Let's start with the basics, because the name "Purchased/Referred Care" doesn't tell you much. PRC is the part of the Indian Health Service that pays for care delivered outside the IHS facility — the specialist, the MRI suite, the cardiac catheterization lab, the physical therapist. It used to be called Contract Health Services (CHS), and if you've been in this system a while, you may still hear elders call it that.
Here's what makes PRC different from a regular insurance referral: it is not unlimited. PRC operates on a finite annual budget that is allocated down from the federal government to each of the twelve IHS Area offices, then to individual service units. When the money is gone, it's gone — until the next fiscal year begins in October. And the budget is almost always gone before October.
Now add the caregiver layer. If you are a Native elder in Bernalillo County caring for a spouse who is also Native, you may have two separate PRC cases at the Albuquerque Area IHS — one for you, one for your spouse. Each case competes for the same limited pool of referral dollars. Each requires its own authorization. Each has its own priority ranking. This is not a bureaucratic technicality. It is the lived reality of trying to coordinate care for two people through a system that was designed, budgeted, and staffed for individuals.
Source: CDC PLACES County Health Data 2023, Bernalillo County, NM (cdc.gov/places)
The 8.2% independent living disability figure is meaningful here. Caregiving situations — where one elder is managing another — almost always involve at least one person with a disability serious enough to affect daily life. When you are the caregiver, your own health needs don't disappear. They just get deprioritized. That is the invisible cost of elder caregiving in Indian Country, and PRC's priority system does almost nothing to account for it.
Federal regulation at 42 CFR Part 136 establishes that PRC services are provided according to a priority ranking. There are seven categories, and funding flows down from Priority 1 until the budget runs dry. Here is what those categories mean in plain language:
| PRC Priority Category | What It Covers | Funded When? |
|---|---|---|
| 1 — Emergent/Acutely Urgent | Life-threatening conditions; emergency room stabilization | Always — legal requirement |
| 2 — Preventable Death/Serious Disability | Conditions that will become emergent without treatment (uncontrolled diabetes, heart failure) | Almost always |
| 3 — Likely to Cause Serious Disability | Orthopedic, neurological, ophthalmology referrals | Usually in first half of fiscal year |
| 4 — Preventive Services | Cancer screenings, vaccinations, wellness visits | Budget-dependent; often deferred |
| 5 — Dental | Non-emergency dental care | Frequently deferred or denied |
| 6 — Elective | Non-urgent procedures, cosmetic concerns | Rarely funded |
| 7 — Excluded by Regulation | Services not covered under IHS statute | Never |
Here is why this matters for caregivers: the conditions that dominate Bernalillo County's health data — 11.6% diagnosed diabetes, 5.4% coronary heart disease, 9.8% asthma (all CDC PLACES 2023) — are chronic conditions. Chronic conditions require ongoing specialist referrals. Ongoing specialist referrals land in Priority Categories 2 and 3. Those categories get funded early in the fiscal year and then become uncertain as the budget depletes. Your spouse's cardiology follow-up in September may not get the same PRC approval it got in November.
The Indian Country Desk sends plain-language alerts when IHS funding changes, PRC budget cycles hit zero, or Medicare plans drop tribal-area providers. Free. No spam. Just what you need to know.
Sign Up for Indian Country AlertsIf you are a Native elder on Medicare — and most Native seniors 65 and older are, because you've earned it — the coordination between Medicare and PRC is not automatic. It is not simple. And it is different for the person seeking care versus the person providing care.
Here is the legal framework: when IHS issues a PRC authorization for outside care, IHS is the primary payer and Medicare is secondary. The outside provider bills IHS first. If IHS pays, Medicare owes nothing. This is actually a good deal when it works — it reduces your cost-sharing. But it only works when a PRC authorization exists before the service is delivered.
If there is no PRC authorization — because the budget ran out, because the priority category wasn't funded, because the 72-hour rule was missed — then Medicare becomes the primary payer and standard Medicare cost-sharing applies. For someone in a Medicare Advantage plan, that means the plan's own network, copay structure, and prior authorization rules take over.
CDC PLACES County Health Data 2023, Bernalillo County, NM. Each condition represents a major driver of PRC referral demand and Medicare cost-sharing for elder caregivers in this county.
In Bernalillo County, you have 8 hospitals in the data. Of those, 6 are acute-care facilities with emergency departments. For Medicare Advantage enrollees, network participation varies by plan. This matters because the Albuquerque Indian Health Center is the primary IHS facility serving urban Native patients in this county, but it does not have inpatient beds. For anything requiring hospitalization, PRC kicks in — or Medicare does. You need to know which one before the ambulance arrives.
Let's be concrete about what exists in this county. Based on CMS Hospital Compare data, there are 8 hospitals in Bernalillo County:
Source: CMS Hospital Compare, April 2026. Psychiatric-only facilities (Haven Behavioral Hospital, Central Desert Behavioral Health) do not accept emergency walk-ins; see FAQ above for behavioral health guidance.
PRC referrals in the Albuquerque area most commonly go to UNM Hospital and Presbyterian Hospital. Both are established IHS billing partners. That does not mean they are in every Medicare Advantage network. Before your spouse's appointment, confirm three things: (1) Is there a PRC authorization? (2) Is the provider in your Medicare Advantage plan's network? (3) Has the 72-hour notification requirement been met?
