Senators Highlight the Needs of Urban Indians in IHS FY 2023 Appropriations Hearing

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On May 11, 2022, the Senate Appropriations Subcommittee on Interior, Environment, and Related Agencies held a hearing to review the Fiscal Year (FY) 2023 President’s Budget for the Indian Health Service (IHS). Several topics were discussed such as the President’s request to shift IHS appropriations from discretionary to mandatory, as well as addressing the needs of urban Indian communities and urban Indian organizations (UIOs). Senator Chris Van Hollen (D-MD) followed up with IHS Acting Director, Elizabeth Fowler, on the establishment of an Urban Indian Interagency Workgroup and highlighted the many underserved American Indians/Alaska Natives (AI/ANs) residing in urban areas.

Watch the full hearing.

Senator Van Hollen Calls Attention to Needs of Urban Indians

In Senator Van Hollen’s remarks to Elizabeth Fowler, he turned to the topic of AI/ANs in urban areas, noting that “In the state of Maryland, we have 40,000 individuals who identify themselves as American Indian or part American Indian, and nearly half of that population resides in Baltimore. Nationally, 7 out of 10 American Indian or Alaska Native people reside in urban areas. In my view, this is a population that has not received the attention or services that are deserved.”

Van Hollen Calls on IHS to Focus on Urban Indian Communities and Support the Establishment of an Urban Indian Interagency Work Group

The Senator followed up his remarks by calling attention to the lack of response from the Biden Administration on his request to create an Urban Indian Interagency Workgroup and took the opportunity to ask the Acting IHS Director for her support in focusing on urban Indians. Fowler stated that “the Indian Health Service considers urban Indian organizations to be a vital component of the Indian health system” and expressed support for the creation of any urban interagency efforts.

On February 3, 2022, Senator Van Hollen, along with Senators Alex Padilla (D-CA), Catherine Cortez Masto (D-NV), Tina Smith (D-MN), Dianne Feinstein (D-CA), Elizabeth Warren (D-MA), Ed Markey (D-MA), Mark Kelly (D-AZ), Amy Klobuchar (D-MN), Patty Murray (D-WA), Tammy Baldwin (D-WI), Jacky Rosen (D-NV), Jeff Merkley (D-OR), and Jon Tester (D-MT) sent a letter to the Biden Administration requesting the establishment of an Urban Indian Interagency Work Group to identify the needs and develop strategies to better serve urban American Indian/Alaska Native (AI/AN) populations. The National Council of Urban Indian Health (NCUIH) worked closely with Senator Padilla on this letter and supports the effort to bring better representation for the needs of American Indians and Alaska Natives who do not reside on Tribal land.

Senator Merkley Emphasizes Importance of UIOs

In his remarks to Elizabeth Fowler, Senator Jeff Merkley (D-OR) followed Senator Van Hollen’s comments about urban Indians and emphasized the importance of UIOs in the state of Oregon. The Senator asked Fowler if more grants went out to UIOs as a result of the 17% increase in funding. Fowler informed that while IHS did not fund any additional UIOs with that funding, the funding will allow some referral-only programs to initiate clinical services to provide their patients. Senator Merkley noted that the committee will submit questions for the record to “better understand how we are spending the additional money in that account and understanding how urban Indian population is being better served, what specific changes have occurred.”

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Urban Indian Health Policy Updates

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✉️NCUIH has been busy: this year we have already submitted 18 comments to federal agencies in 2022. To compare, we submitted 22 in 2021!📈

🏆NCUIH Honors 2022 Urban Indian Health Champions

Yesterday, NCUIH celebrated 2022 honorees: Libby Washburn, Senators Padilla and Moran, along with Representatives Leger Fernandez and Joyce.

On May 24, 2022, the National Council of Urban Indian Health awarded four Congressional Urban Indian Health Champion Awards and one Award for Advocacy and Leadership in Urban Indian Health.

  • The Congressional Urban Indian Health Champion Awards were given to four members of Congress for their outstanding advocacy on behalf of urban Indian health: Senator Alex Padilla (D-CA), Senator Jerry Moran (R-KS), Representative Teresa Leger Fernandez (D-NM-03), and Representative David Joyce (R-OH-14). Libby Washburn (Chickasaw Nation of Oklahoma), the former Special Assistant to the President for Native Affairs, was awarded the Advocacy and Leadership in Urban Indian Health award.
  • What they’re saying: “The federal government must honor our country’s responsibility to Tribal Nations and urban Indians in all our policy decisions. Urban Indian organizations are a lifeline to Native Americans living in urban areas across California and across the nation and yet too many facilities are aging and underfunded,” said Senator Padilla.
  • Last year, NCUIH recognized Senator James Lankford (R-OK), Senator Tina Smith (D-MN), the late Representative Don Young (R-AK-AL), and Representative Ruben Gallego (D-AZ-7) as the 2021 Urban Indian Health Congressional Champions.

NCUIH thanks the awardees for their dedication to upholding the federal trust and treaty obligation to provide the highest level of health to all American Indians/Alaska Natives.

