On July 15, 2014, the House Appropriations Committee marked up its FY 2015 Interior, Environment and Related Agencies appropriations bill (HR 5171; H. Rept. 113-551). We report here on the House Committee recommendations for the Indian Health Service (IHS). Prospects for the bill coming to the House floor are uncertain and on the Senate side the appropriations process is stalled. At this point it looks likely that most, if not all, federal agencies’ FY 2015 activities will be funded by a Continuing Resolution (CR) until after the November elections with a longer term bill being finalized during a lame duck session of Congress. Should the election result in a Republican majority in the Senate, a CR might run into next year, enabling a new Congress to enact the final FY 2015 appropriations bill(s). Nevertheless, the House Committee recommendations will influence negotiations with the Senate on a final bill.
During the markup sessions of the Interior Appropriations bill, Members of both parties emphasized that the increased funding levels for Indian programs had bipartisan support. The same could not be said for much of the rest of the bill. The main points of contention in the bill are the proposed nine percent cut to the Environmental Protection Agency (EPA) budget and the large number of policy riders that would restrict activities of the EPA. House and Senate Democrats will oppose these provisions, as will the Administration.
The House Committee accepted the Obama Administration’s budget proposal for the IHS and proposed an additional $8.2 million over the requested level. Funding is recommended to meet the estimated amount needed to fully fund contract support costs (CSC) with instructions to IHS and BIA to request a reprogramming of funds if the amount is not sufficient. The bill would provide $197.5 million over the FY 2014 enacted level for the IHS. As mentioned above, the Committee proposes a large reduction to the EPA budget, a proposal which will be resisted by the Senate, and so maintaining the proposed IHS and other increases will be challenging.
As expected, the House Committee did not provide funding for the Administration’s Opportunity, Growth, and Security Initiative which would have provided $56 billion equally divided between defense and nondefense spending. The Administration had proposed
$200 million of this amount for construction of health care facilities on the IHS priority list.
Increases over FY 2014 Enacted. Consistent with the Administration’s proposal are increases over FY 2014 of: $63 million for medical inflation; $2.6 million for one percent pay cost increases at the IHS and tribal service delivery level; $70.8 million for staffing of new facilities; $7.9 million to partially fund five newly recognized tribes ($171,000 less than the Administration’s request); $18 million program increase for Purchased/Referred Care;
$29.8 million to fund the estimated full amount for CSC; and $10 million to restore funding taken from the following programs in FY 2014 in order to accommodate needed CSC costs:
$5 million for Indian Health Profession; $1 million for Tribal Management; $1 million for Self-Governance; and $3 million for the Director’s Emergency Fund.
Increases over the Administration’s request are $500,000 for a dental program in Bureau of Indian Education schools; $2.9 million for Urban Indian Health; and $5 million for Indian Health Professions.
Staffing of New Facilities. Consistent with the Administration’s proposal, the bill would provide (in the Services and Facilities accounts combined) $70.8 million for staffing and operations costs for the following new facilities: San Carlos Health Center ($28.4 million); Southern California Youth Treatment Center ($3.2 million); Choctaw (MS) Alternative Rural Health Care Center ($10.9 million); and Kayenta Alternative Rural Healthcare Center ($28.3 million). The Committee Report cautions: “Funds are limited to facilities funded through the Health Care Facilities Construction Priority System or the Joint Venture Construction Program that are newly opened in fiscal year 2014 or that open in fiscal year 2015. None of the funds may be allocated to a facility until such facility has achieved beneficial occupancy status.”
Partial Funding for Built-in Costs. The Administration did not request, nor did the House Committee recommend, funding for non-medical inflation or population growth. The $2.6 million for the one percent pay increase will not cover the full cost, estimated to be $20 million.
Contract Support Costs. The bill contains no cap on CSC spending, but the accompanying Committee Report recommends $617,205,000 for IHS, the same amount requested by the Administration and estimated to fully fund CSC. Should this amount be insufficient, the IHS is to submit a reprogramming request.
The bill, as requested by the Administration, provides that no FY 2014 or FY 2015 CSC funds may be used by the IHS or the BIA to pay prior year contract support costs or to repay the Judgment Fund for judgments or settlements related to past-year CSC claims.
Finally, the bill, consistent with the Interior appropriations acts for FYs 1999-2014, attempts to limit the ability of the IHS and BIA to fund past-year shortfalls in CSC funding from remaining unobligated balances for those fiscal years. This provision has been included in the appropriations acts for many years and has not precluded recovery on past-year CSC claims.
