June 2023 - Page 2 of 2

NCUIH 2023 Policy Priorities Released

June 9, 2023/0 Comments/in Policy Blog/by Haley Smith

NCUIH worked with UIOs to identify policy priorities in 2023 under three themes: upholding the highest health status of all American Indians and Alaska Natives, parity in the Indian Health System, and improving the IHS.

The National Council of Urban Indian Health (NCUIH) is pleased to announce the release of its 2023 Policy Priorities document, which outlines a summary of urban Indian organization (UIO) priorities for the Executive and Legislative branches of the government for 2023. These priorities were informed by NCUIH’s 2022 Policy Assessment.

NCUIH hosted five focus groups to identify UIO policy priorities for 2023, as they relate to Indian Health Service (IHS)- designated facility types (full ambulatory, limited ambulatory, outreach and referral, and outpatient and residential). NCUIH worked with UIOs to identify policy priorities in 2023 under three themes: upholding the highest health status of all American Indians and Alaska Natives, parity in the Indian Health System, and improving IHS.

Read the 2023 Policy Priorities

2023 Policy Priorities:

Upholding the Highest Health Status for All American Indians and Alaska Natives

Fully Fund the Indian Health Service (IHS) and Urban Indian Health at the Amounts Requested by Tribes

Support the Tribal Budget Formulation Work Group request of $51.42 billion for IHS and $973.59 million for the Urban Indian Line Item for FY 2024.
Support Participation and Continued Inclusion of UIOs in the IHS Budget Formulation Process.

Improving Behavioral Health for All American Indians and Alaska Natives

Appropriate $80 Million for Behavioral Health and Substance Use Disorder Resources for Native Americans.
Ensure Critical Resources and Funding Opportunities Related to Behavioral Health and Substance Use Disorder are Inclusive of Urban Native Communities and the UIOs that Help Serve Them.

Protect Funding for Native Health from Political Disagreements

Maintain Advance Appropriations for IHS to Insulate the Indian Health Service from Government Shutdowns and to Protect Patient Lives.
Transition IHS from Discretionary to Mandatory Appropriations.

“Nothing About Us Without Us”: Improving Health Outcomes Through Dialogue and Action

Increase Federal Agency Engagement with UIOs through Urban Confer Policies.
Identify the Needs of and Develop Strategies to Better Serve Urban Native Populations.

Improving Health Outcomes Through Traditional Healing and Culturally-Based Practices

Improve Funding Access for UIOs to Expand traditional Healing and Culturally Based Practices

Improving Native Veteran Health Outcomes

Establish an Urban Confer Policy at the Department of Veterans Affairs (VA).
Engage with UIOs to Successfully Implement the Interagency Initiative to Address Homelessness for Urban Native Veterans.
Increase Urban Native Access to VA Resources that Address Social Determinants of Health (SDOH).

Healing from Federal Boarding Schools

Support Federal Initiatives to allow the Indian Health Service to Support Healing from Boarding School Policies.
Study and Incorporate Findings of the Public Health Impact of Indian Boarding Schools on Urban Natives Today.

Fulfilling the Trust Responsibility

Support Native Communities by Fully Honoring the Federal Trust Responsibility to Provide Healthcare to Native People.
Permanently Reauthorize and Increase Funding for the Special Diabetes Program for Indians (SDPI) at a Minimum of $250 Million Annually.

Tackling the Stigma and Advancing HIV Support Efforts in Native Communities

Increase Innovative Resources to Reduce Stigma and Fear around HIV in Native Communities and Increase Behavioral Health Support Resources at UIOs for Natives Living with HIV.

Improving Food Security for Urban American Indians and Alaska Natives

Increase access to U.S. Department of Agriculture (USDA) Resources and Funding Opportunities for Urban Native Communities and the UIOs that Help Serve Them.
Increase UIO access to fresh produce and other traditional foods for AI/ANs through the IHS Produce Prescription Pilot Program.

