Senate Indian Affairs Announces Hearing for this Wednesday on COVID-19 Impacts in Indian Country and Consideration of the NCUIH Bill to Expand Resources for Urban Indian Health

The Senate Indian Affairs Committee will host an oversight and legislative hearing on S. 3650 on Wednesday, July 1 at 2:30pm in 562 Dirksen. The oversight hearing will cover “Evaluating the Response and Mitigation to the COVID-19 Pandemic in Native Communities”.

The Committee will consider recently introduced bipartisan legislation (S. 3650) 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. The Coverage for Urban Indian Health Providers Act (S.3650), would amend the Indian Health Care Improvement Act to create parity within the Indian Health System. This is a companion bill to H.R. 6535, introduced on April 17, 2020 by Rep. Ruben Gallego (D-AZ) and Rep. Markwayne Mullin (R-OK).

NCUIH has been advocating for swift passage of the FTCA fix (S. 3650 / H.R. 6535) for urban Indian organizations, which will free up thousands of dollars for patient care.

WITNESSES:

Panel I

  • THE HONORABLE RADM MICHAEL D. WEAHKEE, Director, Indian Health Service, U.S. Department of Health and Human Services, Rockville, MD
  • MR. ROBERT J. FENTON, JR., Regional Administrator, Region 9, Federal Emergency Management Agency, U.S. Department of Homeland Security, Washington, DC

Panel II

  • MR. SCOTT DAVIS, Executive Director, North Dakota Indian Affairs Commission, Office of the Governor, State of North Dakota, Bismarck, ND
  • MS. LISA ELGIN, Secretary, National Indian Health Board, Washington, DC (Virtual Witness)

https://www.indian.senate.gov/hearing/oversight-hearing-evaluating-response-and-mitigation-covid-19-pandemic-native-communities

NCUIH Facilitates First Ever Listening Session Between UIOs and CDC on Response to COVID-19

On June 25, the Centers for Disease Control and Prevention (CDC) held the first virtual listening session for Urban Indian Organizations (UIOs) to express their needs and identify gaps related to the COVID-19 response. The purpose of the session was for the CDC to hear about the needs of UIOs during this pandemic. This event was coordinated by CDC and the National Council of Urban Indian Health (NCUIH).

The CDC officials that participated were Dr. José Montero, Director of the Center for State, Tribal, Local, and Territorial Support, and Captain Carmen “Skip” Clelland, Director of the Office of Tribal Affairs and Strategic Alliances. The session was facilitated by NCUIH’s Sunny Stevenson, Senior Manager of Federal Relations, and Jamie Ishcomer-Aazami, Deputy Director.

UIOs expressed concern about distribution of and access to vaccines once they are developed; the need for flexible funding in order to make infrastructure improvements to accommodate social distancing requirements and coronavirus testing; and the need for Urban Indians to be included in data about the coronavirus. Often American Indians and Alaska Natives (AI/ANs) are labeled as “others” and AI/AN data cannot be distinguished. UIOs requested that CDC and other agencies institute an urban confer policy with UIOs. They also requested recurring listening sessions with CDC. Captain Clelland confirmed that CDC will work with NCUIH to coordinate a second listening session.

The Coronavirus Aid, Relief, and Economic Security (CARES) Act provides that “not less than $125,000,000 shall be allocated to tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes” for “CDC-Wide Activities and Program Support”. The law states that the funding shall be for grants or cooperative agreements to carry out surveillance, epidemiology, laboratory capacity, infection control, mitigation, communications, and other preparedness and response activities.

CDC has yet to disseminate any CARES Act funds to UIOs, or announce an opportunity for UIOs to apply for them, even though the CARES Act was signed into law on March 27, 2020.

NCUIH Endorses New SDPI Legislation from Senators McSally, Murkowski, Sinema

On June 11, 2020, Senator Martha McSally (R-AZ) introduced a new bill which would reauthorize the Special Diabetes Program for Indians (SPDI) for five years and would raise funding for the program to $200 million per year. The bipartisan bill is cosponsored by Senators Lisa Murkowski (R-AK) and Krysten Sinema (D-AZ).

In support of the bill, NCUIH Executive Director Francys Crevier stated, “Thank you to Senators McSally, Murkowski and Sinema for their continued leadership in helping Indian Country during an essential time. No one should have to choose to between paying for their insulin or paying their rent. Thankfully the Special Diabetes Program for Indians is ensuring access to health care. The vital services provided by the SDPI are invaluable and have proven success in decreasing diabetes prevalence in the American Indian/Alaska Native populations that are most susceptible. As our nation battles a pandemic exacerbated by diabetes, it is imperative that the Special Diabetes Program for Indians be reauthorized for the long-term to ensure better outcomes for the patients and families who depend on this critical care.”

