North Dakota’s Decision on Federal Health Funds: What It Means for Tribal Communities

Lawmakers Discuss Federal Funding for Tribal Health Care in North Dakota

BISMARCK — A recent committee meeting in North Dakota sparked important discussions about tribal health care funding. State lawmakers faced a proposal aimed at ensuring that at least 5% of federal rural health care funds are allocated to tribal communities.

Currently, North Dakota is working on an application for $500 million in federal funding designated for rural health care over five years. This funding is crucial, given that North Dakota has some of the most significant health care disparities in the country, particularly among its tribal populations.

Rep. Jayme Davis, who represents the Turtle Mountain Band of Chippewa, advocated for this proposal. She highlighted the need for resources to address the gaps in health care. “It’s my people who have the biggest disparities in North Dakota,” she said.

The original plan would split the 5% allocation—60% evenly among five tribes and 40% for targeted grants to tribal governments and health organizations. Davis expressed concern that without a set-aside for tribes, larger health organizations might receive the bulk of the funding, leaving smaller, rural communities in the lurch.

Several lawmakers shared their doubts about the necessity of a guaranteed percentage. Rep. Jon Nelson, a Republican from Rugby, believed that more than 5% would naturally benefit tribal members as long as the process is fair. “I would be shocked and disappointed if only 5% of the funding would go towards programs that directly and indirectly affect tribes,” he stated.

Sen. David Clemens felt confident that tribes would be adequately served. He argued against designating a fixed amount to specific groups, believing in a naturally equitable distribution.

Sarah Aker, from the Department of Health and Human Services, warned that setting aside funds could limit the state’s flexibility in funding allocation. The state’s application to the federal government is due by November 5 and must detail the spending plan for the allocated funds.

With the proposal not gaining traction, Davis modified her motion, seeking to give tribal applications a slight edge in the grant evaluation process instead of a specific percentage. However, the committee did not vote on this second motion.

The funding distribution method remains undecided. Aker mentioned that the department will likely use a combination of formal procurement and grant applications but aims to make the application process accessible for smaller entities.

Davis also pushed for tribal representation on the committee determining the grant awards. Although Aker’s department has consulted with tribal stakeholders, Davis stressed the importance of having a dedicated tribal voice involved. “Nobody knows us better than we know ourselves,” she asserted.

This debate about federal health funding for tribal communities underscores a larger conversation about equity in health care access. A recent report from the National Center for Health Statistics shows that American Indian and Alaska Native populations face higher rates of chronic illnesses than other demographics. A focus on equitable funding could help bridge this gap, improving health outcomes in some of the most underserved areas of the country.

For more information on tribal health disparities and funding initiatives, visit the Centers for Disease Control and Prevention and National Indian Health Board resources.

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