Ending the Epidemic of Missing or Murdered Indigenous Peoples (MMIP)

Reauthorize the Family Violence Prevention and Services Act (FVPSA) and Pass the BADGES for Native Communities Act.
Honor Executive Order 14053: Improving Public Safety and Criminal Justice for Native Americans and Addressing the Crisis of Missing or Murdered Indigenous People by Including UIOs in Prevention and Intervention Efforts.

Improving Native Maternal and Infant Health

Include a Tribal and UIO Health Provider Representative on the Advisory Committee on Infant and Maternal Mortality to Complement the Work of the Standing IHS Ex-officio Member.
Increase the Health Resource Services Administration’s Engagement with UIOs through Urban Confer and UIO Listening Sessions Regarding the Provision of Healthcare to Native Mothers and Infants.

Achieving Parity in the Indian Health System

Increasing Resources to Support More Comprehensive Care for Medicaid-IHS Beneficiaries

Enact the Urban Indian Health Parity Act to Ensure Permanent Full (100%) Federal Medical Assistance Percentage (FMAP) to Expand Services Provided at UIOs.

Improving the Indian Health Workforce

Inclusion of UIOs in National Community Health Aide Program (CHAP).
Improve the Medicaid workforce through the Inclusion of UIOs in the VA’s Pilot Program on Graduate Medical Education and Residency Program (PPGMER).
Permit U.S. Public Health Service Commissioned Officers to be Detailed to UIOs.

Improving the Indian Health Service

Accurately Account for Provider Shortages

Engage with the Health Resources and Services Administration (HRSA) so that UIOs receive Health Professional Shortage Area (HPSA) Scores that Accurately Reflect the Level of Provider Shortage for UIO Service Areas.

Data is Dollars: Improving Data in Indian Health

Re-Introduce the Tribal Health Data Improvement Act.
Improve Reporting for UIO Data.
Improve Health Information Technology /Electronic Health Records.

Continuity in UIO Support from the Indian Health System

Improve Area Office Consistency with Respect to Oversight and Management.
Improve Communication at the IHS Area Level.

Elevate the Health Care Needs of American Indians and Alaska Natives Within the Federal Government

Re-Introduce the Stronger Engagement for Indian Health Needs Act to elevate the IHS Director to Assistant Secretary for Indian Health.

Policy Update: Congressional Hearing Demonstrates Need for HHS Urban Confer Policy

June 8, 2023/0 Comments/in Policy Blog/by NCUIH

The National Council of Urban Indian Health (NCUIH) CEO, Francys Crevier (Algonquin), testified before the House Natural Resources Subcommittee on Indian and Insular Affairs at a legislative hearing on the Urban Indian Health Confer Act (H.R. 630).

Congressional Hearing Reveals Critical Impact of Lack of Urban Confer Requirement on Urban Native Lives

NCUIH CEO Francys Crevier (Algonquin) testifies before the House Natural Resources Subcommittee on Indian and Insular Affairs.

WASHINGTON, D.C. (June 7, 2023) – On Wednesday, National Council of Urban Indian Health (NCUIH) CEO Francys Crevier (Algonquin) testified before the House Natural Resources Subcommittee on Indian and Insular Affairs in support of the Urban Indian Health Confer Act (H.R. 630), sponsored by Ranking Member Raúl Grijalva (D-AZ-7). This legislation passed by 406 votes in the last session of the House of Representatives and is up for consideration again this Congress. On March 29, 2023, the Senate Committee on Indian Affairs passed out of committee the Senate bipartisan companion bill (S.460) introduced by Senator Smith (D-MN) and Senator Mullin (R-OK). NCUIH will request a full House Committee markup and expeditious floor consideration.

Go deeper: The legislation, H.R. 630, would establish an urban confer requirement between Department of Health and Human Services (HHS) agencies and offices and urban Indian organizations (UIOs).

Crevier spoke on the critical importance of establishing a confer process within HHS in matters relating to the provision of healthcare to urban American Indians and Alaska Natives.

