Join us for a timely discussion on how Indian tribal governments and affiliated organizations are tapping the capital markets to finance critical infrastructure needs, particularly healthcare facilities and workforce housing. Recent transactions, including a $132 million medical staff housing project and a $185 million patient housing project in Kotzebue, Alaska, illustrate a growing model that pairs tax-exempt bond financing with federal lease reimbursements through Section 105(l) of the Indian Self-Determination and Education Assistance Act. This framework supports both healthcare facilities and housing, providing a reliable funding source for tribal communities.

Key Takeaways:

• How patient treatment and workforce housing constraints are directly impacting healthcare staffing and access in tribal communities
• The growing role of Section 105(l) reimbursements as a predictable, financeable revenue source
• Structuring considerations for tax-exempt bond and/or P3 financings backed by operating and lease revenues
• Credit and rating perspectives, including the importance of federal funding and system liquidity
• How these models can be replicated across tribal and nonprofit healthcare systems