Overview

Section 105(l) of the Indian Self-Determination and Education Assistance Act (ISDEAA) provides tribal health organizations with a powerful, long-term strategy to support the sustainability of health care facilities used to carry out contracted or compacted federal health care functions. 

Through the IHS 105(l) Lease Program, Indian Health Service enters into annual facility funding agreements that reimburse eligible facility-related expenses incurred during the performance of contracted or compacted programs, functions, services, and activities (PFSAs) for Indian beneficiaries. 

To be eligible, the facility must 

• already be constructed; 
• be owned, leased, or held in trust by the tribe; and 
• be used to support tribal administration or PFSAs authorized under ISDEAA. 

For tribal health organizations, a 105(l) lease is more than a funding mechanism—it is a reliable, revenue source that stabilizes operating budgets, offsets rising facility costs, and supports continued investment in health care infrastructure. When implemented strategically, 105(l) leasing strengthens tribal self-determination and enhances long-term program viability. 

Eligible Entities

The 105(l) Lease Program is available to: 

1. Federally Recognized Tribes operating health programs under ISDEAA Title I contracts or Title V compacts 
2. Tribal Organizations (Including Consortiums) Legally established entities that are controlled, sanctioned, or formally authorized by one or more federally recognized tribes and operating health PFSAs under an approved ISDEAA contract or compact.
3. Inter-tribal health consortiums may qualify if they meet the statutory definition of a “Tribal Organization” and hold the appropriate ISDEAA agreement.

Urban Indian Health Organizations are excluded from 105(l) lease eligibility because the law’s statutory and regulatory language limits eligibility to federally recognized tribes and tribal organizations operating under ISDEAA self-determination contracts or self-governance compacts. 

Supporting Long-Term Sustainability 

A key benefit of the 105(l) Lease Program is its contribution to the financial and operational sustainability of tribal health systems. Lease payments may include: 

• Fair market rental value, creating predictable facility revenue 
• Operations and maintenance costs, such as utilities, custodial services, and routine upkeep 
• Facility support costs necessary to maintain safe, compliant, and functional health care spaces 
• Annual adjustments based on the Consumer Price Index or documented cost increases 

Application Process: High-Level Steps

1. Confirm ISDEAA Authority
   Ensure your Tribe or consortium operates under an active Title I contract or Title V compact
2. Document Governance (For Consortiums)
   Maintain current tribal resolutions authorizing the organization as a Tribal Organization under ISDEAA
3. Prepare a Lease Proposal
   Include facility description, ownership documentation, PFSA alignment, and detailed cost justification.
4. Engage with IHS
   Coordinate submission through your Area Office and align lease timing with contract or compact cycles

Why 105(l) Leasing Matters for Tribal Health Systems

When used strategically, the 105(l) Lease Program:

• Reduces reliance on short-term or unstable funding sources
• Preserves program funds for direct patient care
• Supports facility modernization and compliance with health care standards
• Strengthens tribal control over health care infrastructure
• Plan multiyear budgets with greater certainty 
• Reinvest in facility maintenance and modernization 
• Expand clinical services without diverting program funds
• Strategically Plan capital projects with 105(l) revenues to repay financing

For many tribal health organizations, 105(l) leasing is a cornerstone of sustainable, self-determined health care delivery. 

Learn More

Successfully structuring and negotiating a Section 105(l) lease requires careful documentation, alignment with ISDEAA agreements, and strategic planning around facility use and cost allocation.

With proper planning, Section 105(l) leasing can become a reliable and sustainable infrastructure funding strategy for tribal health systems.

For more information or to discuss strategic readiness, request support below.