American Indian Communities in Minnesota
Health and Human Services

What is the health and economic status of Minnesota's American Indian population?

According to a recent Minnesota Department of Health publication, "Populations of Color in Minnesota Health Status Report," American Indians fare poorly on many measures of health status and economic well-being. For example:

• The infant mortality rate for American Indians actually increased between the 1978-1982 time period and the 1989-1993 time period, from 13.9 up to 16.2 deaths per 1,000 live births. The rate for other Minnesota minority groups declined.

• For some age groups, American Indians have death rates three times higher than for whites. For example, among persons aged 25 to 44, the death rate for American Indians was 338 per 100,000, and for whites was 106 per 100,000.

• American Indians have high rates of death from accidental injury, suicide, cirrhosis of the liver, heart disease, diabetes, and other causes.

• 21.5 percent of American Indians lack health insurance, compared with 8.8 percent of the white population.

• Between 1979 and 1989, the percentage of American Indians living in poverty rose from 30 percent to 44 percent. Among whites, it remained unchanged at 9 percent. In 1989 the poverty rate for American Indian children was 54.2 percent, compared to 8.4 percent for white children.

• In 1990 the unemployment rate for American Indian males was 24.2 percent, compared to 5.6 percent for white males. For females, the American Indian unemployment rate was 14.9 percent, versus 3.9 percent for whites.

• 28.9 percent of American Indian households lack a vehicle and 22.2 percent have no telephone. The comparable rates for white households are 7.8 percent and 2.1 percent.

For which public health care programs do American Indians qualify?

American Indians are eligible for all of Minnesota's public health care programs, including Medical Assistance (MA), General Assistance Medical Care (GAMC), and MinnesotaCare, if they meet income, asset, and other eligibility requirements. In addition, the federal government funds the Indian Health Service (IHS), which provides health care to American Indians, and many of the American Indian tribes and bands in Minnesota operate health programs. The 1998 Legislature authorized a tribal purchasing model for health care services under which tribe could operate the MA and GAMC programs for Indians who reside on or near a reservation.

A number of public health care programs include funding specifically set aside to meet the needs of American Indians. For example, the state Consolidated Chemical Dependency Treatment Fund formula includes allocations for American Indians living on and off reservations. The federal Alcohol, Drug Abuse and Mental Health block grant includes an allocation for American Indian services. The state law establishing community health boards authorizes special grants to these boards to provide services to American Indians living off reservations. These grants are administered by the Minnesota Department of Health and awarded on a competitive basis. Current grantees serve the Bemidji area, Duluth, Minneapolis, and St. Paul.

How do American Indians get access to public health care programs?

American Indians living on or near American Indian reservations typically use health care services provided directly by the federal Indian Health Service (IHS), offered by other providers under contract with IHS, or provided by their reservation government. The most common arrangement is to have clinic services provided on the reservation by the IHS or the tribe, with contract services available in local communities for more complex needs. The Leech Lake and Red Lake reservations have their own hospitals. The Lower Sioux reservation does not operate a clinic, but provides health care through contracts with local providers. The Shakopee-Mdewakanton reservation provides health insurance coverage to members. In addition, many of the reservations operate community health nursing programs.

Low-income urban Indians generally obtain health care by applying for the MA or GAMC programs. A number of public health clinics, such as the Indian Health Board of Minneapolis and the Model Cities Health Center in St. Paul, provide services to Indians through the Prepaid Medical Assistance Program (PMAP). Many American Indians seek services through these clinics in order to obtain culturally appropriate services not generally available from private providers.

Specialized services for American Indians are available for mental health and chemical dependency problems. Funded through the federal block grant and other sources, 13 programs operated by the American Indian community provided mental health services to over 10,000 clients in 1996. Most tribes provide chemical dependency services on the reservation or nearby. In addition, the state regional treatment center in Brainerd provides culturally appropriate services through the Four Winds Lodge.

Do large numbers of American Indians use public health care programs?

