Tribal Budget Formulation Work Group Recommends $196.8 Million for Urban Indian Health in FY 22

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NCUIH and UIO Leaders Attend FY 2022 IHS National Tribal Budget Work Session

On February 13 – 14, 2020, the Tribal Budget Formulation Work Group (TBFWG) convened in Arlington, Virginia to develop the National Tribal Budget Recommendation for fiscal year (FY) 2022. This is a two-day annual meeting where the two tribal representatives from each Indian Health Service (IHS) Area come together to review and consolidate all the Areas’ budget recommendations into a set of national health priorities and budget recommendations. During this year’s session, the TBFWG recommended a $90,900,000 increase to the Urban Indian Health budget line item from their FY 2021 recommendation made last year, which was approximately $105,900,000. This is a substantial increase from the recommendation in the FY 2021 President’s budget as the total TBFWG recommendation for Urban Indian Health, $196,800,000, nearly doubles the FY 2021 recommendation. The Urban Indian Health line item was listed as the 11th overall priority in the TBFWG’s National Tribal Budget Recommendation.

In addition, during this year’s session, the TBFWG recommended a $2,763,251,000 increase to the Program Expansion component of the FY 2022 IHS budget, which is a 30% increase over the FY 2021 budget recommendation. The National Council of Urban Indian Health (NCUIH) Board members, staff, and other Urban Indian Organization (UIO) leaders were in attendance at the National Tribal Budget Work Session, although no Urban Indian representative sits on the TBFWG.  Reports from several Areas made clear that UIOs had engaged thoroughly in their Area budget formulation meetings, leading to the TBFWG recommendation.  In fact, the Bemidji, Billings, California, Great Plains, Oklahoma, Phoenix, Portland, and Tucson Areas recommended an increase to Urban Indian Health, as indicated in the chart below.

Although NCUIH did not have an opportunity to present at the session, NCUIH Director of Federal Relations, Julia Dreyer, presented UIO budget priorities during an IHS webinar on January 29, 2020.

Region Recommended Increase for Urban Indian Health
Average 90,941
Alaska 0
Albuquerque 0
Bemidji 316,571
Billings 136,405
California 54,865
Great Plains 274,325
Nashville 0
Navajo 0
Oklahoma 137,163
Phoenix 46,314
Portland 70,786
Tucson 54,865
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PRESS RELEASE: NCUIH Releases 2018-2019 Urban Indian Organization Shutdown Report

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FOR IMMEDIATE RELEASE
Contact: Meredith Raimondi
202-417-7781
mraimondi@ncuih.org

Report Shows Devastating Impacts of Shutdown and Highlights Urgency for Advance Appropriations and 100% FMAP

WASHINGTON, DC (February 14, 2020) – The National Council of Urban Indian Health (NCUIH) has released the 2018 – 2019 Urban Indian Organization Shutdown Report. The report summarizes and presents the results of a survey NCUIH circulated during the 2018-2019 shutdown to capture important metrics and narratives regarding its impacts. The United States federal government shutdown of 2018-2019 occurred from midnight Eastern Standard Time on December 22, 2018 until January 25, 2019. Nineteen out of forty-one Urban Indian Organizations (UIOs) reported. The responses from this survey were used in NCUIH’s policy and legislative advocacy initiatives during and after the shutdown. Although the Indian health care delivery system consists of three prongs — Indian Health Service (IHS), Tribal Health Programs, and UIOs — the report focuses on UIOs.

“The 2018-2019 Urban Indian Organization Shutdown Report demonstrates that the longest U.S. government shutdown in history had instant, longstanding, and severe negative impacts on UIOs and the American Indians and Alaska Natives (AI/ANs) they serve across the country. The federal trust responsibility to provide for the healthcare of all AI/ANs mandates that federal funding problems be fixed so that the impacts of any future shutdowns are minimized, and the lives of AI/ANs are not put at risk. Because UIOs operate on very low margins, every aspect of their abilities to deliver essential healthcare was affected by the 2018-2019 shutdown, including their abilities to hire and retain staff, to provide direct services, and, in some cases, even to remain open and available for their patients. IHS funding at the level of need, an increase in the Urban Indian Health budget line item, advance appropriations, and 100% FMAP for UIOs are all necessary fixes to protect the delivery of healthcare to AI/ANs,” said Francys Crevier, Executive Director of NCUIH.

