NCUIH FY22 IHS Urban Indian Health Budget Analysis

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WASHINGTON, DC (June 16, 2021) – Recently, on May 28, 2021, President Biden released the detailed annual budget proposal for Fiscal Year (FY) 2022. The proposal includes a total of $131.7 billion for the Department of Health and Human Services (HHS), which represents a nearly 23.5% increase to current enacted budget for FY21. The request includes $8.5 billion for the Indian Health Service (IHS), a $2.2 billion increase from FY21 and $100 million for urban Indian health, a nearly 60% increase. The request also endorses NCUIH’s priority fix for allowing urban Indian organizations to use existing IHS funding for facilities improvement and renovations.

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Representative Rueben Gallego Emphasizes Need for Full UIO Facilities Funding

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Subcommittee on Indigenous Peoples of the United States Hearing: “Oversight Hearing on Examining Federal Facilities in Indian Country”.

On June 17, 2021, the Subcommittee on Indigenous Peoples of the United States Hearing: “Oversight Hearing on Examining Federal Facilities in Indian Country”. At the hearing Chair Teresa Leger Fernandez and Ranking Member Don Young Mr. Jason Freihage, Deputy Assistant Secretary for Management, Office of the Assistant Secretary for Indian Affairs; Mr. Randy Grinnell, Deputy Director for Management Operations, Indian Health Service; The Honorable Chief Allan, Chairman, Coeur d’Alene; The Honorable David Hill, Principal Chief, Muscogee Creek Nation; The Honorable Victoria Kitcheyan, Chairwoman, Winnebago Tribe of Nebraska; The Honorable Ned Norris Jr., Chairman, Tohono O’odham Nation; The Honorable Timothy Nuvangyaoma, Chairman, Hopi Tribe. The hearing comes as an oversight to facilities deterioration and the bureaucracy surrounding timely construction and funding and its impact in Native communities on and off the reservation.

Many committee members expressed over the inadequacies in the IHS priority construction planning process and overall compounding backlog of construction projects looming in Indian Country. In addition, Tribal leaders gave personal accounts of the overall devasting facilities conditions including unsafe school structures, to sanitation, and inability to provide basic clinical needs.

Rep. Rueben Gallego gave recognition to the IHS budget that includes a proposal to Urban Indian organizations to use their funds on renovation extra projects like other contractors, but stop short of full praise of the inclusion when directing questions to Mr. Randy Grinnell, Deputy Director for Management Operations, IHS to “expand the IHS proposal and explain why removing this restriction is necessary to allow UIOs to better serve their patients and passing legislation to just to enact the proposal” and “why language still exists as a restriction on UIOs today, when most no longer use the accreditation standard mentioned”? In response, Mr. Grinnell explained “in the past, up until now UIOs were not able to utilize funds from IHS related to any facility issues unless it had to do with accreditation through one of the accrediting bodies. Now there is proposed language in the 22 CJ that will help to address that issue, going forward. In addition, an urban confer is in place, where IHS receives input from those facilities on their needs”. Encouraged by Mr. Grinnell’s response Rep. Gallego went further to ask if “IHS feel positive about passing legislation to just to enact the proposal”? In response Mr. Grinnell stuttered in his explanation stating “he’s not exactly sure why the language for UIOs was included that way in the law, but he can only speculate that the drafters of that law did not have an understanding about the UIOs and their need. And referred the subcommittee to the IHS CJ on that issue for theFY22 President’s budget.” NCUIH along with 29 other Native organizations recently included this request in a joint letter on infrastructure priorities, which also advocated for $21 billion for Indian health infrastructure inclusive of UIOs.

Watch Hearing Here

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NCUIH FY22 IHS URBAN INDIAN HEALTH BUDGET ANALYSIS

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NCUIH FY22 IHS Urban Indian Health Budget Analysis

The President’s request includes nearly 60% increase for urban Indian health and endorses the NCUIH UIO facilities fix.

