Indian Health Service

Since 1955, the Indian Health Service (IHS), an agency within the U.S. Department of Health and Human Services, has had the responsibility of providing federal health services to American Indian and Alaska Native peoples. The health services provided include medical, dental, and environmental health programs. The provision of health services to federally recognized Indians grew out of a special relationship between the federal government and Indian tribes. This government-to-government relationship is based on Article 1, Section 8 of the U.S. Constitution and has been given form and substance by a number of treaties, laws, Supreme Court decisions, and executive orders.

The IHS comprises 12 regional administrative units called area offices, which are located in areas of highest Indian concentration. The area offices consist of 155 service units, 92 of which are operated by tribes. The IHS operates 36 hospitals, 59 health clinics, two school health centers, and 49 health stations. Tribes have the option of exercising self-determination by taking over the operation of an IHS facility through a Title I contract (P.L. 93–638) or Title V self-governance compact (P.L. 93–638). The 1975 Indian Self-Determination Act built on IHS policy by giving tribes the option of staffing and managing IHS programs in their communities and providing funding for the improvement of tribal capacity to contract under the act.

In fiscal year 2001, the IHS user population, which counts American Indians and Alaska Natives who used IHS services at least once during the prior three years, was more than 1.3 million.

[Page 244]Indian people using IHS hospitals and clinics must be members of a federally recognized tribe and have a Certificate of Degree of Indian Blood (CDIB), which is issued by the tribe of which the person is a member. Medical services are limited to those with a CDIB. However, if a patient is married to a non-Indian, his or her spouse may be seen for counseling, but other medical services may be with held from the non-Indian spouse.