April 15th

Letter sent to Tribal Members:

Dear Shoshone-Bannock Tribal Members,

We hope this message finds you and your families in good health and spirits.
The Shoshone-Bannock Tribes is interested in expanding and assuming management of the remaining Indian Health Service (IHS) programs at the Not-Tsoo Gah-nee clinic under the Indian Self-Determination 638 Act (ISDA). We write to begin an open dialogue about the benefits of doing so and why we must act now to preserve vital health care services for our people.

The ISDA allows Tribes to assume the delivery of IHS-funded health programs through either Title I contracts or more flexible Title V compacts. These contracts honor the government-to government relationship and affirm the federal trust responsibility to provide healthcare to Native people. ISDA contracting has helped many Tribes improve healthcare access, tailor services to community needs, and ensure local accountability.

The Shoshone-Bannock Tribes have successfully operated IHS programs under the direction of the FHBC and the THHS for nearly 50 years. Due to lack of funding and personnel issues at the IHS-operated Fort Hall Service Unit in recent years, the Tribes have spent an approximate average of $4.5 million annually referring patients for services outside of the Not-Tsoo Gah-nee clinic. Instead of diverting healthcare dollars away from the Tribes, we hope to increase services locally and generate revenue to further expand health care services for our membership.

We’ve provided the tribal resolution authorizing the exploration of this important initiative, and a FAQ document to provide more information for your review. We’ll be providing weekly updates in the ShoBan News. To learn more, please join us at one of the following informational events:

• At upcoming District Meetings, the THHS Director and Staff will present.
• On May 9, Two informational sessions (maximum occupancy 400) at the Hotel Event Center with special guests; morning and afternoon (repeated) with lunch (Scan OR code to RSVP).
• On May 10, we’ll be presenting at the Tribes’ Annual Meeting. We encourage Tribal Members to stay informed, ask questions, and provide feedback. Your voice will help shape the future of healthcare for generations to come.

Thank you for your time and assistance to improve the health and strength of our Tribal Nation.

Lee Juan Tendoy, Chairman
Fort Hall Business Council
Shoshone-Bannock Tribes

Travis Martin,
Tribal Health & Human Services Director
Shoshone-Bannock Tribes

Informational meeting QR Code

Self Governance Website

Introduction to Self-Governance Authority – Tribal Self-Governance

Frequently Asked Questions and Answers

Q: What does it mean to become a Self-Governing Tribe?
A: In the most basic sense, it means the Tribe has management and control over the decisions
that impact its citizens, including programs and services provided for their benefit. When Tribes
usually talk about self-governance, they are referring to it in the context of the Indian SelfDetermination
Act, which is a federal law that permits Tribes to take over certain federal
programs (like IHS or BIA programs) that the federal government would otherwise run itself
using either self-determination contracts (Title I) or self-governance compacts (Title V). The
idea is that through local control, Tribes can better serve its community.
Q: What is the difference between Title contracts and Title V compacts?
A: The Tribe currently operates some health services through Title I contracts with IHS. These
contracts are based on model contracts, which direct the Tribe’s operation of Title I programs.
Title I contracts do not provide redesign authority or re-budgeting authority without IHS approval.
Title I contracts require the Tribe to largely adhere to the federal structure for operation of the
programs assumed in the contract.
A Title V compact, by comparison, would allow the Tribe to negotiate the provisions and terms
that are most likely to help the Tribe meet its goals for improving health services delivery. A Title
V compact would provide the Tribe redesign and re-budgeting authority, without requiring IHS
approval. With this enhanced authority, the Tribe can be responsive to the direct needs of tribal
citizens.
Q: Why is Self-Governance an attractive option for the Shoshone-Bannock Tribes?
A: Self-Governance will allow the Tribe more flexibility in policymaking, greater control over
health system design, and enhanced budgetary control for health programs. Funding will be
prioritized according to Tribal citizen needs, new programs may be designed, and partnerships
can be created to synergize health services resources. Self-Governance strengthens tribal sovereignty through increased tribal control and involvement in all aspects of delivery of health services for our community.

Q: Does Self-Governance mean we are severing ties with the federal government?
A: No. The federal government retains its trust responsibility, including funding obligations.
Self-Governance strengthens Tribal control but maintains the nation-to-nation relationship.
Q: When will this transition take place?
A: We are planning to assume the remaining programs effective October 1, 2025.

