House Releases FY 2023 Appropriations Bill with $200 Million for Urban Indian Health, Fails to Include Advance Appropriations

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The bill is to be considered by Full Committee this week and includes $8.1 billion for IHS, $1 billion less than the amount requested by the President.

Today, June 28, 2022, the House Appropriations Subcommittee on Interior, Environment, and Related Agencies released the Committee Bill Report for the fiscal year (FY) 2023 budget with $200 million for urban Indian health. The report and bill will be considered by the full House Appropriations Committee tomorrow morning and was approved by the House Subcommittee on Interior on June 21, 2022. The bill authorizes $8.1 billion for the Indian Health Service (IHS)— an increase of $1.5 billion from FY22 but $1 billion below the President’s request. Despite robust advocacy from Tribes and Urban Indian Organizations (UIOs), the bill does not include advance appropriations. Other key provisions include $17 million for generators for IHS/Tribal Health Programs/UIOs and $3 million for a Produce Prescription Pilot Program for Tribes and UIOs to increase access to produce and other traditional foods. A more detailed analysis follows below.

“NCUIH is grateful for the Committee’s inclusion of $200 million for urban Indian health for Fiscal Year 2023, but disappointed to see the reduced request from last year given all of the effects of COVID-19 and the growing costs of inflation. Unfortunately, the proposed amount would not fully fund the Indian Health Service and does not include critical advance appropriations. We especially thank Congresswoman McCollum and Ranking Member Joyce for their continued efforts to provide resources for Native healthcare and achieve advance appropriations. Too many Native lives have been lost during times of funding instability and we have had enough. We hope that House leaders will hear the calls of Indian Country to prioritize equity and provide stable funding for our health in accordance with the trust responsibility.” – Francys Crevier (Algonquin), CEO, NCUIH.

The President’s budget proposed to shift IHS from discretionary funding to mandatory funding in FY 2023. In the meantime, Native health advocates requested Advance Appropriations. To much disappointment, the House bill does not provide (or even mention) advance appropriations for IHS. Advance appropriations is a long-standing priority for Indian Country and advocates have been requesting Congress to provide stable funding for IHS especially considering the COVID-19 pandemic which has had tremendous, adverse impacts for American Indians and Alaska Natives. In the past month alone, NCUIH sent a letter to request Speaker Pelosi to allow for advance appropriations and NCAI and NIHB sent an action alert to request the Appropriations Committee include advance appropriations. Previously, NCUIH, along with 28 Representatives and 12 Senators requested advanced appropriations for IHS until such time that authorizers move IHS to mandatory spending.

Line Item FY22 Enacted FY23 TBFWG Request FY23
President’s
Budget		 FY23 House Proposed
Urban Indian Health $73,424,000 $949,900,000 $112,514,000 $200,000,000
Indian Health Service $6,630,986,000 $49,800,000,000 $9,100,000,000 $8,100,000,000

Background and Advocacy

On March 28, 2022, President Biden released his budget request for Fiscal Year FY 2023 which included, for the first time ever, $9.3 billion in mandatory funding for IHS for the first year with increased funding each year over ten years. On April 25, 2022, the Indian Health Service (IHS) published their FY 2023 Congressional Justification with the full details of the President’s Budget, which included $112.5 million for Urban Indian Health— a 53.2% increase above the FY 2022 enacted amount of $73.4 million.

Full Funding, Advance Appropriations, and Mandatory Funding a Priority

NCUIH 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.

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 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. On May 27, 2022, a group of 12 Senators sent a letter to the Senate Interior Appropriations Committee with the same requests.

During last week’s House Interior Subcommittee markup on the FY2023 funding bill, Rep. Chellie Pingree said of mandatory funding: “This shift requires legislative action by the authorizing committee, the House Committee on Natural Resources. In the absence of that legislation, I have included discretionary funding in this bill to ensure that there is no risk of a disruption in healthcare while that process is underway.”

Bill Highlights

Indian Health Service: $8.1 billion

  • $8.1 billion for the Indian Health Service, an increase of $1.5 billion above the FY 2022 enacted level.

Urban Indian Health: $200 million

  • Bill Report: “The recommendation includes $200,000,000 for Urban Indian Health, $126,576,000 above the enacted level and $200,000,000 above the budget request. This amount includes $31,000 transferred from the Alcohol and Substance Abuse Program as part of the for NIAAA program. The Committee expects the Service to continue including current services estimates for Urban Indian health in annual budget requests.”

Mandatory Funding:

  • Bill Report: “For fiscal year 2023, the Administration proposed reclassifying IHS accounts as mandatory and did not submit a discretionary budget proposal. However, IHS did not provide implementation language and at the time of writing this report, the authorizing committees have not enacted the President’s proposal. Because the authorizing committees have not acted, the Committee is providing discretionary funds for IHS for fiscal year 2023 to ensure health care for Native Americans is not negatively impacted.”
  • Note: There is no mention of advance appropriations for IHS in this bill.

Equipment: $118.5 million

  • Bill Report: “The recommendation includes $118,511,000 for Equipment, $88,047,000 above the enacted level and $118,511,000 above the budget request. The bill continues $500,000 for TRANSAM.
  • The report further states: “The Committee is aware that the increasing severity and frequency of extreme weather events has motivated certain jurisdictions to adopt de-energization protocols to reduce the risks of catastrophic wildfires. While these protocols are useful in limiting loss of life in affected communities, they can also have dire consequences for Tribal Health Programs located in impacted areas. To increase the resilience of these facilities, the recommendation includes an additional $17,000,000 to purchase generators for IHS, Tribal Health Programs, and Urban Indian Organizations located in areas impacted by de-energization events. In procuring backup generators, the Indian Health Service is directed to determine the most cost-effective method, which may include leasing. In determining the most cost-effective procurement method, the Service shall account for life-cycle maintenance costs associated with direct ownership and clinics’ capabilities to maintain these generators.”

Electronic Health Records: $284.5 million

  • Bill Report: “To improve the current IT infrastructure system to support deployment of a new modern electronic health records (EHR) solution, the recommendation includes $284,500,000 for Electronic Health Records, $139,481,000 above the enacted level and $284,500,000 above the budget request.
  • The report further states: “The Committee urges IHS to continue moving forward with modernizing its aging EHR system by replacing it with a solution that is interoperable with the new EHR at the Department of Veterans Affairs and with systems purchased by Tribes and UIOs. Modernization should include robust Tribal consultation and planning to ensure that Tribes and UIOs are enabled to take full advantage of resulting modern health information technology and are not unduly burdened during this process.”

Mental Health: $130 million

  • Bill Report: “The recommendation includes $129,960,000 for Mental Health, $8,014,000 above the enacted level and $129,960,000 above the budget request.”

Alcohol and Substance Abuse: $264 million

  • Bill Report: “The Committee provides $264,032,000 for Alcohol and Substance Abuse, $5,689,000 above the enacted level and $264,032,000 above the budget request. This amount transfers $31,000 to Urban Indians from the former National Institute on Alcohol Abuse and Alcoholism (NIAAA). Funding for Substance Abuse and Suicide Prevention grants is continued at fiscal year 2022 enacted levels.”

