Senate Introduces Bill Authorizing Special Behavioral Health Program for Indians after NCUIH Efforts

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Sen. Tina Smith introduces bill to amend the IHCIA to authorize special behavioral health programs for Indians, including urban AI/AN persons and the UIOs that serve them. This revision of the IHCIA helps Congress to fulfill its trust obligations to AI/AN populations while Urban Indians continue to disproportionately suffer from behavioral health issues at a rate much higher than the general population.

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House Passes Vote on NCUIH-Endorsed Tribal Health Data Bill

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On June 22, 2021, the House of Representatives met to debate legislation including H.R. 3841, the Tribal Health Data Improvement Act of 2021, under suspension of the regular House procedural rules. Rep. Markwayne Mullin (R-OK), citizen of the Cherokee Nation, introduced the bill on June 11 on behalf of himself and cosponsor Rep. Tom O’Halleran (D-AZ). The House requested a recorded vote on June 23, 2021 where H.R. 3841 passed with broad bipartisan support.

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NCUIH Federal Relations Director Advocates During the DHS Community Engagement Roundtable

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The National Council of Urban Indian Health (NCUIH) attended the Department of Homeland Security Community Engagement Roundtable on Racial Equity, Community Policing, and Supporting Underserved Communities on June 24th, 2021. Director of Federal Relations, Sunny Stevenson, spoke to the Officer for Civil Rights and Civil Liberties, Katherine Culliton-González, on the inadequate healthcare and federal data standards of AI/AN people. Racial inclusivity in data standards is important for accurately representing the decades of adversity Native people have faced in fatal encounters with law enforcement, trafficking of indigenous women and girls, racism, and healthcare disparities like seen during the COVID-19 pandemic.

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VISUALIZING COVID-19: A YEAR IN URBAN INDIAN ORGANIZATION SERVICE AREAS

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URBAN NATIVE COMMUNITIES: AN OVERLOOKED POPULATION 

Urban Native communities often battle a set of myths – especially the stereotype that American Indian and Alaska Native (AI/AN) people only live on reservations or rural areas. Urban AI/AN people often must prove that they exist in order to obtain the resources they need to address the health disparities their communities face. The first year of the COVID-19 pandemic has only made data on the needs of Urban AI/AN communities more important. However, some public health systems have characteristically overlooked AI/AN people and contributed to widespread disparities. 

First, a list of realities: 

  • The COVID-19 pandemic, which has plagued our country for over a year now, was first detected in UIO service areas.  The first U.S. case was reported in the Seattle area by late January2 and community transmission detected in Santa Clara County by late February.3  Both areas experienced the first known COVID-19 deaths due to community transmission by mid to late February.4,5   
  • In the first year of pandemic data, there were more than 28,646,373 confirmed cases of COVID–19 nationally, and 514,117 reported deaths associated with COVID-19 (as of February 28, 2021.)   
  • Cities have been the most affected by the pandemic, accounting for 84.5% of cases (n = 24,197,682) and 82.9% of deaths (n = 426,271) shown in figures 1. 
  • However, different cities have had different experiences over the past year due to state and local differences in mitigation measures and resource allocation. 
  • Each urban AI/AN community is different. Yet across the nation, Urban AI/AN people face specific disparities that put them at a higher risk of severe COVID-19 or transmission of the virus.  Urban AI/AN people are about three times more likely to live in poverty, be uninsured, or have diabetes compared to their non-Hispanic White neighbors. And Urban AI/AN people are 1.5-1.8 times as likely to live in multigenerational or crowded housing, smoke, or have asthma. 
  • There are 41 Urban Indian Organization (UIOs) with over 70 facilities, located in 38 cities across the country.  Each provides their local AI/AN community with culturally-competent services.

Urban Indian Organizations have been on the front lines of the pandemic since it began. They are coping with increased pandemic-related need, despite limited budgets and resources. But how do UIO service areas compare to the rest of the country?  How have their needs and conditions changed over time?  

