Correcting the Record on the Contract Health Services Program

The Indian Health Service (IHS) faces daily challenges in providing health services to 1.9 million American Indians and Alaska Natives, often in remote and rural areas. Medical and dental care provided at an IHS or tribal health care facility is called direct care. The Contract Health Services (CHS) Program is for medical and dental care provided away from an IHS or tribal health care facility, usually as a result of a physician referral. Services are approved for payment if a patient meets residency requirements, notification requirements, medical priority, and use of alternate resources and if funding is available. The IHS and tribally operated CHS programs are funded with annual appropriations from Congress. However, the amount of our annual appropriations is not sufficient to cover all referrals, resulting in some referrals being denied or deferred according to medical priorities. The IHS calculates additional costs for thousands of cases of referral health care not available in an IHS or tribal care facility and that would have been purchased from outside providers had sufficient CHS funding been available. Based on current IHS estimates, this unmet need is an additional $861 million, more than the current budget of $779 million for the CHS program. The President’s budget request for IHS includes these estimates of unmet need each year.

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