Fiscal Year 2010 Budget in Brief
Indian Health Service
(dollars in millions)
| 2008 | 2009 | 2009 | 2010 | 2010 |
Services | |||||
Clinical Services: | 3,228 | 85 | 3,424 | 3,748 | +324 |
Contract Health Services (non add) | 579 | -- | 634 | 779 | +145 |
Health Information Technology (non add) | -- | 85 | 3 | 16 | +14 |
Preventive Health | 128 | -- | 135 | 144 | +9 |
Contract Support Costs | 267 | -- | 282 | 389 | +107 |
Tribal Management/Self-Governance | 8 | -- | 9 | 9 | -- |
Urban Health | 35 | -- | 36 | 38 | +2 |
Indian Health Professions | 36 | -- | 38 | 41 | +3 |
Direct Operations | 64 | -- | 69 | 69 | +4 |
Diabetes Grants | 150 | -- | 150 | 150 | -- |
Subtotal, Services Program Level | 3,916 | 85 | 4,139 | 4,588 | +449 |
| |||||
Health Care Facilities Construction | 37 | 227 | 40 | 29 | -11 |
Sanitation Facilities Construction | 94 | 68 | 96 | 96 | -- |
Facilities & Environmental Health Support | 170 | -- | 178 | 193 | +15 |
Maintenance & Improvement | 59 | 100 | 60 | 60 | -- |
Medical Equipment | 21 | 20 | 22 | 23 | +1 |
Subtotal, Facilities Program Level | 381 | 415 | 396 | 401 | +5 |
Total, Program Level | 4,297 | 500 | 4,536 | 4,989 | +454 |
| |||||
Health Insurance Collections | -795 | -- | -799 | -799 | -- |
Rental of Staff Quarters | -6 | -- | -6 | -6 | -- |
Diabetes Grants 1/ | -150 | -- | -150 | -150 | -- |
Total, Budget Authority | 3,346 | 500 | 3,581 | 4,035 | +454 |
| 15,014 | -- | 15,144 | 15,254 | +110 |
1/ These funds were pre-appropriated in P.L. 107-360 and the Medicare, Medicaid, and SCHIP Extension Act of 2007.
*American Recovery and Reinvestment Act of 2009 (Recovery Act)
The Indian Health Service raises the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.
The FY 2010 Budget requests nearly $5 billion for the Indian Health Service (IHS), an increase of $454 million over FY 2009. The Budget request, which represents the largest proposed increase for the agency in the past 20 years, makes a crucial investment in the Indian health system to reduce the disparities experienced by American Indians and Alaska Natives. The Budget will provide funds to improve the Indian health system. IHS, in partnership with Tribes, provides primary care, behavioral and community health, and sanitation services for a growing population of eligible American Indians and Alaska Natives.
FULFILLING THE UNIQUE ROLE OF THE INDIAN HEALTH SERVICE
IHS provides comprehensive health services to members of more than 560 Federally recognized Tribes through direct services in 45 hospitals, 288 health centers, and 313 health stations, school health centers, and Alaska village clinics. As part of the unique relationship between Tribes and the Federal Government, IHS provides American Indians and Alaska Natives with preventive health care and direct medical care, and contracts with hospitals and health care providers outside the IHS system to purchase care it cannot provide through its own network. IHS works with Tribes to ensure their maximum participation in administering the programs that impact their communities. In addition to the provision of health care services, IHS activities include building sanitation systems to provide water and waste disposal for Indian homes; supporting Tribal self-governance through contract funding; and providing scholarships and loan repayment awards to recruit health professionals, including American Indians and Alaska Natives, to serve in areas with high provider vacancies.
Recovery Act
IHS received $68 million for Sanitation Facilities Construction, which will be used to build sanitation systems and provide American Indian and Alaska Native homes with potable water. In FY 2007, an estimated 36,000 American Indian and Alaska Native homes did not have access to a clean water supply.
Using Recovery Act funds, IHS estimates it will provide approximately 16,000 homes with safe, potable water, access to which can significantly reduce the incidence of gastroenteritis and other serious environmentally-related diseases.
Reducing Resource Disparities in Service Provision: The Budget includes approximately $45 million for the Indian Health Care Improvement Fund, a significant investment aimed at creating parity in funding among service sites. Providing additional funds to service sites with the greatest resource deficiencies will help ensure that all eligible American Indians and Alaska Natives have access to quality health care.
STRENGTHENING THE INDIAN HEALTH SYSTEM
The Budget includes several increases to support and expand the provision of health care services and public health programs for American Indians and Alaska Natives, as well as building on the resources provided in the American Recovery and Reinvestment Act of 2009.
Population Growth and the Cost of Providing Care: The FY 2010 Budget request reflects a sustained investment in providing care to a growing population of American Indians and Alaska Natives. The Indian population is growing at a faster rate than the U.S. population as a whole, and the IHS service population is expected to increase by 1.5 percent in FY 2010. These increases are coupled with the rising cost of health care and salaries for Federal and Tribal employees who provide needed health services in often remote areas. The FY 2010 Budget includes $141 million to cover pay, population growth, and inflation.
