Tribal providers tell IHS study current reporting systems substantially undercount California Native populations

Tribal providers and IHS participants at the California-area population study kickoff warned that existing reporting systems substantially undercount American Indian and Alaska Native residents in California, a discrepancy that could shrink the user population used to size proposed regional specialty centers.

Angie, a California tribal member and Facility Appropriations Advisory Board (FAB) participant, said the study needs a method to capture tribes’ own data. "We need a methodology to have responses from tribes on what their actual data looks like," she said, adding that EHR and reporting problems in urban areas have produced unreliable site counts and that federal reorganizations have raised concerns about area‑office capacity.

Jonathan Rasch, California Area IHS director for environmental health and engineering, told the group that California’s IHS active user population is dramatically lower than the census population, estimating the IHS user population is "less than 10%, maybe on the range of, like, 5% of the Native American census population." Consultants and other participants acknowledged the magnitude of the discrepancy and discussed potential supplemental sources such as Medi‑Cal and Covered California but cautioned that state reports often rely on tribal self‑reporting and that access and harmonization could be challenging.

Scott Black, CEO of American Indian Health and Services in Santa Barbara, described local audit experience that shows many Native patients receiving specialty care are not reflected in IHS reports. He said his Santa Barbara service area contains about 2,400 American Indian and Alaska Native residents and that roughly one-third of those individuals use the clinic; he and other providers said those local counts often do not appear in federal user reports because patients travel across county lines or use non‑IHS systems.

Participants pointed to several practical measures for the data request: seek community‑ and county‑level counts where available, include state enrollment datasets (Covered California) and consider whether Medi‑Cal can provide identifiers that support tribal counts. Several speakers cautioned that even if a dataset exists it may not be practical to obtain or acceptable to IHS headquarters, underlining the need for early HQ engagement on acceptable sources.

The meeting produced no formal rulings; instead the group agreed on a process: the consulting team will circulate a data‑request checklist for the work group to review and prioritize, and the team will coordinate with the area office and IHS headquarters before finalizing the methodology.