oversight

Award of Indian Health Professions Scholarships

Published by the Government Accountability Office on 1999-01-15.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

Office of Special Investigations


B-281711

January l&l999

‘I’he Honorable Ben Nighthorse Campbell
Chairman, Committee on Indian Affairs
United States Senate .

Subject: Award of Indian Health Professions Scholarshins

Dear Mr. Chairman:

We investigated the U.S. Department of Health and Human Services’ Indian Health
Service (IHS) award of Indian Health Professions Scholarships (graduate scholarships)
pursuant to 25 U.S.C. section 1613a of the Indian Health Care Improvement Act
(IHCIA). Pursuant to a 1992 amendment of that act, IHS is restricted to awarding
graduate scholarships to Indians who are members of federally recognized tribes. This
letter responds to your November 13,1998, request that we report to you on our
investigative findings regarding recipients of scholarships under 25 U.S.C. section
1613a.

Results    in Brief


In summary, 87 of the 1,164 students who received graduate scholarships pursuant to
25 U.S.C. section 1613a for the 1993-.1997 academic years were ineligible because they
were not members of federally recognized tribes. These 87 students received
$4.7 million in scholarship funds. IHS explained that 38 of the 87 students received
scholarship awards because they had previously received undergraduate or graduate
scholarships under an expanded definition of “Indian.” IHS believed that irrespective of
the language of the statute, the legislative history supports permitting these students to
continue receiving scholarship awards. In our view, the language of the statute clearly
provides that these students are ineligible for graduate scholarships, and we find little
support in the legislative history for a contrary view.

As for the remaining 49 students, IHS explained that it had relied solely upon
documentation provided by applicants to establish federally recognized tribal
membership. Its reliance on inaccurate documentation resulted in the award of
scholarships to students who were not members of federally recognized tribes.

During our investigation, we made suggestions to both IHS and the U.S. Department of
the Interior’s Bureau of Indian Affairs (BIA) to assist them in determining claims of




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tribal membership. BIA is acting on our suggestion regarding documentation of tribal
membership, and IHS has adopted our suggestion to use BIA documents to determine
Indian eligibility. Further, MS officials have stated that they will request congressional
clarification of the eligibility requirement.

Backmound


In 1976, Congress enacted the IHCIA to improve the level of health care for American
Indians and Alaska Natives.l In order to obtain sufficient health professionals to meet
the health care needs of the Indian and Alaska native community, the IHCIA, among
other things, created three programs. These programs were directed at (1) recruitment
of students with a potential for education or training in the health professions, (2)
awarding health professions preparatory (undergraduate) scholarships, and (3)
awarding health professions (graduate) scholarships. The first two programs were
codified at section 1612 and section 1613 of title 25 of the U.S. Code. The graduate
scholarship program, however, was created by amending a provision of the Public
Health Service Act, 42 U.S.C. section 234.’

Under IHCIA, the definition of an Indian is critical in determining eligibility to
participate in the recruitment and scholarship programs. The definitional provision
that was in the statute at the time the act was passed defined Indian in a narrow
manner to include only individuals who were members of a federally recognized tribe.3
However, that provision provided a more expansive definition for purposes of the
recruitment and undergraduate scholarship programs. For these two programs, the
definition included not only members of a federally recognized tribe but also any
individual who was (1) a member or a descendant in the first or second degree of a
member of a state-recognized tribe, band, or other organized group of Indians; (2)
Eskimo or Aleut or other Alaska Native; (3) considered by the Secretary of the Interior
to be an Indian for any purpose; or (4) determined to be an Indian under regulations.4

The graduate scholarship program at section 234 of title 42 had its own definition of
Indian. It specifically referenced and incorporated the expansive definition of Indian
that applied to the recruitment and undergraduate programs in title 2L5 Thus, all three


’Pub. L. No. 94-43’7,90 Stat. 1400 (1976).

* Pub. L. No. 94-437,90 Stat. 1403 (1976).

a M. at section 4,90 Stat. 1401, codified at 25 U.S.C. section 1603(c).



 ’ Section 104 states the following:

           (0 For purposes of this paragraph, the term Indians has the same meaning given that term by subsection (c) of
           section 4 of the Indian Health Care Improvement Act and includes individuals described in clauses (1) through
           (4) of that subsection.
 Footnote continued.




