NCUIH Endorses Bipartisan, Bicameral Bill to Improve Public Health Emergency Preparedness for Indian Health Care Providers

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On March 31, 2022, Senator Elizabeth Warren (D-Mass.), Representative Ruben Gallego (D-Ariz.), Senator Martin Heinrich (D-N.M.), and Representative Tom Cole (R-Okla.) introduced the Centers for Disease Control and Prevention (CDC) Tribal Public Health Security and Preparedness Act (S. 3968). The bill would allow Tribes  to apply directly to the Centers for Disease Control and Prevention (CDC) for Public Health Emergency Preparedness (PHEP) program funds. Currently, only states and certain local entities may apply for PHEP funds to respond to public health emergencies. The bill  authorizes $750 million for each of fiscal years 2023 through 2025 for the PHEP program 5% tribal set-aside of the total CDC PHEP funds.  Additionally, urban Indian organizations (UIOs) are included in several important consultation provisions in the bill that would ensure they are included in crafting public health plans.

“The National Council of Urban Indian Health (NCUIH) is pleased to endorse Rep. Gallego’s CDC Tribal Public Health Security and Preparedness Act which provides Tribes access to Public Health Emergency Preparedness (PHEP) program funds and includes urban Indian organization input on the development of public health plans. The COVID-19 pandemic has had devastating impacts on Native communities, and this bill’s equitable access to critical preparedness funds will ensure Indian Country will be better prepared to respond to future public health emergencies.” – Francys Crevier (Algonquin), CEO, NCUIH.

The CDC Tribal Public Health Security and Preparedness Act is cosponsored by Senators Tina Smith (D-Minn.), Amy Klobuchar (D-Minn.), Cory Booker (D-N.J.), Tammy Baldwin (D-Wisc.), and Bernie Sanders (I-Vt.). The bill has been endorsed by leading Native American advocacy groups— including the National Congress of American Indians, National Indian Health Board, and NCUIH. It currently awaits consideration.

This bill has been added to the NCUIH legislative tracker and can be found here.

Background

Inequities in access to public health resources has caused the COVID-19 pandemic to have a disproportionate impact on Indian Country. The CDC Tribal Public Health Security and Preparedness Act helps address this issue by:

  • Allowing   to apply directly to the CDC PHEP program;
  • Requiring the CDC to fund at least ten tribes for emergency preparedness and include a
  • Exempting tribes   needing to match funds and waive many of the reporting requirements to minimize the administrative burden on tribal nations; and
  • Requiring grant recipients to include tribes, tribal organizations, and urban Indian organizations in their consultation process in their development of public health plans.

 

Senate Text of Bill

Senator Warren’s Press Release

 

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President Biden Continues to Demonstrate Strong Commitment to Urban Indians, Proposes Over 50% Increase for Urban Indian Health for FY 2023

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The FY 2023 budget request includes $113 million for urban Indian health, a 53% increase over the FY 2022 enacted amount and mandatory appropriations for IHS.

On April 25, 2022, the Indian Health Service (IHS) published their Fiscal Year (FY) 2023 Congressional Justification with the full details of the President’s Budget, which includes $112.5 million for Urban Indian Health— a 53.2% increase above the FY 2022 enacted amount of $73.4 million. According to the IHS Congressional Justification, “This funding increase could support an estimated 1,072,935 health care, outreach, and referral services to Urban Indian users in FY 2023.” The President’s proposal included a total of $127.3 billion in discretionary funding for the Department of Health and Human Services (HHS) and, for the first time ever, $9.3 billion in mandatory funding for IHS for the first year, which includes $9.1 billion in proposed law funding and $147 million in current law funding for the Special Diabetes Program for Indians (SDPI). The budget proposes increased funding for IHS each year over ten years, building to $36.7 billion in FY 2032, to keep pace with population growth, inflation, and healthcare costs.

