If Talawepi were enrolled as a tribal member in one of the Pueblos that surround Santa Fe, she would likely have been able to have the procedure at St. Vincent and have the bill sent over to Indian Health Service—the federal agency that oversees the Santa Fe Indian Hospital—so that she would pay nothing out of pocket. But because she is Hopi, the Santa Fe Indian Hospital will not cover the costs of the outside referral. And her Medicaid plan won't pay for enough of the procedure at a private hospital to make it affordable.