NCUIH Submits Testimony to House and Senate Veterans Affairs Committees

On March 18, 2021, the House and Senate Veterans Affairs Committee invited the National Council of Urban Indian Health to submit testimony on ongoing issues facing urban Native veterans.

NCUIH made the following recommendations:

  • Urge VA to Reimburse UIOs ASAP and Include Urban Indians in Copayment Exemption
  • Provide Oversight to the VA to Interpret Eligibility in Favor of Increasing Access to Care and Consistent with the PL 116-315 and Indian Health Care Improvement Act (25 U.S.C 1602)
  • Remove Non-Committal Language of Only “Exploring Options” to Extend VHA Consolidated Mail Outpatient Pharmacy Access to UIOs

Why Does this Matter to UIOs?:

AI/AN veterans often prefer to use Indian Health Care Providers (IHCPs), including UIOs, for reasons such as cultural competency, community and familial relations, and shorter wait times.

Policy Contact: Meredith Raimondi, mraimondi@NCUIH.org

PRESS RELEASE: NCUIH Applauds the Cancellation of Keystone XL Pipeline Permit

FOR IMMEDIATE RELEASE

Press Contact: Sara Williams, swilliams@NCUIH.org

Washington, D.C. (January 21, 2021) – On his first day in office, President Joe Biden signed a series of Executive Orders including the cancellation of the Keystone XL (KXL) oil pipeline.

“It is exciting to know that the Biden Administration is sincere about its commitment to Indian Country by showing such urgency for Tribal Sovereignty and health,” said National Council of Urban Indian Health CEO Francys Crevier (Algonquin). “We encourage the Administration to continue their work and to halt the construction of additional dangerous pipelines on tribal lands, such as the Dakota Access Pipeline (DAPL).”  

The KXL pipeline was set to go through the heart of the Oceti Sakowin territory. This pipeline violated the Fort Laramie Treaty of 1851 and Lame Bull Treaty of 1855, both in which the United States committed to protecting against future harm to the tribes’ natural resources. The U.S. did not consult with Tribal leaders before proposing the pipeline. The pipeline posed significant adverse health risks as well as damage to traditional and sacred lands.

The revocation of this permit is a good sign that this administration is eager to work with AI/AN populations to build a healthy and more prosperous future.

PRESS RELEASE: Congressional Leaders Request Resources for Urban Indians in Budget Reconciliation

FOR IMMEDIATE RELEASE

Policy Contact: Meredith Raimondi, mraimondi@NCUIH.org

Press Contact: Sara Williams, swilliams@NCUIH.org

Washington, D.C. (February 8, 2021) Today, 26 House Representatives called on Congressional leaders to prioritize expanding resources for urban American Indians and Alaska Natives (AI/AN) in the COVID-19 budget reconciliation. At a critical time when AI/ANs are dying at alarming rates from COVID-19, the federal government must do more to fulfill its trust and treaty obligations to serve this population. The letter specifically asks for Congress to include a fix that will provide parity for Urban Indian Organizations (UIOs) and provide significant cost savings to cash-strapped states.

“Urban Indian Organizations are serving an at-risk population in some of the hardest-hit urban centers in 117 counties across 24 states and are doing so with limited supplies and resources. Now is the time to ensure these organizations have equal access to federal resources so they can continue to fulfill the federal government’s trust responsibility to Indian country. At a time when states are most strapped for resources, this fix would allow more resources to flow back into our states and provide parity to UIOs,” said Rep. Ruiz and the 26 Members of Congress in their letter.

According to a February 4, 2021, article by The Guardian, “Covid is killing Native Americans at a faster rate than any other community in the United States, shocking new figures reveal. American Indians and Alaskan (sic) Natives are dying at almost twice the rate of white Americans, according to an analysis by APM Research Lab shared exclusively with the Guardian.”

“One in 475 Native Americans has died from COVID-19 since the start of the pandemic. As Congress works with the new Administration to ensure equity in the pandemic response, a good first step would be fixing this long-standing problem that is impeding critical access to health care for our relatives in urban areas. Additional resources for Urban Indian Organizations (UIOs), who have been on the frontlines since day one of this pandemic, also translates to major cost savings for state Medicaid funds that can be immediately redirected to patient care,” said National Council of Urban Indian Health CEO Francys Crevier (Algonquin).

There is a trust responsibility to provide healthcare to all AI/ANs that is a duty of the United States government. Section 3 of P.L. 94-437, the Indian Health Care Improvement Act, declares that “it is the policy of the Nation, in fulfillment of its special responsibilities and legal obligations to the American Indian people, to ensure the highest possible health status for Indians and urban Indians.”

