Tribal Self-Governance Health Care and Social Services Delivery Effectiveness Evaluation Feasibility Study: Draft Literature Review - Revised Report. II.1 Tribal Self-Governance/Tribal Management of Health and Social Service Programs

03/04/2003

Tribes currently manage a number of Department of Health and Human Services programs under several arrangements, including self-governance compacts, self-determination contracts, competitive grants, and demonstration programs. Each of these arrangements may provide differing degrees of autonomy to Tribes and may involve different reporting and compliance requirements.

The authority for Tribal management of federally funded programs was initially provided by Congress under the Indian Self-Determination and Education Assistance Act of 1975 (P.L. 93-638).(1) Title I of that Act authorized Tribes to assume management of Bureau of Indian Affairs/DOI and Indian Health Service programs through contractual agreements. From 1975 to the present, Congress has expanded the opportunities for Tribes to manage their own programs and has increased the degree of Tribal authority and discretion in management. P.L. 100-472 amended P.L. 93-638 in 1988 to add Title III, which authorized the Tribal Self-Governance Demonstration Project that allowed Tribes to assume greater control over BIA programs that they managed, including consolidation and re-designs of programs to better meet individual Tribal priorities and needs. In 1992, as part of P.L. 102-477, Congress extended the Title III self-governance demonstration to provide for Tribal self-governance of Indian Health Service programs. Based on the success of these demonstration projects, Congress made Tribal self-governance a permanent program within BIA in 1994 (Title IV), and made permanent Tribal self-governance of IHS programs in 2000 (Title V).

Within the Department of Health and Human Services, Tribal self-governance has been limited to IHS programs. Tribes may choose to manage these IHS programs under Title 1 contractual arrangements or through self-governance compacts under Title V. Bauman et al. (September 1999) point out that there are reasons that some Tribes might choose to contract rather than seek a compact. To receive a Title I contract, the Tribe does not need any prior experience in program management, while evidence of management experience is required for a Title V compact. In addition, the Secretary of DHHS has only a limited time frame within which to accept or decline a Tribe's Title I proposal, while acceptance of a Title V application may take longer. Self-governance compacts offer more flexibility in using funds and re-designing programs and their terms are more flexible and subject to negotiation. However, substantial autonomy and discretion are also permitted for Title I Tribes and, as a result, the advantages of Title V compacts are not dramatically greater than those for Title I contracts.

Tribes manage other DHHS health and social service programs, under contracts, grants, and demonstration programs. These Tribally-managed programs, however, do not generally offer the flexibility of program design and use of funds that self-governance provides to Tribes, and often require extensive application processes and detailed separate reporting requirements.

In the Self-Governance Amendments of 2000 (P.L. 106-260), Congress re-affirmed its commitment to Tribal self-governance. In the Preamble to the Act, the Congress defined the goal of self-governance as "to permit an orderly transition from Federal domination of programs and services to provide Indian Tribes with meaningful authority, control, funding, and discretion to plan, conduct, redesign, and administer programs, services, functions, and activities (or portions thereof) that meet the needs of individual Tribal communities." Specifically, the Congress directed the Secretary of DHHS to "conduct a study to determine the feasibility of a Tribal self-governance demonstration project for appropriate programs, services, functions, and activity (or portions thereof) of the agency [HHS]."

The Office of the Assistant Secretary for Planning and Evaluation conducted the Tribal Self-Governance Demonstration Feasibility Study for Planning and Evaluation, DHHS in 2001-2002. The Draft Report on the Study, released November 5, 2002, identified 11 DHHS programs as "feasible for inclusion in a Tribal self-governance demonstration project". These 11 programs are:

  • Administration on Aging
    • Grants for Native Americans
  • Administration for Children and Families
    • Tribal Temporary Assistance for Needy Families
    • Low Income Home Energy Assistance
    • Community Services Block Grant
    • Child Care and Development Fund
    • Native Employment Works
    • Head Start
    • Child Welfare Services
    • Promoting Safe and Stable Families
    • Family Violence Prevention: Grants for Battered Women's Shelters
  • Substance Abuse and Mental Health Services Administration
    • Targeted Capacity Expansion

There are Tribes currently managing each of these DHHS programs that are recommended for inclusion in a Tribal Self-Governance Demonstration program, under contractual arrangements or grant awards. The Self-Governance Demonstration program, as detailed in the Draft Report, would permit a simpler, multiple-program application process and simpler and consolidated reporting requirements. Most importantly, the Demonstration program would provide "Tribes with the flexibility to change programs and reallocate funds among programs" (p.19) to better address specific Tribal community priorities.

Initiation of a DHHS Tribal Self-Governance Demonstration requires Congressional action prior to implementation. With the prospect that Congress may authorize such a demonstration, DHHS has identified a need to address the absence of conclusive quantitative evaluation to document the successes and outcomes of Tribal management of health and social services programs. DHHS contracted with Westat to conduct the Tribal Self-Governance Evaluation Feasibility Study to provide background information and to assess the feasibility of conducting a rigorous and defensible evaluation of Tribal management of health and social services programs under self-governance compacts and self-determination contracts. This Draft Literature Review provides background information on the current state of knowledge on the processes and outcomes associated with Tribal management - under self-governance compacts, contracts, and grants - of DHHS health and social service programs. The literature search focuses on identifying existing studies of Tribally-managed IHS programs and on studies that have been conducted of Tribal management of the 11 DHHS programs that have been suggested for inclusion in the DHHS Tribal Self-Governance Demonstration program.