American Indians and Alaska Natives (AI/ANs) have a greater chance of having type 2 diabetes than any other group. SDPI is an extremely successful program for both Tribes and for Urban Indian Organizations (UIOs).

Background

The Special Diabetes Programs for Indians Reauthorization Act of 2020

  • Reauthorizes funding for the SDPI for 5 years, from fiscal years 2021 through 2025.
  • Provides an increase in funding from $150 million to $200 million per year.
  • Allows tribal awardees to have the option to receive SDPI funds through self-governance contracts, cooperative agreements, or compact under the Indian Self-Determination and Education Assistance Act (ISDEAA).

https://www.mcsally.senate.gov/news/press-releases/mcsally-introduces-bill-to-reauthorize-the-special-diabetes-program-for-indians

Text of the bill can be found HERE.

Center for American Progress Recommends Urgent Action to Address the Chronic Underfunding of the Indian Health Service System and Disparities in Urban Indian Health

On June 18, 2020 the Center for American Progress, a Washington DC based think tank, released report on the COVID-19 response in Indian Country. The detailed report focuses on 7 key areas for addressing health inequities in Indian country during the pandemic: inclusion in COVID-19 data; addressing bureaucratic barriers; supporting tribal economies; addressing the underfunded Indian health system; developing critical infrastructure; funding tribal public safety and justice needs, and restoring tribal homelands. The report highlighted how underfunded the Indian health system was prior to COVID-19 and elaborated on how much stress Urban Indian Organizations (UIOs) have been under since the pandemic began.

The report included recommended policy solutions for better funding and supporting Indian Health Service (IHS). Topping the list of solutions is increasing funding for IHS and prioritizing urban Indian health. The other solutions mirror those UIOs have been asking for: access to the Strategic National Stockpile; reauthorization of the Special Diabetes Program for Indians (SDPI); to include pharmacists; licensed marriage and family therapists, and licensed counselors as eligible providers for Medicare reimbursement; extending Medicare telehealth waivers; and removing restrictions and barriers for UIOs. Most importantly, the report calls for the inclusion of UIO-specific language in all Indian health system related legislation to ensure UIOs receive the resources intended.

Key Highlights

Recommendation: Address the chronic underfunding of the Indian Health Service system

The IHS is the federal agency that oversees and provides health care to AI/AN communities through Indian tribes, tribal organizations and urban Indian organizations, together known as the I/T/U system. Before COVID-19, the IHS was already so underfunded that expenditures per patient were just one-fourth of the amount spent in the veteran’s health care system and one-sixth of what is spent for Medicare.33 IHS facilities are, on average, understaffed by 25 percent.34 Now, the IHS is scrambling to provide crisis services to a vulnerable and hard-hit constituency with its stretched-thin staff, inadequate facilities, and severe lack of funds.

While the CARES Act provided $1 billion to the IHS, unmet needs are estimated at $32 billion.35 Federal assistance during the pandemic has not been forthcoming; the Sault Ste. Marie Tribe of Chippewa Indians, for example, received only two test kits for a tribe of 44,000 people.36 The Oyate Health Center, a major health provider in Rapid City, South Dakota, which transitioned into tribal management in 2019, received almost no tests, PPE, or cleaning supplies.37 The Seattle Indian Health Board was sent body bags when it asked for more medical supplies to fight COVID-19.38 Urban Indian organizations are some of the worst hit, with 83 percent forced to reduce services and almost half unable to deliver medicine.39 Overwhelmed facilities are forced to fly patients into larger cities for treatment and must foot the transportation bill.40

The I/T/U system requires an urgent injection of funds and investment in capacity, but the likelihood of a prolonged COVID-19 pandemic lasting months or years necessitates that the federal government not renege on its duties to support the treatment of diabetes, asthma, substance abuse, and other immunocompromising diseases that are increasing the AI/AN fatality rate.