The interruption in funding precipitated by the shutdown had dire consequences for UIOs and, consequently, on American Indians and Alaska Natives (AI/ANs) across the country. The impact on AI/ANs, many of whom depend on UIOs for their healthcare needs, ranged from patients unable to get vital medication for chronic conditions to fatal overdoses. UIOs had to make difficult decisions regarding cancellation of certain services, reduction in practitioner hours, staff retention, facility operation, and whether to use savings earmarked for other purposes to shield staff and patients from the impact of the shutdown.

NCUIH shifted its policy and advocacy focus during the shutdown to limit the disruptions to the daily operations of the UIOs it represents and urged Congress and the administration to immediately end the shutdown and restore funding to IHS. Following the shutdown and restoration of funding, NCUIH remains dedicated to establishing safeguards for UIOs against potential shutdowns in the future. NCUIH is working with Congressional officials to raise awareness for bills that would provide the Indian Health Service (IHS) with advance appropriations (H.R. 1128, S. 229) and provide 100% Federal Medical Assistance Percentage (FMAP) for UIOs (H.R. 2316, S. 1180).

Key Findings

UIOs operate on very low margins.

  • UIOs operate on very low margins such that even very minor changes to their funding structures lead to devastating impacts on the services they provide to AI/ANs and even affect their abilities to keep their facilities operational.

All aspects of the urban Indian healthcare delivery system were impacted by the shutdown, but the UIO workforce was the first to experience its disastrous effects.

  • The survey results point to a pattern which suggests that among the difficult decisions UIOs were forced to make during the 2013 and the 2018-2019 shutdowns, delaying hiring, reducing hours, and laying off staff were typically the first decisions made.

UIO services were greatly impacted.

  • Another pattern the survey highlighted is that UIOs were forced to cut back on services that were not as consequential as others, such as dental services, transportation, case management, and community outreach services. However, some UIOs were forced to cut even the essential services such as substance abuse services and purchase requests for diabetes and blood pressure medications.

UIOs were forced to use savings designated for other purposes to shield staff and patients from the impact of the last two government shutdowns.

  • Yet another pattern illustrated in the survey results suggests that UIO leaders made an effort to protect their staff and current services by using savings earmarked for program growth.

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PRESS RELEASE: President Proposes $49.6 Million in FY 2021 Budget for Urban Indian Health

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FOR IMMEDIATE RELEASE
Contact: Meredith Raimondi
202-417-7781
mraimondi@NCUIH.org

Request for FY 2021 is $8 Million below FY 2020 Enacted

WASHINGTON, DC (February 11, 2020) – On February 10, 2020, the President released the annual budget proposal for Fiscal Year (FY) 2021. The proposal includes a total of $96.2 billion for the Department of Health and Human Services (HHS), which represents a nearly 10 percent cut to current enacted budget. Under the request, the Indian Health Service (IHS) would receive approximately $6.4 billion in FY 2021.  NCUIH, in conjunction with the Tribal Budget Formulation Workgroup (TBFWG), had encouraged the Administration to fund IHS at $9.1 billion with an urban Indian health line item of $105.9 million for FY 2021. This is an increase of $48.2 million for urban Indian health over the enacted FY 2020 budget. The proposed IHS budget falls nearly $3 billion short of TBFWG’s overall IHS recommendation, and the proposed urban Indian health funding amount constitutes $56.3 million less than the TBFWG recommendation.

“NCUIH looks forward to working with the Administration and Congress to fully fund IHS and the urban Indian health care line item. NCUIH was encouraged by the enacted FY 2020 IHS budget of approximately $6.0 billion, an increase of 4% above the enacted FY 2019 level. The FY 2020 Enacted appropriation funded urban Indian health at approximately $57 million and provided over $115,000 in increases for 39 of the 41 Urban Indian Organizations. For FY 2021, NCUIH encourages Congress to meet the TBFWG recommendation of approximately $106 million for the urban Indian Health line item, which is $56.3 million above the President’s FY 2021 request,” said Francys Crevier, Executive Director of NCUIH.

Congress will consider the President’s request as it begins to draft appropriations bills for FY 2021. Please find below a summary of some of the proposed funding amounts that would impact urban Indian health.  A more in-depth analysis of the White House’s FY 2021 Budget is forthcoming.

