HHS Publishes Revised AFCARS Final Rule Streamlining ICWA-related Reporting

On May 12, 2020 the Department of Health and Human Services (HHS) published a final rule with revisions to the Adoption and Foster Care Analysis Reporting System (AFCARS) regulations. The streamlined final rule will lessen the AFCARS data-reporting requirements for Title IV-E agencies.

The expanded 2016 AFCARS regulations covered Indian Child Welfare Act of 1978 (ICWA)-related data elements to be reported to HHS. The streamlined rule asked Title IV-E agencies to report if a child is an Indian child as defined by ICWA, if the child is a tribal member, of which tribe a child is a member of, and if the ICWA applies to the child, was the tribe sent legal notice. No other ICWA-related data elements are to be reported.

The National Council of Urban Indian Health submitted comments on the potential rule change, as did Tribes and tribal organizations. Commenters with tribal interests did not support reduction in the data elements of required reporting and requested all ICWA-related data elements be reinstated from the 2016 Final Rule as they are needed to assess ICWA compliance. The commenters also claimed the data helps to address disparities and analyze outcomes for Indian children and families.

The Administration for Children and Families (ACF) explained the reduction in the ICWA-related data elements was recommended due to the low population of American Indian/ Alaska Native children in foster care. ACF further explained that DOI is the lead agency for all ICWA compliance and the 2016 ICWA-related data elements place HHS in a position of interpreting ICWA requirements without having the authority to do so. The only authority they have is over the collection data elements related to the Title IV-E programs.

The rule will go into effect on July 13, 2020.

IHS Announces Phase 4 COVID-19 Funding Allocation Decisions

Includes $50 million to UIOs for testing

On May 19, 2020 the Indian Health Service (IHS) announced the most recent round of COVID-19 funding determinations in a Dear Tribal Leader and Urban Indian Organization Leader Letter (DULL).  The DULL outlines the total allocations for the $750 million appropriation for Indian Country Health Care Providers in the Paycheck Protection Program and Health Care Enhancement Act (PPPHCEA).  The Act was signed into law on April 24, 2020 and provided the funding to the Department of Health and Human Services (HHS) under the Public Health and Social Services Emergency Fund, to be used in support of testing and testing related activities for Tribal Health Programs (THPs) and Urban Indian Organizations (UIOs).

IHS’s funding determinations include $50 million for UIOs, which will be distributed through the existing Indian Health Care Improvement Act (IHCIA) contracts. As outlined in the Act, the funds are to be used for the purchase, administration, process, and analysis of COVID-19 testing, including the support for workforce, epidemiology, and use by employers in other settings. UIOs IHCIA contracts will receive modified scopes of work and bilateral modifications to their IHCIA contracts consistent with the funding purposes for which the funds were appropriated.

Other funding determinations announced in the DULL include $550 million to IHS Federal health programs and THPs, of which $50 million is to be used for new Purchased/ Referred Care (PRC) funds. $100 million will be used to purchase tests, testing supplies, and PPE for the IHS National Supply Service Center (NSSC). UIOs are eligible to receive supplies from the NSSC. The final $50 million is allocated for nation-wide coordination, epidemiological, surveillance, and public health support.

This third round of COVID-19 funding comes after the April 29, 2020 Urban Confer and Tribal Consultation calls regarding this funding as well as weekly IHS-hosted UIO Leader COVID-19 calls advocated for by the National Council of Urban Indian Health (NCUIH). NCUIH continues to advocate on behalf of UIOs and the urban Indian populations they serve during this public health crisis.

Read the DULL

Policy Alert: NCUIH to Testify Before House Appropriations on COVID-19 Response

The House Interior Appropriations Subcommittee will hold a hearing on Indian Health Service Covid-19 Response on Thursday, June 11 at 1:00 PM ET.

On June 11, 2020, Executive Director Francys Crevier of the National Council of Urban Indian Health (NCUIH) will testify before the House Appropriations Subcommittee on Interior, Environment, and Related Agencies. The hearing is on the COVID-19 Response and will be led by Chair Betty McCollum and Ranking Member David Joyce.

Watch the hearing live here.


Panel one

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

Panel two

Stacey Bohlen
Chief Executive Officer, National Indian Health Board

Francys Crevier
Executive Director, National Council of Urban Indian Health

PRESS RELEASE: Senate Passes Package with Health Care Access for Urban Native Veterans Act at a Critical Time


Contact: Meredith Raimondi, 202-932-6615, mraimondi@ncuih.org

The Health Care Access for Urban Native Veterans Act was also included in the House passed HEROES Act.

Washington, DC (June 4, 2020) – Today, the Senate passed S. 886, the Indian Water Rights Settlement Extension Act with a substitute amendment offered by Senators Tom Udall, Jerry Moran and Mitt Romney. The four-bill package included S. 2365, the Health Care Access for Urban Native Veterans Act of 2019 which allows the Indian Health Service and the U.S. Department of Veterans Affairs to enter into agreements for the sharing of medical facilities and services with urban Indian organizations.

“In the middle of pandemic that is ravaging Native communities, urban Indian veterans are being left behind by the United States government. Now more than ever, Native veterans need access to life-saving health care. We are grateful for the Senate Committee on Indian Affairs including Chairman Hoeven and Ranking Member Udall for recognizing the urgency of pushing this legislation across the finish line,” said Francys Crevier, Executive Director.

Current Status

The House of Representatives companion bill (H.R. 4153) was ordered to be reported favorably by the Committee on Natural Resources on March 11, 2020. It was also included in the recent HEROES Act passed by the House on May 15, 2020.

Background on S.886

S. 886, the Indian Water Rights Settlement Extension Act, as amended, includes:

  • S. 2365, the Health Care Access for Urban Native Veterans Act of 2019 allows the Indian Health Service within the U.S. Department of Health and Human Services, U.S. Department of Veterans Affairs, and the U.S. Department of Defense to enter into agreements for the sharing of medical facilities and services with urban Indian organizations;
  • S. 279, the Tribal School Federal Insurance Parity Act
  • S. 1875, the Aamodt Litigation Settlement Completion Act of 2019
  • S. 1207, the Navajo-Utah Water Rights Settlement Act

Background on the Health Care Access for Urban Native Veterans Act

Last year, the National Congress of American Indians passed a resolution calling on Congress to “enact legislation ensuring the provision of health care to American Indian and Alaska Native veterans living in urban centers.” This important urban Indian health bill also has widespread endorsements by NCUIH’s valued partners across Indian Country along with valuable veteran organizations, Iraq and Afghanistan Veterans of America, and VoteVets.


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.