Immediate policy solutions:
  • Increase immediate funding to the IHS and prioritize urban Indian health, including access to the national service supply center for essential testing equipment; equipment purchases and replacements; and IHS hospitals and health clinic on-site treatment capacity
  • Expedite the reauthorization of the IHS Special Diabetes Program for Indians (SDPI) and other programs that deal with immunocompromising conditions that require uninterrupted care
  • Provide all I/T/U facilities access to the Strategic National Stockpile and Public Health Emergency Fund
  • Include pharmacists, licensed marriage and family therapists, licensed counselors, and other providers as eligible provider types under Medicare for reimbursement to I/T/U facilities in order to lessen the burden of mental health on immunity
  • Extend waivers under Medicare for the use of telehealth in Indian Country
  • Remove restrictions and barriers on care provision through urban Indian health organizations
Long-term policy solutions:
  • Increase funding for the IHS and strengthen coordination among federal, tribal, state, and local health agencies
  • Fund job-training programs to address staff shortages through the Indian Health Care Improvement Act
  • Provide a tax incentive for IHS professionals similar to other public sector health workers
  • Ensure an explicit mention of urban Indian organizations in I/T/U-related legislation to combat the invisibility of urban AI/AN suffering

https://www.americanprogress.org/issues/green/reports/2020/06/18/486480/covid-19-response-indian-country/

Statement of Solidarity

Washington, DC (June 17, 2020) – Today, the National Council of Urban Indian Health released the following statement:

We stand in solidarity with our Black relatives who have been subject to centuries of violence. The recent senseless murders of George Floyd, Breonna Taylor, and Ahmaud Arbery, are a painful reminder of this country’s dark history that has not been forgotten. The National Council of Urban Indian Health stands with our Black brothers and sisters and our Afro-Indigenous relatives. We condemn racism in any form and demand justice from the system that caused this suffering.

Our world has spent the past few months embroiled in battle against a pandemic that is disproportionality affecting communities of color. The structures which created this country left a legacy of systemic racism that has directly affected the health and well-being of our communities. While the pandemic has only cast a cloud on our communities more recently, Black Americans and Native Americans have been battling for generations. As the world takes to the streets, we see that our brothers and sisters are in pain.

The COVID-19 pandemic has brought many underlying health disparities to the surface. Socioeconomic disparities are one of the largest factors in determining health outcomes, and here Black Americans and Native Americans top the charts again. With a lack of access to quality food, housing, and education combined with intergenerational trauma, both communities already face staggering inequities. The added stress of a pandemic is enough to topple communities and cause death rates to skyrocket. Especially when these populations are more likely to be low-wage, essential workers, and less likely to have access to essential resources like running water. The exact same disparities which underlie the health crisis in our communities are the ones that create over-policing in our communities, disproportionate use of force by the police, and higher rates of incarceration. But we know these disparities did not arise on their own.

The United States was built atop stolen land, and it was built by stolen bodies, stolen labor. The United States owes an invaluable debt to its Indigenous population and its slave descendants.

But now is the time to begin trying to heal old wounds through instituting lasting systemic change. We cannot heal when senseless murders are happening in our communities each day. It is time for the United States to invest in the communities who built this country.

As Natives, we cannot remain silent as the population who holds with us in every regard continues to die in the streets. As health care professionals, as we’re in the midst of a another public health crisis, systemic racism, we cannot remain silent as the mental, physical, and spiritual health of this Nation is in peril due to the historical traumas our peoples have endured for centuries. We cannot allow this world to steal the breath from another soul. We cannot continue to support the system as it exists, as it is working the way it was meant to- against Black and Brown lives. We must be active in holding the United States accountable to change.

We urge you to educate and require more of yourself, your peers, and your family members. We must speak out in the face of blatant racism, in the face of microaggressions, to be prepared to make mistakes and to learn from them. It is long past time to create space for Black and Afro-Indigenous voices. Together, we will continue fight against any discrimination within our communities. Today, and tomorrow, we call on you to lend your resources, your signature, and your voice as we demand systemic change. It is we who are responsible for creating a better society.

We remember Philando Castile, Tamir Rice, Eric Garner, Sandra Bland, Michael Brown, Trayvon Martin, we remember Paul Castaway, Zachary Bearheels, Sarah Lee Circle Bear, Corey Kanosh, Jason Pero, and we remember the countless others whose lives touched our communities but whose names never see a headline.

