Congressional Leaders Request $200 Million for Urban Indian Health in FY22

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On April 30, 28 Congressional leaders requested $200.5 million for urban Indian health in FY22 from the House Appropriations Committee.

Reps. Grijalva and Gallego requested $200.5 million for urban Indian health with $12 billion for IHS as recommended by the Tribal Budget Formulation Workgroup in a forward appropriations letter to Chairwoman Pingree and Ranking Member Joyce of the House Interior Appropriations Committee. The letter cited that this increase in funding would “make a huge difference to UIOs in providing care to urban Indians due to historically low funding levels for urban Indian health. Another letter by Reps. Adam Smith and Don Young included $200.5 million for urban Indian health and $24 million for Tribal Epidemiology Centers in FY22.

These appropriations letters come as a continued effort by NCUIH to address acute health disparities for AI/ANs living in urban areas, who suffer greater rates of chronic disease, infant mortality and suicide compared to all other populations that have only been exacerbated by COVID-19. Congress has acknowledged these the significant health care disparities in Indian Country, but continuously underfunds IHS at around $4,000 per patient, and UIOs at less than $700 per patient even though AI/ANs living in urban areas comprise over two-thirds of the total American Indian Alaska Native population.

These Appropriations letters send a powerful and straightforward message to Chairwoman Pingree and Ranking Member Joyce and members of Congress to fulfill the federal government’s trust responsibility to all AI/ANs to provide safe and quality healthcare, funding for urban Indian health must be significantly increased.

NCUIH is grateful for the support of the following Representatives:

  • Ruben Gallego
  • Raul Grijalva
  • Adam Smith
  • Don Young
  • Nanette Diaz Barragan
  • Karen Bass
  • Earl Blumenauer
  • Emanuel Cleaver II
  • Sharice L. Davids
  • Diana DeGette
  • Suzanne DelBene
  • Sylvia Garcia
  • Steven Horsford
  • Sheila Jackson Lee
  • Pramila Jayapal
  • Ro Khanna
  • Teresa Leger Fernandez
  • Zoe Lofgren
  • Doris Matsui
  • Gwen Moore
  • Eleanor Holmes Norton
  • Tom O’Halleran
  • Ilhan Omar
  • Raul Ruiz, MD
  • Kim Schrier, MD
  • Greg Stanton
  • Marilyn Strickland
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IHS Releases FAQs Document Regarding FTCA Extension to UIOs

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On April 23, the Indian Health Service (IHS) released a Frequently Asked Questions (FAQ) document regarding Federal Tort Claims Act (FTCA) Coverage for Urban Indian Organizations (UIOs). This FAQ document follows Congress’ amendment to 25 U.S.C. § 5321(d) on January 3, 2021 to extend FTCA coverage to UIOs and their employees to the same extent and in the same manner as to Tribes and Tribal Organizations.

Why Does this Matter to UIOs?:

FTCA coverage for UIO allows for funding that would have been spent on the purchase of medical malpractice insurance to be used on programs and services that benefit their clients.

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Senators Smith and Murkowski Re-introduced Tribal Health Data Improvement Act

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On April 27, Sen. Tina Smith and Sen. Lisa Murkowski re-introduced NCUIH endorsed legislation to improve tribal health data surveillance. The bill intends to address challenges faced by tribes and tribal epidemiology centers when trying to access federal healthcare and public health surveillance data systems. NCUIH worked closely on the development of this bill to ensure urban Indians are adequately counted. If passed, the bill would require:

  • The Department of Health and Human Services to give tribes, tribal epidemiology centers, and the Indian Health Service access to public health surveillance programs and services.
  • The Centers for Disease Control (CDC) to give technical assistance to tribes and tribal epidemiology centers and to engage in tribal consultations on American Indian/Alaska Native (AI/AN) birth and death records
  • CDC to enter cooperative agreements with tribes, tribal organizations, urban Indian organizations, and tribal epidemiology centers to address misclassification of AI/AN birth and death records and public health surveillance information

Encourage states to enter into data sharing agreements with tribes and tribal epidemiology centers.

