Assumptions & Expansions
Assuming new programs and expanding services are among the most significant decisions Tribal leadership makes. THA's team of subject matter experts comes alongside your leadership — providing the planning, assessment, and implementation support your Nation needs to move forward with clarity and confidence.
Supporting Your Future — one transition at a time.
Your Future
Sustainable health systems don't happen by accident. THA guides Tribal Nations through the transitions, assumptions, and infrastructure decisions that protect access to care for future generations.
See how we support Tribal futures. ↓
Your Programs
Strong programs require strong operations. THA works alongside Tribal leadership to optimize financial performance, strengthen clinical operations, and ensure every program delivers maximum value to your community.
Your People
Healthy communities begin with accessible, high-quality care. THA helps Tribal Nations strengthen the programs, services, and systems that keep your people well — today and for generations to come.
Here's how we can help:
Feasibility & Readiness Assessments
Review operational capacity, financial projections, workforce availability, and infrastructure requirements.
Community Health & Service Gap Analysis
Assess population trends, utilization patterns, and unmet needs to guide responsible service development.
Phased Implementation Planning
Develop phased action plans that align governance, staffing, facilities, and funding timelines.
Title I Transition Strategy
Advise on compliance, operational readiness, financial sustainability and governance alignment.
Strategic & Long-Range Health System Planning
Align proposed growth with Tribal priorities, governance direction, community needs and long-term sustainability.
Operational & Program Reviews
Evaluate workflows, service lines, and financial performance to identify strengths and risk areas.
Pre-Award & Start-Up Guidance
Support early planning, funding development, and transition phases.
Title V Transition Strategy
Advise on compliance, operational readiness, financial sustainability and governance alignment.
Understanding Title I and Title V
The Indian Self-Determination and Education Assistance Act (ISDEAA) gives Tribal Nations several pathways to manage programs and services that the Indian Health Service would otherwise provide — from early planning through full self-governance.
Tribal Management Grant (TMG)
A planning grant that helps Tribes build the administrative capacity and infrastructure needed to assume IHS programs. TMGs support feasibility studies, organizational development, and readiness planning — an important first step for Tribes considering Title I or Title V.
IHS Self-Governance Cooperative Agreement
Provides funding and technical assistance to help Tribes prepare for and enter the Self-Governance program. Cooperative Agreements support Tribes in developing the financial management systems, governance structures, and operational capacity required for Title V compacting.
Title I — Self-Determination Contracting
Tribes contract with IHS to operate specific programs and services. IHS approval is required for major changes.
Title V — Self-Governance Compacting
Tribes have broader flexibility to redesign, consolidate, or redirect funding without prior IHS approval — emphasizing Tribal control and long-term sustainability.
Tribes may combine Title I, Title V, and direct services in ways that best meet their community's needs — making these approaches complementary rather than mutually exclusive. THA helps Tribal leadership evaluate which pathway best fits their Nation's priorities, readiness, and long-term vision.
Operations. Transitions. Outcomes.
Executive guidance and hands-on support for Tribal and Urban Indian health systems.