COVID-19 RELIEF BILLS Include Support for Indian Country Including Urban Indians

The proposal begins to address the many urgent needs of Indian Country.

On December 14, a bipartisan group of lawmakers released two bills totaling $908 billion that would provide economic relief amid the COVID-19 pandemic, including several Indian Country relief measures. The first bill titled “Emergency Coronavirus Relief Act of 2020,” provides $748 billion in unemployment assistance, COVID-19 vaccine funding, health care funding, and other emergency relief. The second bill, “Bipartisan State and Local Support and Small Business Protections Act,” allocates $160 billion for state, local, and tribal government aid and liability protection for business.

In summary, the first bill provides the following for IHS, tribal organizations and Urban Indian Organizations (UIOs):

$1 billion in to IHS in Provider Relief Funds
$350 million to IHS for COVID-19 testing and contact tracing purposes
$129 million from CDC to IHS to carry out activities with respect to coronavirus vaccine distribution, administration, and communications
$185 million set aside for Indian tribes, Tribal organizations, and urban Indian organizations for substance use disorder and behavioral health efforts

On December 4, 2020, NCUIH, NCAI, and NIHB wrote a letter to Congress regarding this COVID-19 package. In the letter, the organizations requested $2 billion in emergency funds to Indian Health Service (IHS) for immediate distribution to Indian Health Service/Tribal Health Program/UIO (I/T/U) system, minimum $1 billion to replenish lost third-party reimbursements across the I/T/U system, a minimum five percent I/T/U funding set-aside for vaccine distribution and administration, and long-term reauthorization of the Special Diabetes Program for Indians (SDPI).

Next Steps

Congress is close to an agreement and will continue negotiations to pass a final relief package.
NCUIH will continue to monitor developments.

Summary

FUNDING: EMERGENCY CORONAVIRUS RELIEF ACT OF 2020

PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

This bill provides $1 billion in Provider Relief Funds to IHS to assist IHS directly operated programs, programs operated by tribes and tribal organizations, and urban Indian organizations
- $700 million shall be used to supplement reduced third-party revenue collections
- $200 million shall be allocated at the discretion of the Director of IHS for maintenance and improvement projects or construction of existing or new temporary structures necessary to the purposes specified in this Act, for water and sanitation infrastructure, or for other needs at IHS and tribal facilities
- $100 million shall be allocated at the discretion of the Director of the IHS for additional expenditures necessary to the purposes specified within this Act

VACCINE TESTING AND CONTACT TRACING

Provides $350 million to IHS, which may allocate the funds to tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes for COVID-19 testing and contact tracing purposes

VACCINE DISTRIBUTION AND ADMINISTRATION

Provides $6 billion for CDC-wide activities and program support with $2.58 billion to be made available for vaccine distribution and administration
- $129 million shall be allocated to IHS to fund IHS directly operated programs, programs operated by tribes and tribal organizations, urban Indian organizations, and health service providers to tribes to carry out activities with respect to coronavirus vaccine distribution, administration, and communications
- The remainder of the $2.58 billion allocation can be made available for other activities regarding COVID-19, including grants, contracts, or cooperative agreements to States, localities, territories, tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes to provide additional assistance with distribution and administration of coronavirus vaccines, as determined appropriate by the Secretary.

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES

$3.15 billion allocated for the Substance Abuse and Mental Health Administration (SAMHSA) program support
- $1.3 billion shall be for the State Opioid Response Grant
- $50 million shall be made available to Indian Tribes and Tribal organizations
- $185 million set aside for Indian tribes, Tribal organizations, and urban Indian organizations for substance use disorder and behavioral health efforts

FUNDING: BIPARTISAN STATE AND LOCAL SUPPORT AND SMALL BUSINESS PROTECTIONS ACT

CORONAVIRUS LOCAL COMMUNITY STABILIZATION FUND

Provides $160 billion to the Coronavirus Local Community Stabilization Fund for State and Tribal entities
- Of this amount, $8 billion shall be reserved for Tribal entities and 60 % be allocated based on relative population of each Tribal entity and 40% based on the number of employees for each Tribal entity

