HEALTHCARE · ISSUE 1 OF 4
IHS vs 638 — Who Runs What
What it is
IHS facilities are federally operated. 638 facilities are tribally operated under P.L. 93-638 self-determination contracts. The distinction matters for oversight, staffing, billing, and who is accountable when something goes wrong. Most candidates in the 2026 interviews could not define a 638 facility when asked directly. Cal noted this is one of the most critical things a president or delegate should understand.
The accountability gap: When a 638 facility has a problem, the oversight chain runs through the tribal health board, IHS, and potentially HHS — three layers, each with partial authority. Nobody owns the full handoff.
Learn
Understand the system — then consult an expert
Healthcare 101 — IHS vs 638: who operates what, how funding flows, and who oversees each.
Credentialing, Privileging & 638 vs IHS — the detailed accountability picture.
The NDOH enabling law — CO-50-14 and HEHSCJA-01-18: the Council actions that created the Navajo Department of Health.
Consult an expert: Ask about 638 oversight →
Plan & Assess
Where candidates stand — weigh it yourself
Healthcare & 638 — candidates side by side — what each candidate said about 638 facilities, oversight, and their accountability plan.
Ask any candidate: Can you define a 638 healthcare facility and name one specific oversight concern you would address as president or delegate? Full list →
Act
What you can do now
Request it: 638 facility contracts are public under federal law. How to request records →
Report a concern: Healthcare oversight complaints go to the NDOH and IHS. Find the right door →
Report & Monitor
Track progress — hold the right office accountable
What should be public: 638 contract terms, facility audit results, credentialing board meeting minutes, and patient complaint outcomes. What should be public →
Track: Healthcare survey → · Community Findings → · Share what you observe →
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