A Native American advocacy group is making a big push to get out the Indigenous vote in this year's elections.

It is hiring field organizers across the state and turning to technology. Western Native Voice calls its initiative "No Vote Left Behind in 2024." The group is hiring 14 part-time organizers, on reservations and in urban areas.

Sami Walking Bear, outreach and field director for Western Native Voice, said the group hires locally, so the organizers will be trusted members of Montana's seven tribal communities. She explained they will encourage people to exercise their right to vote, as historically, tribal voices have been underrepresented.

"We've never been promoted to use that voice in any schooling or upbringing," Walking Bear pointed out. "It's our civic duty to vote. It affects everything in our daily lives; policy, funding."

Registering to vote requires someone to have a physical address, and many places on tribal reservations do not have them. Western Native Voice is creating an app using online geographical location coordinates to create a physical address, in an effort to increase voter registration numbers.

The geolocation codes are the same ones used to create a so-called 911 address, which rescue crews use to respond to emergencies. Walking Bear pointed out codes will also allow people who are homeless to register to vote, because they will have a physical address. She added the geocodes will assist the communities in other ways.

"Eventually what we're hoping is that this data will be able to help the tribes finish their 911 mapping," Walking Bear emphasized. "(We will) assist in any other way we can with this data and the resources we have."

Between increasing "boots on the ground" in local communities and using the app, Western Native Voice hopes to turn out a record number of Montana's Indigenous voters in this year's elections.

Montana's Indigenous population is pushing back against efforts to limit ballot collection on tribal lands.

Many members of the state's seven tribes live several hours from the nearest polling place. The Montana Supreme Court has ruled two laws make it prohibitive for people living on reservations to reach a polling place or mail an absentee ballot before Election Day. The state is now asking the U.S. Supreme Court to review that ruling.

Ronnie Jo Horse, executive director of the group Western Native Voice, said they collect ballots from tribal residents who face transportation and other hurdles that keep them from getting to a physical polling place and added the service was very important during the pandemic.

"We had a novel virus going around," Horse pointed out. "A lot of people were afraid to leave their houses because Native Americans had a really high mortality rate than any other group in America."

The bills ended Election Day voter registration and third-party ballot collection services in Montana but the state's high court ruled them unconstitutional and stopped them from taking effect.

The American Civil Liberties Union said voters on tribal lands have "disproportionately relied on" Election Day voter registration and ballot collection services in Montana to cast ballots. Horse stressed the critical services need to be protected.

"If they did put (up) more barriers or even take away ballot collection, those will actually put up barriers for all of Montana, not only Native Americans, to make that decision and cast their vote," Horse contended.

Election Day registration has been the law in Montana for 15 years and efforts to end it were seen as measures to make voting for Indigenous people more difficult. Early voting in Montana starts Oct. 7.


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By Robert Bordeaux for Arts Midwest.
Broadcast version by Mike Moen for Wisconsin News Connection reporting for the Arts Midwest-Public News Service Collaboration

Language is the center-point of any culture. For Indigenous people, keeping and carrying forward their language becomes a decolonial act — a reclamation of space. 

This has been Laura C. Red Eagle’s journey. A writer and language enthusiast, Red Eagle is a member of the Ho-Chunk Nation, whose traditional territories include land in Wisconsin, Minnesota, Iowa, and Illinois.

Red Eagle grew up in rural Wisconsin with her non-native mother, away from her Ho-chunk communities in the area. During this time, she had trouble navigating her identity, culture, and community. Her father’s family were fluent Ho-chunk speakers, but they spoke to her in English when they shared space. In high school, Red Eagle decided to start learning her traditional language. She joined a language camp offered by the Ho-chunk community in Black River Falls. This lit the fire to her language-learning journey.

Over the years, she noticed a deep yearning to create community around language learning. Post-secondary education didn’t offer what she was hoping for. Determined, she decided to gather her own resources. 

These resources were few and far between — common for many Indigenous languages. As oral languages, resources weren’t created until colonial contact. Made by non-speakers, non-native individuals and organizations, complications arose around the control of translations and learning methods, and access to these materials. 

A Space to Share

Red Eagle tracked down a tape that offered Ho-chunk for colors, numbers, and animals, but she craved to dive deeper.

