Tribal healthcare providers in Alaska are set to receive $193 million in payments for past work, with more settlements expected.

Six providers will receive payment for 45 past contract support cost claims from the Indian Health Service, or IHS, Sen. Mark Begich announced April 25.

Contract support costs are what Tribes pay to manage Tribal health programs. In 2012, the Supreme Court said that Tribes should be fully compensated for those costs when delivering federal trust responsibilities, such as health care. Under a 1975 Congressional act, authorized entities contract with IHS to operate health care programs ranging from clinic 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.

Southcentral Foundation will receive the largest payment — $96.5 million for 17 claims, dating back to 1997. That organization helps run the Alaska Native Medical Center in Anchorage, and operates facilities in the Anchorage and Matanuska-Susitna Borough areas, as well as parts of rural Alaska.

Yukon-Kuskokwim Health Corp. will receive $39 million for seven claims, Bristol Bay Area Health Corp. will receive $25.5 million for 19 claims, Maniilaq Association will receive $25 million for 6 claims, Arctic Slope Native Association will receive $6.7 million for 15 claims, and Ketchikan Indian Corp. will receive $364,989 for three claims, according to an announcement from Sen. Mark Begich.

Tanana Chiefs Conference has past claims that have not yet been resolved, as do other organizations. However, it is unclear when those claims will be resolved and, according to an email from the IHS, it is against the agency’s policy to release information about pending claims.

Begich said that about 15 additional claims are still pending, for about four or five Tribal providers.

Begich said the size of the organization doesn’t matter in addressing the claims, and that the settlements so far have ranged from Ketchikan Indian Corp.’s $364,989 to Southcentral Foundation’s $96.5 million. Eventually, every one of the claims should be fully recognized, he said.

According to a letter from Acting IHS Director Yvette Roubideaux to Begich, the claims in Alaska total about $273 million, with almost $200 million of that settled so far.

The unsettled claims are one reason he hasn’t supported moving IHS Acting Director Yvette Roubideaux’s reappointment out of the Indian Affairs committee, Begich said.

He wants the claims settled, and a funding source identified, before she receives the reappointment.

Begich is also looking for Roubideaux to develop a stable funding source for the IHS going forward, he said, so that contract support costs are paid every year, and the back-claims aren’t necessary.

Begich said the contract support costs have been on his radar since he joined the Senate, but he’s gotten increasingly aggressive on the issue over time.

“I don’t know why these have been stalled for so many years,” he said.

Begich said he got particularly agitated last year when he was expecting President Barack Obama to make a bold statement about the settlements when he met with tribes, and the announcement didn’t come.

“It was totally unacceptable,” Begich said.

Once he started raising the issue about the unpaid Alaska claims, Begich said he started getting calls from other tribes looking for their payments, too.

Then he tied to the issue to the question of Roubideaux’s reappointment.

“I said no,” he said. “Not until I see some realistic settlements.”

In an April 24 statement, Sen. Lisa Murkowski also praised the announcement of Southcentral Foundation’s settlement, but noted that more issues needed to be resolved.

“This agreement to settle up $96 million in obligations is a major step forward, but also a reminder that promises remain unkept nationwide,” Murkowski wrote in a formal statement. “I will continue to press and advocate for our First People to receive the high quality medical care and treatment they are promised by America’s trust responsibility to them.”

YKHC CEO Dan Winkelman said April 24 that while his organization had received a settlement for its contract support cost claims, he was also looking for more stable funding in general.

“It’s really important for IHS to restore the pre-sequestration appropriation amounts,” he said.

Although Congress fully funded contract support costs, the agency has still been subject to sequestration, which affects the funding Tribal health providers receive, he said, although not the services they provide. Pre-sequestration, YKHC received $72 million; this year, it received $68, he said.

“We’re still providing at pre-sequestration levels,” he said.

Molly Dischner can be reached at molly.dischner@alaskajournal.com.