April Policy Updates: Take Action to Increase IHS Funding and More

In this Edition:

🗓 Take action to ask Congress for increased funding for the Indian Health Service.

🌍 Mark your calendars for upcoming meetings and comment opportunities.

🚀 Learn about our recent advocacy efforts.

Action Alert: Contact Congress to Increase Funding for Indian Health TODAY

Contact Congress

We need your help contacting Congress to support access to health care for urban Native communities!

Representatives Ruben Gallego (D-AZ-03) and Raúl Grijalva (D-AZ-07) are leading a letter to the leadership of the Appropriations Subcommittee on Interior, Environment, and Related Agencies.

The letter calls for the highest possible funding for Urban Indian Health and Indian Health Service and recommends funding at $965.3 million and $53.85 billion, respectively.

  • These amounts reflect the recommendations made by the Tribal Budget Formulation Workgroup.
  • The letter also calls for advance appropriations for IHS for FY 2026 and protection against sequestration in the final FY 2025 spending bill.
  • To ensure that the Indian Health Service receives as much support as possible, we encourage you to contact your Member of Congress and request that they sign on to the Gallego-Grijalva Urban Indian Health letter.

Go deeper and find the text of the letter to send: Action Alert: Contact Congress to Increase Funding for Indian Health TODAY


NCUIH Participates in Congressional Roundtable to Advocate for Native Veterans

Francys and Sonya

NCUIH was invited to participate in a roundtable to discuss critical health care issues facing urban Native veterans.

Go deeper: On April 16, Sonya Tetnowski, CEO of Indian Health Center of Santa Clara Valley and NCUIH Board President, attended a roundtable hosted by the House Committee on Veterans Affairs.

  • The roundtable discussed issues facing Native veterans, equity in access to healthcare and benefits for veterans, and the state of cultural competency at the VA and community care providers.

Why it matters: NCUIH was able to discuss the importance of traditional healing for Native veterans and ensure that Congress understands the importance of the trust obligation for health care owed to all Native people, including our veterans.

New Resource: 2024 Policy Priorities Released

Policy Priorities

2024 Policy Priorities

The National Council of Urban Indian Health is pleased to announce the release of its 2024 Policy Priorities document.

  • It outlines a summary of urban Indian organization (UIO) priorities for the Executive and Legislative branches of the government for 2024.
  • These priorities were informed by NCUIH’s 2023 Policy Assessment.

NCUIH hosted five focus groups to identify UIO policy priorities for 2024, 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 2024 under eight themes.

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The document contains talking points and recommendations for each priority.

Go deeper: Read the full priorities and the overview document.

NCUIH in Action: CEO Speaks at Native Youth Policy Panel

USET Native Youth

On April 26, Francys Crevier (Algonquin), JD, CEO was honored to join an impactful event with Native high school students organized by the Close Up Foundation in partnership with United South and Eastern Tribes.

  • Francys joined an action expert panel, emphasizing the importance of involving youth in policy advocacy to address pressing community issues.
Emily

NCUIH Policy Analyst Emily Larsen at Budget Consultation.

On April 9 and 10, NCUIH represented Urban Indian Organizations at the Health and Human Services 26th Annual Tribal Budget Consultation.

Congressional Updates: FY25 American Indian and Alaska Native Witness Day and FY24 Health Budget News

Congress dealing with surprise medical bills

On May 8, 2024, Todd Wilson, Executive Director of Helena Indian Alliance-Leo Pocha Clinic and NCUIH board member, will be NCUIH’s witness for the House Appropriations Committee’s American Indian and Alaska Native Witness Days.

What else?: On March 22, Congress passed the remaining 6 appropriations bills to fund the government for FY24.

  • The Labor-Health and Human Services appropriations bill is included in this package.

Some highlights include:

  • $6 million creation of an Initiative for Improving Native American Cancer Outcomes that includes Urban Indian Organizations.
  • Level funding for HIV funding, including maintaining $5 million for the Tribal Set-aside for the Minority HIV/AIDS Prevention and Treatment program.

Monitoring the Bench: Becerra v. San Carlos Apache/Becerra v. Northern Arapaho Tribe (Consolidated)

Illustration of two gavels forming an x in front of the Supreme Court building

Why it matters: This issue relates to federal responsibility to pay “contract support costs” to Tribes not only to support IHS-funded activities, but also to support the Tribe’s expenditure of third-party income.

