CHA CLOUD, HAM MITT & ASSOCIATES Post Office Box 1145 Bemidji, Minnesota 56601 218-751-1712 A DRAFT MISSION STATEMENT OF THE UNITED STATES GOVERNMENT TO PROVIDE AND DELIVER HEALTH CARE FOR EVERY FEDERALLY RECOGNIZED AMERICAN INDIAN AND ALASKA NATIVE PREPARED BY MONTE C. HAMMITT, M.P.A. IT IS THE MISSION OF THE UNITED STATES GOVERNMENT TO FULFIL THE FEDERAL OBLIGATION TO PROVIDE AS AN ENTITLEMENT HEALTH CARE FOR EVERY FEDERALLY RECOGNIZED AMERICAN INDIAN AND ALASKA NATIVE. THE MISSION OF THE UNITED STATES GOVERNMENT IS TO PROVIDE HEALTH CARE AS AN ENTITLEMENT TO EVERY FEDERALLY RECOGNIZED AMERICAN INDIAN AND ALASKA NATIVE. THE UNITED STATES GOVERNMENT HAS A CONSTITUTIONAL OBLIGATION OF TRUST RESPONSIBILITY, TREATY RIGHTS, STATUTORY RIGHT, COURT DECISIONS, AND MAINTENANCE OF A GOVERNMENT TO GOVERNMENT RELATIONSHIP WITH THE AMERICAN INDIAN TRIBES AS SOVEREIGN NATIONS. THE UNITED STATES GOVERNMENT DEFINES HEALTH AS THE STATE OF COMPLETE PHYSICAL, MENTAL, SOCIAL, EDUCATIONAL, ECONOMICAL, AND SPIRITUAL WELL BEING OF AMERICAN INDIANS AND ALASKA NATIVES AND NOT MERELY THE ABSENCE OF DISEASE OR INFIRMITY. THE GOAL OF THE UNITED STATES GOVERNMENT IN ACHIEVING THE MISSION OF THE UNITED STATES GOVERNMENT IS TO: RAISE THE HEALTH STATUS OF EVERY FEDERALLY RECOGNIZED PROVIDE AS AN ENTITLEMENT A COMPREHENSIVE HEALTH CARE PROVIDE FOR TRIBES AN OPTION FOR SELF-GOVERNANCE WITH Historic Perspective Bemidji Area of The Indian Health Service The Bemidji Area of the Indian Health Service consists of twenty-nine federally recognized tribal governments, eleven in the State of Wisconsin, eleven in Minnesota and seven in Michigan. Indian Health Service and tribal health delivery systems provide a wide range of health care to a service population in excess of 65,000 native americans. Significant Indian communities also exist within several metropolitan centers including; Minneapolis/St. Paul, Milwaukee, Green Bay, Detroit and Chicago. The urban Native American population estimated to be in excess of 100,000 is a result of economic migration and government relocation policies and programs of the 1940's, 1950's and 1960's. Partial health services within these five locations are provided under provision of Title V of the Health Care Improvement Act. Tribal Government History The majority of tribes in the Bemidji are descendants of the Algonquin linguistic family, which includes; Chippewa, Ottawa, Potawatomi, and Menominee. The Algonquin territory extended at one time from the Atlantic coast to the Rocky mountains. Descents of the Great Sioux Nations; including the Lakota, Dakota and Winnebago, also have a long history in the Minnesota, Wisconsin area. Early encounters between Native Americans and Europeans in the area were generally peaceful with the exception of involvement in disputes between the French, the English, and the American Colonies over trade territory and land acquisition. Treaties affecting tribes in the area were consummated between 1830 and 1890 and follow the general policies employed by the United States Government during the period. Vast land areas and natural resources were given up for the right to remain within the traditional home lands. Promises of economic assistance and health care were major elements of treaties affecting area Tribes. In general, Tribal governments in the three state area are organized under provisions of the Wheeler Howard (Indian Reorganization) Act of 1936. The Red Lake Tribe retained its sovereign tribal status approved in 1918 and reorganized in 1958. The Menominee Tribe of Wisconsin accepted termination in 1954 but obtain restoration in 1973. Three Michigan Chippewa and Ottawa tribes recently regained federal recognition; the Sault Ste. Marie in 1974, Grand Traverse Ottawa-Chippewa in 1980, and Lac Vieux Desert Chippewa in 1989. Two additional Ottawa Bands in Michigan are currently working toward recognition. Much of the meager land base retained by Treaty was removed from Tribal control as a result of General Allotment Act of 1887 and various state and private tax forfeit and questionable purchase arrangements. Today tribal governments in the three states are among the most progressive in the nation. Although the effects of long term economic depression and poverty still persists, tribal self-determination, and economic stimulus of Indian gaming are having a dramatic impact on the health and well being of the population served by these tribal units of government. The United States Government policies in delivering treaty acquired health services has been affected by the overall changes in the federal Indian policy over the years. Health services in the Area originated under the Bureau of Indian Affairs and consisted of hospitals at Red Lake, Cass Lake, White Earth and Fond du Lac in Minnesota. Hospitals in Hayward, and Tomah Wisconsin provided services to Wisconsin while Michigan Tribes received no federal sponsored health care. Prior to the Transfer Act of 1955 which transferred health service responsibilities to the Public Health Service, decisions had been made to discontinue direct federal health care to all locations except for Red Lake, Cass Lake and White Earth. With the implementation of the Transfer Act administrative, responsibility for the limited health services in Minnesota was assigned to the Aberdeen Area Office. A field office was established in Bemidji, Minnesota to assist in the implementation of Indian Facilities Construction Act, PL 81-121 passed in 1959, and to initiate and monitor a contract health services program for Wisconsin, Michigan and Minnesota. Sub-field offices were later added at Rhinelander, Wisconsin and Sault Ste. Marie, Michigan to assist in the expansion of services and to provide technical support in developing tribal health delivery systems. In 1975, as a result of strong tribal insistence, the three-state area was programmatically separated from the Aberdeen Area and designated as the Bemidji Area Program Office. Ten years later in 1986, the office was designated as an "Area Office." Although significant expansion to administrative and program functions was anticipated, the Bemidji Area remains relative small and under staffed in proportion to the area and population served. From 1975 to the current day, tribal governments have assumed a leadership role in developing and operating health delivery systems. Almost everything that exists today is a result of tribal and Indian Health Service collaboration in developing programs and services utilizing special congressional appropriations initiated by area Tribes and periodic infusion of equity funding provided by the Congress. Area tribes have been leaders in the operation of health services under the Indian Self-Determination Act of 1975. Major health centers are being operated, a hospital designed and built, a health center constructed and extensive sanitation facilities constructed under PL 93-638 contracts and grants. Approximately 66% of the area budget is under contract with the twenty-nine tribes. Most of the health facilities in use have been constructed by tribes utilizing Economic Development Administration, Housing and Urban Development and Tribal resources. Staffing is provided under PL 93-638 contracts and Third Party Billing. ontract Health Program is more restrictive. ulk of IHS funding is historic base plus mandatories. ess has, over the last ten years, appropriated funds for equity; I are distributed based on unmet need determined by population to erved and workload. and Tribes have a national patient registrations system which is to determine service population. This data is used in ributing new resources. dji Area, 26 of the 29 tribes operate their health service under PL 538. rea tribes are under Self-Governance compacts; 2 additional in FY |