Please see the Contract Support Costs section elsewhere in this Memorandum for the text of the CSC Committee Report and bill language.
IDEA Data Collection Language. The bill would continue to authorize the BIA to collect data from the IHS and tribes regarding disabled children in order to assist with the implementation of the Individuals with Disabilities Education Act (IDEA):
Provided further, That the Bureau of Indian Affairs may collect from the Indian Health Service and tribes and tribal organizations operating health facilities pursuant to Public Law 93-638 such individually identifiable health information relating to disabled children as may be necessary for the purpose of carrying out its functions under the Individuals with Disabilities Education Act. (20 U.S.C. 1400, et. seq.)
Prohibition on Implementing Eligibility Regulations. The prohibition on the implementation of the eligibility regulations, published September 16, 1987, would be continued.
Services for non-Indians. The provision that allows the IHS and tribal facilities to extend health care services to non-Indians, subject to charges, would be continued. The provision states:
Provided, That in accordance with the provisions of the Indian Health Care Improvement Act, non-Indian patients may be extended health care at all tribally administered or Indian Health Service facilities, subject to charges, and the proceeds along with funds recovered under the Federal Medical Care Recovery Act (42 U.S.C. 2651-2653) shall be credited to the account of the facility providing the service and shall be available without fiscal year limitation.
Assessments by DHHS. The bill would continue the provision that has been in Interior appropriations acts for a number of years which provides that no IHS funds may be used for any assessments or charges by the Department of Health and Human Services “unless identified in the budget justification and provided in this Act, or approved by the House and Senate Committees on Appropriations through the reprogramming process.”
Limitation on No-Bid Contracts. The bill would continue the provision regarding the use of no-bid contracts. The provision specifically exempts Indian Self-Determination agreements and reads:
Sec. 413. None of the funds appropriated or otherwise made available by this Act to executive branch agencies may be used to enter into any Federal contract unless such contract is entered into in accordance with the requirements of the Chapter 33 of title 41 United States or chapter 137 of title 10, United States Code, and the Federal Acquisition Regulations, unless:
(1) Federal law specifically authorizes a contract to be entered into without regard for these requirements, including formula grants for States, or federally recognized Indian tribes; or
(2) such contract is authorized by the Indian Self-Determination and Education and Assistance Act (Public Law 93-638, 25 U.S.C. 450 et seq., as amended) or by any other Federal laws that specifically authorize a contract within an Indian tribe as defined in section 4(e) of that Act (25 U.S.C. 450b(e)); or
(3) Such contract was awarded prior to the date of enactment of this Act.
FUNDING FOR INDIAN HEALTH SERVICES
FY 2014 Enacted $3,982,842,000
FY 2015 Admin. Request $4,172,182,000
FY 2015 House Committee $4,180,386,000
Definition of Indian. The House Committee acknowledges the problems caused by various definitions of “Indian” and urges the Department of Health and Human Services, the IHS, and the Treasury Department to work together to establish a consistent definition of Indian with regard to health care. The Committee Report states:
The Committee recognizes the Federal government’s trust responsibility for providing healthcare for American Indians and Alaska Natives. The Committee is aware that the definition of who is an “Indian” is inconsistent across various Federal health programs, which has led to confusion, increased paperwork and even differing determinations of health benefits within Indian families themselves. The Committee therefore directs the Department of Health and Human Services, the Indian Health Service, and the Department of the Treasury to work together to establish a consistent definition of an “Indian” for purposes of providing health benefits.
SPECIAL DIABETES PROGRAM FOR INDIANS
While the entitlement funding for the Special Diabetes Program for Indians (SDPI) is not part of the IHS appropriations process, those funds are administered through the IHS. The SDPI is currently funded through FY 2015 at $150 million, minus a two percent reduction ($3 million) due to the sequestration of non-exempt mandatory programs. (PL 112-240).
HOSPITALS AND CLINICS
FY 2014 Enacted $1,790,904,000
FY 2015 Admin. Request $1,862,501,000
FY 2015 House Committee $1,857,625,000
Included in the total is $20.8 million for medical inflation; $2.57 million for pay cost increase; $41.6 million for staffing of new facilities; $3.6 million for newly-recognized tribes; $3 million restoration to the Director’s Emergency Fund; $4.7 million for epidemiology centers; $172 million for Health Information Technology; and recurring funding of $8.9 million for the domestic violence prevention initiative.