What else?: NCUIH joined the Amicus Brief filed by the National Indian Health Board on February 19.

Did you know?: The oral Argument occurred March 25.

Go deeper: The Court appeared split on whether the federal government should be responsible. There is no good prediction for the outcome at this point

What’s next: Decision to be released by June 30, 2024.

Federal Update: Medicaid Coverage of Traditional Healing at IHS and Tribal Facilities

Illustration of an x-ray with a broken red cross that reads "Indian Health Service"

The Centers for Medicare and Medicaid Services (CMS) are seeking feedback on a proposed Traditional Healing Framework for section 1115 demonstrations.

  • CMS is seeking advice and input on the scope of coverage of traditional health care practices that could be provided at IHS and tribal facilities, recommendations on provider qualifications, and monitoring and evaluation criteria.
  • Through section 1115(a) demonstration authority, CMS can provide expenditure authority allowing a state to claim federal funding for new services not otherwise coverable under Medicaid.
  • CMS recently provided an overview of the section 1115(a) demonstration process and a high-level overview of the four pending demonstration proposals to cover traditional health care practices.
  • CMS discussed its framework for potential coverage of traditional health care practices, consistent with the authorities in the Indian Health Care Improvement Act.

Go deeper: The presented Framework does not include UIOs as eligible facilities under the proposed framework.

What’s New?: To allow more time for comments, the comment period has been extended to COB Friday, May 3, 2024.

Upcoming Events

NCUIH

April 29-May 2: NCUIH Annual Conference 2024 in Washington, D.C.

May 7-8: House Interior Appropriations AI/AN Public Witness Day in Washington, D.C.

May 9: Tribal Consultation & Urban Confer Health IT Modernization Program: Deployment and Cohort Planning (Virtual)

Thank you for your advocacy and leadership! We look forward to seeing you in Washington, DC soon at our conference!

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NCUIH Signs Partners in Health and Association of Indian Physicians Letter Requesting $30 Million to Address Chronic Clinical Staff Shortages in Indian Country

On March 14, 2024, the National Council of Urban Indian Health (NCUIH) joined Partners in Health and 22 other organizations and institutions in sending a letter to House and Senate Interior-Environment Appropriations Subcommittee Leadership expressing support for the inclusion of $30 million in additional funding for the Fiscal Year (FY) 2025 Interior, Environment, and Related Agencies appropriations bill to support the graduate medical education (GME) programs. GME programming addresses urgent physician vacancy rates in the Indian Health Service (IHS) Facilities/Tribally Operated Programs/Urban Indian Organizations (I/T/U) system through funding to recruit, train, and retain health care workers.

IHS GME Programs vs. Other Government Agencies

Currently, IHS does not receive any funding for a GME program. The chart below shows the funding given to other federal agencies for their respective GME programs.

Agency Full-time GME trainees or rotation slots Annual GME budget line Annual funded trainees located at or partnered with I/T/Us
Indian Health Service 0 $0 0
Health Resources and Service Administration: Teaching Health Center Graduate Medical Education Program (mandatory) 932 (AY22) $119 million (FY23) 69 (6 programs)
Health Resources and Services Administration: Children’s Hospitals Graduate Medical Education Program 8,244 (FY21) $385 million (FY23) 0
Veterans’ Health Administration 12,000 slots with 6 rotators per year [75,000 trainees) $874 million (FY23) 0 (the 2018 MISSION Act Pilot Program on Graduate Medical Education and Residency Program set to train 100 individuals)
Centers for Medicaid and Medicare Services: Medicare (mandatory) 98,542 (FY20) $16.2 billion (FY20) 6 (1 program)
44 states: Medicaid No exact figure $7.39 billion (2022) 2 (1 program)
Department of Defense 1,455 No exact figure 0
National Total 144,660 (2021) $25 billion 77 (8 programs)

Importance of Staff Increases at UIOs

The Government Accountability Office has reported that the IHS has a 25% vacancy rate for health care providers. This issue is felt by Urban Indian Organizations (UIOs). Chronic underfunding of IHS has created challenges for UIOs to recruit and retain providers due to an already limited workforce with experience serving in American Indian and Alaska Native (AI/AN) communities. Expansion of the GME program would create more opportunities to fill gaps in staffing at UIOs, fulfilling the federal trust responsibility to provide quality healthcare to AI/AN people.

