Incoming IHS Director Commits to Assisting Urban Indian Organizations with Medicaid Parity

On May 25, 2022, during the Senate Committee on Indian Affairs (SCIA) nomination hearing to consider Roselyn Tso (Navajo) to be Director of the Indian Health Service (IHS), Senator Maria Cantwell (D-WA) inquired about the status of Federal Medical Assistance Percentage (FMAP) for Urban Indian Organizations (UIOs) during questioning. Senator Cantwell asked if Ms. Tso would commit to securing 100% FMAP for UIOs should she become the IHS Director and advocated for the federal government to pay its fair share to IHS Medicaid beneficiaries in urban areas, “I wanted to ask you about 100% FMAP funding for urban Indian health…urban Indian organizations are not treated the same […] It is a big inequity in the delivery of care.” In her response, Ms. Tso committed to working on this important parity issue for UIOs, “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 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 on how important this need is. So I will work with you on this if I am confirmed.”

Senator Cantwell also advocated for an end to the disparate treatment of UIOs regarding reimbursement for IHS Medicaid Beneficiaries and emphasized that paying a lower FMAP simply because of where someone lives is unjust and unequal. This question helped to promote the interests of urban UIOs to ensure that they are not forgotten when it comes to reimbursement for services to Medicaid beneficiaries, as Ms. Tso made no mention of urban Indians or 100% FMAP for UIOs in her remarks.

Senator Cantwell is a fierce advocate for the rights of urban AI/ANs and the National Council of Urban Indian Health (NCUIH) deeply appreciates her efforts to bring the FMAP issue to the Committee.


FMAP is the percentage reimbursed to the states for health care provided by Medicaid. Typically states and the federal government split the cost of providing funding to Medicaid beneficiaries. However, IHS care for Medicaid beneficiaries is entirely covered by the federal government. Many urban AI/ANs rely on Medicaid for their health care and 100% FMAP would ensure that the services provided to urban AI/ANs were paid for. It also saves states millions of dollars.

Including UIOs in 100% FMAP would ensure that AI/ANs are treated equally when it comes to the fulfillment of the trust responsibility. The federal government has a trust responsibility to all AI/ANs, regardless of where they live. Living off the reservation should not mean that your health care provider receives less in Medicaid funds. Implementing parity would rectify the disparities experienced by urban AI/ANs and would allow UIOs to provide more services to urban AI/ANs. It would fulfill the intent behind Congress’ assertion that the provision of health care for AI/ANs “does not stop at the borders of the Indian reservation.”

Once again, we thank Senator Cantwell for her support of urban AI/ANs and look forward to collaborating with her office in the future on this important issue.

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