In her opening statement, Crevier called attention to the government’s violation of the trust obligation to Native people by not considering the health of those who reside in urban areas, “when we submit letters to HHS regarding our issues, they are not required to respond due to the lack of a confer policy, meaning 70% of our population often is not considered when it comes to HHS initiatives.”

Underscoring challenges faced during the COVID-19 pandemic that were exacerbated by a lack of confer, Crevier further highlighted the need for a clear communication pathway between federal health agencies and UIOs.

In particular, Crevier highlighted that key information regarding vaccine distribution for the initial COVID-19 vaccine rollout was miscommunicated which resulted in delayed distribution to many UIOs putting UIO patients at risk.

“The lack of an urban confer requirement between HHS and UIOs has resulted in missed opportunities for information and resources, endangering the lives of Native people.“

-NCUIH CEO, Francys Crevier (Algonquin)

What they’re saying:

In her opening remarks, Ranking Member Teresa Leger Fernández (D-NM-3) emphasized the barrier to UIOs in receiving life-saving vaccines for Native patients, noting that “the lack of communication between HHS and UIOs with the vaccine rollout illuminated the real problem when you don’t have a confer policy.”

Bipartisan Members of Congress Emphasized the Need for Urban Confer Legislation

Representative Grijalva, Sponsor of H.R. 630

Rep. Raúl M. Grijalva (D-AZ-7), who introduced this legislation, stressed its importance to urban Native communities, “[H.R. 630] is about correcting history and avoiding future problems.” –

What they’re saying:

In response to Crevier’s testimony, Chair Harriet Hageman (R-WY-AL) mentioned her conversations with HHS and the need for an urban confer policy, emphasizing that “we must do a better job at providing healthcare to our tribal members, we have got to do better…it is extremely important that we start fixing situations and that it is absolutely unacceptable in terms of the quality of health care to our tribal members.”

Remarks from HHS

In her opening statement, Melanie Egorin, HHS Assistant Secretary for Legislation, stated that “HHS is dedicated to enhancing the health and well-being for all Americans and affirming our relationship with AI/AN communities to improve the health and safety of tribal communities.”

Egorin further stated that “The Indian Health Service is the only agency within the federal government to implement this formal process, as a best practice, and is a critical partnership opportunity.”

Rep. Teresa Leger Fernández reaffirmed her support for this legislation, responding to Egorin’s remarks that “There may be good best practices, but we want to make sure that best practices become statutory to ensure a good anchor for these conversations to continue.”

Urban Confer in Practice

HR 630

Why it matters: This commonsense solution has garnered bipartisan support from Congress, as demonstrated by its passage in the House last Congress by 406 votes.

Currently, IHS is the only agency required to confer with UIOs on matters affecting Native people.

Inclusivity and Representation: UIOs represent the interests and needs of American Indians and Alaska Natives living in urban areas, who make up over 70% of the Native population. By establishing an urban confer requirement, Congress would ensure that the voices of urban Native communities are heard and included in decision-making processes that impact their healthcare services.
Responsive Policy-Making: Requiring urban confer would provide HHS with the opportunity to gather firsthand information and insights from UIOs regarding the challenges, priorities, and solutions necessary for improving the health and well-being of urban Native populations. This direct engagement facilitates more informed and responsive policy-making, leading to the development of effective legislation that addresses the unique needs of urban Native communities.
Strengthening the Indian Healthcare System: UIOs play a crucial role in the Indian healthcare system by providing essential healthcare services to urban Native populations. By establishing an urban confer requirement, Congress would ensure that UIOs have direct communication channels with relevant federal health agencies, leading to improved coordination, collaboration, and resource allocation. This strengthens the overall Indian healthcare system, benefiting both UIOs and Tribal healthcare facilities.
Access to Resources and Information: Urban confer sessions enable UIOs to access critical information, resources, and opportunities from federal health agencies. It helps prevent missed opportunities, miscommunication, and delays in the delivery of healthcare services to urban Native communities. By fostering open and free exchanges of information, urban confer sessions ensure that UIOs receive timely and accurate information, enhancing their ability to serve their patients effectively.
Upholding Federal Trust Responsibility: The federal government has a trust responsibility to provide healthcare services to Native people, regardless of their geographic location. An urban confer requirement recognizes the federal government’s obligation to fulfill this responsibility and ensures that all agencies within HHS engage with UIOs. It establishes a formal process for meaningful consultation and collaboration, reinforcing the government’s commitment to improving healthcare for Native populations.