Funding & Financial Responsibility
Q: Will the Tribe have to pay for services that the federal government currently covers?
A: No. The federal government must still fund the programs at the same level, and the Tribe is
also entitled to receive additional funds to cover the Tribe’s administrative and other costs
needed to run the programs.
Q: Can we generate additional revenue through Self-Governance?
A: Sometimes. For instance, on the health care side, many Tribes bill third-party payers (such as
Medicaid, Medicare, and private insurance) and then use those additional revenues to enhance
and expand services and reinvest in their healthcare system.
Q: What happens if federal funding is reduced or delayed?
A: Tribes can include financial protections in their agreements, including the ability to stop
providing services if the government does not provide sufficient funding, and they may have
more flexibility in managing resources during funding gaps, such as shutdowns or continuing
resolutions.

Service Delivery & Quality of Care
Q: Will services be reduced?
A: No. In fact, most Tribes improve and expand services, tailoring them to meet specific
community needs more effectively: Will we still be able to go to the same clinic or see the
same doctors?
A: Yes. The clinic locations will remain the same. The Tribe also plans to offer the existing IHS
employees the ability to keep their federal employment and stay in their current positions, but
under Tribal control.
Q: What will happen to current IHS employees if the Nation assumes operations?

Q: What are examples of improvements other Tribes have seen when assuming their programs?
A: Tribes have reported shorter wait times, more culturally appropriate care, expanded services (e.g., dental, mental health), and better patient satisfaction.
Governance & Oversight
Q: Who oversees the programs once they are assumed?
A: The Tribal government-typically through a designated department or health board­oversees operations, policies, and staffing.
Q: Will Tribal Members have input in how services are run?
A: Yes. Self-Governing Tribes often have more community engagement and transparency in decision-making. For instance, Tribal members can run to be on the health board, and the Fort Hall Business Council will have ultimate oversight over our health program.
Q: Can we decide which programs to take over?
A: Yes. The Tribe can choose to take over specific programs incrementally or assume full control depending on capacity and readiness. The Tribe has operated some IHS programs under a self-determination program for decades. Now, we are finally ready to take over the remaining programs at the Fort Hall Service Unit.
Risks & Readiness
Q: What are the risks of Self-Governance?
A: The main risk of self-governance is the same as the risk of any Tribal health program-that the federal government may reduce funding for services. This risk remains the same whether or not our Tribe assumes new services or continues to allow IHS to manage some services. The Tribe will also need to ensure it has strong financial management and the ability to recruit and maintain staff-but these challenges can be mitigated with planning, training, and support.
Q: How do we know if we’re ready?
A: The Tribe has been preparing for this assumption for nearly a decade. In 2019, we hired a consultant to come in and do a comprehensive survey to see ifwe were ready, and we passed! However, with the COVID-19 pandemic, the Council decided to put this transition on hold. We now have solid leadership and internal management structures in place, and given current changes in the federal government, this is a prime time to move forward ..
Q: What is involved in the planning process?

A: The Tribe requested several pieces of information from IHS so it can begin analyzing the
services currently provided. The planning process also includes intensive analysis of the Service
Unit finances to ensure we can continue growing revenues and expanding services. We will also
meet with employees and plan for the transition to Tribal management. The goal of the planning
process is to ensure we are ready to operate these programs on October 1.
Q: Have other Tribes in our region taken over IHS programs?
A: Yes. In fact, we are one of only 3 Tribes in the Area that have not taken over the entire IHS
program or is not currently in negotiations to do so. If we move forward with our assumption,
only 2 out of 43 Tribes in the Portland Area will continue receiving services from federallyoperated
Service units.
Q: Are there support systems to help us transition?
A: Yes. National organizations like the Self-Governance Communication and Education Tribal
Consortium (SGCE) and experienced Tribal leaders often provide technical assistance and
mentorship. For instance, here are other sources of support:
• IHS Office of Tribal Self-Governance & Area Offices: Provide guidance on the
transition process.
• National Indian Health Board (NIHB): Offers technical assistance and advocacy
resources.
• Northwest Portland Indian Health Board: Serves 43 Tribes in the IHS Portland Area,
providing support, resources, advocacy and training.
• Other Self-Governance Tribes: Many Tribes that have successfully assumed programs
can provide peer support and best practices.
If you have questions, please submit them using this form by scanning the QR code. Responses
will be shared during upcoming informational meetings or sent to you directly via the email
address you provide.