“The Indian Health System and urban Indian health have long been severely underfunded: only 1% of the Indian health budget goes to urban Indian health despite more than 70% of American Indians and Alaska Natives residing in urban areas. We are grateful for the President’s inclusion of $113 million for urban Indian health in FY 2023. President Biden has shown a strong commitment to urban Indian communities, and we recognize this Administration’s dedication to improving outcomes for all of Indian Country. As the final amount still falls well short of fully funding the Indian Health Service to properly provide health care services for all Natives in the United States to meet the trust responsibility, we will continue to push Congress to provide all the resources necessary to protect the lives of the entire Native population, regardless of where they live,”

– Francys Crevier (Algonquin), CEO, NCUIH

 

Line Item

FY21
Enacted

FY22 Enacted

FY23 TBFWG Request

FY23
President’s
Budget
Urban Indian Health  $62,684,000 $73,424,000  $949,900,000  $112,514,000
Indian Health Service $6,236,279,000 $6,630,986,000 $49,800,000,000 $9,100,000,000

 

The National Council of Urban Indian Health requested full funding for urban Indian health for FY 2023 at $949.9 million and at least $49.8 billion for IHS in accordance with the Tribal Budget Formulation Workgroup (TBFWG) recommendations. The marked increase for FY23 is a result of Tribal leaders, over several decades, providing budget recommendations to phase in funding increases over 10-12 years to address growing health disparities that have largely been ignored. The Congressional Justification states, “IHS recognizes that we must continue to work in consultation with Tribes and confer with Urban Indian Organizations, and with our partners in Congress, to ensure the budget is structured and implemented correctly with the resources identified over the next 10 years.”

Background and Advocacy

On March 28, 2022, President Biden released his budget request for Fiscal Year FY 2023, pending the more detailed IHS budget request released April 25, which includes specifics on the IHS budget request, including the funding recommendations for urban Indian health.

On April 5, 2022, NCUIH President-Elect and CEO of the Indian Health Center of Santa Clara Valley, Sonya Tetnowski (Makah Tribe), testified before and submitted public witness written testimony to the House Appropriations Subcommittee on Interior, Environment, and Related Agencies regarding FY 2023 funding for Urban Indian Organizations (UIOs). NCUIH requested $49.8 billion for the Indian Health Service and $949.9 million for Urban Indian Health for FY 2023 as requested by the TBFWG, Advance appropriations for IHS, and support of mandatory funding for IHS including UIOs.

NCUIH recently worked closely with Representatives Gallego and Grijalva on leading a Congressional letter to the House Committee on Appropriations in support of increasing the urban Indian health line item for FY 2023. The letter has bipartisan support and calls for the highest possible funding for Urban Indian Health up to the TBFWG’s recommendation of $949.9 million and advanced appropriations for IHS until such time that authorizers move IHS to mandatory spending.

Next Steps

The Appropriations Committees will review the President’s Budget for consideration as they craft their bills for FY 2023. NCUIH will continue to work with the Biden Administration and Congress to push for full funding of urban Indian health in FY 2023.

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Tribal Veteran Advocate Conference To Be Held May 2-3, 2022

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The Department of Veterans Affairs (VA) will be hosting a two-day Tribal Veteran Advocate Conference on May 2 and 3, 2022 from 10 a.m. to 3 p.m. PST (1 p.m. to 6 p.m. EST). This conference will involve training on understanding VA benefits and programs and will provide updates about the latest news affecting American Indian and Alaska Native Veterans. Topics which will be addressed during the training include: specially adapted housing grants, advance care planning, Program of Comprehensive Assistance for Family Caregivers (PCAFC), and Native Veteran spouses and dependency.

To register for the virtual training, click here.

