NCUIH Submits Comments to DOI on Boarding School Initiative and the Lasting Impact on Urban Indian Health

On December 23, 2021, the National Council of Urban Indian Health (NCUIH) submitted comments to the Department of the Interior (DOI) regarding the agency’s Federal Boarding School Initiative (Initiative). NCUIH reiterated its ongoing support for the Administration’s efforts to address the legacy of boarding school programs, while urging the Administration to use the Initiative to address the public health impact of boarding schools on urban American Indian and Alaskan Natives (AI/ANs). NCUIH emphasized the importance of studying not only the impact of boarding school programs for survivors, but also the lasting impact of the intergenerational trauma caused by boarding schools within urban AI/AN communities.

Background

On June 22, 2021, DOI Secretary Haaland issued a memorandum directing DOI to prepare a report addressing the “intergenerational trauma, cycles of violence and abuse, disappearance, premature deaths, and other undocumented bodily and mental impacts.” This Initiative came weeks after the discovery of 215 Indigenous children’s remains were found at a boarding school site in Canada. Secretary Haaland noted that to “promote spiritual and emotional healing in [AI/AN] communities, we [DOI] must shed light on the unspoken traumas of the past…no matter how hard it will be.”

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.

NCUIH’s Role

Following Secretary Haaland’s memorandum, NCUIH issued a statement commending Secretary Haaland for beginning the process of holding the United States to account for the effects of its boarding school policy.  NCUIH also reiterated its support of the Initiative’s ability to address Indian Country’s historical trauma. NCUIH recognizes the deeply sensitive and emotional impact that federal boarding schools have on the AI/AN community at large, including the continued impact on the many UIOs we serve and their constituents. NCUIH exists, in part, because of the historic oppression of the AI/AN population including federal boarding schools that resulted in the growing AI/AN populations in cities.

Additionally, NCUIH endorsed the Truth and Healing Commission on Indian Boarding School Policies in the United States Act. This bill would create a Truth and Healing Commission on Indian Boarding School Polices in the United States. The Commission will provide a space for AI/AN people to speak about their personal experiences in government-run boarding schools and allow them to provide recommendations to the government. NCUIH is in full support of this Commission and hopes to see DOI establish a similar commission in the Initiative that includes a UIO representative to represent AI/ANs who reside in urban settings.

Importance of Including Urban Indians in the Initiative

In its comments, NCUIH urged DOI and the Administration to address the ongoing effects of Indian boarding schools on AI/AN health.  Specifically, NCUIH requested that DOI incorporate the following items into the Initiative:

  • Partner with AI/AN organizations, including UIOs, to fully study and understand the impact of boarding school trauma and assist survivors in healing from this trauma.
  • Study the lasting impact of boarding school policies, including intergenerational trauma, on the social determinants of health of contemporary AI/AN communities, including those in urban areas
  • Include the UIOs representing the seventy percent (70%) of AI/ANs living in urban areas in DOI’s process through urban confer
    • NCUIH’s comments recognized the importance of Tribal sovereignty and the government-to-government relationship as vital to the Initiative, but noted failure to include UIOs in consultation will leave a significant portion of the AI/AN population without a voice
  • Ensure a comprehensive assimilation of data by making all AI/AN communities true partners in the Initiative.

The DOI report on the investigation is scheduled to be finished in April 2022. NCUIH will remain close to the investigation and monitor for updates. NUCIH will also continue to advocate for the inclusion of UIOs in the process and encourage DOI to incorporate a study of the impact of the boarding schools on urban AI/AN health into the Initiative.

Senator Cantwell Highlights Urban Indian Organizations in Senate Committee on Indian Affairs Oversight Hearing on VAWA

On December 8, 2021, the Senate Committee on Indian Affairs (SCIA) held an oversight hearing on “Restoring Justice: Addressing Violence in Native Communities through VAWA Title IX Special Jurisdiction.” Focusing on the successes and challenges of Title IX of the 2013 Violence Against Women Act (VAWA 2013), the hearing coincided with the committee’s release of the Reauthorization draft text.

When Congress passed VAWA 2013, it included a provision for Indian Tribal governments to exercise criminal jurisdiction over certain non-Indians who commit domestic violence against Indian victims on Tribal lands or violate qualifying protection orders. Although VAWA 2013 has been instrumental in these cases, there remain impactful jurisdictional gaps such as, being able to prosecute crimes against children, dating violence, sex trafficking, as well as co-occurring crimes such as assault on a law enforcement officer or DUI.

