July 2016

TRIBAL SELF-GOVERNANCE 

ISSUE

The Indian Health Service (IHS) Tribal Self-Governance Program

recognizes that tribal leaders and members are in the best position to 

understand the health care needs and priorities of their communities. 

The number of Tribal Self-Governance Program success stories grows 

each year, and the IHS supports this success by offering information, 

technical assistance, and policy coordination.

BACKGROUND

Tribal governments continue to develop innovative solutions to the 

health care delivery challenges of their communities. Tribes consider the needs and circumstances of their 

members when selecting from available health care options. Tribes may choose one or a combination of 

the following options: 

1. Continue to receive direct health care services offered by the IHS to American Indians and Alaska 

Natives. 

2. Use the authority of the Indian Self-Determination and Education Assistance Act (ISDEAA), Titles I 

and V, to assume responsibility for health care formerly offered by the federal government. Tribes may 

contract with the IHS through self-determination contracts and annual funding agreements under Title I 

or self-governance compacts and funding agreements under Title V. 

3. Fund the establishment of their own programs or supplementation of ISDEAA programs. 

Congress recognized the importance of tribal decision-making in tribal affairs and the importance of the 

nation-to-nation relationship between the United States and Tribes through the passage of the ISDEAA 

(Public Law 93-638) in 1975. Subsequent amendments to the ISDEAA strengthened the federal policies 

supporting tribal self-determination and self-governance. In 1992, Congress amended the ISDEAA to 

authorize a Tribal Self-Governance Demonstration Project within the IHS, giving federally recognized 

Tribes the option of entering into self-governance compacts to gain more autonomy in the management 

and delivery of their health care programs. That same year, the IHS established the Office of Tribal SelfGovernance to oversee the implementation of the Tribal Self-Governance Program. By the end of 1994, 

14 Tribes exercised their option to enter into self-governance compacts. In 2000, Congress passed the 

Tribal Self-Governance Amendments (Public Law 106-260) to create Title V of the ISDEAA and

authorize the IHS Tribal Self-Governance Program (25 U.S.C. § 458aaa et seq.; 42 C.F.R. Part 137). 

STATUS Today, self-governance compacting affords Tribes the most flexibility to tailor health care services to the 

needs of their communities. Tribes overwhelming agree that having the ability to create a comprehensive 

approach to health services is the greatest benefit of the Tribal Self-Governance Program. Other benefits 

include improved communication between tribal programs; partnerships with state and local governments 

to provide services; innovative health programs; establishment of the Tribal Self-Governance Advisory 

Committee; and creation of the Office of Tribal Self-Governance to serve as a federal-tribal liaison, offer 

technical assistance to Tribes, coordinate and lead policy discussions, and provide access to the IHS 

Director. Program success is demonstrated by the increasing number of Tribes choosing to participate. As 

of July 2016, the IHS and Tribes have negotiated 90 self-governance compacts that are funded through 

115 funding agreements with over 350 (or 60 percent) of the 567 federally recognized Tribes. This 

program constitutes approximately $1.8 billion (or nearly 40 percent) of the IHS budget.

OPTIONS/PLANS 

The IHS will continue to support and promote tribal self-governance. 

ADDITIONAL INFORMATION

For referral to the appropriate spokesperson, contact the IHS Public Affairs Staff at 301-443-3593.