WASHINGTON, DC (June 16, 2021) – Recently, on May 28, 2021, President Biden released the detailed annual budget proposal for Fiscal Year (FY) 2022. The proposal includes a total of $131.7 billion for the Department of Health and Human Services (HHS), which represents a nearly 23.5% increase to current enacted budget for FY21. The request includes $8.5 billion for the Indian Health Service (IHS), a $2.2 billion increase from FY21 and $100 million for urban Indian health, a nearly 60% increase. The request also endorses NCUIH’s priority fix for allowing urban Indian organizations to use existing IHS funding for facilities improvement and renovations.

The Tribal Budget Formulation Workgroup (TBFWG) requested the Administration to fund IHS at $12.759 billion with an urban Indian health line item of $200.5 million for FY22. These suggested increases were formulated to counteract failed Indian healthcare policies and to fulfill the federal trust obligations to all AI/ANs in the administration of healthcare to American Indian/Alaska Native (AI/AN) populations.

The Budget includes the following legislative proposals:

  • Exempt the IHS from discretionary sequester
  • Authorize Urban Indian Organizations to use their resources for facilities activities
  • Provide the IHS full discretionary use of Title 38 hiring authorities

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) confer to evaluate options, including mandatory funding, to provide adequate, stable, and predictable funding for IHS in the future. The proposal also includes an advanced appropriation for IHS in FY23 to ensure a more predictable funding stream. NCUIH has long advocated for advanced appropriations for IHS to begin closing the funding disparities that have long hindered Indian Health Care Providers.

NCUIH looks forward to working with the Administration and Congress to fully fund IHS and the urban Indian Health line item. Congress will consider the President’s request as it begins to draft appropriations bills for FY 2022. The House Appropriations Committee will markup its bill on June 28, 2021.

Please find below a summary of some of the proposed funding amounts that would impact urban Indian health.

URBAN INDIAN LINE ITEM

  • The spending proposal recommends a funding level for the urban Indian Health line item at $100 million. This is an approximately $38 million increase from the FY 2021 enacted amount of $62 million, but it is approximately $100.5 million below the TBFWG FY22 recommendation of $200.5 million.

IHS

The President’s Budget for fiscal year 2022 includes a total discretionary budget authority of $8.5 billion, which is $2.2 billion or 36 percent above the enacted FY 2021 funding level.

This includes four accounts:

  • Services: $5.7 billion
  • Facilities: $1.5 billion
  • Contract Support Costs: $1.1 billion .
    • Remains an indefinite discretionary appropriation for fully funding CSC
  • Payments for Tribal Leases: $150 million
    • Remains an indefinite discretionary appropriation for fully funding the cost of section 105(l) leases
  • Contract Support Costs and Payments for Tribal Leases are proposed to shift to mandatory funding in FY 2023.

SERVICES AND FACILITIES

Funding Increases (Services & Facilities)

  • $207 million to fully fund Current Services
    • Offsets increasing costs due to pay, inflation, and population growth
  • $125 million for staffing and operating costs of newly-constructed healthcare facilities

Funding Increases (Hospitals and Health Clinics)

  • $190 million for a general program increase
  • $22 million for the Hepatitis C and HIV Initiative ($27 million total)
  • $20 million for the National Community Health Aide Program ($25 million total)
  • $27 million to offset the rising cost of HHS-wide assessments for information technology, human resources, financial management, and other activities

FACILITIES MAINTENANCE AND IMPROVEMENT

  • The President’s FY22 requested discretionary budget for Facilities Maintenance and Improvement is $222,924,000. This is a $53,952,0000 increase over the FY21 Enacted amount but remains $256,050,000 below the TBFWG requested of $478,974,000.Advanced Appropriations
  • Under advance appropriations, the IHS would request funding in two phases, comparable to the Veteran’s Health Administration. The first phase would address the amount necessary to maintain the current level of services and fully fund known costs, like staffing of new facilities. This amount that would be included for FY 2023 in the FY 2022 President’s Budget and appropriation.  In the second phase, the FY 2023 President’s Budget would address policy proposals that reflect input from Tribal and Urban Indian Organization leaders, as well as the Administration’s goals. While advance appropriations would provide the IHS funding for both FY 2022 and FY 2023, the funding for FY 2023 would not “score” against the discretionary funding caps until it became available in FY 2023.