During the hearing, Senator Maria Cantwell (D-WA) brought to light the work of urban Indian organizations (UIOs) regarding Missing and Murdered Indigenous People (MMIP). Many UIOs conduct home visits and are at the front-line to identify domestic violence and other risk factors for MMIP. The National Council of Urban Indian Health (NCUIH) has been advocating for MMIP efforts and urban Indians to be included in the VAWA reauthorization to strengthen these critical services provided at UIOs for AI/ANs.

VAWA Hearing on Heels of Recent EO from Biden on MMIP

On November 15, 2021, President Biden signed Executive Order 14053 (E.O.) on Improving Public Safety and Criminal Justice for Native Americans and Addressing the Crisis of Missing and Murdered Indigenous People (MMIP) during the White House Tribal Nations Summit. NCUIH is pleased to see that the E.O. specifically mentions the Department of Health and Human Services (HHS) and the Secretary of the Interior conferring with UIOs on developing a comprehensive plan to support initiatives related to MMIP. We are also pleased to see that the E.O. highlights the need for improved data surrounding this crisis as it relates to urban Indian communities. NCUIH has voiced the importance of gathering more data on these communities, specifically on Missing and Murdered Indigenous Women.

CDC strengthens COVID-19 Booster Guidance

On November 29, CDC strengthened its recommendations on who should aim to complete a booster dose of the COVID-19 vaccine. This new recommendation urges that everyone ages 18 and older should receive a booster at least 6 months post completion of a 2-dose regimen, or 2 months post a single dose inoculation.

With the emergence of the Omicron variant, the importance of vaccination, and the use of boosters, as a prevention method is even more important. CDC Director, Dr. Rochelle Walensky also encouraged those who are unvaccinated to change that as soon as possible. Dr. Walensky also highlighted the importance of getting tested should you experience symptoms.

For more information, the Coronavirus Resources Center on the NCUIH website includes links to any recent guidance  or updates from federal agencies about COVID-19.

NCUIH Thanks Julia Dreyer for Her Service

NCUIH would like to thank Julia Dreyer, the Vice President of Public Policy, for her service to Indian Country as she moves on to her next endeavor! For the past four years, Julia has tirelessly advocated on behalf of American Indians and Alaska Natives living in urban settings. During Ms. Dreyer’s tenure, NCUIH has thrived and achieved significant wins for American Indian and Alaska Native health (AI/AN) care, such as more agency engagement on pressing issues, fighting against work requirements for AI/ANs, 100% FMAP for 8 quarters for services at Urban Indian Organizations (UIOs), UIO inclusion within every COVID-19 relief bill, and the amendment to the Indian Health Care Improvement Act to allow UIOs to use their line item funds for facilities related spending. Please join NCUIH in thanking Julia!

Julia Dreyer, NCUIH Vice President of Public Policy (Left) and Francys Crevier, NCUIH CEO (Right)

FY 2022 Update on IHS Special Diabetes Program for Indians: SDPI Funding Levels Reduced and 1-Year Extension of Current Grant Cycle

On November 15, 2021, the Indian Health Service (IHS) sent out a Dear Tribal Leader and Urban Indian Organization Leader letter (DULL) that discussed the Special Diabetes Program for Indians (SDPI) for fiscal year (FY) 2021 and the upcoming changes for the program in FY 2022. As a grant program inclusive of all three components of the Indian Health Service/Tribal Health Program/Urban Indian Organization (I/T/U) system, SDPI has been a resounding and demonstrable success in reducing diabetes and diabetes-related illnesses in Indian Country.

Background

In 2004, Congress established the SDPI Demonstration Projects to translate research-based interventions for diabetes prevention and cardiovascular disease (CVD) risk reduction into AI/AN community-based programs and health care settings. In total,  The SDPI Demonstration Projects successfully translated diabetes science and reduced the risk of diabetes in high risk individuals, and reduced CVD risk factors in people with diabetes. In 2010, the SDPI Demonstration Projects transitioned into the SDPI Initiatives to continue their prevention work and begin disseminating the strategies and lessons learned to other I/T/U health programs.

