Some taxpayer-funded tribal clinics in urban areas recently have stopped admitting people who cannot document their federal tribal status even though the clinics are required by law to provide health care for all people of American Indian ancestry, some patients and clinic officials say, the AP/Boston Herald reports. Indian Health Service oversees 33 clinics nationwide that provide no-cost or discounted care to American Indians and Alaska Natives who live in cities. More than 60% of those populations live in urban areas. The clinics are funded under the American Indian Health Care Improvement Act of 1976, which requires clinics to serve members of tribes that are recognized by states or the federal government, as well as their descendents. Many states recognize tribes that the federal government does not, the AP/Herald reports. However, Martin Young -- who chairs a Santa Barbara, Calif., clinic board -- said the clinic received a letter last fall from the Bureau of Indian Affairs instructing it to deny no-cost health services to people from unrecognized tribes or who do not have a bureau identification card. Young said the clinic has since turned away about 200 patients. An IHS spokesperson said the letter explained who was eligible for care and did not instruct the clinic to deny services. However, clinic managers in Tucson, Ariz.; Wichita, Kan.; and Boston said they also received similar orders.

Reaction
Susette Schwartz, director of the Hunter Health Clinic in Wichita, said, "IHS is suddenly saying that you can't serve this Indian even though he looks Indian, and his family says he's Indian and has all of this history of being Indian, but he doesn't have this piece of paper." She added, "We need some consistency." Federal officials say the clinics are doing the best they can with limited funds, which could be eliminated entirely under President Bush's fiscal year 2008 budget proposal. Paul Redeagle, deputy director of the Indian Health Service office in Sacramento, said, "We recognize that the urban Indian population is in need of care and we don't want to disenfranchise any native Americans who are living in urban areas." The Senate Indian Affairs Committee likely will discuss who is entitled to no-cost care at its meeting on Thursday, according to the AP/Herald (AP/Boston Herald, 3/8).

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