House Passes NCUIH-Endorsed Bipartisan Bill that Improves Home and Community-Based Services for Native Veterans, Includes Collaboration with Tribal Programs and Urban Indian Organizations

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On December 5, 2023, the House passed the National Council of Urban Indian Health (NCUIH)-endorsed legislation, the Elizabeth Dole Home-and Community-Based Services for Veterans and Caregivers Act of 2023 (H.R. 542) with a vote of 414-5. The bill has now been received in the Senate. The original sponsor, Rep. Julia Brownley (D-CA-26) reintroduced this bipartisan legislation on January 26, 2023, which would direct the Department of Veterans Affairs (VA) to expand options for long-term home and community services. The bill also directs the VA to collaborate with the Director of the Indian Health Service (IHS) and representatives from tribal health programs and Urban Indian Organizations (UIOs) to ensure the availability of home-and community-based services for Native American veterans, including Native American veterans receiving health care and medical services under multiple health care systems. The bill currently has 63 Democrat and 13 Republican co-sponsors.

Specifically, the bill expands existing Home and Community Based Services (HCBS):

  1. The Veteran Directed Care Program, which provides veterans a flexible budget to hire friends, family, and neighbors to help with activities of daily living, such as bathing, or instrumental activities of daily living, such as making meals.
    1. The bill directs the VA Secretary to ensure the availability of the program for eligible veterans who are Native American veterans receiving care and services furnished by the Indian Health Service, a tribal health program, an Urban Indian organization, or (in the case of a Native Hawaiian veteran) a Native Hawaiian health care system, to the extent practicable.
  2. The Homemaker and Home Health Aide Program, which allows VA to contract with a community partner that employs home health aides to care for veterans in their homes, providing skilled services, case management, help with daily living, or to ease caregiver burnout.
  3. The Home-Based Primary Care Program, which allows for a VA physician to supervise a health care team that provides care in the veteran’s home for a veteran who has difficulty traveling or is isolated.
  4. The Skilled Home Health Care Program, which allows for VA to contract with a community health agency to provide in-home care for veterans who have higher levels of need like wound care, speech therapy, or skilled nursing.

“Every veteran should have the right to a peaceful and dignified life after their service to our country, and every veteran should have the right to stay in their home and receive the care they need, the care they have earned, and the care they deserve.” – Congresswoman Julia Brownley (D-CA)

Background on Native Veterans

Native Veteran Disparities 

Native veterans have served in the United States military in every armed conflict in the Nation’s history and have traditionally served at a higher rate than any other population in the United States. Unfortunately, Native veterans suffer significant disparities when they transition to civilian life. For example, Native veterans are more likely to be uninsured and have a service-connected disability than other veterans. Native veterans suffer these disparities no matter where they live. Native veterans living in urban areas experience the same poor physical and mental health outcomes as Native veterans in rural areas. In addition, urban Native veterans generally have lower incomes, higher unemployment, lower education attainment, higher VA-service connected disability, and generally live in poorer housing conditions than non-Native urban veterans.

Urban Indian Organizations Provide Culturally Competent Care for Native Veterans

UIOs are essential partners in serving Native veterans and are vital to improve care and access to services for Native veterans because of their deep ties to the Native community in urban areas. UIOs currently serve seven of the ten urban areas with the largest Native veteran populations, including the following areas: Phoenix, Arizona; Los Angeles, California; Seattle, Washington; Dallas, Texas; Oklahoma City, Oklahoma; New York City, New York; and Chicago, Illinois.

UIOs are uniquely positioned to assist the VA in improving culturally competent healthcare access for Native people. As such, this partnership has the potential to improve the quality of care and well-being to Native veterans in urban areas, but it is also consistent with the United States’ trust responsibility to provide services and resources to improve the health of all Native people.

Next Steps

This bill has been received in the Senate. NCUIH will continue to monitor the bill’s progress.

PRESS RELEASE: NCUIH CEO and Helena Indian Alliance Honored with IHS Director’s Special Recognition Awards in Urban Leadership

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FOR IMMEDIATE RELEASE

WASHINGTON, D.C. (December 13, 2023) – On December 8, 2023, the Indian Health Service’s Director’s Award Committee honored the National Council of Urban Indian Health’s (NCUIH) CEO, Francys Crevier J.D. (Algonquin) and the Helena Indian Alliance with the 2022 Director’s Special Recognition Award in Urban Leadership.

Pictured L to R: Andrea Palm, Deputy Secretary of the Department of Health and Human Services (HHS), Francys Crevier, NCUIH CEO, and Roselyn Tso, Director of the Indian Health Service

Pictured L to R: Andrea Palm, Deputy Secretary of the Department of Health and Human Services (HHS), Francys Crevier, NCUIH CEO, and Roselyn Tso, Director of the Indian Health Service

“I am grateful for the 2022 Director’s Special Recognition Award, which recognizes the tireless efforts of the National Council of Urban Indian Health in advocating for the health and rights of Indigenous communities. This award is not just a personal achievement but a symbol of the collective impact we can make when we work together. Our Urban Indian Organizations, Tribes, and Tribal organization partners have been integral to our movement. I share this honor with our partners, our dedicated team, and the entire Native community living in urban areas as we continue our mission to foster positive change and ensure equitable access to health care.” – NCUIH CEO Francys Crevier (Algonquin)

The Urban Leadership Award recognizes Ms. Crevier’s dedication to advocating for the rights of Indigenous people, better health care in Indian Country, and previously representing Tribes as an in-house counsel. Francys has been instrumental in steering NCUIH’s mission forward for the betterment of health care in Indian Country and championing the rights of Indigenous communities to ensure a healthier seven generations. The award highlights the significance of urban Native advocacy and marks a milestone in the ongoing journey towards equitable health care and justice for Indigenous communities.