Go deeper: https://ncuih.org/2022/05/25/press-releasencuih-honors-2022-urban-indian-health-champions/

📊New Resource: Urban Indian Health Funding

Despite the trust and treaty obligation of the federal government to provide health care to AI/ANs, urban Indian health has been historically underfunded and insufficient to meet the needs of AI/ANs living in urban areas.

NCUIH recently released a one-pager showcasing the history of funding for the urban Indian health line item of the Indian Health Service (IHS) budget.

  • This document shows a graph of the Tribal Budget Formulation Workgroup Request, President’s Budget Request, and enacted funding amounts for urban Indian health for fiscal years 2020, 2021, and 2022.
  • Unfortunately, year after year, the Tribal Budget requests have gone largely ignored as evidenced in this resource.
  • The graphs are intended to convey how far we need to go to begin meeting the health care needs of all American Indians/Alaska Natives (AI/AN).

The bottom line: Urban Indian organizations (UIOs) provide a range of services for the urban AI/AN population and receive only about 1% of the total IHS annual budget.

By the numbers: The FY 2022 urban Indian health line item is currently just $73.4 million, which represents a 17.13% increase above the FY 2021 enacted level and the highest increase in the past 10 years. This amount, however, is insufficient and falls well below the Tribal Request of $200.5 million.

✉️NCUIH Submits Comments to DOJ on Missing and Murdered Indigenous People

On April 15, 2022, NCUIH submitted written comments and recommendations to the Department of Justice (DOJ) on the Missing and Murdered Indigenous Persons (MMIP) crisis.

  • NCUIH thanked the DOJ for its commitment to working with Tribes to develop and support Tribally-driven solutions to violent crime and MMIP. NCUIH emphasized that working with all AI/AN communities across the U.S. is required by EO 14053).
  • NCUIH further offered to aid DOJ in establishing strong working relationships with UIOs as it works to address these pressing public safety issues.

Go deeper: https://ncuih.org/2022/04/20/ncuih-submits-comments-to-doj-on-missing-and-murdered-indigenous-people/

Bipartisan Group of Over Two Dozen Congressional Leaders Request Increased Resources for Urban Indian Health and Support Mandatory Funding

On April 26, 2022, Reps. Grijalva and Gallego along with 26 Congressional leaders requested up to $949.9 million for urban Indian health in FY23 and advanced appropriations until authorizers move IHS to mandatory spending.

What they’re saying: The letter stated that “this increase in funding is necessary to address health disparities in the American Indian and Alaska Native (AI/AN) population. AI/ANs are 3.2 times more likely to be hospitalized for COVID-19 and 2.2 times more likely to die from the virus when compared with white patients.”

Why it matters: This letter comes as a continued effort by the NCUIH to address acute health disparities for AI/ANs living in urban areas. Congress has acknowledged these significant health care disparities in Indian Country.

Mandatory Funding: The Congressional leaders also stated their support for the President’s proposal of mandatory funding.

  • The Indian health system is not shielded from the negative impacts of government shutdowns, continuing resolutions, and automatic sequestration cuts.
  • Already underfunded, these disruptions can have serious consequences to UIOs’ ability to provide critical patient services.
  • The letter states that “until authorizers act to move IHS to mandatory funding, we request that your subcommittee provide advance appropriations to the Indian health system to improve certainty and stability.”

The bottom line: This letter sends a powerful message to Chairwoman Pingree, Ranking Member Joyce, and members of Congress. To fulfill the federal government’s trust responsibility to all AI/ANs, funding for urban Indian health must be significantly increased.

Go deeper: https://ncuih.org/2022/05/10/bipartisan-group-of-over-two-dozen-congressional-leaders-request-increased-resources-for-urban-indian-health-and-support-mandatory-funding-for-indian-health-in-fy23/

Thank you for all you do in your advocacy!

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NCUIH Policy Updates

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Welcome to our new Policy Updates! We’re still figuring it out so please bear with us!

Let’s dive in.

1 Big Thing: 10 Senators Request $950 Million for Urban Indian Health

Senator Tina Smith led a letter to the Senate Appropriations Committee asking for bold and robust funding for urban Indian health.

The big picture: NCUIH worked with Senator Smith to secure the support of 10 Senators for increased resources for UIOs.

What they asked for:

  • $949.9 million for urban Indian health,
  • mandatory funding for the Indian Health Service (IHS),
  • securing advance appropriations for IHS

What they’re saying: “This funding request is essential to providing quality, culturally-competent health care to AI/AN people living in urban areas.”

Why it matters: Funding for urban Indian health increased by 17% last year and the traction we’re gaining among Senators will be instrumental as budget negotiations happen in the coming months.

What’s next: Funding runs out on September 30 and it’s unclear if Congress will pass a budget or do a continuing resolution instead.

