IHS Announces Dissemination of Final $367 million in CARES Act funding with $20 million for UIOs

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On April 23, the Indian Health Service (IHS) announced its decision to distribute $20 million to Urban Indian Organizations (UIOs) in COVID-19 relief aid from the remaining CARES Act resources. These funds will be distributed through existing Indian Health Care Improvement Act (IHCIA) contracts by providing a one-time base amount for each UIO and an additional amount based on each UIO’s Urban Indian users. The announcement came in a Dear Tribal Leader and Urban Indian Organization Leader Letter (DULL) which announced the final allocation decisions for the agency’s remaining $367 million in CARES Act funding.

The DULL also announced a transfer of $125 million to the IHS Facilities Account for IHS and tribal health programs facilities. An additional $50 million will be allocated to IHS health programs and Tribal Health Programs for Community Health Representatives and Public Health Nursing, while $26 million will be set aside for Tribal Epidemiology Centers. The remaining funds will be used for IHS telehealth expansion, COVID-19 prevention, COVID-19 testing, cleaning of IHS facilities, and COVID-19 response and recovery messaging.

These funding allocations finalize the total use of CARES Act funding for IHS. The agency received $1.032 billion from this third wave of COVID-19 legislation. NCUIH continues to advocate for the resources UIOs need to combat COVID-19 by working with lawmakers and federal agencies.

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PRESS RELEASE: Senate Clears COVID-19 Testing Package, President Expected to Sign

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FOR IMMEDIATE RELEASE

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

The bill includes $750 million to Indian Country for COVID-19 testing and response.

Washington, DC (April 23, 2020) – On April 21, 2020, H.R. 266, the Paycheck Protection Program and Health Care Enhancement Act, passed the Senate by voice vote.  The bill is now in the House of Representatives and is on track to pass today. The President has indicated he will sign the bill.

“As our urban Indian organizations (UIOs) have been on the front lines of the COVID-19 crisis from day 1, we are grateful for the inclusion of Tribes and urban Indians in the most recent legislation. We appreciate a continued commitment to Indian Country by Leader Chuck Schumer. We hope that the government acts swiftly to provide these life-saving tests and resources to our programs on the ground. We will continue to work with our national partner organizations NIHB and NCAI to push for more assistance in the next package, “said Francys Crevier.

The bill includes $25 billion for COVID-19 testing with not less than $11 billion to states, local territories, tribes, tribal organizations, urban Indian organizations, or health service providers to tribes. Out of the $11 billion, not less than $750 million will be allocated in coordination with the Director of the Indian Health Service to tribes, tribal organizations, urban Indian organizations, or health service providers to tribes. These funds are to be used for: “necessary expenses to develop, purchase, administer, process, and analyze COVID–19 tests, including support for workforce, epidemiology, use by employers or in other settings, scale up of testing by public health, academic, commercial, and hospital laboratories, and community-based testing sites, health care facilities, and other entities engaged in COVID-19 testing, conduct surveillance, trace contacts, and other related activities related to COVID–19 testing.”

The deal will total $484 billion, including $310 billion to replenish the funding for the Paycheck Protection Program. This bill also expands the scope of the Paycheck Protection Act allowing for small banks, credit unions, and non-profits to be eligible for the funds. Of this $310 billion, $75 billion is intended for eligible health care providers. Eligible health care providers include “public entities, Medicaid or Medicare enrolled suppliers and providers, and for-profit and not-for-profit entities” that “provide diagnoses, testing, or care for individuals with possible cases of COVID-19.”

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The National Council of Urban Indian Health (NCUIH) is the national non-profit organization devoted to the support and development of quality, accessible, and culturally-competent health and public health services for American Indians and Alaska Natives (AI/ANs) living in urban areas. NCUIH is the only national representative of the 41 Title V Urban Indian Organizations (UIOs) under the Indian Health Service (IHS) in the Indian Health Care Improvement Act (IHCIA). NCUIH strives to improve the health of the over 70% of the AI/AN population that lives in urban areas, supported by quality, accessible health care centers.

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PRESS RELEASE: Gallego, Mullin Introduce FTCA Bill to Reduce Burdens for Urban Indian Organizations

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FOR IMMEDIATE RELEASE

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

The long-needed fix would allow urban Indian organizations to direct funds back to the patients who need it most.

