This text discusses the Eastern Shoshone Tribe’s takeover of the Indian Health Service (IHS) clinic on their reservation. The tribe had been preparing to take over management of the clinic since 2019 but was delayed by the pandemic. The pandemic also highlighted the need for local control, as the tribe faced challenges with COVID-19 testing and vaccinations, hiring and retaining health care workers, and providing care for sick tribal members.This text discusses the Eastern Shoshone Tribe’s takeover of the Indian Health Service (IHS) clinic on their reservation. The tribe had been preparing to take over management of the clinic since 2019 but was delayed by the pandemic. The pandemic also highlighted the need for local control, as the tribe faced challenges with COVID-19 testing and vaccinations, hiring and retaining health care workers, and providing care for sick tribal members. The tribe secured approval to take over management of the clinic through a 638 self-governance compact with the IHS. This will give the tribe control over clinic staffing, specialty care, and which patients to treat. The tribe aims to make the clinic accessible to everyone, regardless of enrollment or Native American status. The ability to bill more patients, particularly those with private insurance, will benefit the clinic’s profitability and allow for the expansion and improvement of health care services. Tribes have the right to health care provided by the IHS as part of the federal government’s trust and treaty responsibility. More than half of tribes choose to use federal funds to manage health care operations locally. This has proven to be effective, as tribes have shown better responsiveness and decision-making. A recent Supreme Court decision will open the door for more tribes to take control of IHS clinics and hospitals, as the federal government will be responsible for more of the administrative costs incurred. However, the Indian Health Service faces significant funding challenges. It received less than $7 billion in funding in 2024, while advocates estimate that $51 billion would be needed to effectively meet Native health care needs and trust and treaty obligations. Congress has options to free up more federal dollars or make cuts to other parts of the IHS budget. The Eastern Shoshone Tribe plans to use the additional funding to expand services, build new facilities, provide more transportation support, and hire specialized doctors. The tribe believes that proper compensation will help them improve health care and address the needs of their community.
In 2019, the Eastern Shoshone Tribe in central Wyoming began preparing to take over management of the Indian Health Service clinic that served its community. Those plans were delayed by the pandemic, however, which also provided a stark reminder of why the tribe wanted local control of the clinic in the first place.
“We had challenges,” said John St. Clair, chairman of the tribe’s operating council, including issues with conducting COVID-19 testing and vaccinations, hiring and retaining health care workers and providing the care needed by sick tribal members.
“The biggest obstacle was the Indian Health Service,” St. Clair said. “It wasn’t necessarily the management, it was just the bureaucracy they had to go through.”
The Indian Health Service did not respond to a request for comment about the pandemic response on the Eastern Shoshone Tribe’s Wind River Reservation.
The tribe could have bypassed the bureaucracy if they had run the clinic themselves. So the works council prepared an application to take over management through a 638 self-governance compact with the IHS. The application was approved, and as of July 1, the Eastern Shoshone Tribe will decide for itself what happens when it comes to clinic staffing, specialty care, and which patients to treat.
“We’re going to make our clinic so that anyone can use it,” St. Clair said. “It doesn’t matter if they’re enrolled or not enrolled or even a Native person.”
According to St. Clair, the ability to bill more patients, particularly those with private insurance, will benefit the clinic’s profitability and expand and improve health care services.
Tribes have the right to health care provided directly by the Indian Health Service. This is part of the federal government’s constitutional trust and treaty responsibility to tribes.
According to the Self-Governance Communication and Education Tribal Consortium, more than half choose to use the federal funds set aside for their health care and manage operations locally.
“We’ve shown that when (tribes) have control, we do much better,” said Ron Allen, chairman of that consortium and of the Jamestown S’klallam Tribe. “We seem to be able to respond faster. We can make decisions faster.”
Allen said a recent U.S. Supreme Court decision will open the door for more tribes to take control of IHS clinics and hospitals. In Becerra v. San Carlos Apache Tribe , the Supreme Court justices held the federal government responsible for more of the administrative costs these tribes incur, including when the tribes bill Medicaid, Medicare and private insurers.
“And it’s a big amount,” Allen said of the administrative costs. “It’s a very large part of the budgets of tribal clinics and hospitals.”
Federal government lawyers estimate that tribal health systems spend between $800 million and $2 billion annually on such overhead costs.
“So (the Supreme Court decision) was a great encouragement to the tribes,” Allen said.
And it’s a huge financial headache for the Indian Health Service, which now has to come up with that extra money.
“The bill that has to be paid is going to be huge,” on top of a huge existing deficit, said Elizabeth Reese, a law professor at Stanford University. “The Indian Health Service is just shamefully and shamefully underfunded.”
The agency received less than $7 billion in funding in 2024, compared to the $51 billion advocates estimate would be needed to effectively allow the IHS to meet Native health care needs and its trust and treaty obligations to tribes.
According to Reese, Congress has a number of options: It could free up more federal dollars to fund the IHS’s new mandate, allowing more overhead costs to be reimbursed.
“I’m obviously skeptical that knowing that Congress is fighting over money that we’re going to get there,” Reese said. She said it’s more likely that cuts will be made to other parts of the already tight IHS budget that pays for everything from facility maintenance to operations to health care.
Because, unlike most federal health care programs, the agency relies on discretionary funding.
“That means that funding is up for elimination every year,” Reese said. “Every year, the funding doesn’t automatically grow with inflation.”
In a statement, IHS urged Congress to shift the funding to the mandatory side of the federal budget to protect it from painful cuts. That’s how Medicare, Medicaid and the Children’s Health Insurance Program are funded.
St. Clair said proper compensation will help tribes like his improve health care.
“It comes at a good time for us,” St. Clair said. “We can expand our services right away. We can look at an ambulance, and the county and the tribes have been talking about that for a long time.”
Additionally, St. Clair said the tribe can get to work building new facilities, providing more transportation support and hiring specialized doctors, improvements the Eastern Shoshone Tribe has been waiting for.
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