NCUIH RELEASES 2021 LEGISLATIVE PRIORITIES

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NCUIH RELEASES 2021 LEGISLATIVE PRIORITIES

NCUIH is pleased to announce the release of the 2021 Legislative Priorities. NCUIH hosted five focus groups to identify Urban Indian Organization (UIO) policy priorities for 2021, as they relate to Indian Health Service (IHS)-designated facility types (full ambulatory, limited ambulatory, outreach and referral, and outpatient and residential). The top priorities for 2021 include $200.5 million for UIOs in FY22, advance appropriations, behavioral health funding for UIOs, full 100% FMAP for UIOs permanently, removal of facilities restrictions and the establishment of an urban confer policy at HHS, among others. NCUIH will continue to work with Congress on advancing these priorities on behalf of UIOs for 2021.

Why Does this Matter to UIOs?:

The current public health crisis has exacerbated the need for legislative action as it pertains to UIOs.

Policy Contact: Meredith Raimondi, mraimondi@NCUIH.org

Read our Priorities

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PRESS RELEASE: IHS Announces Medical Malpractice Coverage for Urban Indian Health Workers Following Enactment of NCUIH Legislation

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Washington, D.C. (March 26, 2021) – On Monday, March 22, the Indian Health Service (IHS) announced the successful implementation of the Federal Tort Claims Act (FTCA) to Urban Indian Organizations (UIOs) and their employees to the same extent and in the same manner as to Tribes and Tribal Organizations. The National Council of Urban Indian Health (NCUIH) has advocated for over 20 years for medical malpractice coverage for urban Indian health workers. With this essential change, a single organization can redirect up to $200,000 annually to patient care.

 

Congressional champions Reps. Ruben Gallego (D-AZ) and Markwayne Mullin (R-OK), along with Senators Tina Smith (D-MN), Tom Udall (D-NM), James Lankford (R-OK), and Martha McSally (R-AZ), worked tirelessly to ensure this important fix to expand resources for UIOs. NCUIH legislation to provide coverage for urban Indian health workers passed late last year as a standalone bill with broad bipartisan support.

 

“During the pandemic, every dollar makes a difference for these critical organizations providing care to urban Indians,” said NCUIH CEO Francys Crevier (Algonquin). “We applaud our Congressional advocates in helping stretch our limited resources to serve urban Indians at such a critical time. As Natives continue to have the highest death rates in the world, the federal government must uphold its trust responsibility and continue to provide every possible opportunity to increase access to care.” 

 

“Federal tort law currently omits coverage for UIOs, and especially during the coronavirus pandemic, UIOs, like other already covered Tribal health facilities, need to have the peace of mind that they can utilize their funds for care, not court cases,” said Senator Lankford.

 

“Oklahoma City Indian Clinic has spent hundreds of thousands of dollars each year on liability insurance for our providers,” said NCUIH Vice-President and CEO of Oklahoma City Indian Clinic Robyn Sunday-Allen. “With this parity, we can now put every cent back into services. We applaud the leadership of Senator Lankford on helping redirect our limited resources back to patients and families who rely on our services now more than ever.”

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NCUIH Submits Testimony to Senate Committee on Indian Affairs

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NCUIH recently submitted testimony to the Senate Committee on Indian Affairs for the Oversight Hearing “A call to action: Native communities’ priorities in focus for the 117th Congress.” In the testimony, NCUIH outlined how 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. NCUIH has worked closely with Representative Raul Ruiz (D-CA) and key Congressional leaders to push for the inclusion of 100% FMAP for services provided at UIOs. Last week, Representative Ruiz introduced H.R.1373 the Urban Indian Health Parity Act, bipartisan legislation, with 12 original cosponsors to extend the 100% FMAP provision permanently to expand resources for American Indians and Alaska Natives living in urban areas especially as COVID-19 pandemic continues to ravage Native communities.

Why Does this Matter to UIOs?:

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.