Next Steps

NCUIH will continue to work with Congressional leaders and the Biden Administration to build a better COVID-19 response for AI/ANs.

PRESS RELEASE: American Rescue Plan Act Passes with Historic Investment in Urban Indian Health

FOR IMMEDIATE RELEASE

Policy Contact: Meredith Raimondi, mraimondi@NCUIH.org

Press Contact: Sara Williams, swilliams@NCUIH.org

Washington, D.C. (March 10, 2021) – Today, the House passed H.R.1319 American Rescue Plan Act, the COVID-19 relief package. On March 6, the Senate passed the plan with a 50-49 vote. The bill includes $6.1 billion for Indian health programs with $84 million for urban Indian health and two years of 100% Federal Medical Assistance Percentage coverage (FMAP) to Urban Indian Organizations (UIOs) for Medicaid services for IHS-beneficiaries. The bill is set to be signed into law by President Biden no later than March 14.

“We are encouraged by the work of Congress to pass the American Rescue Plan Act with robust funding towards urban Indian health and expanded opportunities for Medicaid-IHS beneficiaries. As our frontline health heroes at urban Indian organizations are leading the way, along with the rest of the Indian health system, in vaccinating our populations, we hope to see better outcomes for our relatives,” said National Council of Urban Indian Health CEO Francys Crevier (Algonquin). “This pandemic is far from over as Native lives are still being lost at twice the rate of non-Hispanic whites, so these critical resources will help honor trust and treaty obligations while improving outcomes for all Native communities.”

The Indian health provisions in the American Rescue Plan Act reflect many recommendations in the tribal inter-organization letter sent on February 2. These investments for Indian health will be critical for shoring up necessary resources to combat COVID-19 as January “was the deadliest so far in the US, with 958 recorded Native deaths – a 35% increase since December, a bigger rise than for any other group.” “Native communities need relief. We listened, and we took action. With more than $31 billion for Tribal governments and Native programs, the American Rescue Plan delivers the largest one-time investment to Native communities in history,” said Senator Brian Schatz (D-HI), Chair of the Senate Committee on Indian Affairs and a member of the Senate Appropriations Committee. “This historic funding is a down payment on the federal government’s trust responsibility to Native communities and will empower American Indians, Alaska Natives, and Native Hawaiians to tackle COVID-19’s impacts on their communities.”

NCUIH has worked closely with Representative Raul Ruiz (D-CA) and key Congressional leaders to push for 100% FMAP for 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 the COVID-19 pandemic continues to ravage Native communities.

NEXT STEPS

NCUIH is grateful for the inclusion of urban Indians into H.R.1319 and commends those Congressional leaders for their continuous support. NCUIH will continue to push for long-term 100% FMAP for UIOs with H.R. 1373.

Overview of Indian Health Provisions

  • $6.094 billion in funding for Indian health programs
  • $2 billion for lost revenue
  • $500 million for Purchased/Referred Care
  • $140 million for information technologies, telehealth, and electronic health records infrastructure
  • $84 million for urban Indian health programs
  • $600 million for vaccine-related activities
  • $1.5 billion for testing, tracing, and mitigating COVID-19
  • $240 million for public health workforce
  • $420 million for mental and behavioral health prevention and treatment services among Indian tribes, tribal organizations, and urban Indian organizations
  • $600 million for funding support of tribal health care facilities and infrastructure
  • $10 million for potable water delivery

All funds appropriated in this section will be made available to Tribes through IHS to avoid any further disbursement delays similar to those experienced in previous COVID-19 relief efforts.

Read the Final Bill Text Here

American Rescue Plan Act Passes with Historic Investment in Urban Indian Health

The plan includes $84 million for urban Indian health and two years of 100% Federal Medical Assistance Coverage for Urban Indian Organizations.

Washington, D.C. (March 10, 2021) – Today, the House passed H.R.1319 American Rescue Plan Act, the COVID-19 relief package. On March 6, the Senate passed the plan with a 50-49 vote. The bill includes $6.1 billion for Indian health programs with $84 million for urban Indian health and two years of 100% Federal Medical Assistance Percentage coverage (FMAP) to Urban Indian Organizations (UIOs) for Medicaid services for IHS-beneficiaries. The bill is set to be signed into law by President Biden no later than March 14.

