As a RN who worked in North Dakota, we worked with the BIA system allot. The BIA is the Bureau of Indian Affairs. I did go to a reservation when we ran clinic there. There was an amount that was given for health care and when that money ran out - they waited. If you needed elective surgery, you waited until the next round of monies came in. Emergencies did not wait. It reminds me of what the Canadian system seems to be. Thanks