A January report shows that in rural counties home to large numbers of American Indians, including in Montana, people are more likely to rely on Medicaid for health insurance across all age groups. About 23% of Montanans rely on Medicaid for their health coverage. But the four counties with the highest rates - roughly 40%- are all home to American Indian reservations. That's according to a report from the Georgetown Center for Children and Families on Medicaid's role in rural areas.

Joan Alker, executive director of the Georgetown Center for Children and Families, says that's a national pattern.

"This is important because if Congress moves ahead to make large cuts, these areas and Indian Country more generally will be in big trouble," she explained.

Alker added that documents leaked from the House Budget Committee show it's considering cuts to Medicaid between $200 -billion and $2.3 trillion. She added that the cuts are not a "foregone conclusion." This week, a Montana bill to start phasing out the state's Medicaid expansion was voted down by the Senate on Tuesday and a bill to remove the program's June sunset date passed the House on Monday.

Jason Smith, executive director of the Montana Consortium for Urban Indian Health, said Medicaid provides health coverage for individuals while being a critical source of revenue to the Urban Indian Organizations to help sustain their operations.

"I would say the UIOs, particularly, had a lot of revenue coming from Medicaid. So it's really a great secondary source of funding that has helped their organizations run and provide services for the communities," he contended.

As of January, more than 14,000 American Indians in Montana were enrolled in Medicaid expansion.


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CORRECTIONS: Washington Gov. Bob Ferguson was not at the 3rd annual taskforce summit. An earlier version incorrectly stated he had attended. In addition, the story now mentions that the American Indian Health Commission organized the summit. (11:12 a.m. PST, June 30, 2025)

Native Americans in Washington state face opioid and fentanyl overdose rates four times the national average and leaders are calling for more investment in treatment centers and transitional housing to address the problem.

While nationally fentanyl overdoses have declined, Native American fatalities have surged since the pandemic.

Rep. Debra Lekanoff, D-Bellingham, is part of the State Tribal Opioid-Fentanyl Taskforce. She serves Whatcom County, where overdose-related fatalities are the highest in the state.

"I can't tell you the number of times that the Native American communities of Lummi Nation and of the Nooksack Tribe have stood next to their graves being in such sadness from the loss of their grandmothers, their mothers, their children," Lekanoff recounted.

During the taskforce's third annual summit, organized by the American Indian Health Commission, tribal leaders and state agencies met for three days and heard from community members in recovery from opioid use disorder.

Last year, Lekanoff noted, the task force partnered with tribal governments and invested in substance abuse treatment facilities based on a successful model created by the Swinomish.

"The model that Swinomish created 12 years ago has now been incorporated into over 20 tribally owned substance abuse disorder facilities that are healing all Washingtonians," Lekanoff explained.

Lekanoff added in the next couple of years the task force will focus on transitional housing for those recovering from substance abuse. She stressed it is a nonpartisan issue and it will take everyone working together to make change.

"It is going to take us recognizing that we're one people, we're one family, we're one community in Washington state," Lekanoff emphasized.


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American Indian and Alaska Native communities in Colorado continue to face significant gaps in health care access, quality and outcomes, according to a new analysis of the Colorado All Payer Claims Database.

While the communities face higher rates of many chronic conditions, they are also not getting important preventive care.

David Wright, data manager at the Denver Indian Center, said fear remains a primary barrier, pointing to decades of mistreatment, including the forced sterilization of women and federal policies forcing medicine men and other spiritual leaders into mental asylums up until 1978.

"Native people, for a long time, have been used to advance medical research without their consent," Wright pointed out. "And so there's a large mistrust within the native communities against the medical profession."

Between 2018 and 2024, American Indian and Alaska Native people were diagnosed with kidney disease, autoimmune, nervous, metabolic and endocrine disorders such as diabetes at rates far above their white peers. Wright noted the analysis, produced in partnership with the Center for Improving Value in Health Care, will be used to create a culturally tailored education program for health providers.

Without additional training, Wright pointed out health professionals are likely to continue to assume chronic conditions are due to an individual's dietary choices. Many do not understand for more than 100 years, tribes had to rely on government rations, typically high in carbohydrates and salt, to get enough calories.

"Because of the forced relocation and the reservation systems, and relying on heavily carbohydrate related rations," Wright added.

Poverty, lack of affordable housing and the breakdown of family systems also disproportionately affect health outcomes. Wright argued better health will require treating the whole person, not just specific medical conditions. When people are out of balance in any one area, he stressed there are ripple effects.

"If we're not able to provide stable housing -- which is not only of mental and emotional and physical importance -- but it also will affect the outcomes and the teachings and the role modeling you need for your children and your family structures," Wright emphasized.


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Ho-Chunk has kicked off its summer internship program in Nebraska after sifting through 600 applicants.

It is opening pathways to higher education and leadership positions within the Winnebago Tribe in Nebraska. The Ho-Chunk Incorporated internship program will mentor nearly two dozen students this summer, 14 of whom are members of the Winnebago Tribe.

Aaron LaPointe, CEO of Ho-Chunk Capital, started as an intern and said the program is an opportunity for interns to learn a business from the ground up - and he has personal experience.

"I was studying agriculture, and the CEO here at Ho-Chunk was like, 'What? We have a tribal member studying agriculture? He's got to run this farm,'" LaPointe recounted.

LaPointe started by running the farm and ascended to head Ho-Chunk Capital, an investment arm of the corporation. He took on several other roles on his way up the ladder, too. The internship program is highly competitive. From hundreds of applicants, only 24 were accepted.

In addition to learning skills they need to be successful in business, LaPointe said, interns also gain the confidence to do their jobs.

"Our interns aren't just sitting in a cubicle off to the side filing," he explained. "They're in the board meetings, they're in the executive board meetings and strategizing business, and we really make it a well-rounded experience."

The internship program runs until Aug. 1.