To the Black community—we know these injustices will not be undone in a week, in a month, a year. It will take constant commitment from the entire Nation. The traumas you have faced, know you are not alone in them, and that we will heal together. As Natives we know we are all connected, that the Black community needs investment and healing but it is not an island alone. We must share our resources and share our healing. You cannot be healthy while everyone else around you is sick. We must heal each other by investing in one another. And for our Afro-Indigenous relatives, we want to assure you that you have a safe space in our Urban Indian Organizations, and that your voices are not only heard but are cherished. We are resilient and we are still here because we can stand together. #NativesforBlackLives

“The beauty of anti-racism is that you don’t have to pretend to be free of racism to be an anti-racist. Anti-racism is the commitment to fight racism wherever you find it, including in yourself. And it’s the only way forward.” -Ijeoma Oluo

Urban Indian Organizations represent the trust responsibility the federal government has to its non-reservation Native populations. The trust responsibility is a recognition of the debt the United States owes its Indigenous population, health care we paid for with our land and blood.

Recommended Reading

  • “How to Be an Antiracist” by Ibram X. Kendi
  • “White Fragility: Why It’s So Hard for White People to Talk about Racism” by Robin DiAngelo
  • “Biased: Uncovering the Hidden Prejudice That Shapes What We See, Think, and Do” by Jennifer L. Eberhardt
  • “The New Jim Crow: Mass Incarceration in the Age of Colorblindness” by Michelle Alexander
  • “So You Want to Talk About Race” by Ijeoma Oluo
  • “Raising White Kids” by Jennifer Harvey
  • “The Black and the Blue: A Cop Reveals the Crimes, Racism, and Injustice in America’s Law Enforcement” by Matthew Horace and Ron Harris
  • “Just Mercy: A Story of Justice and Redemption” by Bryan Stevenson
  • “The Fire Next Time” by James Baldwin
  • “They Can’t Kill Us All: Ferguson, Baltimore, And A New Era In America’s Racial Justice Movement” by Wesley Lowery
  • “Hood Feminism: Notes From The Women That The Movement Forgot” by Mikki Kendall
  • “Ain’t I a Woman: Black Women and Feminism” by Bell Hooks
  • “Open Season: Legalized Genocide of Colored People” by Ben Crump
  • “From Slavery To Freedom: A History of African Americans” by John Hope Franklin
  • “The Third Reconstruction: How a Moral Movement Is Overcoming the Politics of Division and Fear” by Jonathan Wilson-Hartgrove and William Barber II
  • “Between the World and Me” by Ta-Nehisi Coates
  • “Stamped: Racism, Antiracism, and You” by Jason Reynolds and Ibram X. Kendi

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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.

Senators Murkowski, Manchin, and Sinema Introduce NCUIH Endorsed Legislation to Help Families and Children Facing Homelessness During COVID-19

Fact Sheet on the Bill

Text of the Bill

On June 10, Senators Lisa Murkowski (R-AK), Joe Manchin (D-WV), and Kyrsten Sinema (D-AZ) introduced the bi-partisan Emergency Family Stabilization Act. This legislation creates an emergency funding stream to provide grants for organizations that assist children, youth, and families experiencing homelessness during the COVID-19 pandemic. The program will be overseen by the Administration for Children and Families, a division of the Department of Health and Human Services (HHS). The legislation aims to provide emergency funding to underserved populations and areas, including those in rural and tribal communities. UIOs are included in the bill and are considered family stabilization agencies, therefore UIOs would be eligible for competitive grants through this legislation. The National Council of Urban Indian Health is an endorsing organization for the Emergency Family Stabilization Act and fought for the inclusion of UIOs in the legislation.

“We applaud Senators Lisa Murkowski (R-AK), Joe Manchin (D-WV),  Dan Sullivan (R-AK), and Kyrsten Sinema (D-AZ) in advocating for support for children, youth, and families in crisis or experiencing homelessness during the COVID-19 pandemic. Amidst a deadly pandemic, urban Indian organizations are continuing to serve families and individuals experiencing homelessness. As many homeless shelters are closed, American Indians and Alaska Natives depend on the life-saving culturally-competent care and community services they are receiving from our programs right now. We are hopeful that Congress will act quickly to get the resources to the children, youth, and families who need them most,” said Francys Crevier, Executive Director of NCUIH.

NCUIH Testifies Before Congress on First-Ever COVID-19 Oversight Hearing with IHS

Executive Director Francys Crevier stressed the need for the federal government to uphold the trust responsibility to Indian Country.

Washington, DC (June 11, 2020) – Today, the House Committee on Appropriations Subcommittee on Interior, Environment and Related Agencies held a hearing on the Indian Health Service (IHS) Covid-19 Response. The first panel included Rear Admiral Michael Weahkee, Director of IHS. The second panel started with Stacy Bohlen, CEO of the National Indian Health Board and finished with Francys Crevier, Executive Director of the National Council of Urban Indian Health (NCUIH). The hearing brought attention to the disparate impacts of the COVID-19 pandemic on Indian Country and the response by the Indian Health Service.

