Join the NCUIH Youth Council’s Indigi-Wellness Healer Campaign!

Koolamaski/ Hello my name is Faith Bowman. I am from the Stockbridge-Munsee Band of Mohican Nation in Wisconsin and I am currently a graduate student at the University of Utah.  am here as an alumni of the NCUIH Youth Council and to share with you the amazing work the 2020 Youth Council has been doing.

First, I want to say Anushiik, Yaw^ko, and give many thanks to all who participated in the Healing Gathering. The 2020 youth council is dedicated to helping Urban Native youth in their cultural, spiritual, and wellness journey. This year’s focus is on healthy relationships and indigenous love and overall wellness. As Native youth continue to struggle with wellness challenges because of COVID-19, NCUIH’s youth council wants to create a platform that amplifies youth voices and stories to the national level through its Indigi-Wellness Healer Campaign.

Join the Indigi-Wellness Healer Campaign

NCUIH’s Youth Council is excited to share that the Indigi-Wellness Healer Campaign. The Indigi-Wellness Healer Campaign is a social media campaign By Native Youth FOR Native Youth consisting of two hashtag themes- #NativeHealing and #IndigiLove- to express the importance of mental & physical wellness and healthy Native relationships, especially during the coronavirus pandemic.

Anushiik (Thank you)!

Click on the links below for more information

Visit Campaign Website to Download Toolkit, Create/Submit your Post & Win Amazing Prizes

Enter the Indigi-Wellness Healer Campaign Social Media Raffle and/or Concept Contest by August 20, 2020 @ 11:59 PM ET to win prizes from WE R NATIVE, Healthy Native Youth, United National Indian Tribal Youth, Inc (UNITY), the Center for Native American Youth and more!

RSVP to Indigi-Wellness Healer Campaign

NCUIH Vice President Testifies on FTCA Coverage for UIOs

On July 22, Robyn Sunday-Allen, NCUIH Vice President and Chief Executive Officer of the Oklahoma City Indian Clinic, testified before the House Subcommittee for Indigenous Peoples of the United States. Ms. Sunday-Allen testified in support of H.R. 6535, the Coverage for Urban Indian Health Providers Act. H.R. 6535 would extend Federal Tort Claims Act coverage to urban Indian organizations (UIOs).

“At the Oklahoma City Indian Clinic, we spend approximately $200,000 annually on malpractice insurance, money which would be more effective if used to provide culturally competent health care to urban AI/ANs. If UIOs were covered under the FTCA, we would put every one of these dollars back into services including, but not limited to mammograms, pap smears, immunizations (adult and children), and dental sealants,” said Ms. Sunday-Allen.

During the hearing multiple parties expressed support for H.R. 6536:

“This fix would save UIOs up to $250,000 per year in coverage costs, money that can be instead spent directly on patient care. This is especially important during the current crisis which has hit UIOs extremely hard, with over 80 percent of clinics reporting cuts to services due to resource shortages. 70 percent of Native Americans today live in urban settings making our support for urban Indian organizations essential to ensuring that health care is accessible to all native people and that our trust responsibility is upheld.” said Chairman Gallego.

“COVID-19 has had a devastating impact on Native communities. In Chicago, Native Americans chart a 15 percent COVID-19 mortality rate, but we know these numbers could be higher. COVID-19 did not cause these disproportionate outcomes, rather it has exposed longstanding, systemic inequities. We cannot afford to leave urban Indians without access to care during this public health crisis. It’s long overdue to give our Urban Indian Health Centers a boost in resources to ensure our Native communities have access to high-quality health care. The ability of urban Indian organizations to provide cost-effective health services has been jeopardized by the lack of FTCA coverage commonly afforded to other federally funded Indian health programs. This should not be the case, especially during a pandemic,” said Representative Jesús “Chuy” García.

“UIOs are purchasing liability insurance with resources that could be better utilized to expand services available to Urban American Indian and Alaska Native patients. The rising cost of liability insurance and the general cost of providing health care services adversely impact the ability of UIOs to provide needed services. As a result, UIOs have had to substantially reduce or eliminate certain kinds of staff and health services, such as dental services. UIOs are an integral part of the IHS health care system. They provide high quality, culturally relevant health care services and are often the only health care providers readily accessible to Urban American Indian and Alaska Native patients. IHS endorses the policy to extend FTCA coverage to UIOs, which is consistent with the FY 2021 Budget request,” said Rear Admiral Weakhee, IHS Director.

NCUIH is grateful for the support of our Congressional and IHS partners and will continue to push for FTCA coverage and parity for urban AI/ANs and UIOs.

The Senate held a hearing on the companion bill (S. 3650) on July 1, 2020.