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NCUIH Partners with Native American Lifelines to Provide COVID-19 Vaccine

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After months of tireless advocacy, the National Council of Urban Indian Health (NCUIH) has partnered with Native American Lifelines (NAL), the University of Maryland, Baltimore, and the Indian Health Service (IHS) to bring the COVID-19 vaccine to urban Indians in the Washington, DC, Maryland, and Virginia metropolitan area. Vaccine appointments are being held at the University of Maryland, Baltimore, can be scheduled online, and are open to DMV metropolitan Natives (ages 16+) as well as non-Native individuals who work in organizations serving the Native community.

Read more about this new development from local news outlets:

University of Maryland, Baltimore opens COVID vaccine clinic for Indigenous peoples

UMB opens first regional COVID-19 clinic exclusively for Native Americans

COVID-19 Vaccine Available for Native Americans at UMB

UMB News: COVID-19 Vaccine Available for Native Americans at UMB

Vaccine clinic for Native Americans opens in Baltimore

Local clinic aims to get vaccinations to Native American community

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IHS Releases FAQs Document Regarding FTCA Extension to UIOs

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On April 23, the Indian Health Service (IHS) released a Frequently Asked Questions (FAQ) document regarding Federal Tort Claims Act (FTCA) Coverage for Urban Indian Organizations (UIOs). This FAQ document follows Congress’ amendment to 25 U.S.C. § 5321(d) on January 3, 2021 to extend FTCA coverage to UIOs and their employees to the same extent and in the same manner as to Tribes and Tribal Organizations.

Why Does this Matter to UIOs?:

FTCA coverage for UIO allows for funding that would have been spent on the purchase of medical malpractice insurance to be used on programs and services that benefit their clients.

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NCUIH Partners with Native American Lifelines to Provide COVID-19 Vaccine

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After months of tireless advocacy, the National Council of Urban Indian Health (NCUIH) has partnered with Native American Lifelines (NAL), the University of Maryland, Baltimore, and the Indian Health Service (IHS) to bring the COVID-19 vaccine to urban Indians in the Washington, DC, Maryland, and Virginia metropolitan area. Vaccine appointments are being held at the University of Maryland, Baltimore, can be scheduled online, and are open to DMV metropolitan Natives (ages 16+) as well as non-Native individuals who work in organizations serving the Native community.

 

Read more about this new development from local news outlets:

University of Maryland, Baltimore opens COVID vaccine clinic for Indigenous peoples

UMB opens first regional COVID-19 clinic exclusively for Native Americans

COVID-19 Vaccine Available for Native Americans at UMB

UMB News: COVID-19 Vaccine Available for Native Americans at UMB

Vaccine clinic for Native Americans opens in Baltimore

Local clinic aims to get vaccinations to Native American community

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NEW STATE OPIOID RESPONSE GRANT REAUTHORIZATION LEGISLATION NOW INCLUDES UIOS

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On April 8, 2021, Rep. David Trone introduced a bill titled “State Opioid Response Grant Authorization Act of 2021” to amend the 21st Century Cures Act to reauthorize and expand a grant program for State response to the opioid use disorders crisis, and for other purposes. This bill authorizes funding at $1.75 billion for each of fiscal years 2022 through 2027, to remain available until expended.

This bill includes a 5% set aside of the funds made available for each fiscal year for Indian Tribes, Tribal organizations, and Urban Indian Organizations (UIOs) to address substance abuse disorders through public health-related activities such as implementing prevention activities, establishing or improving prescription drug monitoring programs, training for health care practitioners, supporting access to health care services, recovery support services, and other activities related to addressing substance use disorders.

NCUIH has long advocated for UIOs to be added to the SOR grants given the extent of the impact of the opioid epidemic on urban Indians. NCUIH supports Rep. Trone’s legislation to reauthorize the 21st Century Cures Act grant program for State response to the opioid crisis and its inclusion of UIOs.

 

READ BILL
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Action Alert: Contact Congress to Increase Funding for Urban Indian Health TODAY

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Dear Urban Indian Health Advocates,

We need your help contacting Congress to support Urban Indian Organizations!

