Indian hospital funds run out quickly

By Jomay Steen, Journal Staff Writer | Thursday, October 27, 2005

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RAPID CITY - A board of tribal chairmen representing American Indian people from South Dakota, North Dakota, Nebraska and Iowa wants more health funding for Indians.

Officials estimate the Indian Health Service budget covers only 40 percent of medical need in Indian Country.

That means IHS runs out of money for medical procedures about half-way through the year and patients are denied payment for treatment or stuck with the bills.

Jesse Taken Alive, Standing Rock Sioux Tribe Council representative to the Aberdeen Area Tribal Chairmen’s Health Board, said people from the impoverished tribal communities on Standing Rock Indian Reservation who seek health care at the Indian Health Service hospital often have received services without understanding they could be responsible for a medical bill.

This happens when Indian Health Service hospitals, clinics and health centers funded through U.S. Department of Health and Human Services have spent their medical budgets for the year, usually by June in a given year. The IHS budget year runs from January to December.

When they operate without funding, the IHS hospitals or clinics submit bills for patient services to Contract Health Services, an IHS agency that ensures federal regulations are followed and distributes federal funds to the 13 IHS service units and 17 tribal programs in the Aberdeen area.

Contract Health reviews the bills on a case-by-case basis. Critical care such as for heart-attack patients or car-crash victims has the first priority for payment; a procedure such as knee-replacement surgery could be bumped back into the next budget cycle or simply denied. In some cases, grants might cover the less critical procedures. But if it’s not covered, officials said, patients need to find out before the procedure, or they will be liable for the bill.

“They’ve received the service, the CHS referral committee has issued a denial of payment and then he’s stuck for a bill,” Taken Alive said. “It’s so unfair.”

Taken Alive worries about those who lack resources, patient advocates or money to pay the bills. The systematic denial of payment has led many in his tribe to delay seeking care for serious health problems.

“The reality on the reservation is that people decide it’s easier not to get medical treatment,” he said.

On the first day of the three-day 19th annual Aberdeen Area Tribal Chairmen’s Health Board Consumer Conference this week, 100 American Indian health and tribal officials met at the Rushmore Plaza Holiday Inn in Rapid City.

John Blackhawk, Aberdeen Area Tribal Chairmen’s Health Board chairman, said what is immediately apparent at this year’s conference is the critical underfunding of Indian Health Services serving the Indian community.

But the IHS budget has remained the same for a decade, Blackhawk said.

Blackhawk said it is crucial that the tribes lobby congressional delegations from Nebraska, North Dakota, South Dakota and Iowa for more funding for their IHS health service units.

Terrance Veo, Cheyenne River Sioux Tribe health committee member and council representative, agreed.

“The fight is in Washington with budget appropriations,” Veo said.

Not only should the delegations support legislation for more funding, but Veo said the money received doesn’t go as far because of inflation and grant money is scarce.

“We have a lot of lobbying to do,” Veo said.

Flora Odegaard, CHS officer from the IHS Office of Resource Management in Aberdeen, said Contract Health Services has distributed an annual budget of $53 million, with $45.2 million going to Indian Health Service units and $7.8 million going to tribal programs.

Current funding is estimated to be 40 percent of what is needed, she said.

Odegaard said that the $53 million annual budget at one time met 60 percent of the need but that skyrocketing medical health costs have consumed the health units and clinic budgets.

In her session, “Don’t Get Sick After June,” Odegaard said that if medical funds were insufficient, then medical procedures for priority payment must be established by the tribes.

She said that not every Indian health facility runs at a loss but that those hospitals that operat within budget do so by proactively establishing the priorities of treatment.

“We’re trying to be the patient advocate, but a lot of the times, our hands are tied,” Odegaard said.

Contact Jomay Steen at 394-8418 or jomay.steen@rapidcityjournal.com