Topic	Funding/Section	Language
Public Health and Social Services Emergency Fund	$1,000,000,000	“That of the amount made available under this paragraph in this Act, not less than $1,000,000,000 shall be transferred to the Indian Health Service, which may allocate the funds for Indian Health Service directly operated programs, programs operated by tribes and tribal organizations under the Indian Self-Determination and Education Assistance Act (25 U.S.C.5301 et seq.), and contracts or grants with Urban Indian organizations under title V of the Indian Health Care Improvement Act (25 U.S.C. 1601 et seq.)”
	$700,000,000	“$700,000,000 shall be used to supplement reduced third party revenue collections”
	$200,000,000	“$200,000,000 shall be allocated at the discretion of the Director of the Indian Health Service for maintenance and improvement projects or construction of existing or new temporary structures necessary to the purposes specified in this Act, for water and sanitation infrastructure, or for other needs at Indian Health Service and tribal facilities”
	$100,000,000	“$100,000,000 shall be allocated at the discretion of the Director of the Indian Health Service for additional expenditures necessary to the purposes specified within this Act”
Vaccine Testing and Contact Tracing	$350,000,000	“transfer $350,000,000 to the Director of the Indian Health Service, which may allocate the funds to tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes for such purposes.”
Vaccine Distribution and Administration	$6,000,000,000,	“For an additional amount for ‘‘CDC-Wide Activities and Program Support’’, $6,000,000,000 to remain available until expended, to prevent, prepare for, and respond to coronavirus, domestically or internationally, including for distribution and administration of and communications about coronavirus vaccines”
	$2,580,000,000	“From the $6,000,000,000 appropriated under the heading ‘‘Department of Health and Human Services—Centers for Disease Control and Prevention—CDC-Wide Activities and Program Support’’, the Secretary of Health and Human Services (referred to in this section as the ‘‘Secretary’’) shall make available— $2,580,000,000 for activities described in paragraph (3) (Vaccine distribution and administration)”
	$129,000,000	“$129,000,000 shall be transferred to the Indian Health Service, which may, in consultation with the Director of the Centers for Disease Control and Prevention, allocate the funds for Indian Health Service directly operated programs, for programs operated by tribes and tribal organizations under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5301 10 et seq.), for contracts or grants with urban Indian organizations under the Indian Health Care Improvement Act (25 U.S.C. 13 1601 et seq.), and for health service providers to tribes to carry out activities with respect to coronavirus vaccine distribution, administration, and communications.”
	Remainder of $2,580,000,000	“From the amount made available under paragraph (1)(B) and not allocated under subparagraph (A), the Secretary shall make available the remainder of such amount for other activities to prevent, prepare for, and respond to coronavirus, domestically or internationally, including—[…] a contingency fund for additional amounts the Secretary may award, including through grants, contracts, or cooperative agreements, to States, localities, territories, tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes to provide additional assistance with distribution and administration of coronavirus vaccines, as determined appropriate by the Secretary.”
Substance Abuse and Mental Health Services	$3,150,000,000	“Provided, That in addition to amounts provided herein, for an additional amount, $150,000,000 for grants to communities and community organizations who meet criteria for Certified Community Behavioral Health Clinics pursuant to section 223(a) of Public Law 113–93 […] For an additional amount for carrying out titles III and V of the PHS Act, including grant programs under such title V, with respect to substance abuse treatment and prevention, $3,000,000,000”
	$1,300,000,000	“Provided, That of such amount, $1,300,000,000 shall be for the State Opioid Response Grants for carrying out activities pertaining to opioids, stimulants, and alcohol undertaken by State agencies responsible for administering the substance abuse prevention and treatment block grant under subpart II of part B of title XIX of the PHS Act (42 U.S.C. 300x–21 et seq)”
	$50,000,000	“Provided further, That of such amount, $50,000,000 shall be made available to Indian Tribes and Tribal organizations”
	$185,000,000	“For an additional amount for carrying out titles III, V, and XIX of the PHS Act, in coordination with the Indian Health Service, with respect to substance use disorder and behavioral health among Indian tribes, tribal organizations, and urban Indian organizations, $185,000,000: Provided, That such amount is designated by the Congress as being for an emergency requirement pursuant to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Control Act of 1985 (2 U.S.C. 901(b)(2)(A)(i)).”
Coronavirus Local Community Stabilization Fund	$160,000,000,000	“Out of any money in the Treasury of the United States not otherwise appropriated, there are appropriated for making payments to States and Tribal entities under this section, $160,000,000,000 for fiscal year 2021, to remain available until expended.”
Coronavirus Local Community Stabilization Fund	$8,000,000,000	“Of the amount appropriated under paragraph (1), the Secretary shall reserve $8,000,000,000 of such amount for making payments to Tribal entities under subsection (c)(7), subject to subparagraph (B).”

Why is this important to UIOs?

UIOs need additional funding to provide adequate health care for American Indians/Alaska Natives and ensure successful COVID-19 vaccine distribution and administration.