NCUIH Youth Council Indigi-Wellness Healer Campaign Launching Tomorrow July 24!!

NCUIH Youth Council Member Benjamin Sandecki shares with Native youth on what it means to be an Indigi-Wellness Healer and to Save-the-Date for the Launch of their Contest!

Learn how to become an Indigi-Wellness Healer!

Osiyo! My name is Benjamin Sandecki and I am a tribal member of the Cherokee Nation of Oklahoma. I am currently pursuing a doctorate degree in pharmacy at Southwestern Oklahoma State University College of Pharmacy. Throughout my pharmacy career, I have been privileged to intern at the Oklahoma City Urban Indian Clinic where my experience has directly allowed me to appreciate the importance of Native American health and wellness. I am also a current National Youth Council Advisory member representing the National Council of Urban Indian Health (for short NCUIH). I am excited to share with Native Youth across Indian Country about NCUIH’s Youth Council’s new launch date for our upcoming Indigi-Wellness Healer Campaign. In May, Youth Council members hosted a National Native Youth Healing Gathering in partnership with UNITY and UNITY’s Peer Guides. During this National Native Youth Healing Gathering we covered:

  1. Wellness Best Practices and Resilience tools for Native Youth during COVID-19 Pandemic
  2. Learned how to use strength-based healing approaches
  3. The UNITY Peer Guides shared how they heal and stay well during these challenging times and
  4. We provided the purpose of the youth council’s campaigns & how to become an Indigi-Wellness Healer.

NCUIH’s Youth Council is excited to share that the Indigi-Wellness Healer Campaign will launch on Friday, July 24th, 2020! As Native youth continue to struggle with wellness challenges because of COVID-19, NCUIH’s youth council wants to create a platform that amplifies youth voices and stories to the national level through its Indigi-Wellness Healer Campaign.

The Indigi-Wellness Healer Campaign is a social media campaign by Native Youth for Native Youth consisting of two hashtag themes- #NativeHealing and #IndigiLove– to express the importance of mental & physical wellness and healthy Native relationships, especially during the coronavirus pandemic. To me, an indigenous wellness healer is one who consistently supports others in their positive mental, physical, emotional, and spiritual wellness journey. The Indigi-Wellness Healer Campaign is designed to help empower and inspire AI/AN youth to help with healing, self-love, and forming healthy relationships while connecting youth with Native youth-driven resources to build youth resiliency and improve the overall health of youth for the next seven generations!

Click on the links below to 1) RSVP to our Facebook event page for the Indigi-Wellness Healer campaign, 2) sign-up to NCUIH’s e-newsletter to receive important next steps on being an Indigi-Wellness Healer, 3) Learn more about the Indigi-Wellness campaign and you are one step closer to winning some awesome prize bundles!  Lastly, make sure to also apply to NCUIH’s 2020 Urban Indian Youth Council (only 2 weeks left).

RSVP to Facebook Event

Sign-up to NCUIH’s E-newsletter to Receive Important Steps on Indigi-Wellness Contest

2 Weeks Left to Apply! NCUIH’s Urban Indian Youth Council Class of 2020

An Indigenous Wellness Healer is one who:

  1. Using their culture to be a shield to protect them, while also knowing when to get help
  2. Inspiring Native Youth to heal themselves and practicing self-care
  3. Investing in positive change for mental, physical, emotional/ spiritual health and sharing your story to inspire others
  4. Promoting resiliency, building healthy relationships, promoting generational healing to empower the next seven generations

All AI/AN youth and allies across Indian Country are invited to participate.

Who: All AI/AN youth 25 years years old or younger.
What:  NCUIH Youth Advisory Council’s Indigi-Wellness Healer Campaign Contest
When: Participate online July 24th, 2020 – August 7th, 2020. Winners will be announced by August 30,  2020.
Where: Online, by uploading your social media posts on your Facebook, Twitter, and/ or Instagram pages. Make your settings as Public for the NCUIH’s Office to view your submission.
Why: Our two hashtag campaigns are designed to help empower and inspire AI/AN youth to heal, to promote self- love, and love between family, friends, and partners, while connecting youth with Native youth-driven resources to build youth resiliency and improve the overall health for the next seven generations!

NCUIH in the News: Executive Director on Native America Calling Program on COVID-19 Impacts on Indian Country

Listen to Recording

WASHINGTON, DC (July 21, 2020) – On July 21, 2020, NCUIH Executive Director Francys Crevier joined Native America Calling for a program on the COVID-19 impacts on Indian Country.

From the Koahnic Broadcast Corporation:

In hotspots for COVID-19 around the United States, Native people make up a disproportionate percentage of infections. This is especially true in the Southwest, where Native American residents significantly outnumber other populations who test positive for the coronavirus. In addition, a new report finds young people of color experience social conditions that put them at greater risk if they contract COVID-19. We’ll take a look at some of the factors that contribute to increased Native representation among those who are infected and how some tribes are working to turn it around.


