Document Type



Purpose This report was prepared in response to Section 719 of Public Law (P.L.) 100-713, the Indian Health Care Amendments of 1988. Section 719 requires the Secretary of the Department of Health and Human Services (DHHS), through the Indian Health Service (IHS), to conduct a study to determine the impact of the eligibility regulations published as a final rule on September 16, 1987. The regulations changed the eligibility criteria for health care services provided by the IHS. The overall goal of this study was to determine the anticipated impact of the Final Rule on reservation, urban Indian and Alaska Native populations. Methods The study design called for three distinct data collection efforts: 1) Tribal consultation; 2) case studies of six geographically and culturally diverse tribes; and 3) a sample survey of IHS users. Tribal consultation efforts focused on the determination of concerns about the study and positions concerning the impact of the Final Rule expressed by participating tribal leaders and urban Indian program representatives. The tribes selected for case studies were: 1) Confederated Tribes of Warm Springs; 2) Laguna Pueblo; 3) Winnebago Tribe; 4) St. Regis Mohawk; 5) Miami Tribe of Oklahoma; and 6) Nondalton Village, Alaska. A total of 1,736 IHS users were selected as the sample. Results Specific findings of the study are presented in the following areas: 1) full participation and consultation with Indian and Alaska Native Tribal governments and representatives of urban Indian health care programs; 2) number of American Indians by IHS Service Area who are currently eligible for IHS services; 3) number of American Indians and Alaska Natives who would be eligible for IHS health care if the Final Rule were implemented; 4) final impact of the the Final Rule on the contract health care budget and the clinical budget of the IHS; 5) impact of the Final Rule on the social, cultural, economic, and health status of reservation and urban Indian populations; 6) alternative services and programs available to those persons who will lose eligibility for IHS health care services under the Final Rule; 7) program changes the IHS would be required to make if the Final Rule is implemented - training, resource allocation, and community health. Conclusion If the Final Rule were implemented in 1995, between 261,000 and 283,000 current IHS beneficiaries would lose eligibility under the Final Rule. Prior federal policies have negatively affected the ability of many Indians to establish tribal membership. The Final Rule will compound past errors with the loss of eligibility for IHS services. The impact of implementing the Final Rule on American Indian and Alaska Native communities is uncertain; nevertheless, the likely results include a decrease in economic resources, increased social conflict, increased mortality and morbidity. The Final Rule can and should be modified to accomodate the problems identified in the study.

Publication Date



Indian Health Service, Staff Officer of Planning, Evaluation and Research, Rockville, MD 20857.