Since the inception of SDPI, it has achieved real, demonstrable success, with a 50% reduction in diabetic eye disease rates,drops in diabetic kidney failure, and a 54% decline in End Stage Renal Disease.Given the high rates of diabetes and diabetes-related illnesses AI/ANs face, it is imperative that SDPI is administered in a way that continues to reduce these rates – and in a manner that is inclusive of UIOs. AI/ANs have the highest diabetes prevalence rates of all racial and ethnic groups in the United States, with AI/AN adults almost three times more likely than non-Hispanic white adults to be diagnosed with diabetes.According to 2018 data from the Centers for Disease Control and Prevention, AI/ANs were 2.3 times more likely than non-Hispanic whites to die from diabetes and twice as likely to be diagnosed with end stage renal disease than non-Hispanic whites. SDPI is therefore a critical program to address the disparate high rates of diabetes among AI/ANs.

SDPI has directly enabled UIOs to provide critical services to their AI/AN patients, in turn significantly reducing the incidence of diabetes and diabetes-related illnesses among urban Indian communities. funding. Facilities use these funds to offer a wide range of diabetes treatment and prevention services, including but not limited to exercise programs and physical activity, nutrition services, community gardens, culinary education, physical education, health and wellness fairs, culturally-relevant nutrition assistance, food sovereignty education, group exercise activities, green spaces, and youth and elder-focused activities. To continue the path of success in reducing the rate of diabetes in Indian Country, IHS must continue to provide this essential funding to UIOs.

NCUIH has long advocated for an increase in SDPI funds.  NCUIH

 

FY 2022 Changes and Updates

Starting in FY 2022, SDPI funding will reduce from $150 million to $147 million each year. This reduction is due to a mandatory sequester which reflects a required 2% reduction continuing through 2023 under current law. While the SDPI grant cycle was due to end on December 31, 2021, IHS learned of the time intensive requirements and IHS has determined that FY 2022 will constitute a 1-year extension of the current grant cycle, extending it to a seventh year. IHS believes this extension will allow more time to work on the notice of funding opportunity and decrease some of the administrative burden for SDPI grantees.

Tribal Leaders Diabetes Committee Meeting Held on December 8, 2021

On December 8, 2021, IHS held a Tribal Leader Diabetes Committee (TLDC) meeting to discuss the current SDPI Funding Distribution. This funding includes $130.2 million in Tribal and IHS grants. A portion of that total will go to 14 IHS grants as well as Technical Assistance services for 8 IHS areas.  Urban Grants will receive $8.5 million in funding with $100k going to Technical Assistance. The SDPI Funding Formula is used to determine how much of the $130.2 million goes to each Area for Tribal/IHS grants. This formula includes information about diabetes prevalence, user population (AI/ANs who have used IHS services at least once in the past 3 years), and the tribal size adjustment. The meeting also announced a new Notice of Funding Opportunity (NOFO) which allows for new and open competition. Urban Indian health programs operated by UIOs are eligible for this NOFO pursuant to a grant or contract with IHS.

 

The TLDC meeting also outlined a FY 2023 SDPI timeline and issues for consideration, including the potential risk for a decrease in annual SDPI grant amounts due to the open competition, how grantees can be held harmless under the current situation, whether there will be a change in the SDPI funding formula, and what the Tribal Consultation/Urban Confer process will look like moving forward.

NCUIH-Endorsed Protecting Moms Who Served Act Enacted

On November 30, 2021, President Biden signed the Protecting Moms Who served Act (H.R. 958/S. 796) into law. This bipartisan legislation introduced by Representative Lauren Underwood (D-IL-14) and Senators Susan Collins (R-ME) and Tammy Duckworth (D-IL) is the first of 12 bills in the historic Momnibus Act to be enacted. This bill addresses the maternal mortality crisis among Veterans by:

  • Investing $15 million in maternity care coordination programs at the Department of Veterans Affairs facilities; and
  • Commissioning the first-ever comprehensive study of maternal mortality, morbidity, and disparities among Veterans.
    • The report on maternal morbidity and mortality includes an assessment on the barriers to determining the data and recommendations for improvements in tracking maternal health outcomes among pregnant and postpartum veterans who are eligible to use the Indian Health Service, Tribal health programs, or urban Indian health organizations.