Abigail Echo-Hawk (Pawnee) – director of the Urban Indian Health Institute and chief research officer at the Seattle Indian Health Board

Francys Crevier (First Nation Algonquin) – executive director of the National Council of Urban Indian Health

Leonela Nelson (Navajo) – Research Program Supervisor Johns Hopkins Center for American Indian Health

Warren Goklish (Apache) – Contact Tracing & Expanded Testing Coordinator at the Johns Hopkins Center for American Indian Health

PRESS RELEASE: NCUIH Vice President to Testify at House Natural Resources Legislative Hearing on FTCA Bill for UIOs


Contact: Meredith Raimondi, 202-932-6615,

WASHINGTON, DC (July 20, 2020) – On July 22, Robyn Sunday-Allen, NCUIH Vice President and Chief Executive Officer of the Oklahoma City Indian Clinic, will testify before the House Subcommittee for Indigenous Peoples of the United States. Ms. Sunday-Allen will be testifying on Tuesday, July 22 at 2 PM in support of H.R. 6535, the Coverage for Urban Indian Health Providers Act. H.R. 6535 would extend Federal Tort Claims Act coverage to urban Indian organizations (UIOs).

“Oklahoma City Indian Clinic has been operating on the front lines of this crisis with limited resources. We spend hundreds of thousands of dollars each year on liability insurance for our providers. With parity in FTCA, we would put every cent back into services which will allow us to fulfill our mission of providing excellent health care to American Indians. Increasing access to quality health care and preventive wellness services and producing positive health outcomes for urban American Indians living in central Oklahoma is the business we are in,” said Robyn Sunday- Allen, CEO of Oklahoma City Indian Clinic, and NCUIH Vice President.

Passage of H.R. 6535 would ensure that UIOs achieve parity with the rest of the IHS/Tribal health providers/urban Indian organizations system (I/T/U system). Currently, UIOs are the only part of the I/T/U system who do not receive FTCA coverage. This act, if passed, would save individual UIOs up to $250,000 a year on medical malpractice insurance, money that could be used to hire additional providers, provide additional programs, and to respond to COVID-19 and future public health emergencies.

The Senate held a hearing on the companion bill (S. 3650) on July 1, 2020.  At the hearing, Indian Health Service (IHS) Director RADM Weahkee endorsed the bill on behalf of IHS.

FTCA coverage for UIOs currently has bipartisan support in the House and Senate, Executive Branch, and from the Tribal Budget Formulation Workgroup.

The link to watch the livestream of the hearing can be found here.

COVID-19 Presents Significant Risks for American Indian and Alaska Native People

The Kaiser Family Foundation posted this article to its blog on May 14, 2020.  They stated,

“[t]he COVID-19 emergency presents significant risks for the over 5 million individuals who self-identify as American Indian and Alaska Native (AIAN) alone or in combination with another race. AIAN people live across the country, but are concentrated in certain states, with roughly half living in seven states (CA, OK, AZ, TX, NM, WA, and NY). Under treaties and laws, the federal government has a unique responsibility to provide health care services to AIAN people. AIAN people face disproportionate risks from the COVID-19 outbreak given significant underlying disparities in health, social, and economic factors. Addressing their needs as part of COVID-19 response efforts will be key for preventing further widening of these disparities and fulfilling the federal government’s federal trust responsibility.

The arrticale cotnaisn 3 charts and disucsses barriers to treatment, new finanncial burdens from COVID 19, and contains several links to support its discussin of underlying disparities. They note,  “AIAN individuals are more likely to lack access to clean water and plumbing and to live in substandard and crowded housing situations, limiting the ability to practice frequent hand washing and social distancing.”

NCUIH Executive Director to Testify at Hearing on COVID-19 in Indian Country: The Impact of Federal Broken Promises on Native Americans

The hearing on the “Impact of Federal Broken Promises on Native Americans” will be livestreamed on Friday at 10 AM ET.

WASHINGTON, DC (July 17, 2020) – On Friday, July 17 at 10:00AM ET, NCUIH Executive Director Francys Crevier will testify before of the United States Commission on Civil Rights regarding COVID-19 and its impact on American Indians/Alaska Natives (AI/ANs). The Commission will hear testimony from experts, including Executive Director Crevier, on how Federal Broken Promises with regard to COVID-19 have impacted AI/AN healthcare, infrastructure, access to water, and broadband access.