CHARTING THE PANDEMIC IN SERVICE AREAS  

Hotspots and outbreaks of the novel coronavirus have transitioned across the USA, through Southern California, the Southwest, and the Northeast as seen in figures 2 and 3.  In each region, Urban Indian communities face the most extreme brunt of the pandemic, with stretched resources and high social vulnerabilities to the virus in their clientele.   

Figure 2: Evolution of New 14-Day COVID-19 Cases from 03-01-2020 to 02-28-2021  

Figure 3: Evolution of Case Rate (New 14-Day COVID-19 Cases per 100,000 population) from 03-01-2020 to 02-28-2021 6

In fact, each UIO service area has been in the top 10 percent counties by number of new cases at least once in the past year. Further, each service area has been a high risk of transmission zone for at least 11 weeks in the past year. But each has faced a different challenge.   

To see how conditions have fared in different UIO service areas, use the interactive map below. 

This interactive map allows you to zoom in on each UIO service area, and see how this area has fared over the last year compared to the rest of the country. To zoom in on a service area, click the thick black lines outlining the UIO regions. You may need to zoom in with your mouse-wheel on some areas, particularly where multiple UIOs are clustered like in the Bay area and western Montana. You can then zoom into figures and maps using your mouse or by clicking on the figures. To zoom back out, move to the far right hand side and you should see two buttons. You can return to the starting national map by clicking the “home” button, and zoom-out to the previous page using the “up-arrow” button. Learn more about our data sources and the measurements used by clicking the glossary button on the lower right hand side of the map.

For example, let’s walk through how to use this with the example of Los Angeles County, where roughly 165,513 AI/AN people live (see figure A below).  By February 28th 2021, there were 1,190,894 confirmed COVID-19 cases and 21,328 deaths.  Since March 2020, Los Angeles has been in the top 10 counties in the nation by 14-day rolling average of new cases for 43 weeks (figure B). During weeks it was not in the top 10 counties, LA was still in the top 32 (or 10%) of counties – which are signified by the red and gold line respectively.  Figure C shows how the 14-day rolling new case average has changed over the course of the pandemic, specific to this service area. You can see that cases peaked locally in December-February with a smaller peak in late July. Figure D shows these new cases in the form of a transmission rate, which factors in the population of the Los Angeles area and compares this with the CDC COVID-19 risk categories. Case rates above the red line indicate “high transmission risk” and the gold line indicates the cutoff for “substantial transmission risk”7. As you can see, Los Angeles county has been at high transmission risk category for 25 weeks, or 48% of the last year. Figure E and F shows the number of new deaths over time.

Figure A                                                     Figure B

 

                                                                                                  

As you can see, Los Angeles county has been consistently ranked at the top of US counties by number of new cases every week since May 2020, has experienced peaks and valleys, and has generally been a very “high transmission” county. Such a large and persistent burden will affect the AI/AN population that lives there and the providers that serve them. 

Figure C                                                                                                  Figure D

Figure E                                                                                                 Figure F

CONCLUSIONS 

The story is the similar across the country, in all 38 urban service areas. Please investigate other areas. Some cities saw peaks in the first wave of spring 2020, others in the late summer, and many more in the winter of 2020-2021. Yet at any given time, there was usually a UIO serving in the top counties in the Nation. Native populations exist in each of these areas, but are often overlooked as a “small population“.  Even when racial data on cases and deaths doesn’t exist or include AI/AN people, it is important to remember that UIOs have been on the frontlines providing culturally-competent care in the hotspots of the pandemic. We must remember that UIOs are struggling against these surges every day, as are the people they serve.    

NCUIH hopes this data tool brings some awareness of the magnitude of this issue, as millions of AI/AN people continue to live and struggle against coronavirus.  We also hope this data is helpful for UIOs in their communication, advocacy, and grant writing activities.   

