#### ![](media/image1.png){width="0.21875in" height="9.375in"}FEDERAL BASIS FOR HEALTH SERVICES

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| **ISSUE**\                                                            |
| An awareness of the legal basis for the federal obligation to provide |
| health care to American Indians and Alaska Natives is important when  |
| designing health care programs, developing federal budgets,           |
| coordinating with other agencies, and obtaining regulation waivers    |
| for selected Indian programs.                                         |
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| **BACKGROUND**\                                                       |
| The trust relationship establishes a responsibility for a variety of  |
| services and benefits to Indian people based on their status as       |
| Indians, including health care. This relationship has been defined in |
| case law and statute as a political relationship that further         |
| distinguishes Indians from racial classification for purposes of      |
| affirmative action laws and other federal statutes that establish     |
| federally funded programs for the general public.                     |
|                                                                       |
| Treaties between the United States Government and Indian Tribes       |
| frequently call for the provision of medical services, the services   |
| of physicians, or the provision of hospitals for the care of Indian   |
| people. Even before these treaties, the United States Constitution    |
| specifically addressed the federal government's primacy role in       |
| dealing with Indians in the commerce and treaty clauses. Supreme      |
| Court cases, such as Cherokee Nation v. Georgia (1831), specifically  |
| address the relationship between Tribes, states, and the federal      |
| government. Out of this case and others, the guardian/ward            |
| relationship was created that forms the basis of the trust            |
| relationship.                                                         |
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| ![](media/image2.png){width="3.1166666666666667in"                    |
| height="5.334027777777778in"}The Snyder Act of 1921 (25 USC 13) and   |
| the Indian Health Care Improvement Act (25 USC 1601) of 1976 provide  |
| specific legislative authority for Congress to appropriate funds      |
| specifically for the health care of Indian people. In addition,       |
| numerous other laws, court cases, and Executive Orders reaffirm the   |
| unique relationship between Tribal governments and the federal        |
| government.                                                           |
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| # SITUATION                                                           |
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| There still exits a belief that American Indians and Alaska Natives   |
| are not citizens of their state and are not eligible for state        |
| programs and benefits. American Indians and Alaska Natives, as        |
| citizens of the United States, are eligible to participate in all     |
| public, private, and state health programs available to the general   |
| population. In addition, they also have treaty rights to federal      |
| health care services though the Department of Health and Human        |
| Services. The federal duty to uphold the treaty responsibility for    |
| health care to Indians is accomplished by consulting with Indian      |
| Tribes and then actively advocating for policy, legislative, and      |
| budgetary planning for Indian health care.                            |
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| **ADDITIONAL INFORMATION**                                            |
|                                                                       |
| For referral to the appropriate spokesperson, contact the IHS Public  |
| Affairs Staff at 301-443-3593.                                        |
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