In 2013, the Helmsley Charitable Trust’s Rural Healthcare Program funded the publication of a project to assist a South Dakota American Indian tribe with evaluating the feasibility of assuming management of healthcare services for their tribal members. From this experience, a toolkit was created to help tribes to ”638,” or negotiate for sovereign control of tribal healthcare. This resource, titled the 638 Toolkit: Considerations for Tribes Regarding Contracting or Compacting for Clinical Services from the Indian Health Service Under PL 93-638, provides an outline of key factors to consider when assessing the feasibility of transferring health funding and management to tribal leadership, and the steps to take to navigate the process.

View the 638 Toolkit.