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Our Work Reducing American Indian Health Disparities

Improving health and well-being for Native American people in Montana.

Montana’s Medicaid Tribal Health Improvement Program (T-HIP) offers an unprecedented opportunity for Native nations to create wellness and disease prevention programs. Much of our work in this area involves providing grant funding and technical assistance to support the development of these programs and convening program directors.

Native American people in Montana experience higher rates of many illnesses and live shorter lives, on average, than non-Native Montanans. These statistics reflect long-standing inequities, not only in health care but in basic needs such as housing, food, and employment. Historically, the funding for wellness and disease prevention programming has met only a tiny fraction of the need.

The state of Montana worked with Native nations to create T-HIP in 2017. The program allows Native nations to receive Medicaid funding for designing and delivering culturally-based wellness and disease prevention programs to their communities. T-HIP will enable tribes to build disease prevention programs and address barriers to health such as trauma, unemployment, poor quality housing, and lack of access to healthful foods.

Establishing effective T-HIP projects will need successful planning, careful evaluation, and stable and disciplined program development work over many years. We play a supporting role by providing technical assistance from our staff and consultants. We also organize meetings for T-HIP staff from around the state and give grants to jumpstart planning and implementation.

Beyond T-HIP, we also support planning for programs to address the basic needs for health, such as housing, food security, education, and employment.

Our Support


We provide grants or contracts with consultants to help tribes plan for and develop new programs and evaluation strategies and to cover start-up costs for new T-HIP programming. All funding under this initiative is by invitation only.

Selection Criteria

Only tribes and tribal government agencies are eligible to apply for funding under this initiative.

Successful invited grant or contract applications must meet the following criteria:

  • Document commitment from tribal leadership to implement the T-HIP program.
  • Identify key staff and the tribal department where the T-HIP program will be established.
  • Have in place a Indian Health Services 638 contract for health promotion/disease prevention services, or use grant funds in part to develop the contract.
  • Tribes may use grant funds to pay for the services of a contractor if needed. Any contractor chosen should have expertise in American Indian public health systems and a track record of successful efforts to engage and support tribal health systems.