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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
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Indian Health Service FY2016 Budget Request and Funding History: Fact Sheet
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.1 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
The Snyder Act of 19213 provides general statutory authority for IHS.4 In addition, specific IHS
programs are authorized by two acts: the Indian Sanitation Facilities Act of 19595 and the Indian
Health Care Improvement Act (IHCIA).6 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’s Health Insurance Program (CHIP), the Department of Veterans Affairs (VA), and 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,7 unlike most
agencies within HHS, which receive their appropriations through the Labor, Health and Human
Services and Education appropriations act.8 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
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.9 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
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)
2016
Program or Activity
2010
2011
2012
2013
2014
2015 (Req.)
Clinical
and
Preventive
Services
4,139 4,171 4,335 4,277 4,436 4,607 4,858
Clinical Services
3,845a 3,877b 4,038c 3,987d 4,142e 4,303f 4.545g
Purchased/Referred Care (non-add)h (779) (780) (844) (801) (879) (914) (984)
Preventive
Health
144 144 147 143 147 154 163
Special Diabetes Program for Indiansi
150 150 150 147 147 150 150
Other
Health
Services
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
Tribal
Management/Self-Governance
9 9 9 8 6 8 8
Direct
Operations
69 69 72 68 66 68 68
Contract
Support
Costs
398 398 471 448 612 663 718
Indian
Health
Facilities
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
Facilities/Environmental Health Support 193 193 199 194 211 220 227
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
2016
Program or Activity
2010
2011
2012
2013
2014
2015 (Req.)
Medical
Equipment
23 23 23 21 23 23 24
Total, Program Level
5,100
5,140
5,418
5,307
5,649
5,906
6,392
Less Funds from Other Sources
Col ections
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
5,103
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 are taken from the FY2016 HHS Budget in Brief. These documents are available at http://www.hhs.gov/
budget/.
Notes: Individual amounts may not add to subtotals or totals due to rounding.
a. Includes $891 million in collections from Medicare, Medicaid, CHIP, private insurance, and other programs.
b. Includes $915 million in collections from Medicare, Medicaid, CHIP, private insurance, and other programs.
c. Includes $954 million in collections from Medicare, Medicaid, CHIP, private insurance, and other programs.
d. Includes an estimated $1,021 million in collections from Medicare, Medicaid, CHIP, private insurance, and
other programs.
e. Includes an estimated $1,060 million in collections from Medicare, Medicaid, CHIP, the Department of
Veterans Affairs, private insurance, and other programs.
f.
Includes an estimated $1,106 million in collections from Medicare, Medicaid, CHIP, the Department of
Veterans Affairs, private insurance, and other programs.
g. Includes an estimated $1,131 million in collections from Medicare, Medicaid, CHIP, the Department of
Veterans Affairs, private insurance, and other programs.
h. This was previously referred to as “Contract Health Services.”
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” and Selected Program Exemptions and Special Rules, coordinated by Karen Spar.
j.
Includes $6 million that IHS received from rental of staff quarters.
k. Includes $8 million that IHS received (or is expected to receive) from rental of staff quarters.
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’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
Elayne J. Heisler
Specialist in Health Services
eheisler@crs.loc.gov, 7-4453
Congressional Research Service
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