“On behalf of the National Council of Urban Indian Health (NCUIH), which represents 74 urban Indian facilities across the country, we are grateful for your tireless efforts in ensuring all of Indian Country has the resources needed to protect and care for our relatives. This disease, like the federal obligation to Native people, does not stop at the borders of a reservation. This pandemic has exacerbated the long-standing behavioral health disparities due to decades of historical trauma and will have lasting impacts for years to come. We thank you for including urban Indians in COVID-19 legislation. We urge Congress and the Administration to honor the federal trust obligation by providing the whole IHS System with all the resources necessary to serve the families who need them most,” said Francys Crevier, Executive Director of NCUIH in her testimony.

“The United States government has a trust responsibility to Indian tribes and signed treaties promising to provide health care and other services. Hundreds of years later, the failure to meet these treaty and trust obligations continues…The federal government has not been able to overcome the historical neglect and meet the true needs of Indian Country,” said Chair Betty McCollum in her opening remarks.

“All of the resources [from Congress] make a real difference in helping to fulfill our IHS mission as we continue to work with tribal and urban Indian organization partners to deliver crucial services during the pandemic,” said Rear Admiral Michael Weahkee in his remarks.

Hearing Information

Chair Betty McCollum

Rear Adm. Michael D. Weahkee  Director, Indian Health Service

Stacy Bohlen Chief Executive Officer, National Indian Health Board

Francys Crevier Executive Director, National Council of Urban Indian Health

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NCUIH Testimony Highlights

  • NCUIH requests that funds appropriated to UIOs by Congress are swiftly appropriated.  “COVID-19 funds have been needlessly tied up for weeks – and in more than instance months – by other agencies, thereby creating unnecessary barriers to pandemic response at UIOs”.
  • NCUIH requests that “UIOs have avenues for direct communication with agencies charged with overseeing the health of their AI/AN patients, especially during the present health crisis.” “Only IHS has a statutory requirement to confer with UIOs, which has enabled other agencies to ignore the needs of urban Indians and neglect the federal obligation to provide health care to all AI/ANs – including the more than 70% that reside in urban areas.”
  • NCUIH requests that Congress and federal agencies continue to act to ensure that UIOs can access PPE and testing equipment. During the pandemic “UIOs were not allocated any Abbott Rapid Response tests from IHS or FEMA. We have had to fight every step of the way for any testing capabilities”.
  • NCUIH requests that the federal government remedy longstanding inequities that UIOs face including
    • 100% Federal Medical Assistance Percentage (FMAP) reimbursement for UIOs
    • Federal Tort Claims Act coverage for UIOs
    • Reimbursement from the VA for services provided to Native Veterans
    • Including UIOs in the national Community Health Aide Program and Indian Health Care Improvement Fund
  • NCUIH requests that “the federal government ensures our frontline heroes receive the same protections as all other public health employees and provides adequate resources to UIOs to enable the continued provision of high quality and essential services. UIOs need equal access to programs like the Community Health Aide Program and community health workers to get to high risk patients.”
  • NCUIH requests that UIOs are given access to facilities funding through at least an $80 million urban facilities line item. “Some facilities are located in 50+ year old buildings that already required expensive repairs and these needs have been significantly exacerbated by the pandemic.” UIOs need funding “in order to include necessary improvements like physical separations to enable safe distancing, air purification systems, and negative pressure rooms to control viral spread.”
  • NCUIH requests that IHS release previously appropriated funds for UIOs to build telehealth capacity.
  • NCUIH appreciates that the HEROES Act includes $1 billion for third party reimbursement relief, however NCUIH “urges Congress to include the full amount of $1.7 billion as recommended by the coalition of national Native American organizations.”
  • NCUIH requests $7.3 million in annual appropriation for behavioral health at UIOs for the next three years to address the previous unmet need for behavioral health funding and account for the increase in behavioral health services due to COVID-19 that will remain for years to come.

Interior Appropriations Subcommittee Testimony National Council of Urban Indian Health

Francys Crevier, Executive Director

June 11, 2020

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.

