LEARNING MISSION
Why this guide matters
Healthcare governance — 638 contracts, boards, budgets — decides what care exists within driving distance. Following it is self-defense.
How we’ll know it’s working
Honest, countable signs only: questions submitted · instruments gathering answers · pages read and rated useful · and more people who can explain how these decisions actually get made. Counts publish, dated, on Community Findings.
Healthcare
≈ 18 min read · or listen, or skim the bold lines
Why People Stay Sick — the companion Improvement Mission on the social determinants of health (the formal name): water, housing, food, income, and distance, and why treating illness without treating conditions never catches up.
Telehealth on the Nation — the doors, checked
- IHS facilities (Chinle, Crownpoint, Gallup, Kayenta, Shiprock service units) — IHS runs regional telehealth programs; offerings vary by location and may include behavioral health, dermatology, endocrinology, and other specialties. Care is free to tribal members; start by calling your service unit and asking “what telehealth visits do you offer, and do I need a referral for each?”
- 638 tribal health corporations (Tuba City Regional, Fort Defiance/Tséhootsooí, Winslow, Sage Memorial, Utah Navajo Health System) — each sets its own telehealth services and referral rules; same question, their number.
- VA/IHS partner clinics for veterans (inside the Chinle, Kayenta, and Tuba City facilities) — primary care and mental health for veterans by clinical video telehealth, phone, and in person.
- Behavioral health by phone — often the easiest telehealth door: many behavioral-health visits can happen by phone where broadband is thin. Ask your facility’s behavioral health department directly.
- The honest constraint — broadband. Where video fails, ask whether a telephone visit counts; at many facilities it does.
Four doors — who are you helping?
I’m an elder — or caring for one
The Navajo Division of Social Services’ Department of Family Services handles elder protection, adult in-home care, and family well-being. Telehealth can bring visits closer (the doors above) — and many behavioral-health visits work by phone. Gap: a complete, current elder-services directory with phone numbers — not yet found. Know one? Send it in.
I’m a veteran — or helping one
VA/IHS partner clinics operate inside the Chinle, Kayenta, and Tuba City facilities — primary care and mental health for veterans by video telehealth, phone, and in person, with emergency and walk-in care at those facilities. Deeper: the Veterans learning mission. Gap: current benefits-navigation contacts by agency — not yet found.
I’m helping a young person
The Department of Child Care & Development helps families access child care; the Navajo Family Assistance Program covers school materials and utility costs; the Department for Self-Reliance adds cash assistance and career services. Gap: which services take applications online vs. in person — not yet found.
I’m a caretaker stretched thin
You’re the door most systems forget. Start with the elder and youth doors above for the person you care for — and for yourself: behavioral-health visits by phone exist at most facilities; ask yours. Gap: respite-care options on the Nation — not yet found, and worth finding.
Data & your voice
Surveys, by subject · the results so far · Where’s the data? — every mission runs on what the community measures.
Healthcare affects every Diné family. This module helps you understand how the system works, who is responsible for which parts, what challenges exist, what solutions are proposed — and how to evaluate them for yourself. It does not tell you what to think.
Everything in this guide
Learn
Learning & information
Why People Stay Sick (social determinants) · Healthcare 101 · 638 vs. IHS · all lessons
Evaluate
Evaluation tools
The five lenses · what candidates said about healthcare (topic links coming with the Issue Explorer)
Participate & collect
Community participation — every submission is data this guide compiles
Ask a question · share an experience · suggest a resource or expert or metric
Official sources
Official resources
IHS, 638, AHCCCS, the NDOH enabling law, and more in the boxes below and the Resource Library.
Where the healthcare numbers actually live. If you want to check a claim — anyone’s, including ours — these are the public sources: IHS Navajo Area for facilities and service units; AHCCCS for Arizona Medicaid enrollment and policy; CMS for federal program rules and provider data; the Navajo Epidemiology Center for Nation-level health statistics; and Resolution CO-50-14, hosted here, for the law that created the Department of Health.