What appears as a House Committee recommendation of $4.8 million below the Administration’s requested amount is a transfer of loan repayment funds to the Health Professionals account, thus consolidating all loan repayment funds into one line item.
The House Committee directs IHS to address the need for more health care volunteers by implementing a simplified and centralized credentialing process. The Committee Report states:
Because IHS faces a health care provider shortage of 1,500 professionals, the Committee directs the Service to expeditiously convene a meeting of interested Tribes and health care organizations to design a pilot program to address credentialing problems and report the results to the Committee within 180 days of the enactment of this Act.
FY 2014 Enacted $165,290,000
FY 2015 Admin. Request $175,654,000
FY 2105 House Committee $176,154,000
Included in the total is $1.67 million for medical inflation, $8.2 million for staffing of new facilities, and $468,000 for newly-recognized tribes. The $500,000 increase recommended by the House Committee is for an initiative to increase preventive dental care in Bureau of Indian Education (BIE)-funded elementary schools by bringing dentists and hygienists into the schools. The IHS and the BIE are directed to consult with tribes about the piloting of this initiative.
The Committee directs the IHS “to work toward completion of electronic dental records (EDR) at the remaining 80 of 230 Federal and tribal dental sites.”
FY 2014 Enacted $77,980,000
FY 2015 Admin. Request $82,025,000
FY 2015 House Committee $82,025,000
Included in the total is $880,000 for medical inflation, $2.8 million for staffing of new facilities, and $319,000 for newly-recognized tribes.
ALCOHOL AND SUBSTANCE ABUSE
FY 2014 Enacted $186,378,000
FY 2015 Admin. Request $193,824,000
FY 2015 House Committee $193,824,000
Included in the total is $2.8 million for medical inflation, $4.3 million for staffing of new facilities, and $289,000 for newly-recognized tribes.
Recurring funding of $15.5 million for the Meth/Suicide Prevention and Treatment Initiative is included.
(Formerly Contract Health Services)
FY 2014 Enacted $878,575,000
FY 2015 Admin. Request $929,041,000
FY 2015 House Committee $929,041,000
Included in the funding is $51.5 million for the Catastrophic Health Emergency Fund, the same as FY 2014. The $50 million increase over FY 2014 consists of $32.5 million for medical inflation, $2.6 million for newly-recognized tribes and a program increase of $15.4 million.
The Committee, noting that the IHS and tribes must prioritize care under this program (Levels I-V), encourages them to measure the impact of funding increases at each level of care.
Medicare-like Rates Legislation Encouraged. The Administration has proposed that tribes, the IHS, and urban Indian organizations utilizing the Purchased/Referred Care program be charged Medicare-like rates for non-hospital services, thus stretching the funding for Purchased/Referred Care. Medicare-like rates are currently required for hospital services. A 2013 Government Accountability Office report concluded that IHS and tribal facilities would save millions of dollars and be able to increase care if the Medicare-like rate cap was imposed on non-hospital providers and suppliers through the Purchased/Referred Care program. The House Committee concurs and in its Report urges the IHS to “work aggressively with the relevant committees” to enact such authorizing legislation.
PUBLIC HEALTH NURSING
FY 2014 Enacted $70,909,000
FY 2015 Admin. Request $76,353,000
FY 2015 House Committee $76,353,000
Included in the funding is $713,000 for medical inflation, $4.5 million for staffing of new facilities, and $257,000 for newly-recognized tribes.
FY 2014 Enacted $17,001,000
FY 2015 Admin. Request $18,263,000
FY 2015 House Committee $18,263,000
Included in the funding is $237,000 for medical inflation, $861,000 for staffing of new facilities, and $164,000 for newly-recognized tribes.
COMMUNITY HEALTH REPRESENTATIVES
FY 2014 Enacted $58,345,000
FY 2015 Admin. Request $59,386,000
FY 2015 House Committee $59,386,000
Included in the funding is $917,000 for medical inflation and $124,000 for newly-recognized tribes.
HEPATITIS B and HAEMOPHILUS
IMMUNIZATION (Hib) PROGRAMS IN ALASKA
FY 2014 Enacted $1,826,000
FY 2015 Admin. Request $1,855,000
FY 2015 House Committee $1,855,000
Included in the funding is $29,000 for medical inflation.