Community Health Aide Program (CHAP): $25 million

  • Bill Report: “[…] an additional $20,000,000 is provided to expand the Community Health Aide Program to the lower 48 states with direction for IHS to report within 90 days of enactment of this Act on how funds will be distributed”

Tribal Epidemiology Centers: $34,433,361

  • Bill Report: “[…] an additional $10,000,000 is for Tribal Epidemiology Centers”

Hepatitis C, HIV/AIDS and STDs Initiative: $52 million

  • Bill Report: “[…] an additional $47,000,000 is for the Hepatitis C, HIV/AIDS and STDs initiative.”

Maternal Health: $10 million

  • Bill Report: “The recommendation also includes an additional $4,000,000 to improve maternal health with continued direction to report to the Committee within 180 days of enactment of this Act on use of funds, updates on staff hiring, status of related standards, and the amount of training provided with these funds.”

Alzheimer’s Disease: $5.5 million

  • Bill Report: “The recommendation maintains $5,500,000 to continue Alzheimer’s and related dementia activities at IHS. These funds will further efforts on Alzheimer’s awareness campaigns tailored for the AI/AN perspective to increase recognition of early signs of Alzheimer’s and other dementias; quarterly, competency-based training curriculum, either in-person or virtually, for primary care practitioners to ensure a core competency on assessing, diagnosing, and managing individuals with Alzheimer’s and other dementias; pilot programs to increase early detection and accurate diagnosis, including evidence based caregiver services within Indian Country, inclusive of urban Indian organizations (UIO); and an annual report to the Committee with data elements including the prevalence of Alzheimer’s incidence in the preceding year, and access to services within 90 days of the end of each fiscal year. The Committee continues direction to develop a plan, in consultation with Indian Tribes and urban confer with UIOs, to assist those with Alzheimer’s, the additional services required, and the costs associated with increasing Alzheimer’s patients and submit this information to Congress within 270 days of enactment of this Act.”

Produce Prescription Pilot Program:

  • Bill Report: “The Committee continues $3,000,000 for IHS to create, in coordination with Tribes and UIOs, a pilot program to implement a produce prescription model to increase access to produce and other traditional foods among its service population. Within 60 days of enactment of this Act, the Committee expects IHS to explain how the funds are to be distributed and the metrics to be used to measure success of the pilot, which shall include engagement metrics, and may include appropriate health outcomes metrics, if feasible.”

Headache Disorders Centers of Excellence:

  • Bill Report: “The Committee recognizes that over 560,000 people under IHS care are living with migraine or severe headache disorders and that AI/AN communities have the highest prevalence of both disabling headache disorders and concussion/mild traumatic brain injuries, among any racial or ethnic group in the United States. The Committee is concerned that AI/AN patients with chronic migraine, post-traumatic headache, and other disabling headache disorders often do not receive necessary specialty care. The IHS is encouraged to consider the feasibility of IHS Headache Centers of Excellence and if feasible, developing a budget proposal to establish IHS Headache Centers of Excellence to provide direct care, telehealth, and consultation patient services, as well as education and training.”
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Urban Indian Health Policy Updates: Pushing for stable IHS funding, 2 urban confers this week

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This week marks the end of a busy month with a record of 4 urban confers!

Here’s a preview of what’s coming up this week:

  • Monday, June 27 at 2:00 – 3:30 p.m. ET (NOTE: NEW TIME) – NCUIH Prep Session for Confers: Inter-Agency Workgroup and OUIHP Strategic Plan (Zoom Link)
  • Tuesday, June 28 at 1pm-2pm ET – NCUIH UIO FMAP Check-In (Zoom link.)
  • Tuesday, June 28 at 1:30pm – 3:30pm ET – HHS, USDA, and White House to Host Tribal Consultation on Hunger, Nutrition, and Health (Register here.)
  • Wednesday, June 29 at 10am ET – House Markup of IHS Budget Bill for FY23 (More info and hearing link.)
  • Wednesday, June 29 at 2:30 – 4pm ET – Urban Confer on Urban Indian Interagency Workgroup (Register here.)
  • Thursday, June 30 at 2:30 – 4:00pm ET – Urban Confer on OUIHP Strategic Plan (Register here.)

One more thing: Last week, at the Urban Confer on Infrastructure Study Funding, UIOs informed IHS that more information is needed on the existing infrastructure study to inform a decision on how to spend new funding. Unfortunately, IHS noted if the funding is not used for infrastructure, it must be redirected to “Direct Operations.” Comments are due on August 23, 2022. (Upcoming Urban Confers and Comments)

1 Big Thing: Native organizations push forward on securing stable funding for the Indian Health Service

Last week, NCUIH sent a letter to Speaker Nancy Pelosi to request stable funding for the Indian Health Service (IHS) through Advance Appropriations until mandatory funding is implemented. (Letter)

Last week, the House Appropriations Committee released the draft fiscal year 2023 Interior, Environment, and Related Agencies funding bill and held a markup. The legislation includes funding for programs for the Indian Health Service (IHS).

  • At the markup for this bill, Congresswoman Betty McCollum, who previously introduced the Advance Appropriations bills, noted that there are outstanding concerns with the bill because it does not contain the budget certainty for IHS requested by Tribal leaders and Native organizations.

What’s next: The full Committee meets Wednesday morning so time is of the essence to contact Speaker Pelosi to take action.

In related news: The House proposed urban Indian health line item amount is expected to be released tomorrow.

2. House passes landmark mental health bill

Last week, the House of Representatives passed a monumental bill to address mental health called the Restoring Hope for Mental Health and Well-Being Act of 2022.

Why it matters: This bill contains at least $1.8 billion in grants that are eligible for Urban Indian Organizations.

Go deeper: NCUIH worked closely with Congress to include reauthorization of Native Connections, which expires in September, and the inclusion of UIOs in Native opioid grants.

What’s next: NCUIH will advocate to the Senate to retain Native health provisions and hopes to enhance funding for additional Native behavioral health resources.

(House passes package addressing mental health)

3. On our radar: White House Conference on Hunger, Nutrition, and Health Tribal Consultation Session

The Tribal Consultation is being hosted on June 28, 2022, from 1:30-3:30pm EDT by the White House Domestic Policy Committee (DPC), the Department of Health and Human Services (HHS), and the United States Department of Agriculture (USDA). (Dear Tribal Leader Letter)

To register, visit this link. Written feedback is encouraged and can be submitted to consultation@hhs.gov.

The big picture: These departments are seeking input on strategies to successfully develop and implement a national strategy on hunger, nutrition and health. Specifically, they are seeking input on how to best do the following:

  1. Improve food access and affordability: End hunger by making it easier for everyone — including urban, suburban, rural, and tribal communities — to access and afford food. For example, expand eligibility for and increase participation in food assistance programs and improve transportation to places where food is available.
  2. Integrate nutrition and health: Prioritize the role of nutrition and food security in overall health, including disease prevention and management, and ensure our health care system addresses the nutrition-related needs of all people.
  3. Empower all consumers to make and have access to healthy choices: Foster environments that enable all people to easily make informed healthy choices ¾ increase access to healthy food, encourage healthy workplace and school policies, and invest in public messaging and education campaigns that are culturally appropriate and resonate with specific communities.
  4. Support physical activity for all: Make it easier for people to be more physically active ¾ in part by ensuring everyone has access to safe places to get active ¾ increase awareness of the benefits of physical activity, and conduct research on and measure physical activity.
  5. Enhance nutrition and food security research: Improve nutrition metrics, data collection, and research to inform nutrition and food security policy, particularly on issues of equity, access, and disparities.