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NCUIH Submits Comments to DOJ on Missing and Murdered Indigenous People

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On April 15, 2022, the National Council of Urban Indian Health (NCUIH) submitted written comments and recommendations in response to the Department of Justice’s (DOJ) Dear Tribal Leader letter seeking stakeholder input on DOJ’s efforts to address the unacceptably high rates of violent crime in American Indian and Alaska Native communities and the missing and murdered Indigenous persons (MMIP) crisis. In its comments, NCUIH thanked the DOJ for its commitment to working with Tribes to develop and support Tribally-driven solutions to violent crime and MMIP, while noting the need for the federal government to also work with Urban Indian Organizations (UIOs) to address these issues.  NCUIH emphasized that working with all AI/AN communities across the United States is required by both Executive Order 14053, Executive Order on Improving Public Safety and Criminal Justice for Native Americans and Addressing the Crisis of Missing or Murdered Indigenous People (E.O. 14053), and Deputy Attorney General Monaco’s Memorandum establishing the DOJ’s Steering Committee to Address the Crisis of Missing or Murdered Indigenous Persons.  NCUIH further offered to assist DOJ in establishing strong working relationships with UIOs as it works to address these pressing public safety issues.

E.O. 14053 and Deputy Attorney General Monaco’s Memorandum: Inclusion of Urban AI/AN Communities

AI/AN people are the victims of violence, murder, and rape at rates higher than the national average.  As part of the federal government’s response to these issues, President Biden signed E.O. 14053, on November 15, 2021.  E.O. 14053 directs the federal government to “to strengthen public safety and criminal justice in Indian Country and beyond, to reduce violence against Native American people, and to ensure swift and effective Federal action that responds to the problem of missing or murdered indigenous people.”  E.O. 14053 committed the federal government’s to “[c]onsistent engagement, commitment, and collaboration,” with AI/AN people and communities to “drive long-term improvement to public safety for all Native Americans.”  E.O. 14053 specifically directed the federal government to “build on existing strategies to identify solutions directed toward the particular needs of urban Native Americans,” because “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.”  In addition, E.O. 14053 directed the federal government to “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.”

With respect to DOJ, Section 4 of E.O. 14053, contained the following directives:

  • “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.”
  • “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.”

In addition, on November 15, 2021 Deputy Attorney General Monaco signed a Memorandum establishing a Steering Committee to Address the Crisis of Missing or Murdered Indigenous Persons.  Deputy Attorney General Monaco ordered the Steering Committee to review the Department’s current guidance, policies, and practices with respect to MMIP, recommend any changes necessary to better facilitate the DOJ’s work on MMIP, and to develop a comprehensive plan to strengthen the Department’s work to address the issues of MMIP.  Deputy Attorney General Monaco also directed the Steering Committee to seek and consider the views of stakeholders including UIOs.

NCUIH’s Comments to DOJ

In its comments, NCUIH requested that DOJ ensure its compliance with E.O. 14053’s requirement to “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,” by engaging in consistent and clear communication with UIOs and providing UIOs with notice of future consultations held pursuant to E.O. 14053.  NCUIH further urged DOJ to provide specificity regarding its plans to incorporate UIOs into the policies, procedures, and projects set forth in E.O. 14053 and in Deputy Attorney General Monaco’s Memorandum.

NCUIH noted collaboration with UIOs is not only required by E.O. 14053 and Deputy Attorney General’s Memorandum, but it is also sound public policy.  AI/AN individuals living in urban areas face many, if not all, of the same violent crime and MMIP issues as AI/ANs living on reservations or trust Iand.  UIOs are active and important partners in combatting crime and promoting violence prevention in urban AI/AN communities.  UIOs are also working together to develop innovative partnerships to provide services for victims of crime across jurisdictions.  As a result, UIOs are an integral partner to eradicating these pandemics of violent crime and MMIP.

NCUIH also requested that DOJ establish an Urban Confer policy to set the necessary policies and procedures for direct and clear communication with UIOs.  An Urban Confer is an established mechanism for dialogue between the federal government and UIOs. Urban Confer policies are a response to decades of deliberate federal efforts (i.e., forced assimilation, termination, relocation) that resulted in seventy percent (70%) of AI/AN people living outside of Tribal jurisdictions, thus making Urban Confer integral to address the care needs of most AI/AN persons.

NCUIH will continue to monitor the DOJ’s work on violent crime in Indian Country and MMIP.  NCUIH will also continue to advocate for the inclusion of UIO’s in DOJ’s efforts to ensure that E.O. 14053’s directive to “build on existing strategies to identify solutions directed toward the particular needs of urban Native Americans,” is met.

