The nearest IHS facility is more than a two-hour drive into another state for most of the roughly 55,000 Lumbee citizens living in Robeson County, according to KFF Health News, which reported the story with NPR. The tribe became the 575th federally recognized tribe in December 2025, after President Donald Trump signed the Lumbee Fairness Act, ending a fight its citizens trace back to 1888.
That distance is the practical center of the story, and it is the thing most easily lost when recognition is reported as a health care solution. Eligibility for a health system is not the same as access to one, and for a rural county with among the worst health outcomes in the country, the gap between the two is measured in hours of driving and days of missed work.
Eligibility Opens a Door That Is Already Crowded
The Indian Health Service provides and funds health care for members of federally recognized tribes, and recognition also allows a tribe to contract or compact with IHS to run its own health programs. Tribal chairman John Lowery, who is also a state representative, has called IHS access the biggest benefit of recognition and said he expects health care to take the largest share of the tribe's budget.
The constraint is money. IHS has been chronically underfunded for decades. The agency's own budget workgroup estimated it is nearly $55 billion short this year of what it needs, a figure that describes the system Lumbee citizens have just joined rather than one being built for them.
The Congressional Budget Office estimated in 2022 that recognition could increase IHS spending for the tribe by $247 million over four years. Against a nationwide shortfall in the tens of billions, that is real money and not a solution.
Broader federal pressure has compounded it. Reductions last year initially included layoffs of nearly 1,000 IHS employees, later rescinded, and the administration's proposed 2027 budget would cut more than $150 million from a program addressing diabetes in Native American tribes. Diabetes weighs heavily in Robeson County.
Donald Warne, a physician and researcher at the Johns Hopkins Center for Indigenous Health and a member of the Oglala Lakota tribe, told KFF Health News that no tribe can depend on IHS alone given the resources in that system, while describing recognition as a strong starting point.
Where People Currently Get Care
Until a tribal health system exists, care in Robeson County runs through the same channels it always has, and those channels are strained.
More than half of the county's residents were Medicaid enrollees in 2025, the highest share of any county in North Carolina. Most Lumbee citizens live in and around Lumberton and Pembroke, roughly a half hour from the South Carolina border, and rely on local hospitals, primary care practices and community clinics, traveling elsewhere for specialty care.
Andrea Blackburn, a physician in Lumberton and a tribal citizen, described at a public hearing how, 18 years ago at a nearby medical center, she was taught that patients with certain last names were often referred directly to cardiac catheterization. She said she came to realize that common Lumbee surnames carried an expectation of disease. "Nearly two decades later, I can tell you that reality has not changed," she told tribal leadership and citizens.
Blackburn noted that county rates of heart disease, diabetes and risky substance use continue to rank among the highest in the state, and framed those figures as her own patients and families rather than statistics.
Ronny Bell, a Lumbee citizen and Native health researcher at UNC, has linked today's health picture to the long refusal of federal acknowledgment and to the economic decline that followed the loss of the county's manufacturing and tobacco jobs, while describing recognition as a continuation of the community's resilience.
The Funding Path Voters Rejected
The revenue source many tribes have used to build health systems is not currently available here, because Lumbee citizens voted it down.
Hundreds of federally recognized tribes across 29 states operate gaming, which generated $43.9 billion in fiscal 2024 according to the National Indian Gaming Commission. Two precedents are instructive: the Choctaw Nation of Oklahoma became the first tribe to build its own hospital in 1999, using roughly $25 million in gaming money, and the Eastern Band of Cherokee Indians funded one in 2015 largely with $82 million in gaming funds.
In June, more than 60 percent of Lumbee voters rejected a constitutional amendment that would have let tribal leaders build the infrastructure for a gaming business. Lowery said afterward that he does not plan to revive the initiative, and his term as chairman ends in two years. He has mentioned other possible revenue sources, including gas stations and hotels.
The disagreement inside the tribe was substantive. Research on gaming and tribal health shows facilities, staffing and social services improve, while unhealthy substance use and smoking tend to increase. Brittany Locklear, a social work professor at UNC and a tribal citizen, told a June panel on gaming that negative impacts would come with it. Jada Brooks, a Lumbee citizen and UNC researcher who studies Indigenous health and lives in the county, voted against the casino, citing concern about creating additional health problems.
Brooks also identified what she considers the deeper barrier: whether people feel they can trust the health care system at all.
What Recognition Does Deliver Immediately
One benefit is already in hand and is easy to overlook because it is administrative.
Federal recognition allows Lumbee citizens to be set apart in census data, which researchers say opens a path to clearer information on heart health, cancer rates, diabetes diagnoses and mental health risks. UNC public health researcher Ryan Dial, a tribal member, has noted that much of the relevant data simply has not existed, making the community's specific disparities hard to characterize. Better data is a precondition for targeted programs and grant applications.
For households now, the practical steps are ordinary. Tribal citizens should confirm enrollment records are current, since IHS eligibility runs through documented tribal membership. Anyone considering travel to an IHS facility should call ahead about eligibility verification and available services rather than driving on assumption. Medicaid, marketplace coverage and local federally qualified health centers remain the nearer options for most routine care, and IHS eligibility does not replace them.
IHS did not respond to questions about plans for the tribe's health system, and Lowery did not grant interview requests. What remains unresolved is how the tribe will fund care after the gaming vote, what portion of its budget health will receive, and whether any facility will be built in the county. MedicalDaily will follow the tribe's budget decisions and any IHS announcements.
Frequently Asked Questions
Is the Lumbee Tribe federally recognized? Yes. Recognition came in December 2025, making it the 575th federally recognized tribe.
Are citizens eligible for IHS care now? Yes, eligibility came with recognition. The nearest facility is more than a two-hour drive out of state for most citizens in Robeson County.
Does recognition build a clinic? No. It creates eligibility and the ability to contract with IHS to run tribal health programs. It does not automatically establish facilities.
How much funding is involved? CBO estimated in 2022 that IHS spending for the tribe could rise by $247 million over four years. IHS overall is estimated to be roughly $55 billion short this year.
What happened with the casino? More than 60 percent of Lumbee voters rejected a constitutional amendment enabling gaming infrastructure in June.
Where do residents get care now? Local hospitals, primary care practices and clinics, with travel for specialty care. More than half the county was on Medicaid in 2025.
What should tribal citizens do? Keep enrollment documentation current and call ahead before traveling to an IHS facility to confirm eligibility and services.