The briefing will be streamed here.

civil rights

“I am honored to join this esteemed panel today. As the Broken Promises Report found, the failure of the government to address the wellbeing of Indian Country for the past two centuries has created a system where we are bound to fail — and that has proven no different during this pandemic. It is imperative to officially recognize systemic racism as the central factor of health inequities — NOT race. Our country is reeling from the recent killings of George Floyd and countless others at the hands of police, reckoning with the legacy of racial injustice that their deaths have laid bare, while simultaneously confronting the unequal impact of COVID-19 on people of color. This moment in time is both dangerous and full of great promise,” said Francys Crevier, Executive Director.

In 2018, the Commission issued the Broken Promises: Continuing Federal Funding Shortfall for Native Americans report, which addressed the inadequacy of federal funding for Native American programs despite the United States’ trust responsibility to promote tribal self government, support the general well being of Native American people, tribes and villages, and to protect their land and resources.


Friday, July 17, 2020 | 10:00 a.m. – 11:45 a.m. EDT

  • Introductory Remarks: 10:00 a.m. – 10:10 a.m. EDT
  • Panel: 10:10 a.m. – 11:40 a.m. EDT
    • Geoffrey Blackwell, Chief Strategy Officer, AMERIND Risk Management Corporation
    • Chief William Smith, Chairman, National Indian Health Board
    • Chief Lynn Malerba, Secretary, USET Sovereignty Protection Fund
    • Jonathan Nez, President, Navajo Nation
    • Fawn Sharp, President, National Congress of American Indians
    • Francys Crevier, Executive Director, National Council of Urban Indian Health
  • Closing Remarks: 11:40 a.m. – 11:45 a.m. EDT
    • Catherine E. Lhamon, Chair, U.S. Commission on Civil Rights


All Testimony

Call for Comments

The U.S. The Commission on Civil Rights is requesting comments related to COVID-19 and the Broken Promises Report. Comments can be submitted until Friday, July 24, 2020 to or OCRE/Public Comments, U.S. Commission on Civil Rights, 1331 Pennsylvania Ave. NW, Suite 1150, Washington, DC 20425. The Commission seeks comments on the following questions:

  • Broken Promises found that Native Americans experience distinct health disparities as compared to other Americans which are compounded by Native American healthcare programs being chronically underfunded. How has the outbreak of COVID-19 impacted these health disparities?
  • Broken Promises found that there is a severe lack of affordable housing and adequate physical infrastructure in Indian Country. Due to a lack of federal investment in affordable housing and infrastructure such as roads, water, sewer, and electricity, Native Americans often find themselves living in overcrowded housing without basic utilities and infrastructure. What have been the consequences of these disparities in housing conditions and access to infrastructure during the outbreak of COVID-19?
  • Broken Promises found that telecommunications infrastructure, especially wireless and broadband internet services, is often inaccessible to many Native Americans in Indian Country. These services are necessary to keep the community connected to telehealth services, remote education, economic development, and public safety. Has this lack of telecommunications created additional barriers for Native Americans in coping with and reacting to the pandemic?
  • Have the congressional responses to the pandemic – especially the passage of the CARES Act and other stimulus packages – done enough to help Native people with the challenges posed by COVID-19?
  • Has the Executive Branch’s responses to the pandemic – including its statutory interpretation and administrative implementation of laws passed by Congress – done enough to help Native peoples cope with the challenges passed by Congress?
  • What recommendations should the Commission make to Congress and the federal government to ensure that Native American communities can address the coronavirus pandemic?

NCUIH Endorses COVID-19 Bias and Anti-Racism Training Act from Senator Harris

On July 14, Senator Kamala Harris (D-CA) released the NCUIH endorsed COVID-19 Bias and Anti Racism Training Act. This bill was introduced in order to address the persistent bias in the U.S. healthcare system against Black and Brown people. COVID-19 is disproportionately infecting and killing minority groups, including American Indians and Alaska Natives (AI/ANs).
“Our world has spent the past few months embroiled in battle against a pandemic that is disproportionately affecting communities of color,” said Francys Crevier, Executive Director of the National Council of Urban Indian Health (NCUIH). “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 equity for generations. Senator Harris has been a committed leader who is breaking down the structures that have created needless disparities for Black and Brown communities. We hope Congress will act quickly to pass this important legislation to bring more resources to the families who need it most right now.”
The bill would:
  1.  Create a $200 million grant program for hospitals; other health care providers; state, local, Tribal, and territorial public health departments; and urban Indian organizations to establish or improve bias and anti-racism training programs for health care providers treating COVID-19 patients
  2. Prioritize funding for entities in communities with high racial and ethnic disparities in COVID-19 infection, hospitalization, ICU admission, and death rates.
  3.  Require the Secretary of Health and Human Services to collaborate with health care professionals, policy experts specializing in addressing bias and racism within the health care system, and community-based organizations to develop requirements for evidence-based, ongoing bias and anti-racism training.