SPECIAL DIABETES PROGRAM FOR INDIANS (SDPI)

  • Diabetes and its complications are major contributors to death and disability in nearly every Tribal community. AI/AN adults have the highest age-adjusted rate of diagnosed diabetes (14.7 percent) among all racial and ethnic groups in the United States, more than twice the rate of the non-Hispanic white population (7.5 percent).[1] In some AI/AN communities, more than half of adults 45 to 74 years of age have diagnosed diabetes, with prevalence rates reaching as high as 60 percent.[2]
  • The President’s budget also includes continued funding for the SDPI at $147 million. This is $3 million less than the enacted FY21 amount and $13 million less than FY22 TBFWG request. The Consolidated Appropriations Act, 2021 (P.L. 116-260) authorized SDPI until September 30, 2023. FY 2022 would be the 25th year of the SDPI.

105(I) LEASES

  • The FY 2022 budget adds $49 million for 105(l) leases for a total of $150 million. The TBFWG request of $337 million in FY 2022 for section 105(l) line item was to ensure that growing 105(l) lease costs are fully paid without impacting increases to other critical IHS line items. NCUIH opposes IHS action to unilaterally restrict ISDEAA authorities in the absence of Tribal consultation.

INDIAN HEALTH PROFESSIONS

  • The need for qualified mental health providers; in particular, the TBWFG voiced the difficulty in recruiting and retaining fulltime professionals to work and adapt to Native settings. Knowing of the need to grow Indian health professionals to fill this need, the TBWFG requested a nominal increase to $82,634,000. The President’s FY22 recommendation increases IHP to $92,853,000 million.  This is $25,539,000 above the FY21 enacted level and $10,219,000 million above the Tribal Budget Formulation Workgroup recommendation.

FACILITIES MAINTENANCE AND IMPROVEMENT

  • Current misinterpretations have halted the overall improvements and construction of  UIO facilities.  NCUIH continues to advocate for a substantial infrastructure investment within the UIO health system. Allowing the continued deterioration of critical health facilities goes against the mission of the Indian Health Service and Urban Indian Organizations to provide quality healthcare to all American Indians and Alaska Natives.We hope that once this facilities restriction is lifted that an amendment can be made to the Indian Health Improvement Act to add a line item for UIOs to use funding for facilities.
  • The President’s FY22 requested discretionary budget for Facilities Maintenance and Improvement is $222,924,000. This is a $53,952,0000 increase over the FY21 Enacted amount but remains $256,050,000 below the TBFWG requested of $478,974,000. “Facilities Renovation for Urban Indian Organizations to the extent Authorized for Other Government Contractors SEC. 433. The Secretary of Health and Human Services may authorize an urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)) Provides authority for IHS to make funds available to IHS-funded Urban Indian Organizations for minor renovations to facilities or construction or expansion of facilities, including leased facilities, to the extent authorized for other government contractor”.[3]

CENTERS FOR DISEASE CONTROL AND PREVENTION AND NATIONAL INSTITUTES OF HEALTH

  • The budget request would increase discretionary funding for the Centers for Disease Control and Prevention to $8.7 billion. This is a funding increase of $1.6 billion that would significantly affect the HHS core mission of preventing and controlling emerging public health issues.

Read the Full Analysis

[1] Centers for Disease Control and Prevention (CDC). National Diabetes Statistics Report 2020: Estimates of Diabetes and Its Burden in the United States. Atlanta, GA: U.S. Department of Health and Human Services; 2020. Available at: https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

[2] Lee ET, Howard BV, Savage PJ, et al. Diabetes and impaired glucose tolerance in three American Indian populations aged 45-74 years: the Strong Heart Study. Diabetes Care. 1995;18:599-610

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NCUIH FY22 IHS URBAN INDIAN HEALTH BUDGET ANALYSIS

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NCUIH FY22 IHS Urban Indian Health Budget Analysis

The President’s request includes nearly 60% increase for urban Indian health and endorses the NCUIH UIO facilities fix.

WASHINGTON, DC (June 16, 2021) – Recently, on May 28, 2021, President Biden released the detailed annual budget proposal for Fiscal Year (FY) 2022. The proposal includes a total of $131.7 billion for the Department of Health and Human Services (HHS), which represents a nearly 23.5% increase to current enacted budget for FY21. The request includes $8.5 billion for the Indian Health Service (IHS), a $2.2 billion increase from FY21 and $100 million for urban Indian health, a nearly 60% increase. The request also endorses NCUIH’s priority fix for allowing urban Indian organizations to use existing IHS funding for facilities improvement and renovations.