The Budget Justification noted a need for data sharing agreements with tribal partners in order to access screening test results.
URBAN INDIAN HEALTH
FY 2014 Enacted $40,729,000
FY 2015 Admin. Request $41,375,000
FY 2015 House Committee $44,250,000
Citing the disparity in health funding for urban Indians, the Committee recommended $2.87 million above the requested level. Included is $646,000 for medical inflation.
INDIAN HEALTH PROFESSIONS
FY 2014 Enacted $33,466,000
FY 2015 Admin. Request $38,466,000
FY 2015 House Committee $48,342,000
The $14 million over the FY 2014 level recommended by the Committee consists of:
1) restoration of the $5 million taken from the program in FY 2014 in order to meet CSC needs; 2) a $4.8 million transfer of loan repayment funding from the Hospitals and Clinics line item, thus consolidating loan repayment funds in one line item; and 3) a $5 million program increase.
Programs funded under Indian Health Professions and their estimated FY 2015 amounts are: Health Professions Preparatory and Pre-Graduate Scholarships ($3.68 million); Health Professions Scholarships ($10 million); Extern Program ($1.11 million); Loan Repayment Program ($30 million); Quentin N. Burdick American Indians Into Nursing Program ($1.66 million – four grants); Indians Into Medicine Program ($1.09 million – three grants); and American Indians into Psychology ($717,078 – three grants).
Proposal to Exempt Scholarship and Loan Repayment Programs from Federal Taxes. The Administration proposed, as in past years, to make the IHS Health Professions Scholarship Program and Loan Repayment Program tax-exempt, thus freeing up funding now used to pay taxes on these benefits. The Committee agrees that such legislation should be enacted, noting that 25 percent of the Loan Repayment funds go to pay Federal tax liabilities and that in FY 2013 over 500 loan repayment applicants were turned away due to limited funds. The Committee suggests that the cost of such legislation might be offset by private collections:
The Committee encourages efforts to extend fair tax treatment of Federal scholarship and loan repayment programs to IHS-funded programs so that appropriated funds can help more applicants and further reduce vacancies. To that end, the Committee notes that IHS collected $85.3 million from private insurers in fiscal year 2013, which suggests that increased costs to the government to hire more IHS professionals by fairly adjusting the tax code are at least partially offset by private collections as a result of services provided by those newly-hired professionals. The Committee encourages IHS to re-submit its legislative proposal with the fiscal year 2016 budget and to include defensible estimate of offsets via third party collections.
Use of Defaulted Funds. The bill would continue the provision that allows funds collected on defaults from the Loan Repayment and Health Professions Scholarship programs to be used to recruit health professionals for Indian communities:
Provided further, That the amounts collected by the Federal Government as authorized by sections 104 and 108 of the Indian Health Care Improvement Act (25 U.S.C. 1613a and 1616a) during the preceding fiscal year for breach of contracts shall be deposited to the Fund authorized by section 108A of the Act (25 U.S.C. 1616a-1) and shall remain available until expended and, notwithstanding section 108A(c) of the Act (25 U.S.C. 1616a-1(c)), funds shall be available to make new awards under the loan repayment and scholarship programs under sections 104 and 108 of the Act (25 U.S.C. 1613a and 1616a)
FY 2014 Enacted $1,442,000
FY 2015 Admin. Request $2,442,000
FY 2015 House Committee $2,442,000
As requested by the Administration, the bill would restore the $1 million taken from the program in FY 2014 in order to meet CSC needs.
Funding would be for new and continuation grants for the purpose of evaluating the feasibility of contracting the IHS programs, developing tribal management capabilities, and evaluating health services. Funding priorities are, in order, 1) tribes that have received federal recognition or restoration within the past five years; 2) tribes/tribal organizations that are addressing audit material weaknesses; and 3) all other tribes/tribal organizations.
FY 2014 Enacted $67,894,000
FY 2015 Admin. Request $68,065,000
FY 2015 House Committee $67,894,000
The House Committee did not include the Administration’s request of $171,000 for newly-recognized tribes.
The IHS states in its budget submission that 56.5 percent of the Direct Operations budget would go to Headquarters and 43.5 percent to the 12 Area Offices. Tribal Shares funding for Title I contracts and Title V compacts are also included.