4. From the blog: NCUIH Submits Comments on HIT Modernization, MMIP, Testimony on Indian Health budget

NCUIH Submits Comments to IHS on Resource and Patient Management System Replacement and Health Information Technology Modernization Focus Groups

  • On June 3, 2022, the NCUIH submitted comments and recommendations to the Indian Health Service (IHS) about Health Information Technology (HIT) Modernization Governance regarding the replacement of the Resource and Patient Management System (RPMS).
  • NCUIH recommended IHS ensure focus groups are representative of the entire IHS/Tribal/Urban Indian Organization (I/T/U) system.

NCUIH Submits Written Testimony to Senate Interior Appropriations with FY23 Budget Requests for Urban Indian Health

  • NCUIH submitted public witness written testimony to the Senate Appropriations Subcommittee on Interior, Environment, and Related Agencies regarding Fiscal Year (FY) 2023 funding for Urban Indian Organizations (UIOs) in response to the Subcommittee Hearing, “A Review of the Fiscal Year 2023 President’s Budget for the Indian Health Service,” held on May 11, 2022.
  • NCUIH advocated in its testimony for additional resources for the Indian Health Service and urban Indian Health including $49.8 billion for the Indian Health Service (IHS) and $949.9 million for Urban Indian Health for FY23 (as requested by the Tribal Budget Formulation Workgroup) and advance appropriations for IHS until mandatory funding is enacted.

NCUIH Submits Comments to HHS about Missing and Murdered Indigenous People and Violent Crime Against Native People

  • On May 19, 2022, NCUIH submitted comments and recommendations to Health and Human Services (HHS) about Executive Order (EO) 14053— Improving Public Safety and Criminal Justice for Native Americans and Addressing the Crisis of Missing or Murdered Indigenous People.
  • NCUIH outlined recommendations for HHS including communication and collaboration with UIOs, engagement with UIOs as critical stakeholders in HHS’ comprehensive plan to address the MMIP Crisis and violent crime, and the establishment of an agency-wide Urban Confer policy.

5. One last thing: Senate hears considers bill on Indian boarding schools

On Wednesday, the Senate Committee on Indian Affairs held an Oversight Hearing on “Volume 1 of the Department of the Interior’s Federal Indian Boarding School Initiative Investigative Report” & Legislative Hearing to receive testimony on S. 2907, a NCUIH-endorsed bill to establish a Truth and Healing Commission.

The big picture: Interior Secretary Deb Haaland advocated for a Truth and Healing Commission to examine past U.S. government efforts to eradicate the languages, identities, and cultural practices of American Indians, Alaska Natives, and Native Hawaiians.

(The U.S. is reckoning with its troubled past of Indian boarding schools)

Coming up: On July 10, 2022, comments are due on a proposed urban all-inclusive rate. Share your thoughts with NCUIH tomorrow, June 28 at 1pm-2pm ET during the NCUIH UIO FMAP Check-In (Zoom link.) (Upcoming Urban Confers and Comments)

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House Advances NCUIH-Endorsed Truth and Healing Commission on Indian Boarding Schools Bill

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On June 15, 2022, the House Committee on Natural Resources held a markup to consider a series of bills, including H.R. 5444. Several Members of Congress, such as Senator Cortez Masto (D-NV) and Representative McCollum (D-MN-04), expressed concerns and grievances about the horrific occurrences within boarding schools. Both the Majority and Minority agree that there needs to be a commission, however, four amendments were introduced on subpoena power, the compensation of commission members, the wording around funds, and the possibility for reparations. The only amendment to be accepted was the amendment editing, “such sums as may be necessary”. The bill has passed the committee and will be heading to The House floor.

NCUIH Submitted Testimony in Support of the Act

On May 26, 2022, the National Council of Urban Indian Health (NCUIH) submitted written testimony to the House Natural Resources Subcommittee for Indigenous Peoples of the United States in support of the Truth and Healing Commission on Indian Boarding School Policies in the United States Act (S. 2907/H.R. 5444), which would create a Truth and Healing Commission on Indian Boarding School Policies (the Commission).

Background

NCUIH worked with Senator Elizabeth Warren (D-MA) on this landmark legislation to begin the healing process from Indian Boarding School policies and ensure the inclusion of UIOs in the Commission. This ensures that the stories of the 70% of American Indians/Alaska Natives (AI/ANs) that live in urban areas will be included. 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.

On September 30, 2021, in recognition of the National Day of Remembrance, Senator Elizabeth Warren (D-MA), Congresswoman Sharice Davids (D-KS-3), and Congressman Tom Cole (R-OK-4) introduced the Truth and Healing Commission on Indian Boarding School Policies in the United States Act.

Tasked with investigating and documenting the Indian boarding school policies and the historical and ongoing trauma that resulted, the Commission provides an environment for Native people to speak about their personal experiences and will provide recommendations to the government. Working in collaboration with other agencies, the Commission would also develop recommendations for the federal government on how to acknowledge the trauma and help Native communities heal.

The federal government funded these boarding schools as recently as the 1960s, specifically to wipe out Indigenous cultures. Children were forcibly removed from their families and experienced horrific emotional, physical, and sexual abuse while in custody of these schools. The Commission not only highlights the government’s role in the abuse but will also build on the work of Secretary Debra Haaland and the Department of the Interior in examining what happened at these schools.

On December 23, 2021, NCUIH submitted comments to the Department of the Interior regarding the agency’s Federal Boarding School Initiative reiterating 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 AI/ANs.

Full Text of Testimony:

National Council of Urban Indian Health –Testimony for House Natural Resources Subcommittee for Indigenous Peoples of the United States in Support of Truth and Healing Commission on Indian Boarding Schools

My name is Francys Crevier, I am Algonquin and the Chief Executive Officer of the National Council of Urban Indian Health (NCUIH). On behalf of NCUIH, the national advocate for health care for the over 70% of American Indians and Alaska Natives (AI/ANs) living off-reservation and the 41 Urban Indian Organizations (UIOs) that serve these populations, we hereby submit this public witness testimony in support of legislation that would create a Truth and Healing Commission on Indian Boarding Schools in the United States. 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.

Background and Impact of Indian Boarding School Policies on AI/ANs

The federal government funded boarding schools as recently as the 1960s, specifically to wipe out Indigenous cultures. The horrific aim was to “kill the Indian and save the man.” The United States Government’s Indian boarding school policy authorized the forced removal of hundreds of thousands of Native children, as young as five years old, relocating them from their homes in Tribal communities to one of the 408 Indian Boarding Schools across 30 states[1]. Between 1819 and 1969, 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[2]. Children were forcibly removed from their families and experienced horrific emotional, physical, and sexual abuse while in the custody of these schools. The Relocation and Termination Era and Federal Indian Boarding Schools are inextricably linked to the urbanization of Native people today and the effects are profound.