Remember, you can always ask NCUIH for data analysis or technical assistance via our website. Stay tuned for our second COVID-19 Data Tools post, where we will dive into the specific vulnerabilities to COVID-19 that AI/AN communities face within cities.

By Alexander Zeymo & Andrew Kalweit, posted on Monday June 28, 2021

This post is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award (NOFO OT18-1802, titled Strengthen Public Health Systems and Services through National Partnerships to Improve and Protect the Nation’s Health) funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.

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PRESS RELEASE: NCAI PASSES RESOLUTION URGING CONGRESS TO REMOVE FEDERAL FACILITIES FUNDING BARRIERS FOR URBAN INDIAN ORGANIZATIONS

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The fix called for in the resolution will better ensure that UIOs can meet the changing health care delivery needs for tribal citizens residing in urban areas.

Washington, D.C. (June 28, 2021) – After extensive advocacy from NCUIH and our partners for Urban Indian health, the National Congress of American Indians (NCAI) passed resolution AK-21-020: Call for Congress to Amend Section 509 of the Indian Health Care Improvement Act to Remove Facility Funding Barriers for Urban Indian Organizations (UIOs) on June 24, 2021, during NCAI’s Mid-Year Conference. The resolution urges Congress to enact legislation to amend the Indian Health Care Improvement Act (IHCIA) to remove the language restricting UIO facilities’ funding availability only to minor renovations to meet or maintain accreditation standards.

“Facility-related use of federal funds remains the most requested priority for our UIOs,” said NCUIH CEO Francys Crevier (Algonquin). “The current limitations found in the Indian Health Care Improvement Act force UIOs to use their limited third-party reimbursement funds for necessary minor facility improvements to meet or maintain accreditation by Joint Commission for Accreditation of Health Care Organizations. NCUIH leadership advocated for the adoption of this important resolution, and we applaud NCAI for passing it.”

NCAI resolutions are one of the policy mechanisms used to express the organizational positions on tribal, federal, state, and/or local legislation, litigation, and policy matters that affect tribal governments or communities. NCAI members establish the organization’s positions on issues that affect tribal nations and Native people through a resolution process. Resolutions to be considered at the Mid-Year Convention are only accepted if they are determined to be emergency in nature and national in scope. The resolution, submitted by NCUIH Director of Federal Relations, Sunny Stevenson (Walker River Paiute), calls on Congress to continue to honor the obligations made to tribal members by the federal government.

NCAI has been a longtime partner of NCUIH, having collaborated on previous resolutions adopted in favor of Urban Indian health, including the extension of the Federal Tort Claims Act (FTCA) to be inclusive of UIOs, temporary 100% FMAP for UIOs under the American Rescue Plan Act, and federal reimbursement for AI/AN Veterans served at UIO facilities. Each of these NCAI resolutions has been instrumental in compelling Congressional action to pass these critical means of addressing contemporary issues that urban AI/AN persons encounter in seeking care under the federal trust responsibility. NCAI’s resolution follows the introduction of the Urban Indian Health Providers Facilities Improvement Act under identical House and Senate bills (H.R. 3496 / S. 1797). The bipartisan, bicameral bills will pave the way for increased investment in the renovation and construction of UIO facilities. The passage of the Urban Indian Health Providers Facilities Act would amend Section 509 of the Indian Health Care Improvement Act (25 U.S.C. § 1659), the provision of IHCIA that pertains to UIO facility funding. The amendment will not otherwise affect federal facilities funding for IHS or tribally-operated programs through existing Indian Health Service appropriations for improvements and renovations.

 

RESOURCES

 

Full Resolution Text

List of NCAI Mid-Year Resolutions 

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IHS Announced $3M in SDPI Funding will be Offset by FY21 Funding Due to Sequestration in TLDC Meeting

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On June 15th, the Indian Health Service (IHS) held a virtual quarterly Tribal Leaders Diabetes Committee (TLDC) meeting. It was brought to the attention of the call participants that although Congress has funded the Special Diabetes Program for Indians (SDPI) at the current $150 million per year through Fiscal Year (FY) 2023, the FY2022 President’s budget includes funding for SDPI at $147 million— a $3 million decrease due to a mandatory sequester. While most mandatory spending is exempt, including Social Security, veterans’ programs, Medicaid and other low-income programs, it remains unclear why SDPI would be subject to a sequester.