Chair McCollum, Ranking Member Joyce and Members of the Subcommittee, thank you for inviting me to speak on the impacts of the COVID-19 pandemic on urban Indian health. On behalf of the National Council of Urban Indian Health (NCUIH), which represents 41 urban Indian organizations (UIOs) that serve American Indians and Alaska Natives (AI/ANs) at 74 facilities across the country, we would like to express our gratitude for your tireless efforts in ensuring all of Indian Country has the resources needed to protect and care for our relatives during this pandemic. We also appreciate your commitment to ensuring that the 70% of AI/ANs residing in urban areas have access to critical health care. There is more work to be done and we look forward to working with Congress on ensuring that future emergency legislation provides urban Indian organizations resources to address this crisis. To that end, today I am going to testify with respect to the need for additional resources for UIOs to respond to the pandemic, including at least $80 million in facilities and infrastructure funding, coverage for significant losses in third-party reimbursement dollars, behavioral health funding, and parity for UIOs among the I/T/U system.

Decades of underfunding of the Indian Health Service (IHS) system, coupled with added burdens of chronic disease, put AI/ANs at higher risk of poor outcomes due to COVID-19. The disproportionate impact COVID-19 has on AI/ANs, like the federal obligation for the provision of health care to AI/AN people, does not stop at the borders of a reservation. For instance, AI/ANs are 3 times more likely to have diabetes, more than 1.5 times more likely to have been hospitalized for respiratory infections in the past, and more than 1.5 times more likely to have coronary heart disease than non-Hispanic whites. The Centers for Disease Control and Prevention has identified these conditions as specific risk factors for more serious illness due to COVID-19. Disparities in other social determinants of health also contribute to a disproportionate impact of the novel coronavirus on AI/AN people. During the H1N1 outbreak of 2009, AI/ANs were 4.1 times more likely to die than non-AI/AN people. It is thus essential to continue to provide essential resources to the IHS system – comprised of IHS facilities, tribal facilities, and UIOs – which has been hard hit by the pandemic as facilities shift their operations to prepare for, prevent, and respond to increases in COVID-19 among their patient populations. For instance, one UIO facility in San Jose, California recently reported a 13% positive test rate – higher than the national average.

During the course of the pandemic, 4 programs had to close their doors due to lack of resources and personal protective equipment (PPE) necessary to keep staff and patients safe from this deadly virus and only serve some patients remotely. Thankfully, PPE has become more available and emergency funds have started to flow into UIOs, which has allowed at least 1 program to reopen. At the beginning, however, delays in funding were extremely troublesome. Now, IHS is hosting weekly calls with our leaders and that has been invaluable to ensuring our programs can continue to serve the patients who need them most. We commend IHS for the agency’s invaluable partnership and tireless efforts to disseminate resources to Tribes and UIOs as expeditiously as possible. Unfortunately, funds have been needlessly tied up for weeks – and in more than instance months – by other agencies, thereby creating unnecessary barriers to pandemic response at UIOs. Compounding on this, only IHS has a statutory requirement to confer with UIOs, which has enabled other agencies to ignore the needs of urban Indians and neglect the federal obligation to provide health care to all AI/ANs – including the more than 70% that reside in urban areas. In fact, NCUIH has been unsuccessful at facilitating dialogue between numerous federal agencies and UIO-stakeholders, despite several attempts. This is not only inconsistent with the government’s responsibility, but is contrary to sound public health policy. Agencies have been operating as if only IHS has a trust obligation to AI/ANs, and that causes an undue burden to IHS to be in all conversations regarding Indian Country in order to talk with agencies. It is imperative that UIOs have avenues for direct communication with agencies charged with overseeing the health of their AI/AN patients, especially during the present health crisis.

In addition, the COVID-19 pandemic has highlighted the urgency of rectifying the long-standing inequities UIOs face. Everyone in the country has been fighting for PPE and testing kits. However, those sudden challenges compound the difficulty providing care when combined with the chronic funding and infrastructure gaps UIOs already experience. UIOs were not allocated any Abbott Rapid Response tests from IHS or FEMA. We have had to fight every step of the way for any testing capabilities, meanwhile, at least in two areas UIOs have been leading the way in getting testing available for the counties in which they are located. UIOs are a strong partner in their communities, and yet many have been forced to significantly ramp up facilities and infrastructure and pay premium prices for scarce supplies. These excess costs cascade on top of the extremely limited federal funding UIOs receive, as UIOs receive primary funding from only one line item of IHS – urban Indian health – funded at just below $58 million in FY 2020. Congressional and Administrative action has proved essential to enable UIOs to respond to the pandemic – and must continue as UIOs continue to face this crisis, the response to which mandates additional resources that are also flexible.