Urban Indian Line Item

  • The spending proposal recommends a funding level for the urban Indian line item at $49,636,000. This is an approximately $8 million decrease from the FY 2020 Enacted amount, but it is $865,000 increase from the President’s FY 2020 budget request.

Special Diabetes Program for Indians (SDPI)

  • The President’s budget also includes continued funding for the SDPI at the current funding levels of $150 million through FY 2021. It includes expected spending for the program over a 10-year period if Congress extends funding only through FY 2021 and does not include a long-term re-authorization.

Federal Tort Claims Act

  • The budget proposes to expand medical malpractice coverage under the Federal Tort Claims Act to Urban Indian Organizations (UIOs), which would protect UIO employees from malpractice lawsuits, saving some UIOs upwards of $250,000 annually in malpractice insurance costs. It also proposes an expansion of malpractice coverage for IHS volunteers.

105(l) Leases

  • The FY 2021 budget adds $101 million for 105(l) leases. In FY 2019, IHS was forced to reallocate $72 million in FY 2019 to pay for $101 million in leases under section 105(l) of the Indian Self-Determination and Education Assistance Act. In FYs 2018 and 2019, IHS reprogrammed approximately $782,000 each year from urban Indian health inflation funds to pay for 105(l) leases. The $101 million in 105(l) lease costs in FY 2019 represented a nearly fourfold increase to the amount requested in FY 2018 – if this trend continues, there is concern $101 million will be insufficient and IHS will again reprogram other funds.

Centers for Disease Control and Prevention and National Institutes of Health

  • The budget request would trim funding for the Centers for Disease Control and Prevention by almost 16 percent. This is a funding loss that would affect the HHS core mission of preventing and controlling emerging public health issues, such as opioid and substance use disorders.
  • The proposal includes an approximately $38 billion budget for the National Institutes of Health in FY 2021, which is – about $3 billion less than the current funding level. This cut would affect priorities to include research on the opioid epidemic and stimulants such as methamphetamine, issues that are at critical to address in Indian Country.

National Health Service Corps

  • The proposal seeks to reauthorize the National Health Service Corps loan repayment program with $15 million. UIOs’ employees are eligible for participation in the loan repayment program.

HIV/AIDS at HRSA

  • New programs proposed include a focus on HIV/AIDS with $302 million allocated to the Health Resources and Services Administration (HRSA) for HIV prevention providing the funding for diagnosis services expansion at Health Centers and expanded treatment through the Ryan White HIV/AIDS program.

Quick Glance

  • $6,232,568,000 – IHS budget authority total
  • $4,507,113,000 – IHS services budget
  • $49,636,000 – Urban Indian Health
  • $150,000,000 – Special Diabetes Program for Indians
  • $101,000,000 – Section 105(l) ISDEAA
  • $15,000,000 – The National Health Service Corps loan repayment program
  • $302,000,000 – HRSA for HIV prevention

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PRESS RELEASE: NCUIH Testifies Before House Interior Appropriations American Indian and Alaska Native Public Witness Day

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FOR IMMEDIATE RELEASE

Contact: Meredith Raimondi
202-417-7781
mraimondi@ncuih.org

President Rosette Requested Congress Meet the Urban Indian Health Line Item of $106 Million as Recommended by the Tribal Budget Formulation Work Group

WASHINGTON, DC (February 11, 2020) — National Council of Urban Indian Health President Maureen Rosette (Chippewa Cree Nation) testified before the House Interior Appropriations Subcommittee as part of American Indian and Alaska Native Public Witness Days (February 11 and 12, 2020). President Rosette was invited as an Honorable expert witness participating on the health care panel of the 1st day of tribal and urban leader hearings.

Each year, NCUIH provides in depth testimony addressing the needs of urban Indian health care. This is the second year in a row that President Rosette has spoken to the House Appropriations Subcommittee, thanking them for their continued work.

“NCUIH is appreciative for the Subcommittee’s strong leadership and continued bipartisan support for urban Indian health. For FY 2021, NCUIH requests that the Subcommittee meet the Tribal Budget Formulation Workgroup recommendation of $106 million for the Indian Health Services (IHS) urban Indian health line item,” testified President Rosette.

While delivering testimony, President Rosette advocated for an increase in funding for FY 2021 to a minimum of $81 to $106 million for the Indian Health Services (IHS) urban Indian healthcare line item. The FY 2021 request from the President included $49.6 million, $8 million below current enacted levels. In FY 2020, the House included $81 million in FY 2020 for urban Indian health and the final bill included $57 million, a $6 million increase.