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NCUIH Submits Comments to SAMHSA on SUD Patient Confidentiality Rules, 42 CFR Part 2

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On April 6, 2022, the National Council of Urban Indian Health (NCUIH) submitted written comments and recommendations in response to the Substance Abuse Mental Health Services Administration (SAMHSA)’s Dear Tribal Leader letter regarding the federal requirements for confidentiality of Substance Use Disorder (SUD) patient records found at 42 CFR Part 2 (Part 2). In its comments NCUIH emphasized the importance of including Urban Indian Organizations (UIOs) in discussions on rules and policies, like Part 2, which apply to both UIOs and Tribal healthcare facilities. NCUIH also highlighted that a strong Urban Confer policy and improved communications with UIOs will assist SAMHSA, HHS, NCUIH, and UIOs in collaborating to ensure the highest level of substance abuse treatment and mental health treatment for all American Indian and Alaska Natives (AI/ANs).

NCUIH’s Recommendations to SAMHSA

On March 10, 2022 NCUIH attended SAMHSA’s Tribal Consultation on federal requirements for confidentiality of SUD patient records found at 42 CFR Part 2.  Following the Tribal Consultation, NCUIH submitted written comments to SAMHSA on behalf the 41 Urban Indian Organizations (UIOs) it represents.  In its written comments, NCUIH noted that almost every UIO provides behavioral health, mental health, or SUD care to American Indians and Alaska Natives living in Urban Areas.  In fact, in 2021, 6 UIOs were awarded grants through the SAMHSA-funded Tribal Behavioral Health Grant Program, which is aimed at increasing the support and delivery of culturally-tailored suicide and substance abuse prevention services to AI/AN youth to the age of 24.  NCUIH also noted that because UIOs operate under contracts with the Indian Health Service, and receive other forms of federal funding, Part 2 rules on SUD patient records apply to UIOs which provide SUD counseling to patients.

Accordingly, NCUIH requested that HHS host an Urban Confer with UIOs regarding changes to Part 2.  Informing UIOs of the Part 2 changes and receiving UIO feedback is especially important given the vital work UIOs do to reduce the impact of substance abuse in AI/AN communities.  As providers of culturally focused health care, UIOs are well placed to address and treat SUD in AI/AN patients.  The work UIOs do to combat substance abuse in urban AI/AN communities is essential, given that rural and urban AI/ANs need SUD treatment at virtually the same rate and almost seventy percent (70%) of the AI/AN population lives in urban areas.

NCUIH further recommended that SAMHSA, and HHS more broadly, establish an Urban Confer policy.  Establishing an Urban Confer policy is consistent with the federal government’s trust responsibility to improve the health of AI/ANs.  Urban Confers are also sound public health policy as they will allow SAMHSA and HHS to gain a greater understanding of the AI/AN patient population and increase collaboration with the entire Indian Health Care system.

NCUIH is looking forward to working more closely with SAMHSA on urban AI/AN health and will continue to keep UIOs updated on SAMHSA’s most recent policies and practices that impact their work and affect AI/AN communities.

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NCUIH Submits Comments to IHS on Urban Indian Organization On-Site Review Manual

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On April 12, 2022, the National Council of Urban Indian Health (NCUIH) submitted written comments and recommendations in response to the Indian Health Service’s (IHS) February 11, 2022 notice and request for comment on the information collection titled “Urban Indian Organization On-Site Review,” Office of Management and Budget Control Number 0917-00XX.  NCUIH requested that the on-site review manual be updated regularly, that IHS provide UIOs with a consolidated list of required documents prior to the on-site review, and that IHS enable UIOs to use existing administrative or site visit data in meeting the requirements of the Manual. NCUIH also encouraged the Office of Urban Indian Programs (OUIHP) to host an Urban Confer to personally hear UIO input on and experience with the on-site review process.

IHS On-Site Review Manual

The Indian Health Care Improvement Act (IHCIA) requires the Secretary of Health and Human Services, through the IHS, “to conduct an annual onsite evaluation of each urban Indian organization which has entered into a contract or received a grant under section 1653,” of the IHCIA.   As part of this statutorily mandated process the IHS Office of Urban Indian Health Programs (OUIHP) drafts and publishes the Manual, which is used to accomplish the annual review of UIOs.

