On August 17, 2023, the Indian Health Service (IHS) hosted a listening session for Tribal and urban Indian organization (UIO) leaders to share information and solicit input on advance appropriations implementation. During the listening session, IHS shared that they are currently on track in terms of advance appropriations implementation. In September, IHS plans to start apportionment review and processing and in October, IHS will start distributing funds across the Indian Health, Tribal, and UIO (I/T/U) system. During this process, IHS is seeking input from Tribal and UIO Leaders on advance appropriations implementation regarding the following questions:
- What additional information would be helpful to you?
- Are there any considerations you think IHS is missing?
- What is the best way to collect information about the impact of advance appropriations and success stories?
The IHS will host an identical listening session on Wednesday, September 6, 2023, from 3:00-4:30 p.m., Eastern Time. Click here to join the listening session.
HHS financial systems will re-open after October 1, 2023, for Fiscal Year (FY) 2024 activities. All of the timelines and requirements to receive a payment remain the same. For example, funds will be paid out according to performance periods. If your UIO contract performance period is October – September, the earliest you could receive a payment for FY2024 is October 2023. If your performance period is November – October, the earliest you could receive a payment for FY2024 is November. Additionally, UIOs must have a signed Federal Acquisition Regulation (FAR) contract in place to receive a FY2024 payment.
Activities that did not receive FY 2024 advance appropriations include the following:
- Electronic Health Record Modernization
- Indian Health Care Improvement Fund
- Health Care Facilities Construction
- Sanitation Facilities Construction
- Contract Support Costs
- Section 105(l) Leases (Payments for Tribal Leases)
Background on IHS Advance Appropriations
The FY 2023 Consolidated Appropriations Act (Public Law 117-328) included a total of $5.1 billion in FY 2024 advance appropriations for the Indian Health Service, including the urban Indian health line item. The full year funding level will be available for programs on Oct. 1, 2023, regardless of whether Congress enacts a continuing resolution or full year bill. Advance appropriations provide long overdue funding stability and predictability for the IHS. Congress will determine a final appropriations level for the IHS in the FY 2024 appropriations process and has the ability to significantly increase the IHS budget, in-line with the recommendations of the National Tribal Budget Formulation Workgroup, through additional discretionary appropriations.
After tireless advocacy from the National Council of Urban Indian Health (NCUIH) and our partners across Indian Country, Congress included advance appropriations for IHS in the FY 2023 final spending bill to provide stable funding for FY 2024. The current advanced appropriation expires in FY 2025, and NCUIH is continuing its advocacy to secure advanced appropriations for IHS for future years. NCUIH endorsed the bipartisan, bicameral Indian Program Advance Appropriations Act (H.R.4832/S.2424) which was reintroduced by Sen. Lujan (D-NM), Sen. Mullin (R-OK), Rep. McCollum (D-MN-04), and Rep. Cole (R-OK-04) on July 24, 2023. This bill would authorize advance appropriations for several accounts under the Bureau of Indian Affairs and Bureau of Indian Education within the Department of Interior and IHS within the Department of Health and Human Services.
On March 9, 2023, NCUIH CEO Francys Crevier (Algonquin), testified before and submitted public witness written testimony to the House Appropriations Subcommittee on Interior, Environment, and Related Agencies regarding FY 2024 funding and requested that advance appropriations for IHS be maintained. NCUIH also worked closely with Representatives Gallego and Grijalva on leading a Congressional letter to the House Committee on Appropriations for FY 2024, urging to maintain advance appropriations for IHS until such time that authorizers move IHS to mandatory spending. On April 4, 2023, a group of 12 Senators sent a letter to the Senate Interior Appropriations Committee with the same requests. Due to this advocacy, advance appropriations for IHS was maintained for FY 2025 in both the House and Senate Interior Appropriations proposed FY 2024 spending bills.