PRESS RELEASE: NCUIH Commends Supreme Court Decision as Monumental Victory for Indian Country

McGirt v. Oklahoma reasserts the US treaty with the Muscogee (Creek) Nation.


Contact: Meredith Raimondi, 202-932-6615,

WASHINGTON, DC (July 9, 2020) – On July 9, 2020, in a historic decision the US Supreme Court sided with the Muscogee (Creek) Nation in McGirt v. Oklahoma, a case set to decide the jurisdictional fate for the eastern part of Oklahoma. In a 5-4 decision, the court acknowledged the treaties which the US government has continually broken. “On the far end of the Trail of Tears was a promise. Forced to leave their ancestral lands in Georgia and Alabama, the Creek Nation received assurances that their new lands in the West would be secure forever…Because Congress has not said otherwise, we hold the government to its word” (McGirt v. Oklahoma). This marks a major victory for Indian Country, as the Muscogee (Creek) Nation’s treaties with the US government are upheld.

“Tribal sovereignty is a top priority for the National Council of Urban Indian Health (NCUIH). We know all too well that the promises made to American Indians and Alaska Natives are often broken. Today’s decision is truly a win for all of Indian Country. We commend the court for its decision today and congratulate the Muscogee (Creek) Nation in its victory. We also urge the federal government to do more to rectify longstanding injustices against Indian Country. As allies, we at NCUIH will continue to do all we can to advocate for the sovereignty of all Indian Nations. Today, sovereignty has won,” said Francys Crevier, Executive Director of NCUIH.

“As a Muscogee (Creek) citizen, this decision is more than the court upholding the United States government’s legal obligation as written in treaty, it is the highest court in the land acknowledging that my great-great grandmother’s lands are still ours. No court can define the meaning of our lands, but thankfully, this decision conveys to the world what we have long known to be true,” said Julia Wakeford (Mvskoke), Policy Assistant at NCUIH.

These lands were guaranteed through direct relations with the US Federal government and the Tribe, a relationship which has been undermined by the state of Oklahoma. In the official opinion offered by Justice Neil Gorsuch, it was made clear that only through direct legislative means can this reservation be disestablished. In McGirt v. Oklahoma, the federal government followed through on its treaty obligations, with the court disavowing many actions taken against tribes in this country: “Unlawful acts, performed long enough and with sufficient vigor, are never enough to amend the law. To hold otherwise would be to elevate the most brazen and longstanding injustices over the law, both rewarding wrong and failing those in the right. The judgment of the Court of Criminal Appeals of Oklahoma is Reversed.” (McGirt v. Oklahoma)


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.

NCUIH Testimony for House Hearing on Urgent Needs of Indian Country

On July 8, 2020, the House Committee on Energy and Commerce held a hearing titled “Addressing the Urgent Needs of Our Tribal Communities.” The hearing explored how COVID-19 has uniquely impacted Indian Country, exploring critical infrastructure needs, like access to broadband, electricity, and running water, as well as, the disproportionate health impact COVID-19 has had on Indian Country. The National Council of Urban Indian Health (NCUIH) submitted written testimony for the hearing.


House Committee on Energy and Commerce – “Addressing the Urgent Needs of Our Tribal Communities” National Council of Urban Indian Health – July 8, 2020

Chairman Pallone, Ranking Member Walden, and Members of the Committee, thank you for holding this important hearing on the urgent needs of tribal members living in urban areas. 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 thank you for your commitment to ensuring that the 70% of AI/ANs residing in urban areas have access to critical health care. We appreciate your continued efforts to ensure tribal members in urban areas are included in all relevant legislation. Thank you for allowing us to testify today and for your tireless efforts ensuring that the voices of tribal members living in urban areas are heard.

HEROES Act and Patient Protection and Affordable Care Enhancement Act

NCUIH and the UIOs we represent are grateful for this Committee’s support of American Indians and Alaska Natives in the HEROES Act (H.R. 6800). This bill included the Health Care Access for Urban Native Veterans Act (H.R. 4153) to authorize reimbursement parity for care provided to urban AI/AN Veterans. The HEROES Act also would temporarily authorize 100% Federal Medical Assistance Percentage (FMAP) for UIOs. We appreciate the Committee’s work on the H.R. 1425, the Patient Protection and Affordable Care Enhancement Act because it has the inclusion of the Urban Indian Health Parity Act (H.R. 2316), which would make 100% FMAP for UIOs permanent, creating parity across the Indian health system. This will not only help the families served by these programs, but will inject additional funding support into states – allowing them to better handle this crisis. 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.