 

To cover the sequester, funding must come from other pockets of the IHS budget. IHS Deputy Director for Division of Diabetes, Carmen Hardin, announced that offsets from FY2021 funding will cover the FY2022 SDPI $3 million sequestration to ensure no grantee will receive a decrease in their annual funding amount for FY2022. IHS has not indicated exactly where this offset is coming from, and with only $67.7 million for urban Indian health, there is concern that such redirections of funding could be drawing from already tight margins.

 

There were echoed sentiments among Tribal members on the call concerning the lack of consultation with Tribes around this sequestration and how the funding will be offset. IHS has not initiated urban confer on the matter.

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NCUIH Statement on Indigenous Residential and Boarding Schools

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Washington, D.C. (June 25, 2021) – In Canada this past May, the discovery of 215 unmarked graves at Kamloops Indian Residential School brought past Indigenous traumas into the international spotlight. Yesterday, over 700 more unmarked graves were found on the grounds of the former Marieval Indian Residential School in Canada.

Boarding schools and residential schools are a tragic thread in history that the United States and Canada share: The United States Government Indian Boarding School Policy authorized the forced removal of hundreds of thousands of Native children, as young as 5 years old, relocating them from their homes in Tribal communities to one of the 367 Indian Boarding Schools across 30 States. Between 1869 and the 1960s, the United States federal government stole Native children from their families to destroy their indigenous identities, beliefs, and traditional languages to assimilate them into White American culture through federally funded Christian-run schools.

Today, National Council of Urban Indian Health Chief Executive Officer Francys Crevier (Algonquin) released the following statement in response to these recent discoveries:

“I am devastated to hear the discovery of mass graves of our children, but tragically, I am not surprised. The National Council of Urban Indian Health (NCUIH) exists because of the historic oppression like this that forced relocation of our people by the United States (and Canadian) governments, which included ripping our children from their families and placing them in federally funded boarding schools in their attempt to “kill the Indian, save the man.” Indian Country’s social determinants of health demonstrate the connection to the historical trauma inflicted by these governments that caused tremendous health consequences for our people – most recently with the COVID-19 pandemic taking the lives of many of our relatives. At NCUIH, we are charged with holding the US government to its trust and treaty responsibility of providing health care for all Native people.

The atrocities Native children experienced during the boarding school era are marked by years of pain as Indigenous communities were forced to suffer in silence. These long-standing intergenerational trauma cycles are, unfortunately, nothing new to Native people.  Federal policies in the United States and Canada attempted to destroy Native identity, culture, and language and continue to be a cause of suffering in our communities. For centuries of historic trauma, this process has been a long and challenging journey for our relatives.

With that, we applaud Secretary Deb Haaland, the first Native American cabinet holder, for beginning the conversation to hold the United States government that created these boarding schools accountable through the Federal Indian Boarding School Initiative. The Department of the Interior will identify boarding school sites, locations of known and possible student burial sites located at or near school facilities and identify the children and their tribal affiliations to bring them home to their families.

As the effort continues to bring these children home, we are reminded of the resilience of Native people and ask our relatives to lean on each other as more information from the boarding school era is revealed to the public. While Natives have been well aware of the government’s violation of basic human rights and genocide of our people, it is important for the United States and Canada to finally take responsibility for these horrific actions.

At NCUIH, we are charged with holding the US government to its trust and treaty responsibility of providing health care for all Native people. Our work will continue as we fight to make up for centuries of oppression and needless deaths of our people – including our own children. The United States government can begin to rectify their actions by finally honoring its trust and treaty responsibilities to our people.”