The National Council of Urban Indian Health has tirelessly advocated for improving the health of American Indian and Alaska Native (AI/AN) Veterans and is pleased to endorse Rep. Underwood, Sen. Collins, and Sen. Duckworth’s legislation which advances maternal healthcare for Veterans with a focus on racial and ethnic disparities.

UIO Highlight: Bakersfield American Indian Health Project Vehicle Transportation Services – Cleaning and Disinfection

Rep. Bacon Recognizes 35th Anniversary the Nebraska Urban Indian Health Coalition

On November 2, 2021, Representative Don Bacon (R-NE-02) rose to the floor to honor the 35th anniversary of the Nebraska Urban Indian Health Coalition (NUIHC) in recognition of National Native American Heritage Month.

In his three-minute speech, Rep. Bacon highlighted both the work of NUIHC and Dr. Donna Polk, NUIHC’s Chief Executive Officer.

In recognition of the Nebraska Urban Indian Health Coalition, we shine a spotlight on 35 years of helping elevate the health status and eliminating disparities of urban Indians and other underserved populations in Nebraska and Iowa through education, collaboration, advocacy, and health service delivery. Congratulations to Dr. Polk and her team for 35 years of excellence and serving our great community.” – Rep. Bacon

NUIHC has been serving the urban Indian community of the greater Omaha metropolitan area, Lincoln-Lancaster metropolitan area, and Sioux City, Iowa since 1986. NUIHC’s mission is to elevate the health status of urban Indians and other underserved populations through their culturally and linguistically appropriate health care services, substance abuse and behavioral health treatment programs, and community outreach services.

Upcoming Urban Confer to Discuss ARPA and BBBA Funding for IHS Programs

On November 22, 2021 IHS sent a Dear Urban Tribal Organizational Leader letter (DULL) that outlines an additional $210 million for Public Health Workforce Activities from the U.S. Department of Health and Human Services through the American Rescue Plan Act (ARPA). The DULL also outlines the Build Back Better Act (BBBA) that includes $2.35 billion in additional resources for several Indian Health Service (IHS) programs. Currently, the BBBA is up for consideration in Congress and includes funding for several prioritized IHS programs.

ARPA and BBBA’s IHS Program Impact

Directed funding of the ARPA and BBBA are a result of the disproportionate impact the COVID-19 pandemic has had on American Indian/Alaska Native (AI/AN) communities. The proposed funding emphasizes the urgent need for preparatory action to handle the exacerbated inequalities across the nation.

The allocation of $210 million to IHS is a significant amount of funding that would enable the creation and enhancement of community level programs that are equity focused and results driven. The directed dollars have the capacity to boost public health responses and increase the professional volume that is dedicated to the work in IHS, Tribal, and urban Indian health programs.

Additionally, the BBBA includes $2.35 billion in additional funding for several IHS programs, including, $1 billion to address the 1993 Health Care Facilities Construction Priority List; $945 million for Maintenance and Improvements; $124 million for behavioral health services, including necessary facilities improvements; and $100 million for Urban Indian Organization construction. NCUIH supports the BBBA funding and its planned disbursement to the prioritized IHS programs.

Next Steps

NCUIH will be holding a prep call on Wednesday, December 15, 2021 from 12:00 p.m. – 1:00 p.m. (EST). Join NCUIH’s prep call here. During this meeting, we will review potential talking points and provide a shareable document prior to the IHS Urban Confer Session.

The virtual Urban Confer session will take place to discuss the additional funds on Wednesday, December 15, 2021 from 2:00 p.m. – 4:00p.m. (EST). Join the meeting by clicking here. Written comments are also encouraged on the two funding sources. The deadline to submit written comments is December 23, 2021.

Policy Blast: President Biden Highlights Urban Native Americans in Executive Order on MMIP and in Tribal Nations Progress Report

NCUIH advocacy was critical to the inclusion of Urban Indian Organizations and urban Native Americans in these Administrative efforts.