For instance,  all of this compounds on the inequities UIOs already face – for instance, the federal government does not reimburse states for 100% of the cost of Medicaid services at UIOs like it does for IHS and tribal facilities and UIOs are forced to expend millions of dollars each year in malpractice insurance because they do not receive Federal Torts Claims Act coverage like employees at IHS and tribal facilities (and both employees and volunteers at Community Health Centers). And, UIOs have been interpreted as ineligible for other essential programs or cost-saving measures – including reimbursement from the VA for services to Native Veterans, the national Community Health Aide Program, and Indian Health Care Improvement Fund, to name just a few. All of these factors have contributed to the novel coronavirus’s devastating impacts on UIOs. As our health workers are risking their lives every day, we need the federal government to ensure our frontline heroes receive the same protections as all other public health employees and provide adequate resources to UIOs to enable the continued provision of high quality and essential services. UIOs need equal access to programs like CHAP and community health workers to get to high risk patients.

A March 2020 NCUIH survey found that 83 percent of UIO-respondents have been forced to reduce their services, with 48 percent reporting no capacity for medicine delivery, and 28 percent reporting no capacity for triage space. Distancing guidelines tell us more than ever that proper capacity in essential facilities, such as health care facilities, is necessary. Just because UIOs do not receive funding under other line items does not mean the costs do not exist. UIOs do not have access to facilities funding under the IHS facilities budget line item and also don’t have access to the COVID-19 funding designated for facilities appropriated to the IHS. Now with the pandemic, it is an urgent priority to adequate fund an urban facilities line item to fund the renovations with accreditation restrictions and construction needed to protect our providers as well as their patients. Some facilities are located in 50+ year old buildings that already required expensive repairs and these needs have been significantly exacerbated by the pandemic. Without any federal funding for facilities, UIOs are forced to use their limited resources such as third party revenue that has drastically declined for essential infrastructure fixes – which during the pandemic include necessary improvements like physical separations to enable safe distancing, air purification systems, and negative pressure rooms to control viral spread. Residential Treatment Centers are faced with how to keep their patients housed within their programs, but also safe from the threat of COVID-19, which also means less patients receive care due to social distancing. They need modular buildings and funding for facilities renovation to ensure patients are not exposed to COVID-19 while seeking treatment. In addition, a recent NCUIH survey found that 26% of UIO-respondents needed a new urgent care facility, 26% needed a new infectious disease area, 31% require new modular facilities, and 20% require a new non-emergent care facility. For these reasons, a minimum of $80 million facilities appropriation for UIOs is absolutely vital to maintain the high quality provision of health care to AI/ANs residing in urban areas. Because each UIO is a unique organization with different capacities, patient populations, and community needs, as well as differing degrees of severity in local COVID-19 outbreaks, these funds must be flexible for use in facilities renovation and infrastructure. IHS received over $900 million in facilities funding last year, and Congress allocated $125 million for facilities in the CARES Act and proposed $366 million in the HEROES Act. IHS continues to be underfunded and we fully support desperately needed funding for Tribes. UIOs are eligible for $0 for facilities funds; it is imperative that this is remedied immediately to ensure access to care for our patients.

As UIOs have shifted to respond to the pandemic, telehealth and telemedicine capacity has become an essential component of health care delivery and something for which UIOs must expend considerable resources. IHS has allocated $95 million for telehealth capacity building at I/T/U facilities – but UIOs have not yet seen this funding, despite the immediate need. For instance, one facility has resorted to the purchase of old phones for patients to enable them to access telemedicine visits offsite. This funding is needed now to address these immediate concerns in the middle of the crisis and to prepare for the additional waves of the virus in the immediate future, as public health officials predict.

By being forced to cancel much of the routine care UIOs conduct, billable services have significantly declined, eliminating or severely reducing third-party reimbursement. That source of funding is critical to maintain UIOs’ operations, facilities and staffs. We support the inclusion in the HEROES Act funding of $1 billion for third-party relief, however, we urge Congress to include the full amount of $1.7 billion as recommended by the coalition of national Native American organizations, including the organizations you’re hearing from today. It is of the utmost importance that these funds be available to UIOs and that this does not create yet another lack of parity in the IHS system.