For more information on the history of Native American Boarding Schools, please visit The National Native American Boarding School Healing Coalition website.

Recommended Readings: 

Pipestone My Life in an Indian Boarding School

Boarding School Seasons American Indian Families, 1900-1940

The Middle Five: Indian Schoolboys of the Omaha Tribe

Stringing Rosaries: The History, the Unforgivable, and the Healing of Northern Plains American Indian Boarding School Survivors

They Called Me Uncivilized: The Memoir of an Everyday Lakota Man from Wounded Knee

A Voice in Her Tribe: A Navajo Woman’s Own Story

Boarding School Blues: Revisiting American Indian Educational Experiences

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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.

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Representative Ruben Gallego Emphasizes Need for UIO Facilities Legislation

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On June 17, 2021, the Subcommittee on Indigenous Peoples of the United States held an oversight hearing on “Examining Federal Facilities in Indian Country”. Led by Chair Teresa Leger Fernandez and Ranking Member Don Young, the hearing included testimony from Mr. Randy Grinnell, Deputy Director for Management Operations, Indian Health Service and several other witnesses. The hearing is in response to facilities deterioration and the bureaucracy surrounding timely construction and funding and its impact in Native communities on and off the reservation.

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Rick Mueller Named Deputy Director for the IHS Office of Urban Indian Health Programs

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Mr. Rick Mueller is the new Deputy Director for the IHS Office of Urban Indian Health Programs’ (OUIHP) in Rockville, MD. Rick Mueller is an enrolled member of the Central Council of the Tlingit and Haida Indian Tribes of Alaska. As Deputy Director of the OUIHP, Mr. Mueller is responsible for providing leadership and oversight of the Title V, Indian Health Care Improvement Act initiative and Urban health care delivery system as well as supervising staff and duties. Mr. Mueller has been with the OUIHP since February 2014 and previously served as the Heath System Specialist with OUIHP, where he provided policy analysis and development support for a wide-range of health care delivery and support activities for 41 urban Indian organizations. Before joining the IHS, Mr. Mueller worked a number of years in Alaska with regional Native health corporations, serving in various administrative capacities. Mr. Mueller holds a Bachelor of Science degree from Northern Arizona University in Flagstaff, AZ, and later earned a master’s degree in business administration, with a concentration in health service administration, from Alaska Pacific University in Anchorage, AK. We congratulate and welcome him as he embarks in this critical leadership role for the agency.

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NCUIH Endorses Coronavirus Mental Health and Addiction Assistance Act

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On January 28, 2021, Senators Amy Klobuchar (D-MN), Todd Young (R-IN), and Chris Van Hollen (D-MD) reintroduced the NCUIH endorsed Coronavirus Mental Health and Addiction Assistance Act. The bill intends to address the growing mental health and addiction crisis in the U.S. exacerbated by the COVID-19 pandemic by expanding mental health and substance use disorder services. If passed, the bill would require:

  • The Secretary of Health and Human Services to award grants to establish a Coronavirus Mental Health and Addiction Assistance Network. These grants would go to eligible entities offering appropriate mental health and addiction services, including Urban Indian Organizations (UIOs).
  • Emergency authorization of $100 million to initiate or expand programs offering mental health and substance use disorder services in response to the pandemic, including support groups, telephone helplines and websites, training programs, telehealth services, and outreach services.
  • The Department of Health and Human Services to gather data to better understand the effects of the pandemic on mental health and addiction and make recommendations on how to improve future mental health and addiction response efforts

Even before the pandemic, American Indians and Alaska Natives (AI/ANs) residing in urban areas faced 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. The COVID-19 pandemic has inflamed the need for funding for UIOs to address the behavioral health and substance abuse crisis among urban Indians.

NCUIH welcomes Sen. Klobuchar, Sen. Young, and Sen. Van Hollen’s legislation to support mental health and addiction services during coronavirus pandemic.

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