Ensuring Access to Care
The FY 2010 Budget includes a significant increase to cover the cost of care purchased outside the IHS system, as part of the commitment to strengthen the Indian health system with sustained investments that improve health outcomes and expand access to care for American Indians and Alaska Natives.
In FY 2007, there were 35,154 Contract Health Services cases that could not be funded, often causing patients to delay or defer needed medical treatment or cover costly procedures out of pocket. The FY 2010 Budget request provides $779 million to cover the cost of patients receiving care they need outside the Indian health system.
Contract Health Services: IHS purchases health care from outside the IHS system in cases where no IHS-funded direct care facility exists, the direct care facility cannot provide the required emergency or specialty services, or the facility has more demand for services than it can meet. The Budget includes $779 million, an increase of $145 million, for the purchase of medical care, including essential services such as inpatient and outpatient care, routine and emergency care, and medical support services, such as diagnostic imaging, physical therapy, and laboratory services. These funds are crucial to covering the cost of care for injuries, heart disease, digestive diseases, and cancer, some of the leading causes of death among American Indians and Alaska Natives.
Health Information Technology: IHS has been a recognized leader in health information technology and continues to develop and deploy innovative health IT tools that improve the lives of individual patients, populations and communities. The FY 2010 Budget includes $16 million to support administrative oversight and system maintenance requirements for the IHS health IT program, including the Resource and Patient Management System and the IHS electronic health record (EHR). These funds, used in conjunction with $85 million for Health IT provided in the Recovery Act, will allow IHS to invest in an expanding set of tools that enable and facilitate quality health care delivery through the utilization of information technology.
Construction: The Budget includes $29 million for Health Care Facilities Construction to continue construction of a hospital in Barrow, Alaska and two outpatient facilities in San Carlos and Kayenta, Arizona. Once completed, these facilities will serve a combined projected annual user population of 34,854 patients. The FY 2010 Budget builds upon $227 million provided in the Recovery Act to complete a hospital in Nome, Alaska, and an outpatient facility in Eagle Butte, South Dakota. The budget for facilities construction focuses on projects that have already been initiated.
Staffing New and Renovated Health Facilities: Construction and renovation funds for IHS health facilities have been targeted to expand services at sites experiencing overcrowding. These expansions require new staff and operating support. An additional $27 million is included in the FY 2010 Budget to support staffing and operating costs for four new or expanded facilities to be completed in FY 2010. These facilities include a hospital expansion in Ada, Oklahoma, and three health centers. All four facilities are joint venture projects, where IHS partners with a Tribal entity to provide funds for staffing, equipping, and operating a facility, and participating Tribes cover the costs of design and construction. When these facilities are fully operational, they will be able to meet the increasing demand for services at their sites, where the existing capacity is overextended.
Health Insurance Reimbursements: IHS facilities rely on the collection of third party resources for as much as 50 percent of their operating budgets. In FY 2010, IHS estimates it will receive approximately $799 million in health insurance reimbursements for the provision of care to people covered by Medicare, Medicaid, and private insurers. These funds are essential for covering the costs of hiring additional medical staff, purchasing equipment, making necessary building improvements, and maintaining accreditation standards.
Performance Highlight
Depression is often a factor contributing to suicide, domestic and intimate partner violence, and alcohol and substance abuse. Early identification allows providers to plan interventions and treatment to reduce the impact of depression, including the reduction of suicide rates, which are disproportionately high in Indian communities. In order to improve the mental health and well-being of American Indians and Alaska Natives, IHS increased the proportion of patients aged 18 and older who are screened for depression from 24 percent in FY 2007 to 35 percent in FY 2008.
SUPPORTING INDIAN SELF-DETERMINATION
IHS recognizes that Tribes and Tribal organizations are the most knowledgeable about the type of services needed in their own communities, and that the planning and delivery of health services at the local level ensures effective, quality health care. More than 54 percent of the IHS budget is administered by Tribes through the authority provided to them under the Indian Self-Determination and Education Assistance Act of 1975. The Act allows Tribes to assume the administration of programs that were previously carried out by the Federal Government.
Contract Support Costs: The Budget includes $389 million for contract support costs, an increase of $107 million. Contract support costs are defined as reasonable costs for activities that enable Tribes to develop the infrastructure needed to administer Federal programs. These funds provide Tribes with additional support in the operation of their own health programs. This investment will allow IHS to increase funding significantly to Tribes with existing self-determination agreements in order to ensure they have the resources they need to successfully manage programs at the local level.
Consultation: One of the key components of the government to government relationship with Tribes is consultation, in which Tribal governments and organizations play an integral role in the agency’s budget and policy decision-making processes. In addition to extensive solicitation of Tribal input used to determine the way IHS operates at the local, area, and national level, HHS holds an annual department-wide budget consultation. This process gives Tribal leaders the opportunity to express their budget priorities, and continues to affirm the unique political and legal partnership between Tribes and the Federal Government.