Go deeper:

Next Steps:

NCUIH will continue to advocate for passage of H.R. 630 and S. 460.

PRESS RELEASE: NCUIH Honors 2023 Indian Health Care Warriors and Native Veteran Health Allies

June 8, 2023/0 Comments/in Press Release/by NCUIH

Congressional Awards | Indian Health Care Warrior Awards | Native Veterans Health Ally Awards

NCUIH recognized Tribal partners, Members of Congress, and federal partners for their work in securing advance appropriations for Indian Health Service and in advancing the health of Native veterans.

Robyn Sunday-Allen (NCUIH VP), Francys Crevier (NCUIH CEO), Darren Benjamin (Relation Strategy LLC), Representative Betty McCollum (D-MN), Senator Jeff Merkley (D-OR), Representative Sharice Davids (D-KS), Stacy Bohlen (NIHB CEO), Larry Wright (NCAI ED), Meredith Raimondi (NCUIH VP of Policy and Communications), Walter Murillo (NCUIH Board President).

Washington, D.C.- On May 17, 2023, the National Council of Urban Indian Health (NCUIH) presented fifteen Indian Health Care Warrior Awards for Advance Appropriations for the Indian Health Service (IHS) to Tribal partners, Congressional advocates, federal advocates, as well as three Native Veterans Health Ally Awards during its 2023 Annual Conference: Honoring Our Ancestors & Preparing for the Next Seven Generations: NCUIH Celebrates 25 Years of Health Leadership. 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 (AI/ANs), regardless of where they reside.

Indian Health Care Warrior Award for Advance Appropriations

Tribal Partners: National Indian Health Board and the National Congress of American Indians

Larry Wright (NCAI ED), Stacy Bohlen (NIHB CEO), Walter Murillo (NCUIH Board President).

NCUIH’s president-elect, Walter Murillo (Choctaw), presented the Indian Health Care Warrior Award for Advance Appropriations to Stacy Bohlen (Sault Ste. Marie Tribe of Chippewa Indians), CEO of the National Indian Health Board, and Larry Wright Jr. (Ponca Tribe of Nebraska), Executive Director of the National Congress of American Indians, for their tireless efforts in fighting for advance appropriations for the Indian Health Service. In their acceptance speech, Bohlen succinctly captured the spirit of unity and triumph in her statement, “[w]hen we stand together, we win.” Her powerful quote embodies the essence of collective action and highlights the importance of solidarity in achieving positive outcomes for Native communities.

Indian Health Care Warrior Award for Advance Appropriations: Members of Congress

The Congressional Awards were given to Members of Congress for their work in achieving advance appropriations.

Representative Betty McCollum

Representative Betty McCollum (D-MN).

Representative Betty McCollum delivered a powerful address emphasizing the urgent need for comprehensive legislation to support the Indian Health Service. She remarked, “Until we pass this legislation to permanently authorize advance appropriations for the Indian Health Service and until we provide mandatory funding to IHS, this will always be a fight. It will be a fight to make sure that the US government honors its sacred treaty obligations – we must continue this fight and make sure it is included.”

Representative McCollum’s impassioned words resonated deeply with the audience, highlighting the critical importance of addressing healthcare disparities and ensuring equitable access to quality care for Native communities. Her unwavering commitment to championing the cause of the IHS and advancing the rights of Native communities has been a driving force behind numerous initiatives aimed at securing the necessary support and funding to uphold the sacred treaty obligations of the United States government.

