.
Indian Health Service FY2016 Budget Request
and Funding History: Fact Sheet
Elayne J. Heisler
Specialist in Health Services
May 19, 2015
Congressional Research Service
7-5700
www.crs.gov
R44040
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Indian Health Service FY2016 Budget Request and Funding History: Fact Sheet
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IHS Overview
Indian Health Service (IHS) FY2010-FY2016 Funding: Fact Sheet
December 23, 2015
(R44040)
IHS Overview
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. IHS provides health care for approximately 2.2 million eligible American Indians/Alaska
Natives through a system of programs and facilities located on or near Indian reservations, and
through contractors in certain urban areas.
11 IHS provides services to members of 566 federally
recognized tribes. It provides services either directly or through facilities and programs operated
by Indian Tribes or Tribal Organizations through self-determination contracts and self-governance
compacts authorized in the Indian Self-Determination and Education Assistance Act (ISDEAA).
2
2
The Snyder Act of
1921319213 provides general statutory authority for IHS.
44 In addition, specific IHS
programs are authorized by two acts: the Indian Sanitation Facilities Act of
1959519595 and the Indian
Health Care Improvement Act (IHCIA).
66 The Indian Sanitation Facilities Act authorizes the IHS
to construct sanitation facilities for Indian communities and homes. IHCIA authorizes programs
such as urban health, health professions recruitment, and substance abuse and mental health
treatment, and permits IHS to receive reimbursements from Medicare, Medicaid, the State
Children’ Children's Health Insurance Program (CHIP), the Department of Veterans Affairs (VA), and
thirdparty insurers.
Funding Sources
third-party insurers.
Funding Sources
The IHS has three major sources of funding, described here in order of magnitude: (1)
discretionary appropriations, (2) collections, and (3) mandatory appropriations. The IHS receives
its discretionary appropriations through the Interior/Environment appropriations act,
77 unlike most
agencies within HHS, which receive their appropriations through the Labor, Health and Human
Services and Education appropriations act.
88 IHS
’'s discretionary appropriations are divided into
two accounts: (1) Indian Health Services and (2) Indian Health Facilities.
As a second source of funding, IHS collects funds as reimbursement for health services provided.
IHS, unlike other federal agencies, has the authority to receive reimbursement from other federal
programs such as Medicaid, Medicare, and the Department of Veterans Affairs. IHS also receives
1
For more information about the Indian Health Service (IHS), see CRS Report R43330, The Indian Health Service
(IHS): An Overview.
2
P.L. 93-638; 25 U.S.C. §§450 et seq.
3
P.L. 67-85, as amended; 25 U.S.C. §13.
4
The Snyder Act established this authority as part of the Bureau of Indian Affairs within the Department of the
Interior. The Transfer Act of 1954 (P.L. 83-568) transferred this authority to the U.S. Surgeon General within the
Department of Health, Education, and Welfare (now the Department of Health and Human Services).
5
P.L. 86-121; 42 U.S.C. §2004a.
6
P.L. 94-437, as amended; 25 U.S.C. §§1601 et seq., and 42 U.S.C. §§1395qq and 1396j (and amending other
sections). This act was permanently reauthorized as part of the ACA. See CRS Report R41630, The Indian Health Care
Improvement Act Reauthorization and Extension as Enacted by the ACA: Detailed Summary and Timeline.
7
For more information, see CRS Report R43617, Interior, Environment, and Related Agencies: FY2015
Appropriations.
8
For more information, see CRS Report R43967, Labor, Health and Human Services, and Education: FY2015
Appropriations.
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Indian Health Service FY2016 Budget Request and Funding History: Fact Sheet
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programs such as Medicaid, Medicare, and the Department of Veterans Affairs. IHS also receives reimbursements from state programs (such as workers compensation) and from private insurance.
IHS, under the authority for reimbursements given in IHCIA, is able to retain these payments to
increase services available to its beneficiaries. In addition to reimbursements (its largest source of
collections), IHS collects rent from facilities it owns.
The third and smallest source of IHS funding is a mandatory appropriation of $150 million
annually to support Special Diabetes Programs for Indians.
99 This mandatory funding was
recently
extended through FY2017 in the Medicare Access and CHIP Reauthorization Act (MACRA, P.L.
114-10
).
).
FY2016 Budget Request and Funding History
Table 1 presents IHS
’s FY2016 budget request and prior budget years to show the increase in
's fund from FY2010 through the amounts provided in the FY2016 Omnibus (P.L. 114-113). The table shows increases in both appropriated funds and funds collected by IHS. The table presents IHS
’'s two budget
accounts—Indian Health Services and Indian Health Facilities—and the funds collected and
allocated to programs under these two accounts. These collections and mandatory funding
received from the Special Diabetes Program for Indians are subtracted from program-level
funding to show the agency
’'s discretionary budget authority.
Table 1. Indian Health Service (IHS)
(Millions of Dollars, by Fiscal Year)
2010
2011
2012
2013
2014
2015
2016
(Req.)
