In August of 1996, Congress passed the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (Public Law 104-193). This legislation ended the Aid for Families with Dependent Children (AFDC) and replaced it with a five-year maximum benefit program known as Temporary Assistance for Needy Families (TANF).
For Indian Tribes, the new law allows each tribe to establish its own TANF program, subject to the approval of the Secretary of Health and Human Services, but only funded the program with the 70 percent federal share of the AFDC case load in the Tribe’s selected service area for 1994. States are not obligated to provide the remaining 30 percent share that states required to contribute under the AFDC years.
The concern is whether application of Welfare Reform Legislation will ease social concerns of the Three Affiliated Tribes or simply add to the impoverished conditions existing on the reservation. The Act intends to place welfare recipients on jobs within a five-year period of the decree. The concern, however, is that no immediate focus has been given to the creation of jobs in which the welfare recipients may be placed in order to support his/her family. Secondly, limited resources hinder tribes wishing to design and operate their own TANF programs, and provides little or no technical and fiscal support for the operation their programs. Current legislation and policy also puts tribal nations in direct conflict with the states for resources and case load management.
The impact of the welfare reform law on Indian tribes is as yet unknown. It should be noted that in 2001 Indian persons comprised approximately 53 percent of the welfare case load in North Dakota. The need for collaboration is critical in the areas of job creation, job training, and coordination of social services. Of utmost concern is what happens after five years in a rural area where economic development is nearly non-existent?
Prior to construction of the Garrison Dam, a U.S. Public Health Service Hospital was located at Elbowoods in the center of the reservation. In a one-year period between June 1, 1947 and May 31, 1948, 460 patients were admitted to the hospital and 3,921 were treated as outpatients. The hospital, like the rest of Elbowoods, was flooded after Garrison Dam was completed.
In the following years, the Corps of Engineers promised to construct a new hospital, but the Bureau of Indian Affairs recommended hospital care in cities and towns adjacent to the Three Tribes reservation. The recommendation was based on an analysis of road facilities and vehicle ownership of Tribal members, believing that traveling would be easier on the tribal population.
In 1979 a study was conducted to investigate the feasibility of a hospital, extended and ambulatory care services for the reservation. It was determined at that time to be a credible and feasible venture.
Currently the Indian Health Service operates an ambulatory health center facility on the Fort Berthold Reservation. The main health center, Minne-Tohe, is located at Four Bears. Three field satellite clinics are operated at White Shield, Mandaree, and Twin Buttes.
Due to the geographical makeup of the reservation, Lake Sakakawea physically separates all four facilities from each other. The Minne-Tohe facility is staffed with two physicians, a nurse practitioner, support staff, and a community health nurse. Each of the satellite clinics has the services of a medical assistant.
Since that time, emergent health issues, (Indian Health Service data shows that Fort Berthold had the second highest infant mortality rate in the Aberdeen Area in 1981 and 1982) access to more immediate critical health care, has again brought to the forefront the need for building a reservation-based hospital. (JTAC Report, p. 20)
In 2008, design plans were announced for a new $20 million health-care facility for the Three Affiliated Tribes on the Fort Berthold Reservation. The new health facility will be built on 120-acres that the tribe owns, north of Fort Berthold Community College in New Town. The new health-care facility will replace the existing Minne-Tohe Health Center west of New Town. The Minne-Tohe, which means “Blue Water,” is the main medical facility for the Three Affiliated Tribes on Fort Berthold. It was built in the 1960s as an out-patient clinic, operating five days a week.
The name of the new facility, Elbowoods Memorial Health Facility, is from the community of Elbowoods, which had a hospital with the same name. Elbowoods, which was flooded when Garrison Dam was built, was the headquarters for all of the Indian agency’s programs. The hospital closed but a clinic operated there until it was moved to New Town in the 1950s. The clinic operated in New Town in a small building, then moved to the Bureau of Indian Affairs Administration Building before the Minne-Tohe building was built.
The entire health-care facility will be 43,000-square-feet, which is six times larger than the present Minne-Tohe Health Center. Some programs that do not exist now in the Minne-Tohe center will be provided in the new facility, including eye care and audiology. (Minot Daily News, November 11, 2008)
Prior to the construction of the Garrison Dam, the student population of the Fort Berthold Reservation numbered 861 and was divided among seven day-schools and one high school with facilities located at Elbowoods. Some tribal children were educated off reservation in Bureau of Indian Affairs boarding schools or church-administered educational facilities.
The taking act altered the shape of Indian education on Fort Berthold. Children could no longer be educated in Bureau of Indian Affairs operated schools or in a reservation-wide high school. This forced dispersion of the school population and saw the development of three new elementary and high school facilities being built at White Shield, Mandaree, and Twin Buttes. Cooperative agreements were signed by the Bureau of Indian Affairs with these three public school districts to enable Indian students to be served by those facilities. During the 2008-2009 school year, these facilities served 352 Three Affiliated Tribes children. In the 2008–2009 school year, Three Tribes’ children comprised approximately 91 percent of the 718 children enrolled in the New Town Public School system.
The total Three Affiliated Tribes school children enrolled in the 2008-2009 school year is approximately 1,245.
Three Affiliated Tribes children enrolled in the following counties:
Currently, the three facilities built at Mandaree, Twin Buttes, and White Shield are old facilities. Across the state of North Dakota, counties containing Indian populations were the only counties to show gains in population. The issue of utmost concern to the Three Affiliated Tribes is whether or not the existing facilities will be able to house student enrollment and meet the student needs, as more funding is required for newer, larger school facilities.