Policy Contact: Meredith Raimondi, mraimondi@NCUIH.org

Read the Testimony

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PRESS RELEASE: NCUIH Testified Before House on COVID-19 Impacts in Indian Country

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FOR IMMEDIATE RELEASE

Policy Contact: Meredith Raimondi, mraimondi@NCUIH.org

Press Contact: Sara Williams, swilliams@NCUIH.org

Washington, D.C. (March 23, 2021) – National Council of Urban Indian Health CEO Francys Crevier (Algonquin) testified before the Subcommittee for Indigenous Peoples of the United States, led by Chair Teresa Leger Fernández (D-NM). The hearing is addressed the “Emerging Coronavirus Impacts in Indian Country.”

“Urban Indian Organizations have continuously provided services in the hardest hit urban areas during the entire pandemic,” said Crevier. “There have been vast improvements from where we were a year ago with regards to the availability of supplies, tests, and vaccines, but that will never make up for the sheer number of Native lives lost. Unfortunately, despite improvements, the situation facing Natives has not relented. The bottom line is that what little data exists for Natives shows a stark reality: COVID-19 is killing Native Americans at a faster rate than any other community.”

Rep. Ruben Gallego (D-AZ), an urban Indian health champion, requested additional information about why Urban Indian Organizations (UIOs) cannot make any facilities-related upgrades using federal funds. Ms. Crevier explained that the Indian Health Care Improvement Act contains unnecessary limitations on UIOs and urged for a legislative fix to allow UIOs to use federal funds for facilities. Rep. Chuy Garcia (D-IL) discussed the long-standing inequities experienced by UIOs due to lack of full funding.

“Structural deficiencies led to the devastating impact of COVID-19 on Native American communities,” Said Rep. Leger Fernandez. “We must also identify ways to address the root causes of the impacts. I heard over and over in today’s testimony about the need for full funding as is required by the trust responsibility.”

House Natural Resources Chairman Raul Grijalva (D-AZ) asked Francys Crevier about the importance of an urban confer process. She identified why it is critical for federal agencies like the Department of Health and Human Services (HHS) to have policies that address communicating with UIOs. Ranking Member Don Young (R-AK) discussed the re-introduction of the Rep. Betty McCollum advance appropriations bill for all of the Indian Health Service, including UIOs.

The hearing also included testimony from Chief William Smith, Chairperson and Alaska Area Representative, National Indian Health Board. In his testimony, Chief Smith highlighted the importance of extending permanent 100% Federal Medical Assistance Percentages to UIOs and the need for mandatory appropriations for the Indian Health Service, Tribal organizations, and UIOs.

Ranking Member Bruce Westerman (R-AR) acknowledged the disproportionality of the effect of COVID-19 on American Indian and Alaska Native (AI/AN) populations and that the current funding provided in the American Rescue Plan Act is commendable. Still, it is not sustainable for the needs and efficacy of combatting the historical health issues that plague AI/AN people. To reiterate Rep. Westerman’s request for increased funding, Rep. Young called for the subcommittee to introduce a historical “Native people only” bill to address funding and all the needs that impact AI/AN populations and Native people.

Watch Testimony Read Full Testimony

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House Energy and Commerce Holds Legislative Hearing on ACA including NCUIH’s Bill on 100% FMAP for UIOs

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On March 23, 2021, the Subcommittee on Health of the Committee on Energy and Commerce held a legislative hearing on “Building on the ACA: Legislation to Expand Health Coverage and Lower Costs.” The hearing included a review of several key pieces of legislation including a top priority for urban Indian health and NCUIH – the extension of 100% FMAP to UIOs permanently.

The bill, H.R. 1888, the “Improving Access to Indian Health Services Act”, introduced by Rep. Ruiz (D-CA), would increase the FMAP for Urban Indian Health Programs to 100 percent. It would also authorize Medicaid payment for services furnished by Tribal facilities outside of the four walls of the facility. At the hearing, Dr. Ruiz emphasized that there is no sound policy reason for excluding Urban Indian Organizations from eligibility for the 100% FMAP and advocated for the Committee to pass H.R. 1888.