Creating a Truth and Healing Commission Remains a Critical Priority for AI/ANs

NCUIH was pleased to work with Senator Elizabeth Warren on her landmark legislation to begin a healing process from Indian Boarding School policies. On September 30, 2021, in recognition of the National Day of Remembrance, Senator Elizabeth Warren (D-MA), Congresswoman Sharice Davids (D-KS-3), and Congressman Tom Cole (R-OK-4) Introduced the Truth and Healing Commission on Indian Boarding School Policies in the United States Act (H.R. 5444/S.2907).

Tasked with investigating and documenting the Indian boarding school policies and the historical and ongoing trauma that resulted, the Commission provides an environment for Native people to speak about their personal experiences and will provide recommendations to the government. Working in collaboration with other agencies, the Commission would also develop recommendations for the federal government on how to acknowledge the trauma and help Native communities heal. Senator Warren (D-MA) worked alongside NCUIH to promote UIO inclusion in this legislation. NCUIH is grateful for their support and the support of all co-sponsors for this Commission and for promoting the inclusion of UIOs. Their support has ensured that a longtime priority for UIOs may now become a reality.

Inclusion of UIOs in Truth and Healing Commission

NCUIH thanks the committee and the bill’s sponsors for including UIOs as one of the options for representation on the Commission. This ensures that the stories of the 70% of AI/ANs that live in cities will be included. Urban Indians are often left behind in legislation regarding AI/ANs and it is a sign of your hard work that urban AI/ANs now receive the inclusion they deserve. We thank you for your support of this inclusion provision.

Urban Indians have faced brutal treatment from the government through their forced removal to federally funded boarding schools. In order to truly heal from this experience, urban Indians must be included in efforts to come to terms with the historical trauma experienced by so many urban AI/ANs. In the future, we request that UIO inclusion be made mandatory in legislation impacting the legacy of these boarding schools. UIOs face the legacy of this historical trauma and the voices of urban AI/ANs must be heard.

Conclusion

In order to address these abuses, the Truth and Healing Commission must be formed. The truth of what happened to these AI/AN children must be acknowledged, witnessed, and validated. The government must take accountability for the horrors it oversaw. This Commission would allow AI/ANs to speak about their experiences at federally-funded boarding schools. This Commission will empower AI/AN voices by allowing them to provide recommendations to the federal government. No longer will AI/AN voices be silenced, rather, through this Commission, they would be uplifted. It is NCUIH’s hope that this will usher in a new era where the trust responsibility is better upheld to all Indigenous people, including the over 70% of AI/ANs who reside in urban areas as a result of policies like federal boarding schools.

NCUIH once again thanks this Committee, Senator Warren (D-MA), Congresswoman Sharice Davids (D-KS-3), and Congressman Tom Cole (R-OK-4) for their support of the Truth and Healing Commission on Indian Boarding School Policies. This bill would begin the healing necessary to make amends for past historical injustices. You have the unique opportunity to empower AI/ANs who were subject to the cruelty of these schools. I urge you to take this opportunity to make the changes so desperately needed.

[1] https://www.bia.gov/sites/default/files/dup/inline-files/bsi_investigative_report_may_2022_508.pdf

[2] Ibid.

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NCUIH Submits Comments to IHS on Resource and Patient Management System Replacement and Health Information Technology Modernization Focus Groups

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On June 3, 2022, the National Council of Urban Indian Health (NCUIH) submitted comments and recommendations to the Indian Health Service (IHS) about Health Information Technology (HIT) Modernization Governance regarding the replacement of the Resource and Patient Management System (RPMS). These comments responded to the joint Tribal Consultation and Urban Confer on May 3, 2022 and request for comments. NCUIH thanked the IHS for hosting the joint Tribal Consultation and Urban Confer and for planning two additional Tribal Consultation and Urban Confer sessions in 2022 to address HIT Modernization. Furthermore, NCUIH recommended that IHS ensure HIT Modernization focus groups are representative of the entire IHS/Tribal/Urban Indian Organization (I/T/U) system, identify specific statutes and/or regulations that prevent convening the focus groups before IHS purchases the new Resource and Patient Management System (RPMS), and prioritize interoperability in the RPMS replacement system.

Background

HIT Modernization for the I/T/U system is long overdue. Although HIT is necessary to provide critical services and benefits to American Indians/Alaska Natives (AI/AN) patients, IHS has historically faced challenges in managing clinical patient and administrative data through the 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.” Because HIT is so critical to modern provision of healthcare services, this in turn makes it difficult for AI/AN healthcare providers to provide continuous, consistent care to the already marginalized AI/AN community. Accordingly, NCUIH appreciates that IHS has chosen to fully replace RPMS. Appropriate implementation of HIT Modernization will be a long-term project requiring consistent communication and collaboration between IHS and the entire I/T/U system.

NCUIH’s Requests to HHS

Accordingly, NCUIH makes the following specific comments, requests, and recommendations to IHS:

  • IHS must ensure that HIT Modernization focus groups are representative of the entire I/T/U system.
    • Inclusion of urban Indian organizations (UIOs) in the HIT Modernization process is consistent with, and required by, the federal government’s trust responsibility and the Indian Health Care Improvement Act (IHCIA). Furthermore, it is sound public policy. The UIO experience with RPMS and their needs from the modernization process must be accounted for, because they will inherently differ from the rest of the I/T/U system.
    • NCUIH urges the IHS IT office to proactively reach out to individual UIOs and NCUIH for recommendations on persons willing and able to serve as UIO representatives on the HIT Modernization focus groups. IHS Headquarters should also use Area Offices to reach out to UIOs, as they will have pre-existing local relationships with relevant UIO IT staff.
    • NCUIH offers its assistance if needed to facilitate communication with UIOs relating to the HIT Modernization focus groups or HIT modernization.
  • NCIUH requests that IHS identify the specific provisions of the Federal Acquisition Regulation, as well as any other relevant statutes and/or regulations, which it believes prevent convening the HIT Modernization focus groups at this time.
    • Based on the May 3 Tribal Consultation and Urban Confer, NCUIH understands that IHS identified legal concerns with convening focus groups prior to purchasing a RPMS replacement system and is seeking to minimize the risk of bid protests.
    • NCIUH asks that IHS identify relevant statutes and/or regulations which it believes prevent convening the focus groups at this time, so that Tribes, UIOs, and relevant national organizations may understand IHS’ concerns and provide pertinent feedback.
    • In addition, NCUIH requests an explanation from IHS on how it will utilize the focus groups if a RPMS replacement system is purchased prior to their convening.
  • IHS must prioritize interoperability in the RPMS replacement system.
    • Advancing interoperability is a key component of the 2020-2025 Federal Health IT Strategic Plan and is critical for creating a longitudinal health record that can be used to provide and improve care to AI/ANs.
    • NCUIH and UIOs are concerned that purchasing a RPMS replacement system without utilizing the interoperability focus group runs the risk of recreating RPMS’ existing interoperability problems.
    • If IHS insists on purchasing a RPMS replacement system prior to convening the interoperability focus group, it must use all data gathering tools at its disposal, including surveying I/T/U providers, hosting further Tribal Consultations and Urban Confers, internal technical analysis, and more, to ensure that the RPMS replacement system will prove to be a comprehensive solution for all I/T/U facilities.