Washington, DC (April 21, 2020) – Rep. Ruben Gallego (D-AZ) and Rep. Markwayne Mullin (R-OK) introduced H.R. 6535 last week to expand Federal Tort Claims Act (FTCA) coverage to urban Indian organizations, giving them a desperately needed boost in resources as many suffer critical supply shortages, closures, and financial hardship as a result of the COVID-19 pandemic.

Urban Indian organizations (UIOs) are doing everything they can to keep their doors open during this pandemic while still dealing with paying for costly medical malpractice insurance. Unfortunately, urban Indian organizations may be forced to make extremely difficult choices – facing competing priorities and expenses like increased PPE prices, testing supplies, in addition to very costly malpractice insurance. H.R. 6535 would create parity within the Indian Health Service health system by extending FTCA coverage to urban Indian organizations, who currently are forced to divert resources away from health care in order to foot exorbitant liability costs themselves.

“We are extremely grateful for Congressman Gallego and Congressman Mullin’s leadership in introducing this legislation for a long-needed fix to the medical malpractice liability protection, which ensures parity for Urban Indian Organizations (UIOs). A single UIO can pay as much as $250,000 annually, funds that could be spent providing health care for the American Indians and Alaska Natives they serve. As all other Indian Health Care Providers are covered by FTCA and Community Health Centers employees as well as volunteers are also covered, this legislative fix is critical to ensure continuity of health care in a time when it’s needed most,” said Francys Crevier, Executive Director of NCUIH.

“Urban Indian organizations, including Native Heath in my District, are on the front lines of this pandemic. Individual facilities are reporting skyrocketing costs in the hundreds of thousands and dangerous supply shortages. Three UIOs have already closed their doors as a result of the strain,” said Rep. Gallego, Chair of the Subcommittee for Indigenous Peoples. “We cannot afford to leave urban Indians without access to care during this public health crisis. My bill will both bring long overdue parity to urban Indian health providers and provide an infusion of desperately resources to an urban Indian health system on the brink.”

“Urban Indian Health Centers play a critical role in providing health care to Native Americans. Our bill ensures they are covered by the FTCA so that they won’t have to use their limited resources to cover costly liability bills. I want to thank Congressman Gallego for working with me on this legislation that will improve health care for Native Americans,” said Rep. Mullin.

Next Steps

NCUIH has long-advocated for the introduction of this legislation and will be requesting that lawmakers include it in the next COVID-19 package.

Background

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The National Council of Urban Indian Health (NCUIH) is the national non-profit organization devoted to the support and development of quality, accessible, and culturally-competent health and public health services for American Indians and Alaska Natives (AI/ANs) living in urban areas. NCUIH is the only national representative of the 41 Title V Urban Indian Organizations (UIOs) under the Indian Health Service (IHS) in the Indian Health Care Improvement Act (IHCIA). NCUIH strives to improve the health of the over 70% of the AI/AN population that lives in urban areas, supported by quality, accessible health care centers.

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RADM Weahkee Confirmed by US Senate to be Director of the Indian Health Service

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On April 21, 2020, a new Director of the Indian Health Service (IHS) was confirmed by voice vote in the Senate. The vote confirmed Rear Admiral Michael D. Weahkee, Zuni of New Mexico, to be Director of IHS, Department of Health and Human Services (HHS), for a term of four years.

IHS has not had a Senate-confirmed Director since 2015. HHS Secretary Alex Azar first appointed RADM Weahkee in June 2017 as Acting IHS Director. President Trump nominated RADM Weahkee on October 22, 2019.

NCUIH sent a letter of support of the nomination of RADM Weahkee.

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Reps. Gallego, Mullin Introduce Bill Boosting Resources for Urban Indian Health Organizations

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https://rubengallego.house.gov/media-center/press-releases/icymi-reps-gallego-mullin-introduce-bill-boosting-resources-urban-indian

April 20, 2020
Press Release

WASHINGTON, DC – Rep. Ruben Gallego (D-AZ) and Rep. Markwayne Mullin (R-OK) introduced H.R. 6535 last week to expand Federal Tort Claims Act (FTCA) coverage to urban Indian health organizations, giving them a desperately needed boost in resources as they suffer shortages, closures, and financial hardship as a result of the COVID-19 pandemic.

