In August, the Indian Health Service (IHS) released three notices proposing to expand the Purchased/Referred Care Delivery Areas (PRCDAs) for seven Mid-Atlantic Tribes, the Confederated Tribes of Grand Ronde, and the Spokane Tribe of Indians. Each of these Delivery Area expansions increases the number of Tribal members who are eligible for PRC payment of services but does not increase the funding for these PRC programs.
The Purchased/Referred Care (PRC) Program can pay for medical or dental services delivered outside of IHS and Tribal health facilities if a Tribal member can meet requirements relating to residency, notification, medical priority, and alternate resources. PRC is an impactful program because it can help fill gaps when Tribal members have difficulty accessing direct care from IHS and Tribal facilities that are far away, unable to offer necessary emergency or specialty care, or are over their capacity.
Generally, to be eligible for PRC, a Tribal member must live in a county that contains or shares a border with a reservation—though there are exceptions. After consultation, the Secretary of Health and Human Services can modify the boundaries of PRCDAs. New PRCDA designations must take into account factors, including how many Tribal members would be newly included or excluded and impacts on funding.
In the Mid-Atlantic region proposal, the seven separate PRCDAs for the Pamunkey Indian Tribe, Chickahominy Indian Tribe, Chickahominy Indian Tribe—Eastern Division, Upper Mattaponi Tribe, Rappahannock Tribe, Inc., Monacan Indian Nation, and Nansemond Indian Tribe would combine to create one collective PRCDA. IHS estimates that this redesignation will make a further 1006 Tribal members eligible for PRC. The proposal for the Confederated Tribes of Grande Ronde would expand the PRCDA to now include Clackamas County, which is estimated to grant eligibility to 179 more Tribal members. For the Spokane Tribe of Indians, the revised PRCDA would add Spokane County and Whitman County, making approximately 480 Tribal members newly eligible for PRC.
It is important to note that while these redesignations make more people eligible, none of these changes come with an increase in funding for the PRC programs. There are limits on the capacities of PRC in part because IHS is chronically underfunded and already serves as the payor of last resort to help make up for this shortage of funding. To this end, PRC requires people to seek funding from alternative resources such as Medicare, Medicaid, or other insurance options to be eligible for payment of services.
Comments on these PRCDA expansions are open until August 31 for the Mid-Atlantic Tribes, September 6 for the Confederated Tribes of Grande Ronde, and September 8 for the Spokane Tribe of Indians. Commenting on these notices from IHS is an opportunity to exercise Tribal sovereignty and engage in the management of health systems in Tribal communities. See the Federal Register notices linked above for more information on how to comment.