2. On our radar: Senator Cantwell asks for permanent FMAP for UIOs at Hearing with Roselyn Tso

Nomination Hearing to consider Roselyn Tso to be Director of the Indian Health Service, Department of Health and Human Services (May 25, 2022)

What they’re saying: “I wanted to ask you about 100 percent FMAP funding for our urban Indian health…So the issue is that the impacted urban Indian health care organizations are not treated the same, so they don’t get the whole 100 percent of funding. We were able to fix this I think for one or two years, but to me, it’s a big inequity in the delivery of care. So can you commit to securing 100 percent FMAP funding on a permanent basis for Indian health clinics in urban areas?” said Senator Maria Cantwell (D-WA).

Ms. Tso’s response: “I agree that we need to have equity in terms of funding for all the programs that serve American Indians and Alaska Natives. We also know, I also know that there are some limitations. Indian Health Service nor the department makes a determination on 100 percent FMAP payments. However, we can work with states. We can work with our partners to make sure that there’s education and information flowing of how important this need is. So I will work with you on this if I am confirmed.”

Why it matters: Ms. Tso has been nominated to run the Indian Health Service and President Biden has supported 100% FMAP for services provided at Urban Indian Organizations (UIOs).

The bottom line: If Ms. Tso is confirmed, NCUIH can work with her on long-term solutions for UIOs including collaborating with states.

3. Washington Post Op-ed: The injustices endured by Native American youths continue to this day

What they’re saying: “In short: The legacy of denying Native young people basic — let alone quality — education, health care and opportunities continues to this day. To end this injustice, our country has an obligation to support Native American youths even more fervently now after oppressing them for centuries,” said Katrina vanden Heuvel.

By the numbers: The column explains that IHS provides health care to 2.2 million Native Americans, but IHS would need to double its funding to provide even the base level of care that federal prisoners receive.

Our thought bubble: This article in the Washington Post is an example of connecting the dots on issues that matter in Indian Country. More awareness about the injustices faced by Native American youth is critical to increased funding for Indian health. It cites NCUIH’s legislative priorities!

Go deeper: https://www.washingtonpost.com/opinions/2022/05/31/injustices-native-american-youth/

4. NCUIH Recognized Political Allies at the 2022 Conference: No More Broken Promises

The Congressional Urban Indian Health Champion Awards were given to four members of Congress for their outstanding advocacy on behalf of urban Indian health: Senator Alex Padilla (D-CA), Senator Jerry Moran (R-KS), Representative Teresa Leger Fernandez (D-NM-03), and Representative David Joyce (R-OH-14). Libby Washburn (Chickasaw Nation of Oklahoma), the former Special Assistant to the President for Native Affairs, was awarded the Advocacy and Leadership in Urban Indian Health award.

What they’re saying: “We know that there are more Native Americans living off our Tribal lands than on, and we know that the United States’ trust duty to provide quality healthcare does not stop when you move into a city or town. We also know that too often the urban Indian health centers are overlooked and underfunded,” said Representative Leger Fernandez in her remarks.

PRESS RELEASE: NCUIH Honors 2022 Urban Indian Health Champions

5. Catch up quick: Senators Highlight the Needs of Urban Indians in IHS FY 2023 Appropriations Hearing

Senator Chris Van Hollen’s state of Maryland is served by Native American LifeLines of Baltimore and he noted, “In the state of Maryland, we have 40,000 individuals who identify themselves as American Indian or part American Indian, and nearly half of that population resides in Baltimore.”

On May 11, 2022, the Senate held a hearing to review the Fiscal Year (FY) 2023 President’s Budget for the Indian Health Service (IHS) with Acting Director, Elizabeth Fowler.

What they discussed: The President’s mandatory funding request, as well as addressing the needs of urban Indian communities and UIOs.

What they’re saying: Senator Chris Van Hollen (D-MD) followed up with Ms. Fowler, on the establishment of an Urban Indian Interagency Workgroup and highlighted the many underserved American Indians/Alaska Natives (AI/ANs) residing in urban areas: “In my view, this is a population that has not received the attention or services that are deserved.”

Go deeper: In February, 14 Senators sent a letter to the Biden Administration requesting the establishment of an Urban Indian Interagency Work Group.

The big picture: Ms. Fowler stated that “the Indian Health Service considers urban Indian organizations to be a vital component of the Indian health system” and expressed support for the creation of any urban interagency efforts.

Also: Senator Jeff Merkley (D-OR) emphasized the importance of UIOs and asked Ms. Fowler if more grants went out to UIOs as a result of the 17% increase in funding.

  • Ms. Fowler informed that while IHS did not fund any additional UIOs with that funding, the funding will allow some referral-only programs to initiate clinical services to provide their patients.
  • Senator Merkley noted that the committee will submit questions for the record to “better understand how we are spending the additional money in that account and understanding how urban Indian population is being better served, what specific changes have occurred.”

Learn more: Senators Highlight the Needs of Urban Indians in IHS FY 2023 Appropriations Hearing

Next week, on June 10 at 1:00 pm ET, IHS is hosting a Virtual Urban Confer on Urban Indian Organizations All-Inclusive Rate.