The Indian Health System, commonly referred to as the ITU system, is made up of the Indian Health Service (IHS), Tribal health programs, and urban Indian organizations (UIOs). UIOs provide culturally competent care for the over 70 percent of American Indians and Alaska Natives who live in urban centers. H.R. 6535 would create parity within the ITU system by extending FTCA coverage to urban Indian organizations, who currently are forced to divert resources away from health care in order to foot exorbitant liability costs themselves.

“Urban Indian organizations, including Native Heath in my District, are on the front lines of this pandemic. Individual facilities are reporting skyrocketing costs in the hundreds of thousands and dangerous supply shortages. Three UIOs have already closed their doors as a result of the strain,” said Rep. Gallego, Chair of the Subcommittee for Indigenous Peoples. “We cannot afford to leave urban Indians without access to care during this public health crisis. My bill will both bring long overdue parity to urban Indian health providers and provide an infusion of desperate resources to an urban Indian health system on the brink.”

“Urban Indian Health Centers play a critical role in providing health care to Native Americans. Our bill ensures they are covered by the FTCA so that they won’t have to use their limited resources to cover costly liability bills. I want to thank Congressman Gallego for working with me on this legislation that will improve health care for Native Americans,” said Rep. Mullin.

The National Council for Urban Indian Health (NCUIH) said: We are extremely grateful for Congressman Gallego and Congressman Mullin’s leadership in introducing this legislation for a long-needed fix to the medical malpractice liability protection to ensure parity for Urban Indian Organizations (UIOs). A single UIO can pay as much as $250,000 annually, which could be spent providing health care for the American Indians and Alaska Natives. As all other Indian Health Care Providers are covered by FTCA and it is extended to Community Health Centers as well as volunteers, this legislative fix is needed now more than ever to ensure continuity of health care in a time when it’s needed most.

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NCUIH Hosts First Virtual Site Visit Retreat for Supporting Urban Native Youth Project

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(April 21, 2020) –  NCUIH and two of its Title V Urban Indian Organization (UIO) members, Native American Lifelines (NAL) and Native American Rehabilitation Association, Inc (NARA), participated in their 1st virtual site visit retreat as part of the Native Connections’ Supporting Urban Native Youth (SUNY) project in light of COVID-19 pandemic concerns. SUNY focuses on building the capacity of each urban community to address suicide and substance misuse in youth up to age 24 years. The sites are located in Baltimore, Maryland, and Boston, Massachusetts, as well as Portland, Oregon, respectively.

The four-day-long virtual retreat was structured on the Gathering of Native Americans model (GONA). Each day represented a different GONA theme (Belonging, Mastery, Interdependence, and Generosity) and included team-building activities, ice breakers and self-care practices, which were captured and co-facilitated by the external evaluator, from One Fire Associates, LLC.

NCUIH, NAL Boston, NAL Baltimore & NARA’s Portland staff and leadership were able to build a deeper sense of Belonging, Mastery, Interdependence and Generosity by:

  • Sharing their successes thus far in the five-year grant and hope for the future in the remaining two years.
  • Sharing challenges and best practices on creative ways to implement youth engagement activities during the COVID-19 pandemic.
  • Showing strong interest in providing suicide and substance abuse certification training to their youth populations, possibly through virtual QPR training by a former NCUIH Youth Council member.
  • Participating in breakout session activities that helped each site identify impactful partnerships, partnership challenges for areas of need for support, and partnerships they want to develop/ strengthen.
  • Each site presented their overall UIO youth programming and best practices in how they support their respective communities.
  • Developing strategies for sustainability based on identified priorities for each community, as well as strategic planning actions for the future.
  • NCUIH identified TA support, including connecting peer-to-peer support to each site on areas of developing successful partnerships with academic institutions and correctional facilities to better support each sites’ community.
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NCUIH Joins National Native Organizations in COVID-19 Legislative Request

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(April 20, 2020) – Last week, NCUIH along with a coalition of National Native Organizations sent a letter to Members of both chambers of Congress outlining a joint COIVD-19 recovery legislative proposal for health, education, nutrition, and human services.