“We are encouraged by the work of Congress to pass the American Rescue Plan Act with robust funding towards urban Indian health and expanded opportunities for Medicaid-IHS beneficiaries. As our frontline health heroes at urban Indian organizations are leading the way, along with the rest of the Indian health system, in vaccinating our populations, we hope to see better outcomes for our relatives,” said National Council of Urban Indian Health CEO Francys Crevier (Algonquin). “This pandemic is far from over as Native lives are still being lost at twice the rate of non-Hispanic whites, so these critical resources will help honor trust and treaty obligations while improving outcomes for all Native communities.”

The Indian health provisions in the American Rescue Plan Act reflect many recommendations in the tribal inter-organization letter sent on February 2. These investments for Indian health will be critical for shoring up necessary resources to combat COVID-19 as January “was the deadliest so far in the US, with 958 recorded Native deaths – a 35% increase since December, a bigger rise than for any other group.”

“Native communities need relief. We listened, and we took action. With more than $31 billion for Tribal governments and Native programs, the American Rescue Plan delivers the largest one-time investment to Native communities in history,” said Senator Brian Schatz (D-HI), Chair of the Senate Committee on Indian Affairs and a member of the Senate Appropriations Committee. “This historic funding is a down payment on the federal government’s trust responsibility to Native communities and will empower American Indians, Alaska Natives, and Native Hawaiians to tackle COVID-19’s impacts on their communities.”

NCUIH has worked closely with Representative Raul Ruiz (D-CA) and key Congressional leaders to push for 100% FMAP for 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 the COVID-19 pandemic continues to ravage Native communities.

Final Bill Text

Next Steps

NCUIH is grateful for the inclusion of urban Indians into H.R.1319 and commends those Congressional leaders for their continuous support. NCUIH will continue to push for long-term 100% FMAP for UIOs with H.R. 1373.

Overview of Indian Health Provisions

  • $6.094 billion in funding for Indian health programs
  • $2 billion for lost revenue
  • $500 million for Purchased/Referred Care
  • $140 million for information technologies, telehealth, and electronic health records infrastructure
  • $84 million for urban Indian health programs
  • $600 million for vaccine-related activities
  • $1.5 billion for testing, tracing, and mitigating COVID-19
  • $240 million for public health workforce
  • $420 million for mental and behavioral health prevention and treatment services among Indian tribes, tribal organizations, and urban Indian organizations
  • $600 million for funding support of tribal health care facilities and infrastructure
  • $10 million for potable water delivery

All funds appropriated in this section will be made available to Tribes through IHS to avoid any further disbursement delays similar to those experienced in previous COVID-19 relief efforts.

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NCUIH on PBS: Why Indigenous people in cities feel invisible as pandemic wears on

Originally published by Casey Kuhn on PBS.

Like many other communities of color, Indigenous people across America have been disproportionately affected by the coronavirus because of historical health disparities, lack of basic resources in some parts of the country and poorly funded Indigenous health care.

Navajo Nation, the largest American tribe with more than 300,000 members, has been devastated by loss. As of February 21, at least 1,144 Navajo people have died from the virus. Centers for Disease Control race data from December in 14 states show COVID-19 mortality among American Indians/Alaska natives was 1.8 times higher than white people. In another study of data from 23 states last summer, American Indians/Alaska Natives tested positive for COVID-19 three and a half times the rate white people tested positive.

As COVID-19 began ripping through Reva Stewart’s Navajo Nation community, she started localized community help through an Indigneous store in Phoenix, delivering and making hundreds of care boxes. And then her worst fear came true.

After months of being careful, Stewart’s daughter, Raven, started feeling sick with COVID-19 symptoms over the summer.

“She’s 24, has asthma, low iron levels, and underlying issues, and I was so scared,” Stewart said.

Raven was the third person in Stewart’s Phoenix-based family who became infected with the coronavirus in June. Stewart moved from the Navajo reservation to Phoenix decades ago to pursue her schooling to work in health care. She tries to go back on the reservation on occasion to help her extended family.

“I’ve lost two aunties, three uncles and a couple of cousins,” Stewart said. “It’s sad because you can’t go to the funeral service. I can’t get up and travel to be with family.”

As COVID-19 has swept through Navajo lands, the tribal government enforces lockdowns and curfews, sometimes for weeks at a time. These measures are meant to stop the spread of the virus in a place where most of its residents have to drive long distances for their jobs, to haul water and to get groceries. The checkpoints set up by Navajo police also discouraged outside visitors to come into the area in an effort to contain COVID-19.