Representative Sharice Davids

Robyn Robyn Sunday-Allen (NCUIH VP), Representative Sharice Davids (D-KS), Francys Crevier (NCUIH CEO).

Representative Sharice Davids, a trailblazing voice in Congress and an influential member of the Native American caucus attended the conference in person and emphasized the importance of education in her address, stating, “One of the main priorities for the Native American caucus has been to educate. We need to educate not just our colleagues, but also ensure that our staff and everyone on the Hill has an understanding of how complex and diverse the issues that exist in Indian Country are.” Davids’s voice serves as a powerful catalyst for change, shedding light on the multifaceted challenges faced by Native communities across the country, and actively works to bridge gaps and promote meaningful dialogue in pursuit of equitable solutions.

Senator Jeff Merkle

Robyn Sunday-Allen (NCUIH VP), Senator Jeff Merkley (D-OR), Francys Crevier (NCUIH CEO).

During his acceptance speech, Senator Merkley delivered a compelling message regarding the critical need for advance appropriations for the Indian Health Service. He stated, “The Indian Health Service, which 2.5 million people rely on for their wellbeing, should have never been dependent on the whims of a budget cycle. The rhythm of healthcare means that when you need that care, it is there – not a week later or after Congress figures it out. This provision must be reinstated and reaffirmed forever more.”

Senator Merkley’s words underscored the urgent necessity of ensuring consistent and reliable funding for the IHS, which plays a vital role in providing healthcare services to millions of Native Americans. His unwavering commitment to reinstating the provision for advance appropriations reflects his recognition that healthcare should not be subject to uncertainties and delays caused by the budgetary process.

Majority Leader Chuck Schumer

In his virtual address, Majority Leader Chuck Schumer expressed his gratitude for being awarded the Indian Healthcare Warrior Award for Advance Appropriations. He acknowledged the federal government’s historical neglect of its obligations to support Native communities, particularly in helping them access quality, affordable, and culturally competent healthcare services. However, he expressed pride in the Senate’s historic provision of advance appropriations for the Indian Health Service in the 2023 Omnibus spending package, stating that “IHS was the only federal health care provider that lacked guaranteed funding from year to year- so for the first time in history, we bring Indian Health Services into parity with other health providers.” He promised to continue fighting for Indian Country and hopes to work together to bring more success.

Watch Majority Leader, Chuck Schumer’s Remarks Here

Speaker Emerita Nancy Pelosi

During her virtual acceptance speech, Speaker Emerita Nancy Pelosi highlighted recent policy accomplishments, stating, “Powered by Native voices and your powerful advocacy, we achieved a landmark victory last Congress by securing critical funding for the Indian Health Service.” She added, “Your voices continue to be essential for promoting health and economic justice for tribal communities.”

Watch Speaker Emerita, Nancy Pelosi’s Remarks Here

Senator Lisa Murkowski

Senator Lisa Murkowski expressed gratitude for receiving the Indian Healthcare Warrior award during her virtual acceptance speech but credited the accomplishment to the collective efforts of her fellow advocates. She highlighted her 2013 introduction of legislation to provide Advance Appropriations for IHS and praised the tireless work of tribal organizations in realizing this goal. Senator Murkowski ended by emphasizing that “no matter where Native people live, whether on tribal lands or in urban areas, you deserve quality health care and the federal government has a duty to uphold its trust responsibility.”

Watch Senator Lisa Murkowski’s Remarks Here

Representative Mike Simpson

In his virtual address, Rep. Simpson, the Chairman of the Interior Subcommittee, highlighted the crucial responsibility of his subcommittee to ensure the protection of Native Americans who receive Health Care through IHS funding, particularly from budget uncertainties. He further emphasized that providing funding for Indian Health Care is “not just a trust responsibility, but also a moral one.”

