complications, screening for diabetes and pre-diabetes, nutrition education, and physical fitness activities.

FY 2006 Proposed Budget Overview for the Indian Health Service (Dollars in thousands)

Type FY 2005 (Enacted) FY 2006 (Enacted) Change over FY 2005
Clinical Health Services
Hospitals & Health Clinics $1,289,418 $1,353,070 $63,652
Dental Health $109,023 $118,920 $9,897
Mental Health $55,060 $59,046 $3,986
Alcohol & Substance Abuse $139,073 $144,644 $5,571
Contract Health Services $498,068 $522,522 $24,454
Total, Clinical $2,090,642 $2,198,202 $107,560
Preventive Health Services
Public Health Nursing $45,015 $49,453 $4,438
Health Education $12,429 $13,721 $1,292
Community Health Reps. $51,365 $53,481 $2,116
Immunization AK $1,572 $1,637 $65
Total, Preventive $110,381 $118,292 $7,911
Other Services
Urban Health $31,816 $33,075 $1,259
Health Professions $30,392 $31,353 $961
Tribal Management $2,343 $2,418 $75
Direct Operations $61,649 $62,823 $1,174
Self-Governance $5,586 $5,725 $139
Contract Support Costs $263,683 $267,404 $3,721
Total, Health Services $2,596,492 $2,719,292 $122,800
Indian Health Facilities
Maintenance & Improvement $49,204 $52,155 $2,951
Sanitation Facilities $91,767 $93,074 $1,307
Health Care Facilities Construction $88,597 $38,160 ($50,437)
Facilities & Environmental Health Support $141,669 $152,231 $10,562
Medical Equipment $17,337 $21,159 $3,822
Total, Facilities $388,574 $356,779 ($31,795)
TOTAL PROPOSED BUDGET AUTHORITY $2,985,066 $3,076,071 $91,005
Insurance (Medicare/Medicaid/Private) $632,829(est) $641,920(est) $9,091(est)
Staff Housing $6,200 $6,288 $88
Allocations from Other Sources
Special Diabetes Program for Indians $150,000 $150,000 $0
TOTAL PROGRAM LEVEL $3,774,095 $3,874,279 $100,184