New Report Estimates 400,000 Native Americans Terminated from Medicaid During Unwinding

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NCUIH Joins 8 Organizations in Issuing Report on Impacts of Medicaid Terminations
Medicaid Unwinding Impacts on Native Communities

“The report highlights the disproportionate impact Medicaid unwinding is having on Native communities,” said Francys Crevier (Algonquin), CEO of the National Council of Urban Indian Health. “Medicaid and CHIP coverage are critical to fulfilling the United States’ trust responsibility to maintain and improve Native health, as inadequate insurance coverage is a significant barrier to healthcare access for Native people. Eligible Native children and families are losing coverage for administrative reasons and the federal government has a trust obligation and must do more to protect them.” 

The report is co-authored by the Asian and Pacific Islander American Health Forum, the Leadership Conference on Civil and Human Rights, NAACP, the National Council of Negro Women, the National Council of Urban Indian Health, the National Urban League, the Southern Poverty Law Center Action Fund, UnidosUS, the Coalition on Human Needs, and Protect Our Care.  

Report: Six Months into Unwinding: History’s Deepest Medicaid Losses Demand State Action
Read the Report

From UnidosUS: 

When Medicaid pandemic protections expired on April 1, 2023, states were allowed to redetermine eligibility and begin terminating families’ Medicaid for the first time since February 2020. 

During the first six months of this “unwinding,” more people have lost Medicaid than during any two-year period in American history. More than half of the 10 million people terminated from Medicaid thus far are estimated to come from communities of color. And more than 70% of people terminated from Medicaid may still be eligible. Their coverage is ending because of nothing more than missing paperwork, often resulting from needless state-imposed red tape and bureaucracy. 

The power of state policy to determine unwinding results is illustrated by one key fact: if all states had paperwork termination rates as low as the 10 best states, two-thirds of paperwork terminations would have been prevented, and 4.5 million people would never have had their Medicaid taken away because of state-imposed red tape and bureaucracy. 

We support the administration’s efforts to enforce federal law. And we call on all states to reduce procedural termination rates to the lowest possible level. Until state elected officials have reformed their Medicaid systems so that they would trust them with their own families’ health care, we urge states to place on hold all terminations that result from nothing more than missing paperwork. 

Background on Native Populations and Medicaid 

Fact Sheet: Impact of Medicaid on Health Care for American Indians and Alaska Natives  

  • As of 2020, there are over 9.7 million AI/AN people in the United States. 
    • In 2020, over 1.8 million AI/AN people were enrolled in Medicaid in the United States. 
    • This means that almost 1/5 of the AI/AN population is covered by Medicaid. 
  • In 2019, Medicaid covered 1.3 million urban AI/AN people, including 30% of urban AI/AN adults under age 65.  
    • Comparatively, Medicaid covered 19.8% of all urban U.S. adults under age 65. 
  • UIOs are health care clinics that provide key services to almost every one of the top metro areas where IHS-Medicaid beneficiaries live. 
    • In 2021, 55% of the total population served at UIOs were Medicaid beneficiaries, and 46% of the AI/AN population served at UIOs were Medicaid beneficiaries. 
  • As of FY 2020 (most recent data available), Medicaid accounted for about 10% of the funding for IHS programs. 
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NCUIH Urges Federal Agencies to Protect All Native Children in the Child Welfare System

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On September 15, 2023, the National Council of Urban Indian Health (NCUIH) submitted written comments to the Department of Health and Human Services’ (HHS) Administration for Children and Families (ACF) Assistant Secretary, January Contreras, Department of Interior (DOI) Assistant Secretary, Byan Newland, and Department of Justice (DOJ) Deputy Assistant Attorney General, Gina Allery (collectively “the agencies”) in response to a request for input on strengthening the Indian Child Welfare Act (ICWA). In its comments, NCUIH urges the agencies to consider the needs of American Indian and Alaska Native (AI/AN) children and families living in urban areas in their efforts to promote federal protections for AI/AN children and their parents and caregivers.

