text: I meant - in Alaska, the IHS provides little to no direct services.  All of the IHS money (about $800 million per year) is now given to the ANTHC and they divvy it up.  This is called the "Alaska Compact."  This all happened in the mid 1990's.  In the lower forty-eight, there are still Public Health service doctors and nurses who are federal employees.  However, up here, all of the medical providers are employed by and paid through the big non profit Native entities - with the federal money.