Tribes work to move forward with health care initiative

Officials from Fort Belknap Indian Community met with members of the governing body of Rocky Boy’s Indian Reservation and a state representative Friday to discuss how Montana Native American tribes can start working on and pushing for implementation of a program to improve health in Indian Country.

The state Legislature last session passed a bill sponsored by Rep. Jonathan Windy Boy, D-Box Elder, creating the Community Health Aid Program in Montana.

CHAP is a program to establish dental health, mental health and behavioral health aid technicians for tribal and Indian Health Services facilities. The bill established local area certification boards, which allows tribes to certify and license professionals to be able to provide patients with preventative care and the ability to refer patients to specialists for further care. 

Fort Belknap President Andy Werk Jr. said that since CHAP has been passed it is critically important that tribes start moving forward with working to establish the program throughout the state. Tribes need to work collectively to press the members of Montana’s congressional delegation and IHS to fund the program and establish training areas for the state, he said.

Byron Larson, an independent CHAP consultant for Fort Belknap, said in an interview after the meeting that since CHAP was approved by the state time is critical because tribes have until 2023 to start implementing the program.

He added that IHS has been working for the past two years to establish a national certification board, although he predicts it will be another year before it is established. Montana cannot start establishing the area certification boards, which will be the governing entities of the program in the state, until the national board is established. 

But as IHS is working to establish the national boards, Native American tribes can start working on what the project should look like within the state and push congressional delegates and IHS for how the program should be implemented in Montana, Larson said. He added that each tribe will need to push to have a representative on the national board and push to have certification centers established locally.

Chippewa Cree Business Committee Acting Vice-Chair Ted Whitford said that CHAP is an important tool for Native American communities, and he understands a lot of work needs to be done. He added that having the bill passed was only the first step, and now Montana needs to think about how to best implement the program.

CHAP was first brought to Windy Boy by Fort Belknap Indian Community staff and attorneys, Werk said. A former IHS director had told the Fort Belknap that other states have been utilizing a CHAP program since the 1960s and was originally established to bring health awareness to the community and transport patients to see specialty doctors.

Alaska and Washington state are the only other states in the country with Community Health Aid Programs, he added.

Windy Boy said that CHAP does not authorize technicians to perform any surgical care but allow them to provide precautionary preventative care. CHAP is a nationally approved program, but each state has to approve the bill in order for the program to be implemented within the state, he said.

He added that during the legislative session many misunderstood the objective of CHAP. Native American reservations have a large population of people who are in need of care but have very few providers. 

Whitford said that Montana can learn a lot from Alaska, which has had CHAP implemented since the 1960s. He added that tribes can also learn a lot from each other in what issues each tribe is facing and what issues each tribe finds as priority.

Werk said that in addition to the program allowing for third-party billing, which will economically benefit the tribes, the program also allows for more jobs and educational opportunities for tribal members.

He added that tribes need to push for the congressional delegates and IHS to establish training facilities within the state. He said that every reservation in Montana has a tribal college and many of the tribal colleges already have the ability to do some of the training needed. 

“Tribal colleges, I think, are the best thing for that,” he said.

Larson said that Montana already has existing resources available and those resources should be utilized.

“The other best thing about it is that we are going to be able to train our own Native people that live in our communities and will stay in our communities,” he said. 

Werk said Montana, as one of the few states with CHAP passed by its legislature and one of the only states to have a dental component approved, needs to work in providing the best care possible to the Native American people in Montana.

He added that it was tribal people who worked to have the bill passed in the state and it needs to be tribal people who take a step forward in implementing the program.

“The reason we are doing this is because we want to move,” he said.

Windy Boy said CHAP is a way for tribes to better address the issues reservations face, such as suicide, drug addiction and poor dental health, and provide critical care of tribal members. 

“The people who know what is best for the Indian Country are those in Indian Country,” Windy Boy said.