WASHINGTON, DC—The president is asking for over $4.4 billion in discretionary budget authority for the IHS. Overall, the budget request is 9% over the FY 2010 enacted level.

Among the programs that would experience an increase under the proposed budget is Contract Health Services (CHS). The administration is proposing an $84 million dollar increase to this program. CHS pays for health care services for beneficiaries when care is provided from outside the IHS system in cases where no IHS-funded direct care facility exists; the direct care facility cannot provide the required emergency or specialty services; or the facility has more demand for services than it can meet.

Tribal reservations have complained over the years that funding for CHS often runs out early in the fiscal year, resulting in delayed necessary surgeries or payments for care that the federal government should be funding. In FY 2008, there were 35,953 CHS cases that could not be funded that resulted in patients either delaying or deferring care, or covering the costs themselves, according to the administration.

At a Senate Indian Affairs hearing on funding for Indian programs, Sen Tom Udall, D-NM, called proposed increases to CHS, along with the proposed additional $40 million for Contract Support Costs, “very positive things in this budget.”

Senate Indian Affairs Committee Examines Budget

Testifying before the committee, IHS Director Dr Yvette Roubideaux said that tribes have indicated that they are concerned with how IHS conducts business. “We still have some problems with customer service in our agency. I have made it clear that it is a priority of mine and that we need to treat our patients with respect and dignity, and we will be working very hard on this.”

Sen Jon Tester, D-MT, asked how the IHS budget deals with a lack of funding to resolve problems such as with CHS and customer service. Roubideaux called the budget request “a great next step” in the agency’s ability to make improvements. “In terms of Contract Health Services, we have a lot of work to do to improve the way we do business, how we educate patients, how we work with our referral partners, and how we do our billing. All of those are things we are working on right now.”

Committee Chairman Sen Byron Dorgan, D-ND, told Roubideaux he was concerned about a shortage of mental health services and providers in tribal communities. “Is there some IHS plan to expand those services at this point?”

Roubideaux said the problem of suicide is a “high priority” for IHS and that the agency is working to address this problem with other HHS partners. In addition, the IHS hired a new director for the agency’s behavioral health program, among other things.

Sen Lisa Murkowski, R-AK, expressed concern over the future of the Dental Health Aide Therapists (DHATs) program in her state, and wanted to know what support the IHS would give to the program. DHATs are trained to provide oral health education, preventive services, fillings, and uncomplicated extractions. Students attending the school to become DHATs receive 2,400 hours of training over two years, and use the same textbooks as dental students. The students must have a sponsor agreement with a tribal health organization for which they will work after graduation and certification. The American Dental Association has not supported the program.

Roubideaux told Murkowski that she was not able to comment directly on the program, but said the program is a great “best practices” for the IHS to examine how to deliver better quality health care.

Also testifying was the National Congress of American Indians President Jefferson Keel. He said in written testimony that he was pleased by the 9% proposed increase in IHS funding over the FY 2010 enacted level.

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