NCUIH’s Recommendations

In its comments, NCUIH requested that the agencies:

  • Actively inform state courts and child welfare agencies about the need to utilize urban Indian organizations (UIOs) to meet their obligations under ICWA.
  • Assist Tribes in coordinating with UIOs to strengthen resources and efforts to ensure ICWA is properly implemented.
  • Engage directly with UIOs to improve implementation of ICWA.

By including UIOs in strengthening ICWA, the agencies can ensure that all AI/AN children in the child welfare system, regardless of location, are able to access the protections afforded by ICWA.

Background on ICWA

Congress enacted ICWA in 1978 to re-establish tribal authority over the adoption of Native American children (25 U.S.C. § 1903.) The goal of the Act was to strengthen and preserve Native American family structure and culture. Studies conducted in advance of ICWA’s drafting showed that between 25% and 35% of all Native children were being removed from their homes by state child welfare and private adoption agencies. Of those, 85% were placed with non-Native families, even when fit and willing relatives were available. ICWA was established as a safeguard that requires:

  1. Recognition of Tribal jurisdiction over decisions for their Indian children;
  2. Establishment of minimum Federal standards for the removal of Indian children from their families;
  3. Establishment of preferences for placement of Indian children with extended family or other Tribal families; and
  4. Institution of protections to ensure that birth parents’ voluntary relinquishments of their children are truly voluntary.

According to the National Indian Child Welfare Association (NICWA), ICWA “[l]essens the trauma of removal by promoting placement with family and community . . . [p]romotes the best interest of Indian children by keeping them connected to their culture, extended family, and community, which are proven protective factors . . . [and] [p]romotes placement stability by ensuring that voluntary adoptions are truly voluntary.”

On June 15, 2023, the Supreme Court reaffirmed and upheld the constitutionality of ICWA in a 7-2 ruling. Read more about the ruling here.

NCUIH Work on ICWA

NCUIH is a strong supporter of ICWA and has advocated for the appropriate application of ICWA to all welfare proceedings involving AI/AN children, regardless of where they live. On August 19, 2022, NCUIH and five UIOs  signed on to the National Indigenous Women’s Resource Center’s (NIWRC) amicus brief  to the Supreme Court in support of the constitutionality of ICWA in the  Haaland v. Brackeen case. NCUIH worked directly with NIWRC to engage with UIOs to ensure that the submitted brief was inclusive of urban AI/ANs. On September 7, 2022, NCUIH submitted written comments to the Bureau of Indian Affairs and ACF on the agencies’ efforts to promote the consistent application of ICWA and protect children, families, and Tribes.

A full archive of our work on ICWA can be found on the NCUIH website.

Next Steps

NCUIH will continue to advocate for the appropriate application of ICWA to all welfare proceedings involving American Indian and Alaska Native children, regardless of whether the child is located in an urban or rural community.

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IHS Provides Updates on Timeline and Resources for Seasonal Influenza, RSV, and COVID-19 Vaccines

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On September 22, 2023, the Indian Health Service (IHS) sent a Dear Tribal Leader Letter (DTLL) and Dear Urban Indian Organization Leader Letter (DULL) to provide an update concerning seasonal vaccines and resources available for vaccine-related activities to purchase COVID-19 vaccines. In the letter, IHS discussed vaccines for Influenza, Respiratory Syncytial Virus (RSV), and COVID-19.

IHS provided the following updates:

Influenza Vaccine

Supply of the 2023-2024 seasonal influenza vaccine is expected to be adequate to provide access for all recommended age groups, including the influenza vaccines preferentially recommended for people ages 65 years and older. The Centers for Disease Control and Prevention (CDC) continues to recommend the seasonal influenza vaccine for all people ages six months and older. September and October are the best times for most people to get vaccinated.