Full Text of the Letter

Dear Chairs Simpson and Merkley and Ranking Members Pingree and Murkowski,

We, the undersigned organizations and individuals, write in support of the inclusion of $30 million in new funding in the FY2025 Interior, Environment, and Related Agencies appropriations bills to address chronic clinical staff shortages across Indian Country through graduate medical education (GME) programming. Such funding should be made available to Indian Health Service facilities, Tribally Operated “638” Programs (under P.L. 93-638), and Urban Indian Organizations, collectively referred to as I/T/Us. We support funding for (1) developing and financing physician residency programs, including (A) fully accredited multiyear programs and (B) month-long clinical experiences for medical trainees; (2) developing and financing physician post-residency fellowship programs; and (3) coordinating GME efforts across I/T/Us. These proven interventions to recruit, train, and retain health care workers would help reduce chronic provider shortages across Indian Country. We view these targeted interventions for physician shortages as part of a broader response to workforce shortages across health professions.

Our request here echoes the urgent requests from a variety of key stakeholders. Congress requested a 2018 GAO Report on provider vacancies, which describes the role of GME programs in fulfilling workforce needs (pp. 28, 33, 44-46). The Indian Health Service FY2024 Congressional Budget Justification (p. 57) and FY2023 Justification requested new funding for GME programming. The FY2025 National Tribal Budget Formulation Workgroup’s Request identifies the need for GME programming, e.g., from the Great Plains Area (p. 120) and the Oklahoma City Area (p. 183). The National Indian Health Board’s 2023 Legislative and Policy Agenda for Indian Health (p. 9) calls for specific investments in graduate medical education staffing and infrastructure in Indian Country. Congress explicitly authorized this programming in the Indian Health Care Improvement Act (1616c. Tribal recruitment and retention program and 1616p. Health professional chronic shortage demonstration programs).

Physician vacancy rates were as high as 46% in 2018 across IHS regions (The Indian Health Service and the Need for Resources to Implement Graduate Medical Education Programs, JAMA, 2022; GAO-18- 580). Physician shortages across Indian Country have been attributed to limited recruitment incentives, lower salaries, lengthy hiring processes, and geographic isolation.

(1A) Accredited, multiyear physician residency programs are important for recruiting and retaining physicians to underserved areas. Physicians who train in rural environments are much more likely to stay and work there over the long-term. Although USG invests billions in residency training programs across Medicare, Medicaid, HRSA, VA, and DOD, there are only six established, accredited residency programs across I/T/Us. There is high demand from I/T/U hospitals and prospective residents, including AI/AN trainee who have participated in the USG-funded Indians Into Medicine (INMED) program, to establish additional programs, especially in primary care specialties. Developing and accrediting a residency program is a multiyear process with many steps, and funding to IHS would both fill important gaps in current financing from other federal agencies and enable the creation of new programs across I/T/Us. Discretionary appropriations to HRSA’s Rural Residency Planning and Development (RRPD), Teaching Health Center GME (THCGME), and Primary Care Training and Enhancement (PCTE-RTPC) programs have been productive, with notable impacts on tribal health workforce development. However, this funding does not meet the volume of need, nor does it include additional costs specific to I/T/U program needs. As an example of per-program-cost, HRSA RRPD awards $750,000 over a three-year implementation period for recruitment, faculty development, and accreditation. Residency programs under CMS vary in per-resident reimbursement, but HRSA THCGME program caps total funding at $160,000 per resident. Examples of leading residency programs across I/T/Us include: the IHS Shiprock– University of New Mexico Family Medicine Program, the Chickasaw Nation Family Medicine Residency, and the Seattle Indian Health Board Family Medicine Residency Program.

