The Native Nations Center for Tribal Policy Research at the University of Oklahoma has published a new report analyzing barriers tribal citizens face in accessing cancer care. The Sovereign Report, titled "Purchased/Referred Care and Cancer: Overview and Options for Tribal Consideration," was authored by Grace Fox, a tribal health care policy analyst at the center.
The report examines the Indian Health Service's Purchased/Referred Care (PRC) program, which funds eligible care delivered by non-IHS or non-tribal providers when local services are unavailable. It outlines how PRC intersects with cancer screening, diagnosis, treatment, and follow-up for tribal citizens. Details covered include PRC structure, eligibility requirements, notification timelines, medical-priority levels, coordination with other resources, and funding limitations.
According to the report, cancer is becoming a more pressing public health concern in Indian Country. American Indian and Alaska Native populations are diagnosed at later stages of cancer and have lower participation in screening programs compared to the general U.S. population. These groups also experience higher mortality rates.
"When someone is facing a cancer diagnosis, timing matters," said Fox. "The Purchased/Referred Care program often serves as the bridge to specialty oncology services that aren't available locally. Understanding that process – from referral to authorization to payment – can make a meaningful difference for patients and for tribal health systems."
While drawing on national data and federal regulations, the report includes information specific to Oklahoma—a state with more than 39 Tribal Nations (38 federally recognized) where all 77 counties are designated as purchased and referred care delivery areas under federal guidelines. Despite this statewide designation, individuals must still meet eligibility criteria and secure necessary documentation and funding approval before receiving services.
Fox noted that policy options outlined in the report include self-determination authorities for tribes, regional collaborations among tribal nations, mobile screening units, teleoncology models using telemedicine technology for cancer care delivery, enhanced care coordination efforts, navigation support for patients, and expanded avenues for sovereignty-driven engagement with federal agencies.
Fox’s position was created through collaboration between the Native Nations Center for Tribal Policy Research and the Native American Center for Cancer Health Equity at Stephenson Cancer Center. Funding came from the Improving Cancer Outcomes in Native American Communities (ICON) grant—an initiative aimed at transforming research and policy related to health outcomes among tribal communities.
She said that although originally intended primarily for tribal leaders' use in decision-making processes, interest in the report has extended to clinicians and researchers both within Oklahoma and nationally. Fox credited support from U.S. Rep. Tom Cole via the ICON grant as instrumental in making this work possible; it has helped initiate discussions about PRC policies’ effects on access to cancer care among policymakers in Washington D.C.
"I think of my mom, who had cancer this time last year," Fox said. "Seeing her lived experience and her struggles, and knowing that time was of the essence; she didn't have time to go through Indian Health Service because of how long it would have taken."
"That, on its own, shines a light upon the challenges that exist," she continued. "It shows why tribes and tribal citizens could benefit from having more information and improved pathways to care."
Fox emphasized that their work does not dictate specific actions: "We are not telling tribes what to do. We are providing research-driven analysis and options for consideration that tribes can evaluate within their own governance structures and priorities."
Other members of the Native Nations Center team include Evelyn Cox (research project manager), Tana Fitzpatrick (associate vice president of Tribal Relations), and Quanah Yazzie (office manager). The team continues producing research products—including reports like this one—for distribution among tribal leaders, citizens, clinicians, researchers,and community partners seeking solutions to disparities affecting Indigenous communities.
