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COVID-19 and the Indian Health Service



Updated May 1, 2020
The Indian Health Service (IHS) within the Department of Health and Human Services (HHS) is the lead
federal agency charged with improving the health of American Indians and Alaska Natives. In FY2019,
IHS provided health care to approximnatcly 2.6 million eligible Ainerican Indians/Alaska Natives, Its total
FY2020 annual appropriation was $6.2 billion, As of April 30, IHS has seen more than 3,000 positive
tests for coronavirus among its service population. In particular, the Navaio Nation has experienced one
of the largest outbreaks nationally.

IHS Is a Three-Tiered System with Resource Constraints
IHS provides health care either directly or through facilities and programs operated by Indian tribes (ITs)
or tribal organizations (TOs) through self-determination contracts and self-governance compacts
authorized under P.L. 93-638. IHS also provides services to urban Indians through grants or contracts to
Urbani Indiani Organizations (UlOs). The system is referred to as the /TU svstem, and services available
vary. UlOs offer outpatient services, while the IHS and the ITs may provide both otipationt and inpatient
care, 11-IS does not offer a standard bencfit package, nor is it required to cover certain services that its
beneficiaries may receive at facilities outside of IHS. When services are not available at an IHS facility,
facilities may authorize payment through the Purchased Refirrcd Care Program (PRC). PRC biinds are
limited, and as such, not all PRC claims are authorized; however, IHS has stated that COVID-19 care
meets its medical priorty for payment. UlOs do not have access to PRC fiuls.

IHS and COVID-19
As noted, FT/Us have reported cases of COVID-19; the abiiitx to test for coronavirus and to treat active
cases varies throughout its system. Initially, tribes reported some testing challenges, such as shortages of
tests, the materials necded to administer testing, and the pcrsonal protvctive eqtupinent (PPE) needed by
ieaith providers, IHS has since receed rapid testisng, but these were distributed to sorne, not all IHS
sites.
Despite improvements, IHS faces challenges in delivering COVID-19 care. Specifically, provider
vacmncios have been a long-standing IHS challenge, which may be exacerbated if providers are exposed
or sickened by coronavirus. In addition, some IHS personnol are members of the Commissionod Corps
who have been deployed outside of the IIS system to respond to the disaster, which could increase


                                                                   Congressional Research Service
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