In the two months since Indian Health Board of Billings abruptly closed its doors to the public, advocates for urban American Indians have been working to connect those left without health care to new providers.
It's been difficult.
The Rocky Mountain Tribal Leadership Council and Indian Health Service have sponsored two community meetings designed to help those left without coverage to connect with other health care providers in Billings.
"They haven't been as successful as we were hoping," said Anna Schmitt with the Rocky Mountain Tribal Leadership Council.
Turnout at both meetings was well below what leaders had hoped, and officials aren't sure how many of the Indian Health Board's past patients have been able to find new coverage.
Marguerite Jodry, an Affordable Care Act health care navigator in Billings, who works for Planned Parenthood of Montana, has been trying to assist.
"We've been working closely with the (Rocky Mountain Tribal Leaders Council) to reach out to former IHB patients," Jodry said.
Roughly 5,900 American Indians live in Billings. The Indian Health Board of Billings used to serve most of them. However, outpatient visits had declined rapidly in the past few years. In 2012, the clinic had 4,349 visits. Last year, the number had dropped to 3,026 visits.
Before the board closed its clinic, it was treating only 857 patients. Its closure caught the patients and Indian Health Service officials in town by surprise.
The Indian Health Board of Billings operated as part of the federal Urban Indian Program. Federal law allows for Indian Health Service to contract with health care providers to serve American Indians who live in urban centers rather than on reservations, where IHS clinics are set up.
The health board's contract with IHS expired April 28 and it had a deadline to renew by May 2. For two decades the Indian Health Board of Billings had renewed its contract with IHS without problem. This year, when the deadline came and passed with no renewal contract signed, IHS officials realized something had gone wrong.
However, they had an inkling. The health board's clinic on Alderson Avenue had closed a week earlier with a sign on the door that informed visitors that the building was closed temporarily for repairs.
IHS officials are still unsure what happened but have been working since May to set up a contract with another Urban Indian Program provider. Under federal law, the potential provider is required to be governed by a board of trustees who are members of federally recognized American Indian tribes.
The Billings area office of the IHS formally requested bids from potential providers on June 15. The deadline to respond was Monday and IHS officials have declined to say how many applied under the federal Procurement Integrity Act.
"The Billings area office is currently expediting its review and award of a new contract," said Leonda Levchuk, public affairs specialist for IHS.
In the meantime, advocates for American Indians all across the city are working to make sure people get health care coverage.
Jodry, the navigator, said they are eager for former patients to realize they qualify for a number of federal health care programs, and she encouraged health board patients to call her at 406-869-5045.
IHS and the Rocky Mountain Tribal Leaders office have worked to get the word out that patients can receive care at Pryor Health Station and at the Crow/Northern Cheyenne Hospital in Crow Agency. They've also tried to publicize the various transportation options available.
"We (have) also asked local health care providers and health care organizations for their assistance in accommodating American Indian patients in Billings during this closure," Lavchuk said.
Along with the options in Pryor and Crow Agency, patients can also get care at RiverStone Health in Billings.
"The education needs to happen that they're eligible," Schmitt said.