In the nine years that the current Manual has been in use, UIOs have experienced significant changes, including adapting to the COVID-19 pandemic, and relevant standards of national healthcare accrediting organizations like the Association for Ambulatory Health Care (AAAHC) have changed.  Accordingly, NCUIH submitted comments, drawn directly from UIOs’ experience with the Manual and the annual review process, to inform the IHS on necessary areas of modification in the Manual.  NCUIH’s comments also included general recommendations concerning the annual review process.

NCUIH’s Recommendations to IHS

In its comments, NCUIH made the following requests, and recommendations based on NCUIH’s consultations with UIOs and NCUIH’s subject matter expertise:

  • Update the Manual regularly and as needed to remain consistent with other relevant accreditation processes
  • Provide greater flexibility in the Manual to accommodate diverse UIO program/facility goals and services
  • IHS to provide a consolidated list of requirement documents to UIOs prior to the on-site review
  • Ensure that UIOs can use existing administrative or site visit data in meeting the requirements of the Manual

In addition to the preceding recommendations regarding the Manual itself, NCUIH also requested that OUIHP host an Urban Confer with UIOs to learn about their experiences with the on-site review process.  NCUIH also submitted the following general recommendations concerning the annual review process for consideration:

  • Provide a timeline for processing information collected in the annual review process
  • Improve overall review by ensuring reviewers are licensed medical providers
  • Improve instructions on the limited annual waiver process

NCUIH looks forward to an updated On-Site Review Manual that will provide valuable information for UIOs and IHS.  NCUIH will continuing to monitor development and revision of the On-Site Review Manual and inform UIOs of pertinent information.

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NCUIH Submits Comments to IHS on Health Information Technology Modernization

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On April 8, 2022 the National Council of Urban Indian Health (NCUIH) submitted written comments to the Indian Health Service (IHS) on Health Information Technology (HIT) Modernization. The comments were submitted in response to the IHS’s Dear Tribal Leader and Dear Urban Indian Organization letter dated February 22, 2022.  In its comments, NCUIH thanked the IHS for its commitment to a collaborative HIT modernization process while urging the IHS to advance the HIT Modernization Project to select the best HIT solutions for the for the Indian Health Service/Tribal/Urban Indian Organization (I/T/U) system at the best possible speed.   NCUIH also requested that IHS provide resources, both both human and financial, to continuously evaluate, support, and evolve I/T/U HIT systems as new technology and processes become available; ensure that the RPMS replacement system meets the technical needs of the whole I/T/U system, including UIOs; and requested that IHS continue to be transparent in this long-term, financially significant project, while also prov ensure consistent engagement with all I/T/U providers of all facility types to establish and maintain transparency with UIOs and responsiveness to concerns across the I/T/U system.

The Need for HIT Modernization

HIT “is a broad concept that encompasses an array of technologies to store, share, and analyze health information.” This includes, but is not limited to, “the use of computer hardware and software to privately and securely store, retrieve, and share patient health and medical information.”  HIT Modernization for the I/T/U system is long overdue. Although HIT is necessary to provided critical services and benefits to AI/AN patients, the IHS has historically faced challenges in managing clinical patient and administrative data through the Resource Management System (RPMS). Initially developed specifically for the IHS, years of underfunding and a resulting failure to keep pace with technological innovation have left the RPMS impractical by current HIT standards. RPMS has been in use for nearly 40 years and has developed significant issues and deficiencies during this time, especially in recent years as HIT systems have rapidly advanced in sophistication and usefulness. As the Department of Health and Human Services (HHS) Office of the Chief Technology Officer (OCTO) and IHS found in the 2019 Legacy Assessment, systemic challenges with RPMS “across all of the IHS ecosystem currently prevent providers, facilities and the organization from leveraging technology effectively.”