NCUIH looks forward to the upcoming listening sessions and is confident that UIOs will be valuable subject matter experts in the HIT Modernization focus groups.

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NCUIH Submits Written Testimony to Senate Interior Appropriations with FY23 Budget Requests for Urban Indian Health

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The National Council of Urban Indian Health (NCUIH) CEO, Francys Crevier (Algonquin), submitted public witness written testimony to the Senate Appropriations Subcommittee on Interior, Environment, and Related Agencies regarding Fiscal Year (FY) 2023 funding for Urban Indian Organizations (UIOs) in response to the Subcommittee Hearing, “A Review of the Fiscal Year 2023 President’s Budget for the Indian Health Service,” held on May 11, 2022. NCUIH advocated in its testimony for additional resources for the Indian Health Service and urban Indian Health.

Full Text of Testimony

In the testimony, NCUIH requested the following:

  • $49.8 billion for the Indian Health Service (IHS) and $949.9 million for Urban Indian Health for FY23 (as requested by the Tribal Budget Formulation Workgroup)
  • Advance appropriations for IHS until mandatory funding is enacted

These requests are essential to ensure that urban Indians are properly cared for and move us closer to fulfilling the federal government’s trust responsibility to American Indians/Alaska Natives (AI/ANs).

Background:

On March 28, 2022, President Biden released his discretionary budget request for FY23. This request includes $127.3 billion for the Department of Health and Human Services (HHS), $9.1 billion in mandatory funding for IHS— an increase of $2.5 billion above the 2022 enacted level, and $112.5 million for Urban Indian Health— an increase of $39.1 billion above the 2022 enacted level.

NCUIH previously submitted testimony to the House Appropriations Subcommittee on Interior regarding UIO funding for FY23 and reiterated that “The federal government owes a trust responsibility to tribes and AI/ANs that is not restricted to the borders of reservations. Funding for Indian health must be significantly increased if the federal government is, to finally, and faithfully, fulfill its trust responsibility.”

On May 27, 2022, 12 Senators echoed these requests in a letter to Chairman Jeff Merkley and Ranking Member Lisa Murkowski of the Senate Interior Appropriations Committee. The letter emphasizes that increasing funding “is essential to providing quality, culturally-competent health care to AI/AN people living in urban areas.” Earlier, on April 26, 2022, 28 Representatives sent a letter to the House Interior Appropriations Committee with similar requests.

NEXT STEPS:

The testimony will be read and considered by the Subcommittee as the appropriations process goes forward for Fiscal Year 2023. The Senate markup schedule is yet to be released.

The House Interior Subcommittee markup for its FY 2023 appropriations bill will be held on June 21, 2022, and the Full Committee markup will be held on June 29, 2022. Further details on the timing and location of each markup are to be determined.

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Urban Indian Health Policy Updates: House Proposes $8.1 Billion for IHS in FY23

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☀️Happy Summer Solstice!

Here’s a preview of what’s coming up this week:

Tuesday, June 21

  • 4pm EST – House Interior Appropriations meet to discuss the FY23 Indian Health Service budget. The draft bill is here and includes $8.1 billion for the Indian Health Service, an increase of $1.5 billion above the FY 2022 enacted level. Watch live here.
  • End of Day – Comments are due today for improving the Urban Indian Health Program policy, procedures, and effectiveness. The current Indian Health Service (IHS) Urban Indian Health Program Policy is available online in the Indian Health Manual (IHM), Chapter 19, “Urban Indian Health Program” and the Dear Urban Leader Letter is located here. (Note: The DULL says comments were due yesterday, however, due to the holiday, they are allowing comments to be submitted through today.) NCUIH’s template is here.

Wednesday, June 22 at 2:30 p.m. ET

  • Senate Committee on Indian Affairs Hearing on Federal Indian Boarding Schools – The Senate Committee on Indian Affairs, will lead a hearing titled “Oversight Hearing on Volume 1 of the Department of the Interior’s Federal Indian Boarding School Initiative Investigative Report & Legislative Hearing on S. 2907, Truth and Healing Commission on Indian Boarding School Policies Act.” Witness testimony and live video of the hearing will be available here.

Thursday, June 23

  • 2 – 3pm ET – NCUIH Prep Session for Urban Confer on Infrastructure Study. Join here.
  • 3 – 4:30pm ET – Urban Confer on the Indian Health Service (IHS) Urban Indian Organization Infrastructure Study. Read the Dear Urban Leader Letter released on Friday here. Register here.

1 Big Thing: House Releases FY23 Appropriations Bill with $8.1 billion Proposed for the Indian Health Service

Yesterday, the House Appropriations Committee released the draft fiscal year 2023 Interior, Environment, and Related Agencies funding bill, which will be considered in subcommittee today. The legislation includes funding for programs for the Indian Health Service (IHS).

What’s next: The urban Indian health line item amount is expected to be released next week.

Advance Appropriations: Despite robust advocacy from Native organizations and over 2 dozen Members of the House of Representatives, the bill does not include advance appropriations for IHS. Unfortunately, the House budget resolution did not include language to allow for advance appropriations.

  • NCUIH has secured support from House and Senate leaders for advance appropriations until mandatory funding is enacted and will continue to advocate for this as discussions continue.

By the numbers:

  • $8.1 billion for the Indian Health Service, an increase of $1.5 billion above the FY 2022 enacted level.$5.7 billion for Health Services, an increase of $1 billion above the FY 2022 enacted level.
  • $1.3 billion for Health Facilities, an increase of $367 million above the FY 2022 enacted level.
  • Fully funds Contract Support Costs and Payments for Tribal Leases.

The bottom line: The final fiscal 2022 omnibus spending law (PL 117-103) wasn’t signed into law until nearly half of the fiscal year was over.

  • Top Senate and House appropriators have met a few times in recent weeks in hopes of negotiating a bipartisan agreement on spending levels, a deal that would unlock the door to a speedier legislative process. But the longer the talks drag on, the more likely there will be no agreement until after the midterm elections and a continuing resolution becomes more likely.
  • The impasse has put markups on ice in the Senate Appropriations Committee, where bipartisan support is needed because of the dynamics of a 50-50 Senate. But in the House, where the Democratic majority can pass bills on party-line votes, appropriators are racing ahead.

Go deeper: The draft bill is here. Watch live here.

2. NCUIH Makes Recommendations to Improve Urban Indian Health Program Policies at IHS

Comments are due today for improving the Urban Indian Health Program policy, procedures, and effectiveness.

Go deeper: The current Indian Health Service (IHS) Urban Indian Health Program Policy is available online in the Indian Health Manual (IHM), Chapter 19, “Urban Indian Health Program” and the Dear Urban Leader Letter is located here.

Please e-mail your comments to: urbanconfer@ihs.gov and cc Policy@NCUIH.org. (SUBJECT LINE: IHS Urban Indian Health Program Policy) NCUIH’s template is here.