4,139
4,171
4,335
4,277
4,436
4,607
4,858
3,845a
3,877b
4,038c
3,987d
4,142e
4,303f
4.545g
(779)
(780)
(844)
(801)
(879)
(914)
(984)
144
144
147
143
147
154
163
150
150
150
147
147
150
150
560
560
636
603
753
831
886
Urban Health Projects
43
43
43
41
41
44
44
Indian Health Professions
41
41
41
38
28
48
48
9
9
9
8
6
8
8
69
69
72
68
66
68
68
398
398
471
448
612
663
718
401
410
448
427
460
469
649
Maintenance and Improvement
60j
60j
61k
59k
62k
62k
98k
Sanitation Facilities Construction
96
96
80
75
79
79
115
Health Care Facilities Construction
29
39
85
77
85
85
185
193
193
199
194
211
220
227
Program or Activity
Clinical and Preventive Services
Clinical Services
Purchased/Referred Care (non-add)h
Preventive Health
Special Diabetes Program for
Indiansi
Other Health Services
Tribal Management/Self-Governance
Direct Operations
Contract Support Costs
Indian Health Facilities
Facilities/Environmental Health Support
9
U.S. Department of Health and Human Services, Indian Health Service, “Special Diabetes Program for Indians,”
January 2015, http://www.ihs.gov/newsroom/factsheets/diabetes/.
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Indian Health Service FY2016 Budget Request and Funding History: Fact Sheet
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Program or Activity
Medical Equipment
Total, Program Level
2010
2011
2012
2013
2014
2015
2016
(Req.)
23
23
23
21
23
23
24
5,100
5,140
5,418
5,307
5,649
5,906
6,392
891
915
954
1,021
1,060
1,106
1,131
6
6
8
8
8
8
9
150
150
150
147
147
150
150
4,052
4,069
4,307
4,131
4,435
4,642
5,103
Less Funds from Other Sources
Collections
Rental of Staff Quarters
Special Diabetes Program for Indiansh
Total, Discretionary Budget Authority
Sources: Funding amounts for FY2010, FY2011, FY2012, and FY2013 are taken from IHS’s FY2012, FY2013, and
FY2014 congressional budget justification documents, respectively. Funding amounts for FY2014, FY2015, and
FY2016
(Millions of Dollars, by Fiscal Year)
|
Program or Activity
|
2010
|
2011
|
2012
|
2013
|
2014
|
2015
|
2016
|
|
Clinical and Preventive Services
|
4,139
|
4,171
|
4,335
|
4,277
|
4,436
|
4,607
|
4,674
|
Clinical Services
|
3,845a
3,877b
4,038c
3,987d
4,142e
4,303f
4.368g
Purchased/Referred Care (non-add)h
(779)
|
(780)
|
(844)
|
(801)
|
(879)
|
(914)
|
(914)
|
|
Preventive Health
|
144
|
144
|
147
|
143
|
147
|
154
|
156
|
Special Diabetes Program for Indiansi
150
|
150
|
150
|
147
|
147
|
150
|
150
|
|
Other Health Services
|
560
|
560
|
636
|
603
|
753
|
831
|
891
|
|
Urban Health Projects
|
43
|
43
|
43
|
41
|
41
|
44
|
45
|
|
Indian Health Professions
|
41
|
41
|
41
|
38
|
28
|
48
|
48
|
|
Tribal Management/Self-Governance
|
9
|
9
|
9
|
8
|
6
|
8
|
8
|
|
Direct Operations
|
69
|
69
|
72
|
68
|
66
|
68
|
72
|
|
Contract Support Costs
|
398
|
398
|
471
|
448
|
612
|
663
|
718
|
|
Indian Health Facilities
|
401
|
410
|
448
|
427
|
460
|
469
|
533
|
Maintenance and Improvement
|
60j
60j
61k
59k
62k
62k
83l
|
Sanitation Facilities Construction
|
96
|
96
|
80
|
75
|
79
|
79
|
99
|
|
Health Care Facilities Construction
|
29
|
39
|
85
|
77
|
85
|
85
|
105
|
|
Facilities/Environmental Health Support
|
193
|
193
|
199
|
194
|
211
|
220
|
223
|
|
Medical Equipment
|
23
|
23
|
23
|
21
|
23
|
23
|
23
|
|
Total, Program Level
|
5,100
|
5,140
|
5,418
|
5,307
|
5,649
|
5,906
|
6,098
|
Less Funds from Other Sources
|
|
Collections
|
891
|
915
|
954
|
1,021
|
1,060
|
1,106
|
1,131
|
|
Rental of Staff Quarters
|
6
|
6
|
8
|
8
|
8
|
8
|
9
|
Special Diabetes Program for Indiansh
150
|
150
|
150
|
147
|
147
|
150
|
150
|
|
Total, Discretionary Budget Authority
|
4,052
|
4,069
|
4,307
|
4,131
|
4,435
|
4,642
|
4,808
|
Sources: Funding amounts for FY2010, FY2011, FY2012, and FY2013 are taken from IHS's FY2012, FY2013, and FY2014 congressional budget justification documents, respectively. Funding amounts for FY2014 and FY2015 are taken from the FY2016 HHS Budget in Brief. These documents are available at http://www.hhs.gov/
budget/
.
