Client need

A Pawnee Nation Needs Assessment identified Pawnee, Oklahoma, as one of the state’s hardest hit rural regions by opioid addiction, suicide and accessible medical care. Due to this, Pawnee Nation of Oklahoma, a Central Plains Indian Tribe, began planning the development of a healthcare facility that can provide the medical care needed in the area, including psychiatric diagnoses, medication assisted treatment, intensive outpatient treatment, individual counseling, residential substance use disorder treatment, psychiatric (acute/crisis stabilization) and withdrawal management/detox treatment.

As a startup behavioral health center with limited guaranty capacity while serving predominately low-income populations covered by government payment options, this project was not equipped to support traditional debt underwriting, and capital was required to advance the project.

Baker Tilly Capital solution

The Baker Tilly Capital team helped Pawnee Nation of Oklahoma pool capital together from various sources to construct their 22,000-square-foot, 26-bed adult/geriatric inpatient and outpatient behavioral health and substance use disorder treatment facility. This included $14 million of New Markets Tax Credit (NMTC) financing through Clearinghouse CDFI, $4 million of grants from the USDA and EDA and a $12.4 million USDA guaranteed loan from Native American Bank in order to maximize all funding available allowing the project, which was a five-year endeavor in the making, to proceed.

Results

With our NMTC solutions, Pawnee Nation of Oklahoma is able to:

• Serve 2,040 unique patients annually: Over 75% of them classified as low-income persons, more than 50% Medicaid insured coverage and over 90% of Native American descent.
• Create 53 permanent jobs: Over 37% filled by low-income persons and over 25% filled by Native Americans.
• Provide solutions to the needs identified in letters of support provided by the City of Pawnee, Oklahoma Congress and Senate leaders, the Oklahoma Department of Mental Health and Substance Abuse Services, local healthcare groups and area not-for-profits.

The facility serves as a critical referral source for the Tribe’s adjacent primary care center, which otherwise was unable to provide the necessary mental health treatment for a tribal community experiencing a victimization rate of mental illness 2.5 times the rate of Caucasians in Oklahoma. The facility also provides local, accessible treatment for the predominately rural five-county service area, including both native and non-native members, who previously were forced to travel over 40 miles to Tulsa to seek quality behavioral and mental health treatment.

The Pawnee Nation of Oklahoma partnered with Ascension Recovery Services, an industry leader in developing comprehensive, fully integrated behavioral health systems for vulnerable populations who are uninsured or underinsured, to design the facility’s welcoming, accommodating programming, tailored for the ethnically diverse Tribal community that has not historically had access to treatment.

For more information on this topic, or to learn how Baker Tilly’s NMTC specialists can help advance your next community improvement project, contact our team.

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