NCUIH recommended the following improvement and additions to the Policy:

  • Improve the Policy’s consistency concerning oversight and management
  • Incorporate improved communication and annual training for Area Offices
  • Provide more transparent communication regarding supplemental funding
  • Include an appeals process for UIO Annual Reviews
  • Clarify and update reporting requirements
  • Provide general assistance to other federal agencies

NCUIH also requested that IHS develop additional sections, including:

  • Health Information Technology (HIT) Systems
  • Data Collection
  • Use of Federal Government Facilities and Sources of Supply

3. On our radar: Historic Appointment of Chief Lynn Malerba as First Native U.S. Treasurer

From USET SPF:

  • Today, President Biden announced the appointment of Mohegan Chief Mutáwi Mutáhash (Many Hearts), Marilynn “Lynn” Malerba, and USET Sovereignty Protection Fund Secretary, to be the next Treasurer of the United States.
  • She is the first Native person to hold this position and the highest-ranking Native Treasury official in U.S. history.
  • The Treasurer has direct oversight over the U.S. Mint, the Bureau of Engraving and Printing and Fort Knox and is a key liaison with the Federal Reserve.
  • In addition, the Treasurer serves as a senior advisor to the Secretary in the areas of community development and public engagement.
  • For the very first time, the signature of a Native person, as well as those of two women, Chief Malerba and Treasury Secretary Janet Yellen, will appear on U.S. currency.

4. From the blog: NCUIH Urges Support for Carcieri Fix, Senators Support Urban Indian Health

NCUIH Joins Tribal Partner Organizations Letter Urging Carcieri Fix

  • The United South and Eastern Tribes Sovereignty Protection Fund submitted a letter to the Senate Committee on Indian Affairs (SCIA) calling on the Senate to pass a legislative fix addressing the Supreme Court’s decision in Carcieri v. Salazar, 222 US 379 (2009).
  • The National Council of Urban Indian Health (NCUIH) joined in this letter, along with the National Congress of American Indians, the National American Rights Fund, the National Indian Gaming Association, and the National Indian Health Board, among other Native advocacy organizations.
  • The full text of this letter is available here.

12 Senators Request Increased Resources for Urban Indian Health and Support Mandatory Funding for Indian Health in FY23

NCUIH Submits Written Testimony to Senate Appropriations Subcommittee with FY 2023 Budget Requests for Urban Indian Health

NCUIH Sends Letter in Support of the IHS Request to Detail Public Health Service Commissioned Officers to Urban Indian Organizations

Next week:

  • Monday, June 27 at 1:00 – 2:30 p.m. ET – NCUIH Prep Session for Confers: Inter-Agency Workgroup and OUIHP Strategic Plan (Zoom Link)
  • Tuesday, June 28 at 1pm-2pm ET – NCUIH UIO FMAP Check-In (Zoom link.)
  • Wednesday, June 29 at 10am ET – House Markup of IHS Budget Bill
  • Wednesday, June 29 at 2:30 – 4pm ET – Urban Confer on Urban Indian Interagency Workgroup (Register here.)
  • Thursday, June 30 at 2:30 – 4:00pm ET – Urban Confer on OUIHP Strategic Plan (Register here.)
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NCUIH Submits Comments to HHS about Missing and Murdered Indigenous People and Violent Crime Against Native People

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On May 19, 2022, the National Council of Urban Indian Health (NCUIH) submitted comments and recommendations to Health and Human Services (HHS) about Executive Order (EO) 14053— Improving Public Safety and Criminal Justice for Native Americans and Addressing the Crisis of Missing or Murdered Indigenous People. These comments responded to correspondence, dated April 4, 2022, initiating a Tribal Consultation on the policy directives outlined in EO 14053. NCUIH outlined recommendations for HHS including communication and collaboration with UIOs, engagement with UIOs as critical stakeholders in HHS’ comprehensive plan to address the MMIP Crisis and violent crime, and the establishment of an agency-wide Urban Confer policy.

History of MMIP and EO 14053

According to the National Missing and Unidentified Persons System (NamUs), as of August 1, 2021, data demonstrates that most missing and unidentified cases involving AI/AN persons occur off tribal land. Still, relevant data on violence and crime in urban AI/AN communities is significantly lacking. What data does exist demonstrates a troubling situation for urban AI/AN communities. At least seventy percent (70%) of violent victimization experienced by AI/ANs is committed by persons not of the same race – a substantially higher rate of interracial violence than experienced by white or black victims. Furthermore, a 2019 report from the Minnesota Statistical Analysis Center found that AI/AN persons made up twenty percent (20%) of all victims of sex trafficking in Minnesota in 2017. Additionally, according to the California Consortium of Urban Indian Health’s Red Women Rising initiative, sixty-five percent (65%) of urban Indian women experienced interpersonal violence, forty percent (40%) experienced multiple forms of violence, and forty-eight percent (48%) experienced sexual assault. An October 2021 report by the Government Accountability Office (GAO) on the Missing or Murdered Indigenous Women noted that “tribal organization officials told [GAO] that AI/AN individuals who leave rural villages to move to urban, nontribal areas are at a higher risk of becoming victims to violent crime, including human trafficking, which they stated is a serious concern related to the MMIP crisis.”

NCUIH has consistently advocated for violent crime perpetrated against AI/ANs and the MMIP crisis to be treated as more than solely criminal justice or public safety issues.  Crime and violence are key Social Determinants of Health (SDOH) that both affect the immediate victims and cause negative health impacts throughout AI/AN communities.  Also, according to HHS, “[a]ddressing exposure to crime and violence as a public health issue may help prevent and reduce the harms to individual and community health and well-being.” A 2019 NCUIH survey found that sixty-six percent (66%) of UIOs said the most significant risk factors leading to AI/AN patients missing in their communities are: homelessness, foster system transitioning, domestic violence, substance misuse, and human trafficking, among others.  In turn, the federal government’s trust responsibility to provide “[f]ederal health services to maintain and improve the health of the Indians” requires it to address violent crime against AI/ANs and the MMIP crisis through a holistic and inter-agency approach that supports and improves the health of AI/AN communities and individuals

EO 14053 is a landmark pledge “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.” In EO 14053, the federal government committed 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.” EO 14053 specifically directs 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, EO 14053 directs 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.”  Pursuant to Section 5 of EO 14053, HHS must “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.”

