Diabetes mellitus is one of the most serious health challenges facing AI/AN in Diabetes contributes to several of the leading causes of death in American …
Program Description
Mission and Authority
The mission of the Indian Health Program IHP is to improve the health
status of AI/ANs living in urban, rural, and reservation or rancheria
communities throughout California Health services for American Indians are
based on a special historical legal responsibility identified in treaties
with the US government California voluntarily accepted this
responsibility by adopting Public Law PL 83-280 in 1954, which allowed
for State jurisdiction of Indian affairs The legislative authority for the
program is Health and Safety HS Code, Sections 124575 - 124595 and Title
XVII Chapter 31, Section 1500-1541
Population Characteristics
According to the 2000 United States Census, there were 627,562 AI/ANs
living in California This included 333,346 people who classified
themselves as AI/AN and an additional 294,216 who classified themselves as
AI/AN and one or more other races The AI/AN population in California is
comprised of members of indigenous California tribes as well as members of
tribes from throughout the United States There are more than 107
indigenous California tribes, representing about 20 percent of the nations
approximately 500
tribal groups
Historical Overview of Health Services
US treaty provisions guarantee health and social services to American
Indians However, the development of a Federal Indian Health Service IHS
system in California was slow and fragmented as a result of eighteen
treaties signed but not ratified Consequently, Federal health resources
to the State between the mid 1850s-1950s were almost nonexistent,
consisting of several small sanitation projects, TB sanitariums, and two
hospitals located in isolated areas
A series of federal and state reports documented alarming deficiencies in
the health status of Indians A report issued by the California Indian
Commission in 1963 reported rates of TB, infant mortality, alcoholism,
diabetes, and other diseases higher than rates for the general population
This report prompted activity within the Department of Health Services
DHS in regards to Indian health Small demonstration projects were
conducted with support of federal Maternal and Child Health MCH monies
and a temporary office of Indian Health was established in 1969
The office assisted Indian communities to organize
local primary care
clinics, eventually resulting in the establishment of a network of such
clinics throughout the state A community Board of Directors or Tribal
Council governs each clinic The passage of SB 52 in 1975 represented the
first efforts of the Legislature to directly address Indian health SB 52
directed DHS to create an Indian health branch with a budget to conduct
local programs The branch was reduced to program status in 1983 as part
of the Rural Health Act SB 1117
Historical Overview of IHP Funding
IHP is funded by the State General Fund on an annual basis
Recommendations for division of these funds to support direct clinic
services and other projects is provided to CDHS by the AIHPP
Indian health clinics are selected for program participation through a
Request for Application process, which is released on a three-year cycle
During this time, new clinics are eligible to apply for participation in
the IHP Funding for continuing and new Indian health clinics is
determined by two methods Funding for continuing clinics is determined by
an allocation formula Funding for new clinic awards is dependent on the
total IHP funds available and
has ranged from 40,000 to 80,000 per clinic
for their first fiscal year FY Funding for new clinics in subsequent
FYs is determined by the IHP clinic allocation formula
Other than a 4 decrease in 1991 and a 65 cut in program staff support in
FY 1991-1992, the IHP budget experienced few changes In 1995-1996 the IHP
budget was augmented by 1 million dollars This 35 percent increase
resulted in a 3,876,000 budget for the IHP in FY 1996-1997
In FY 1999-2000, the IHP received a 2 million dollar budget augmentation
resulting in total IHP funding of 5,876,000
In FY 2000-2001, the IHP received an additional increase of 588,000 10
percent of the previous years final budget amount, which resulted in the
current annual allocation of 6,464,000
From 1980-1993, IHP funds were distributed to the same group of clinics
In FY 1993-1994 legal considerations prompted a policy to open the program
to all eligible Indian clinics every fourth year through a RFA process
Since then the IHP has funded about a dozen additional clinics
Health Status
In 2000 a total of 25 million persons 09 of the US population
classified themselves as American Indians/Alaska
Natives AI/AN alone and
41 million 15 classified themselves as AI/AN alone or in combination
with another race Approximately 26 percent of AI/AN lived in poverty,
which was twice the national rate and the highest poverty rate of all
racial/ethnic populations
AI/AN experience persistent socioeconomic burdens and significant health
disparities in their rates of diabetes, cancer, injuries, and pulmonary
diseases
Statistics that reflect the overall low health status of American Indians
in California include:
16 percent of American Indian births in 2002 were to teen moms
compared to 10 percent for Whites
There were 81 deaths per 1000 American Indian live births in 2001
compared to 47 for Whites This rate discrepancy was probably even
higher though as it does not include the finding of an IHP study that
showed misclassification on death certificates for American Indian
children under age 15 was three to four times greater than reported in
state mortality data
74 percent of American Indian mothers in 2001 received first trimester
prenatal care as compared to 90 percent for
Whites
Diabetes prevalence for ages 50-64 is consistently higher among AI/AN
196 as compared to Whites 8
AI/AN with diabetes have a high incidence of diabetes complications
such as eye, kidney, lower extremity amputations, and cardiovascular
disease Cardiovascular disease was the leading cause of death in
AI/AN and diabetes is a high contributing risk factor for