Why Does this Matter to UIOs?:

NCUIH has been working on permanent 100% FMAP for UIOs closely with our Congressional leaders. The federal government has a trust obligation to pay 100% FMAP rates for all IHS-beneficiaries regardless of their physical location. This is a necessary parity fix for urban Indian organizations.

Policy Contact: Meredith Raimondi, mraimondi@NCUIH.org

Read Memo

Read the Bill

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Small Native American Health Centers Face Vaccine Barriers

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This article was originally published on Law360 by Emma Whitford.

Law360 (March 12, 2021, 6:12 PM EST) — The Indian Health Service has reported administering more than 684,000 COVID-19 vaccine doses so far and delivering them to locations as remote as the bottom of the Grand Canyon, but some urban health centers say they’re not part of this early success.

IHS-funded clinics in cities like Phoenix have vaccinated thousands, expanding their eligibility requirements to administer doses to younger Native Americans in addition to elders and essential workers.

But a small organization that contracts with the IHS to serve Native Americans in Boston and Baltimore told Law360 it lacked the storage and staffing required to receive direct vaccine shipments from the IHS back in December. Staff say they have hundreds of potential vaccine patients in their regions but have yet to administer a single dose.

About 70% of Native Americans live in cities, but urban health centers don’t receive a proportional amount of IHS funding. All three IHS-funded urban centers on the East Coast — the third is in New York City — lack on-site medical services, focusing instead on referrals.

For advocates, this discrepancy shows the need to increase overall IHS funding and build up small urban health centers so that Native Americans can have comparable care options regardless of their ZIP code.

“I don’t have any way to store the vaccine, and I don’t have medical providers on site to administer the vaccine,” said Kerry Lessard, executive director of Native American Lifelines, which has locations in Boston and Baltimore providing services such as mental health care and disease prevention.

“When you leave the reservation or a large Native community, you’re penalized, essentially,” Lessard added. “You don’t have access to the services that are guaranteed to you. That is an abrogation of sovereignty.”

In a February resolution, the National Council of Urban Indian Health called on the U.S. Department of Health and Human Services to create an Emergency COVID-19 Urban Indian Task Force and provide “full resources, technical assistance and support” for vaccine distribution at all IHS-funded facilities, specifically mentioning Native American Lifelines of Baltimore and Boston.

While some of the smallest urban clinics, like the Tucson Indian Center in Arizona, are now close to establishing vaccine partnerships with local tribes and governments, NCUIH director Francys Crevier said it has been a heavy logistical burden on facilities that are stretched thin to begin with.

According to the council, there are 63,000 Native Americans and Alaska Natives living in the D.C. metropolitan area.

“If Congress really wants to make a difference, I think that has to start with full funding of IHS and a plan of service expansion to the areas that our population is [in],” Crevier said.

Lessard said she is currently working around the clock in Baltimore trying to leverage her existing relationships in state government and within the Indian Health Service.

In addition to trying to serve members of state-recognized tribes in Maryland that cannot contract directly with the IHS, like the Accohannock, she is fielding vaccine requests from federal workers in Washington, D.C., who are hearing vaccination success stories from friends and family who live on reservations.

Maryland established a Vaccine Equity Task Force this month. A spokesperson told Law360 that a visit with Lessard’s organization “will be scheduled as soon as possible,” and that the state can potentially provide staffing and space to administer vaccines.

By contrast, larger city-based clinics, like Native Health of Phoenix, are already deep into their vaccination programs after starting appointments in mid-December.

Native Health Phoenix Director Walter Murillo has a staff of more than 180 and three locations across the city. He told Law360 he was able to purchase an ultra-cold freezer last summer in anticipation of the vaccine rollout and already has more than 2,200 vaccines, expanding eligibility to people with underlying conditions like diabetes and hypertension who are not currently eligible under Maricopa County guidelines.

“Going through IHS was actually an absolute plus, a blessing to say that we could get those [doses] directly from distribution points from the federal government,” said Murillo, who is also president of the NCUIH. But he acknowledged that his smaller sister organizations are “starting from five steps back.”