Watch Representative Mike Simpson’s Remarks Here

Representative Tom Col

As Representative Tom Cole was unable to attend the NCUIH conference in person, Robyn Sunday-Allen (Cherokee), Chief Executive Officer of the Oklahoma City Indian Clinic and NCUIH Vice President, was able to meet with Representative Cole to recognize his exceptional dedication to Indian healthcare. As a token of appreciation, Sunday-Allen presented Representative Cole with a specially designed blanket created by NCUIH. This award served to acknowledge Representative Cole’s tireless advocacy for Advance Appropriations in Indian healthcare, demonstrating his unwavering commitment to ensuring consistent and sufficient funding for Native communities. The meeting was an opportunity to honor Representative Cole as an Indian healthcare warrior and express gratitude for his outstanding contributions to improving the lives of Native people.

Indian Health Care Warrior Award for Advance Appropriations: federal partners

Three Indian Health Care Warrior Awards for Advance Appropriations were presented to federal partners for their work in achieving advance appropriations: 

Tracy Goodluck, Senior Advisor to the Assistant Secretary for Indian Affairs, U.S. Department of the Interior;
Daron Carriero, Former Senior Policy Advisor for Native Affairs for the White House Domestic Policy Council
The Office of Management and Budget (OMB): Shalanda Young, Director; Liz Carr, Tribal Advisor to Director; and Topher Spiro, Associate Director of Health.

Tracy Goodluck

Robyn Robyn Sunday-Allen (NCUIH VP), Francys Crevier (NCUIH CEO), Tracy Goodluck, Lauren W. Yowelunh McLester-Davis.

Tracy Goodluck’s role as Senior Advisor to the Assistant Secretary for Indian Affairs at the US Department of the Interior is of immense importance in advancing the cause of urban Native issues. With her expertise and dedication, she plays a pivotal role in bringing these often overlooked concerns to the forefront of policy decision-making. Tracy’s deep understanding of the complex challenges faced by urban Native communities enables her to effectively advocate for their unique needs and amplify their voices within the government. Her ability to bridge the gap between policy development and the lived experiences of urban Native populations helps ensure that their perspectives are heard and integrated into meaningful policy reforms.

Daron Carriero

Daron Carriero, a dedicated advocate for Native healthcare, was recognized for his exceptional efforts and awarded for his significant contributions. As a Choctaw Nation citizen and former Senior Policy Advisor for Native Affairs for the White House Domestic Policy Council under President Biden, Mr. Carriero played a crucial role in securing Advance Appropriations for the Indian Health Service. Through his work at the Department of Justice and later at the White House, he actively supported Tribes across the nation by advocating for increased funding and facilitating crucial conversations between key stakeholders. Although unable to attend the ceremony, Mr. Carriero’s unwavering commitment and substantial achievements in advancing Indian healthcare were acknowledged and celebrated.

The Office of Management and Budget: Shalanda Young, Topher Spiro, and Liz Carr

The Office of Management and Budget (OMB), represented by Director Shalanda Young, Associate Director Topher Spiro, and Ms. Liz Carr, Tribal Advisor to Director, were honored for their instrumental contributions to advancing Indian healthcare. Despite being unable to attend the Award Ceremony, their unwavering dedication and tireless efforts played a pivotal role in achieving this momentous milestone. As essential figures in this achievement, their leadership and commitment were crucial in navigating the complex landscape of healthcare funding and policy. The OMB’s invaluable support and partnership have laid the groundwork for future collaborations.

Darren Benjamin

Robyn Sunday-Allen (NCUIH VP), Darren Benjamin, Francys Crevier (NCUIH CEO).

NCUIH also awarded our Ally in Indian Country, Darren Benjamin, for his work within Tribal organizations and in Congress to advance the healthcare of all Native people. While accepting his award, Benjamin noted the crucial role of bipartisan policymaking in saving Native lives. Effective solutions require the support and cooperation of lawmakers from both sides of the aisle, and transcending partisan divides is essential for securing the necessary resources and funding to address pressing issues impacting Native communities, ultimately ensuring their well-being and promoting positive health outcomes.