(1B) Clinical experiences in month-long supervised rotations across I/T/Us provides an important entry point for new physicians to serve in Indian Country. In Rosebud and Navajo Nation, these rotations have recruited physicians who have stayed to serve in permanent staff roles. While these rotations currently occur with limited regional coordination between academic medical centers, I/T/Us, and IHS staff, this system could be coordinated and scaled significantly with financial support from Congress. IHS is the only large federal health system to lack formalized partnerships with academic medical centers. This gap hinders the ability to recruit and retain physicians across I/T/Us. The Veterans Health Administration, in comparison, has had 75 years of active partnership with teaching hospitals through its Office of Academic Affiliations. The VHA 2023 budget of $873.5 million for GME will support 75,000 individual trainees and nearly 12,000 GME positions. Academic partnerships provide many benefits, including stability, shared faculty, clinical, and research staff, and a wealth of experience. Virtually all of VHA GME programming is sponsored by an academic affiliate, and 99% of medical schools are affiliated with VHA. This model should be replicated with I/T/Us.

(2) Post-residency 1-2 year physician fellowship programs have been an important source of high-quality primary care physician recruitment across Indian Country, with notable impacts on reducing vacancies in Navajo Nation, South Dakota, and Alaska. These fellowship programs include supported clinical training and mentorship that taps into the resources and clinical excellence of leading academic medical centers, such as Massachusetts General Hospital, University of California San Francisco, University of Washington, Icahn School of Medicine at Mount Sinai, and the University of Utah. Fellows cost significantly less than locum tenens staffing solutions, while providing the necessary resources to properly integrate and support new physicians into communities of care. Fellowship costs include fellow salary and benefits, travel, housing, professional development, licensing, insurance, recruiting, administration, and faculty time—up to $220,000 per fellow per year. The HEAL Fellowship, a partnership between Navajo Nation and the University of California San Francisco that began in 2015, has recruited and retained two dozen primary care physicians to stay and serve in Navajo Nation. All graduates from the University of Washington Global and Rural Health Fellowship have thus far remained in full-time clinical service across I/T/Us. These successes provide a strong case for scaling up fellowships.

(3) Additional funding could greatly improve the coordination of GME programs across I/T/Us and support IHS working closely with academic medical centers and key agencies such as CMS, HRSA, and VHA. Given the longstanding precedent across I/T/Us of regional coordination and local self-governance, funding should be made available for GME coordination at multiple levels of governance.

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Action Alert: Contact Congress to Increase Funding for Indian Health TODAY

Dear Advocates,

We need your help contacting Congress to support access to health care for urban Native communities!

Representatives Ruben Gallego (D-AZ-03) and Raúl Grijalva (D-AZ-07) are leading a letter to leadership of the Appropriations Subcommittee on Interior, Environment, and Related Agencies.

The letter calls for the highest possible funding for Urban Indian Health and Indian Health Service and recommends funding at $965.3 million and $53.85 billion, respectively.   These amounts reflect the recommendations made by the Tribal Budget Formulation Workgroup. The letter also calls for advance appropriations for IHS for FY 2026 and protection against sequestration in the final FY 2025 spending bill. To ensure that Urban Indian Organizations receive as much support as possible, we encourage you to contact your Member of Congress and request that they sign on to the Gallego-Grijalva Urban Indian Health letter.

You can use the text below as a template to call and/or email your Representative. If you can please, call and email your representative. You can find your representative here.

Thank you for your leadership. Your outreach on this is invaluable to providing greater access to health care for American Indians and Alaska Natives in urban areas.

Sincerely,
The National Council of Urban Indian Health

Ways to Advocate

  • Contact Congress
  • Post on Facebook

CONTACT CONGRESS

Step 1: Copy the email below.
Step 2: Find your representative here.
Step 3: Go to their website and click contact.
Step 4: Paste the email into the form and send. Please contact Meredith Raimondi (policy@ncuih.org) with questions.

Email to Your Representative

Dear Representative [NAME],

As an urban Indian health advocate, I respectfully request you sign on to the Gallego-Grijalva letter to the House Committee on Appropriations in support of increasing funding for the Indian Health Service and the Urban Indian Health line item for FY25.

Urban Indian Organizations (UIOs) provide essential healthcare services to patients from over 500 Tribes in 38 urban areas across the United States. As an integral part of the Indian health care delivery system, UIOs rely on funding from the Indian Health Service (IHS) to provide care to American Indian and Alaska Native people living in urban areas. UIOs depend on scarce federal resources to provide services to their American Indian and Alaska Native patients. The Urban Indian Health line item historically makes up only one percent (1%) of IHS’ annual appropriation and UIOs often only receive direct funding from the Urban Indian Health line item. Without a significant increase to the Urban Indian Health line item, UIOs will continue to be forced to operate on limited and inflexible budgets, that limit their ability to fully address the needs of their patients.