In addition,

NCUIH’s Requests to the IHS

NCUIH made the following specific comments, requests, and recommendations in response to your February 22, 2022, correspondence and March 10, 2022, Tribal Consultation and Urban Confer:

  • IHS must provide resources, both human and financial, to continuously evaluate, support, and evolve I/T/U HIT systems as new technology and processes become available
    • NCUIH requests that IHS provide sufficient funding for off-the-shelf costs of HIT modernization, including maintenance and IT support costs
    • NCUIH advises IHS that it must account for additional delays and costs in its support for I/T/U HIT modernization
    • NCUIH recommends that IHS dedicate a full-time staff person to support UIOs in the Office of IT (OIT) to improve training, support, and personnel in replacing the current RPMS, implementing new systems, and continuing support for UIOs utilizing any other commercial off-the-shelf (COTS) systems
    • NCUIH urges IHS to work with Congress to address budgetary constraints and fiscal law restrictions blocking reimbursement of HIT modernization costs to Tribes and UIOs
  • IHS must ensure that the RPMS replacement system meets the technical needs of the whole I/T/U system, including UIOs
    • NCUIH recommends that the RPMS replacement system provides full support for data exchange and interoperability both within and external to the I/T/U system
    • NCUIH advises IHS that the RPMS replacement system must support data reporting required for regulatory compliance
    • NCUIH requests that the RPMS replacement system provide a user-friendly experience that decreases the burden on I/T/U staff to access, make updates, and work in the new EHR system
  • IHS must ensure consistent engagement with all I/T/U providers of all facility types to establish and maintain transparency with UIOs and responsiveness to concerns across the I/T/U system

NCUIH will continue to closely follow IHS’s progress and policies with HIT Modernization and looks forward to participating in the additional Tribal Consultation and Urban Confer session later in the year.

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NCUIH Submits Comments to VA on Tribal Representation Expansion Project

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On March 30, 2022, the National Council of Urban Indian Health (NCUIH) submitted written comments to the Department of Veteran Affairs (VA) on the Tribal Representation Expansion Project (T.REP). The comments were submitted in response to VA’s notice of Tribal consultation and request for comment. In the comments, NCUIH requested that VA include urban Indian organizations (UIOs) in T. REP or establish a similar program for UIOs.  In addition, NCUIH recommended that VA consult with UIOs to gain a better understanding of the needs of American Indian/Alaska Native (AI/AN) veterans living in urban areas.

The Tribal Representation Expansion Project

VA’s T.REP represents VA’s most recent effort to ensure that AI/AN veterans and their families have access to appropriate representation in the preparation, presentation, and prosecution of their VA benefit claims. The aim of this program is to “ensure that Native American Veterans have access to responsible, qualified representation in the preparation, presentation, and prosecution of their benefit claims before VA.”  VA hopes to build on its work from 2017, when it revised its regulations to permit Tribal veterans’ service offices affiliated be recognized by VA as Tribal organizations in a manner similar to State organizations.

In addition to seeking information regarding the availability of representation for veterans’ claims in Tribal communities, VA is also planning to provide further options for representation.  According to VA, they plan to collaborate with Tribal governments to identify “an individual who is affiliated with their government, is of good character and reputation, and, who, after proper training on VA benefits, would be fit to be authorized by the VA General Counsel to represent on VA benefit claims.”  If a tribal government identifies such a person “[t]he General Counsel then plans to use his discretionary authority, pursuant to 38 CFR 14.630, to specially authorize such individuals to prepare, present, and prosecute VA benefit claims before VA.”

About AI/AN Veterans

AI/ANs have a proud legacy of service in the armed forces of the United States.  This includes at least 12,000 AI/AN men who served the United States in World War One, who suffered a casualty rate five times that of other American forces before this country granted universal citizenship to American Indians; 42,000 AI/ANs who served in the Vietnam War, representing 25% of the total AI/AN population at the time; and at least 33,538 AI/ANs who have served following September 11, 2001.