NCUIH, along with the National Congress of American Indians, National Indian Health Board, Self-Governance Communication & Education Tribal Consortium, National Association of Food Distribution Programs on Indian Reservations, Native Farm Bill Coalition, Intertribal Agriculture Council, National Indian Education Association, American Indian Higher Education Consortium, National Indian Child Welfare Association, and United South and Eastern Tribes Sovereignty Protection Fund, sent the legislative priorities as Congress negotiates the fourth major legislative package on coronavirus.

The proposal included, among other essential proposals, requests for Congress to:

  • Provide sufficient appropriations to IHS for Indian Health Care Providers as they face the pandemic on the frontlines, including:
    • Provide $1 billion for Purchased/Referred Care (PRC).
    • Provide $1.215 billion for Hospitals and Health Clinics.
    • Establish a $1.7 billion Emergency Third-Party Reimbursement Relief Fund for IHS, Tribal Programs, and Urban Indian Organizations.
    • Provide $85 million for equipment purchases and replacements.
    • Provide $161 million for Urban Indian Health.
    • Provide $1 billion for Sanitation Facilities Construction.
    • Provide $750 million for maintenance and improvement of Indian Health Service and Tribal facilities.
  • Authorize technical Medicaid and Medicare fixes including 100% FMAP for services provided at UIO facilities and technical amendments including Tribal and UIO access to the Strategic National Stockpile.
  • Clarify that the VA is authorized to reimburse UIOs for services provided to Native Veterans.

Letters

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Fact Sheet: Impact of COVID-19 Pandemic on Third-Party Reimbursements for the Indian Health System

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Download Fact Sheet: Impact of COVID-19 Pandemic on Third-Party Reimbursements for the Indian Health System

By: Shervin Aazami, Director of Congressional Relations, National Indian Health Board, saazami@nihb.org; Julia Dreyer, Director of Federal Relations, National Council of Urban Indian Health, jdreyer@ncuih.org;

April 2020

Fact Sheet: Impact of COVID-19 Pandemic on Third-Party Reimbursements for the Indian Health System

Priority: Create a $1.7 billion third-party reimbursement relief fund for Indian Health Service (IHS), Tribes and Tribal organizations, and urban Indian organizations (UIOs)

Issue

The COVID-19 pandemic has upended many parts of the Indian health system. As states enforce shelter in place orders, require health care providers to cancel non-emergent procedures, and as social distancing guidelines continue, IHS, Tribal and UIO (collectively “I/T/U”) sites are seeing their patient volumes plummet. Some I/T/U facilities have the capacity to make the transition to telehealth-based service delivery for some routine and non-emergent procedures, but this is not an option for all sites or all procedures. Reduced patient visits and services being offered result in less third-party reimbursements from payers such as Medicare, Medicaid, the Veterans Health Administration (VHA), and private insurance.

  • Because of the chronic underfunding of IHS, most, if not all, of the more than 360 Tribal Nations that elect to administer their healthcare programs through Self-Governance agreements must supplement funds received from IHS with third-party reimbursements. For some Tribes, third-party collections can constitute over half of their operating budgets for healthcare.
  • Tribal Nations have experienced significant reductions in third-party reimbursement—ranging from $800,000 to over $5 million per Tribe over the last 30 days—as a result of suspended services and stay at home orders.
    • In Arizona, initial estimates for March 2020 show that IHS and Tribal third-party collections from Medicaid alone were down nearly $26 million compared to February 2020. These losses are likely underestimated because the Medicaid claims submission process can take up to 12 months in the state.
    • When extrapolated across the 360 Tribally-run health programs, losses are estimated to be higher than $1 billion for just one month.
  • Federally-operated IHS facilities are also heavily reliant on third-party collections to supplement its appropriation.
    • IHS has not publicly released information on third-party collections as a result of COVID-19, but IHS officials indicated they are experiencing reductions. IHS reported to the Government Accountability Office (GAO) in 2019 that it increasingly relies on third-party collections to pay for ongoing operations such as staff payroll, and expansion of on-site services.
    • Reductions in third-party collections are forcing IHS and Tribal sites to further expend limited Purchased/Referred Care (PRC) funds.
  • For UIOs, third party reimbursement dollars equal more than triple the annual appropriation to the Urban Indian Health line item in the IHS budget. Through mid-March 2020, UIOs reported an average of $500,000 in lost third-party reimbursements, while larger full ambulatory UIOs reported losses of more than $1.5 million.
Congress must establish a $1.7 billion relief fund for I/T/U facilities to replenish lost third-party reimbursement dollars. Without this relief, it will lead to even more rationed healthcare and jeopardizes the sustainability of some I/T/U facilities.
Background

