Tultxʷ · The confluence of waters

Two currents, one water.

A 24/7, Native-led nurse advice line for Indian Health Service beneficiaries. Licensed RNs. Evidence-based triage. Care that already knows who you are.

See how the line works Read our story
The line is open · 24 hours · 7 days
tultxʷ · where the waters meet
The premise

The first nurse who picks up should already know who you are.

Tulq is built for that call.
How the line works

Three rings. A clear next step.

From a reservation, from a city apartment, from the road home — the call is answered by a licensed RN working from the same evidence-based protocols 95% of U.S. medical call centers use, paired with judgment that already knows the room.

No. 01

You call.

From a reservation. From a city apartment. From the road home. The line picks up before the third ring — any hour, every day, no recording, no portal, no queue that goes cold at night.

No. 02

A licensed RN listens.

Multi-state-licensed registered nurses, working from Schmitt-Thompson Clinical Content protocols — the framework 95% of U.S. medical call centers use — paired with indigenous-informed clinical judgment.

No. 03

A clear next step.

911 if it needs to be. Self-care if it should be. A warm hand-off into your IHS or Tribal Health Program if that's the right door. The call ends with a plan, not a transfer.

Who picks up

A tribal operator and a nurse who's actually carried the pager.

Built to satisfy both the contracting officer at IHS and the patient on the other end of the call.

Michael Chavez Ross
Founder · CEO · President

Michael Chavez Ross

Snoqualmie tribal citizen · Government & tribal enterprise leader

Enrolled citizen of the Snoqualmie Indian Tribe and currently Deputy Executive Director of External Affairs for the Tribe. Previously the youngest-ever Snoqualmie Tribal Council Vice Chair (two terms). Helped advocate for the reaffirmation of the Violence Against Women Act, Savannah's Act, and the $8 billion tribal CARES Act allocation. Chaired the Tribe's Investment Committee, more than quadrupling its portfolio in two years.

HBS Exec Ed BBA · Seattle U Federal advocacy Tribal governance
Citizenship Snoqualmie Indian Tribe (enrolled)
Contact 206-420-9055
LinkedIn /in/michael-ross
Jayson Minagawa, RN, BSN
Clinical director · RN, BSN

Jayson Minagawa

Multi-state ICU veteran · 11+ years acute & telehealth

Eleven-plus years across Level 1–2 trauma center ICUs (Erlanger Baroness, Enloe, Tacoma General, Kadlec, CHI St. Vincent, Sunrise Las Vegas), Kaiser Northern California Hospital-at-Home telehealth, supermax corrections triage at Pelican Bay, inpatient psychiatry, and current 142-bed SNF leadership as Unit Manager and MDS Coordinator. He has actually carried the pager.

RN · WA · CA · OR BLS / ACLS AWEP Telehealth
Licensure RN — Washington · California · Oregon
Contact upham51@gmail.com
LinkedIn /in/jayson-m
Who we serve

The patients the system keeps losing track of.

Tulq is built for the populations that mainstream telehealth has consistently underserved — and the institutions trying to reach them.

01

IHS beneficiaries, nationwide.

Eligible AI/AN patients across the 12 IHS Areas — from urban centers to the most remote service units.

~2.8M people
02

Tribal nations & 638 facilities.

Tribal health programs operating under the Indian Self-Determination and Education Assistance Act, looking to extend after-hours and surge capacity.

Tribal sovereignty
03

Urban Native communities.

Urban Indian Organizations and the ~70% of AI/AN people who live in cities, where access falls through the cracks between federal and state systems.

~70% of AI/AN
04

Underserved & rural populations.

Communities where the nearest ED is a long, expensive drive — and a phone call to a competent nurse changes what happens next.

Rural access
Why Tulq

Native-owned. Clinically deep. Built for this contract.

Tulq is structurally and culturally aligned with how Indian Country actually works — not retrofitted to look the part.

Pillar 01

Buy Indian Act qualified.

Wholly owned by Michael Chavez Ross, enrolled citizen of the Snoqualmie Indian Tribe. Eligible to compete as an Indian Economic Enterprise under 25 U.S.C. § 47.

25 U.S.C. § 47 · 2022 IHS final rule
Pillar 02

Cross-system clinical depth.

Eleven-plus years of trauma center ICU, Kaiser Hospital-at-Home telehealth, supermax corrections triage, and SNF leadership — directed by a nurse who has actually carried the pager.

RN · WA · CA · OR · BLS · ACLS · AWEP
Pillar 03

Indigenous-informed by design.

Cultural competency built in at the protocol level, not bolted on at training. Informed by tribal governance experience, lineage, and lived understanding.

Schmitt-Thompson aligned · Culturally adapted
The numbers worth knowing

Plainly. Without celebration.

The numbers below are why the line exists. They are not decoration.

Population
2.8M
AI/AN beneficiaries the Indian Health Service is responsible for.
Coverage
12
IHS Areas across the United States, plus ~170 service units.
Urban
~70%
Of AI/AN people who live in urban areas — often outside direct IHS coverage.
Diabetes
3×
Type 2 diabetes prevalence in AI/AN adults vs. non-Hispanic White adults.
Suicide
+91%
Higher likelihood of suicide death in AI/AN people vs. the general U.S. population.
The line
24/7
When Tulq picks up. Every hour. Every day. Every year.
Sources · IHS · KFF · OMH-HHS · 2022–2024 reporting
Our story · in brief

The name comes from the confluence.

Tulq takes its name from tultxʷ — the Lushootseed word the Snoqualmie people use for the place where the Tolt and Snoqualmie rivers come together. It is a word about meeting. Two currents, one water.

Michael's great-grandmother, Ollie Moses, was a direct descendant of signers of the 1855 Point Elliott Treaty. As a child she was taken to Chemawa Indian Boarding School.

Tulq exists, in part, because of what it took to survive that. The line we answer today is part of how that gets repaired.

Read the full story
Contact & capability

Reach the people who'd actually pick up.

For contracting officers, partnership inquiries, and clinical questions — reach out directly. We answer our own phones.

Founder · CEO & President

Michael Chavez Ross

Government & partnerships
Phone 206-420-9055
LinkedIn /in/michael-ross
Based Snoqualmie, WA
Clinical Director · RN, BSN

Jayson Minagawa

Clinical protocols & operations
Email upham51@gmail.com
LinkedIn /in/jayson-m
Licenses RN — WA · CA · OR
Capability statement

Available on request — for contracting officers.

NAICS & UEI registered. SAM.gov ready. Buy Indian Act qualification documentation furnished on contracting officer request.

Request the statement