In Boston, according to Lessard, Sen. Elizabeth Warren’s office helped broker an introduction between Native American Lifelines and the Massachusetts Department of Health, but so far it hasn’t been fruitful. Organizations like Native American Lifelines are “crucial providers of health care” and “all levels of government should work with them,” a spokesperson for Warren told Law360.

Massachusetts’ health department did not comment on the record to Law360, though the Boston Public Health Commission said by email it “would be happy to work with” Native American Lifelines.

But Zoë Harris, program assistant at Native American Lifelines in Boston, said it’s been a frustrating few months for her client base of about 100 people.

“Our client population was frustrated because they were seeing all their family members back home getting access, and they felt like they were being punished because they are no longer on the reservation,” Harris said.

There are also local state-recognized tribes, like the Herring Pond Wampanoag Tribe and Nipmuc Nation, which Harris said rely on the center.

A new pandemic relief bill passed by President Joe Biden on Thursday has $6.1 billion for IHS including “no less than $84 million for urban Indian health programs,” IHS told Law360, in addition to $160 million set aside for them in earlier relief packages.

“IHS supports expanding access to health care for urban Indians” and will “continue to work closely with [urban Indian organizations] on meeting the health care needs of urban Indian communities,” the agency said.

Meanwhile, Harris and her team in Boston are looking to partner with the National Guard or the state’s two federally recognized tribes, the Mashpee Wampanoag Tribe on Cape Cod and Wampanoag Tribe of Gay Head Aquinnah on Martha’s Vineyard.

Both tribes are currently receiving vaccines from IHS, but coordination is challenging, especially with the island-bound Aquinnah.

“For me personally, it sheds the light on needing a fully ambulatory clinic in the Boston area,” Harris said. “We are supposed to be serving the Greater Boston Area … and there are three people in our office. That’s literally a job that’s not possible.”

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Advancing health equity for urban American Indian and Alaska Natives: Q&A with Francys Crevier

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This article was originally published on the Kresge Foundation, by Katharine McLaughlin.

Today, most American Indian and Alaska Natives (AI/AN) in the United States live in cities, and they have unique health needs. The National Council of Urban Indian Health, a Kresge grantee partner, is the only national organization devoted to the support and development of quality, accessible, and culturally competent health services for AI/ANs living in cities.

To learn more about National Council of Urban Indian Health and how its work is critical to support the resiliency of the AI/AN community through meaningful change in the social equity of health care, Kresge recently connected with NCUIH Chief Executive Officer Francys Crevier for a conversation.

Kresge: What is the National Council of Urban Indian Health and what is the organization’s mission?

Crevier: The National Council of Urban Indian Health (NCUIH) is a 501(c)(3) nonprofit organization devoted to the support and development of quality, accessible, and culturally-competent health services for American Indians and Alaska Natives (AI/AN) living in urban settings. Located in Washington, D.C., NCUIH has a national reach advocating for access to culturally competent healthcare for urban American Indian and Alaska Natives across the country.

As the only national organization advocating for the health of urban AI/AN, NCUIH provides critically-needed technical assistance, training, policy support, and other services to the 41 Urban Indian Organizations that provide health services throughout the U.S.

Kresge: What does “urban American Indian and Alaska Native” mean?

Crevier: From the 1700s and 1800s, the federal government’s policy was to strip Tribal land from American Indian and Alaska Native people. In the 19th century, federal boarding schools governed by the doctrine “Kill the Indian, save the man” were established and AI/AN children were taken from their reservations and families and inserted into foreign environments. As recent as the 1950s and 60s, the federal government’s relocation policies forced AI/AN off Tribal land. The relocation policies caused significant problems, including lack of orientation, scarce employment opportunities, serious health concerns, culture shock, and historical trauma associated with forceful assimilation.

Today, about 70 percent of the AI/AN population live in urban areas, which is about four million people. Although more than 70 percent of AI/AN people live in urban areas, they are frequently left out of national discussions on health and, as a result, don’t receive critical comprehensive healthcare resources.