Native Veterans Health Ally Award

The Native Veterans Health Ally Awards were given to individuals for their commitment to advocating on behalf of Native American veterans:

Councilman Nick Lewis (Lummi Nation)
Chief William Smith (Valdez Native Tribe)
The Honorable Denis McDonough, Secretary of Veterans Affairs

Robyn Sunday-Allen (NCUIH VP), Francys Crevier (NCUIH CEO), Honorable Denis McDonough, Roslyn Tso (IHS Director), Councilman Nicklaus Lewis.

NCUIH board member Robyn Sunday-Allen (Cherokee) presented the Native Veterans Health Ally Award to Chief William Smith (Valdez Native Tribe), Councilman Nicklaus Lewis (Lummi Nation), and the Honorable Denis McDonough, in recognition of their work to advance the health and well-being of American Indian and Alaska Native veterans. Chief Smith and Councilman Lewis serve on the Department of Veterans Affairs Advisory Committee on Tribal and Indian Affairs with NCUIH’s Board President Sonya Tetnowski, where they are fierce advocates for Native veterans and secure funding and support for tribal veteran services. Chief William Smith has worked tirelessly to address the disproportionate health challenges faced by Native veterans, particularly those related to mental health. Although unable to attend the ceremony, Chief Smith’s achievements were acknowledged and celebrated. The Honorable Denis McDonough, Secretary of Veterans Affairs, has been instrumental in securing resources for Native veterans, pushing for increased funding for Native health care, and advocating for policies that support Native veteran access to care. In his acceptance speech, Secretary McDonough stated that “If you fight for us, we’ll fight for you. If you take care of us, we’ll take care of you. If you have our backs, we’ll have your backs when you leave the service. Native Veterans have kept their part of that promise. Now, it’s time for us—as a country and at VA—to uphold our end of the bargain. We will not rest until every Veteran gets access to equitable, world-class care and benefits.” Together, these three individuals have made significant contributions to improving the lives of Native veterans and their families.

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

NCUIH Testimony at House Natural Resources Subcommittee on Indian and Insular Affairs

June 7, 2023/0 Comments/in Policy Blog/by NCUIH

June 7, 2023 | 10 a.m. EDT

On Wednesday, June 7, 2023, beginning at 10:00 a.m. EDT, NCUIH CEO Francys Crevier, JD (Algonquin), will be testifying before the Subcommittee on Indian and Insular Affairs at a legislative hearing on the Urban Indian Health Confer Act (H.R. 630), sponsored by Ranking Member Raúl Grijalva (D-AZ-7). NCUIH will speak in support of the NCUIH-endorsed legislation which would require agencies within the Department of Health and Human Services (HHS) to confer with urban Indian organizations (UIOs) on policies related to healthcare for urban American Indian/Alaska Natives (AI/ANs).

Watch Hearing

House Passes Final Debt-Limit Deal with Advance Appropriations Authority for IHS

June 6, 2023/0 Comments/in Policy Blog/by NCUIH

On May 31, 2023, after weeks of negotiations between President Biden and Congress, the House of Representatives passed by a margin of 314 to 117, The Fiscal Responsibility Act (H.R. 3746), which will suspend the debt ceiling through January 1, 2025.

The legislation includes spending caps on the total amount for non-defense discretionary funding for two years.

The Indian Health Service (IHS) falls under non-defense discretionary funding, however, how the caps impact the actual IHS budget has yet to be determined.

The bill also includes “claw backs” of some unobligated COVID-19 funding, however, the American Rescue Plan funding for the Indian Health Service (IHS) is protected from these rescissions.

The legislation included the budgetary authority to extend advance appropriations for IHS for FY25 and FY26 but limits the advance appropriation amount for each year to the FY 2024 appropriated amount.