In her opening remarks today, Chair McCollum stated, “The United States government entered into treaties guaranteeing health care to Native Americans…centuries later the government, our government, the United States government, is still not meeting its responsibilities.”

NCUIH is grateful to be included in the Public Witness Days. NCUIH has been encouraged by the strong leadership of Chair McCollum and Ranking Member Joyce for urban Indian health in FY 2020 and looks forward to continuing these efforts for FY 2021.

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President’s FY 2021 Budget Proposal Includes $50 Million for Urban Indian Health

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The Request for FY 2021 is an Increase of $1 Million from FY 2020 Request, $8 Million Below FY 2020 Enacted

President Trump delivered a fiscally conservative budget proposal for FY2021. Although Congress and the President will negotiate new funding levels once the caps expire in September 2021, the President and congressional leaders had previously settled on new funding caps for the fiscal year ahead. The total Health and Human Services (HHS) budget is set at $96.4 billion which represents a nearly 10 percent cut to its most recent budget and includes $6.2 billion in Indian Health Service (IHS) funds.

Urban Indian Line Item

  • The spending proposal recommends a funding level for the urban Indian line at $49,636,000. This is an $8 million decrease from the enacted budget for FY 2020, but it is a $1 million increase from the President’s FY 2020 budget request for the line item. Meanwhile, IHS received an overall increase of $185 million.

Special Diabetes Program for Indians (SDPI)

  • President Trump’s budget also includes continued funding for the Special Diabetes Program for Indians (SDPI) at the current funding levels of $150 million through FY 2021.

Federal Tort Claims Act

  • The budget expands the Federal Tort Claims Act to Urban Indian Organizations (UIOs), which would protect UIO employees from malpractice lawsuits, saving each UIO an estimated $100,000 annually in malpractice insurance.

105(l) Leases

  • The FY 2021 budget adds $101 million for 105(l) leases. IHS was forced to reallocate $72 million in FY 2019 to pay $101 million for leases under section 105(l) of The Indian Self-Determination and Education Assistance Act (ISDEAA). Approximately $782,000 of which came from urban medical inflation funds.

Centers for Disease Control and Prevention and National Institutes of Health

  • The budget request would trim funding for the Centers for Disease Control and Prevention by almost 16 percent.  Funding loss that would affect the HHS core mission of preventing and controlling emerging public health issues such as opioid abuse.  The President proposes to give the National Institutes of Health a $38 billion budget for FY2021 – about $3 billion less than the current funding level. This cut would affect priorities to include research on the opioid epidemic and stimulants such as methamphetamine, issues that are at critical levels in Indian Country.

National Health Service Corps

  • The National Health Service Corps loan repayment program is reauthorized with $15 million – UIOs employees of UIOs are eligible for participation in the loan repayment program.

HIV/AIDS at HRSA

  • New programs include a focus on HIV/AIDS with $302 million allocated to Health Resources and Service Administration (HRSA) for HIV prevention diagnosis services expansion at health centers and treatment through the Ryan White HIV/AIDS program.

Quick Glance

  • $6,232,568,000 – IHS budget authority total
  • $4,507,113,000 – IHS services budget
  • $49,636,000 million – Urban Indian Health
  • $150,000,000 million – Special Diabetes Program for Indians
  • $101,000,000 million – Section 105(l) ISDEAA
  • $15,000,000 million – The National Health Service Corps loan repayment program
  • $302,000,000 million – HRSA for HIV prevention

A more in-depth analysis of the White House’s FY 2021 Budget is forthcoming.

NCUIH Contact: Carla Lott (cmlott@ncuih.org), Director of Congressional Relations

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Distribution of the Fiscal Year (FY) 2020 Urban Indian Health Funding Increase

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On January 27, 2020, Indian Health Service (IHS) Deputy Director, Michael D. Weahkee, sent out a Dear Urban Indian Organization Leader Letter (DULL) regarding the IHS’s decision on the distribution of funds for the fiscal year (FY) 2020 increase. The letter provides that IHS issued the standard distribution of funds in accordance with the 2018 Urban Confer. 10 percent of the funds will be distributed to the Office of Urban Indian Health Programs (OUIHP) and 90 percent of the funds will be distributed to Urban Indian Organizations (UIOs) via IHS contracts. An equitable distribution methodology will divide the 90 percent evenly among the UIOs for FY 2020.

