The University of Oklahoma’s National Center for Tribal Policy Research recently released a new Sovereign Report titled “Purchased/Provided Care and Cancer: Overview and Options for Racial Consideration.”
Authored by Grace Fox (Seminole), tribal health care policy analyst at the center, the report examines how the Indian Health Service’s Purchased/Referred Care (PRC) program intersects with cancer screening, diagnosis, treatment and follow-up for eligible tribal citizens.
PRC is the program through which the Indian Health Service (IHS) authorizes and pays for appropriate care provided by non-IHS or non-tribal providers when services are unavailable or inaccessible locally. The report provides an overview of the PRC structure, eligibility requirements, notification timelines, medical priority levels, coordination of alternative resources, and funding limitations.
Our work at the Native Nations Center is primarily about tribal leaders and their communities. This report is designed to provide clear, accessible information about how the Indian Health Service’s Purchased/Referral Care program works in practice and where, particularly in cancer care, delays or gaps are most likely to occur.”
Grace Fox (Seminole), racial health care policy analyst;
The report highlights that cancer is an increasingly urgent public health priority in India. American Indian and Alaska Native populations experience later-stage diagnoses, lower screening participation, and higher mortality than the US population as a whole.
“When someone is dealing with a cancer diagnosis, timing matters,” Fox said. “The Purchased/Referred Care program often serves as a bridge to specialty oncology services that are not available locally. Understanding this process – from referral to authorization to payment – ​​can make a significant difference for patients and tribal health systems.”
While the report is based on national data and federal regulations, it also includes information about Oklahoma. Oklahoma is home to more than 39 tribal nations, 38 of which are federally recognized tribes. All 77 counties in the state have designated care delivery areas that have been purchased and referred in accordance with Indian federal health service guidelines. Even with statewide purchased and referred care delivery status, individuals must meet all eligibility, documentation, and funding requirements for program authorization.
Fox said the final section of the report outlines policy options tribes can consider under the current system, including principles of self-determination and self-governance, regional partnerships and service delivery models such as cell monitoring and teleoncology. Teleoncology uses telemedicine technology to deliver cancer care services. The section also examines care coordination and navigation, as well as pathways for sovereignty-driven federal engagement.
Fox’s position as a tribal health care policy analyst at the Native Nations Center for Tribal Policy Research was created as a collaborative effort between the center and the Native American Center for Cancer Health Equity at the Stephenson Cancer Center. It was funded by the Improving Cancer Outcomes in Native American Communities (ICON) grant as part of a larger effort to transform health-related research and policy for tribal communities. The report was developed with the grant initiatives in mind and reflects ongoing discussions among researchers, clinicians, and community partners working to address cancer disparities in racial communities. The rigorous review process by the Native Nations Center for Tribal Policy Research sought to incorporate the multidisciplinary expertise of several members of the cancer health equity team.
Fox said the report has already reached beyond its original audience of tribal leaders, attracting the interest of clinicians, researchers and health partners across Oklahoma and nationally. He said the ICON grant, championed in Congress by U.S. Rep. Tom Cole, has helped make the work possible and has opened conversations with health leaders and policymakers in Washington, D.C., about how DRC policies affect access to cancer care in tribal communities.
While the work is nonpartisan research and policy analysis to support tribal decision-making, it is also shaped by personal experience.
“I think about my mom, who had cancer last year this time,” Fox said. “Seeing her lived experience and her struggles, and knowing that time was of the essence, she didn’t have time to go through the Indian Health Service because of how long it would take.
“That, in itself, shines a light on the challenges that exist,” Fox said. “It shows why tribes and tribal citizens could benefit from having more information and improved pathways to care.”
However, Fox noted that the report is not regulatory. “We’re not telling tribes what to do. We’re providing research-driven analysis and options that tribes can evaluate within their own governance structures and priorities.”
In addition to Fox, the Native Nations Center consists of Evelyn Cox (CHamoru), research project manager, Tana Fitzpatrick, JD (Lakota/Crow/Ponca/Chickasaw), associate vice president of Tribal Relations, and Quanah Yazzie (Navajo), office manager. They continuously work to provide research products to tribal leaders, citizens and partners through reports and updates.