FINDING Every source above is federal or state, except the last two. That is the shape of the problem this guide keeps finding: the Nation’s own healthcare money has no equivalent public dataset — no published budget-to-outcome reporting a voter can open. Fix #5 and #6 on What Needs to Happen Now are that gap, stated as demands.
What this guide produced
Your output (private)
Individual
Lessons you complete and pages you review here are compiled on My Civic Journey — your record of becoming a stronger community member, on your device only.
Community output (published)
Community
Questions, priorities, suggested metrics, and resources submitted for this guide are reviewed by volunteers and compiled into published community findings on this page — the first release will appear once enough submissions arrive. Nothing individual is ever published; findings are collective and anonymous.
Why this matters
Healthy communities depend on far more than hospitals. Healthcare is shaped by clean water, housing, transportation, food security, education, employment, behavioral health, emergency services, environmental conditions, and public policy. Improving it takes collaboration across all of them — no single office, and no single leader, can do it alone.
Past — how we got here
History of healthcare on the Navajo Nation
Key threads in this story: the Indian Health Service and the federal trust responsibility; the movement toward tribal self-governance; 638 contracting (the Indian Self-Determination and Education Assistance Act, which lets tribal organizations run their own health services); the continuing role of traditional healing; and the long work of building facilities and workforce across a vast rural Nation.
Civic Academy lesson
Learning & information
Start with Why People Stay Sick — social determinants of health: the things outside the clinic (money, transportation, food, housing, work, safety) that decide who gets well. Then: Healthcare 101 and 638 vs. IHS & credentialing.
Present — today's system
Who is responsible?
Who is responsible?
Learning & information
By Navajo Nation law, the designated lead agency is the Navajo Department of Health — CO-50-14 charges it with monitoring, regulating, and coordinating health care and public health on the Nation (read the enabling law). Around it, responsibility is shared: the Indian Health Service (Navajo Area), tribal health organizations and 638 organizations (such as Tuba City Regional Health Care and Winslow Indian Health Care Center), Navajo Nation leadership, hospital governing boards, federal partners (HHS, CMS, CDC), state partners (such as Arizona Medicaid), chapter governments, and community organizations.
Current data
Learning & information
This box will hold the best available data on staffing, vacancies, wait times, service locations, and quality measures. We do not display numbers we cannot source.
How do we know how healthcare is doing?
Learning & information — where the measurements come from
Three kinds of measurement already exist — knowing them lets you ask any candidate “measured by what?”:
- Disability 101 — rights, free services, and the doors
- Community Health Assessments (CHAs): 638 organizations survey their own service areas on a cycle. Example: TCRHCC completed its 2024 Community Health Assessment (Navajo Times, Feb 2025) — published every three years, covering Navajo, Hopi, and San Juan Southern Paiute communities in the Tuba City Service Area, and feeding each chapter’s Community Health Improvement Plan.
- The Navajo Epidemiology Center: under the NDOH enabling law, it is charged with collecting health data, tracking disease and vital events, and running public health surveillance for the Nation.
- Community-defined measures: what would you count as improvement — wait times, distance, interpreters, amputations prevented? Suggest a metric.
Who should we ask?
Who should we ask?
Community participation
Healthcare administrators, providers, patients, public health experts, traditional practitioners, behavioral health specialists, Community Health Representatives, researchers, veterans, elders, and youth all hold pieces of this picture.
Ask an Expert
Learning & information
Expert consultations on healthcare leadership, public health, behavioral health, and health policy will be gathered here as interviews are completed.
Case studies for this guide
Learning & information — real records, statuses marked
• The Modern Vascular matter — a federal fraud case over vascular clinics that treated Navajo patients, including a lead surgeon with a documented criminal past and prior board discipline who had earlier worked in Tuba City (per The Arizona Republic’s reporting).
• The sober-living scheme & the Tuba City case — how vulnerable relatives were recruited into fake treatment while Medicaid paid.
• Protect Yourself & Your Relatives — the patterns by topic, with the reporting doors in one place.