Alongside Francys, Todd Wilson (Crow), a distinguished NCUIH board member and executive director of the Helena Indian Alliance in Montana, accepted an Urban Leadership Award on behalf of the Helena Indian Alliance for its outstanding contributions to urban leadership. Mr. Wilson has played a pivotal role in advocating for the rights and well-being of Indigenous communities, demonstrating exceptional dedication to improving health care in Indian Country. His leadership at the Helena Indian Alliance showcases a commitment to improving health care for urban Native populations. Kevin Sandoval, HIM/IT coordinator at the Helena Indian Alliance, won an IHS Director’s Special Recognition Award.

Pictured: Mike Touchette, Helena Indian Alliance (HIA) board chair, Francys Creier, NCUIH CEO, Todd Wilson, HIA executive director, Renee Parsley, HIA board vice chair, and Jason Smith, HIA board treasurer

Pictured: Mike Touchette, Helena Indian Alliance (HIA) board chair, Francys Creier, NCUIH CEO, Todd Wilson, HIA executive director, Renee Parsley, HIA board vice chair, and Jason Smith, HIA board treasurer

Pictured: Kevin Sandoval, Health Information Management/ IT Coordinator at Helena Indian Alliance

Pictured: Kevin Sandoval, Health Information Management/ IT Coordinator at Helena Indian Alliance

This prestigious award follows the recognition bestowed upon Carmelita Skeeter, CEO of the Indian Health Care Resource Center of Tulsa, in 2018. NCUIH remains steadfast in its dedication to enacting positive change and advocating for the rights and well-being of urban Native populations across the United States.

The Director’s Special Recognition Award serves as both validation and inspiration, propelling NCUIH to continue its unwavering commitment to transformative advocacy and enhancing health care access for all Indigenous communities. NCUIH extends its congratulations to Ms. Crevier, Mr. Sandoval, and the Helena Indian Alliance for this well-deserved recognition and significant contributions to Indian country!

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 a national representative advocating for 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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NCUIH Contact: Meredith Raimondi, Vice President of Policy and Communications, mraimondi@ncuih.org, 202-417-7781

PRESS RELEASE: NCUIH Applauds Bipartisan Reintroduction of the Urban Indian Health Parity Act

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FOR IMMEDIATE RELEASE

WASHINGTON, D.C. (November 30, 2023) – On November 30, 2023, Representative Ruiz (D-CA-25) and Representative Bacon (R-NE-02) reintroduced the bipartisan Urban Indian Health Parity Act, which would amend the Social Security Act to set the federal medical assistance percentage (FMAP) at 100% for services provided to Medicaid beneficiaries at urban Indian organizations (100% FMAP for UIOs). This vital provision will help expand access to necessary health services for American Indian and Alaska Native families and children and ensure the federal government is better fulfilling its trust responsibility.

States have received 100% FMAP for services provided to IHS/Medicaid beneficiaries at Indian Health Service and Tribal facilities for decades, and UIOs have advocated for parity through legislation since 1999. Extending 100% FMAP to UIOs will require the federal government to bear the cost of Medicaid services provided to AI/ANs no matter which facet of the Indian health system they utilize, as is required by the trust responsibility. Parity for UIOs will support UIOs in working with their states to improve the Medicaid program for the 46% of Native patients seen at UIOs who are Medicaid beneficiaries.

“We applaud Representatives Ruiz and Bacon for this bipartisan effort to ensure that the federal government honors its trust responsibility to Native people and improves health outcomes that are desperately needed. With broad support from Indian Country, we are hopeful that Congress will move forward with ending this inequity to expand resources for communities that benefit from the necessary services provided by urban Indian organizations and all Indian Health Care Providers,” said Francys Crevier, CEO of NCUIH.

NCUIH recently released a report highlighting the importance of 100% FMAP, which includes case studies of two states, Washington and Montana, that successfully utilized the American Rescue Plan Act’s (ARPA) temporary authorization of 100% FMAP for UIOs to increase funding support for their UIOs. It also provides an extensive history of 100% FMAP in the Indian health care system.

Read the Press Release from Rep. Ruiz and Rep. Bacon here: Congressman Ruiz, Bacon Introduce Legislation to Address the Health Disparities in Native American Communities

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 that lives in urban areas, supported by quality, accessible health care centers.

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NCUIH Contact: Meredith Raimondi, Vice President of Policy and Communications, mraimondi@ncuih.org, 202-417-7781