RSV Vaccine

Vaccination to prevent RSV is also available for certain high-risk persons. This includes approved RSV vaccines available for persons ages 60 years and older, and one of the RSV vaccines, ABRYSVO, is approved for use in pregnant individuals 32-36 weeks gestational age to prevent lower respiratory tract disease (LRTD) and severe LRTD in infants from birth through 6 months of age. There is also the long-acting monoclonal antibody, nirsevimab, which has been approved and recommended to prevent RSV for all infants under 8 months entering their first RSV season, and all American Indian and Alaska Native children ages 8-19 months entering their second RSV season.

COVID-19 Vaccine

In September, the Food and Drug Administration approved and authorized, and the CDC recommended, an updated monovalent mRNA COVID-19 vaccine designed to protect against the currently circulating strains of the virus. All people ages 6 months and older, regardless of prior COVID-19 vaccination status, are recommended to receive this vaccine. The vaccine is now available, so please do not wait to get your updated COVID-19 vaccine.

Like other adult vaccines, after regulatory approval/authorization and recommendation, the updated 2023-2024 COVID-19 vaccines (Pfizer, Moderna, and Novavax, once authorized) will be commercially available through the channels used to procure other routine vaccines. Updated COVID-19 vaccines are available in retail pharmacies.

Vaccines will be available to uninsured or underinsured adults through the HHS Bridge Access Program for a limited time. CDC’s Bridge Access Program provides no-cost COVID-19 vaccines to adults without health insurance and adults whose insurance does not cover all COVID-19 vaccine costs. This program will end by December 31, 2024.

Pediatric COVID-19 vaccines will continue to be available to all American Indian and Alaska Native children via the CDC’s Vaccines for Children (VFC) program. The VFC program is a federally funded program that provides vaccines at no cost to children who might not otherwise be vaccinated because of inability to pay. The CDC buys vaccines at a discounted rate for distribution to registered VFC providers. Children who are eligible for VFC vaccines are entitled to receive those vaccines recommended by the Advisory Committee on Immunization Practices. Eligible children are children through 18 years of age who meet at least one of the following criteria are eligible to receive VFC vaccine:

  • Medicaid eligible: A child who is eligible for the Medicaid program. (For the purposes of the VFC program, the terms “Medicaid-eligible” and “Medicaid-enrolled” are equivalent and refer to children who have health insurance covered by a state Medicaid program)
  • Uninsured: A child who has no health insurance coverage
  • American Indian or Alaska Native: As defined by the Indian Health Care Improvement Act (25 U.S.C. 1603)
  • Underinsured

For any questions related to vaccines, please contact CAPT Kailee Fretland, Pharmacist, Office of Clinical and Preventive Services, IHS, by e-mail at kailee.fretland@ihs.gov.

For any questions pertaining to COVID-19 supplemental funding, please contact Ms. Jillian Curtis, Chief Financial Officer, IHS, by e-mail at jillian.curtis@ihs.gov.

NCUIH Vaccine Advocacy

The National Council of Urban Indian Health (NCUIH) has long supported equitable vaccination access for urban American Indian and Alaska Native people.  With support from the CDC, NCUIH has been working to promote equitable adult vaccination and prevent severe illnesses such as COVID-19 and influenza.  We do this by enhancing the resource and evidence base, developing effective strategies for health care organizations, and creating culturally appropriate materials for individual clinicians that reflect the needs of urban American Indian and Alaska Native people.

Join NCUIH on November 9, 2023, for the second session in our vaccine Community of Learning (CoL) series, “Paths to Vaccine Equity: Annual Vaccinations.” Speakers from NCUIH and Amy Pisani, CEO of Vaccinate Your Family, will discuss the new RSV vaccine and updates to the COVID-19 and influenza vaccines. Participants will learn how collaboration with vaccine organizations can help support vaccine awareness and patient education.

For more information on NCUIH’s vaccine advocacy work, please click here.

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PRESS RELEASE: Vice President Harris Applauds Urban Indian Organization, NATIVE HEALTH, as First Pilot Site for Indian Health Service Voter Registration Program

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FOR IMMEDIATE RELEASE

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

WASHINGTON, D.C. (November 3, 2023) – In response to barriers that have prevented Native communities from participating in elections, the Biden-Harris Administration announced new agency actions to improve voting access. In March, a pilot program through the Indian Health Service was announced, where five facilities would serve as voter registration pilot sites by the end of 2023. Recently, NATIVE HEALTH in Phoenix, Arizona, became the first of these pilot sites to be designated through the National Voter Registration Act.