The IHS is the most chronically underfunded federal healthcare system, with $3,779 in per capita medical expenditures in FY 2018 compared to $9,409 in national per capita health spending that same year. Congress has long recognized the unique role of third-party reimbursements from Medicare, Medicaid, VHA, and private insurance in supplementing the chronic underfunding of IHS. For decades, these third-party payers have played a central role in maintaining the fiscal stability of IHS, Tribal, and urban Indian (collectively “I/T/U”) health systems, and in furthering the federal Trust and Treaty obligations to provide quality healthcare to all Tribal Nations and American Indian and Alaska Native Peoples.

Quick Facts
  •  In FY 2019, federally-operated IHS facilities alone collected $1.14 billion in third party reimbursements, with the vast majority ($995 million) derived from Medicare and Medicaid.
  •  For Tribally-operated health programs, third-party dollars can play an even more crucial role in financing healthcare services. Up to 50-60% of some Tribal healthcare budgets are derived from third-party payers like Medicare and Medicaid.
  •  UIOs are also heavily reliant on third-party dollars to supplement their healthcare resources. From 2014 to 2018, third-party reimbursements at UIOs increased 16% annually.
Benefit of Third-Party Reimbursement Dollars

Over the last several years, I/T/U facilities have experienced a significant increase in third-party reimbursements. At federally-operated IHS sites, third-party reimbursements from Medicare, Medicaid, and private insurance increased by 51% from 2013 to 2018. These dollars are then reinvested in the I/T/U system to bolster availability of healthcare services and expand care access.

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NCAI, NIHB, NCUIH Coalition Letters to House and Senate on COVID-19 4th Package

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Letter from NCAI, NIHB, NCUIH, et al to House Leadership re: COVID-19 4th Package (April 15, 2020)

Letter from NCAI, NIHB, NCUIH, et al to Senate Leadership re: COVID-19 4th Package (April 15, 2020)

Signatories:

  • National Congress of American Indians
  • National Indian Health Board
  • National Council of Urban Indian Health
  • Self-Governance Communication & Education Tribal Consortium
  • National Association of Food Distribution Programs on Indian Reservations Native Farm Bill Coalition
  • Intertribal Agriculture Council National Indian Education Association
  • American Indian Higher Education Consortium National Indian Child Welfare Association
  • United South and Eastern Tribes Sovereignty Protection Fund

Letter Text

April 15, 2020

Re: COVID-19 Recovery Legislative Proposal (Phase #4)

This letter is on behalf of the undersigned American Indian and Alaska Native (AI/AN) organizations, which collectively serve all 574 federally recognized AI/AN tribal nations. The recommendations outlined in this letter encompass critical funding and policy needs to help protect and prepare AI/AN communities to effectively respond to the current 2019 novel coronavirus (COVID-19) pandemic.

As the urgency, infection rate, and death toll of the COVID-19 pandemic intensifies, it has become increasingly clear that Indian Country needs significantly more resources to protect and preserve human life and address the grave economic impacts tribal nations face due to the closure of government operations and tribal enterprises to protect the health of their citizens and surrounding communities. AI/AN communities are disproportionately impacted by the health conditions that the Centers for Disease Control and Prevention (CDC) notes increase risk for a more serious COVID-19 illness, including respiratory illnesses, diabetes, and other health conditions. We urge you to include the following recommendations as you work on a phase 4 package to stem the COVID-19 pandemic. In addition to the specific funding and policy requests outlined below, tribal nations are strongly urging maximum flexibility in the use of new and existing funds to be able to comprehensively address COVID-19 response efforts.

This letter is one of three letters addressing: economic development and employment; tribal governance and housing/community development; and health, education, nutrition, and human services. The language included in this letter covers the health, education, nutrition and agriculture, and human service needs for Indian Country. For your convenience, we have created an abbreviated list to coincide with the specific funding and policy requests found later in the letter. This abbreviated list previews how the letter is organized.