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PRESS RELEASE:NCUIH Honors 2022 Urban Indian Health Champions

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Yesterday, NCUIH celebrated 2022 honorees: Libby Washburn, Senators Padilla and Moran, along with Representatives Leger Fernandez and Joyce.

FOR IMMEDIATE RELEASE

WASHINGTON, D.C. (May 25, 2022) – On May 24, 2022, the National Council of Urban Indian Health (NCUIH) awarded four Congressional Urban Indian Health Champion Awards and one Award for Advocacy and Leadership in Urban Indian Health during its 2022 Annual Conference: No More Broken Promises: A Path to Health Equity in Indian Country. The Congressional Urban Indian Health Champion Awards were given to four members of Congress for their outstanding advocacy on behalf of urban Indian health: Senator Alex Padilla (D-CA), Senator Jerry Moran (R-KS), Representative Teresa Leger Fernandez (D-NM-03), and Representative David Joyce (R-OH-14). Libby Washburn (Chickasaw Nation of Oklahoma), the former Special Assistant to the President for Native Affairs, was awarded the Advocacy and Leadership in Urban Indian Health award. Last year, NCUIH recognized Senator James Lankford (R-OK), Senator Tina Smith (D-MN), the late Representative Don Young (R-AK-AL), and Representative Ruben Gallego (D-AZ-7) as the 2021 Urban Indian Health Congressional Champions.

NCUIH thanks the awardees for their dedication to upholding the federal trust and treaty obligation to provide the highest level of health to all American Indians/Alaska Natives.

“California is home to more urban Indian civic, service, and advocacy organizations than any other state in the nation serving more than 450,000 individuals, and I am proud to advocate for greater federal support of urban Indian health and autonomy […] The federal government must honor our country’s responsibility to Tribal Nations and urban Indians in all our policy decisions. Urban Indian organizations are a lifeline to Native Americans living in urban areas across California and across the nation and yet too many facilities are aging and underfunded,” said Senator Padilla.

“We know that there are more Native Americans living off our Tribal lands than on, and we know that the United States trust duty to provide quality healthcare does not stop when you move into a city or town. We also know that too often the urban Indian health centers are overlooked and underfunded,” said Representative Leger Fernandez in her remarks.

“I recognize that upholding the Tribal trust obligation is a responsibility shared by all members of Congress regardless of the congressional districts we represent. This trust obligation is not optional. The federal government’s push to relocate Native peoples off the reservations and into cities like Cleveland with the promise of job training and other services during the Termination Era had a profound impact on the lives of individuals, families, and Tribes. When those promises, like so many others, went unfulfilled, the right thing to do was, and still is, to provide culturally responsive healthcare access for urban Indians,” said Congressman Dave Joyce.

Award for Advocacy and Leadership in Urban Indian Health

Libby Washburn

During her time as the Special Assistant to the President on Native Affairs, Libby was a strong advocate for Indian Country including urban Indian communities. Her advocacy and leadership were responsible for the inclusion of urban Indian organizations in Executive Order 14053 which addresses the crisis of Missing or Murdered Indigenous People. Libby was also influential in including urban Native Americans in the Biden-Harris Plan for Tribal Nations and played a significant role in the development of the first-ever mandatory funding proposal for IHS that was released as part of the President’s FY 2023 budget.

Urban Indian Health Congressional Champions

Senator Alex Padilla

California is home to 10 urban Indian organizations (UIOs) with a service population of 450,000 AI/ANs. Sen. Padilla has made it a priority to ensure that these communities are provided with the resources and care needed. He introduced the bipartisan Urban Indian Health Providers Facilities Improvement Act to pave the way for increased investment in the renovation and construction of urban Indian health facilities. The Bipartisan Infrastructure Framework included the Padilla–Moran–Lankford Amendment to allow UIOs to make their facilities more COVID-19 compliant and safer by fixing a technicality that prevented clinics from using their federal funding to make renovations.

Sen. Padilla and 13 other senators sent a letter to the Biden Administration requesting the establishment of an Urban Indian Interagency Work Group to identify the needs and develop strategies to better serve urban AI/AN populations. He sent a letter to the Senate Committee on Finance urging for inclusion of permanent 100% Federal Medical Assistance Percentage (FMAP) reimbursement for UIOs and Native Hawaiian Health Care Systems in the reconciliation bill. Recently, he joined Senator Smith’s letter to the appropriations committee to request full funding for the urban Indian health line item in FY23. NCUIH is forever grateful for his commitment to helping us achieve crucial goals through his bipartisan leadership to ensure that UIOs are funded equitably and that urban AI/AN values are upheld.

Senator Jerry Moran

Senator Moran has advocated for the health of all AI/ANs and was an original cosponsor of the Urban Indian Health Facilities Provider Act. On April 9, 2021, Senator Moran arranged the first-ever visit of a U.S. Secretary of Veterans Affairs (VA), Denis McDonough, to a UIO at Hunter Health Clinic in Kansas as a part of a renewed partnership between the VA and UIOs and was instrumental in the enactment of the VA-IHS MOU legislative fix to allow UIOs to be reimbursed for services provided to veterans.