The AI/AN population’s shift to urban areas has put this group at risk for a host of infectious disease issues, as many have experienced economic instability, homelessness, unemployment, poverty, and a lack of a cultural connectiveness or sense of community. Even before the onset of the novel coronavirus, Native communities across the U.S. faced a crisis in health care, including higher rates of health issues due to isolation from Tribal lands and identity, lack of adequate health care, and distressed economic conditions.

Because of consequences due to multiple traumas, having culturally competent and sensitive healthcare services available to urban AI/AN is a vital part of quality care.

Kresge: What is an Urban Indian Organization?

Crevier: Urban Indian Organizations (UIOs) are nonprofit organizations that provide local urban AI/AN with a range of healthcare and social services. UIO services are culturally tailored to combat specific health disparities associated with urban AI/AN populations, which is the key to preventing and treating serious health problems and diseases.

Through NCUIH’s active representation of UIOs’ main needs and gaps, NCUIH raises awareness about issues impacting UIOs and ensures their interests are included in key policy discussions for increased resources to better serve urban AI/AN communities.

Kresge: How has the COVID-19 pandemic impacted Indian Country?

Crevier: The COVID-19 pandemic exacerbated existing imbalances in access to culturally-competent health care for urban AI/AN.

While the pandemic’s impact has been devastating throughout the country, AI/AN are 3.5 times more likely to have serious illness. This pandemic has been deadlier for Native Americans than other groups as 1 in 475 AI/AN have died from COVID-19.

Throughout the COVID-19 pandemic, NCUIH continues to be at the forefront of advocating for Indian health to ensure the stability of UIOs that provide culturally competent healthcare services to AI/AN living in cities. Because of the catastrophic impact of this virus, most recent efforts have focused on increasing availability of and confidence in the COVID-19 vaccine.

NCUIH’s advocacy ensured UIOs had access to COVID-19 vaccines because they did not receive federal resources during the H1N1 pandemic or the recent Zika outbreak. As such, many UIOs received their vaccines through the Indian Health Service (IHS). Those providers have administered 9,000 doses so far and have another 7,000 on hand to distribute shortly. They’re hoping to eventually vaccinate more urban AI/AN across the country. However, some urban Indians will still be left out as several cities don’t have any UIO health providers due to longstanding inadequate funding for urban programs.

Due to historical trauma and mistrust caused by a long record of institutional racism, many AI/AN are less likely to be vaccinated against COVID-19.

To support vaccine confidence among AI/AN, we will be kicking off our #BeAGoodRelative campaign the week of March 15 as an effort to increase vaccine participation among urban AI/AN. NCUIH’s goal through this ongoing campaign is to encourage urban AI/AN to get vaccinated. The #BeAGoodRelative campaign utilizes a toolkit full of fun swag for urban AI/AN that includes masks, stickers, and fliers for UIOs to distribute as community members receive the COVID-19 vaccine.  To find out more and download the toolkit, follow NCUIH on Twitter, Facebook or YouTube.

For more information on NCUIH’s critical work to support the resiliency of the AI/AN community through meaningful change in the social equity of health care, visit www.ncuih.org.

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Representative Ruiz (D-CA) Introduces Legislation to Expand Resources for Urban Indian Organizations

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The Urban Indian Health Parity Act (H.R. 1373), championed by Representative Raul Ruiz (D-CA), and introduced by the National Council of Urban Indian Health as a priority legislative item, worked closely with Congressional members to advocate for resources to meet the unmet needs of Urban Indian Organizations especially as the COVID-19 pandemic continues to ravage Native communities. This bipartisan legislation with 12 original cosponsors will ensure that the American Indians and Alaskan Natives living outside of Tribal lands will receive quality healthcare. The bill specifies that the federal government’s responsibility will go beyond Tribal reservations to provide 100% Federal Medical Assistance to Urban Indian Organizations.

Why Does this Matter to UIOs?

With additional resources freed up by this legislation, UIOs will be able to expand patient care and provide more services to tackle the COVID-19 pandemic.