There are at least 140,000 living AI/AN veterans nationwide.  NCUIH estimates that 67% percent of the veteran population identifying as AI/AN alone lives in metropolitan areas.  UIOs currently serve six of the ten urban counties with the largest veteran AI/AN alone populations, including Maricopa County, Arizona; Los Angeles County, California; San Diego County, California; Bernalillo County, New Mexico; Oklahoma County, Oklahoma; and Tulsa County, Oklahoma.  AI/AN veterans regularly prefer to see UIOs over other health care providers thanks to the provision of culturally competent care (including traditional healing services), community and familial relationships, shorter wait times, and shorter distance to travel.

Unfortunately, despite a distinguished record of service, VA’s statistics show that AI/AN veterans were more likely to be unemployed, were more likely to lack health insurance, and were more likely to have a service-connected disability when compared to veterans of other races.  In addition, in Fiscal Year 2017, AI/AN veterans used Veterans Benefits Administration (VBA) benefits or services at a lower percentage than veterans of other races.  It is important to note that AI/AN veterans living in urban areas face many of the same barriers to accessing competent representation in VA claims that AI/AN veterans face on reservations.  For example, AI/AN veterans living in urban areas face significant barriers to accessing representation on VA benefit claims based on their location, they deal with the same language barriers that AI/AN veterans living in rural areas face, and they must overcome cultural barriers to representation as well.

NCUIH’s Role

NCUIH has consistently advocated for UIO inclusion with VA-led initiatives and played a critical role in getting legislation passed in 2020 which established the VA Advisory Committee on Tribal and Indian Affairs and in the subsequent nomination and selection of NCUIH President-Elect Sonya Tetnowski as a UIO representative on the Committee.  Given the large portion of the AI/AN veteran population living in urban areas and UIOs’ ability to reach AI/AN veterans, inclusion of UIOs in T.REP would help VA accomplish its goal of “ensur[ing] that Native American Veterans and their families have access to responsible, qualified representation in the preparation, presentation, and prosecution of their benefit claims before VA.”  Accordingly, NCUIH made the following specific comments, requests, and recommendations to VA in response to the notice:

  • NCUIH recommends that VA expand T. REP to provide accreditation opportunities for staff at UIOs.
    • In the alternative, NCUIH requests that VA establish a similar accreditation program for staff at UIOs.
  • NCUIH requests that VA consult with UIOs to better understand the needs of AI/AN veterans living in urban areas.
    • NCUIH recommends that VA establish an Urban Confer policy to set the necessary policies and procedures for direct and clear communication with UIOs.

NCUIH appreciates the VA for its commitment to ensuring that AI/AN veterans “have access to responsible, qualified representation in the preparation, presentation, and prosecution of their benefit claims before VA.” NCUIH will continue to monitor this program and engage with VA to support greater provision of benefits to AI/AN veterans living in urban areas.

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Resource: Comparison of the Veteran Health Administration and IHS Facilities Funding Document Released on NCUIH Website

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Social Support for Elders May Help Prevent Cardiovascular Disease and Death

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Researchers from the University of Washington Seattle released a report on Valentine’s day that shows that increasing social support could not only improve depressive symptoms, but also prevents cardiovascular disease and even pre-mature death in older American Indian and Alaska Native (AI/AN) people.

Researchers studied AI/AN adults who participated in the Strong Heart Family Study from 12 communities in over 3 regions between 2000-2003 and, “ .” There was a correlation between those who had reported depressive symptoms, lower quality of life, isolation, heart disease, and death.

Participants in the study were middle-aged adults. The depressive symptoms cited were emotions such as anger self-criticism, and cynicism, and were matched with poor quality of life and isolation. However, better social support saw lower cynicism levels, anger, and trauma. Researchers found that depression and a poorer quality of life, along with social isolation created a higher risk for mortality and cardiovascular events. However, social support lowered that risk. Overall, the study suggests that social support leads to better mood and quality of life in AI/AN elders, and may even lower cynicism, stress, and overall disease risk.

Urban Indian Organizations already provide so much programming and support for their elders, not only in the form of social connections, but also health services. It is a priority to connect elders to one another and other resources to help address social determinants of health and close the health inequalities that urban Indian communities face in the United States.

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