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1986 to 2006
In the past twenty years CRIHB has held 80 quarterly meetings where Indian health leadership and staff have come together to discuss local, State and National issues, to network and learn from each other and to agree on collaborative actions to improve and protect health services. CRIHB has never failed to make a quorum in all that time.

CRIHB is a founding member of the National Indian Health Board and represents Tribes and Tribal Health Programs in California to the NIHB today. We actively supported their move to Washington DC resulting in an expansion in their advocacy role with both Indian Health Service (IHS) and Congress.

CRIHB worked with the NIHB as an active part of a national coalition to add language to the Medicare Modernization Act that will limit the ability of hospitals to charge more than Medicare rates to IHS and Tribal Health Programs.

CRIHB acquired funding from The California Endowment to establish the ACTION FOR INDIAN HEALTH CAMPAIGN. The first formal arrangement for joint political action with Riverside San Bernardino County Indian health and Indian Health Council since those programs left the organization in 1977.

The ACTION FOR INDIAN HEALTH CAMPAIGN was successful in protecting American Indians in California from premiums and co payments for Medi-Cal coverage that were imposed on everyone else under Governor Schwarzenegger’s Medi Cal Redesign Plan.

CRIHB board members incorporated the Turtle Health Plan in 2000 as primary strategy to maximize Medi-Cal funding for Tribal and Urban health Programs in California. Over $2 million in grant funds were invested in developmental actives in support of this strategy.

The CRIHB Area Office Functions Contract begun in 1995 established a new model of Indian Self-Determination Act contracting in which resources are pooled to acquire economies of scale but placed under tribal control to increase responsiveness and quality.

CRIHB leadership, legislative success and research products lead to the development of a single national standard for accurately measuring IHS funding short falls initially known as the Level of Need Funded methodology and now called the FDI index.

CRIHB working nationally with other Tribal Health Contractors brought about the IHS/HCFA Memorandum of Agreement, which extended the IHS encounter rate process for billing Medi Cal to California, which continues today. Back billing under this method created a onetime $8.5 million windfall for Tribal Health programs in California.

CRIHB maintains a close working relationship with the California Department of Health Services and the Health and Welfare Agency to advance Indian health interests at the state level. These relationships have facilitated oversight and problem solving with the Indian Health Program, the Healthy Families Program.

CRIHB maintains close working relationships with the federal Indian Health Service at the Area and
National levels. In October 2003, IHS Director Dr. Grim was hosted to a two-day tour of CRIHB member programs and the CRIHB Central Office resulting in his increased knowledge of CHS funding issues, data issues, and federally unrecognized Indians of California.

CRIHB Executive Director James Crouch represents California Tribes and Tribal Organizations to the Tribal-Technical Advisory Group to the federal Center for Medicare and Medicaid Services. In that capacity, he has helped shape CMS policy on the role out of Medicare Part D Pharmacy benefits and Medicaid Administrative Match programs.

In 1989, CRIHB and the Northwest Portland Area Indian Health Board (NPAIHB) began holding bi-annual joint meetings where joint policy resolutions are passed. This work has helped shape how Tribal Health Programs are treated under federal Medicaid rules guaranteeing individual Indians the right to access their local health programs at full reimbursement.

In 1994 in conjunction with the Northwest Portland Area Indian Health Board CRIHB changed national IHS policy on the distribution of CHS funds resulting in a $10 million allocation increase to California almost doubling the Area wide distribution on a recurring basis.

In 1994 with the help of CRIHB General Council Barbara Karshmer CRIHB drafted the Indian health program section of the Emergency Rule that implemented the states two-plan model of managed care. This guaranteed that Managed Care providers could not take Indian clients away from Tribal and Urban Indian Health Programs.

In 1999, CRIHB worked with Sandra Shewery then Director of the new Healthy Families Program to assure that Indian children would have access to that program at no cost including special provisions for Indians of California who were not members of federally recognized tribes. These rules continue to be in force.

CRIHB has developed close working relationships with private foundations in California resulting in millions of dollars of grant funds for Tribal Health Programs in California from The California Endowment, the Wellness Foundation, the Blue Cross Foundation of California, and others.

In 2000, CRIHB assured that Tribal and Urban Indian Health programs were included in Cedillio/Alarcon facility construction grant program resulting in 25 awards with a total dollar value of $4,952,863 in new state fund for California Indian country. A new round of funding will be awarded this spring under these rules distributing $35 million in settlement funds from the Wellpoint/Alliant
merger. CRIHB Pharmacist Amir Khoyi coordinated the participation of California Tribal Health Programs into the three-year PIC program for discounted pharmaceuticals resulting in $3,151,104 in cost savings for pharmaceuticals statewide. In 1991, the CRIHB Executive Director served on the Advisory Committee and coordinated the research that documented the unmet health needs of California Indians justifying to Congress their special eligibility for health services from the IHS.

