A $132 Million Workforce Housing Project Could Change How Indian Country Staffs Its Hospitals

Tribal health workforce housing is no longer a wish list item — it is getting built and getting funded.

Maniilaq Association Closes Financing on 12-Community Housing Project in Northwest Alaska

As reported by Tribal Business News, Tribal Development Partners LLC has closed financing on a $132 million workforce housing project in Kotzebue, Alaska, designed to stabilize health care staffing across 12 Native communities served by Maniilaq Association. Maniilaq manages health, social, and tribal services for approximately 7,600 people across 36,000 square miles of the Northwest Arctic, employing roughly 550 staff including 80 full-time medical professionals. Fitch Ratings assigned Maniilaq an A- Issuer Default Rating with a Stable Outlook in January 2026, underscoring the financial strength behind this project.

Maniilaq currently has dozens of open health care positions — including physicians, registered nurses, behavioral health therapists, community health aides, and dental providers — with employee housing offered through its existing 84-unit housing program, making the expansion even more critical for recruitment across the region.

Section 105(l) Lease Revenue Is Powering a New Era of Tribal Infrastructure

The deal is backed by Section 105(l) lease funding, a federal revenue mechanism that has exploded in Indian Country. A new analysis from the Federal Reserve Bank of Minneapolis Center for Indian Country Development shows that total annual Section 105(l) lease revenue to tribes grew from $800,000 in 2016 to an estimated $612.7 million in 2024, with cumulative inflation-adjusted payments totaling approximately $1.81 billion. The number of active leases surged from just two in 2016 to 1,890 in 2024. As Tribal Business News also reported, the Oneida Nation, Leech Lake Band of Ojibwe, and San Carlos Apache Healthcare Corporation are pursuing similar bond-financed health care projects leveraging this same funding stream.

Why Workforce Housing Matters for Health Staffing

The Indian Health Service has identified a $10.3 billion backlog in health care facility construction needs dating back to 1992. Without safe, modern housing for physicians, nurses, and Native practitioners, rural and remote IHS facilities cannot recruit or retain the culturally competent providers Our Relatives and elders depend on. Meanwhile, Alaska House Bill 184 advanced in February 2026 to authorize state investment in workforce housing with five or more units, reflecting the urgency felt across all communities statewide.

Ellsworth applauds the leadership of Maniilaq Association and every tribe using Section 105(l) leasing to build the infrastructure that Native populations need. Staffing Indian Country starts with giving health care workers a place to live. Ellsworth stands ready to support IHS facilities and tribal health programs with culturally competent, mission-driven professionals who understand the unique needs of Native health systems.