Tribal Health Compliance Hub
Sovereignty-first compliance frameworks for federally recognized tribes navigating 638 contracts, state pass-through funds, and the RHTP tribal set-aside.
Articles
13 articles
Braided Funding Is an Operations Problem, Not a Policy Problem
The braided funding conversation has been about how funders design programs. The missing conversation is about what happens inside grantee organizations when incompatible compliance frameworks collide.
Tribal Health and Braided Compliance: ISDEAA, 2 CFR 200, and Everything In Between
Tribal health programs manage funding under fundamentally different compliance frameworks simultaneously. This guide covers the operational reality of braided compliance for tribal nations — from CSC reconciliation to multi-agency reporting.
CSC Reconciliation: Recovering the Contract Support Costs Your Tribal Health Program Is Owed
A practical guide to Contract Support Cost reconciliation for tribal health programs operating 638 contracts — covering estimated vs. actual tracking, IHS settlement, dispute mechanisms, and the dollars at stake.
CSC Reconciliation Calculator
A calculator for tribal health programs to track Contract Support Cost entitlement, compare estimated vs. actual direct costs, and identify CSC underrecovery throughout the contract year.
The Six-Month Gap: Why Some States Are Already Funding Providers While Others Haven't Named a Lead Agency
Three months after the same CMS award, New Jersey is reviewing applications while 21 states have shown zero visible implementation activity. Here's where every state stands and what it means for providers.
Grants vs. Contracts vs. Cooperative Agreements: The RHTP Mechanism Choice That Determines Everything
Whether your state issues grants, contracts, or something else entirely changes what you need to prepare, how you'll be paid, and whether your organization can realistically compete. Here's the full state-by-state picture.
The $6,305 Problem: Why the Smallest Rural States Get 100x More RHTP Funding Per Person
Rhode Island receives $6,305 per rural resident. Texas receives $66. The same program, the same rules — and a 96x per-capita disparity that shapes competitive intensity, award size expectations, and whether RHTP is transformative or supplemental in your state.
North Carolina Moved First. Here's What Sub-Grantees Are Learning the Hard Way.
North Carolina released its RHTP sub-grantee solicitation 60 days after the CMS award — faster than any other large state. Hub lead applications close April 2. What other states should learn from what's already going wrong.
Tribal Invisibility: Why States With 100+ Tribes Still Don't Have Published RHTP Set-Asides
Oregon set aside 10% for 9 tribes. Connecticut reserved 3.5% for 2 tribes. California — home to 109 federally recognized tribal nations — has published no set-aside at all. The pattern: states with the smallest tribal populations designed the clearest pathways.
The Reimbursement Trap: How RHTP Payment Models Are Designed to Fail the Providers Who Need Them Most
A Critical Access Hospital operating on a 2% margin has $240,000 in cash cushion. An RHTP sub-grant on a reimbursement basis requires that hospital to front $500,000 it doesn't have. The organizations RHTP was created to help are the ones least able to absorb the funding mechanism.
The Implementation Equity Gap: Where RHTP's Delivery Mechanism Breaks
Chatterjee et al. proved RHTP allocations are misaligned with rural health needs. 84 days of implementation data reveal a second, independent problem: no observable relationship between funding level and implementation speed. Geography now determines access to federal funds.
What 29 Solicitations Reveal About Where RHTP Applicants Will Fail
Nine states have published RHTP sub-grantee solicitations. The patterns across 29 documents expose the compliance gates that will eliminate most applicants — and the positioning decisions that separate winners from the eligible.
Braided vs. Blended vs. Sequenced Funding: What the Distinction Actually Means for Compliance
The terms braided, blended, and sequenced are used loosely in the field. The compliance implications of each are fundamentally different. This guide defines each approach precisely from an operational perspective.
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