The letter calls for the highest possible funding for the Indian Health Service and the Urban Indian Health line item and recommends funding at $53.85 billion and $965.3 million, respectively, and requests that the committee to maintain advance appropriations for FY2026, and to protect IHS from sequestration in the final FY 2025 spending bill. I respectfully ask that you help honor the Federal trust obligation to provide health service to American Indian and Alaska Natives, no matter where they live by signing on to this letter.

Sign on to the letter by reaching out to Emma Reidy (emma.reidy@mail.house.gov) with any questions.

Thank you for your leadership and your commitment to urban Indian health.

Sincerely,
[contact information]

POST ON SOCIAL MEDIA

Facebook

Post your support on your Facebook.

Example post:

We need your help to support urban American Indian and Alaska Native communities! Urban Indian Organizations provide essential healthcare services to American Indian and Alaska Native patients from over 500 Tribes in 38 urban areas across the United States. Call on your Representative TODAY and urge them to sign on to the Gallego-Grijalva Urban Indian Health funding letter.

 

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

 

NCUIH Supports Tribal Sovereignty

NCUIH respects and supports Tribal sovereignty and the unique government-to-government relationship between our Tribal Nations and the United States. NCUIH works to support those federal laws, policies, and procedures that respect and uplift Tribal sovereignty and the government-to-government relationship. NCUIH does not support any federal law, policy, or procedure that infringes upon, or in any way diminishes, Tribal sovereignty or the government-to-government relationship.

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Veterans Affairs Publishes Final Rule Confirming UIO Eligibility for Placement of Graduate Medical Students

On November 13, 2023, the Department of Veterans Affairs (VA) adopted as final, with changes, a proposed rule amending its medical regulations to establish a new pilot program on graduate medical education and residency (PPGMER), as required by the VA MISSION Act of 2018. The PPGMER is designed to help expand health care access for Veterans in rural, tribal, and underserved areas across the country. It will do so by funding physician residents’ clinical rotations in non-VA health care facilities, prioritizing facilities operated by Indian Tribes or tribal organizations, and the Indian Health Service. No fewer than 100 residents will be placed in these facilities as well as facilities located in communities that the VA Secretary has designated as underserved. The proposed rule provides a framework to establish additional medical residency positions at certain covered facilities. In issuing the final rule, VA stated that § 17.245(f) of the rule already allows VA to consider UIOs as covered facilities for the purposes of PPGMER. Placement of residents at UIOs would be in addition to those residents at IHS and Tribal facilities.

Please click here for the news release announcing the PPGMER.

 

For more information about the PPGMER, contact Andrea Bennett, Office of Academic Affiliations, Veterans Health Administration, Department of Veterans Affairs, at (202) 368–0324 or VAMission403Help@va.gov.

Next Steps

VA will issue a request for proposals (RFP) in Summer 2024 to solicit the interest of graduate medical education (GME) sponsoring institutions and interested health care facilities to partner in establishing resident rotations beginning in July 2025. The Office of Academic Affiliations will hold information sessions for relevant stakeholders about the RFP process prior to its release. UIOs are urged to follow the development of this program closely for its potential to relieve workforce shortages through the placement of medical residents.

We will continue to monitor ongoing implementation of the VA PPGMER and provide updates on how the program impacts urban Indian communities.

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Congress Approves Final Six Spending Bills for FY 2024, Includes Funding for Native Cancer Initiative and UIO Behavioral Health Project Funding

The bill includes $116.8 billion for HHS—a $995 million increase, and $6 million for new Improving Native American Cancer Outcomes Initiative.

On March 23, 2024, the Further Consolidated Appropriations Act, 2024 (H.R.2882), also known as a ‘minibus,’ was signed into law by President Biden, finalizing appropriations for the remaining six spending accounts for fiscal year (FY) 2024. This follows the  passage of the Consolidated Appropriations Act, 2024 on March 8, that finalized the first six spending accounts, including the Interior appropriations bill. The bill, which passed in the House with a 286-134 vote, followed by final passage in the Senate with a 72-24 vote, is the final package of final spending bills for FY 2024 and included Labor, Health, and Human Services (LHHS) appropriations.

