The Indian Health Service announced May 1 that it has settled additional contract support cost claims with Alaska providers, but an unknown number are still in limbo.

IHS Acting Director Yvette Roubideaux sent a letter to Sen. Mark Begich May 1 informing him that additional Alaska claims have been settled. The Aleutian Pribilof Islands Association, Mount Sanford Tribal Consortium, Norton Sound Health Corp. and Metlakatla Indian Community received a combined $15.6 million for work done previously for which they were underpaid, bringing the total for the Alaska settlements so far to $209 million.

Contract support costs are what Tribal organizations pay to manage Tribal health programs. In 2012, the Supreme Court said that Tribes should be fully compensated for the cost of delivering federal trust responsibilities, such as health care.

Now, the IHS is working to repay those groups for prior years when they were not reimbursed for their full costs, and last week, the IHS announced more than $193 million in settlements to six Alaska Tribal health providers.

But other Tribes are still waiting for settlements, including the Kenaitze Indian Tribe, which recently constructed the new Dena’ina Wellness Center in Old Town Kenai.

“Contract support costs are an ongoing topic of conversation between the Kenaitze Indian Tribe and the Indian Health service,” said Jaylene Peterson-Nyren, executive director of the Kenaitze Indian Tribe.

“We’re waiting on Indian Health Services to decide how they’re going to proceed with the thousands of smaller claims like our own that have not been resolved,” she said.

Nyren would not disclose the tribe’s claim amount.

“That’s not a number that we can talk about in public,” she said.

Begich said in a May 1 interview with the Journal that he’s concerned about the number of providers who still haven’t received settlements, and he will not budge on Roubideaux’s reappointment until he sees additional progress, although the May 1 announcement indicated that the claims are moving in the right direction.

Begich had previously told the Journal that he had put a hold on her reappointment until multiple issues related to Tribal health care funding were resolved.

The number of unresolved claims is still unknown. Begich said he has asked the IHS for more information on the total number of claims, and how many Tribes are not even at settlement stage, and has not yet received a written response.

“How many tribes are still in that group?” Begich asked.

In addition to the Kenaitze Tribe, the Tanana Chiefs Conference has said its claims are still pending.

Roubideaux’s May 1 letter also said that the Council of Athabascan Tribal Governments and Seldovia Village Tribe both have claims in federal court, which are scheduled for mediation this summer.

The IHS has also made an additional 15 offers, which are still pending. The service will not release details about pending claims, so the value of those pending offers is not known. It’s also unknown how many Tribes would benefit from the 15 offers.

Despite the remaining questions, Begich said he was glad to see additional claims resolved in the past week, and the pace of resolution picking up.

“It was a drip at a time, and now it’s a full waterfall,” Begich said.

Alaska settlements have represented about 56 percent of the total claims settled by the IHS and 72 percent of the value of settlements to date, according to Roubideaux’s letter.

“(Alaska has) the biggest contract service delivery system,” Begich said.

Begich said he expected that the Alaska settlements would total around $250 million when they’re all completed, although that is an estimate, and the IHS has not provided a total of the pending claims.

Each of the claims is being paid at an average of about 80 cents paid per dollar claimed, with interest, Begich said.

The settlements aren’t just a political victory. It also represents an influx of cash into the Tribal health care system in the state.

“This money comes into the Alaska economy,” he said.

Health providers are still deciding how to use the funding. Although it is a long-time coming, Begich said that no one had wanted to decide how to use the money until it materialized.

The providers will have discretion in deciding in how to use the funds. According to Director of IHS Public Affairs Staff Constance James, the money must be used consistently with the terms of individual settlement agreements and the Indian Self-Determination and Education Assistance Act.

Under a 1975 Congressional act, authorized entities contract with IHS to operate health care programs ranging from clinics to hospitals, to fulfill the federal government’s trust responsibility to provide health care services to Alaska Natives and American Indians.

In Alaska, members of 229 federally-recognized tribes receive health care services from 32 organizations, according to the IHS website.

Reach Molly.Dischner at molly.dischner@alaskajournal.com and Rashah McChesney at rashah.mcchesney@peninsulaclarion.com