Tribal leaders who testified before the House subcommittee highlighted concrete examples where assuming authority under the Indian Self-Determination and Education Assistance Act improved care and urged Congress to secure funding and technical supports to replicate those outcomes.

Cherokee Nation Principal Chief Chuck Hoskin Jr. said 638 ‘‘has been transformational,’’ describing how Cherokee Nation assumed operations of the Claremore facility and ‘‘immediately invested $11,000,000 to take that neglected facility from the IHS standard to the Cherokee standard’’ and plans a new $244,000,000 health campus. He argued that such transitions require predictable federal funding and recommended either continued advanced appropriations or making certain IHS appropriations mandatory to avoid service disruptions during federal budget lapses.

Greg Abramson of the Spokane Tribe recounted transitioning to a Title V compact on April 1, 2025. He described information-technology failures—particularly RPMS incompatibility—that ‘‘crippled our pharmacy operations, third party billing and referrals’’ during the transition and urged HHS to fully fund tribal EHR transitions or modernize RPMS to protect continuity of care.

Winnebago Council Member Victoria Kitchian described assuming a troubled hospital in 2018, regaining CMS certification in April 2023, and expanding services and revenue; she urged publishing uniform performance metrics, creating a 638 implementation manual, strengthening area-office capacity, and clarifying and fully funding inherently federal functions so program funds flow appropriately through 638 agreements rather than grants.

Witnesses and members also recommended structured technical assistance partnerships—pairing smaller tribes with experienced self-governance tribes, academic institutions or tribal colleges and universities—to build staffing pipelines and administrative capacity that make transitions feasible. The panel left the record open for written follow-up and additional documentation.