The minibus appropriates $116.8 billion for the Department of Health and Human Services (HHS) for FY 2024, which is $995 million above the comparable FY 2023 level; $7.4 billion for Substance Abuse and Mental Health Services Administration (SAMHSA) for FY 2024, which is $19 million above the FY 2023 enacted level; and $8.9 billion for Health Resources and Services Administration (HRSA), an increase of $54 million compared to FY 2023 enacted levels. Despite tight budget constraints, there were modest increases and protection of current funding levels for key programs in HHS.

UIOs Included in Improving Native American Cancer Outcomes Initiative

The LHHS spending bill appropriates $6 million to Improving Native American Cancer Outcomes, which creates the Initiative for Improving Native American Cancer Outcomes. The bill directs the National Institute on Minority Health and Health Disparities to locate the Initiative at an NCI-designated cancer center demonstrating strong partnerships with Tribes, Tribal Organizations, and urban Indian organizations, to ultimately improve the screenings, diagnosis, and treatment of cancer for Native patients. NCUIH was proud to successfully advocate for the inclusion of UIOs in this critical program for all Native communities.

Protection of HIV/AIDS Funding

Congress successfully protected funding for HIV/AIDS prevention and treatment. The LHHS bill protected critical funding sources for key programs that work to improve health outcomes for Native communities, such as $2.6 billion for the Ryan White HIV/AIDS program, $165 million for Ending the HIV Epidemic, and $60 million for the Minority HIV/AIDS Prevention and Treatment Program, which includes a $5 million Tribal set-aside. Despite threats to cut funding to this vital program, Congress was ultimately able to save the Ryan White HIV/AIDS program, saving thousands of lives across the country. This program provides grants to eligible entities, including UIOs, to aid in the prevention and treatment of HIV/AIDS.

Native H.E.A.L. Program Funding Secured

The Labor, Health, and Human Services bill also provided Native American Lifelines of Boston Community Project Funding to create the Native H.E.A.L. program. This funding will allow Native American Lifelines of Boston (NAL) to engage in activities focused on the behavioral health needs of Urban American Indians in Massachusetts by providing culturally informed education on opiates, medication-assisted treatment (MAT), harm reduction strategies and/or risk factors related to opiate use disorder. Senator Warren and Senator Markey are strong supporters of NAL Boston and were critical in securing this Community Project Funding NAL Boston.

Bill Text:

Overview of Labor, Health, and Human Services Funding:

Table

Line Item FY 2023 Enacted FY 2024 President’s Budget Request FY 2024 House Passed FY 2024 Senate Passed FY 2024 Enacted
Health Resources and Services Administration   $9.7 billion $9.47 billion $7.5 billion $9.14 billion $8.9 billion
Substance Abuse and Mental Health Services Administration   $7.5 billion $10.6 billion $7.28 billion $7.7 billion $7.4 billion
National Institute of Health $47.5 billion $50.77 billion $45.12 billion $49.2 billion $48.6 billion
Centers for Disease Control   $9.2 billion $11.64 billion $7.59 billion $7.77 billion $9.2 billion

Analysis:

Health Resources and Services Administration

  • $8.9 billion for HRSA for FY 2024
  • $2.6 billion for the Ryan White HIV/AIDS program for FY 2024
  • $165 million for Ending the HIV Epidemic
  • $365 million for Rural Health Programs
  • $27 million for Native Hawaiian Health Care
  • $128.6 million for National Health Service Corps
  • $1 million for Center of Excellence for Eating Disorders – Screening and Referrals

Centers for Disease Control and Prevention

  • $24 million for Good Health and Wellness in Indian Country for FY 2024

Office of the Secretary – General Departmental Management 

  • $60 million for the Minority HIV/AIDS Prevention and Treatment Program
    • $5 million Tribal set-aside within the Minority HIV/AIDS Prevention and Treatment program

Substance Abuse and Mental Health Services Administration

  • $7.4 billion for SAMHSA for FY 2024
  • $4.2 billion for Substance Use Services for FY 2024
  • $237 million for Substance Abuse Prevention Services
  • $986.5 million for Mental Health Block Grant for FY 2024
  • $520 million for 988 Implementation and Behavioral Health Crisis Services
  • $130 million for Childrens Mental Health Services
  • $1.93 billion for Substance Use Prevention, Treatment, and Recovery Service Block Grants
  • $1.58 billion for State Opioid Response Grants
  • $23.67 million for Tribal Behavioral Health Grants