NCUIH’s Requests to HHS

NCUIH issued the following comments and recommendations regarding the creation of HHS’ comprehensive plan and its implementation of EO 14053:

  • NCUIH requests that HHS honor EO 14053 through consistent and clear communication, as well as collaboration, with UIOs.
    • In EO 14053, the federal government committed 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.” This includes working with Tribal leaders and UIOs to drive meaningful prevention and intervention efforts.
    • Communication and collaboration with UIOs is not only required by EO 14053, but also sound public policy. Working with UIOs will help HHS make local connections, source, share, and analyze data, better understand the extent and causes of violent crime against AI/ANs and the MMIP epidemic, and evaluate the adequacy of research and data collection efforts at CDC and NIH.
    • NCUIH is ready, willing, and able to assist HHS communicate with UIOs and develop ongoing relationships to support this work.
  • NCUIH requests that HHS engage UIOs as critical stakeholders in its comprehensive plan to support prevention efforts that reduce risk factors for the victimization of Native Americans and increase protective factors.
    • NCUIH is appreciative that IHS recently held an Urban Confer on EO 14053 with UIOs. However, NCUIH emphasizes that it is the responsibility of the Secretary, and HHS as a whole, not just IHS, to work with urban AI/AN communities to reduce violent crime and address the MMIP epidemic.
    • UIOs are already engaged in culturally focused, community-based prevention efforts such as projects funded through the Domestic Violence Prevention Program, partnerships to provide services for victims of crime, and direct services for substance abuse disorders, mental health, and behavioral health.
  • NCUIH requests that HHS establish an Urban Confer policy to set the necessary policies and procedures for direct and clear communication with UIOs.
    • Urban Confer policies are a response to decades of deliberate federal efforts (i.e., forced assimilation, termination, relocation) that resulted in 70 percent of AI/AN people living outside of Tribal jurisdictions. Urban Confers are integral to addressing the care needs of most AI/AN persons and fulfilling the government’s trust responsibility.
    • Developing and implementing an Urban Confer policy for HHS is sound public health policy. Given the gravity of MMIP and violence against AI/ANs, it is imperative that HHS as a whole address these problems holistically and agency-wide, not solely at the IHS level. Urban Confers would enable UIOs to share feedback, recommendations, and testimony on the unique needs of their UIOs.

NCUIH will continue to closely follow HHS’ implementation EO 14053 and advocate for the resources needed to address the MMIP crisis and violent crime against AI/ANs, regardless of where victims live.

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NCUIH Joins Tribal Partner Organizations Letter Urging Carcieri Fix

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On April 14, 2022 the United South and Eastern Tribes Sovereignty Protection Fund submitted a letter to the Senate Committee on Indian Affairs (SCIA) calling on the Senate to pass a legislative fix addressing the Supreme Court’s decision in Carcieri v. Salazar, 222 US 379 (2009).  The National Council of Urban Indian Health (NCUIH) joined in this letter, along with the National Congress of American Indians, the National American Rights Fund, the National Indian Gaming Association, and the National Indian Health Board, among other Native advocacy organizations.  The full text of this letter is available here.

Carcieri v. Salazar and its Impact on Indian Country

In 2009 the Supreme Court issued its decision in Carcieri v. Salazar.  The case considered whether the Secretary of the Interior could use his authority pursuant to the Indian Reorganization Act (IRA) to take land into trust for the Narragansett Tribe.  The Court held that the IRA Act did not apply to Tribes not recognized by the federal government at the time the statute was enacted in 1934.  Because the Narragansett were not formally recognized by the federal government until 1983, the Court further held that the Secretary of the Interior did not have the authority to take land into trust for the Tribe.

According to testimony provided by then-Assistant Secretary for Indian Affairs Larry Echo Hawk in 2011, “The Carcieri decision was inconsistent with the longstanding policy and practice of the United States under the Indian Reorganization Act of 1934 to assist federally recognized tribes in establishing and protecting a land base sufficient to allow them to provide for the health, welfare, and safety of tribal members, and to treat tribes alike regardless of their date of federal acknowledgment.”  The Supreme Court’s decision has had a significant impact on the federal government’s fee-to-trust process, requiring the Department of the Interior (DOI) to engage in extensive legal and historical research prior to taking land into trust and in some cases, stopping DOI from taking land into trust for some tribes all together.

Tribal Partner Organizations Letter Urges Carcieri Fix

The April 14, 2022 letter urged SCIA “as the Senate committee tasked with leading strong U.S.-Tribal Nation diplomatic relations and protecting the principles of our sovereign status, to work toward enactment of legislation that would reaffirm the status of existing Tribal trust lands and restore certainty and fairness to the Tribal land into trust process by fixing the flawed Carcieri decision.”  The letter notes that twice during the 117th Congress, the House of Representatives had passed legislation to address Carcieri, and that it is time for the Senate to also pass similar legislation.

As a passionate supporter of Tribal sovereignty and strong Tribal economies, NCUIH was proud to join the Tribal Partners Organization letter with other leading American Indian and Alaska Native advocacy organizations.  NCUIH urges Congress to pass legislation which restores the Secretary of the Interior’s authority to take land into trust for all federally recognized Tribes and which reaffirms the status of existing Tribal trust lands.

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NCUIH Policy News: 3 More Urban Confers in June and More

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Welcome to our new Policy Updates! Below are some key dates to keep in mind. The upcoming schedule can also find be found here.

June Urban Confer Schedule

NCUIH Prep Calls and Focus Groups

NCUIH will host prep calls ahead of the confers. (We are still waiting for Dear Urban Leader Letters from OUIHP for the confers.)

  • 6/23 at 2 pm – 3 pm ET – Infrastructure Study (Zoom Link)
  • 6/27 at 1 pm – 2:30 pm ET – Urban Indian Interagency Workgroup and OUIHP Strategic Plan (Zoom Link)
  • 6/28 at noon – 1pm ET – NCUIH UIO AIR Check-In (Zoom Link)

Upcoming Urban Confer Comment Deadlines

  • 6/20 – Urban Indian Health Policy Chapter 19 (DULL)
  • 7/10 – Urban AIR (DULL)

Let’s dive in.

1 Big Thing: Bipartisan Urban Indian Health Confer Act Introduced

NCUIH has been working with Congress to establish a formal confer policy with UIOs and federal agencies.

On May 26, 2022, Senators Tina Smith (D-MN) and James Lankford (R-OK) introduced the Urban Indian Health Confer Act (S. 4323).

The big picture: The legislation would require the Department of Health and Human Services to confer with urban Indian organizations (UIOs) on policies and initiatives regarding health care for the over 70% of American Indians and Alaska Natives (AI/ANs) living off of reservations.

  • NCUIH worked closely with Senators Smith and Lankford on the introduction of this Senate companion bill to H.R. 5221, which passed the House of Representatives by 406 to 17 in November.

What they’re saying: At a hearing on October 5, 2021, HHS explained that rollouts of COVID-19 vaccines were delayed to urban Indians due to a lack of an urban confer policy.

What’s next: The bill was referred to the Senate Committee on Indian Affairs. It awaits consideration.

Action item: Please get in touch with your Senator to ask them to request that the Senate Committee on Indian Affairs to move forward on this legislation.

Go deeper: Bipartisan Urban Indian Health Confer Act Introduced by Senators Smith and Lankford

2. Federal Relations: NCUIH submits comments on MMIP and SDPI

Recent Comments

MMIP: On Friday, NCUIH submitted comments to IHS on MMIP and recommended the following:

  • HHS must honor EO 14053 through timely, consistent, and clear communication, as well as collaboration, with UIOs
  • HHS must include UIOs as Critical Stakeholders in HHS’ Comprehensive Plan
  • Increase access to technical assistance to UIOs for sexual assault nurse training
  • Support UIOs in developing victim advocacy programs
  • HHS should support improved data collection and reductions in misclassification of urban AI/ANs in relevant data
  • Support inclusion of AI/AN and tribal affiliations on intake forms
  • HHS should develop an Urban Confer Policy

(Read comments.)