Finally, it is imperative that Congress appropriate funds for the significantly increased need for behavioral health services at UIOs. UIOs do not receive direct funds from the Mental Health, or Alcohol and Substance Abuse line items and instead must use the urban Indian health line item to account for these essential services. The COVID-19 pandemic and its unprecedented impacts on society have already led to an increased need for behavioral health services. Even before the pandemic, AI/ANs residing in urban areas faced significant behavioral health disparities – for instance, 15.1% of urban AI/ANs report frequent mental distress as compared to 9.9% of the general public and the AI/AN youth suicide rate is 2.5 times that of the overall national average. Congress must appropriate funds to not only address the previous unmet need but account for the increase in behavioral health services that is now critical and will remain so for years to come. TO that end, we respectfully request a $7.3 million in annual appropriation for behavioral health at UIOs for the next 3 years.

It is the obligation of the United States government to provide these resources for AI/AN people residing in urban areas. We thank Congress for the inclusion of UIOs in prior COVID-19 legislation and urge Congress to continue to take this obligation seriously by providing UIOs with all the resources necessary to protect the lives of their AI/AN patient populations. We request Congress continue to explicitly include UIOs in legislation where the whole Indian Health Care delivery system, I/T/U, is meant to benefit. Finally, we respectfully request that, as the FY 2021 appropriations process is underway, Congress keep in mind the significant and devastating strain unforeseen emergencies like the present pandemic and government shutdowns have on the underfunded Indian health system – and the additional stress that UIOs are faced with due to lack of inclusion in critical programs. As you know, Black and Brown lives matter and this committee has the opportunity to be the change we wish to see in this country. We are grateful for you for holding for this hearing today and for making sure our tribal members living in urban areas are not left behind.

HHS Issues New Lab Reporting Guidance for COVID-19

In accordance with the recently passed Coronavirus Aid, Relief, and Economic Security (CARES) Act, the U.S. Department of Health and Human Services (HHS) issued new guidance that requires all laboratories to submit COVID-19 testing results in real-time, within 24 hours of an individual being tested, along with additional demographic data to HHS.The goal of the guidance is to provide public health officials with the best information available to inform their responses and recommendations concerning COVID-19.

The new reporting requirements are designed to monitor disease trends in an effort to better anticipate and allocate resource needs. The additional demographic data reporting measures will help identify and address any disparities and ensure that all groups have equitable access to testing.

IHS Granted Sixth Year of SDPI Grant Cycle

On May 20, 2020, the Indian Health Service (IHS) released a Dear Tribal and Urban Organization Leader Letter to provide updates about the Special Diabetes Program for Indians (SDPI). The letter stated that In the Coronavirus Aid, Relief, and Economic Security (CARES) Act. SDPI was allocated $150 million for fiscal year (FY) 2020 and $25 million for FY 2021. With the additional FY 2020 funds, all current SDPI grants have now been authorized up to their full annual grant amounts.

The letter also noted that the current authorization for SDPI expires on November 30, 2020, ending the SDPI 5-year grant cycle. However, IHS stated that with the “high volume of demands related to the COVID-19 pandemic” IHS anticipated that this would be a difficult time to have grantees prepare a competitive application. “Accordingly, the IHS requested and the Department of Health and Human Services granted us an exception to allow FY 2021 to be added as a sixth year to the current SDPI grant cycle extending it through FY 2021.” This means that IHS is able to employ a continuation application process for FY 2021, which is a less demanding application process for grantees.

CDC Reports COVID-19 has Disparate Impact on Minorities including American Indians and Alaska Natives

A Centers for Disease Control (CDC) report presented to lawmakers revealed the disparate impact that COVID-19 is having on racial and ethnic minorities. The report found that while African Americans make up 13% of the U.S. population, they constitute 27% of all coronavirus cases. Hispanic or Latino Americans constitute 28% of all cases, while making up only 18% of the U.S. population. While the rate of infection varies among the American Indian/Alaska Native population, the Navajo Nation currently has the highest per-capita infection rate of COVID-19 in the United States. This demographic data is not complete as it has only been available in 47.9% of cases.

These racial disparities and lack of comprehensive demographic data have caught the attention of Rep. Rosa DeLauro (D-Conn.). Rep. DeLauro serves as the Chairwoman of the House Appropriations HHS and Education Subcommittee. She told reporters that she wanted more funding to be appropriated to address and get more information on these health disparities. “I will continue to push for funding to reduce health disparities in subsequent relief packages as well as in the appropriations bill which we will begin to write for 2021,” Rep. DeLauro said. According to Rep. DeLauro, it would take approximately $750 million over a few years in order to get quality health data. The CARES Act, which was passed in response to the pandemic, allocated $500 million for public health surveillance and analytics.

Throughout the pandemic, NCUIH has fought to obtain access to coronavirus funding for UIOs in order to ensure that American Indians and Alaska Natives are not left behind during this crisis.