“Native American voters often face significant barriers to accessing the right to vote. We are working to change that. For the firsttime ever, Tribal members can now register to vote at an Indian Health Service facility, Native Health of Phoenix.” – Vice President Kamala Harris

“Our Native communities routinely face barriers not only with access to voting, but with registering to vote itself. The IHS Voter Registration Pilot Program will help address and eliminate these barriers. We are honored that one of our Urban Indian Organizations is leading the way as the first site to launch this program. NATIVE HEALTH has made civic engagement a priority. We look forward to seeing what other sites are selected for this program and will continue to uplift this work.” – NCUIH CEO, Francys Crevier (Algonquin).

“Voting is a social determinant of health, and we are critical access point to enable our communities to participate in the fundamental civic duty of voting. We are honored to be the first pilot site for this essential program that will make it easier for eligible Native Americans to exercise our right to vote.” Walter Murillo (Choctaw), NCUIH Board President-Elect and CEO of NATIVE HEALTH.

At a recent event, IHS Deputy Director Benjamin Smith (Navajo) stated, “President Biden pledged to designate five Indian Health Service voter registration pilot sites by the end of this calendar year. We are honored to be here and celebrate NATIVE HEALTH as the first to gain National Voter Registration Act designation under the Indian Health Service in alignment with the president’s vision.”

Native Health

About NCUIH
The National Council of Urban Indian Health (NCUIH) is the national non-profit organization devoted to the support and development of quality, accessible, and culturally competent health and public health services for American Indians and Alaska Natives (AI/ANs) living in urban areas. NCUIH is the only national representative of the 41 Title V Urban Indian Organizations (UIOs) under the Indian Health Service (IHS) in the Indian Health Care Improvement Act (IHCIA). NCUIH strives to improve the health of the over 70% of the AI/AN population living in urban areas, by supporting their access to high-quality, culturally-competent care.

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Indian Health Service Launches Voter Registration Pilot Program at Indian Health System Sites

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On March 5, 2023, President Biden announced agency actions to make the voting process more accessible in alignment with recommendations made by the Native American Rights Fund (NARF). This included a new initiative at the Indian Health Service (IHS) piloting “high-quality voter registration services across five different IHS facilities before the end of 2023”.

Urban Indian Organization, Native Health is First Announced Site

The first facility to be announced under this pilot program was Native Health, located in Phoenix, Arizona. Vice President Kamala Harris made the announcement on October 23, 2023, by stating:

Native Health has been active in voting rights and dedicated to increasing Native participation in the voting process. In 2022, they distributed Get Out the Vote information at various events, invited guests for voting related discussions on their podcast, Native Talk Arizona, and highlighted the importance of voter registration through social media. As part of this pilot program and being a NVRA designated site, they will continue this work by ensuring anyone who steps into their clinic is provided with an opportunity to register to vote. This includes staffing their table and voter registration kiosk, which can be found at their Central location.

Presidential Actions Related to Promoting Access to Voting for Native Communities

On March 7, 2021, President Biden signed an Executive Order on Promoting Access to Voting. Within the Executive Order, he included a specific section, Section 10, establishing a Native American Voting Rights Steering Group. This section sets out specific responsibilities and recommendations for that Steering Group, including:

  1. Engaging in meaningful and robust consultation with Tribal Nations and Native leaders
  2. Studying best practices for protecting Native American voting rights and produce a report outlining recommendations, including:
    1. Increasing voter outreach, education, registration, turnout, voting access, and mitigating internet accessibility issues in Native communities;
    2. Increasing language access and assistance;
    3. Mitigating barriers by providing guidance on how to use Tribal government ID cards as valid voter ID cards;
    4. Facilitating collaboration between local election officials, Native communities, and Tribal election offices; and
    5. Addressing other areas identified during the consultation process.