Policy Contact: Meredith Raimondi, mraimondi@NCUIH.org

Learn More

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STATEMENT: NCUIH Statement Supporting Asian Americans and Pacific Islanders

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FOR IMMEDIATE RELEASE

Press Contact: Sara Williams, swilliams@NCUIH.org

Stop Asian Hate

Washington, D.C. (March 19, 2021) –  Today, National Council of Urban Indian Health Chief Executive Officer Francys Crevier (Algonquin) released the following statement:

“This week, we once again bore witness to violence led by hate. In a state that has a long history of discrimination against Black, Indigenous, and people of color (BIPOC), we stand in solidarity with our Asian American and Pacific Islander (AAPI) relatives who have been subjected to centuries of violence and oppression. Our hearts and prayers go out to the families and loved ones of all eight victims.

According to the Stop AAPI Hate, there have been 3,795 reported incidents of hate against the AAPI community from March 19, 2020, to February 28, 2021. These incidents range from verbal harassment to civil rights violations. The primary site of reported discrimination is at a place of business. These alarming trends have been on the rise since the start of the pandemic.

This violent act, performed on the stolen land of the Muscogee Creek and the Cherokee peoples in the Atlanta metro areas, reminds us of the devastating ruling in Cherokee Nation v. Georgia, where the rights of the Cherokee people were stripped and they were displaced from their land.

We condemn discrimination and violence in all forms and we ask the U.S. government to commit to eliminating the structures of racism that embolden these violent acts.”

Recommended Resources:

Stop AAPI Hate National Report

Resources for Combating Anti-Asian Racism

Anti-Racism Resources for the AAPI Community

Asian American Racial Justice Toolkit

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Hearing: Subcommittee for Indigenous Peoples of the United States – Emerging Coronavirus Impacts in Indian Country Hearing

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March 23, 2021 | 1:00 p.m. Eastern time

Watch Live on Facebook   Watch Live on YouTube

The Subcommittee for Indigenous Peoples of the United States, led by Chair Teresa Leger Fernández (D-N.M.), will hold a hearing titled A Year in Review: The State of COVID-19 in American Indian, Alaska Native, and Native Hawaiian Communities—Lessons Learned for Future Action. The event will focus on policy recommendations from tribal health, elder, housing and Native Hawaiian experts on the current state of coronavirus and its impact on Indigenous populations throughout the pandemic.

At the end of 2020, the Centers for Disease Control and Prevention (CDC) found that among 14 states participating in its analysis, the overall coronavirus mortality rate among American Indian and Alaska Native persons was 3.5 times higher than that of White populations. By the end of 2020, the mortality rate for American Indian and Alaska Native individuals was 3.5 times higher than that of White populations. In Hawaii, Pacific Islanders account for nearly 30 percent of cases even though they make up only 4 percent of the population.

Witnesses include:

Francys Crevier

Chief Executive Officer

National Council of Urban Indian Health

 William Smith

Chairperson and Alaska Area Representative

National Indian Health Board
Larry Curley

Executive Director

National Indian Council on Aging

 Adrian Stevens

Acting Chairman, Board of Directors

National American Indian Housing Council
Carmen “Hulu” Lindsey

Chair

Office of Hawaiian Affairs

 Dr. Charles Grim (minority witness)

Secretary, Department of Health

Chickasaw Nation
Rodney Cawston (minority witness)

Chairman, Colville Business Council

Confederated Tribes of the Colville Reservation

Who should attend? UIO ED/CEOs, UIO Staff, Stakeholders, Tribal Partners and Tribes, Feds, IPC Champions, IPC Fellows

Objectives: The Subcommittee for Indigenous Peoples of the United States, led by Chair Teresa Leger Fernández (D-N.M.), will hold a hearing titled A Year in Review: The State of COVID-19 in American Indian, Alaska Native, and Native Hawaiian Communities—Lessons Learned for Future Action. The event will focus on policy recommendations from tribal health, elder, housing and Native Hawaiian experts on the current state of coronavirus and its impact on Indigenous populations throughout the pandemic.

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