Over the next couple of weeks, I’ll continue my series on the healthcare matrix for American Indians. Last week I covered the basics of the Indian Health Service. This week’s write-up is about something called “638’s”.
Tribes and Tribal Organizations can elect to administer healthcare services that normally would be administered by the IHS. This option is available under Public Law 93-638… a.k.a. the Indian Self Determination and Education Assistance Act of 1975. Under the Act, Tribes and Tribal Organizations can either: 1) Administer programs and services the IHS would otherwise provide (referred to as Title 1 Self-Determination Contracting); or 2) Assume control over health care programs and services that the IHS would otherwise provide (referred to as Title V Self-Determination Governance Compacting). Since the Public Law ends in the numbers 638 many people refer to facilities that operate under these provisions as “638’s”.
Tribes can choose to combine the options above based on their individual needs and circumstances. The IHS and Tribes and Tribal Organizations have negotiated numerous “638” self-governance compacts- in fact this program constitutes about 38% of the IHS budget ($1.5B). In Arizona, there are about 30 “638” facilities administered by various tribes or tribal entities. Here’s a listing of the “638’s” in AZ.
Next week I’ll cover Medicaid and Medicare options for American Indians.