FHBC Chair Donna Thompson attends IHS realignment meeting in Montana
FHBC Chairwoman Donna Thompson speaks at the Indian Health Service realignment meeting in Billings, Mont. on January 7. (Photo courtesy of Office of Public Affairs)
By MICHAEL STEELE
Tribal Policy Analyst
BILLINGS, Mont. — Joined by tribal leaders from Montana, Wyoming, and South Dakota, Fort Hall Business Council Chairwoman Donna Thompson traveled to Billings, Montana on January 7 to participate in a Tribal Consultation with the Indian Health Service (IHS) leadership focused on realigning the Agency’s organizational structure.
The consultation continued discussions from July of 2025 focused on efforts to modify IHS’s structure at the area, regional, and national levels to enable a, “…patient-centered, self-determination-driven, operationally efficient, and fiscally sustainable system,” to strengthen partnerships and support Indians.
No cuts or decreases to services are proposed for the Fort Hall Service Unit. However, discussions confirmed that under a new structure, Not-tsoo-Gah-Nee Indian Health Center, and other federally-operated health facilities, would report to a new regional office, while the Portland Area Office would transition to serve in liaison and advisory roles.
The consultation began with Acting Director Clayton Fulton presenting the need for accountability, improved operations support to service units, and reduced variation in health care. He further explained that IHS’s structure has not been modernized in decades, yet changes to laws, tribal populations, court decisions, and self-governance contracts drive realignment. Fulton then explained that approximately 65 percent of its budget is transferred to Tribes to meet self-governance obligations. The remaining 35 percent of the IHS budget funds direct-service facilities and programs. Thus, realignment and standardization are necessary to meet obligations under current funding constraints.
Chairwoman Thompson first questioned where regional offices would be located, how would current staff be affected, and what guarantees would be given to ensure that realignment would not siphon funds from current IHS programs. In his response, Deputy Director Benjamin Smith offered that decisions and boundaries for regional offices have not yet been made. He added that staffing challenges, to include hiring, are also main drivers for realignment. He then emphasized that realignment must be a cost-neutral endeavor because dollars cannot be reallocated.
Later, Thompson advocated for IHS to include mandatory funding in future budget requests to mitigate against the risk of future decreased congressional appropriations in an already underfunded agency. She also voiced her concerns about IHS’s challenges hiring new employees, and asked the leadership to include the identification of risk as part of realignment efforts. She concluded, “Although every Tribe is different, our concerns are the same. Our concerns center on ensuring that the IHS continues to provide care to our people.”
Other tribal leaders expressed concerns about realignment creating new bottlenecks if functions are consolidated, the need for transparency, updating and protecting tribal funding shares, and ensuring to shield IHS staff from additional workload. Discussions also included creating separate offices focused on self-governance and direct-service tribes to provide subject matter experts that can address the uniqueness of each tribe.
IHS will continue realignment planning with updates expected this spring.
