Cherokee Nation releases comprehensive health care report, recommendations on telemedicine, dialysis support, Medicare coverage

TAHLEQUAH, Okla. - Cherokee Nation Principal Chief Chuck Hoskin Jr. and Deputy Chief Bryan Warner announced recommendations from three comprehensive health care access findings examining telemedicine utilization, dialysis treatment availability, and Medicare enrollment among Cherokee citizens.

The findings, conducted by Cherokee Nation Health Services work groups at the request of the Council of the Cherokee Nation, identify strategic opportunities to enhance health care access both on the Cherokee Nation Reservation and for at-large Cherokee Nation citizens.

The findings reveal that while CNHS operates the largest tribally operated health care system in the United States, serving over 2 million patient visits annually, significant opportunities exist to expand access through innovative partnerships and targeted support programs.

"These comprehensive findings and recommendations reflect our administration's commitment to building a world-class system of wellness for our Cherokee people," said Principal Chief Chuck Hoskin Jr. "By taking a data-driven approach to understanding health care access barriers, we can make strategic investments that truly serve our citizens' needs."

The telemedicine findings found that 6% of CNHS visits over the past six months were conducted via telemedicine, with particularly strong adoption in behavioral health (25%) and psychiatry (72%). However, barriers including limited broadband access and licensure restrictions across state lines limit expansion for at-large citizens currently. CNHS will implement several short-term initiatives, including developing a telemedicine queue system to reduce no-shows, expanding broadband hubs at community centers, and recruiting providers licensed in states with high Cherokee Nation citizen populations. Long-term goals include partnerships with external health systems and establishing telemedicine services for diabetes prevention programs.

The report acknowledged significant barriers and changes coming for access to telemedicine nationwide, however.

The report finds that the end of the national Public Health Emergency, which began as pandemic response, will curtail telemedicine access for millions of Medicaid patients across the United States beginning October 1, 2025. Whether such access is restored or otherwise expanded is largely a decision of Congress and other federal leaders.

"The report reveals some opportunities to expand access to telemedicine that is within Cherokee Nation's control," said Chief Hoskin. "But, because so much of the control over telemedicine is in the hands of federal leaders, the report enables us to develop government relation strategies to help effect change in the country."

At-Large Councilor Johnny Jack Kidwell, who specifically requested consideration of telemedicine expansion for citizens living outside the reservation, praised the findings.

"This is exactly the kind of thoughtful analysis our at-large citizens deserve. With nearly 35% of Cherokee Nation citizens living outside Oklahoma, we must find creative ways to extend our health care reach. From the outside we knew that, particularly with telemedicine, there are barriers beyond our immediate controls. However, the reports tell us what the challenges are so that we are better able to address them long term both within our system and as a matter of federal health care policy. Whether you are an at-large citizen or not, all three reports are important to understanding our health care future."

The dialysis access findings confirmed that while CNHS successfully provides inpatient dialysis at W.W. Hastings Hospital, outpatient dialysis is primarily delivered through 13 privately operated centers within the reservation. The study found that End-Stage Renal Disease affects Native Americans at 2.3 times the rate of the non-Native population, with diabetes as the leading cause.

Rather than operating independent dialysis centers, the report recommends that Cherokee Nation pursue strategic partnerships with private providers, including potential land lease agreements for centers near CNHS facilities and expanded home dialysis programs. The tribe will also enhance patient transportation services and integrate specific nutrition support for patients through the Cherokee Nation Food Distribution Program.

"These findings and recommendations demonstrate that excellent health care isn't just about having great facilities - it's about ensuring our citizens can access the care they need, when they need it, wherever they are," said Deputy Chief Bryan Warner. "From rural areas of our reservation to Cherokee Nation citizens living coast to coast, we're committed to removing barriers and expanding access through strategic partnerships and innovative programs."

The Medicare usage report revealed that while 13,214 CNHS patients are enrolled in Medicare Part A, enrollment in Parts B, C, and D remains significantly lower. Medicare represents 21.6% of all CNHS revenue, highlighting both the program's importance to tribal health care sustainability and the opportunity for expansion. Cherokee Nation will launch a Medicare Part B sponsorship pilot in 2026 for income-eligible citizens and expand the existing Part D sponsorship program from 440 to 1,000 citizens. Recommendations include an expansion to include at-large Cherokee citizens and focus on those with the highest prescription drug costs.

The findings emphasized Cherokee Nation's leadership in prevention through the Special Diabetes Program for Indians, which has reduced new kidney failure cases by 50% nationwide. Within the reservation, 70% of participating patients have their diabetes and hypertension under control, the report noted.

Cherokee Nation is simultaneously investing in health care infrastructure, including a new $400 million hospital and $84 million outpatient health center in Salina, while expanding broadband access to rural communities through an $80 million initiative that will support telemedicine expansion.

The health care access findings and recommendations align with Cherokee Nation's broader vision of ensuring no citizen lives more than 30 minutes from quality health care. By leveraging partnerships with private providers, expanding federal program access, and investing in technology infrastructure, the tribe continues its commitment to addressing health care disparities that disproportionately affect Native American communities.

The work groups included health care leadership, tribal government officials, and technical experts who conducted thorough analyses of current utilization, barriers, and opportunities. Their recommendations provide a roadmap for sustainable health care expansion that balances tribal sovereignty with strategic partnerships.

Deputy Secretary of State Canaan Duncan served as the Hoskin/Warner Administration's point person on all three committees.

"Reports like these reflect the way this administration tackles complex issue and how it responds to questions raised by the council, and our citizens, on these topics," said Duncan. "We believe in transparency and letting facts, law and policy guide us to sets of recommendations."

Patient Benefit Coordinators will also play a crucial role in implementing these initiatives, the reports suggest, helping citizens navigate Medicare enrollment and access newly available services. Cherokee Nation currently employs 28 Patient Benefit Coordinators systemwide, with plans to add additional staff to support expanded programs. To read the reports, visit: https://www.cherokee.org/our-government/executive-branch/reports/2025-reports/.