He also introduced the now-enacted Native American Veterans PACT Act to exempt Native veterans from copayments and co-sponsored the Improving Trauma Systems and Emergency Care Act – which included UIOs as eligible entities.

Senator Moran has taken many actions throughout his career on behalf of AI/AN people and we are grateful for his service.

Representative Teresa Leger Fernandez

From the time that Representative Leger Fernandez entered congress, she has been a fierce advocate for our AI/AN communities. As the Chair of the Subcommittee for Indigenous Peoples of the United States, she has been an influential voice on legislation impacting Indian Country. She was also a co-sponsor of the Urban Indian Health Confer Act and the NCUIH-endorsed Truth and Healing Commission on Indian Boarding School Policies Act and was a signee of the Gallego Grijalva letter to the appropriations committee to request full funding for the urban Indian health line item. Representative Leger Fernandez forties leadership that cares and expresses the values of human dignity.

Representative David Joyce

Representative Joyce has been a strong advocate in upholding the federal treaty and trust obligations to Indian Country. His commitment to urban Indians is most prevalent in his legislation as co-sponsor of the Urban Indian Health Confer Act, co-sponsor of the Stronger Engagement for Indian Health Needs Act which elevates the IHS director to an assistant secretary, and his leadership as the Ranking Member of the House Appropriations Committee’s Subcommittee on Interior, Environment, and Related Agencies which passed the Tribal Budget Formulation Workgroup recommendation of $200.5 million of urban Indian health for the FY22 bill. We are humbled by his generosity of spirit and compassion for his fellow human beings.

Honoring Congressman Don Young

NCUIH also honored the late Representative Don Young, who previously received NCUIH’s 2021 Urban Indian Health Congressional Champion Award. As the longest-serving member of Congress, Rep. Young was a long-time ally of all Native people and tirelessly worked on critical issues affecting Indian Country throughout his incumbency. His leadership on the Subcommittee for Indigenous People was unwavering when it came to upholding the federal treaty and trust obligations and its extension to urban Indians. He championed programs such as the Special Diabetes Program for Indians (SDPI) and led efforts to amend the Violence Against Women Act (VAWA) to criminally prosecute offenders on Native lands, among countless other efforts for the betterment of Indian Country. His fierce leadership, voice, and dedication to upholding the trust responsibility to all Native people will truly be missed and remembered.

NCUIH Contact: Meredith Raimondi, Vice President of Public Policy, mraimondi@ncuih.org

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Urban Indian Health Policy Updates

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NCUIH has been busy: this year we have already submitted 18 comments to federal agencies in 2022. To compare, we submitted 22 in 2021!

NCUIH Honors 2022 Urban Indian Health Champions

Yesterday, NCUIH celebrated 2022 honorees: Libby Washburn, Senators Padilla and Moran, along with Representatives Leger Fernandez and Joyce.

On May 24, 2022, the National Council of Urban Indian Health awarded four Congressional Urban Indian Health Champion Awards and one Award for Advocacy and Leadership in Urban Indian Health.

  • The Congressional Urban Indian Health Champion Awards were given to four members of Congress for their outstanding advocacy on behalf of urban Indian health: Senator Alex Padilla (D-CA), Senator Jerry Moran (R-KS), Representative Teresa Leger Fernandez (D-NM-03), and Representative David Joyce (R-OH-14). Libby Washburn (Chickasaw Nation of Oklahoma), the former Special Assistant to the President for Native Affairs, was awarded the Advocacy and Leadership in Urban Indian Health award.
  • What they’re saying: “The federal government must honor our country’s responsibility to Tribal Nations and urban Indians in all our policy decisions. Urban Indian organizations are a lifeline to Native Americans living in urban areas across California and across the nation and yet too many facilities are aging and underfunded,” said Senator Padilla.
  • Last year, NCUIH recognized Senator James Lankford (R-OK), Senator Tina Smith (D-MN), the late Representative Don Young (R-AK-AL), and Representative Ruben Gallego (D-AZ-7) as the 2021 Urban Indian Health Congressional Champions.

NCUIH thanks the awardees for their dedication to upholding the federal trust and treaty obligation to provide the highest level of health to all American Indians/Alaska Natives.

Go deeper: https://ncuih.org/2022/05/25/press-releasencuih-honors-2022-urban-indian-health-champions/

New Resource: Urban Indian Health Funding

Despite the trust and treaty obligation of the federal government to provide health care to AI/ANs, urban Indian health has been historically underfunded and insufficient to meet the needs of AI/ANs living in urban areas.

NCUIH recently released a one-pager showcasing the history of funding for the urban Indian health line item of the Indian Health Service (IHS) budget.

