Puyallup Tribal Self-Governance Planning Project - The Puyallup Tribal Health Authority (PTHA), the health care entity of the Puyallup Tribe of Indians, proposes a one-year project under the Indian Health Service’s Tribal Self-Governance Planning Cooperative Agreement to prepare for the Tribe’s transition from an Indian Self-Determination and Education Assistance Act (ISDEAA) Title I contract to a Title V Self-Governance Compact. This transition will expand Tribal authority over federal health programs, enabling the Tribe to manage services tailored to the needs of American Indian and Alaska Native (AI/AN) people in Pierce County, Washington. In 2025, the Puyallup Tribal Council requested PTHA to lead this transition. While PTHA has nearly 50 years of experience in health service delivery and federal contract management, moving to Title V requires additional preparation. Specifically, PTHA must analyze the flow of IHS funding, assess internal capacity, evaluate which programs can be feasibly assumed, and strengthen community-based planning. These efforts will help the Tribe determine which Programs, Services, Functions, and Activities (PSFAs) it can responsibly manage under a Title V compact. The project’s objectives include: (1) Analyze IHS budgets to understand funding flow from the federal level to the IHS Area Office to PTHA, (2) Develop a formal, replicable process to evaluate PSFA feasibility, (3) Assess internal service capacity and legal and financial readiness to determine which PSFAs the Tribe may assume, and (4) Summarize all findings with final recommendations and a proposed plan for future negotiations. Expected outcomes of the project include improved understanding of IHS funding structures, documented readiness to assume selected PSFAs, and a roadmap for expanding self-governance. These efforts will support long-term sustainability by enhancing local decision-making authority, improving service integration across Tribal health programs, and allowing the Tribe to pursue health care delivery models grounded in community strengths. By investing in this planning process, the Puyallup Tribe of Indians is taking a major step toward strengthening its health system, expanding Tribal sovereignty, and advancing high-quality care for AI/AN families across its service area.
