The Trump administration is touting its $50 billion Rural Health Innovation Program as the largest U.S. investment in rural health care. But the government has made minimal reference to Native American tribes, which are sparsely populated and in need of significant improvements in health care access.
Federally recognized tribes cannot apply directly for any portion of the Rural Health Fund, only from the state. And the state is not required to consider tribal needs. But state applications for five-year payments show that some states with significant Native American populations did so anyway.
Workforce development, technology upgrades and traditional healing are some of the initiatives targeting Native American communities included in applications from some states on Nov. 5 by the Centers for Medicare and Medicaid Services. The funds were a late addition to the One Big Beautiful Bill Act in response to concerns about the harm the Republican bill’s spending cuts would have on rural hospital finances.
some states, Including Idaho.nevada, and oregonIt is also considering setting aside 3 to 10 percent of federal payments for distribution to tribes. Washington proposed setting aside $20 million a year.
Federally recognized tribes have a direct relationship with the U.S. government, but state governments can also allocate resources to tribes and create policies that support tribal priorities. States and tribes share concerns about the impact the massive Republican budget bill signed by President Donald Trump in July will have on the U.S. health care system. The law is expected to reduce federal Medicaid spending by nearly $1 trillion and increase the number of uninsured people. About 10 million peopleAccording to KFF, a health information nonprofit that includes KFF Health News.
CMS spokeswoman Catherine Howden said states should develop applications in collaboration with key stakeholders, including the state’s tribal affairs office or tribal liaison, as well as “Indian health care providers, if applicable.” However, these organizations do not include tribal governments or official tribal representatives.
Tribes can apply for Rural Health Innovation Fund grants through their state. But in recent calls with federal health officials, tribal leaders expressed frustration at being seen as just another stakeholder in the issue rather than a sovereign nation. Tribal sovereignty guides most intergovernmental consultations on proposed federal actions that would have a significant impact on tribes.
“Even in scenarios where tribal consultation is required, the quality and quantity of tribal consultation by state is all over the place,” said Liz Malerba, director of policy and legislative affairs for the United South and Eastern Tribes Sovereignty Protection Fund, which advocates for tribal nations from Texas to Maine. Malerva is a citizen of the Mohegan tribe.
Federal policies work better when tribal nations can directly receive funding that supports essential services in their communities, Malerva said, adding that tribal leaders will likely vary significantly in the impact of programs on their communities.
there is 574 federally recognized tribes and Over 7 million Native Americans and Alaska Native populations face low life expectancy and low life expectancy. One of the poorest health outcomes When compared to other demographics. The Indian Health Service is a federal agency that provides health care to American Indians and Alaska Natives. Historically underfunded By Congress.
KFF Health News analyzed how 12 states with large Native American populations considered tribes when developing federal funding plans.
Idaho, washington, montanaand Arizona It was one of the states that held tribal consultations or listening sessions ahead of the Nov. 5 application deadline.
In states where tribes were not represented, some Native American leaders made sure their voices were heard in other public hearings. Jerilyn Church, CEO of the Great Plains Tribal Leaders’ Health Board, said she attended the October public meeting in South Dakota because she felt it was important for state leaders to consider how the program’s resources could be used on reservations. The state has nine federally recognized tribes, and Native Americans make up 9% of the population.
“I felt like we had to help be that advocate,” said Church, a citizen of the Cheyenne River Sioux Tribe.
In the proposed plan included in South Dakota’s application for rural funding: Identified Tribal Community Needs and funding for improved telehealth and doula programs. The state also said it will continue to meet with the Great Plains Tribal Health Commission throughout the five-year funding cycle.
In Oklahoma, where more than 14% of the population is Native American, tribal representatives were invited to weigh in with the rest of the public as the state gathered information for applications, details of which were not made public.
“We welcome all input from Oklahomans,” said Erica Rankin-Riley, a state health department spokeswoman.
north dakota Identify tribes in your state as partners It participated in the Rural Health Innovation Program and included initiatives such as expanding physician residency slots through tribal rotations and providing opportunities for farm-to-table food distribution. but Lawmakers there refused to support the proposal. It would have promised tribes 5% of their federal allocation. The state has five federally recognized tribes, and Native Americans make up nearly 5 percent of the population.
Some states have included proposals to fund high-priority initiatives for tribes.
Washington’s application The Rural Fund included initiatives focused on improving the health of Native American communities. Those goals include investments in workforce development for tribes, better coordination of care between tribes and rural hospitals, and $2.4 million annually to support Washington State University’s rural health education programs, including the Native Health Program.
Alaska’s Proposal Alaska Native village clinics included the integration of Native traditional healing. According to the application, this includes providing visits to traditional healing homes, hands-on training for healers, and traditional medicine training for health care providers and staff.
one of the following Five initiatives in Oregon It will support the state’s nine federally recognized tribes in improving health outcomes. The state estimates the plan will require $20 million annually, or 10 percent of the Rural Health Innovation Program grant.
Regardless of whether a state has identified funding for a tribe or included tribal priorities in its proposal, a tribe may apply to the state for a subgrant of Rural Health Transformation Program funds. Larger tribes with more resources, such as grant writers and staff to implement programs, may benefit, but smaller tribes may struggle to generate competitive applications.
Church said the Great Plains Tribal Leaders’ Health Board will know the fruits of its efforts when states are notified of their rural health funding allocations by the end of the year.
“I hope that through the work we’ve done, the advocacy we’ve done, the outreach we’ve done, resources will be brought to our tribe,” Church said.
KFF Health News South Dakota correspondent Arielle Zionts contributed to this report.