  • This document shows a graph of the Tribal Budget Formulation Workgroup Request, President’s Budget Request, and enacted funding amounts for urban Indian health for fiscal years 2020, 2021, and 2022.
  • Unfortunately, year after year, the Tribal Budget requests have gone largely ignored as evidenced in this resource.
  • The graphs are intended to convey how far we need to go to begin meeting the health care needs of all American Indians/Alaska Natives (AI/AN).
  • The bottom line: Urban Indian organizations (UIOs) provide a range of services for the urban AI/AN population and receive only about 1% of the total IHS annual budget.

By the numbers: The FY 2022 urban Indian health line item is currently just $73.4 million, which represents a 17.13% increase above the FY 2021 enacted level and the highest increase in the past 10 years. This amount, however, is insufficient and falls well below the Tribal Request of $200.5 million.

NCUIH Submits Comments to DOJ on Missing and Murdered Indigenous People

A magnifying glass viewing a stack of folders.

On April 15, 2022, NCUIH submitted written comments and recommendations in response to the Department of Justice’s (DOJ) Dear Tribal Leader letter seeking stakeholder input on the 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. NCUIH thanked the DOJ for its commitment to working with Tribes to develop and support Tribally-driven solutions to violent crime and MMIP.  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).  NCUIH further offered to assist DOJ in establishing strong working relationships with UIOs as it works to address these pressing public safety issues.

Bipartisan Group of Over Two Dozen Congressional Leaders Request Increased Resources for Urban Indian Health and Support Mandatory Funding

On April 26, 2022, Reps. Grijalva and Gallego along with 26 Congressional leaders requested up to $949.9 million for urban Indian health in FY23 and advanced appropriations for the Indian Health Service (IHS) until such time that authorizers move IHS to mandatory spending.

What they’re saying: The letter stated that “this increase in funding is necessary to address health disparities in the American Indian and Alaska Native (AI/AN) population. AI/ANs are 3.2 times more likely to be hospitalized for COVID-19 and 2.2 times more likely to die from the virus when compared with white patients.”

Why it matters: This letter comes as a continued effort by the NCUIH to address acute health disparities for AI/ANs living in urban areas. Congress has acknowledged these significant health care disparities in Indian Country.

Mandatory Funding: The Congressional leaders also stated their support for the President’s proposal of mandatory funding.

  • The Indian health system is not shielded from the negative impacts of government shutdowns, continuing resolutions, and automatic sequestration cuts.
  • Already underfunded, these disruptions can have serious consequences to UIOs’ ability to provide critical patient services.
  • The letter states that “until authorizers act to move IHS to mandatory funding, we request that your subcommittee provide advance appropriations to the Indian health system to improve certainty and stability.”

The bottom line: This letter sends a powerful message to Chairwoman Pingree, Ranking Member Joyce, and members of Congress. In order to fulfill the federal government’s trust responsibility to all AI/ANs, funding for urban Indian health must be significantly increased.

Go deeper: https://ncuih.org/2022/05/10/bipartisan-group-of-over-two-dozen-congressional-leaders-request-increased-resources-for-urban-indian-health-and-support-mandatory-funding-for-indian-health-in-fy23/

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Resource: Funding for Urban Indian Health FY2020-2022

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The National Council of Urban Indian Health (NCUIH) recently released a one-pager showcasing the history of funding for the urban Indian health line item of the Indian Health Service (IHS) budget. This document shows a graph of the Tribal Budget Formulation Workgroup Request, President’s Budget Request, and enacted funding amounts for urban Indian health for fiscal years 2020, 2021, and 2022. Unfortunately, year after year, the Tribal Budget requests have gone largely ignored as evidenced in this resource. The graphs are intended to convey how far we need to go to begin meeting the health care needs of all American Indians/Alaska Natives (AI/AN).

View the resource

Urban Indian organizations (UIOs) provide a range of services for the urban AI/AN population and are primarily funded by a single line item in the annual Indian health budget, which constitutes about 1% of the total IHS annual budget.

The FY 2022 urban Indian health line item is currently just $73.4 million, which represents a 17.13% increase above the FY 2021 enacted level and the highest increase in the past 10 years. This amount, however, is insufficient and falls well below the Tribal Request of $200.5 million.

The Declaration of Nation Indian Health Policy in the Indian Health Care Improvement Act states that “Congress declares that it is the policy of this Nation, in fulfillment of its special trust responsibilities and legal obligations to Indians to ensure the highest possible health status for Indians and urban Indians and to provide all resources necessary to effect that policy.” Despite the trust and treaty obligation of the federal government to provide health care to AI/ANs, urban Indian health has been historically underfunded and insufficient to meet the needs of AI/ANs living in urban areas. Each year, Tribal leaders calculate the funding needs for IHS and urban Indian health, but these critical requests continue to be ignored by the federal government.

