Northern Cheyenne's IHS TMG 2025 - The Northern Cheyenne Tribe (NCT) is located on the Northern Cheyenne Indian Reservation, encompassing approximately 447,000 acres in the rural regions of Rosebud and Big Horn Counties in southeastern Montana. The reservation includes five distinct communities: Ashland, Birney, Busby, Muddy, and Lame Deer. Lame Deer serves as the tribal capital. The total number of Indian Health Service (IHS) Beneficiaries currently using the services (as of April 2025) is 6,657. As of January 2024, the NCT has approximately 12,340 enrolled tribal members with about 4,667 residing on the reservation (Northern Cheyenne Tribal Enrollment Department January 2024). The NCT experiences high rates of unemployment and poverty. Specifically, the NCT suffers from an unemployment rate of 7.5%, more than two and a half times that of the State rate of 2.8% and nearly double that of the national rate of 4.1%. Forty-one percent (41%) of individuals on the reservation live below the poverty level compared to 11% for the Nation and 12% for the State. Additionally, the income levels for the Northern Cheyenne community fall well below those of communities Statewide and Nationwide. The median household income for the reservation is $41,400 compared to $80,610 for the United States and $79,220 for Montana. Educational attainment levels on the Northern Cheyenne Indian Reservation are low; this is an unfortunate trend seen across the country among Native Americans as a whole. Bachelor’s Degree or higher achievement rates for Northern Cheyenne community members is 13.5%, as compared to 36.2% for the nation and 34.6% for the State of Montana (2023: ACS 5-Year Estimates). The Northern Cheyenne Tribal (NCTH) seeks to strengthen its health care delivery system by exploring the assumption of all, or part, of the existing Quality Assurance and Program Improvement (QAPI) program currently managed by IHS. The proposed Tribal Management Grant (TMG) project will support a comprehensive feasibility study to assess the viability, resources, and readiness of the Tribe to assume this responsibility. Specific weaknesses and gaps in services or infrastructure we have observed over time include the following: Lack of coordinated quality improvement; Patient dissatisfaction and systemic gaps in care; Workforce limitations and access barriers; Lack of culturally responsive care and evaluation; Limited capacity for ongoing, and data driven quality improvement. The NCTH is proposing one overall objective: During the project period of July 1, 2025 through June 30, 2026, the NCTH will complete a comprehensive feasibility study to determine the Tribe’s capacity to assume full or partial management of the QAPI program currently overseen by IHS. The proposed TMG project will lead to meaningful improvements in program operations by identifying specific gaps in quality management and outlining concrete steps to close them. It will strengthen data collection and evaluation processes, promote a more integrated approach to patient care, and support culturally relevant quality assurance protocols. As part of this project, the NCTH will produce one (1) tangible deliverable, which is the QAPI feasibility study report.