Lastly, the deal includes expanding certain work requirements for federal nutrition and cash assistance programs but does not include new work requirements for Medicaid.

House of Representatives Passes Final Debt-Limit Deal with Advance Appropriations Authority for IHS

Spending Caps for Non-Defense Discretionary Spending, including the Indian Health Service

This legislation “caps” (limits) non-defense spending from FY23 through FY24 and only increases by 1% in FY25. The FY24 cap for non-defense discretionary spending is $704 billion, with $121 billion for veteran’s medical care and the rest of the $538 billion would be allocated to other areas, such as IHS.

Go deeper: The agreement authorized increased spending for Veterans’ healthcare but does not include a similar specific authorization for Indian Health Service.

By the numbers: IHS was funded at $6.9 billion in FY23 and Congressional appropriators still retain authority on how the capped spending will be appropriated across federal programs.

What’s it all mean? At this point, it is unclear how the IHS budget for FY24 will be impacted.

“Claw Backs” on COVID-19 Relief Funds

What’s a “claw back”? The agreement includes “claw backs” which rescinds unobligated balances (funds that have been appropriated for a program or other purpose but have not been spent) from some COVID-19 funding.

The bottom line: IHS funds from the American Rescue Plan Act are protected however, it remains unclear what remaining other COVID-19 unobligated balances exist for IHS and whether they would be protected.

For urban Indian organizations (UIOs), COVID-19 funds that the UIO has received will not be clawed back.
Certain other COVID-19 funds that have not been obligated are potentially subject to claw backs.

Yes, but: At this time, IHS has not issued guidance about the effects on non-ARPA IHS COVID-19 unobligated funds that may be clawed back.

Advance Appropriations for the Indian Health Service: The bill authorizes advance appropriations for IHS for FY25 and FY26.

What’s next: It is still up to Appropriations Committees to appropriate that advance appropriation, but this sets up and enables them to do so. The funding must stay at the FY24 spending level.

Work Requirements for Federal Programs

The big picture: The bill adds some increased work requirements to qualify for the Supplemental Nutrition Assistance Program (SNAP).

The bill raises the age requirement to 51 years of age in FY23, 53 in FY24, and 55 in FY25.
However, the bill adds an exemption to work requirements for homeless individuals, veterans, and persons who are under 24 and were in a state foster care system until age 18 or any higher age as required by the state.
The bill does not include explicit work requirement exemptions for American Indian and Alaska Native recipients.
These amendments sunset on October 1, 2030.

What about Medicaid work requirements? Notably, the bill does not enact stricter work requirements for Medicaid, as in the House’s original debt limit legislation.

On May 8, 20223, NCUIH signed on to a Partnership for Medicaid letter to Congressional Leadership expressing concern about work requirements as a mandatory condition for Medicaid eligibility in the debt ceiling bill.
With over 1.8 million American Indians and Alaska Natives enrolled in Medicaid, NCUIH has worked diligently to ensure beneficiaries do not needlessly lose coverage.

How did we get here? The Fiscal Responsibility Act (H.R. 3746) comes after weeks of negotiation between President Biden and House Republicans after the House of Representatives previously passed the Limit, Save, Grow Act of 2023 (H.R. 2811) to lift the US debt limit for a year.

That legislation included several measures, including reverting federal spending to FY22 levels, limiting spending increases to 1% a year for the next 10 years, rescinding any unspent Covid-19 funds, and enacting stricter work requirements for social programs such as Medicaid.
The legislation was dead on arrival in the Democratic-led Senate as President Biden had indicated that he would veto the legislation.
In response to this legislation, NCUIH released a statement calling on Congressional leaders to safeguard Indian health funding from proposed cuts.

Looking Forward: This legislation will now be considered in the Senate, hoping to pass it by Friday, June 2. NCUIH will continue to advocate for the protection of the Indian Health Service.

Resources

Full Bill Text – H.R. 3746
NCUIH Statement – Proposed Legislation to Lift US Debt Limit Threatens Native Health Care