cardiovascular disease
Diabetes mellitus is one of the most serious health challenges facing
AI/AN in the United States today Diabetes contributes to several of
the leading causes of death in American Indians - heart disease,
cerebrovascular disease, pneumonia, and influenza On average, AI/AN
are 26 times as likely to have diabetes as non-Hispanic whites of a
similar age
From 1999 through 2001, AI/AN had significantly higher average death
rates due to chronic liver disease and cirrhosis
From 1999 through 2001, AI/AN females in California had the highest
average death rate from accidents Injuries cause 75 of all deaths
among Native Americans age 19 and younger The
overall death rate
from preventable injuries remains nearly twice as high for native
people as for the general population
IHP Program Activities
Existing law directs the Department of Health Care Services to address the
comparatively low health status of the AI/AN population through the
maintenance of a program consisting of all of the following:
Technical and financial assistance to local agencies concerned with the
health of American Indians and their families: Financial assistance funds
32 American Indian clinics and two Traditional Indian Health education
projects Technical assistance includes quality of care reviews, program
planning, and evaluation, and a home visitation program targeted at high
risk AI/AN pregnant and parenting families using federal funding
Studies of the health and health services available to American Indians
and their families throughout the state: The IHP assisted with the
completion of a congressionally mandated statewide report regarding the
health status of nonfederal recognized Indians The IHP also funded the
LA Feasibility Study, which examined options for the development of
health care
services to AI/ANs residing in LA County
The American Indian Health Policy Panel AIHPP: The AIHPP is the IHPs
statutorily mandated advisory panel The AIHPP provides advice to CDHS
and IHP on the level of resources, priorities, criteria, and guidelines
necessary to implement the Indian Health Program AIHPP members are
nominated by their respective communities and are appointed by the CDHS
Director
The coordination with similar programs of the Federal Government, other
states, and voluntary agencies: The IHP routinely collaborates with the
Federal Indian Health Service IHS on Indian health issues The IHP is
currently collaborating with IHS to assist tribal clinics and communities
in emergency and bioterrorism preparedness for AI/AN health clinics
Other IHP Activities: HS Code Section 124585 d also specifies that the
program will distribute funds in accordance with a formula and assist
programs to maximize third-party payment systems Additionally, H S Code
Section 124580 requires the CDHS to provide sufficient funding to improve
AI/AN access to other service programs within the CDHS including
Maternal, Child and Adolescent Health
MCAH; Women, Infants, and
Children WIC Supplemental Nutrition Program; programs for the aging;
etc
Clinic Funding via the Allocation Formula
IHP primary care funds are distributed in compliance with Health and Safety
Code Section 124585 d and Title 17, Chapter 31, Section 1532, according
to a need and performance driven formula that is comprised of five weighted
factors
Factor 1:
Systems Evaluation SE 46: This factor is based on the scored
biennial, on-site evaluation of the clinics Medical, Dental, Community
Health Services and Board / Administrative / Fiscal systems Individual
clinic scores are used to determine funding amounts for this component
The SE is conducted using rigorous protocols allowing for clinic
preparation time and standardized evaluation processes This factor of
the IHP clinic allocation formula addresses the demonstrated ability of a
clinic to carry out proposed services and that the clinic has adequate
staff to provide the services
Factor 2:
Foundational Criteria 22: A clinic eligible for IHP funding must
provide at least two of the following three components: Medical, Dental
and Community Health
Services CHS Funds are distributed
proportionately according to the service components that a clinic
provides This factor of the IHP clinic allocation formula addresses the
ability of the program to comply with the statewide plan for Indian
health services and existing priorities for services
Factor 3:
Grant Objectives 15: This factor measures how well grantees have met
the numerical service objectives in their grants Data to measure
achievement of grant objectives are obtained from the number of visits
reported on the Progress Reports submitted by the clinic This factor of
the IHP clinic allocation formula addresses the number of individuals to
be served and the demonstrated ability of the clinic to carry out the
proposed services
Factor 4:
Population Service Index 15: Funding for this factor is based on the
number of individual AI/AN patients actually served during the calendar
year Data to measure this factor are also obtained from the progress
reports submitted by the clinic A per capita rate based on the
unduplicated patients served by each grantee determines the funds awarded
for this factor This factor of the
IHP clinic allocation formula also
addresses the number of individuals to be served
Factor 5:
Target Population 2: This final factor recognizes the size of the
AI/AN population in a clinics service area The population figures used
are from estimates of the service area population prepared by the IHS
using the US Census Bureau A per capita figure determines the funds
awarded for this factor This factor of the IHP clinic allocation formula
also addresses the number of individuals to be served
Contact Information
For additional information on activities of the Indian Health Program,
please contact Andrea Zubiate, Coordinator, at 916 449-5770, or at
azubiate@dhscagov
Address correspondence to:
Andrea Zubiate, Coordinator
Indian Health Program
California Department of Health Services
1501 Capitol Avenue
Suite 716044, MS 8502
PO Box 997413
Sacramento, CA 95899-7413
IHP Fax: 916 449-5776
IHP website: wwwdhscagov/ihp
Program Description Revised September 2007
Source:kidneymobile.org