Then, a timely interaction set the stage for her next chapter of language-learning. At her father’s funeral, she heard Jon Greendeer (current president of Ho-Chunk Nation) speak in Ho-Chunk. After a conversation, he offered resources and other community members to connect with around the language. The importance of community learning spaces kept surfacing for Red Eagle. 

“Learning the language in a judgment-free zone opens doors into learning about history, the ways of thinking, and being, and what is important, and so much more,” she says.

Her perseverance led to the Indigenous Language Table at the Wisconsin Institute for Discovery (WID) in Madison. It’s a space for active language practice beyond the classroom. The Indigenous Language Table is a communal gathering that meets once a week. It emphasizes the importance of using the language in everyday conversations.

To young Indigenous people and new language learners, Red Eagle says: find a class, build a community, and create spaces for language use. 

Red Eagle remains steadfast in creating a supportive community for language learners, even with the struggles of language revitalization work. “Language is ultimately about connecting as human beings and creating a sense of belonging,” she says. She envisions more Indigenous Language Tables across Wisconsin and beyond. Her story is a testament to the resilience and dedication required to revive and sustain Indigenous languages. Her efforts with the Indigenous Language Table offer a blueprint for creating vibrant language communities.


Robert Bordeaux wrote this story for Arts Midwest.


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By Arielle Zionts and Katheryn Houghton for KFF Health News.
Broadcast version by Kathleen Shannon for Greater Dakota News Service reporting for the KFF Health News-Public News Service Collaboration

When the Indian Health Service can't provide medical care to Native Americans, the federal agency can refer them elsewhere. But each year, it rejects tens of thousands of requests to fund those appointments, forcing patients to go without treatment or pay daunting medical bills out of their own pockets.

In theory, Native Americans are entitled to free health care when the Indian Health Service foots the bill at its facilities or sites managed by tribes. In reality, the agency is chronically underfunded and understaffed, leading to limited medical services and leaving vast swaths of the country without easy access to care.

Its Purchased/Referred Care program aims to fill gaps by paying outside providers for services patients might be unable to get through an agency-funded clinic or hospital, such as cancer treatment or pregnancy care. But resource shortages, complex rules, and administrative fumbles severely impede access to the referral program, according to patients, elected officials, and people who work with the agency.

The Indian Health Service, part of the Department of Health and Human Services, serves about 2.6 million Native Americans and Alaska Natives.

Native Americans qualify for the referred-care program if they live on tribal land - only 13% do - or within their nation's "delivery area," which usually includes surrounding counties. Those who live in another tribe's delivery area are eligible in limited cases, while Native Americans who live beyond such borders are excluded.

Eligible patients aren't guaranteed funding or timely help, however. Some of the Indian Health Service's 170 service units exhaust their annual pool of money or reserve it for the most serious medical concerns.

Referred-care programs denied or deferred nearly $552 million in spending for about 120,000 requests from eligible patients in fiscal year 2022.

As a result, Native Americans might forgo care, increasing the risk of death or serious illness for people with preventable or treatable medical conditions.

The problem isn't new. Federal watchdog agencies have reported concerns with the program for decades.

Connie Brushbreaker, a member of the Rosebud Sioux Tribe, has been denied or waitlisted for funding at least 14 times since 2018. She said it doesn't make sense that the agency sometimes refuses to pay for treatment that will later be approved once a health problem becomes more serious and expensive.

"We try to do this preventative stuff before something gets to the point where you need surgery," said Brushbreaker, who lives on her tribe's reservation in South Dakota.

Many Native Americans say the U.S. government is violating its treaties with tribal nations, which often promised to provide for the health and welfare of tribes in return for their land.

"I keep having my elders here saying, 'There's treaty rights that say they're supposed to be able to provide these services to us,'" said Lyle Rutherford, a council member for the Blackfeet Nation in northwestern Montana who said he also worked at the Indian Health Service for 11 years.

Native Americans have high rates of diseases compared with the general population, and a median age of death that's 14 years younger than that of white people. Researchers who have studied the issue say many problems stem from colonization and government policies such as forcing Indigenous people into boarding schools and isolated reservations and making them give up healthy traditions, including bison hunting and religious ceremonies. They also cite an ongoing lack of health funding.