The Tribal Budget Formulation Workgroup (TBFWG) requested the Administration to fund IHS at $12.759 billion with an urban Indian health line item of $200.5 million for FY22. These suggested increases were formulated to counteract failed Indian healthcare policies and to fulfill the federal trust obligations to all AI/ANs in the administration of healthcare to American Indian/Alaska Native (AI/AN) populations.

The Budget includes the following legislative proposals:

  • Exempt the IHS from discretionary sequester
  • Authorize Urban Indian Organizations to use their resources for facilities activities
  • Provide the IHS full discretionary use of Title 38 hiring authorities

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) confer to evaluate options, including mandatory funding, to provide adequate, stable, and predictable funding for IHS in the future. The proposal also includes an advanced appropriation for IHS in FY23 to ensure a more predictable funding stream. NCUIH has long advocated for advanced appropriations for IHS to begin closing the funding disparities that have long hindered Indian Health Care Providers.

NCUIH looks forward to working with the Administration and Congress to fully fund IHS and the urban Indian Health line item. Congress will consider the President’s request as it begins to draft appropriations bills for FY 2022. The House Appropriations Committee will markup its bill on June 28, 2021.

Please find below a summary of some of the proposed funding amounts that would impact urban Indian health.

URBAN INDIAN LINE ITEM

  • The spending proposal recommends a funding level for the urban Indian Health line item at $100 million. This is an approximately $38 million increase from the FY 2021 enacted amount of $62 million, but it is approximately $100.5 million below the TBFWG FY22 recommendation of $200.5 million.

IHS

The President’s Budget for fiscal year 2022 includes a total discretionary budget authority of $8.5 billion, which is $2.2 billion or 36 percent above the enacted FY 2021 funding level.

This includes four accounts:

  • Services: $5.7 billion
  • Facilities: $1.5 billion
  • Contract Support Costs: $1.1 billion .
    • Remains an indefinite discretionary appropriation for fully funding CSC
  • Payments for Tribal Leases: $150 million
    • Remains an indefinite discretionary appropriation for fully funding the cost of section 105(l) leases
  • Contract Support Costs and Payments for Tribal Leases are proposed to shift to mandatory funding in FY 2023.

SERVICES AND FACILITIES

Funding Increases (Services & Facilities)

  • $207 million to fully fund Current Services
    • Offsets increasing costs due to pay, inflation, and population growth
  • $125 million for staffing and operating costs of newly-constructed healthcare facilities

Funding Increases (Hospitals and Health Clinics)

  • $190 million for a general program increase
  • $22 million for the Hepatitis C and HIV Initiative ($27 million total)
  • $20 million for the National Community Health Aide Program ($25 million total)
  • $27 million to offset the rising cost of HHS-wide assessments for information technology, human resources, financial management, and other activities

FACILITIES MAINTENANCE AND IMPROVEMENT

  • The President’s FY22 requested discretionary budget for Facilities Maintenance and Improvement is $222,924,000. This is a $53,952,0000 increase over the FY21 Enacted amount but remains $256,050,000 below the TBFWG requested of $478,974,000.Advanced Appropriations
  • Under advance appropriations, the IHS would request funding in two phases, comparable to the Veteran’s Health Administration. The first phase would address the amount necessary to maintain the current level of services and fully fund known costs, like staffing of new facilities. This amount that would be included for FY 2023 in the FY 2022 President’s Budget and appropriation.  In the second phase, the FY 2023 President’s Budget would address policy proposals that reflect input from Tribal and Urban Indian Organization leaders, as well as the Administration’s goals. While advance appropriations would provide the IHS funding for both FY 2022 and FY 2023, the funding for FY 2023 would not “score” against the discretionary funding caps until it became available in FY 2023.