Official resources
Official references
Official resources
- IHS Navajo Area — facilities
- 638 Self-Determination Act (IHS)
- Navajo Department of Health — the enabling law (CO-50-14 & the 2018 Master Plan) —
- Purchased/Referred Care (PRC)
- Tuba City Regional Health Care Corporation
- Winslow Indian Health Care Center / Dilkon Medical Center
- Arizona Medicaid (AHCCCS)
- The Joint Commission
Future — what would success look like?
Possible goals the community has named: better access and shorter waits, more providers, stronger prevention, better behavioral-health access, improved maternal health, greater transparency, and more local healthcare capacity.
Success metrics
Evaluation tools
What measurement would show healthcare is actually improving — access, quality, safety, patient experience, workforce, prevention? Community-defined measures belong here.
Evaluation — the five lenses
How to weigh any healthcare proposal
Evaluation tools — the same lenses used across this site
- Transparency & accountability: Who is responsible? How will progress be measured, and who reports it? Can the public verify?
- Root cause: Does this solve the underlying problem, or only the symptoms?
- Culture: Does this strengthen K'é? Does it respect Hózhó? Does it honor future generations?
- Collaboration: Who needs to work together — healthcare, schools, families, government, traditional knowledge holders?
- Prevention vs. damage control: Does this prevent illness, or only respond after harm? Could prevention reduce future costs?
Apply these to anything — including what candidates say about healthcare. What you conclude is yours.
Community reflection
Your experience matters
Community participation — reviewed by a volunteer before anything publishes
My contribution
Every visitor can leave with one action: learn something new, ask one good question, share one resource, help someone navigate the system, attend one meeting, or suggest an expert. Small contributions, repeated, are how community capacity grows.
The 638 oversight gap — a seam in accountability
The pattern, stated carefully
Facilities operated under P.L. 93-638 self-determination contracts answer to federal contract law. That creates a seam: when a concern arises about a 638 facility’s internal conduct — its personnel processes, its complaint handling — it is genuinely unclear which forum, if any, a person on the Navajo Nation can turn to. The Nation’s own oversight authority exists on paper: Resolution CO-50-14 (2014) gives the Department of Health power to “monitor, evaluate, regulate, enforce” health services and to review health care agreements. Whether and how those powers are exercised over 638 contractors is a question, not a finding — and it is one of the questions we think candidates and officials should answer on the record.
What protection exists — and its limits: the Navajo Nation Code does contain a retaliation prohibition: 2 N.N.C. § 3767 (enacted 1988) bars any adverse or punitive action against parties and witnesses to an ethics complaint before the Ethics and Rules Committee. That is real protection — for that process. What we did not find, in the sources checked as of July 2026, is a broader whistleblower statute covering, for example, a health-facility employee who reports wrongdoing internally or to another body. Bounded finding, both directions: § 3767 exists and is narrower than a general shield; nothing broader was findable — and per the Seams in the Law, “not findable” is itself part of the problem. A protection nobody can find protects nobody — and a narrow one people believe is broad protects them worse.
Independent corroboration: the Diné Nihi Kéyah Project — a law-school effort indexing Navajo law — identifies the same mechanism at a structural level: because tribal programs are funded through 638 contracts, federal handbooks and trust regulations often function as the primary law on the ground, effectively inverting the intended hierarchy so that contractual obligations outrank the Navajo Nation Code and Diné Fundamental Law. Their finding, credited to them; read their analysis directly.
Related
Disability 101 — rights, services, and the doors · Case study: the sober-living scheme · Case study: the Modern Vascular matter · Task Guides Improvement Missions (9) · Resource Library · How to evaluate proposals · My Civic Journey
The election angle
What the candidates said about this, the plain facts, and the questions worth asking: the issue page →
How we got here — the history of hospitals on the Nation
A · Primary source for the resolutions cited. C for the accounts drawn from interviews, pending video check. How we verify →
Before 638 — why tribes took over their own hospitals
Dr. Christine J. Benally, who worked on what became Title 26 in the 1990s, told Cal Nez why the change came:
“In the early 70s, there’s a lot of advocacy from Native Americans across the country because BIA wasn’t, they considered BIA wasn’t doing their job or IHS wasn’t providing appropriate care. So, the 638 law came to being.”