In 1997, the CRIHB Executive Director served as the National Tribal Co Chair of the multi year effort to establish a uniform national actuarial method for quantifying funding shortfall for IHS and tribally operated health programs.

In 1999, CRIHB established with grant funds the Indian Health Status Collaborative with the UCSF Institute for Health Policy, which successfully linked IHS and State databases documenting significant health disparities and a hospitalization rate 60 times greater than IHS could determine from their data alone.

In 2001 the CRIHB Indian Health Collaborative documented that Medicaid expenditures on Indian clients of Tribal Health Programs was 80% of that spent on a matching non Indian population this study was subsequently published in the American Journal of Public Health.

In 2001, the CRIHB Indian Health Collaborative completed a study on ambulatory care preventable hospitalizations further documenting the need for increased funding for Tribal Health Programs in California. This study was published along with a supporting editorial in the journal Medical Care.

In 2005 CRIHB was funded to establish an IHS Epidemiology Center for California in partnership with Indian Health Council and Riverside San Bernardino County Indian Health Inc

In 2005 CRIHB published Community Health Profiles of health related indicators for the 24 largest Tribal Health Programs in the state which will help them in the development of funding proposals to federal, state and philanthropic funding agencies.

For the past 15 years (since 1991), Family and Community Health Services Department (FCHS) has housed the American Indian Tobacco Education Partnership (AITEP), the premier American Indian-specific Tobacco education and misuse prevention program in the nation.

AITEP has created two advocacy campaigns that have been recognized at a national Level. Countering the misuse of American Indian Imagery on commercial tobacco products and the Second Hand Smoke Casino Advocacy Campaign.

In 2005, FCHS secured a 5-year, $2,375,000 grant from the Centers for Disease Control and Prevention (CDC), to expand tobacco education services to all tribes in the state, as well as to the urban Indian programs in California, Nevada and Utah (the only grantee to receive both the implementation and capacity grants).

In 2004, FCHS secured tribally elusive Homeland Security funding for $185,000 for three years for a total of $555,000, the majority of which is subcontracted down to the community level.

In August of 2004, FCHS secured a 3-year; $17.1 million grant from SAMHSA for the provision of alcohol and drug treatment services for all American Indians and Alaska Natives residing in the State of California (The only tribal grantee nationwide).

From 2000-2005, FCHS provided directly for our tribes and tribal health programs more than $88,000 in Injury Prevention mini-grants, $148,000 in Tobacco mini-grants, $200,000 in GONA mini-grants, $1,010,500 in Nutrition subcontracts, $112,500 in teen pregnancy prevention subcontracts, and $160,000 in Homeland Security subcontracts.

From 2000-2005, FCHS has received $348,000 to conduct Injury Prevention activities in Native American Communities and held the first ever Indian Specific California Conference on Injury Prevention with approximately 45 participants.

The CDC TEPTS program has trained over 50 community members to be Certified Tobacco Educators and has provided cultural competence training for the California Smokers’ Helpline counselors.

Since 1996, FCHS has been providing Maternal & Child Health Conferences and has trained over 400 tribal health program staff on issues relevant to Maternal & Child Health.

Since 1997, FCHS has conducted a Teen Pregnancy Prevention program and provided services to over 500 American Indian youth. Teen Pregnancy rates for AI youth in California are going down.

For the past 5 years, FCHS has hosted the Nutrition Council for California Indian Clinics conference calls and annual meeting therefore providing a central location for Dietitians at Tribal Health Programs to communicate and collaborate as well as obtain continuing education.

CRIHB staffs are recognized as leaders in their fields and sit on 60 national, state, county and Indian Health service committees/workgroups and boards.

Since 2000, CRIHB Tribal Head Start has purchased three new buses for the Head Start programs totaling just over $150,000 in purchases. This provided safe and much needed transportation to the 84 children served in Del Norte County.

During 2001-2004, CRIHB Tribal Head Start served 532 children. Of those children: 1) 70 received necessary medical treatment; 2) 174 received necessary dental treatment; 3) 80 were provided disabilities services under an individualized Education Plan. A yearly average of 150 family support services (i.e. transportation, housing, clothing, adult education, etc.) was provided in the form of referrals, information, education, and donations.

In June 2005, CRIHB Tribal Head Start was granted a state facility license and opened the doors to 20 children in Sonoma County to provide comprehensive preschool and family services at Lytton Rancheria Head Start.

