Alaskan officials say their funding streams come from aggressively seeking grants, their partnership with the veterans department, and billing Medicaid and Medicare.

Other tribes have used casino revenues, something not available in substantial amounts to Sioux San. And it is not entirely clear yet how much funding Sioux San will be able to win from other sources, including grants and Medicaid and Medicare.

Jerilyn Church, the chief executive of the Great Plains Tribal Chairmen’s Health Board, which oversees Sioux San, said the group was aiming to reopen Sioux San’s inpatient unit and emergency room, but that doing so would take years.

For now, the health board is addressing the hospital’s vacancies, reviewing its bill practices and researching grant opportunities to bring new money for equipment and hiring. Ms. Church said the board was also working to develop a pilot program to buy private insurance for the sickest of patients.

Charmaine White Face, 72, a member of the Oglala Sioux Tribe, is among a group of Native Americans in Rapid City who are not convinced that the management change will be successful.

Ms. White Face thinks there should have been more planning and communication with the residents who primarily use the hospital before the change. But most concerning, she said, is the lack of money to achieve the health board’s goals.

“In order to be successful like in Alaska, the tribes, or the native organization, has to have a lot of other resources, and the tribes here in the Great Plains do not,” Ms. White Face said. “We are too poor here.”