The DULL provides that the Urban Indian Health funding increase available for distribution in FY 2020 to the OUIHP and UIOs is $5,000,000. The Agency will move forward with distribution as outlined below:

FY 2020 Urban Indian Health Funding Increase – Category

Total Amount

Percentage of Funds
OUIHP

$500,000

10%
39 UIOs: $115,385 per Urban Indian Organization

$4,500,000

90%
Total FY 2020 Funding Increase Distribution

$5,000,000

100%

Why is this important to UIOs?

  • This is the UIOs overall funding distribution increase for FY 2020.
NCUIH Contact: Julia Dreyer (jdreyer@ncuih.org), Director of Federal Relations
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Transfer of Former NIAAA Programs from ASAP to OUIHP is Complete

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On January 27, 2020, Indian Health Service (IHS) Principal Deputy Director, Michael D. Weahkee, sent out a Dear Urban Indian Organization Leader Letter (DULL) informing UIOs that the transfer of the former National Institute on Alcohol Abuse and Alcoholism programs (NIAAA) from the IHS Alcohol and Substance Abuse Program (ASAP) to the IHS Office of Urban Indian Health Programs (OUIHP) had been completed.

The DULL notes that IHS has completed three critical steps, which were previously identified. Accordingly, each former NIAAA program is defined as a UIO under the Indian Health Care Improvement Act, the internal management of contract funds have been transferred from the ASAP to the OUIHP, and IHS took steps to formally reprogram funds from the ASAP budget to the Urban Indian Health budget for fiscal year 2020.

Why is this important to UIOs?
  • IHS is informing UIOs that the actions needed to complete the transfer of former NIAAA programs to OUIHP, as identified in an October 13, 2017 DULL, have been completed.

NCUIH Contact: Julia Dreyer (jdreyer@ncuih.org), Director of Federal Relations

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NCUIH to Testify before House Interior Appropriations

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Washington, DC (February 10, 2020) – On Tuesday, February 11, 2020, National Council of Urban Indian Health President Maureen Rosette (Chippewa Cree Nation) will testify before the House Interior Appropriations Subcommittee as part of American Indian and Alaska Native Public Witness Days (February 11 and 12, 2020). The hearing will begin at 9:00 AM at 2008 Rayburn House Office Building and will be livestreamed. Ms. Rosette is expected to testify at 10:10 AM during the Health Care Panel.

In the testimony, NCUIH will advocate for an increase in funding to a minimum of $81 to $106 million for the Indian Health Services (IHS) urban Indian healthcare line item, constituting 2% of the total IHS budget. The higher end of this range, $106 million, is what the IHS Tribal Budget Formulation Workgroup requested minimum is for Fiscal Year (FY) 2021. The House included $81 million in FY 2020 for urban Indian health and the final bill included $57 million, a $6 million increase.

NCUIH is grateful to be included in the Public Witness Days. NCUIH has been encouraged by the strong leadership of Chair McCollum and Ranking Member Joyce for urban Indian health in FY 2020 and looks forward to continuing these efforts for FY 2021.

The deadline to submit written testimony is Friday, March 6th.

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PRESS RELEASE: NCUIH President-Elect Walter Murillo Recognized as Health Equity Health Advocate of the Year by Families USA

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The Native Health CEO was one of four awardees honored this year.

WASHINGTON, DC (February 7 , 2020) – Walter Murillo (Choctaw Nation of Oklahoma), Chief Executive Officer at Native Health in Phoenix, Arizona, has been recognized as Health Equity Health Advocate of the Year by Families USA. Murillo was selected for his exemplary work championing for better health care in Arizona in his over 21 years at Native Health. Under his leadership, Native Health has long provided quality, culturally-competent health care for urban Indians.

“Walter truly understands what it means to be a health equity health advocate,” said Frederick Isasi, Families USA’s executive director. “He is working tirelessly in Arizona to ensure that his neighbors do not face barriers accessing quality health care because of who they are, where they live or how they identify.”

Murillo was honored on January 24, 2020 at an awards luncheon during the Families USA 2020 Health Action Conference in Washington, D.C. Each year during its Health Action Conference, Families USA honors the efforts of state and community leaders in advancing social justice through health care advocacy. Awards are presented in recognition of the organization’s four focus areas: Health Equity, Health Care Value, Coverage and Consumer Experience.

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