SPECIAL DIABETES PROGRAM FOR INDIANS (SDPI)

  • Diabetes and its complications are major contributors to death and disability in nearly every Tribal community. AI/AN adults have the highest age-adjusted rate of diagnosed diabetes (14.7 percent) among all racial and ethnic groups in the United States, more than twice the rate of the non-Hispanic white population (7.5 percent).[1] In some AI/AN communities, more than half of adults 45 to 74 years of age have diagnosed diabetes, with prevalence rates reaching as high as 60 percent.[2]
  • The President’s budget also includes continued funding for the SDPI at $147 million. This is $3 million less than the enacted FY21 amount and $13 million less than FY22 TBFWG request. The Consolidated Appropriations Act, 2021 (P.L. 116-260) authorized SDPI until September 30, 2023. FY 2022 would be the 25th year of the SDPI.

105(I) LEASES

  • The FY 2022 budget adds $49 million for 105(l) leases for a total of $150 million. The TBFWG request of $337 million in FY 2022 for section 105(l) line item was to ensure that growing 105(l) lease costs are fully paid without impacting increases to other critical IHS line items. NCUIH opposes IHS action to unilaterally restrict ISDEAA authorities in the absence of Tribal consultation.

INDIAN HEALTH PROFESSIONS

  • The need for qualified mental health providers; in particular, the TBWFG voiced the difficulty in recruiting and retaining fulltime professionals to work and adapt to Native settings. Knowing of the need to grow Indian health professionals to fill this need, the TBWFG requested a nominal increase to $82,634,000. The President’s FY22 recommendation increases IHP to $92,853,000 million.  This is $25,539,000 above the FY21 enacted level and $10,219,000 million above the Tribal Budget Formulation Workgroup recommendation.

FACILITIES MAINTENANCE AND IMPROVEMENT

  • Current misinterpretations have halted the overall improvements and construction of  UIO facilities.  NCUIH continues to advocate for a substantial infrastructure investment within the UIO health system. Allowing the continued deterioration of critical health facilities goes against the mission of the Indian Health Service and Urban Indian Organizations to provide quality healthcare to all American Indians and Alaska Natives.We hope that once this facilities restriction is lifted that an amendment can be made to the Indian Health Improvement Act to add a line item for UIOs to use funding for facilities.
  • The President’s FY22 requested discretionary budget for Facilities Maintenance and Improvement is $222,924,000. This is a $53,952,0000 increase over the FY21 Enacted amount but remains $256,050,000 below the TBFWG requested of $478,974,000. “Facilities Renovation for Urban Indian Organizations to the extent Authorized for Other Government Contractors SEC. 433. The Secretary of Health and Human Services may authorize an urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)) Provides authority for IHS to make funds available to IHS-funded Urban Indian Organizations for minor renovations to facilities or construction or expansion of facilities, including leased facilities, to the extent authorized for other government contractor”.[3]

CENTERS FOR DISEASE CONTROL AND PREVENTION AND NATIONAL INSTITUTES OF HEALTH

  • The budget request would increase discretionary funding for the Centers for Disease Control and Prevention to $8.7 billion. This is a funding increase of $1.6 billion that would significantly affect the HHS core mission of preventing and controlling emerging public health issues.

Read the Full Analysis

[1] Centers for Disease Control and Prevention (CDC). National Diabetes Statistics Report 2020: Estimates of Diabetes and Its Burden in the United States. Atlanta, GA: U.S. Department of Health and Human Services; 2020. Available at: https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

[2] Lee ET, Howard BV, Savage PJ, et al. Diabetes and impaired glucose tolerance in three American Indian populations aged 45-74 years: the Strong Heart Study. Diabetes Care. 1995;18:599-610

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President’s Budget Request Includes Nearly 60% Increase for Urban Indian Health

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President’s Budget Request Includes Nearly 60% Increase for Urban Indian Health
The FY 22 budget request includes $8.5 billion for IHS and $100 million for urban Indian health, a nearly 60% increase over the FY 21 enacted amount. WASHINGTON, DC (May 28, 2021)Today, May 28, the Biden Administration released the detailed annual budget proposal for Fiscal Year (FY) 2022. The proposal includes a total of $131.7 billion for the Department of Health and Human Services (HHS), which represents a nearly 23.5% increase to current enacted budget for FY21. The request includes $8.5 billion for the Indian Health Service (IHS) and $100 million for urban Indian health.