FY 2014 Enacted $4,727,000
FY 2015 Admin. Request $5,727,000
FY 2015 House Committee $5,727,000
As requested by the Administration, the bill would restore the $1 million taken from the program in FY 2014 in order to meet CSC needs.
The Self-Governance budget supports implementation of the IHS Tribal Self-Governance Program including funding required for Tribal Shares; oversight of the IHS Director’s Agency Lead negotiators; technical assistance on tribal consultation activities; analysis of Indian Health Care Improvement Act new authorities; and funding to support the activities of the IHS Director’s Tribal Self-Governance Advisory Committee.
The IHS estimates that in FY 2015, $1.6 billion will be transferred to tribes to support 89 ISDEAA Title V compacts and 114 funding agreements.
CONTRACT SUPPORT COSTS
FY 2014 Enacted $587,376,000
FY 2015 Admin. Request $617,205,000
FY 2015 House Committee $617,205,000
The bill contains no caps on CSC spending, but the accompanying Committee Report recommends $617,205,000 for IHS and $246,000,000 for BIA, the amounts requested by the Administration. Should those amounts be insufficient, the agencies are to submit a reprogramming request. The Report language reads as follows:
The Committee recommendation includes $167,205,000 as requested for full funding of the estimated support costs. The Committee expects IHS to submit a reprogramming request to the Committee if the final calculated contract support costs exceed this amount, in order to ensure that contract support costs are fully paid. The Committee recognizes that inconsistencies exist between Indian Affairs and IHS in the ways that contract support costs are estimated and managed, and encourages both the agencies and the Tribes to recommend ways that the Committee can be helpful in promoting consistency. Tribes that exercise their self-determination rights and enter into contracts with multiple Federal agencies shouldn’t have to navigate inconsistent rules across different agencies.
The BIA report language is substantively identical except for the recommended amount.
The bill, as requested by the Administration, provides that no FY 2014 or FY 2015 CSC funds may be used by the IHS or the BIA to pay prior year CSC or to repay the Judgment Fund for payment of judgments or settlements related to past-year CSC claims. For contract support costs, fiscal year 2015, the bill provides (Section 406 regarding FY 2014 is comparable):
Sec. 407. Amounts provided by this Act for fiscal year 2015 under the headings “Department of Health and Human Services, Indian Health Service, Indian Health Services” and “Department of the Interior, Bureau of Indian Affairs and Bureau of Indian Education, Operation of Indian Programs” are the only amounts available for contract support costs arising out of self-determination or self-governance contracts, grants, compacts, or annual funding agreements for fiscal year 2015 with the Bureau of Indian Affairs or the Indian Health Service: Provided, That such amounts provided by this Act are not available for payment of claims for contract support costs for prior years, or for repayments for settlements or judgments awarding contract support costs for prior years.
The bill, consistent with the Interior appropriations acts for FYs 1999-2014, attempts to limit the ability of the IHS and BIA to fund past-year shortfalls in CSC funding from remaining unobligated balances for those fiscal years. This provision has been included in the appropriations acts for many years and has not precluded recovery on past-year CSC claims.
Sec. 405. Notwithstanding any other provision of law, amounts appropriated to or otherwise designated in committee reports for the Bureau of Indian Affairs and the Indian Health Service by Public Laws 103-138, 103-332, 104-134, 104-208, 105-83, 105-277, 106-113, 106-291, 107-63, 108-7, 108-108, 108-447, 109-54, 109-289, division B and Continuing Appropriations Resolution, 2007 (division B of Public Law 109-289, as amended by Public Law 110-5 and 110-28), Public Laws 110-92, 110-116, 110-137, 110-149, 110-161, 110-329, 111-6, 111-8 and 111-88, 112-10, 112-74 and 113-6 for payments for contract support costs associated with self-determination or self-governance contracts, grants, compacts, or annual funding agreements with the Bureau of Indian Affairs or the Indian Health Service as funded by such Acts, are the total amounts available for fiscal years 1994 through 2013 for such purposes, except that for the Bureau of Indian Affairs, tribes and tribal organizations may use their tribal priority allocations for unmet contract support costs of ongoing contracts, grants, self-governance compacts or annual funding agreements.