SDPI: On May 16, 2022, NCUIH submitted comments and recommendations to the IHS about the Special Diabetes Program for Indians (SDPI).

  • In the comments, NCUIH emphasized the importance of SDPI and its impact in reducing health disparities related to diabetes for AI/AN populations. NCUIH also proposed recommendations for fiscal year (FY) 2023 including an increase in funding to at least $250 million with built-in automatic annual medical inflationary increases and additional support for UIOs seeking supplemental funding sources for diabetes-related care.

(Read comments.)

3. Legislative news: Approps testimony, Commissioned Officers for UIOs, Long COVID legislation

NCUIH Submits Written Testimony to Senate Appropriations Subcommittee with FY 2023 Budget Requests for Urban Indian Health

In the testimony, NCUIH requested the following:

  • Fully fund IHS at $49.8 billion and Urban Indian Health at $949.9 million for FY23 (as requested by the Tribal Budget Formulation Workgroup)
  • Advance appropriations for IHS until mandatory funding is enacted
  • Increase funding for Electronic Health Record Modernization
  • Increase funding to $30 million for Good Health and Wellness in Indian Country (GHWIC)
  • Permanently reauthorize Native Connections (Tribal Behavioral Health Grant)
  • Include urban Indians in the language for all health programs
  • Include UIOs in critical opioid grants

NCUIH Sends Letter in Support of the IHS Request to Detail Public Health Service Commissioned Officers to Urban Indian Organizations

Why it matters: Detailing officers to UIOs would aid UIOs in providing skilled, culturally competent healthcare, help address workforce shortages, and increase collaboration across the federal healthcare system.

NCUIH Endorses Bicameral Bill that Extends Grants to Urban Indian Organizations to Treat Long COVID

  • On April 7, 2022, Representative Ayanna Pressley (D-MA-07) and Senator Tammy Duckworth (D-IL) introduced the bicameral Targeting Resources for Equitable Access to Treatment for Long COVID (TREAT Long COVID) Act (H.R. 7482/S. 4015) to increase access to medical care and treatment for communities and individuals struggling with Long COVID.
  • Specifically, this legislation would establish a grant program for eligible entities, including urban Indian organizations (UIOs) for creating or enhancing the capacity to treat patients with Long COVID through a multidisciplinary approach.

4. New Resource: Funding for Urban Indian Health FY2020-2022

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).

(Resource)

In the news: Tribal Mental Health Gets New Focus, But Equity Barriers Remain (Bloomberg)

  • Our thought bubble: Always good to see coverage on equity barriers, but a failure to mention UIOs and the 70% of Native people off-reservation in a “deep dive” article is disappointing.
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12 Senators Request Increased Resources for Urban Indian Health and Support Mandatory Funding for Indian Health in FY23

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On May 27, 2022, 12 Senators 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.

Senator Tina Smith (D-MN) and 11 other Senators requested up to $949.9 million for urban Indian health in FY23 and advanced appropriations for IHS until such time that authorizers move IHS to mandatory in a letter to Chair Merkley and Ranking Member Lisa Murkowski of the Senate Interior Appropriations Committee. The letter emphasizes that increasing funding “is essential to providing quality, culturally-competent health care to AI/AN people living in urban areas.” On April 26, 2022, a group of 28 Representatives sent a letter to the House Interior Appropriations Committee with the same requests.

This letter comes as a continued effort by the National Council of Urban Indian Health (NCUIH) to address acute health disparities for American Indians/Alaska Natives (AI/ANs) living in urban areas, who suffer greater rates of chronic disease, infant mortality and suicide compared to all other populations that have only been exacerbated by COVID-19. Congress has acknowledged these significant health care disparities in Indian Country, but continuously underfunds IHS at around $4,000 per patient, and urban Indian organizations (UIOs) at less than $700 per patient even though AI/ANs living in urban areas comprise over two-thirds of the total AI/AN population.

The senators also stated their support for the President’s proposal of mandatory funding. The Indian health system is currently 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.

This Appropriations letter sends a powerful and straightforward message to Chair Merkley and Ranking Member Lisa Murkowski, and members of the Senate that in order to fulfill the federal government’s trust responsibility to all AI/ANs to provide safe and quality healthcare, funding for urban Indian health must be significantly increased.

NCUIH is grateful for the support of the following Senators:

  1. Tina Smith
  2. Dianne Feinstein
  3. Tammy Baldwin
  4. Chris Van Hollen
  5. Amy Klobuchar
  6. Catherine Cortez Masto
  7. Maria Cantwell
  8. Alex Padilla
  9. Ben Ray Lujan
  10. Jacky Rosen
  11. Elizabeth Warren
  12. Bernard Sanders

Full Letter Text

Dear Chairman Merkley and Ranking Member Murkowski,

We write to thank you for your proven commitment to urban Indian health and the 41 Urban Indian Organizations (UIOs) and to request you continue your support by appropriating $949.9 million for urban Indian health, supporting the President’s proposal for mandatory funding for the Indian Health Service (IHS), and securing advance appropriations for IHS in the Fiscal Year (FY) 2023 Interior, Environment, and Related Agencies Appropriations Act.

UIOs operate 77 facilities across the nation in 22 states, serving the approximately two thirds of American Indian and Alaska Native (AI/AN) people who live in urban areas. UIOs are an important part of the IHS, which oversees a three-prong system for the provision of health care: Indian Health Service, Tribal Programs, and Urban Indian Organizations (I/T/U). UIOs are not eligible for other federal line items that IHS and Tribal facilities are, like hospitals and health clinics money, purchase and referred care dollars, or IHS dental services dollars. Therefore, this funding request is essential to providing quality, culturally-competent health care to AI/AN people living in urban areas.

Our request for $949.9 million for urban Indian health reflects the recommendation made by the Tribal Budget Formulation Workgroup (TBFWG), a group of Tribal leaders representing all twelve IHS service areas. The significantly increased request for FY23 reflects the full funding needed for urban Indian health. Tribal leaders are unified in this request for full funding.

Chronic underfunding of IHS and urban Indian health has contributed to the health disparities among AI/AN people. Additionally, AI/AN people living in urban areas suffer greater rates of chronic disease, infant mortality and suicide compared to all other populations. Urban Native populations are less likely to receive preventive care and are less likely to have health insurance.

Yet, despite the historical acknowledgement from Congress of the significant health care disparities in Indian Country, IHS is underfunded at around $4,000 per patient, and UIOs receive less than $700 per patient.

In order to fulfill the federal government’s trust responsibility to all AI/AN people to provide safe and quality healthcare, funding for urban Indian health must be significantly increased. It is also imperative that such an increase not be paid for by diminishing funding for already hard pressed IHS and Tribal providers. The solution to address the unmet needs of urban Native and all AI/AN people is an increase in the overall IHS budget.

As a result of the COVID-19 pandemic, UIOs are reporting historic numbers of new patients. Should funding return to pre-pandemic levels, UIOs would not have the staff or resources to continue to meet the community need. A budget increase would allow UIOs, as well as IHS and Tribal facilities, to hire more staff, pay appropriate wages, and expand vital services, programs, and facilities.

Thank you for your continued support of urban Indian health and your consideration of this important request.

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