On November 15, 2021, President Biden signed Executive Order 14053 (E.O.) on Improving Public Safety and Criminal Justice for Native Americans and Addressing the Crisis of Missing and Murdered Indigenous People (MMIP) during the White House Tribal Nations Summit. Also on the same day, President Biden released a Progress Report highlighting the Administration’s commitment to address the needs of Indian Country and included a special section on “Urban Native Americans”. The Administration also mentioned the priority of ensuring 100% FMAP. Advocacy by the National Council of Urban Indian Health (NCUIH) was critical to urban Natives being prioritized by the White House and our work had a significant impact on Urban Indian Organizations (UIOs) being included in the E.O and the Progress Report.

NCUIH is pleased to see that the E.O. specifically mentions the Department of Health and Human Services (HHS) and the Secretary of the Interior conferring with UIOs on developing a comprehensive plan to support initiatives related to MMIP. NCUIH has been working on an urban confer bill, the Urban Indian Health Confer Act (H.R. 5221), that recently passed the House (406-17) with overwhelming support. NCUIH is pleased to see that the E.O. specifically mentions the Department of Health and Human Services (HHS) and the Secretary of the Interior conferring with UIOs on developing a comprehensive plan to support initiatives related to MMIP. We are also pleased to see that the E.O. highlights the need for improved data surrounding this crisis as it relates to urban Indian communities. NCUIH has voiced the importance of gathering more data on these communities, specifically on Missing and Murdered Indigenous Women. On July 2, 2021, NCUIH submitted comments to the Department of Justice on Savannah’s Act requesting UIOs and urban Indians to be incorporated into improving data relevancy, access, and resources.

The Progress Report, released by the White House ahead of the Tribal Nations Summit, highlights the Administration’s commitment to address the needs of Indian Country, including the needs of the 70% American Indians/Alaska Natives (AI/ANs) living in urban areas. NCUIH has emphasized that 70% of AI/ANs reside in urban areas and rely on UIOs to provide them with culturally competent health care. NCUIH is pleased to see that the Progress Report highlights the Administration’s commitment to ensuring UIOs receive 100% Federal Medicaid Assistance Percentage (FMAP) and include urban Indian issues within the context of public safety and justice. Over this past year, NCUIH advocacy has secured 2 years of 100% FMAP for UIOs in the American Rescue Plan Act, and the House recently passed the Build Back Better Act which includes an additional 8 fiscal quarters of 100% FMAP for UIOs.

Executive Order

The E.O. includes the following for American Indian and Alaska Natives living in urban areas and the role of UIOs in addressing these issues:

  • Given that approximately 70 percent of American Indian and Alaska Natives live in urban areas and part of this epidemic of violence is against Native American people in urban areas, we must continue that work on Tribal lands but also build on existing strategies to identify solutions directed toward the particular needs of urban Native Americans.
  • Earlier this year, the Secretary of the Interior and the Attorney General announced a Joint Commission, established pursuant to the Not Invisible Act, that includes: representatives of Tribal, State, and local law enforcement; Tribal judges; Native American survivors of human trafficking; health care and mental health practitioners who have experience working with Native American survivors of human trafficking and sexual assault; Urban Indian Organizations focused on violence against women and children; and family members of missing or murdered indigenous people.
  • The Federal Government must prioritize addressing this issue and its underlying causes, commit the resources needed to tackle the high rates of violent crime that Native Americans experience over the long term, coordinate and provide resources to collect and analyze data, and work closely with Tribal leaders and community members, Urban Indian Organizations, and other interested parties to support prevention and intervention efforts that will make a meaningful and lasting difference on the ground.
  • 4. Improving Data Collection, Analysis, and Information Sharing.
    • (a) The Attorney General, in coordination with the Secretary of the Interior and the Secretary of Health and Human Services (HHS), as appropriate, shall sustain efforts to improve data collection and information-sharing practices, conduct outreach and training, and promote accurate and timely access to information services regarding crimes or threats against Native Americans, including in urban areas, such as through the National Crime Information Center, the Next Generation Identification system, and the National Violent Death Reporting System, as appropriate and consistent with applicable law.
    • (c) The Attorney General, in coordination with the Secretary of the Interior and the Secretary of HHS, shall develop a strategy for ongoing analysis of data collected on violent crime and missing persons involving Native Americans, including in urban Indian communities, to better understand the extent and causes of this crisis. Within 240 days of the date of this order, the Attorney General, the Secretary of the Interior, and the Secretary of HHS shall report jointly to the President on the strategy they have developed to conduct and coordinate that analysis and shall identify additional resources or other support necessary to implement that strategy.