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programs had the same definition of Indian. The first two programs were solely for
Indians; but the graduate program was not limited to Indian applicants, although they
were accorded priority in receiving scholarships.

In the 1988 reauthorization of IHCIA, Congress repealed the graduate program in title
42 and added the program as section 1613a of title 25 with one major change: the
program was now limited to Indians.6 As set out in section 1613a, the definition of
Indian was the same as it had been in the now-repealed section of title 42,’ which was
the same definition applicable to the recruitment and undergraduate programs.
Congress, however, did provide a grandfather clause that allowed the students,
including non-Indians, who were in the program at the time of the reauthorization to
continue receiving scholarships.’

In 1992, Congress again reauthorized IHCIA.g Among other things, the reauthorization
deleted the definition of Indian specifically contained in section 1613a.l’ With the
deletion of this provision, section 1613a was no longer subject to the expanded definition
of Indian applicable to the recruitment and undergraduate scholarship programs. Now,
the graduate scholarship program applies only to Indians who are members of a
federally recognized tribe.”

Award       of Indian      Health     Professions         Scholarships


IHS awarded graduate scholarships pursuant to 25 U.S.C. section 1613a to 1,164
students for the 1993-97 academic years, totaling about $48,376,000.12 We identified 87
of these students who should not have received scholarships because they were not
members of a federally recognized tribe.13 Those 87 students received about $4,721,000
in scholarship funds. IHS grandfathered 38 of the 87 students into the graduate

Pub. L. No. 94-437, section 104,90 Stat. 1403-1404 (1976).

’ Pub. L. No. 100-713, section 104,102 Stat. 4787 (1988).




* Pub. L. No. 102673,106 Stat. 4526 (1992).

“I&   at section 104,106 Stat. 4532 (1992).

I125 U.S.C. section 1603(c) (1988) provides that for purposes of chapter 18, an Indian is a member of a federally
recognized tribe, except that, for purposes of 25 U.S.C. section 1612 and 25 U.S.C. section 1613, an Indian shall mean an
individual who is (1) a member or descendant in the first or second degree of a member of a state-recognized tribe, band,
or organized group of Indians; (2) an Eskimo or Aleut or other Alaska Native; (3) considered by the Secretary of the
Interior to be an Indian; or (4) determined to be an Indian under regulations.

I* IHS provided us the total number of scholarship recipients and the total amount of scholarships, including tuition and
stipend to the students, awarded for the 1993-97 academic years.

I3 One of these ineligible recipients is the child of the current Chief of IHS’s Indian Scholarship Branch.




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scholarship program. For the remaining 49 students, MS relied on inaccurate
applicant-provided documentation regarding tribal membership.

Thirtv-eight Grandfathered Students

IHS explained that it awarded graduate scholarships to 38 of the 87 students after
determining that “all students who had received scholarships prior to October 1992
would be grandfathered in as they were continuation awards.” In support of its position,
IHS asserted that once a student receives a health professional preparatory scholarship,
the student does not recompete for a graduate scholarship. According to MS, once a
scholarship is awarded, the student continues in his or her career track or health
profession until completion of the degree program or the scholarship funding cap is met,
whichever comes first. IHS also argued that the legislative history of the IHCIA
supports its position because it makes clear that the recruitment and scholarship
programs, while separate, are interrelated. Therefore, according to IHS, it would be
inconsistent to use a narrow definition to determine eligibility for the graduate
scholarship program while a broader definition is used to determine eligibility under the
recruitment and preparatory scholarship programs.

We believe the statutory language is clear that these persons were not eligible for
graduate scholarships and find little support for IHS’s position in the legislative history.
While the original act passed in 1976 quite plainly and unequivocally provided for a
large number of applicants to qualify for graduate scholarships, Congress took steps
both in 1988 and 1992 to limit those persons who were eligible for such scholarships.
Pursuant to the most recent amendments, Congress specifically deleted the definition of
Indian at 25 U.S.C. section 1613a, which had permitted various groups of persons to
qualify as Indians for purposes of obtaining graduate scholarships. This left the
applicable definition found at 25 U.S.C. section 1603(c). This section contains a broad
definition of Indian only for the recruitment and preparatory scholarship programs. The
definition that applies to the graduate scholarship program is limited to members of a
federally recognized tribe.