Health

Health Section 1: Critical Funding and Access Needs
  • Provide $1 billion for Purchased/Referred Care (PRC).
  • Provide $1.215 billion for Hospitals and Health Clinics.
  • Establish a $1.7 billion Emergency Third-Party Reimbursement Relief Fund for IHS, Tribal Programs, and Urban Indian Organizations.
  • Provide $85 million for equipment purchases and replacements.
  • Provide $161 million for Urban Indian Health.
Health Section 2: Critical Infrastructure
  • Provide $2.5 billion for Health Care Facilities Construction to include support for new and current planned projects, the Small Ambulatory Health Center Program, and the Joint Venture Construction Program.
  • Provide $1 billion for Sanitation Facilities Construction.
  • Provide $750 million for maintenance and improvement of Indian Health Service and Tribal facilities.
Health Section 3: Technical Medicaid/Medicare Fixes
  • Authorize Medicaid reimbursements for Qualified Indian Provider Services and Urban Indian Organizations.
  • Provide reimbursements for services furnished by Indian Health Care Providers outside of an IHS or Tribal Facility.
  • Ensure parity in Medicare reimbursement for Indian Health Care Providers.
  • Include pharmacists, licensed marriage and family therapists (LMFTs), licensed professional counselors, and other providers as eligible provider types under Medicare for reimbursement to IHS, Tribal health programs, and Urban Indian Organizations.
Health Section 4: Technical Amendments Needed
  • Expand telehealth capacity and access in Indian Country by permanently extending waivers under Medicare for the use of telehealth and enacting certain sections of the CONNECT to Health Act.
  • Make the IHS Scholarship and Loan Repayment Program tax exempt.
  • Implement ways to facilitate interagency transfers of funding that tribal nations can access to address COVID-19 and its impacts so that funding can be disbursed to tribal nations quickly.
  • Implement ways to disburse funding to tribal nations using existing funding mechanisms already in place when possible.
  • Provide Tribal and UIO access to the Strategic National Stockpile.
  • Provide Tribal and UIO access to the Public Health Emergency Fund.
Health Section 5: Legislative Amendments and Reauthorizations
  • Move Contract Support Costs to mandatory appropriations.
  • Move 105(l) lease agreements to mandatory appropriations.
  • Permanently reauthorize the Special Diabetes Program for Indians with automatic annual adjustments tied to medical inflation, and permit tribes and tribal organizations to receive funds through Self-Determination contracts or Self-Governance compacts.
  • Provide mandatory appropriations for Village Built Clinics.

Education

Education Section 1: K-12 Educational Needs
  • Authorize Tribally Controlled Grant Schools to access Federal Employee Health Benefits (FEHB).
  • Ensure that a tribal state of emergency is included in the definition of aqualifying emergency.
  • Ensure access to healthy meals for all students that are impacted by school closures andhave no other means to get these meals.
Education Section 2: K-12 Education Infrastructure and Broadband Needs
  • Provide $115 million for wireless hotspots for BIE students and teachers as animmediate solution to school closures.
  • Provide $60 million for laptops for BIE students and teachers as an immediate solution to school closures.
Education Section 3: Higher Educational Needs
  • Provide an additional $7 million in the Interior-Bureau of Indian Education account to meet the immediate and critical needs of Tribal College and Universities (TCUs).
  • Authorize Tribal Colleges and Universities as eligible to participate in the E-Rate program.
  • Establish a $16 million TCU set-aside in the USDA-Rural Utilities Service Program using existing funds.
  • Provide at least $500 million in the Interior-BIE account for a TCU Deferred Maintenance & Rehabilitation Fund, as authorized under the Tribally Controlled Colleges and Universities Assistance Act.
Education Section 4: Education Infrastructure and Broadband Needs