But according to census data, more than three quarters of the country’s Indigenous people don’t live on designated tribal lands. More than half of all American Indians live in cities. According to the Indian Health Service, at least 6,766 Indigenous people in urban areas tested positive for COVID-19 from the beginning of the pandemic in March 2020 to mid-February.

The Phoenix metropolitan area has the third-highest American Indian population in the country, after New York City and Los Angeles. Indigenous people also make up about 4 percent of the COVID-19 cases in Phoenix metro. The data also show that cases and hospitalizations rates for Indigenous people are double the total population in Maricopa County which encompasses Phoenix, one of the largest counties in the country.

When Stewart’s older daughter, Michelle, had symptoms that quickly deteriorated to the point where she felt like she couldn’t breathe and called 911, she was taken to a Phoenix hospital. The hospital found she had a 104 degree temperature and low oxygen levels, but released her from the emergency room after an hour of treatment.

“She said the security guard said she couldn’t wait in the front and had to get off the campus because she was COVID-19 positive, and had to wait down the street away from the hospital in the [100-degree] heat,” Stewart said. A hospital spokeswoman told PBS NewsHour it’s their policy to keep COVID-19 patients in the emergency room until their ride arrives.

Stewart was furious and terrified, as her two daughters and their father were now sick at the same time.

“I started to hyperventilate,” she said. “I put plastic everywhere, doubled up my mask, picked her up and didn’t want to scare her, but I was scared too.”

By July, Stewart said she was grateful they were all doing better, despite some lingering symptoms. “It was really stressful and scary.”

For American Indians living in urban settings, like Stewart, the Indian Health Service offers health care through more than 40 nonprofit health programs, called Urban Indian Organization facilities or UIO. These are not directly funded through federal money, but rather through IHS grants. Stewart’s daughter was not taken to an IHS facility like the Phoenix Indian Medical Center, which frustrated Reva.

‘Urban Indians are invisible’

“In general… urban Indians are invisible. A lot of times our urban Indian organizations may be missed,” said Dr. Rose Weahkee, acting director of the Office of Urban Indian Health Programs. “They’re an integral part to the IHS system. They provide culturally appropriate, quality health care to our Indian patients and are a safety net for families living off the reservation who want to maintain ties to cultural traditions, which is important when addressing COVID-19.”

Weahkee, who is a member of the Navajo Nation, said about $103 million from CARES Act funding is going to help urban Indian centers, with about half of that money going to COVID-19 testing. She also said the IHS has done outreach with urban Indigenous people to understand their specific concerns better.

“One way we wanted to get those urban needs is have the Indian Health Service director hold biweekly calls with urban Indian center leaders so the IHS can help provide updates, clinical guidance and testing data,” she said. “It’s also an opportunity to hear from urban programs on what their priorities are and needs and concerns.”

One concern is underreported COVID-19 positivity rates. While IHS hospitals on tribal lands often have the knowledge and resources to keep more complete racial data, tribes and urban Indian centers are not required to share their COVID-19 testing data on the federal level. That can lead to gaps in racial health data.

Abigail Echo-Hawk, director of tribal epidemiology center Urban Indian Health Institute in Seattle, worries the COVID-19 positivity numbers in urban Indigenous communities do not tell the whole story.

“From the limited data that we do have, we are seeing a disproportionate impact… our community is seeing and having higher rates of positive COVID tests,” Echo-Hawk said. “But we know that is a gross underreport. If we had the real data, I think that that disparity would be much higher.”

Echo-Hawk, who is Pawnee, said the best data on Indigenous people is typically collected on the reservations and by Indian Health Service facilities. Non-tribal entities, like hospitals, cities and counties, don’t always follow the best data collection practices for identifying someone’s race, Echo-Hawk said. Data is especially vulnerable for mixed-race people, which is the case for many Indigenous people.

“When you go into a clinic waiting room or your family fills out forms for you, they may not even have the box that says ‘check this box to identify as American Indian or Alaska native,’” she said. “Another problem is that we find a lot of people may be uncomfortable asking somebody’s race and ethnicity. For American Indian/Alaska native people, we are one of the highest-growing groups of multi-race individuals. So there is no specific look, no specific skin color. We need to be asked the questions.”

The Urban Indian Health Institute recently released a report grading each state on its COVID-19 data collection when it comes to complete Indigenous records. The average was a D+. More than a dozen states failed the assessment, which took into account whether the state includes American Indian/Alaska Native as a population on its data dashboards