House Passes Infrastructure Bill with Urban Indian Health Facilities Fix

The bill includes an amendment to allow Urban Indian Organizations to use existing funds for necessary infrastructure projects.

On November 5, 2021, the House of Representatives passed the bipartisan infrastructure bill with a vote of 228-206. The bipartisan infrastructure bill, which passed the Senate in August, includes the Padilla-Moran-Lankford amendment, which will allow Urban Indian Organizations (UIOs) to use existing resources to fund infrastructure projects to better serve patients and families. The urban Indian health amendment was the first amendment in the infrastructure package to get voted on in the Senate back in August, and it passed with overwhelming support. The package does not include the $21 billion Native health infrastructure ask but does include $11 billion for Native communities with $3.5 billion for the IHS sanitation facilities construction program (UIOs are not eligible for this program).

“We applaud leaders in Congress who supported the bipartisan infrastructure bill with our amendment championed by Senators Padilla, Lankford and Moran. This technical fix will be critical to expanding health care infrastructure for Native communities who have been devastated by the COVID-19 pandemic. While no new funding for urban Indian health was provided in this bill, we are hopeful that Congress will soon pass Build Back Better, which would provide additional resources for urban Indian communities,” said Francys Crevier, CEO of NCUIH (Algonquin).

Background and Advocacy

Urban Indian Organizations are a fundamental, inseverable component of the Indian Health Service/Tribal Health Program/UIO (I/T/U) system, face chronic underfunding. The National Council of Urban Indian Health (NCUIH) has long advocated for adequate funding for all three parts of the I/T/U system to better serve the American Indian and Alaska Natives.

Section 509 of the Indian Health Care Improvement Act (IHCIA) currently permits IHS from providing UIOs with funding for minor renovations by mandating that funding only be provided to UIOs that meet or maintain compliance with the accreditation standards set forth by The Joint Commission (TJC). These restrictions on facilities funding have ultimately prevented UIO facilities from obtaining the funds necessary to improve the safety and quality of care provided to AI/ANs in urban settings. The Padilla-Moran-Lankford amendment included in the Infrastructure bill removes this restriction to allow UIOs to use existing federal dollars on necessary facility needs. NCUIH has worked closely on a bipartisan basis for the past year on the technical legislative fix to support health care for tribal members who reside off of reservations.

• Policy Alert: Policy Alert: Senate Passes Bipartisan Infrastructure Bill with Amendment to Support Urban Indian Health
• PRESS RELEASE: Bipartisan Padilla-Moran-Lankford NCUIH Amendment for Urban Indian Health Passes Senate (August 2, 2021)
• Urban Indian Health Facilities Provider Act (H.R. 3496) introduced by Congressman Ruben Gallego (D-AZ) and Congressman Don Bacon (R-NE)
• Urban Indian Health Facilities Provider Act (H.R. 3496) introduced by Senators Alex Padilla (D-CA), James Lankford (R-OK) along with co-sponsors Moran (R-KS), Feinstein (D-CA), and Smith (D-MN)
• NCUIH testimony before the House Natural Resources Subcommittee for Indigenous Peoples of the United States (SCIP) and the Senate Committee on Indian Affairs (SCIA) in support of the Urban Indian Health Facilities Provider Act (H.R. 3496 / S. 1797)
• National Congress of American Indians resolution to “Call for Congress to Amend Section 509 of the Indian Health Care Improvement Act (IHCIA) to Remove Facility Funding Barriers for Urban Indian Organizations”

Next Steps

The Infrastructure bill will be sent to the President’s desk for signature. The rule to consider the Build Back Better bill also passed and will await further consideration by the House of Representatives.