Representative Ruben Gallego (D-AZ) and Raúl Grijalva (D-AZ) are leading a letter to the Chair and Ranking Member of the Appropriations Subcommittee on Interior, Environment, and Related Agencies. This subcommittee appropriates funding for the Indian Health Service and for Urban Indian Organizations.

The letter calls for an increase in funding of a minimum of $200.5 million for urban Indian health. This funding increase is necessary to address the chronic underfunding UIOs have experienced, particularly during a global pandemic that is killing Natives at the highest rates worldwide. This amount also reflects the recommendation made by the Tribal Budget Formulation Working Group (TBFWG). To ensure that the urban Indian health line item receives as much support as possible, we encourage you to contact your Member of Congress and request that they sign on to the Gallego-Grijalva Urban Indian Health letter by the deadline of April 23.

You can use the text below as a template to call and/or email to your Member of Congress. If you can please, call and email your representative. You can find your representative here.

Thank you for your leadership. Your outreach on this is invaluable to providing greater access to health care for American Indians and Alaska Natives in urban areas.

Sincerely,

NCUIH

STEPS TO CONTACT CONGRESS

  • Step 1: Copy the email below.
  • Step 2: Find your representative here.
  • Step 3: Paste the email into the form and send. Please contact Meredith Raimondi (policy@ncuih.org) with questions.

Email to Your Member of Congress

Dear Representative,

As an urban Indian health advocate, I respectfully request you sign on to the Gallego-Grijalva letter to the House Committee on Appropriations in support of increasing the urban Indian health line item to $200.5 million for FY22.

As of the 2010 Census, it was reported that over 70% of American Indians and Alaska Natives (AI/ANs) reside in cities. There are 41 Urban Indian Organizations (UIOs) that provide health care through the Indian Health Care Improvement Act to reach this population as part of the government’s trust responsibility to all AI/AN people.

As an integral part of the AI/AN health care delivery system, UIOs rely on funding from IHS to provide care to urban AI/AN people. UIOs depend on scarce federal resources to provide services to our AI/AN patients at the rate of only $672 per patient compared with the national average of over $11,000 per patient. The primary source of funding for UIOs is the urban Indian health line item. The letter requests increasing funding to at least $200.5 million, which reflects the recommendation made by the Tribal Budget Formulation Working Group (TBFWG) for FY 2022. Because of the pandemic, UIOs are serving record patients through vaccination and testing clinics along with all regular operations.

To sign, on please contact Ms. Mariel Jorgensen (Mariel.Jorgensen@mail.house.gov) from Rep. Gallego’s office by April 23.

Thank you for your leadership and your commitment to upholding the United States trust responsibility.

Sincerely,

YOUR NAME

SOCIAL MEDIA

Facebook

Post your support on your Facebook.

  • Example post:
  • Urban Indian Organizations receive just $672 per patient compared with the over $11,000 per patient national average. You can make a difference! Call your Representative to sign on the Gallego-Grijalva Urban Indian Health Funding letter by April 23.

TWITTER

From your Twitter account, tweet to your Member of Congress.

  • Find your Member of Congress here.
  • Example tweet:

Dear [@ Member’s handle], please sign on to Gallego Grijalva letter for $200.5 million for #urbanIndianhealth in FY22 @ncuih_official.

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IHS Leaders Applaud Montana UIO Vaccine Efforts as Outstanding in Recent Visit

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On April 7, Indian Health Service (IHS) Acting Director, Elizabeth Fowler, and Billings Area Indian Health Service Director, Bryce Redgrave, visited the Indian Family Health Clinic (IFHC) in Great Falls, Montana to commentate the millionth dose of the COVID-19 vaccine administered across the Indian Health Delivery System.

Fowler highlighted the UIO’s efforts and successful contribution to combat the pandemic as part of the reason why she chose to visit the clinic: “What has stood out to me so far is hearing stories from our dignitaries, their experience here, and just my initial entrance. The focus on the screening, how they’ve re-purposed some of their areas in order to do the screening.”

During the commemoration, IFHC announced their new “I Made the Choice” program to encourage vaccinations among youth and further their efforts in tackling COVID-19.