Nutrition and Agriculture

Nutrition and Agriculture Section 1: Critical Funding and Access Needs
  • Clarify CARES Act Food Distribution Program on Indian Reservations (FDPIR) funding covers administrative costs, reimbursement of emergency food purchases, and authorizes FDPIR Indian Tribal Organizations to procure food locally and regionally; waive the non- federal cost share requirements; and allow for necessary administrative flexibility for verifications, certifications, and service.
  • Temporarily waive the prohibition on dual use of the Supplemental NutritionAssistance Program (SNAP) and FDPIR during the same month.
  • Provide assistance to Farm Service Agency (FSA) borrowers for relief andimplementation of policies to provide support for tribal producers and entities.
  • Increase the SNAP maximum benefit available to all households by 15 percent andthe minimum benefit from $16 to $30 and delay implementation of the proposed and final SNAP rules.
  • Provide parity and eligibility for tribal governments and Indian Tribal Organizations inthe Emergency Food Assistance Program (TEFAP).
  • Adequately Fund the Federally Recognized Tribes Extension Program (FRTEP) at $30 million.
  • Provide for agriculture lending through Community Development Financial Institutions (CDFIs).
  • Create a COVID-19 Perishable Products Loss Fund due to market disruption.
Nutrition and Agriculture Section 2: Infrastructure Funding and Broadband Needs
  • Create a 15 percent tribal set aside in the USDA ReConnect Broadband program and Distance Learning and Telemedicine Grant Program to enhance broadband access and long- distance healthcare in Indian Country.
  • Increase funding for tribal-specific projects under all USDA Water and Environmental Grant Programs by $200 million.
  • Expand the use and increase funding for the Rural Development (RD) Community Facilities Programs.
  • Provide tribal specific funding for the Local Access Market Programs (LAMP).
  • Expand USDA RD programs Substantially Underserved Trust Area (SUTA) designationto all programs at RD to support tribal priority.
  • Enhance Natural Resources Conservation Service (NCRS) programing for tribal producers, including: full advanced payments for socially disadvantaged producers; remove/waive requirements of one year prior control, the need for a Conservation Stewardship Program technical service provider, and compensation to former lessees of tribal lands for the installation of existing conservation practices; and ease requirements for beginning farmers/ranchers.

Human Services

Human Services Section 1: Temporary Assistance for Needy Families (TANF)
  • Appropriate funding in the amount of $2 billion to the TANF Contingency Fund (TCF) and allow tribal nations access in order to meet the significant needs of Tribal TANF recipients.
  • Create and provide $5 billion to a TANF Emergency Fund similar to the fund created in the American Recovery and Reinvestment Act (ARRA) with a waiver of non-federal contribution for tribal nations and flexibility for tribal nations to spend in areas specific to each tribal grantee.
Human Services Section 2: Veterans
  • Require the Veterans Health Administration (VHA) to reimburse IHS and tribal nations for services under PRC.
  • Exempt Native veterans from copays and deductibles at VHA facilities.
  • Authorize UIOs as eligible for VA reimbursement.
Human Services Section 3: Indian Child Welfare Services
  • Provide $30 million for tribal governments under Title IV-B, Subpart 1 of the Social Security Act.
  • Provide $45 million for tribal governments under Title IV-B, Subpart 2 of the Social Security Act to be divided as follows:
    • $20 million to mandatory funding for tribal nations.
    • $20 million to discretionary funding for tribal nations.
    • $5 million to the Tribal Court Improvement Project.
  • Provide $20 million for tribal governments under Title IV-E Chafee funds.
    • Authorize language allowing tribal nations to directly access the Social Services Block Grant Program by establishing a 5 percent tribal nation set aside in the statute.

Thank you for your consideration of the recommendations outlined in this letter. We look forward to working with you to ensure that Indian Country’s concerns and priorities are comprehensively addressed, as we respond to the COVID-19 pandemic.

Sincerely,

  • National Congress of American Indians
  • National Indian Health Board
  • National Council of Urban Indian Health
  • Self-Governance Communication & Education Tribal Consortium
  • National Association of Food Distribution Programs on Indian Reservations
  • Native Farm Bill Coalition
  • Intertribal Agriculture Council
  • National Indian Education Association
  • American Indian Higher Education Consortium
  • National Indian Child Welfare Association
  • United South and Eastern Tribes Sovereignty Protection Fund
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Resources from the Federal Government

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IHS

CDC

Administration for Children and Families

Administration for Community Living

Administration for Native Americans

AHRQ

CMS

FEMA

FCC

FDA

IRS

Department of Labor

House Committee on Natural Resources

Office of Management and Budget

SAMHSA

SBA

USDA

Veterans Affairs

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