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Urban Indian Leaders Invited to Apply for CDC Healthcare Infection Control Practices Advisory Committee Membership

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On April 6, 2022, the Centers for Disease Control and Prevention (CDC) published a notice on the Federal Register soliciting nominations for membership on the agency’s Healthcare Infection Control Practices Advisory Committee (HICPAC) by September 17, 2022. HICPAC is seeking members that are experts in a range of health fields including, but not limited to, infectious diseases, internal medicine, epidemiology, health policy, public health, and related medical fields to provide guidance to the federal government on the development and evaluation of healthcare infection prevention and control guidelines; the development of policy statements regarding the prevention and surveillance of healthcare-associated infections and healthcare; and new and updated surveillance methodologies related to healthcare- associated infections. The National Council of Urban Indian Health (NCUIH) encourages nominations of Urban Indian organization leaders and members.

Read the Federal Register notice here.

Read more about HICPAC here.

Nomination Details

Nominations for membership on the HICPAC must be submitted by September 17, 2022. All nominations should be mailed to HICPAC, Division of Healthcare Quality Promotion, NCEZID, CDC, 1600 Clifton Road NE, Mailstop H16-3, Atlanta, Georgia 30329-4027, emailed (recommended) to hicpac@cdc.gov, or faxed to (404) 639-4043. Candidates should submit a current curriculum vitae, including complete contact information (telephone numbers, mailing address, email address), and at least one letter of recommendation from person(s) not employed by the U.S. Department of Health and Human Services. Members may be invited to serve for four-year terms.

Please contact NCUIH policy if you would like assistance with submission or if you plan to apply.

HICPAC Objectives and Scope

HICPAC is a federal advisory committee appointed to provide advice and guidance to the Department of Health and Human Services and CDC regarding the practice of infection control and strategies for surveillance, prevention, and control of healthcare-associated infections, antimicrobial resistance, and related events in United States healthcare settings. The committee consists of 14 members knowledgeable in the fields of expertise including, but not limited to, infectious diseases, infection prevention, healthcare epidemiology, nursing, clinical and environmental microbiology, surgery, hospitalist medicine, internal medicine, epidemiology, health policy, health services research, public health, and related medical fields.

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NCUIH Endorses Bipartisan Bicameral Bill that Extends Grants to Address Maternal Mental Health and Substance Use Disorders to Urban Indian Organizations

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On March 14, 2022, Representatives Katherine Clark (D-MA-5) and Senator Kirsten Gillibrand (D-NY) introduced the bipartisan, bicameral Into the Light for Maternal Mental Health and Substance Use Disorders Act of 2022 (H.R. 7073/S. 3824). The bill reauthorizes and expands a grant program to screen and treat maternal mental health and substance use disorders at $24 million through each of Fiscal Years (FYs) 2023 through 2028, as well as adds Indian Tribes, Tribal organizations, and urban Indian organizations (UIOs) to be eligible for these grants. The bill would also codify the Maternal Mental Health Hotline— a national 24/7 voice and text program that is operated by licensed health care professionals who are trained on helping pregnant or postpartum women and family members affected by maternal mental health and substance use disorders. The bill authorizes $10 million for each of fiscal FYs 2023 through 2028 to carry out this program.

The Into the Light for Maternal Mental Health and Substance Use Disorders Act of 2022 is co-sponsored by Representatives Jaime Herrera Beutler (R-WA-03), Michael Burgess, M.D. (R-TX-26), Doris Matsui (D-CA-06), Yvette Clarke (D-NY-09), Young Kim (R-CA-39), and Senators Shelley Moore Capito (R-WV), Tammy Baldwin (D-WI), and Lisa Murkowski (R-AK). The bill has been endorsed by over 120 organizations, including the National Council of Urban Indian Health (NCUIH).

“NCUIH is pleased to endorse Rep. Clark and Sen. Gillibrand’s Into the Light for Maternal Mental Health and Substance Use Disorders Act of 2022. We are grateful for the addition of Indian Tribes, Tribal organizations, and UIOs to be eligible for these critical grants to address maternal mental health and substance use, as these conditions are the most common complications of pregnancy and childbirth, and Native women face significant maternal mental health disparities,” – Francys Crevier (Algonquin), CEO, NCUIH.

Next Steps

The bill was referred to the House Energy and Commerce and Senate Health, Education, Labor, and Pensions Committees. It currently awaits consideration. This bill has been added to the NCUIH legislative tracker and can be found here.

Background

President Biden’s FY 2023 budget proposal demonstrates a strong commitment to advancing maternal health in American Indian/Alaska Native communities. The President’s budget supports the maternal mental health hotline and the screening and treatment for maternal mental depression and related behavioral disorders:

  • “The United States has the highest maternal mortality rate among developed nations, and rates are disproportionately high for Black and American Indian and Alaska Native women. The Budget includes $470 million to: reduce maternal mortality and morbidity rates; expand maternal health initiatives in rural communities; implement implicit bias training for healthcare providers; create pregnancy medical home demonstration projects; and address the highest rates of perinatal health disparities, including by supporting the perinatal health workforce. The Budget also extends and increases funding for the Maternal, Infant, and Early Childhood Home Visiting program, which serves approximately 71,000 families at risk for poor maternal and child health outcomes each year, and is proven to reduce disparities in infant mortality. To address the lack of data on health disparities and further improve access to care, the Budget strengthens collection and evaluation of health equity data. Recognizing that maternal mental health conditions are the most common complications of pregnancy and childbirth, the Budget continues to support the maternal mental health hotline and the screening and treatment for maternal mental depression and related behavioral disorders.”
  • “Improving Maternal Health ($10 million): Provides $4 million above FY 2022 enacted to improve maternal health in AI/AN communities. Funding supports preventive, perinatal, and postpartum care; addresses the needs of pregnant women with opioid or substance use disorder; and advances the quality of services provided to improve health outcomes and reduce maternal morbidity.”