(e) The Secretary of HHS shall evaluate the adequacy of research and data collection efforts at the Centers for Disease Control and Prevention and the National Institutes of Health in accurately measuring the prevalence and effects of violence against Native Americans, especially those living in urban areas, and report to the President within 180 days of the date of this order on those findings and any planned changes to improve those research and data collection efforts.

  • 5. Strengthening Prevention, Early Intervention, and Victim and Survivor Services.
    • (a) The Secretary of HHS, in consultation with the Secretary of the Interior and Tribal Nations and after conferring with other agencies, researchers, and community-based organizations supporting indigenous wellbeing, including Urban Indian Organizations, as appropriate, shall develop a comprehensive plan to support prevention efforts that reduce risk factors for victimization of Native Americans and increase protective factors, including by enhancing the delivery of services for Native American victims and survivors, as well as their families and advocates.

 

Progress Report

The Progress Report included the following sections and features urban Indians:

  • Meeting Obligations to Urban Native Americans
    • According to the US Census Bureau, over 70 percent of Native Americans live in urban cities away from Tribal lands. President Biden is ensuring that the Administration supports and is giving a voice to the urban Indian population. The Administration has included Urban Indian Organizations in Tribal listening sessions on topics and issues such as health care, education, funding, housing, maternal care and voting rights, to name a few. It has also ensured that Urban Indian Health Organizations (UIHOs) receive 100 percent Federal Medical Assistance Percentages (FMAP) for Medicaid and included urban Indian issues within the context of public safety and justice. President Biden has also ensured that payments from Tribal governments to Tribal members from the CARES Act and the ARP do not count as income for purposes of Social Security Income benefits and included budget increases that will go directly to UIHO’s to provide much needed health care to the urban Indian population. And the Build Back Better Plan will provide families, especially children, with the much needed support for early childhood education and child tax credits for families – which will positively impact the urban Indian population.
  • Responding to the COVID-19 Pandemic in Indian Country
    • In the height of the pandemic, per capita COVID-19 infection rates for American Indians and Alaska Natives were three times higher than for all Americans. These disparities also produced higher mortality rates. To address these disparities, with the assistance of Tribal Nations, Urban Indian Organization health facilities, and Alaska Native health corporations, the Administration through the Department of Health and Human Services and Indian Health Service, implemented an effective COVID-19 plan in Indian Country and succeeded in making Native Americans the most vaccinated group in the United States.
    • Investing ARP Funds to Combat COVID-19 in Indian Country
      • $84 million for Urban Indian Organizations
    • Improving Health Care Delivery for Native Americans Through the ARP
      • The ARP required the Centers for Medicaid to provide a 100 percent federal Medicaid match to Urban Indian Health Programs, rather than limiting them to receive the regular Medicaid match rate for the state in which they are located.
    • Providing Access to the Strategic National Stockpile
      • President Biden signed Executive Order 14001, “A Sustainable Public Health Supply Chain,” allowing access to the Strategic National Stockpile for Tribal governments, IHS healthcare providers, and Urban Indian Organizations.
    • Vaccine Distribution in Indian Country
      • Working with Tribal communities and Urban Indian Organization health facilities, the IHS has administered more than 1.7 million doses to patients, health care employees, essential workers, and others in Native communities
    • Initiative on Ending the HIV Epidemic
      • The President’s FY 2022 budget request includes $27 million to support HIV prevention, care, and treatment services to help accelerate and strengthen the HIV response in Indian Country. HIV disproportionately affects American Indian and Alaska Native Men who have sex with Men (MSM). In 2018, 67 percent of diagnoses among American Indian and Alaska Native people were among MSM. The proposed increase for the IHS will support HIV care teams located in geographic areas of the U.S. serviced by IHS, Tribal, and Urban Indian Organization (I/T/U) facilities. Funds will scale-up clinical support programs designed to increase HIV prevention medication uptake and to meet viral suppression goals for primary antiretroviral therapy programs served by I/T/U facilities in Indian Country.
    • White House Engagement with Tribal Leaders
      • Community Development: Traditional Food, Subsistence, and Community Level Food and Feeding Programs; the National American Housing; Urban Indian Issues; Buy Indian Act; and Native Language Immersion Schools and Language Preservation.