American Indians, who comprise roughly one percent of the state population, are over-represented in the MA caseload. For fiscal year 1996, 4.6 percent of MA fee-for-service recipients were American Indians, and they accounted for 2.9 percent of MA fee-for-service expenditures.

For which public welfare programs do American Indians qualify?

American Indians qualify for all programs available in Minnesota, including General Assistance, Minnesota Supplement Aid, Food Stamps, and the Minnesota Family Investment Program - Statewide (MFIP-S) (which replaced the AFDC program on January 1, 1998), if they meet eligibility requirements.

How do American Indians access public welfare programs?

Access is attained through county human service agencies under the same procedures used for other Minnesotans. A number of tribes that operated the employment and training services component of the AFDC program are continuing to provide employment and training services under MFIP-S.

The 1996 federal welfare reform legislation authorized tribes to also operate the income maintenance portion of this program. The Mille Lacs Reservation government has decided to operate MFIP-S for families with an adult enrolled in the Band who reside in the six county area that includes Aitkin, Benton, Crow Wing, Mille Lacs, Morrison, and Pine counties. The reservation will also administer the Food Stamp and Medical Assistance programs for these clients. The startup date is expected to be January 1, 1999. The tribe plans to operate a program identical to the MFIP-S program operated in the remainder of Minnesota and will utilize the statewide computer system and state forms for ease of administration. Other administrative details will be included in a contract to be negotiated between now and the startup date.

The Mille Lacs tribal government is one of only 12 in the nation that have decided to assume the responsibility of operating an income maintenance program since they were authorized to do so in 1996, according to the Department of Human Services (DHS). Other Minnesota tribes have expressed an interest in operating MFIP-S but have not yet made a final decision, according to DHS.

Do large numbers of American Indians receive public welfare benefits?

American Indians are over-represented on AFDC caseloads. In September 1997, about 12,600 American Indians were receiving AFDC, representing 8.7 percent of the AFDC caseload. They also represent 7.2 percent of the state's Food Stamp caseload.

What is the Indian Child Welfare Act?

The Indian Child Welfare Act (ICWA)⁽¹⁰²⁾ is a federal law that was enacted in 1978 to re-establish tribal authority over the adoption of American Indian and Native Alaskan children. The goal of the act was to strengthen and preserve American Indian families and culture. The ICWA regulates placement proceedings involving American Indian children, including child protective cases, adoption, guardianships, termination of parental rights, runaway/truancy matters, and voluntary placement of children.

What is the Minnesota Indian Family Preservation Act?

The Minnesota Indian Family Preservation Act ⁽¹⁰³⁾ is the state law that is substantially similar to the federal ICWA. If there are conflicts between the two laws, the federal ICWA takes precedence.

To whom do the laws apply?

The laws apply to American Indian children who are unmarried and under the age of 18. The child must be either a member of a federally recognized American Indian tribe or must be eligible for membership in a federally recognized American Indian tribe.

What do the laws do?

The laws require that placement cases involving American Indian children be heard in tribal courts if possible, and permit the child's tribe to be involved in state court proceedings. They require testimony from expert witnesses who are familiar with American Indian culture before a child can be removed from his or her home. If a child is removed from the home, the laws require that the American Indian child be placed with extended family members, other tribal members, or other American Indian families, if possible.

What is the Indian Child Welfare Law Center?

The Indian Child Welfare Law Center is located in Minneapolis, and its mission is to work with the American Indian community to preserve and reunite American Indian families by providing culturally appropriate legal services to American Indian children, parents, extended family members, and tribes in cases governed by the American Indian Child Welfare Act, and to serve as a community development resource for American Indian Child Welfare Act education, advocacy, and public policy.

The Law Center provides legal representation for extended American Indian family members who wish to obtain custody of or adopt an American Indian child. The Law Center also provides legal representation to parents and American Indian custodians who want their fostered children back, and it has created a foster care diversion program to help prevent foster placement of American Indian children. The Law Center also provides public education for attorneys, social workers, battered women's shelter staff, guardians ad litem, American Indian agency staff, and other groups involved with American Indian child welfare.