The Ak-Chin Indian Community was faced with a dilemma: The 1,100-member tribe was notified that its contract for health care services with its neighbor, the Gila River Indian Community, was coming to an end.

At the same time, the building housing the clinic that serves Ak-Chin tribal members and other Native people living nearby was small, decades old and in need of restoration or replacement.

In addition, tribal leaders had been long concerned about travel to obtain specialized health care. Ak-Chin’s lands are just south of the town of Maricopa, and people traveling to Phoenix for specialized services routinely face a grueling one-hour drive including 18 miles of State Route 347, an overcrowded four-lane highway that’s one of the state’s more dangerous.

A community group that advocates for safety improvements found that more than 2,500 accidents occurred on the stretch in the past 10 years, including 80 with serious injuries or deaths.

With all this in mind, Ak-Chin decided to open its own facility crafted to meet specific community needs and wishes, through a collaboration with the Indian Health Service. The tribe also broke ground for a new dialysis center to serve community members with kidney care services.

The new clinic and dialysis center are part of a growing trend in Indian Country: tribes taking charge of their health care dollars to tailor systems that meet their own needs and enhance tribal member health.

Ak-Chin is one of the many tribes across the United States and in Arizona that use a groundbreaking law that provided for more self-governance and increased flexibility in tackling health issues like diet, exercise and preventive care. Some health care experts say shifting health care management to tribes is already reaping results in some communities.

Tribal health care: The Navajo Nation has a cancer clinic, a tribal first

What is a ‘638 compact?’

The Indian Self-Governance and Educational Responsibility Act, signed into law by President Richard Nixon in 1975, is also known as P.L. 93-638 or just “638.” It allows tribes to contract with IHS to receive the funding for their members that once was allocated to federal agencies like the Bureau of Indian Affairs and the Indian Health Service.

“Tribes now administer more than 60% of Indian Health Services’ budget,” said Health and Human Services Secretary Robert F. Kennedy Jr. in April during a tribal self-governance conference in the Gila River Indian Community.

“This is one of the largest transfers of federal program control in our government, and it’s working,” he said. Tribes are taking more hospitals, clinics, and programs to 638 status. The IHS website pointed out that most tribes directly manage at least some of their health care programs.

“When tribes can tailor their health care to meet their needs, the quality of that care increases,” said A.C. Locklear, chief executive officer of the National Indian Health Board, which advocates for improvements in tribal health.

Locklear, a member of the Lumbee Tribe of North Carolina said tribes can choose to assume management of part or all of their community’s health care.

“Some take pharmacy services on as a first step,” he said. Others may decide to take over their entire program. “It’s an opportunity for them to tailor what makes the most sense for that community.”

For example, Locklear said, the Alaska Native tribal health care system provides each client with a coordinated team, including a nurse, physician, behavioral health specialist and a nutritionist.

Other tribes are incorporating wellness programs, including exercise, growing or harvesting traditional foods to replace unhealthy foods and other such preventive programs to reduce chronic diseases like diabetes and cardiovascular diseases.

Also, many tribes are including traditional healers as part of their health team, thanks to a 2004 amendment that expanded coverage of such practitioners by IHS and Medicaid programs. Arizona expanded its own coverage through the Arizona Health Care Cost Containment System, or AHCCCS, in 2025.

And, Locklear said, the self-governance law has also allowed tribes to create specialized care services. For example, he said, the Navajo Nation was able to build a facility to treat cancer patients in Tuba City to deal with a cancer cluster caused by the effects of now-closed uranium mines in the area.

“That provides care for patients so they don’t have to drive long distances to receive care,” he said.

Ak-Chin takes charge of its health care

When Ak-Chin was faced with the end of the contract with its neighboring tribe to staff and run its primary care facility, leaders decided to make improvements to its facility and add some specialized care.

In addition to negotiating a compact with IHS, the tribe applied for the agency’s Joint Venture Construction Program. Under the program, tribes or tribal organizations fund construction, purchase or renovation of a health care facility and lease it to IHS at no cost for 20 years. In return, IHS requests funding from Congress to staff, operate and maintain the facility.

Ak-Chin Chairman Gabriel Lopez said Ak-Chin was one of seven tribal programs out of a pool of more than 25 applicants for this year’s selection.

“We’ll build it and negotiate services with IHS funding the staff,” Lopez said. “Ak-Chin will run its 638 program under the self-governance act.”

Lopez said members of Arizona’s congressional delegation offered support. Rep. Eli Crane, a Republican whose sprawling district includes Ak-Chin and 13 other tribes, and Democratic Sens. Ruben Gallego and Mark Kelly smoothed the way with IHS, he said.

Crane said in a statement that the IHS facility is a “historic investment in rural health care,” a sentiment echoed by Locklear.

“Tribal health care programs can serve as a model to improve health care in rural areas,” Locklear said.

“They helped us move forward,” Lopez said. “They asked us our needs and then sent support letters.”

The tribe will break ground for the health center sometime in 2026. When completed about 24 months later, sometime in 2028, the 39,000-square-foot health center will house six program rooms, a therapeutic pool area, offices, locker rooms, physical therapy area, indoor walking track and a full workout floor, which will include cardiovascular and resistance training and power lifting platforms.

Ak-Chin also determined that more specialized care was needed in its community. That led the tribe to its newest health care venture: a dialysis facility. The tribe broke ground for that facility in December 2025. The dialysis clinic will be completed in fall 2026 with an estimated opening in December 2026.

“This is such a blessing to us,” Lopez said. “It’s a testimony to our past and current leadership.

“We need to take care of our own.”

Debra Krol reports on Indigenous communities at the confluence of climate, culture and commerce in Arizona and the Intermountain West. Reach Krol atdebra.krol@azcentral.com.Follow her on X, formerly known as Twitter,@debkroland on Bluesky at @debkrol.bsky.social.

This article originally appeared on Arizona Republic: Ak-Chin tribe in Arizona will open its own health care center