The National Council of Urban Indian Health (NCUIH) and the Tribal Budget Formulation Workgroup (TBFWG) requested the Administration to fund IHS at $12.759 billion with an urban Indian health line item of $200.5 million for FY 2022. These suggested increases were formulated to counteract failed Indian healthcare policies and to fulfill the federal trust obligations to Tribal Nations in the administration of healthcare to American Indian/Alaska Native (AI/AN) populations.

“For decades, urban Indian health has been severely underfunded even though more than 70% of American Indians and Alaska Natives reside in urban areas.  We are pleased to see the President’s inclusion of $100 million for urban Indian health in FY22, which represents an important step towards achieving full funding.  As the federal trust responsibility for health care follows all Natives off of reservations into the cities where many of us reside today, it is encouraging to see the Administration and Congress finally prioritizing the Indian health system with a significant increase in resources for next year,” said Francys Crevier.

On April 14, 2021, NCUIH submitted public witness written testimony to the House Appropriations Subcommittee on Interior, Environment, and Related Agencies regarding Fiscal Year (FY) 2022 funding for Urban Indian Organizations (UIOs).

On April 12, 2021, President Biden released his discretionary budget request for Fiscal Year FY 22, pending the more detailed IHS budget request released today, which includes specifics on the IHS budget request, including the funding recommendations for urban Indian health. The request includes $8.5 billion in discretionary funding for IHS, a $2.2 billion increase from FY21. The $2.2 billion increase for IHS will go towards promoting health equity for AI/ANs. The proposal also includes an advance appropriation for IHS in FY23 to ensure a more predictable funding stream.

Next Steps

Congress will consider President Biden’s request as it begins to draft appropriations bills for FY 2022.  A more in-depth analysis of the White House’s FY 2022 Budget is forthcoming.

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NCUIH Submits Written Testimony to Senate Interior Appropriations with FY22 Budget Requests for UIOs

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NCUIH Submits Written Testimony to Senate Interior Appropriations with FY22 Budget Requests for UIOs

The National Council of Urban Indian Health (NCUIH) CEO, Francys Crevier, submitted public witness written testimony to the Senate Appropriations Subcommittee on Interior, Environment, and Related Agencies regarding Fiscal Year (FY) 2022 funding for Urban Indian Organizations (UIOs) in response to the Subcommittee Hearing, Addressing Health Disparities in Indian Country: Review of the Indian Health Service’s COVID Response and Future Needs, held on April 28.

UIOs provide culturally competent health care to some of the 70% of American Indians and Alaska Natives (AI/AN) living in cities and are primarily funded by a single line item in the annual Indian health budget, which constitutes approximately 1% of the total Indian Health Service (IHS) annual budget. The devastating impact of the COVID-19 pandemic on Indian Country proved the dire need for increased funding and resources for UIOs, who have continuously provided services in the hardest hit urban areas during the entire pandemic.

In her testimony, NCUIH requested the following:

  • $200.5 million for Urban Indian Health for FY22
  • Include report language to allow use of facilities funding to UIOs
  • Advance appropriations for IHS
  • UIOs be insulated from unrelated budgetary disputes through a spend faster anomaly so that critical funding is not halted

These requests are essential to ensure that urban Indians are properly cared for and moves us closer to fulfilling the federal government’s trust responsibility to AI/ANs.

NEXT STEPS:

The testimony will be read and considered by the subcommittee as the appropriations process goes forward for Fiscal Year 2022. NCUIH previously submitted testimony to the House Appropriations Subcommittee on Interior regarding UIO funding for FY22.

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 Biden Administration is expected to release his comprehensive budget on May 27.

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NCUIH EFFORTS ON MMIP LEAD TO CONGRESSIONAL AND ADMINISTRATIVE ACTION

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On May 5, Acting Indian Health Service (IHS) Director Elizabeth Fowler released a statement on Missing and Murdered Indigenous Persons (MMIP) Awareness Day. In the statement, Director Fowler identified IHS senior advisor, Elizabeth Carr as lead on the agency’s efforts to address MMIP. Before NCUIH advocacy, Missing and Murdered Indigenous People fell within law enforcement and jurisdictional issues. The response toward MMIP was to make sure Tribes had jurisdiction over non-Indian violent offenders. While incredibly important, this response missed the preventative part of this epidemic. Due solely to NCUIH’s work, we have successfully incorporated public health approaches to this problem.

