Blue Stone Strategy Partners

Blue Stone Strategy Partners is heading to Green Bay for the 2026 Great Lakes Area Tribal Public Health Conference, August 11–12 at the Oneida Casino Hotel.

If you are attending, join Eric Metcalf, Blue Stone’s Healthcare Director, for:

Healthcare as an Economic Engine: Tribal Clinics as Revenue-Generating Enterprises
August 12 | 2:30–4:00 PM | Oneida/Cayuga

Eric will discuss how Tribal clinics can strengthen enrollment, improve third-party collections, and reinvest revenue into expanded services such as dental care, behavioral health, pharmacy services, and new facilities.

While you are there, stop by the Blue Stone booth for a free five-minute Public Health Infrastructure Readiness Assessment. Our team will help identify your community’s strengths, potential gaps, and practical next steps for strengthening its public health infrastructure.

We look forward to connecting with Tribal Leaders and public health professionals from across the Great Lakes region.

Offshore casinos took an estimated $13.5 billion in gross gaming revenue last year. That is more than every regulated U.S. iGaming state combined.

Nearly half of Americans who played online slots or table games played on one of those sites. More than half of them believed the site was legal.
Those players are already in your market.

Many of them are your guests.

Jake Robinson and Marcus Yoder wrote Sovereignty in the Digital Age for Council members, gaming executives, and general managers who need a clear read on what is coming and what to do about it.

Inside:

• Why the line between gaming and everything else has already blurred, and the numbers behind it
• A four-quadrant framework for finding your Tribe's position: Defend, Hedge, Build, or Lead
• A pathway that starts under authority your Tribe already holds, with no compact renegotiation required
• Three questions every Council should be able to answer before this fiscal year closes

Oklahoma's Class II mobile operators are 24 to 36 months ahead of every other Tribe in the country.

That gap is not closing on its own.

Read Sovereignty in the Digital Age Now: https://bit.ly/4pS4sBn

From our upcoming research paper with Innovation Capital, Sovereignty in the Digital Age, Tribal operators are beginning to exercise their rights under IGRA to pursue a new form of gaming: Class II mobile gaming.

In January 2026, the Muscogee (Creek) Nation launched a Class II mobile gaming app across its reservation, including portions of Tulsa, Oklahoma.

As Tribal gaming consumers spend more with non-Tribal digital gaming platforms, Tribal operators have an opportunity to compete while keeping more gaming revenue within Tribal communities.

Sovereignty in the Digital Age examines what this shift could mean for the future of Tribal gaming. Stay tuned for the full paper.

The Shakopee Mdewakanton Sioux Community (SMSC) stepped in to support other tribes. Through SMSC grant funding, Tribal Nations across the Midwest sat down with Blue Stone for two-day strategic planning work sessions covering governance, economic development, housing, healthcare, and workforce, all in one focused conversation.

One Chairman said the sessions gave his team "greater clarity and momentum." Projects that had stalled started moving again.

This is what Nations investing in Nations looks like.

Read the full story: https://hubs.li/Q04qFLFx0

For generations, Tribal healthcare has been viewed primarily as a cost center. But what if it could become one of your Nation's strongest economic assets?

Join us tomorrow for Reframing Tribal Healthcare: From Cost Center to Economic Engine, where we'll explore how Tribal Nations can strengthen healthcare systems while creating new opportunities for financial sustainability, workforce development, and long-term sovereignty.

We'll discuss practical strategies for:
• Maximizing federal funding and reimbursement
• Strengthening healthcare financial performance
• Aligning healthcare investments with Tribal economic development
• Building resilient healthcare systems that support community well-being

If you're a Tribal Leader, healthcare executive, board member, or involved in Tribal governance, we hope you'll join the conversation.

Tuesday, July 28
9:00 AM PST

Register here: https://hubs.li/Q04qRLJw0

The 2025 Medicaid cuts didn't hit Tribal health systems the way many expected.

That doesn't mean the risk is gone.

The biggest threat isn't a lower reimbursement rate. It's the gradual loss of Medicaid enrollment that quietly shifts more care into uncompensated care over time.

The question isn't whether Tribal Nations should prepare. It's whether they'll do it while today's revenue still gives them the ability to invest.

Our latest article looks at why leading Nations are diversifying healthcare revenue now and what that means for the future of Tribal health systems.

Read the full article here: https://hubs.li/Q04qhc2D0

Healthcare has long been viewed as one of a Nation's largest operating expenses. But the strongest Tribal health systems are proving it can become something more.

As federal funding becomes less predictable and Medicaid policy continues to evolve, Tribal Leaders have an opportunity to strengthen financial resilience by treating healthcare as an economic engine, not simply a cost center.

Join Blue Stone Strategy Partners for a live webinar exploring how Tribal Nations are building stronger, more sustainable healthcare systems through strategic planning, revenue diversification, and operational excellence.

Reframing Tribal Healthcare: From Cost Center to Economic Engine
Tuesday, July 28, 2026
9:00 AM PST

During this webinar, we'll discuss:

- What the recent Medicaid changes mean for Tribal healthcare systems
- Why relying on a single payer creates long-term financial risk
- How leading Tribal Nations are diversifying healthcare revenue
- Strategies to strengthen the revenue cycle and maximize existing resources
- Ways healthcare investments can support broader Tribal economic development

Whether your Nation is planning future healthcare investments, expanding services, or evaluating long-term financial sustainability, this session will provide practical ideas and examples to help inform your next steps.

Reserve your seat today.
https://bit.ly/4prg26h

Gaming revenue plateaued near $42 billion in 2024, the first slowdown since 2020. U.S. healthcare spending reached $4.9 trillion and grows through downturns.

Most Tribal health systems are still run as cost centers, capped by what Congress appropriates. Some Nations have made the shift. One built a $95 million health campus that finances itself. Another grew service-hub revenue from under $2 million to more than $14 million. A third lifted net income 30% without adding a single patient.

On Tuesday, July 28 at 9 a.m. Pacific, Blue Stone Strategy Partners is hosting Reframing Tribal Healthcare: From Cost Center to Economic Engine, a free one-hour webinar for Tribal Leaders and the executives shaping their Nation's economy. We will cover Title V self-governance, Section 105(l) lease maximization, and a four-phase roadmap a Council can authorize one de-risked step at a time.

Register Now: https://bit.ly/44w6ehY

The future of Tribal gaming is evolving. While gaming will remain a critical economic driver, the next decade is likely to bring new opportunities beyond traditional casino expansion. In partnership with Innovation Capital, we've spent the past several months researching the trends, challenges, and opportunities shaping what comes next.

Coming Soon.

The July edition of Blue Stone Strategy Partners' 90-Day Funding Outlook is now available, highlighting upcoming federal and state funding opportunities across healthcare, housing, infrastructure, economic development, workforce development, energy, public safety, and more.

Funding awareness is only part of the equation. Preparation is what turns opportunities into projects.

Subscribe today to receive each new edition of the 90-Day Funding Outlook delivered directly to your inbox and stay informed about upcoming opportunities for Tribal Nations.

Subscribe here: https://bit.ly/4vPYMu0