The Impact of COVID-19 on Indian Country

There is a pressing need for the health care services provided by UIOs. Urban AI/ANs experience disproportionate rates of chronic diseases and are therefore more likely to need access to health care. Urban 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. These chronic diseases have been identified by the Centers for Disease Control as risk factors for serious illness or death due to COVID-19. In addition, Urban AI/ANs are also 3 times more likely to be uninsured, are more likely to have AIDS, and are less likely to be vaccinated than Non-Hispanic Whites. Urban AI/ANs also face 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. Funds are needed to provide culturally competent care in order to address these disparities, the policy fixes below will free up additional funding which UIOs can use to provide additional services to urban AI/ANs.

Parity for UIOs

Decades of underfunding of the IHS system coupled with the recent COVID-19 pandemic have highlighted the urgency of rectifying the long-standing inequities UIOs face. UIOs do not have parity with IHS and Tribal Health Providers in many cost saving programs. UIOs already operate on thin financial margins and receive funding from a single line item, which is less than 1% of the total IHS budget. This chronic underfunding is exacerbated by UIOs inability to participate in essential cost-saving measures. UIOs are unable to be fully reimbursed for the services they provide to urban AI/ANs, they have to pay hundreds of thousands of dollars for medical malpractice insurance, and they do not receive reimbursement from the Department of Veterans Affairs (VA) for services provided to urban AI/AN Veterans. Implementing simple policy fixes including 100% FMAP, Federal Torts Claim Act (FTCA) coverage, and reimbursement for services provided to urban AI/AN veterans would be a step toward ensuring that the federal government’s Trust Responsibility to provide health care for urban AI/ANs is fulfilled.

First, when UIOs provide services they are unable to fully recover their costs because the services are not reimbursed at 100% Federal Medical Assistance Percentage (FMAP).  In the IHS/Tribal Health Provider/Urban Indian Organization (I/T/U) system, only UIOs have been excluded from the 100% FMAP rate. In effect, the federal government only covers 100% of the cost of Medicaid services for AI/ANs receiving those services at an IHS or tribal facility and skirts full responsibility if an individual happens to receive the service in an urban area. 100% FMAP reimbursement has allowed IHS and Tribes to receive reimbursement at higher rates and for additional services, allowing IHS and tribal providers to reinvest the money they have saved into the Indian health system. UIOs providing services to tribal members residing in urban areas are unable to receive full FMAP reimbursement for the services they provide. This is a dereliction of the trust obligation to urban Indians and significantly reduces the rate UIOs receive from states for Medicaid services – leading to considerably less funding for UIOs as compared to their counterparts in the IHS system. The HEROES Act would temporarily authorize 100% FMAP for services at UIOs during the pandemic, however, the need for 100% FMAP is continuous and does not end when the pandemic ends. The Urban Indian Health Parity Act included in H.R. 1425, the Patient Protection and Affordable Care Enhancement Act would make 100% FMAP permanent and would ensure parity among the I/T/U system.

Second, UIOs do not have parity with the rest of the I/T/U system because they are forced to expend millions of dollars each year for malpractice insurance because they do not receive FTCA coverage like employees at IHS and tribal facilities. Extending FTCA coverage to UIOs is a simple legislative fix that has strong bipartisan support and the benefits would be significant. A single UIO may pay as much as $250,000 annually in medical malpractice insurance, funds which could instead be used to invest in better health outcomes for their communities or to prepare for public health emergencies like the one we are currently facing. By freeing up federal funding for UIOs, they would be better able to serve their communities with high-quality health care. For instance, some UIOs have reported to NCUIH that they are hesitant to hire additional providers or provide additional services as they cannot cover the costs of additional medical malpractice insurance, even as they are prepared to cover the new salaries and related costs. This directly and substantially limits the services UIOs can provide to their patients as the cost of adding providers or new services to malpractice insurance policies can be the sole prohibition to service expansion.

NCUIH urges this Committee to extend FTCA coverage to UIOs and to support the Coverage for Urban Indian Health Providers Act (H.R. 6535). The Senate recently held a legislative hearing considering S. 3650, their companion bill. This bipartisan legislation would extend FTCA coverage to UIOs and would ensure parity among the I/T/U system. Passing this legislation would enable UIOs to put the money they currently spend on malpractice insurance towards providing additional services, hiring additional staff, hiring specialists, responding to COVID-19, and providing living wages to UIO staff.