President’s FY 2023 Budget

OMB FACT SHEET: President Biden’s FY 2023 Budget Honors Commitments to Tribal Nations and Tribal Communities

HHS FY 2023 Budget in Brief

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Resource: American Indian/Alaska Native Data on COVID-19 Document Released on NCUIH Website

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The National Council of Urban Indian Health (NCUIH) recently released an infographic about American Indian/Alaska Native (AI/AN) Data on COVID-19 on the NCUIH website. This document shows the disproportionate impacts of the COVID-19 pandemic on AI/ANs and Indian Country’s success with vaccinations for the virus. Native communities face some of the harshest disparities in health outcomes of any population in the U.S. and are disproportionately impacted by the COVID-19 pandemic. The impact of COVID-19 on American Indian and Alaska Native health will continue beyond the pandemic. Loss of American Indian and Alaska Native lives—especially the loss of elders—means loss of Native culture, including language, ceremonies, and more.

View the resource

Disproportionate Rates of COVID-19 Cases, Hospitalizations, and Mortality Among AI/ANs

American Indians and Alaska Natives have infection rates over 3.5 times higher than non-Hispanic whites, are over 3.2 times more likely to be hospitalized as a result of COVID-19 and have higher rates of mortality at younger ages than non-Hispanic whites.

AI/AN Children and Orphanhood Due to COVID-19

1 of every 168 AI/AN children experienced orphanhood or death of caregivers due to the pandemic, and AI/AN children were 4.5 times more likely than white children to lose a parent or grandparent caregiver.

Indian Country Lead on Vaccination Rates

As of February 2022, AI/ANs have the highest vaccination administration rates in the U.S with 70.6% of AI/ANs having received at least one dose of the COVID-19 vaccine, according to CDC Vaccine Administration Data. As of January 2022, UIOs that use IHS vaccine distribution have administered over 164,095 doses of the COVID-19 vaccine and fully vaccinated 65,957 people.

AI/AN Food Insecurity and COVID-19

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NCUIH Endorses Bill to Understand and Address Long COVID, Including in Urban Indian Communities

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On March 3, 2022, Senator Tim Kaine (D-VA) introduced the Comprehensive Access to Resources and Education (CARE) for Long COVID Act (S. 3726). This bill would improve research on long COVID as well as expand resources for those dealing with the long-term impacts of the virus. Specifically, the bill authorizes $50 million for each of fiscal years 2023 through 2027 to fund grants to eligible entities, including Tribes, Tribal organizations, and urban Indian organizations (UIOs), to support legal and social service assistance for individuals with long COVID or related post-viral illnesses. Additionally, UIOs are included in outreach and research activities of the long-term symptoms of COVID–19 by the Patient-Centered Outcomes Research Trust Fund.

“The National Council of Urban Indian Health (NCUIH) is pleased to endorse Senator Kaine’s Comprehensive Access to Resources and Education (CARE) for Long COVID Act. The pandemic has taken a disproportionate toll Indian Country and the public health crisis continues to affect Native communities experiencing symptoms of long COVID. This bill is a step in the right direction to better understand the long-term effects of the virus and provide support for those suffering.” – Francys Crevier (Algonquin), CEO, NCUIH.

The Comprehensive Access to Resources and Education (CARE) for Long COVID Act is co-sponsored by Senators Richard Blumenthal (D-CT), Tammy Duckworth (D-IL), Edward Markey (D-MA), and Tina Smith (D-MN). The bill was referred to the Senate Health, Education, Labor, and Pensions Committee. It currently awaits consideration.

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

Background

The COVID-19 pandemic has had devastating and disproportionate impacts on American Indians/Alaska Natives and continue to feel the lingering effects of the virus. This legislation aims to address this issue by:

  • Accelerating research by centralizing data regarding long COVID patient experiences;
  • Increasing understanding of treatment efficacy and disparities by expanding research to provide recommendations to improve the health care system’s responses to long COVID;
  • Educating long COVID patients and medical providers by working with the CDC to develop and provide the public with information on common symptoms, treatment, and other related illnesses;
  • Facilitating interagency coordination to educate employers and schools on the impact of long COVID and employment, disability, and education rights for people with long COVID; and
  • Developing partnerships between community-based organizations, social service providers, and legal assistance providers to help people with long COVID access needed services.

 

Senate Text of Bill

Senator Kaine’s Press Release

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