 From colonial times to present, Tribes have been recognized as sovereign governments, with a distinct form of government, a distinct land base, a distinct culture and a distinct citizen base  Mohegan land Claims Against Colony of Connecticut heard in London Courts in 1700’s  Petitions to divide land among Mohegan Tribal members rather than be controlled by overseers  Strong leaders, strong governments despite all efforts to undermine

“The Indians though Living amongst the King’s Subjects in these Countries are a Separate and Distinct People from them, they are treated with as Such, they have a Polity of their own, they make Peace and War with any Nation of Indians when they see fit, without control from the English.” Source: 1743 interim ruling on jurisdiction by Commissioner Daniel Horsmanden

 We beg leave to lay our concerns and burdens at Your Excellencys Feet. The times are exceedingly alter’d. Yea the Times have Turn’d ever thing Up side down, or rather we have Chang’d the good Times, Chiefly by the help of the White People; For in Times past, our Fore-Fathers live in Peace, Love and great harmony; and had everything in Great plenty. When they wanted meat, they wou’d just run into the Bush a little ways with their Weapons and wou’d Soon bring home good Venison, Racoon, Bear and Fowl, if they Choose to have Fish, they wou’d only go to the River or a long the Sea Shore and they wou’d presently fill their cannoous with Variety of Fish, both Scaled and Shell Fish, - and they had a bundance of Nuts, Wild Fruit, Ground Nuts and Ground Beans, and they planted but little Corn and beans. –and they kept no Cattle or Horses, for they needed none.-And they had no Conention about their lands.

 It lay in Common to them all, and they had but one large Dish, and they Cou’d all eat together in peace and love.—But, alas, it is not So now. All our Fishing Hunting and Fowling is entirely gone. And we have now begun to Work on our Land, keep Cattle, Horses and Hogs; and we Build Houses, and fence in Lots. And now We plainly See that one Dish and one Fire will not do any longer for us. Poor widows and Orphans must be pushed one side and there they must Set a Crying, Straving and Die. And So We are now Come tour Good Bretheren of the Assembly, With Hearts full of Sorrow and Grief, for immediate help.

 And therefore, our most humble and Earnest Request and Petition is that our Dish of Suckuttush may be equally divided amongst us, that everyone may have his own little Dish by himself, that He may eat Quietly, and do with his Dish as he pleases and let everyone have his own Fire………

 United States Constitution  Marshall trilogy recognizing the principle of inherent tribal sovereignty and the trust doctrine imposing certain types of fiduciary duties upon the United States. Cannons of construction require the United States to interpret treaties in favor of the Indians, interpret them liberally and interpret them as the Indians would have understood them  Snyder Act 1921

 Johnson O’Malley Act  Indian Reorganization Act of 1934 as amended  Establishment of the Indian Health Service 1955  Indian Self-Determination Act of 1975 as amended  Indian Health Care Improvement Act permanently reauthorized as part of the Affordable Care Act

 Fundamental Premise of Tribal Self- Governance  Failed United States Indian Policy of Paternalism  We know our communities best and how best to serve them  We are the keepers of our culture, our families and our future  We are accountable to all our relations past and present

 The Federal government has acknowledged a responsibility to consult with tribes on all matters of policy  The Federal government is charged with facilitating compacts with tribes to ensure that the philosophy of self-determination and self-governance is carried out at the local level  Culture of partnership with Federal agencies to advocate for the provision of accessible, high quality health care to American Indians and Alaska Natives  Tribes insist on a seat at the table and believe the role of consultation is to partner with federal agencies to shape effective policy.  New opportunities= new responsibilities

 We are:  holistic  Able to leverage scarce resources and make them meaningful  creative  3 rd party billing/collaboration  Provision of services to Non-Indians/Alaska Natives to increase reimbursement opportunities and increase services to natives  Traditional medicine alongside modern medicine

 Use of telemedicine  Use of physician extenders/aides  SDPI  Wellness initiatives  Cutting edge—interdisciplinary approach vs. silo mentality

 Ability to redesign and reallocate resources to ensure that the needs of the community/goals of the community are reflected in the care provided = respect for regional and tribal differences  Stable base funding vs. annual grant process.  Ability to “roll-over” funds from one year to the next if unexpended  Less bureaucracy = more funding for direct care  More accountability at the local level

 Established 1996  Provides information dissemination, education, advocacy and policy guidance for the implementation of Self-Governance within Indian Health Services; meeting with the Director of Indian Health Services and staff regularly  Each of the 12 regions are represented by a tribal leader and technical advisor  Operates by consensus  Represents all Tribes not individual Tribes

 Works in concert with the Office of Tribal Self- Governance to develop meeting agendas and educational opportunities  Annually develops strategic plan in consultation with all self-governance tribes  Supports all Tribes in their determination of how best to provide health care for their people: Direct Service vs. Title I Contract vs. Title V Compact