Health | National

Indian Health Service takes steps to expand community health aide program

Monday, January 9, 2017

Dental health aide therapists in Alaska have been successfully providing services to rural Native villages for more than a decade. Photo: Alaska Native Tribal Health Consortium

The Indian Health Service is moving forward with plans to expand the community health aide program.

Community health aides, particularly dental therapists, have proven successful in Alaska and tribes in the Lower 48 are interested in building on the effort. To assist with that goal, the IHS is forming a new workgroup that will develop a national expansion policy for the program.

“Increased access to health care is a top priority for IHS, and community health aides expand much-needed health services for American Indian and Alaska Native communities,” Mary L. Smith, the principal deputy director of the IHS, said in a press release on Monday.

Dental care isn't the only area that could see a boost as part of an expansion. Community health representatives and behavioral health aides could be trained and certified to serve throughout Indian Country.

"Community health aides are already providing quality health care in some parts of Indian Country, and with the expansion of this program, Native American communities across the nation will have access to these valuable health workers,” Smith said.

The dental therapy program, however, stands to be the most complex part of any expansion. The Indian Health Care Improvement Act includes a provision -- inserted at the behest of national dental organizations -- that attempts to limit therapists to states where they have already been authorized under state law.

Tribes view the restriction as an infringement on their sovereignty and the federal-tribal relationship. As a result, therapists have been slow to expand in the Lower 48 despite their success in Alaska and the extreme dental health needs in Indian Country.

Additionally, while the IHCIA foresees an expansion of dental therapists, it prohibits the IHS from reducing funding for Alaska. The issue was raised during consultation about expansion efforts, according to a report released by the IHS on Monday.

The IHS didn't release a timeline of the next steps but the process would be moving forward under the administration of Republican president-elect Donald Trump. He has not said anything about Indian health but supports efforts to repeal the Affordable Care Act, a move that would dismantle the IHCIA.

Trump has nominated Rep. Tom Price (R-Georgia), a critic of the ACA, to lead the Department of Health and Human Service. He is also responsible for choosing a director for the IHS.