Program Overview

The Urban Indian Health Programs (UIHP) consist of 34 non-profit 501(3) (c) programs nationwide. The programs are funded through grants and contracts from the I.H.S., under Title V of the Indian Health Care Improvement Act, PL 94-437, as amended. Approximately 45% of the UIHPs receive Medicaid reimbursement as Federally Qualified Health Centers (FQHC) and others receive fees for service under Medicaid for allowable services, i.e. behavioral services, transportation, etc. Over 28.8 million dollars are generated in other revenue sources. In the Omnibus Reconciliation Act (OBRA) of 1993, Title V, and tribal 638 programs were added to the list of specific programs automatically eligible for FQHC designation. The range of contract and grant funded programs listed below are provided in facilities owned or leased by the Urban organization. The I.H.S. is required by law to conduct an annual program review using various program standards of I.H.S. and to provide technical assistance.

Range of I.H.S./Urban grant and contract programs include: information, outreach and referral, dental services, comprehensive primary care services, limited primary care services, community health, substance abuse (outpatient and inpatient services), behavioral health services, immunizations, HIV activities, health promotion and disease prevention, and other health programs funded through other state, federal, and local resources, i.e. WIC, Social Services, Medicaid, Maternal Child Health, etc.

Hunter Health Care Clinic, Wichita	Sacramento Urban Indian Health
Seattle Indian Health Board	Spokane Urban Indian Health
San Francisco/Oakland Urban Indian Health	Milwaukee Indian Health Board
Minneapolis Indian Health Board	Indian Health of Santa Clara
South Dakota Urban Indian Health, Pierre	American Indian Health, Detroit
Helena Indian Alliance, MT	Indian Health Board of Billings
NARA/Northwest Inc., Portland	Billings Indian Health Board
Nebraska Urban Indian Health Coalition, Lincoln

URBAN INDIAN POPULATION/USER INFORMATION....of the 2.235 million total AI/ANs residing in the United States, 1.3 million reside in urban areas (58%); 1.2 million are active I.H.S. users; 427,000 are I.H.S. urban Indian active users; of the 140,000 total UIHP users, 100,000 are AI/ANs; over 700,000 are patient encounters; since 1970, the urban Indian growth rate has been 5% per decade.

FUNDING LEVEL ESTIMATED AT 22% of the projected need for primary care services. Eighteen additional cities have been identified as having an urban population large enough to support an UIHP.

I.H.S. budget structure separates funding (FY 01, 29.8 million).
- Contract dollars, 20.9 million
- Grant dollars, 7.7 million, with a focus on behavioral health and alcoholism services.
- Over 28.8 million dollars generated in other revenue and used for primary care services.
- 6-8 Residential Alcohol Treatment Programs funded by the I.H.S. Alcohol Branch.

I.H.S. URBAN INDIAN PATIENTS WHO ARE I.H.S. ACTIVE USERS FOR DIRECT AND CONTRACT HEALTH SERVICE (CHS).....Limitations of direct care availability at I.H.S. facilities and the CHS program restricts eligibility based upon residence and priorities to life and limb emergencies.

I.H.S. URBAN INDIAN PATIENTS WHO ARE USERS OF DIRECT CARE BUT NOT CHS....CHS is denied for an estimated 2/3 of urban Indian active users (280,000).

UHIP PATIENTS RESIDING IN URBAN TITLE V LOCATIONS......Limitations of UIHP direct care capability and other available health care in a particular urban area may not be accessible due to cultural and administrative barriers, inability to pay and/or lack of third party coverage.

FOR AI/ANs (including both urban and rural Indians) NOT ELIGIBLE FOR I.H.S.…..(terminated Indians, landless Indians, non-federal tribes, state-recognized tribes, tribes in the process of recognition), access to health care may not be available unless they have third party-type coverage or access to services through an UIHP.

FOR AI/ANs UNSERVED (including urban and rural) by the I.H.S./T/U HEALTH DELIVERY SYSTEM; this number is 700,000 to 900,000 and includes census Indians who live in areas where access to the I/T/U is not available. More than 50% may not be eligible for I.H.S. under the present eligibility criteria. (USET, CA, PA, 10% in CHSDA).

I.H.S. OPEN DOOR POLICY - The I.H.S. does not deny direct health care to Indian patients due to residence, urban or rural. If you are an eligible Indian patient and seek services at an I.H.S. or tribal facility, then available direct care is provided. You must show proof that you are a member or descendant of a federally recognized tribe.

I.H.S. ACTIVE PATIENT USERS - To be counted as an I.H.S. active user, an eligible patient (urban, rural, and on reservations) must reside in a community located in the service unit's (SU) geographically designated Contract Health Service Delivery Area (CHSDA) serviced by the I.H.S. or tribal facility. Urban Indians represent 427,000 of the 1.2 million total active users of I.H.S..

CONTRACT HEALTH SERVICES - CHS is restricted if a patient lives outside of their tribal CHSDA, usually in a county contiguous to their home reservation. Estimates are that 2/3 of urban Indian active users are not eligible for CHS (280,000 active users).

URBAN INDIAN PATIENTS who access I.H.S./tribal direct and CHS services reside in urban settings such as Phoenix, Portland, Spokane, Reno, Green Bay, Billings, Albuquerque, Santa Rosa, San Diego, Tulsa, Carson City, Santa Fe, Tacoma, Rapid City, Duluth, Anchorage, Elko, Tacoma, Auburn, Tucson, Oklahoma City, Ft. Lauderdale, Yuma, etc. (11/34 of Title V UIHPs are located in CHSDAs)

OKLAHOMA URBAN SERVICE UNIT DEMONSTRATION - In OK, there are two urban I.H.S. service units that were originally funded as urban programs: Tulsa and Oklahoma City. These programs operate as I.H.S. direct care service units using I.H.S. hospitals for referrals and specialty care. Authorization for this demonstration project is under IHCIA, Title V, Section 512.

UIHPs that are eligible for loan repayment sites, 104 scholarships, commissioned corp. assignments, or program-mandated technical assistance are mandated under Title V.

NUMEROUS EXAMPLES of patient care coordination for outpatient care, pharmacy, lab, home care, behavioral services, alcohol residential treatment/referrals, etc.

FQHC automatic designation was provided to tribes and urban programs, in OBRA 93.

ELEVEN UIHPS are located in the I.H.S. CHSDAs (targeted service area) designations. Patient referrals are made back and forth and several use the I.H.S. RPMS patient care management system.

THREE STATES that have implemented UNIFORM ELIGIBILITY regardless of residence because the entire state is viewed as the CHSDA (a targeted service area) are: OK, AK, and NV.

MIGRATION - an estimated 25% of urban Indians migrate back to an I.H.S. or tribal health facility to obtain health care. Although eligible for direct care, these patients are not counted as I.H.S. active users because of residency outside of the designated contract health care service area.