Self-determination was not a theory. It was a response to failure.
The federal law — Public Law 93-638
The Indian Self-Determination and Education Assistance Act, universally called “638” after its public law number, let tribes contract to run programs the federal government had been running.
Two paths, both named in CO-50-14: a Title I contract, and a Title V self-governance compact — more autonomy, less federal supervision.
Council candidate Greg Bigman notes the same law reaches schools: “with schools they can choose to do PL 93-638 or they can go with the 100-296 or 297.” C
The Nation’s own health law — a twenty-year gap
- CJY-70-95 (1995) — the Navajo Nation established the Navajo Division of Health. A · named in CO-50-14
- 1995–2014 — President Shelly’s transmittal memo describes what happened next: “the Nation has seen substantial growth and changes. However, our health laws have remained stagnant or have seen piecemeal changes.” In that period the Nation compacted and contracted health programs, and established its own Epidemiology Center and Public Health Emergency Preparedness Program.
- CO-50-14 (Oct. 23, 2014; signed Nov. 6, 2014) — replaced the Division with the Navajo Department of Health. Shelly called it “the first tribally operated, state-like health department.” Passed 13 in favor, 2 opposed.
- HEHSCJA-01-18 (2018) — the Department’s Master Plan of Operation.
Nineteen years passed between the two health laws. The Council’s own Findings in CO-50-14 say why it mattered: there was “no division, department, office or program… delegated or authorized as the primary agent to monitor, evaluate, regulate, enforce, and coordinate health care.”
What the new department was not given
Read § 1604 and the President’s memo together:
- No licensure over physicians or clinics. The Department may write and enforce health codes — codes it must first draft. It plainly licenses only traditional practitioners and medical transportation.
- No reach into 638 money. The law “does not authorize the department to intercept or impede existing self-determination funding for our contracted and compacted facilities.”
The Council found a “need to establish and operate a system for licensure and certification” — and did not grant one. Under Montana v. United States, it may have been able to.
An open question: how many 638 facilities are there?
We do not know, and the candidates disagree.
One told Cal there are “14 facilities on the Navajo Nation that are operating… 12 of them are under IHS. And two of them are 638 facilities.”
But across the interviews, candidates named as 638 or tribally run: Tuba City Regional, Winslow Indian Health Care Center, Tséhootsooí Medical Center (Fort Defiance), Sage Memorial (Ganado), DelCon, and a Utah health system.
That is more than two. We are not saying any candidate is wrong — we are saying there is no published list a voter can check.
The through-line
1975 — tribes take over their hospitals because federal care was failing.
1995 — the Nation creates a Division of Health.
1995–2014 — the health laws go “stagnant.”
2014 — the Nation creates a state-like health department, and withholds the power to license doctors or follow 638 money.
Today — an outside company can treat Diné patients here and bill Medicare directly, and the Nation never sees the bill.
Self-determination arrived. The tools to police it did not.
The law behind this guide
- CO-50-14 — created the Navajo Department of Health. Gave it no authority to license physicians or clinics, and no reach into 638 self-determination funding.
- HIPAA — 42 U.S.C. § 1320d-6. Enforced by the U.S. Office for Civil Rights. Not by the Navajo Nation.
- Anti-Kickback (§ 1320a-7b(b)) · Stark (§ 1395nn) · False Claims Act (31 U.S.C. § 3729) — all federal.
- Oliphant v. Suquamish (1978) — no inherent tribal criminal jurisdiction over non-Indians. Montana v. United States (1981) — but a tribe may license nonmembers who contract with it.
What we found
The Council’s own 2014 Findings say there was “no division, department, office or program… delegated… to monitor, evaluate, regulate, enforce.” Then it created a department and left the powers out. Sixteen candidates raised oversight or board reform — the most-raised answer in any area.
How we’ll know it worked
When someone asks whether the Navajo Department of Health should license physicians — and gets an answer.