The IHS Urban Indian Health Program supports contracts and grants to 34 urban health programs funded under Title V of the Indian Health Care Improvement Act. Approximately 100,000 American Indians use 23 Title V Urban Indian health programs and are not able to access hospitals, health clinics, or Purchased/Referred Care (PRC) administered by IHS and tribal health programs because they either do not meet IHS eligibility criteria or reside outside of IHS and tribal service areas. Another 49,000 AI/AN use 11 Title V programs in cities that are located in IHS or tribal service delivery areas.
Recent studies on the urban AI/AN population documented poor health and revealed that the lack of adequate health care was a serious problem for most families. Since 1972, the IHS has gradually increased its support for health related activities in off-reservation settings aimed at assisting AI/AN populations to gain access to available health services, and also to develop direct health services when necessary.
In its 1992 amendments to the Indian Health Care Improvement Act, the Congress specifically declared the policy of the Nation "in fulfillment of its special responsibilities and legal obligations to the American Indian people to assure the highest possible health status for Indians and urban Indians and to provide all resources necessary to affect that policy."
The IHS addresses this responsibility by funding 34 urban Indian health organizations operating at 41 sites located in cities throughout the United States. Primary care clinics and outreach programs provide culturally acceptable, accessible, affordable, accountable, and available health services to an underserved urban off-reservation population.
The 34 programs engage in a variety of activities, ranging from the provision of outreach and referral services to the delivery of comprehensive ambulatory health care. Services currently include medical services, dental services, community services, alcohol and drug abuse prevention, education and treatment, AIDS and sexually transmitted disease education and prevention services, mental health services, nutrition education and counseling services, pharmacy services, health education, optometry services, social services, and home health care. Fifteen of the programs are designated as Federally Qualified Health Centers (FQHC) and provide services to Indians and non-Indians.
Ambulatory medical care services are provided throughout the off-reservation Indian health programs, including: prenatal and postpartum care; women's health; immunizations for both children and adults; pediatrics; chronic disease (geriatric health and diabetes) clinics; adult health; maintenance; acute medical care, infectious disease treatment and control (tuberculosis, sexually transmitted disease); and referral to specialized providers when needed.
Dental care services are provided by many programs, including direct patient care - preventative and restorative. Dental education and screening for both children and adults are provided in both the clinic and community settings. When needed, referrals are made to specialists for orthodontics, periodontics, selected restorative procedures, and oral surgery.
Community outreach services are provided throughout the urban off-reservation health programs, including: patient and community education; patient advocacy; outreach and referral; and transportation. The outreach worker serves an important function as a liaison between the off-reservation health program and the community, and works to make health services more available and accessible to those community members who need them.
Alcohol treatment services are provided at 10 off-reservation Indian sites that were originally funded by the National Institute of Alcohol Abuse and Alcoholism. Funds were transferred into the Urban Indian Health Program in FY 1993 to continue these Urban treatment centers under Title V of the Indian Health Care Improvement Act. At least 28 additional NIAAA programs are in the process of being transferred.
The AIDS and sexually transmitted disease (STD) information is provided at conferences, seminars, workshops, and community meetings at all of the IHS Title V funded off-reservation Indian health programs. These education and prevention services include culturally sensitive information provided to a variety of audiences through the use of posters, pamphlets, presentations, and community education. Additional AIDS services include HIV testing, pre- and post-test counseling, family support groups, and referral for additional treatment for AIDS if needed.
Mental health and social services include individual family and group counseling and support groups to address the problems of abuse, self-esteem, depression, and other emotional problems and conditions.
Additional services available at various off-reservation Indian health programs include primary and secondary prevention activities, i.e., diabetes, maternal and child health, women's health, men's health, nutrition education and counseling for prenatal care and chronic health conditions, social services, community health nursing and home health care, and other health promotion and disease prevention activities.
- The Urban Indian Health Program participates in line item increases as appropriated by Congress.
- The contracts and grants are awarded pursuant to a DHHS/IHS class Justification for Other than Full and Open Competition (JOFOC) for Title V, Urban Indian Contracts. The applicable statutes are the Snyder Act of 1921 (25 U.S.C., 13) and Title V of the Indian Health Care Improvement Act (PL 94-437), as amended. The JOFOC is also pursuant to Federal Acquisition Regulation 6.302-5 and 41 U.S. C., 253 (c) (5) and the use of set asides under the Buy Indian Act, 25 U.S.C., 47. Full and open competition need not be provided for when a statute expressly authorizes or requires that the acquisition be made from specified sources such as identified by Title V and pursuant to the Buy Indian Act.
- The Urban Indian Health Program line item is distributed through contracts and grants to the individual Urban Indian Health programs. The distribution is based upon the historical base funding of these programs.
- The funding level is estimated at 22% of the projected need for primary care services.
- Eighteen (18) additional cities have been identified as having an urban population large enough to support an Urban Indian Health Program.