Gaps Persist in Indian Health Service ‘Referred Care’ Program

Title

Gaps Persist in Indian Health Service ‘Referred Care’ Program: Native Americans Facing Barriers to Accessing Essential Healthcare

Introduction

Native Americans across the United States are entitled to free healthcare, but a critical program meant to bridge the gaps in medical services is falling far short. The Indian Health Service (IHS) 'Referred Care' program, designed to provide access to care when IHS facilities cannot meet the needs of patients, is severely hampered by resource shortages, complex rules, and administrative fumbles. This has resulted in tens of thousands of requests for funding being rejected each year, forcing patients to either forgo treatment or pay out-of-pocket for medical bills that are often daunting.

The Problem

In theory, Native Americans are entitled to free healthcare when the Indian Health Service foots the bill at its facilities or sites managed by tribes. However, in reality, the agency is chronically underfunded and understaffed, leading to limited medical services and making it difficult for patients to access care. The Purchased/Referred Care (PRC) program aims to fill these gaps by paying outside providers for services that patients might be unable to get through an agency-funded clinic or hospital, such as cancer treatment or pregnancy care.

Eligibility Requirements

Eligibility for the referred-care program depends on residency. Native Americans qualify if they live on tribal land, which accounts for only 13% of the population, or within their nation’s “delivery area,” usually including surrounding counties. Those who live in another tribe’s delivery area are eligible in limited cases, while Native Americans who live beyond such borders are excluded.

The Struggle for Funding

Despite the critical need for the referred-care program, funding remains a significant issue. Congress budgeted nearly $7 billion for the Indian Health Service this year, with roughly $1 billion set aside for referred-care. However, a committee of tribal health and government leaders has long advocated for funding recommendations that far exceed the agency’s budget. The latest report suggests that the Indian Health Service needs a staggering $63 billion to cover patients' needs for fiscal year 2026, including $10 billion specifically for referred care.

Real-Life Impacts

The consequences of these gaps are stark. Patients often face long delays and denials of care, which can have severe health implications. For example, Connie Brushbreaker, a 55-year-old patient from Rosebud, South Dakota, needed to see an orthopedic surgeon due to intense shoulder pain. However, hospital staffers initially refused, saying the unit only covered patients at imminent risk of dying. It wasn’t until months later, after an appeal, that Brushbreaker was approved for funding and underwent surgery in July.

Administrative Challenges

Resource shortages and complex rules severely impede access to the referral program. An estimated third of positions within the referred-care program were unfilled as of June. The agency is also grappling with administrative fumbles that slow down the process. Brendan White, an agency spokesperson, acknowledged these challenges and noted that about 83% of health units managed by the IHS were able to approve all eligible funding requests this year. The agency is actively working to improve prioritization and tackle staffing shortages.

Expanding Delivery Areas

In an effort to expand access, the Indian Health Service recently expanded some delivery areas to include more people. Additionally, the agency is studying whether it can afford to create statewide eligibility in the Dakotas.

Patient Experiences

Jonni Kroll of the Little Shell Tribe of Chippewa Indians of Montana does not qualify for the referred-care program because she lives nearly 400 miles from her tribe’s headquarters in Deer Park, Washington. She criticizes the current eligibility system, arguing it echoes old government policies meant to keep Indigenous people in one place, thereby limiting access to jobs, education, and healthcare.

Future Prospects

Enhanced funding could significantly address these gaps. The Fiscal Year 2023 President’s Budget proposed an historic increase in the IHS budget, which could fully address the funding gap and improve health outcomes for American Indians and Alaska Natives. Tribes are in favor of increased federal appropriations to meet unmet needs. This additional funding could help address staffing shortages, strengthen disease prevention programs, increase access to trauma-informed mental health and substance use disorder treatment, and modernize healthcare infrastructure.

Conclusion

The Indian Health Service 'Referred Care' program is a critical lifeline for many Native Americans. However, its shortcomings are well-documented and have severe health implications. By highlighting these gaps and advocating for increased funding, we can work towards ensuring that all Native Americans have access to the healthcare they deserve. The time to act is now to address the chronic underfunding and understaffing that plague this essential program.

References

• IHS Report on PRC Program
• Gaps in Indian Health Service Referred Care
• Healthcare Disparities Report
• Patients Suffer When IHS Doesn’t Pay for Outside Care