1. Tribal Shares Fundamentals
Lindsay King, MBA
Director, Office of Tribal Self-Determination
Agency Lead Negotiator
Oklahoma City Area, Indian Health Service

2. 11/19/2014
Defining Key Terms
In general, the IHS receives two major categories of funding that support either Programs, Services, Functions and Activities (PSFAs) or Inherent Federal Functions. We refer to these two categories of funding as Tribal Shares and Residual, respectively.
Inherent Federal Functions – functions that must, by law, be carried out by a federal official.
Residual – the amount of funds required to perform Inherent Federal Functions, under the theoretical assumption that all available PSFAs and associated Tribal Shares have been assumed by Tribes through Indian Self-Determination and Education Assistance Act (ISDEAA) contracts (Title I) or compacts (Title V).
Programs, Services, Functions and Activities (PSFAs)– are all elements of a healthcare operation, direct and administrative in nature, that may be delivered by the IHS at the Service Unit, Area or Headquarters levels in a direct service operation or that may be contracted or compacted to be operated directly by a Tribe or Tribal Organization.
Tribal Share – the amount of funds required to perform Inherent Federal Functions, under the theoretical assumption that all available PSFAs and associated Tribal Shares have been assumed by tribes through Indian Self-Determination and Education Assistance Act (ISDEAA) contracts (Title I) or compacts (Title V).
Transfer of shares is a Tribal choice.

3. PSFAs & Tribal Shares PSFAs
Tribes decide to contract all, a portion, or none
Tribal Shares Associated funds follow the decision about the PSFA
Tribe contracts or compacts to perform functions A, B, C …
Tribe takes funds associated with contracted functions A, B, C …
Transferred
$$$
A, B, C $
XYZ
Tribe leaves functions X, Y, Z for IHS to perform
PSFA supporting other Tribes
Funds supporting PSFA to other Tribes
Tribe leaves funds associated with functions X, Y, Z
Retained
Funding
This chart does NOT depict Inherent Federal Functions and Funds

4. 3 Levels of Tribal Shares are Available
Headquarters Tribal Shares
Portion benefiting each Tribe
Area Level Tribal Shares
Program/Service Unit Level Tribal Shares
PSFAs and associated
Tribal Shares are available from all 3 levels of the IHS. + +

5. How are Tribal Shares determined?
Direct Financial Measures: Tribal Shares are precisely determined when financial accounts record actual spending for PSFAs for a Tribe, e.g. IHS funds at a service unit/health clinic serving 1 Tribe.
Program Measures: Tribal Shares may be calculated in proportion to workloads, services, or patient counts for each Tribe. These formulas are most common for PSFAs associated with the Office of Environmental Health and Engineering.
Proxy Formula: A proxy formula calculates tribal shares in proportion to indirect measures such as user counts, number of Tribes, tribal jurisdiction or other general distributive factors.

6. Proxy Formula Example: Tribal Size Adjustment (most HQ PSFAs)
Most HQ PSFAs collectively benefit 573 federally recognized Tribes. The TSA formula calculates a $ benefit for all Tribes in proportion to tribal user counts.
92% of the total funds associated with HQ PSFAs are calculated on a per user basis (applies to every Tribe)
8% of the total $$ are identified for small Tribes of less than 2,500 users, calculated on a sliding scale that diminishes approaching 2,500 users.
This adjustment is intended to address economy of scale issues
TSA Formula
92% of TSA $ is calculated per user for all Tribes
Aggregate funds for ~ 50 HQ PSFAs
Portions for all Tribes +
8% if < 2,500 users

7. Protections for Tribal Shares
Shares are determined when a PSFA is initially contracted or compacted. The amount is recurring thereafter.
Subsequent negotiations occur before annual appropriations are known. Tribal Shares are ESTIMATED and adjusted when the appropriation is enacted. The Funding Agreement is then amended.
Recurring shares for contracted or compacted PSFAs are protected from reductions except for limited reasons stated in ISDEAA, e.g. an Act of Congress.
Funds may be added to a contract or compact for special projects or limited time periods but are non-recurring and cannot be expected in future years.
New or Restored Federally Recognized Tribes Policy

8. Special Circumstances
Consortia – Tribal Shares associated with individual Tribes maybe consolidated for ISDEAA agreements
Delegation to another Tribe – a Tribe may direct it’s shares to another Tribe to carry out the PSFA for its members (some examples in Oklahoma)
Grandfathered Tribal Shares – a few unique agreements were implemented early in the 1990’s especially in pilot projects before self-governance became permanent. Some of the arrangements were grandfathered.

9. Examples of Proxy Formulas for Area Tribal Shares
Methodologies vary by Area Office
User Population, Tribal Reservations or Jurisdictions, Proportion of the Overall Recurring Base, Hybrid Approach, e.g. 70/30 split or some other combination.
Each Area is responsible for calculating and distributing their respective Area Tribal Shares.
Contact your local Agency Lead Negotiator for more information on your Tribe’s Area Tribal Shares.

10. Reading & Interpreting the Financial Tables
Now that we’ve talked about HOW tribal shares are determined and we know that they are transferred to Tribal operation via an ISDEAA (638) contract or compact, how do we decipher the financial tables that identify the Service Unit, Area and HQ level shares?
Let’s take a look at some examples in the next 6 slides.

11. Table 1 -IHS Appropriation
Major IHS Accounts
Changes Made By Congress
Final IHS Budget

12. Table 2 – HQ and Area Budget Split
Total Amounts Tracked On Area Or Local Tables
Amounts Tracked On HQ Tables

13. Table 3 – HQ PSFA Breakout
PSFAs
Available For Shares
Unavailable For Shares

14. Table 4: HQ Shares Available to a Tribe
Tribe’s Portion Of Each PSFA
Portion Available In FA

15. Self-Governance FA Table
4/22/2018

16. Self-Governance FA Table
4/22/2018

17. Questions??
Contact Information
701 Market Drive, Oklahoma City, OK 73114