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BIDEN FY22 BUDGET REQUEST INCLUDES ADVANCE APPROPRIATIONS AND $2.2 BILLION INCREASE FOR IHS

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BIDEN FY22 BUDGET REQUEST INCLUDES ADVANCE APPROPRIATIONS AND $2.2 BILLION INCREASE FOR IHS

On April 12, 2021 President Biden released his discretionary budget request for Fiscal Year (FY) 2022, pending a more detailed version in the coming months, which will include the funding recommendations for urban Indian health. This request includes $131.7 billion for the Department of Health and Human Services (HHS), a 23.5% increase from the 2021 enacted level, and $8.5 billion in discretionary funding for the Indian Health Service (IHS), a $2.2 billion increase from FY21. The additional $2.2 billion requested for IHS will go towards promoting health equity for American Indians/Alaska Natives (AI/ANs) and include Urban Indian Organization (UIO) consultation to evaluate options, including mandatory funding, to provide adequate, stable, and predictable funding for IHS in the future. The proposal also includes an advance appropriation for IHS in FY23 to ensure a more predictable funding stream.

In a press release on the budget, IHS Acting Director Elizabeth Fowler stated, “The budget request for the IHS is developed in close partnership with tribes, tribal organizations, urban Indian organizations, and other key stakeholders to ensure it reflects the evolving health needs of American Indian and Alaska Native people and communities.”

Background and Next Steps

NCUIH has long advocated for advance appropriations for IHS to begin closing the funding disparities that have long hindered AI/AN communities. NCUIH has also requested inclusion of UIOs for urban confer with a philosophy of “no policies about us without us”.

The Appropriations Committees will review the President’s Budget for consideration as they craft their bills for FY23. NCUIH has requested $200.5 million forFY23 for urban Indian health with at least $12.759 billion for the Indian Health Service in accordance with the Tribal Budget Formulation Workgroup (TBFWG) recommendations. NCUIH will continue to work with the Biden Administration and Congress to push for full funding of urban Indian health in FY22.

Overview of Budget Request

The budget request includes the following for health:

Department of Health and Human Services

  • $131.7 billion for HHS, a $25 billion or 23.5% increase from the 2021 enacted level

Indian Health Service

Centers for Disease Control and Prevention

  • $8.7 billion in discretionary funding, an increase of $1.6 billion over the 2021 enacted level
    • Promotes Health Equity by Addressing Racial Disparities
      • $153 million for CDC’s Social Determinants of Health program, an increase of $150 million over the 2021 enacted level, to support all States and Territories in improving health equity and data collection for racial and ethnic populations.
    • Advances the Goal of Ending the Opioid Crisis
      • $10.7 billion, an increase of $3.9 billion over the 2021 enacted level, to support research, prevention, treatment, and recovery support services, with targeted investments to support populations with unique needs, including Native Americans, older Americans, and rural populations.
    • Commits to End the HIV/AIDS Epidemic
      • $670 million, an increase of $267 million over the 2021 enacted level, to support the critical effort to end the HIV/AIDS epidemic in the United States. Investments in CDC, the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), and NIH aim to reduce new HIV cases aggressively while increasing access to treatment, expanding use of pre-exposure prophylaxis (also known as PrEP), and ensuring equitable access to services and supports.
    • Provides Funding to Reduce the Maternal Mortality Rate and End Race-Based Disparities in Maternal Mortality
      • $200 million to reduce maternal mortality and morbidity rates for Black and American Indian/Alaska Native women nationwide, bolster Maternal Mortality Review Committees, expand the Rural Maternity and Obstetrics Management Strategies program, help cities place early childhood development experts in pediatrician offices with a high percentage of Medicaid and Children’s Health Insurance Program patients, implement implicit bias training for healthcare providers, and create State pregnancy medical home programs.
    • Addresses the Public Health Epidemic of Gun Violence in America
      • $100 million for CDC to start a new Community Based Violence Intervention initiative—in collaboration with Department of Justice—to implement evidence-based community violence interventions locally in communities of color, as Black men make up six percent of the population but over 50 percent of gun homicide victims, and American Indians/Alaska Natives and Latinos are also disproportionately impacted.

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