In September 2005, CRIHB Tribal Head Start provided travel expenses to a family who could not afford to take their child to UC Davis for treatment for cancer tumors. Since its inception, the program has assisted families in emergency situations or hardships, to the extent possible.

In September 2004, CRIHB Tribal Head Start hired its first “Health and Disabilities Coordinator” to oversee the component areas of health and disabilities. This addition was part of the program’s long-term goal to build its infrastructure and was necessary given the high number of special needs children that enroll in the program - always over the required minimum of 10% of enrollment.

In October 2003, CRIHB Tribal Head Start, along with the CRIHB Nutritionist, implemented a new cycle menu process for the Child Care Food Program to insure that children receive two healthy meals when in attendance.

In September 2003, CRIHB Tribal Head Start was awarded one-time Health & Safety funding for building improvements to Head Start facilities (all tribal buildings). Building improvements totaled just over $18,000.

In September 2002, CRIHB Tribal Head Start opened its doors to twenty additional children as part of the Elk Valley Rancheria Head Start expansion. The program was able to increase its base funding by $100,000 in order to provide for the additional slots and services.

In September 2001, CRIHB Tribal Head Start carried out major infrastructure improvements, to include obtaining approval to reprogram Home-Base funding for twenty children into two full-time positions: 1)HSFIS Coordinator (to coordinate tracking software implementation and activities); and 2)Education Coordinator located in Del Norte County (to oversee the operations of Elk Valley and Howonquet Head Start).

In March 2001, construction was completed on a new Head Start / Child Care building on Smith River Rancheria for the Howonquet Head Start Program. CRIHB Tribal Head Start provided major funding ($309,644) toward the construction.

In September 1994, CRIHB was approved to serve 154 children on Rancheria’s throughout rural California in order to provide comprehensive preschool and family services to include a high-quality preschool education but also preventative medical and dental services, developmental screenings, and referrals and family support services.

The California Rural Indian Health Board operated a Health Careers Opportunity Program for 10 years before it was defunded, that program sponsored the first 8 American Indian Medical Doctor’s in California.

The California Rural Indian Health Board (CRIHB) Phillip R. Lee scholarship program has grown substantially over the past 6-years awarding between 30 – 40 scholarships per year for $30,000/year.

The CRIHB scholarship program has made awards to more than 60 students from over 30 different Tribes during this past 6-year period from the Phillip R Lee Scholarship program.

The CRIHB administered the IHS Professional Development Scholarship (2002 – 2005) and awarded 15 students approximately $250,000 in Scholarship funds primarily supporting students in nursing programs.

In 2003, the CRIHB web page was renovated to allow CRIHB member programs to have logins and passwords access to post and manage their job announcements and recruitment materials. The section also has information for job seekers and allows them to register and post on-line resumes into a database that is searchable by the program recruiters.

Since 1995, CRIHB has provided training and technical assistance to health programs and Tribes in HR areas such as Sexual Harassment, personnel policies, position descriptions, employee relations, and other labor law issues. We have also facilitated and promoted networking between the program and Tribal HR Representatives.

CRIHB sponsored the passage of SB 308 in 2002 – an act to amend Section 14132.47 of the Welfare and Institutions Code, relating to Medi-Cal. Act authorizes Tribes and Tribal Health Programs to participate in the Medi-Cal Administrative Activities Program (MAA) creating a new revenue stream for Indian health programs. Currently eighteen Tribal Health Programs from across the state have signed up with CRIHB to participate in the MAA program.

CRIHB prides itself on strong financial management and control. Since the fiscal year, ending June 30, 1996 CRIHB has received an unqualified audit with no findings in nine out of ten years. No major findings were identified during this time. This trend has helped solidify CRIHB's status as a well-managed and reliable organization in the eyes of funders and other interested parties resulting
in additional opportunities for CRIHB member programs and partners.

As of January 2006 CRIHB successfully manages more than 30 grants from approximately 20 separate Federal, State and philanthropic funding agencies. These awards represent approximately $30 million in annual funds. In excess of 50% of these funds are passed through to CRIHB subcontractors, member programs and to a lesser extent, other Indian health programs throughout

Starting in 2003, in response to Sarbanes Oxley, CRIHB spearheaded a migration toward compliance with the California Non-Profit Integrity Act among CRIHB affiliated Indian health programs. Though not formally adopted until 2005, this pro-active approach served as a head start toward meeting the requirements of the law.

In 1992 CRIHB administered 420,000 in non IHS grant and contract funds today we are operating over 11,000,000 in non IHS funds

When CRIHB was founded 1969 there were no IHS funds allocated to support health care for Indians in California today IHS allocates over $130,000,000 in health services and facility services funds to Tribes, Tribal Organizations and Urban Indian Health Programs in California.



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