FUNDING FOR INDIAN HEALTH FACILITIES
FY 2014 Enacted $451,673,000
FY 2015 Admin. Request $461,995,000
FY 2015 House Committee $461,995,000
MAINTENANCE AND IMPROVEMENT
FY 2014 Enacted $53,614,000
FY 2015 Admin. Request $53,614,000
FY 2015 House Committee $53,614,000
Maintenance and Improvement (M&I) funds are provided to Area Offices for distribution to projects in their regions. Funding is for the following purposes: 1) routine maintenance;
2) M&I Projects to reduce the backlog of maintenance; 3) environmental compliance; and
4) demolition of vacant or obsolete health care facilities. Of the funding requested, $50.1 million would be allocated to sustain the condition of federal and tribal healthcare facilities buildings;
$3 million for environmental compliance projects; and $500,000 for demolition projects.
FACILITIES AND ENVIRONMENTAL HEALTH SUPPORT
FY 2014 Enacted $211,051,000
FY 2015 Admin. Request $220,585,000
FY 2015 House Committee $220,585,000
Included in the funding is $973,000 for medical inflation, $8.5 million for staffing of new facilities, and $67,000 for newly-recognized tribes.
FY 2014 Enacted $22,537,000
FY 2015 Admin. Request $23,325,000
FY 2015 House Committee $23,325,000
Included in the funding is $788,000 for inflation. The IHS budget proposed to distribute the FY 2015 requested funds as follows: $17.3 million for new and routine replacement medical equipment at over 1,500 federally- and tribally-operated health care facilities; $5 million for new medical equipment in tribally-constructed health care facilities; and $500,000 each for the TRANSAM and ambulance programs.
Construction of Sanitation Facilities
FY 2014 Enacted $79,423,000
FY 2015 Admin. Request $79,423,000
FY 2015 House Committee $79,423,000
Four types of sanitation facilities projects are funded by the IHS: 1) projects to serve new or like-new housing; 2) projects to serve existing homes; 3) special projects such as studies, training, or other needs related to sanitation facilities construction; and 4) emergency projects. The IHS sanitation facilities construction funds cannot be used to provide sanitation facilities in HUD-built homes.
The IHS proposes to distribute up to $48 million to the Area Offices for prioritized projects to serve existing homes; up to $5 million for projects to clean up and replace open dumps on Indian lands; and $2 million would be reserved at IHS Headquarters ($1 million for special projects and emergency needs; $500,000 to collect homeowner data and demographic information in three IHS Areas; and $500,000 for improving data collection systems to help fund a Water Resource Center to develop teaching materials and techniques for homeowners and communities to support usage in a way that promotes health). The Water Resource Center is in partnership with the Alaska Native Tribal Health Consortium whose funding stream began in
FY 2012 with $250,000 and is expected to be funded for five years through FY 2016.
Remaining funding will be for new and like-new homes, including for sanitation facilities for homes of the disabled or sick with a physician referral, with priority for BIA Housing Improvement Projects.
Construction of Health Care Facilities
FY 2014 Enacted $85,048,000
FY 2015 Admin. Request $85,048,000
FY 2015 House Committee $85,048,000
The FY 2015 IHS health facility construction is proposed as follows:
• Kayenta Health Center in Kayenta, AZ – $18,869,000 to complete construction of the health care facility and staff quarters
• Northern California Regional Youth Treatment Center in Davis, CA – $17,161,000 for site preparation and to begin and complete construction of the treatment center
• Fort Yuma Health Center in Winterhaven, CA – $46,292,000 to begin and complete construction of the replacement health center which received design funding in 2008
• Gila River Southeast Health Center in Chandler, AZ – $2,726,000, to continue construction of the health center which received design funding in 2008 and initial construction funds in 2009.
TRANSAM Equipment, Ambulances, Demolition Fund. The bill would continue language to provide up to $500,000 to purchase TRANSAM equipment from the Department of Defense, $500,000 to be deposited in a Demolition Fund to be used for the demolition of vacant and obsolete federal buildings, and up to $2.7 million for the purchase of ambulances.
THIRD PARY COLLECTIONS
The IHS estimates a total IHS and tribal Medicare, Medicaid and private insurance collections of $1,196,961,000 in FY 2015.
Medicare $153 million federal; $64 million tribal
Medicaid $679 million federal; $172 million tribal
Private Insurance $90 million
Veterans Administration $39 million
The tribal Medicare and Medicaid numbers above are combination of estimates made by the Centers for Medicare and Medicaid and estimates of tribal collections due to direct billing between FY 2002 through FY 2013.
If we may provide additional information or assistance regarding FY 2015 Indian Health Service appropriations, please contact us at the information below.