<\/p>\n
The Indian Health Service \u2014 the federal agency tasked with providing health services to Native American communities \u2014 has long been the go-to health care provider for tribes in New Mexico and across the country.<\/p>\n
But in recent years, that has started to change, and a growing number of tribes are deciding that managing their own clinics and behavioral health programs will help build healthier, more resilient communities.<\/p>\n
Allen Barlow, who runs the Kewa Health Corporation in Santo Domingo Pueblo, says for a long time, tribes didn\u2019t have much of an option when it came to health care. \u201cIHS has gotten away with being the only game in town for decades,\u201d Barlow said.<\/p>\n
For some tribes, that\u2019s been a problem. IHS is notoriously underfunded.<\/p>\n
Another sticking point is that large federal health programs aren\u2019t always able to address nuances of public health in diverse tribal communities. \u201cTribes want to be able to tailor their programs to meet the needs of their population. IHS is able to do that sometimes and sometimes they\u2019re not,\u201d Barlow said.<\/p>\n
But the Affordable Care Act changed the equation.<\/p>\n
Since the ACA, Santo Domingo became one of many tribes to use an old sovereignty law that lets them opt out of IHS care and instead get a check for the money the agency would have spent on them. With the expansion of Medicaid, tribes are able to get more federal dollars to cover the costs of running their own health programs. Over the last three years, Santo Domingo\u2019s health program has grown by almost 70 percent.<\/p>\n
And that\u2019s translated into better health outcomes for the community. Santo Domingo now does better than the average tribe on childhood obesity, hepatitis, and access to dental care, among other things.<\/p>\n
They\u2019ve also grown their economy by creating health care jobs for tribal members.<\/p>\n
But making the switch from IHS can be a risky move.<\/p>\n
\u201cI think that the tribes really need to look at themselves internally first,\u201d said Anthony Yepa, a former IHS manager who now works as a consultant to tribes transitioning to self-run programs. \u201cOnce you get to take over a clinic or the doctors and the nurses, and even the lab and the pharmacy, that becomes a very administratively burdensome as well as clinically burdensome task for a lot of the tribes that do not have the resources to do that.\u201d<\/p>\n
So going it alone can mean being stuck with the logistics of managing clinics and pharmacies and losing all of IHS\u2019s expertise and infrastructure.<\/p>\n
But for some tribes, there\u2019s a more attractive option: keep IHS in charge of running clinics and hospitals, but make their behavioral health program an independent and tribally run.<\/p>\n
Melissa Martinez is a native of Taos Pueblo who works in the tribal behavioral health program there. \u201cThe move from IHS has been the best thing for this tribe ever,\u201d she said. \u201cBecause it gives it more independence and not so many red tape to go through with IHS. So it\u2019s benefitted the community quite a bit.\u201d<\/p>\n
Martinez says one major benefit is the freedom to experiment, and to figure out how their addiction recovery program can be most helpful to the community.<\/p>\n
At a local gym where clients of the program come to exercise, Mark Mash, a clinical psychologist who runs Taos Pueblo Behavioral Health Services, said that customizing their recovery program had made it possible for the tribe to incorporate regular exercise into their approach. \u201cIn order to really overcome addiction and sustain recovery, people have to really get excited about their health,\u201d Mash said.<\/p>\n
Mash has designed Taos Pueblo\u2019s program to emphasize holistic health treatments, Pueblo culture and community resilience. They\u2019ve also teamed up with the tribal judicial system and created a wellness court, a kind of tribal drug court.<\/p>\n
It\u2019s an approach most outpatient programs don\u2019t have. And Mash says it has meant patients are more able to be productive members of their community.<\/p>\n
\u201cYeah I feel good, my mind\u2019s clear, I got a lot of energy. My wife says she can\u2019t keep up with me,\u201d said Dwayne Kopepassah is a client at Taos Pueblo\u2019s recovery program. \u201cComing over here just helps me take away my anger, all those negative thoughts I\u2019m having, if I feel like drinking I just come and burn a sweat and it\u2019s all gone, you know?\u201d<\/p>\n
It\u2019s hard to know exactly how much more effective these tribally run behavioral health programs really are. There isn\u2019t much data to back up the benefits you hear about from clients and employees.<\/p>\n
And given the risks, breaking away from IHS might not be a wise move for some tribes.<\/p>\n
But it is clear that here in Taos Pueblo \u2014 like in other tribal behavioral health programs \u2014 using Medicaid reimbursements to customize and grow has made it possible to treat a lot more people.<\/p>\n
Ed Williams is the public health New Mexico reporter for KUNM. He has reported on environmental, social justice, immigration and Native American issues in the U.S.<\/p>\n
This story is part of the State of Change project, produced in partnership with the Solutions Journalism Network. This article was published on hcn.org on Oct. 27.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":" A growing number of tribes manage their own clinics and behavioral programs<\/p>\n","protected":false},"author":1,"featured_media":75180,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[],"tags":[21,13,28,561,668,144],"naviga_topic":[],"class_list":["post-75179","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","tag-cortez","tag-frontpage-lead","tag-headlines","tag-native-american","tag-public-health","tag-towaoc"],"acf":[],"author_name":"dh_admin","_links":{"self":[{"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/posts\/75179","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/comments?post=75179"}],"version-history":[{"count":0,"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/posts\/75179\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/media\/75180"}],"wp:attachment":[{"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/media?parent=75179"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/categories?post=75179"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/tags?post=75179"},{"taxonomy":"naviga_topic","embeddable":true,"href":"https:\/\/dh.durangoherald.com\/tj\/wp-json\/wp\/v2\/naviga_topic?post=75179"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}