UNM Hospital's 2-star CMS rating is worth noting. It reflects national quality metrics, not a statement about Native patient care specifically. UNM has one of the stronger Native health programs in the region and houses the Native American Studies health initiative through its medical school. A 2-star rating means there are areas of improvement on CMS metrics — it does not mean it's the wrong hospital. But it is data you should have.
No. And this is where I see families get hurt the most.
IHS eligibility flows from the individual's tribal membership or status — not from marriage. If you are a tribally enrolled elder and your spouse is not Native, your spouse has no IHS eligibility and no PRC eligibility. Full stop. Your spouse must rely entirely on their own Medicare coverage (and any Medicaid if dual-eligible) for all care.
The reverse also creates complications: if your spouse is Native and enrolled but you are not, you are the caregiver navigating a system you have no direct access to as a patient. You may be managing PRC authorizations, tracking 72-hour notification windows, and coordinating hospital visits for your spouse — all from the outside.
There is one area of limited coordination that sometimes surprises people: IHS can provide care to non-Native family members in emergency situations when no alternative care is available and the IHS facility has capacity. This is a discretionary authority, not a right. Do not plan around it. But if you are in a true emergency and no other option exists, an IHS facility can and sometimes does provide stabilizing care to non-Native family members.
Source: CDC PLACES County Health Data 2023, Bernalillo County, NM (cdc.gov/places)
This question doesn't have a universal answer, but it has a framework. Let me give you the framework.
Original Medicare (Parts A + B) has the advantage of no network restrictions. If Presbyterian Hospital or UNM Hospital accepts Medicare — and both do — Original Medicare pays there. If IHS issues a PRC authorization, IHS pays first and Medicare pays any remainder. There are no prior authorizations from a private insurance company. For elders managing complex situations — PRC authorizations, multiple specialists, potential hospitalizations — Original Medicare's flexibility is genuinely valuable.
The trade-off: Original Medicare has no out-of-pocket maximum. If PRC runs out of money and you end up bearing Medicare cost-sharing, there is no cap on what you could owe in a catastrophic year. Most people add a Medigap (supplemental) policy to cover this exposure. Medigap Plan G is the most comprehensive available to new enrollees today and covers the Part A deductible ($1,676 per benefit period in 2026), Part B excess charges, and most coinsurance.
Medicare Advantage (Part C) adds an annual out-of-pocket maximum — typically $3,500 to $8,500 depending on the plan — which provides catastrophic protection. Many MA plans also include dental, vision, and hearing benefits that Original Medicare does not cover. For Native elders with diabetes or hearing loss (6.5% hearing disability rate in Bernalillo County — CDC PLACES 2023), these add-ons can have real value.
The trade-off with MA: prior authorizations and network restrictions can conflict with PRC referral patterns. If PRC authorizes care at a specific specialist who is out of your MA plan's network, you face a choice. And if your MA plan requires prior authorization for the same procedure that PRC has already authorized, you may need to work both bureaucracies simultaneously. This is not hypothetical. It happens regularly.
Dual-eligible Native seniors — those who have both Medicare and Medicaid — may have access to D-SNP (Dual Eligible Special Needs Plans) in Bernalillo County, which are designed specifically for this population and often include care coordination services. If your household is at or near Medicaid income limits, D-SNP plans are worth a dedicated conversation with a SHIP counselor (see action steps below).
Yes, for most urban Native patients in Bernalillo County, the Albuquerque Indian Health Center (AIHC) — operated by the Albuquerque Area IHS — is the primary doorway into the PRC system. The center is located at 4212 Isleta Blvd SW, Albuquerque, NM 87105, phone (505) 248-4000. It provides primary care, some specialty services, pharmacy, dental, and behavioral health.
AIHC serves members of over 20 tribal nations and is the service unit that holds Bernalillo County's PRC budget allocation. When their PRC budget runs low — typically late in the federal fiscal year (July through September) — lower-priority referrals get deferred. This is not a failure of the center. It is a failure of Congress to appropriate IHS at the level the treaties require.
AIHC also houses the PRC unit that processes authorizations. For a caregiver managing two people's healthcare, establishing a relationship with the PRC coordinator at AIHC is one of the highest-value actions you can take. These are the staff who can tell you, in real time, whether a specific referral is fundable in the current fiscal quarter. That information is not published anywhere. You have to ask.
The CDC PLACES data for Bernalillo County paints a clear picture of where health burden is concentrated. For Native elders in this county — who statistically carry higher rates of most chronic conditions than the general county population — these numbers are a floor, not a ceiling.
Diabetes (11.6% of adults, CDC PLACES 2023): This is the chronic condition most likely to drive PRC referral volume — endocrinology, podiatry, ophthalmology, nephrology. All of these are Priority Category 2 or 3 referrals, meaning they compete for mid-tier PRC funding. If your spouse has diabetes and needs quarterly specialist visits, plan for the reality that some of those visits will need Medicare to serve as primary payer when PRC runs low.
Coronary Heart Disease (5.4%, CDC PLACES 2023): Cardiac care is expensive and often requires rapid authorization. The 72-hour notification rule is particularly critical here