The independent source for health policy research, polling, and news.
The Trump administration is touting its $50 billion Rural Health Transformation Program as the largest-ever U.S. investment in rural health care. But the government made minimal mention of Native American tribes in sparsely populated areas and in need of significant improvements to health care access.
Federally recognized tribes can鈥檛 directly apply for a share of the rural health fund 鈥 only states can. And states aren鈥檛 required to consider tribes鈥 needs. But state applications for the five-year payout show some states with significant Native American populations did so anyway.
Workforce development, technology upgrades, and traditional healing are a few of the initiatives specifically aimed at Native American communities that some states included in their applications, which were due to the Centers for Medicare & Medicaid Services on Nov. 5. The fund was a late addition to the One Big Beautiful Bill Act in response to worries about the harm the spending reductions in Republicans鈥 bill would have on rural hospitals鈥 finances.
Some states, , Nevada, , are also considering setting aside 3% to 10% of their federal payouts to distribute among tribes. Washington proposed setting aside $20 million per year.
Federally recognized tribes have direct relationships with the U.S. government, but state governments also allocate resources to tribes and can create policies that support tribal priorities. States and tribes share concerns about the effect that the massive GOP budget bill, which President Donald Trump signed into law in July, will have on the U.S. health system. The law is expected to reduce federal Medicaid spending by nearly $1 trillion and increase the number of uninsured by , according to 麻豆女优, a health information nonprofit that includes 麻豆女优 Health News.
Catherine Howden, a CMS spokesperson, said that states are required to develop their applications in collaboration with key stakeholders, including the state governments鈥 tribal affairs offices or tribal liaisons, as well as 鈥淚ndian health care providers, as applicable.鈥 But these entities do not include tribal governments or official tribal representatives.
Tribes can apply for Rural Health Transformation Fund subgrants through their states. But during a recent call with federal health officials, tribal leaders expressed frustration about being regarded as just another stakeholder in the issue rather than sovereign nations. Tribal sovereignty guides most government-to-government consultations over proposed federal actions that would have a substantial effect on tribes.
鈥淓ven in a scenario where tribal consultation is required, the quality and quantity of that tribal consultation on a state-by-state basis is all over the place,鈥 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. Malerba is a citizen of the Mohegan Tribe.
Federal policy works better when tribal nations are directly eligible for funding that supports essential services in their communities, Malerba said, adding that tribal leaders are concerned that the reach of the program into their communities will vary considerably.
There are and Native American and Alaska Native people in the U.S. The population faces a lower life expectancy and when compared with other demographics. The Indian Health Service, the federal agency responsible for providing health care to Native Americans and Alaska Natives, has been by Congress.
麻豆女优 Health News analyzed how 12 states with significant Native American populations took tribes into account as they developed plans for the pot of federal money.
, , , and were among the states that held tribal consultations or listening sessions ahead of the Nov. 5 application deadline.
麻豆女优 Health News is working to collect and post complete application materials, by state, here and will update this repository as new materials, released in response to public records requests, arrive.
In states that did not initiate input from tribes, some Native American leaders made sure their voices were heard in other public hearings. Jerilyn Church, CEO of the Great Plains Tribal Leaders鈥 Health Board, said she attended an October public meeting in South Dakota because she felt it was important for state leaders to consider how they could use the program’s resources on reservations. There are nine federally recognized tribes in the state, and Native American people make up 9% of the population.
鈥淚 felt like we needed to help be that advocate,” said Church, a citizen of the Cheyenne River Sioux Tribe.
In the proposed initiatives included in its rural fund application, South Dakota such as improved telehealth and funding for doula programs. It also said the state will continue meeting with the Great Plains tribal health board throughout the five-year funding cycle.
In Oklahoma 鈥 where more than 14% of the population is Native American, a higher share than in most other states 鈥 tribal representatives were invited to weigh in with the rest of the public when the state was gathering information for its application, the details of which have not been publicly released.
鈥淲e鈥檝e welcomed input from any Oklahoman,鈥 said state health department spokesperson Erica Rankin-Riley.
North Dakota in the Rural Health Transformation Program and included initiatives such as expanding physician residency slots with tribal-specific rotations and opportunities for farm-to-table food distributions. But that would have pledged 5% of its federal allotment to tribes. There are five federally recognized tribes in the state, and Native Americans make up nearly 5% of the population.
Some states did include proposals to fund high-priority initiatives for tribes.
for the rural fund included an initiative focused on improving health among Native American communities. Its goals include investing in workforce development for tribes, better care coordination between tribes and rural hospitals, and $2.4 million annually to support Washington State University’s rural health education programs, including its Indigenous health program.
included integrating Indigenous traditional healing in Alaska Native village clinics. It would include offering traditional-healing house calls, hands-on training for healers, and traditional-medicine training for health care providers and staff, according to the application.
One of would support the state鈥檚 nine federally recognized tribes in improving health outcomes. The state estimates the initiative would require $20 million per year, or 10% of the Rural Health Transformation Program award.
Whether or not states identified funding for tribes or included tribal priorities in their proposals, tribes will be eligible to apply to their states for subgrants of the Rural Health Transformation Program money. While larger tribes that have more resources, such as grant writers and staff to implement programs, could benefit, smaller tribes may struggle to produce competitive applications.
Church said that the Great Plains Tribal Leaders鈥 Health Board will know the fruits of its labor when states are notified of their rural health fund allotments by the end of the year.
鈥淗opefully the work that we did, the advocacy that we did, and the outreach,鈥 Church said, 鈥渨ill result in resources getting to our tribes.鈥
麻豆女优 Health News South Dakota correspondent Arielle Zionts contributed to this report.