UIOs also need reimbursement parity with IHS and Tribal Health Providers when providing care to AI/AN Veterans. The rest of the I/T/U system receives reimbursement from the VA for services provided to AI/AN veterans, however, the VA does not reimburse UIOs for care provided to AI/AN Veterans living in urban areas. Most AI/AN Veterans live in urban areas and would benefit from the culturally competent care provided at UIOs. Studies have shown veterans are more likely to receive care if they can choose where that care is received – and UIOs provide the only culturally competent care available in many communities. If UIOs receive reimbursement from the VA they can provide more culturally competent services to urban AI/AN veterans. AI/ANs serve in the military at higher rates than any other group and they deserve to receive care regardless of where they choose to live. The Senate recently passed S. 886, the Indian Water Rights Settlement Extension Act, which included S. 2365, the Health Care Access for Urban Native Veterans Act of 2019. This bill would allow 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. The House companion, H.R. 4153, was included in the HEROES Act and we are grateful for your support for the HEROES Act and urban AI/AN Veterans.

Permanently Reauthorize SDPI

No one should have to choose to between paying for their insulin or paying their rent. Thankfully the Special Diabetes Program for Indians (SDPI) 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 SDPI be reauthorized for the long-term to ensure better outcomes for the patients and families who depend on this critical care.

The CDC has noted diabetes as one of the pre-existing conditions that increase a person’s risk for a more serious COVID-19 illness. Diabetes rates among American Indians and Alaska Natives are twice the rates of the national average, placing AI/AN communities at significantly higher risk of contracting a more severe COVID-19 infection.Congress established the SDPI to address high rates of Type-2 diabetes among American Indians and Alaska Natives. It has worked. SDPI is one of the most successful public health programs ever implemented. Because of SDPI, rates of End Stage Renal Disease and diabetic eye disease have dropped by more than half. A report from the Assistant Secretary for Preparedness and Response found that SDPI is responsible for saving Medicare $52 million per year. Despite its great success, SDPI has been flat-funded at $150 million since 2004 and has lost over a third of its buying power to medical inflation.

Right now, SDPI is set to expire on November 30, 2020. Many short-term extensions have caused significant distress for SDPI programs and have created undue challenges for our patients and community members. They have also led to the loss of providers, curtailing of health services, and delays in purchasing necessary medical equipment due to uncertainty of funding – all while Indian health care programs also battle the COVID-19 pandemic. A permanent reauthorization would ensure UIOs have the necessary funds to address diabetes and the increased risk it poses for a more serious COVID-19 illness.

Urban Indian Facilities Funding

A national investment in Indian health facilities construction funding is necessary. UIOs are unable to receive funding from the IHS Health Care Facilities Construction Priority program, the Maintenance & Improvement IHS budget line item, or participate in the agency’s Joint Venture Construction Program. As a result, UIOs have had to take out loans and collect donations in order to build and maintain health facilities for a growing population.  UIOs thus have to spend millions to build, repair, and maintain their facilities—millions that could be going to increased services for their patients. Many UIOs are located in aging buildings – for example, the facility in Denver, CO is in a more than 50-year old building. Without access to facilities funding like that available to IHS and tribal facilities, UIOs must use their already limited resources on facilities. Equitable construction and facility support funding for UIOs can be accomplished by including language authorizing a new budget line item to address UIO infrastructure needs.

Not all UIOs use the Accreditation Association for Ambulatory Health Care (AAAHC) or Joint Commission, yet the Indian Health Care Improvement Act only ties facilities renovation for accreditation, not for urgently needed changes or changes related to COVID-19. A common sense change is to remove the barriers to this language to ensure UIOs can use facility funds without restrictions.

A need exists for a UIO future facilities assessment as created in IHCIA but which has not been completed.  Absent this, it is nearly impossible to know the full extent of needs of one of the three components of the IHS health system – which is a failure of the federal obligation.

Include UIOs in the National Community Health Aide Program

Although UIOs are eligible for the Community Health Aide Program CHAP under the national expansion policy authorized in the Indian Health Care Improvement Act (IHCIA) and IHS official properly initiated Urban Confer with UIO in 2016, IHS changed its position in 2018 and further excluded UIOs from the consultation and confer process. IHS asserts that UIOs are excluded simply because they are not explicitly included in the statutory language of the nationalization of CHAP. UIOs are eligible for other similarly situated programs under IHCIA, including the Community Health Representative program, and Behavioral Health and Treatment Services programs. UIOs are explicitly named in the statement of purpose in IHCIA, included throughout its Subchapter 1 on increasing the number of Indians entering the health professions and to assure an adequate supply of health professionals involved in the provision of health care to Indian people. CHAP is are proven program and utilizing it to the fullest extent permissible within the entire Indian health system will increase the availability of health workers in AI/AN communities. Because the purpose of IHCIA explicitly includes UIOs, the interpretation and implementation of any policy that implements IHCIA must be read to include UIOs when they are not explicitly excluded.

