Purpose The objective of this study was to research organizational models for the management of block grants, to identify the functions and responsibilities of the current Indian Health Service (IHS) organization, to estimate the staffing and overhead costs for IHS, and to determine a model for IHS in the event that all direct health care services are delivered by tribal organizations instead of IHS. The purpose of the study was to identify an organizational structure, staffing, and cost estimate for an IHS organization which is focused on the responsibilities of managing tribal self-governance and Indian Self-Determination Act funds. Methods The analysis required research on organizational structure, managerial responsibilities, and operational issues for a variety of Federal agencies, including Substance Abuse and Mental Health Services Administration, the Health Resources and Services Administration, the Centers for Disease Control and Prevention, and the National Institutes of Health. The analysis also involved obtaining, processing, tabulating, and summarizing IHS agency-wide budget and staffing, personnel costs, overhead costs, and other factors which impact on the budget needs of IHS under a structure which is block grant management oriented. Results The IHS Headquarters organization could be restructured to fully carry out the self-governance program management and support mission in Rockville, Maryland. The IHS Area Offices could be reorganized to carry out technical assistance and data collection and evaluation, as well as direct liaison with the Tribes. Conclusion This analysis reviews the potential changes within IHS, if all health care service delivery is turned over to the tribes