Voting as a Social Determinant of Health

These steps towards protecting voting rights are important outside of the political context because they can have a direct impact on health. Voting as a Social Determinant of Health has been acknowledged by the American Medical Association (AMA), and was included in their resolution from  2022, “Support for Safe and Equitable Access to Voting.” Social Determinants of Health are nonmedical factors that influence health outcomes, often the conditions or systems that shape conditions of daily life.

The AMA has identified that “more voting is associated with better health outcomes.” This is also reflected through research, where it’s noted that health disparities create gaps in voter participation, which influences biased health policy, and reinforces the same health disparities that prevent people from voting. Since voting is a tool to have voices heard about issues and preferred policies, without engagement from all constituents, those with important needs go unheard and are left out of the process. For health, this means the conditions impacting one’s health remain unchanged and continue to lack the political support needed to address them.

Native American Rights Fund Recommended Included Integration with IHS Facilities

Before this announcement, the NARF touched on the issue of obtaining National Voter Registration Act (NVRA) designation, as it has support throughout the Native community. Specifically, NARF noted that “by integrating voter registration services into their regular interactions with patients, IHS and 638-compacting facilities can leverage their significant reach and critical role in Indian country to move us closer to a democracy in which all communities are valued and thrive.”

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Celebrating Native American Heritage Month: NCUIH’s Commitment to Indigenous Health

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Celebrating Native American Heritage Month: NCUIH's Commitment to Indigenous Health

November marks the observance of Native American Heritage Month, a time to honor and celebrate the rich cultures, histories, and contributions of Native American and Indigenous communities. At the National Council of Urban Indian Health (NCUIH), this month holds profound significance as it aligns with our ongoing commitment to supporting the health and well-being of Indigenous populations across the country. NCUIH celebrates Native American heritage every day by holding the federal government responsible for their unmet federal trust responsibility to Native people.

Preserving Heritage through Health Initiatives:

NCUIH plays a pivotal role in advocating for the right to healthcare in urban Indian communities, emphasizing preserving cultural heritage as a crucial aspect of overall well-being. By addressing healthcare disparities and championing policies that prioritize the unique needs of Native Americans, our organization contributes to the preservation of Indigenous heritage.

Cultural Competency in Healthcare:

One of NCUIH’s key initiatives involves promoting cultural competency within the healthcare system. We believe that healthcare services should not only be accessible but also culturally sensitive and responsive to the diverse needs of Native American communities. Through advocacy and collaborative efforts, NCUIH strives to ensure that healthcare providers recognize and respect the cultural contexts that influence the health choices of Indigenous individuals.

Addressing Health Disparities in Urban Native Settings:

As urbanization continues to impact Native American communities, NCUIH works tirelessly to address health disparities that often arise in urban settings. Our initiatives focus on improving healthcare access and mental health services and addressing social determinants of health that disproportionately affect urban Indian populations. By doing so, we contribute to the holistic well-being of individuals while preserving the cultural fabric that defines their identity.

Advocacy for Equitable Policies:

Native American Heritage Month serves as a reminder of the resilience and strength of Indigenous communities throughout history. NCUIH channels this spirit into advocacy efforts aimed at influencing policies that impact the health and wellness of urban Indians. By actively engaging with policymakers, we strive to create an environment where health policies are inclusive and considerate of the unique challenges urban populations face. Read more about our policy priorities here.

The Call to Action:

As we celebrate Native American Heritage Month, NCUIH invites individuals and organizations to join us in our commitment to the health and well-being of indigenous communities. By fostering awareness, advocating for equitable policies, and supporting culturally competent healthcare, we can collectively contribute to preserving and celebrating Native American heritage. Now is a poignant time to reflect on the importance of organizations like NCUIH in ensuring that the health needs of indigenous populations are acknowledged and met. Together, let us honor the resilience and contributions of Native American communities by continuing to advocate for their health and well-being.

Help support our vital work by making a tax-deductible donation here.

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