Representative Grijalva also introduced a resolution designating May 5th as the National Day of Awareness for Missing and Murdered Indigenous Women and Girls. The resolution, which was also introduced in the Senate, has bipartisan support and has been endorsed by NCUIH.

Read the statement below or on the IHS website here.

Today, I want to recognize Missing and Murdered Indigenous Persons Awareness Day. This is a day to remember and honor the lives of missing and murdered American Indians and Alaska Natives. Our communities have been deeply affected by our missing and murdered relatives. Native people are resilient, and we must show our support to prevent the violence that has devastated so many of our communities. The Biden Administration has shown its support for tribal nations on this important issue, and under the leadership of Secretary of the Interior Deb Haaland, we now have an opportunity to bring the needed resources and attention to stop the violence that plagues our communities.

The contributing factors of the MMIP crisis require the attention of leaders at all levels of government in collaboration with Native American communities. The Indian Health Service will continue to support these efforts through our participation and support of the White House Council on Native American Affairs and the Presidential Task Force on Missing and Murdered American Indians and Alaska Natives. Recognizing the ties between domestic and sexual violence, trafficking and MMIP, the IHS supports our communities through our nationally-funded Domestic Violence Prevention and Forensic Health Care programs and continues to work to improve the way we document and screen suspected human trafficking. Today, I am also announcing that the IHS senior advisor, Elizabeth Carr, will lead our agency’s efforts to address MMIP. We look forward to working with the Administration as we end the MMIP crisis using a public health and safety approach.

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IHS Releases Q&A Regarding CRRSAA Funding for UIO Facility-Related Expenses

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IHS Releases Q&A Regarding CRRSAA Funding for UIO Facility-Related Expenses

 

On Friday May 21st, Indian Health Service (IHS) Director of the Office of Urban Indian Health Programs released a Q&A regarding the use of the $790 million allocation to IHS for UIO facility improvements to support COVID-19 testing, contact tracing, containment, mitigation, and related activities authorized by the Coronavirus Response and Relief Supplemental Appropriations Act (CRRSAA):

Question: Can the funding that urban Indian organizations (UIOs) receive from the Coronavirus Response and Relief Supplemental Appropriations Act (CRRSAA) transferred from the Public Health and Social Services Emergency Fund (PHSSEF) for COVID-19 testing be used for facilities-related expenses (renovation, construction, or expansion, etc.)?

Response: Yes, funds may be used for the rent, lease, purchase, acquisition, construction, alteration, renovation, or equipping of non-federally owned facilities to improve COVID-19 preparedness capability at the State and local level. For the $790 million for testing and related activities that are transferred to IHS from the (PHSSEF), the appropriation has the following relevant provision:

“Provided further, That funds an entity receives from amounts described in the first proviso in this paragraph may also be used for the rent, lease, purchase, acquisition, construction, alteration, renovation, or equipping of non-federally owned facilities to improve coronavirus preparedness and response capability at the State and local level”.

UIOs are contributing to coronavirus preparedness and response at the local level, and their facilities are not federally owned. Accordingly, so long as the urban Indian organization’s efforts are contributing in that manner and are otherwise consistent with the purpose of the appropriation for COVID-19 testing-related activities, this provision applies to UIOs. The authority to use CRRSAA funds transferred from the PHSSEF for facilities-related purposes is limited to facilities expenses related to COVID-19 testing. Other funds transferred through a UIO’s contract pursuant to the Indian Health Care Improvement Act (IHCIA) are generally not authorized for use for construction, renovation, or expansion, unless it is for the purpose of achieving or maintaining Joint Commission accreditation. In addition, any construction, renovation and expansion of urban Indian organization facilities must comply with FAR Part 36, “Construction and Architect-Engineer Contracts”. Finally, the UIO should consider whether the entire project is in support of their IHS IHCIA funded program, or whether only a share of the project is attributable to their program.

COVID-19 has exacerbated failing infrastructures at UIOs due to longstanding needs without funding. NCUIH has long been advocating for UIOs to have funding flexibility for facility renovations and upgrades to comply with COVID regulations.

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