Furthermore, in 1988 when Congress repealed the scholarship program under the
Public Health Service Act and reestablished it under 25 U.S.C. section 1613a, it enacted
a grandfather provision that provided that all students who had previously been
receiving graduate scholarships under the Public Health Service Act would continue to
receive them under the reauthorization. However, Congress did not include a similar
provision when it amended 25 U.S.C. section 1613a in 1992. We believe that Congress’s
different treatment of past scholarship recipients in the 1992 amendments is persuasive
evidence that the Congress intended to narrow the recipients who could receive
graduate scholarships. See Chicago v. Envtl. Defense Fund, 511 U.S. 328,338 (1994),
citing Keene Corn. v. United States, 508 U.S. 200,208 (1993).

We are not persuaded by IDS’s assertion that the graduate scholarship program should
be expanded to include those who are not members of a federally recognized tribe
because the recruitment, preparatory, and graduate scholarship programs are “separate



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but interrelated.” While there is clearly some logic to this argument, it is not sufficient
to overcome the plain meaning of the definition in 25 U.S.C. section 1603(c); and we do
not find any explicit evidence in the legislative history that Congress intended that the
broad definition used to define Indian in the recruitment and preparatory programs
should apply to the graduate scholarship program. At most, the legislative history
raises some question as to whether Alaska Natives were intended to be included as
eligible scholarship recipients because they were included in a discussion about the
goals of the graduate scholarship program.14 The legislative history does not, however,
support IHS’s position that the members or descendants of members of state-recognized
tribes who were already receiving program funds should receive graduate scholarships.

Fortv-nine Students With Inaccurate Documentation

IHS also explained that it had determined that the remaining 49 students were eligible
for scholarship awards as members of federally recognized tribes based on the agency’s
reliance on documentation provided by applicants. The Certificate of Degree of Indian
Blood (CDIB) was the most prevalent documentation on which IHS relied. That
document, which is issued by BIA or a tribe, provides for the scholarship applicant to
specify the name of the tribe to which he or she has blood relationship. Based on
interviews with the Tribal Enrollment Officer for each tribe to which a scholarship
recipient claimed membership, we determined that the documentation provided by the
49 students did not reflect valid membership in the identified tribes.

Acceptance        of Suglgestions        bv Agencies


During our investigation, we suggested that BIA incorporate an individual’s tribal
enrollment number on the BIA form “Verification of Indian Preference for Employment
in the Bureau of Indian Affairs and the Indian Health Service Only” (Form BIA 4432).
As a result of BIA’s acceptance of this suggestion, the tribal enrollment number as well
as the Tribal Enrollment Officer’s signature will serve to identify tribal membership.

We also suggested that IHS use the BIA Form 4432 rather than the CDIB to determine
tribal membership for eligibility under the Indian Health Scholarship program. IHS
has accepted this suggestion. Further, according to IHS officials, MS will request that
Congress clarify the intent of eligibility for the Indian Health Professions Scholarship
Program in future congressional hearings on the reauthorization of Indian Health Care
Improvement Act programs.




I’Specifically, the Senate Report accompanying the bill stated that the amendment was intended to ensure that
preparatory and health professions scholarships are available to American Indians and Alaska Natives across a wide
range of disciplines. S. Rep. No. 102392 at 8 (1992).




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ScoDe and Methodologv

We conducted our investigation between August and November 1998. We contacted the
enrollment office of each of the over 150 tribes cited in the scholarship applications for
academic years 1993-97 and confirmed the students’ status with the individual tribes.
We then reviewed the file for each student who was determined not to be a member of a
federally recognized tribe. We included only the Indian eligibility section of the
recipients’ applications in our reviews. We interviewed the Tribal Enrollment Officer
for each tribe to which a scholarship recipient claimed membership. We also
interviewed cognizant officials of both IHS and BIA.



We will send copies of this letter to the Director, Indian Health Service and will make
copies available to others on request. If you have any questions or need additional
information, please contact Assistant Director Ronald Malfi at (202) 512-6722.

Sincerely yours,




Robert H. Hast
Acting Assistant Comptroller General
  for Special Investigations




 (600491)
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