. FY2016 funding levels are from the explanatory materials released by the House Appropriations Committee to accompany P.L. 114-113.
Notes: Individual amounts may not add to subtotals or totals due to rounding.
a.
a.
Includes $891 million in collections from Medicare, Medicaid, CHIP, private insurance, and other programs.
b.
b.
Includes $915 million in collections from Medicare, Medicaid, CHIP, private insurance, and other programs.
c.
c.
Includes $954 million in collections from Medicare, Medicaid, CHIP, private insurance, and other programs.
d.
d.
Includes an estimated $1,021 million in collections from Medicare, Medicaid, CHIP, private insurance, and
other programs.
e.
e.
Includes an estimated $1,060 million in collections from Medicare, Medicaid, CHIP, the Department of
Veterans Affairs, private insurance, and other programs.
f.
f.
Includes an estimated $1,106 million in collections from Medicare, Medicaid, CHIP, the Department of
Veterans Affairs, private insurance, and other programs.
g.
g.
Includes an estimated $1,131 million in collections from Medicare, Medicaid, CHIP, the Department of
Veterans Affairs, private insurance, and other programs.
h.
h.
This was previously referred to as
“"Contract Health Services.
”
i.
"
i.
PHSA Sec. 330C provides an annual appropriation of $150 million through FY2017 for this program. These
mandatory funds were subject to a 2% sequestration in FY2013 and FY2014. See CRS Report R42050,
Budget “Sequestration” Budget "Sequestration" and Selected Program Exemptions and Special Rules, coordinated by
Karen Spar.
j.
[author name scrubbed].
j.
Includes $6 million that IHS received from rental of staff quarters.
k.
k.
Includes $8 million that IHS received
(or is expected to receive)from rental of staff quarters.
l.
Includes $9 million that IHS expects to receive from rental of staff quarters.
IHS Collections
IHS Collections
Collections from third party payors for health services provided comprise a growing percentage
of IHS
’'s clinical services budget. Medicaid is the largest source of IHS
’'s collections—
approximately 70% of all reimbursements collected in FY2014, the most recent year of final data
available—followed by Medicare (21% in FY2014) and private insurance (8% in FY2014).
Beginning in FY2014, IHS began receiving reimbursements from the VA for services provided to
IHS beneficiaries who were also eligible for services through the VA (these reimbursements were
0.7% of all of IHS
’'s third party collections in FY2014). For FY2013, reimbursements were
approximately $340,000; therefore, these funds are not visible in Figure 1. However,
reimbursements increased in FY2014 and are expected to increase in both FY2015 and FY2016
(see Figure 1
).
).
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Indian Health Service FY2016 Budget Request and Funding History: Fact Sheet
Figure 1. IHS Reimbursements by Source, FY2010-FY2016 (Expected)
(Dollars in Millions)
Source: Funding amounts for FY2010, FY2011, FY2012, FY2013, FY2014, FY2015, and FY2016 are taken from
IHS’ IHS's FY2012, FY2013, FY2014, FY2015, and FY2016 congressional budget justification documents, respectively.
Funding amounts for FY2014, FY2015, and FY2016 are taken from the FY2016 HHS Budget in Brief. These
documents are available at http://www.hhs.gov/
budget/.
Author Contact Information
[author name scrubbed], Specialist in Health Services
([email address scrubbed], [phone number scrubbed])
Footnotes
| 1.
|
For more information about the Indian Health Service (IHS), see CRS Report R43330, The Indian Health Service (IHS): An Overview.
|
| 2.
|
P.L. 93-638; 25 U.S.C. §§450 et seq.
|
| 3.
|
P.L. 67-85, as amended; 25 U.S.C. §13.
|
| 4.
|
The Snyder Act established this authority as part of the Bureau of Indian Affairs within the Department of the Interior. The Transfer Act of 1954 (P.L. 83-568) transferred this authority to the U.S. Surgeon General within the Department of Health, Education, and Welfare (now the Department of Health and Human Services).
|
| 5.
|
P.L. 86-121; 42 U.S.C. §2004a.
|
| 6.
|
P.L. 94-437, as amended; 25 U.S.C. §§1601 et seq., and 42 U.S.C. §§1395qq and 1396j (and amending other sections). This act was permanently reauthorized as part of the ACA. See CRS Report R41630, The Indian Health Care Improvement Act Reauthorization and Extension as Enacted by the ACA: Detailed Summary and Timeline.
|
| 7.
|
For more information, see CRS Report R43617, Interior, Environment, and Related Agencies: FY2015 Appropriations.
|
| 8.
|
For more information, see CRS Report R43967, Labor, Health and Human Services, and Education: FY2015 Appropriations.
|
9.
|
U.S. Department of Health and Human Services, Indian Health Service, "Special Diabetes Program for Indians," January 2015, http://www.ihs.gov/newsroom/factsheets/diabetes/.
budget/.
Author Contact Information
Elayne J. Heisler
Specialist in Health Services
eheisler@crs.loc.gov, 7-4453
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