Congress budgeted nearly $7 billion for the Indian Health Service this year, of which roughly $1 billion is set aside for the referred-care program. A committee of tribal health and government leaders has long made funding recommendations that far exceed the agency's budget. Its latest report says the Indian Health Service needs $63 billion to cover patients' needs for fiscal year 2026, including $10 billion for referred care.

Brendan White, an agency spokesperson, said improving the referred-care program is a top goal of the Indian Health Service. He said about 83% of the health units it manages have been able to approve all eligible funding requests this year.

White said the agency recently improved how referred-care programs prioritize such requests and it is tackling staff shortages that can slow down the process. An estimated third of positions within the referred-care program were unfilled as of June, he said.

The Indian Health Service also recently expanded some delivery areas to include more people and is studying whether it can afford to create statewide eligibility in the Dakotas.

Jonni Kroll of the Little Shell Tribe of Chippewa Indians of Montana doesn't qualify for the referred-care program because she lives in Deer Park, Washington, nearly 400 miles from her tribe's headquarters.

She said tying eligibility to tribal lands echoes old government policies meant to keep Indigenous people in one place, even if it means less access to jobs, education, and health care.

Kroll, 58, said she sometimes worries about the medical costs of aging. Moving to qualify for the program is unrealistic.

"We have people that live all across the nation," she said. "What do we do? Sell our homes, leave our families and our jobs?"

People applying for funding face a system so complicated that the Indian Health Service created flowcharts outlining the process.

Misty and Adam Heiden, of Mandan, North Dakota, experienced that firsthand. Their nearest Indian Health Service hospital no longer offers birthing services. So, late last year, Misty Heiden asked the referred-care program to pay for the delivery of their baby at an outside facility.

Heiden, 40, is a member of the Sisseton-Wahpeton Oyate, a South Dakota-based tribe, but lives within the Standing Rock Sioux Tribe's delivery area. Native Americans who live in another tribe's area, as she does, are eligible if they have close ties. Even though she is married to a Standing Rock tribal member, Heiden was deemed ineligible by hospital staff.

Now, the family has had to cut into its grocery budget to help pay off more than $1,000 in medical debt.

"It was kind of a slap in the face," Adam Heiden said.

White, the Indian Health Service spokesperson, said many providers offer educational materials to help patients understand eligibility. But the Standing Rock rules, for example, aren't fully explained in its brochure.

When patients are eligible, their needs are ranked using a medical priority list.

Connie Brushbreaker's doctor at the Indian Health Service hospital in Rosebud, South Dakota, said she needed to see an orthopedic surgeon. But hospital staffers said the unit covers only patients at imminent risk of dying.

She said that, at one point, a worker at the referred-care program told her she could handle her pain, which was so intense she had to limit work duties and rely on her husband to put her hair in a ponytail.

"I feel like I am being tossed aside, like I do not matter," Brushbreaker wrote in an appeal letter. "I am begging you to reconsider."

The 55-year-old was eventually approved for funding and had surgery this July, two years after injuring her shoulder and four months after her referral.

Patients said they sometimes have trouble reaching referred-care departments due to staffing problems.

Patti Conica, a member of the Standing Rock Sioux Tribe, needed emergency care after developing a serious infection in June 2023. She said she applied for funding to cover the cost but has yet to receive a decision on her case despite repeated phone calls to referred-care staffers and in-person visits.

"I've been given the runaround," said Conica, 58, who lives in Fort Yates, North Dakota, her tribe's headquarters.

She now faces more than $1,500 in medical bills, some of which have been turned over to a collection agency.

Tyler Tordsen, a Republican state lawmaker and member of the Sisseton-Wahpeton Oyate in South Dakota, says the referred-care program needs more funding but officials could also do a "better job managing their finances."

Some service units have large amounts of leftover funding. But it's unclear how much of this money is unspent dollars versus earmarked for approved cases going through billing.

Meanwhile, more tribes are managing their health care facilities - an arrangement that still uses agency money - to try new ways to improve services.

Many also try to help patients receive outside care in other ways. That can include offering free transportation to appointments, arranging for specialists to visit reservations, or creating tribal health insurance programs.

For Brushbreaker, begging for funding "felt like I had to sell my soul to the IHS gods."

"I'm just tired of fighting the system," she said.


Arielle Zionts and Katheryn Houghton wrote this story for KFF Health News.


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