Establish a UIO Confer Policy for HHS

Currently, only IHS has a legal obligation to confer with UIOs.  It is imperative that the many branches and divisions within HHS and all agencies under its purview establish a formal confer process to dialogue with UIOs on policies that impact them and their AI/AN patients living in urban centers. Urban confer policies do not supplant or otherwise impact tribal consultation and the government-to-government relationship between tribes and federal agencies.

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.

Include UIOs in Advisory Committees with Focus on Indian Health

When UIOs are not expressly included within statute to participate in tribal advisory workgroups or committees, they are prohibited from participating in a voting role or excluded altogether. UIO inclusion in critical advisory committees on Indian health is necessary to reflect the reality of the majority of the AI/AN population, as more than 70% of AI/ANs living in urban centers today. Without explicit inclusion of UIO representation in statute, workgroups using the Federal Advisory Committee Act (FACA) intergovernmental consultation exemption exclude UIO leaders in their charters by default. For UIO leaders to participate in advisory committees without impacting the intergovernmental exemption to FACA, Congressional action is needed.

Establish a $1.7 billion Emergency Third-Party Reimbursement Relief Fund for Indian Health Service (IHS), Tribal Programs, and Urban Indian Organizations.

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. 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.

Third-party reimbursements from Medicare, Medicaid, the Veterans Health Administration, and private insurance are integral to the fiscal stability of Urban Indian Organizations (UIOs) and to the Indian health system as a whole. Unfortunately, the COVID-19 pandemic is upending this system. As states enact shelter-in-place ordinances, require health care providers to cancel all non-emergent procedures to prepare for the COVID-19 surge, and continue social distancing guidelines, UIOs must encourage patients to stay home if they are able, reducing in-person visits and thus third-party dollars with them. The removal of all this routine care is leaving only non-billable services, eliminating the ability to seek third-party reimbursement that is critical to maintaining operations.

While UIOs are trying to transition more towards remote health service delivery mechanisms like telehealth, these services are not consistently reimbursed at the same level as in-person care. UIOs are experiencing millions in lost third-party reimbursement as a result. UIOs need the ability to access relief funds for the purpose of covering past or current COVID-19 healthcare expenses, and to compensate for shortfalls in third-party reimbursement dollars as a result of the pandemic. Because each tribe, tribal organization, and UIO’s financial situation is unique, we urge the creation of a $1.7 billion relief fund, and whereby Indian health programs can submit claims for relief funding based on their health care service needs or losses related to COVID-19.

Ensure Parity in Medicare Reimbursement for Indian Health Care Providers.

I/T/U facilities are experiencing significant economic disruption and loss of third party revenues, including Medicare billing, as a result of the COVID-19 pandemic. This crisis is exacerbated by the fact that Indian Health Care Providers are not fully reimbursed for the cost of providing Medicare covered services. Unlike other Medicare providers, Indian health care providers do not bill the AI/AN Medicare patients they serve. This means that as a general rule, Indian health care providers only receive 80 percent of reasonable charges, and are not paid the remaining 20 percent by their patients. As a result, I/T/U facilities are only being paid 80 cents on the dollar by the Medicare program compared to other providers. This legislation is needed to ensure that the United States reimburses Indian Health Care Providers in full for Medicare services they provide to AI/AN people, and to ensure that AI/AN people can seek services outside the Indian health system without having to face significant cost-sharing burdens they may not be able to afford. The United States has a federal trust responsibility to provide health care for AI/ANs, and cost-sharing requirements are inconsistent with this obligation. Medicaid exempts AI/ANs from cost-sharing, and Medicare should do the same.

Expand Telehealth Capacity Building for I/T/U

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.

Advanced Appropriations

When limited UIO funding is delayed or cut off during events such as a government shutdown, there are devastating effects upon a UIOs ability to provide health care. IHS and funded programs must receive advance appropriations. To illustrate, UIOs are so chronically underfunded that during the 2018-2019 shutdown, several UIOs had to reduce services, lose staff or close their doors entirely, forcing them to leave their patients without adequate care. In a UIO shutdown survey, 5 out of 13 UIOs indicated that they could only maintain normal operations for 30 days. For instance, Native American Lifelines of Baltimore is a small clinic that received three overdose patients during the last shutdown, two of which were fatal. IHS gives them just less than $1,000 total for mental health services for both facilities. To say the funding is inadequate is an understatement.


The House Committee on Energy and Commerce has long been a proponent of health care for urban AI/ANs. We appreciate your support for urban AI/ANs in the HEROES Act as well as in the Patient Protection and Affordable Care Enhancement Act. Too often, tribal members living in urban areas are forgotten and left behind, this Committee is working to ensure that the Trust responsibility to urban AI/ANs is upheld. Thank you for inviting us to testify and for your continued support of health care for urban AI/ANs.