Indian Health · Research · Teaching · Professional Work
This site brings together selected work from my career in Indian health, with a particular focus on how Indian health programs are financed, organized, and understood.
The site includes a substantial research series on Indian Health Financing, along with teaching materials, professional resources, and selected work from other areas of my career.
Explore the Site
Papers The Indian Health Financing Series, related papers, and the compiled bibliography.
Research Map A visual and thematic guide showing how the papers connect — by layer, by theme, and by recommended reading path.
Graphics Downloadable graphics from the research, organized by topic.
Managing Tribal Health Programs Practical materials drawn from experience managing Indian health programs, developing grant proposals, and working with health policy and administration.
Course A graduate-level course on Indian Health Finance, including lecture notes and instructional materials.
AI Sandbox Papers written mainly by AI on Indian health finance questions, each marked with an IHF-AI badge, with my occasional analysis.
This site is an archive of work developed over many years. Some materials are historical; others are intended to provide a framework for understanding current issues. All papers and technical reports are open-access for citation and academic research within Indian health.
Recent Updates
Hank Adams and the Policy Process (October 2026) Hank Adams’s work, traced through six stages of the policy cycle, from setting the agenda to implementation and evaluation. It is a study of how research, argument, and the trust of partners turn Tribal goals into policy. Go to the page →
AI Sandbox (October 2026) A separate home for papers written mainly by AI, with my own analysis of them added from time to time. Each paper carries an IHF-AI badge so it is never confused with my own work. Go to the AI Sandbox →
Word Versions of the IHF Series (October 2026) All 19 papers in the Indian Health Financing Series can now be downloaded as Word documents as well as PDFs, for readers who want to quote, adapt, or excerpt them. Go to the Papers Index →
Data Tables (October 2026) American Community Survey (PUMS) tabulations on AI/AN health coverage, with key figures and downloadable spreadsheets. View the tables →
Making Indian Health Financing Policy: Federal and State Rulemaking, Implementation, and Tribal Consensus (September 2026; revised October 2026) Indian health financing does not move through a single policymaking process. Federal statutes and rules may require state Medicaid action, tribal-state consultation, federal-tribal agreements, or facility-level implementation. This paper examines those different pathways and asks a simple question: how many governmental decisions are required before a policy becomes operational financing? Read the paper (PDF) →
How the Papers Fit the Research Map
The papers in this archive represent different parts of a continuing examination of how Indian health care is financed, delivered, measured, and improved. The Indian Health Finance Research Map provides a framework for understanding the major areas of this research, while the Indian Health Finance Research Timeline shows how the work developed over four decades.
No claim is made that the author participated in the 1970s — his career in health began in the 1980s, and in Indian health in 1995.
This timeline shows the development of the research across more than four decades. The work evolved from participation in national policy and technical advisory efforts into a broader body of research examining Indian health financing, data, coverage, and health system performance.
The early work established a foundation in federal and Tribal health policy. Later research increasingly focused on Medicaid, Medicare, enrollment, data, and financing relationships — bringing together the policy experience and data work that inform the research presented on this site.
Is This Site for You?
This site is built primarily for Tribal leaders, Tribal health directors, program administrators, and Tribal health researchers and policy analysts working within Indian health systems — not as a general-audience resource for the broader health policy field. It assumes working familiarity with Indian health financing, Tribal sovereignty, the federal trust relationship, and the lived realities of AI/AN communities.
Numbers and findings drawn from Indian health data can look straightforward but rarely are — population counts, funding comparisons, and coverage statistics all carry historical and legal context that shapes what they actually mean. Readers approaching this material without that grounding are encouraged to consult Tribal health leadership or established Indian health policy expertise before applying it elsewhere.
The site focuses on the long-term financing, policy development, and administrative data systems of American Indian and Alaska Native health care. It is primarily an academic and historical resource, not a source of current regulatory updates, clinical or epidemiological guidance, or active political advocacy.
This work is offered in service of Tribal Nations.
See what this site does not cover
To help Tribal researchers and policy analysts quickly determine if this repository is a value-added resource, please note that the following topics fall outside the scope of this site:
Not a News Source: This site is primarily an academic and historical repository documenting long-term structural finance, Medicaid/Medicare policy, administrative data systems, and the development of American Indian and Alaska Native health care financing. New papers are added from time to time, but the site is not maintained as a source of current news, regulatory changes, or policy updates.
No Clinical or Epidemiological Guidance: The repository does not provide clinical information, medical advice, disease surveillance, or current epidemiological findings. Its focus is on health care financing, policy, administration, and the historical development of systems affecting AI/AN health care.
No Public Health Practice Guidance: This is not a resource for current public health practice or clinical protocols.
No Active Policy Advocacy: The material documents and analyzes the development of health financing policy and administrative systems. It is not intended to serve as an active advocacy platform or to represent the current policy positions of Tribes, Tribal organizations, federal agencies, or other institutions.
Historical Rather Than Current: Many of the documents reflect the circumstances, data, and policy environment in which they were originally produced. Readers should not assume that historical findings, estimates, regulations, or policy descriptions remain current.
If you work in or study Indian health, and your research concerns the historical development of Indian health financing, Medicaid and Medicare policy, Tribal health administration, or the administrative data systems used to understand these programs, this repository may be useful.
Ask Dr. Fox
Have a question about this research? Ask Dr. Fox — the AI assistant in the bottom right corner of each page — for answers grounded in the papers themselves. It searches this site and the papers posted here, not the internet, and it updates daily as new material is added.
About the Author
I worked in Indian health as a Tribal health program administrator, a Tribal health director for the Port Gamble S’Klallam, Skokomish, and Squaxin Island Tribes. I worked for two leading Indian health organizations: in executive leadership and policy at the Northwest Portland Area Indian Health Board and from 2019 to 2023 as the Director of National Indian Health Board’s Data Project. The need to respond, with data, to the Covid crisis interrupted some of the work you see here. More about me →