National Institute on Minority Health and Health Disparities

  • $6 million for Improving Native American Cancer Outcomes
  • $4 million for a Native Hawaiian/Pacific Islander Health Research Office

Important Behavioral and Mental Health Provisions (Restoring Hope For Mental Health And Wellbeing)

  • $14.5 million for grants for Tribes and Tribal Organizations for Medication-Assisted Treatment for Prescription Drug and Opioid Addiction
  • $14 million for Peer-Supported Mental Health Services
  • $15 million for Infant and Early Childhood Mental Health
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NCUIH 2024 Policy Priorities Released

NCUIH 2024 Policy Priorities

The National Council of Urban Indian Health (NCUIH) is pleased to announce the release of its 2024 Policy Priorities document, which outlines a summary of urban Indian organization (UIO) priorities for the Executive and Legislative branches of the government for 2024. These priorities were informed by NCUIH’s 2023 Policy Assessment.

NCUIH hosted five focus groups to identify UIO policy priorities for 2024, 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 2024 under eight themes: full funding for native health initiatives, elevating native voices and fostering dialogue, building health equity, honoring promises to native veterans, embracing traditional healing and behavioral wellness, healing generational trauma and protecting native lives, addressing workforce recruitment and retention challenges, and improving the Indian Health Service.

2024 Policy Priorities:

FULL FUNDING FOR NATIVE HEALTH INIATIVES

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

  • Support the Tribal Budget Formulation Workgroup Request of $53.85 billion for IHS and $965.25 million for the Urban Indian Line Item for FY 2025.
  • Support Participation and Continued Inclusion of Urban Indian Organizations in the IHS Budget Formulation Process.

Protect Funding for Native Health from Political Disagreements

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

Meeting the Trust Obligations for IHS-Medicaid Beneficiaries Receiving Services at Urban Indian Organizations

  • Enact the Urban Indian Health Act (H.R. 6533) to Ensure Permanent Full (100%) Federal Medical Assistance Percentage (FMAP) for Services Provided at UIOs (100% FMAP for UIOs).

Supporting Native Communities

  • Support Native Communities by Passing the Honoring Promises to Native Nations Act.

ELEVATING NATIVE VOICES AND FOSTERING DIALOGUE

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

  • Increase the Department of Health and Human Services Engagement with Urban Indian Organizations through Urban Confer Policies.
  • Establish an Urban Confer Policy at the Department of Veterans Affairs (VA).
  • Better Serve Urban Native Populations by Establishing an Urban Indian Organization Interagency Workgroup.

Make All Native Voices Heard: Ensuring Equitable Access to Voting

  • Protect and Expand Access to Voting by Reintroducing the Native American Voting Rights Act.

Inclusion of Urban Native Communities in Resource Allocation

  • Ensure Critical Resource and Funding Opportunities are Inclusive of Urban Native Communities and the Urban Indian Organizations that Help Serve Them.

Continuity in Urban Indian Organization Support from the Indian Health System

  • Improve Area Office Communication and Consistency.

BUILDING HEALTH EQUITY: ADDRESSING SOCIAL DETERMINANTS OF HEALTH

Improving Native Maternal and Infant Health

  • Strengthen the Ability of the Advisory Committee on Infant and Maternal Mortality to Address Native Maternal and Infant Health.
  • Increase the Federal Engagement with Urban Indian Organizations through Urban Confer on the Provision of Health Care to Native Mothers and Infants.
  • Ensure Critical Investments in Native Maternal Health by Passing the Black Maternal Health Momnibus Act (H.R. 3305/S.1606).

Addressing the Housing Crisis for Urban Natives

  • Improve Funding Access for Urban Indian Organizations to Expand Housing Services.

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 American Indians and Alaska Native Communities and the Urban Indian Organizations that Serve Them.
  • Increase Urban Indian Organization Access to Fresh and Traditional Foods Through Increased Funding for the Indian Health Service Produce Prescription Pilot Program.

Tackling the Stigma and Advancing HIV Support Efforts in Native Communities

  • Increase Innovative Resources to Reduce Stigma Around HIV in Native Communities.

Permanently Reauthorize and Increase Funding for the Special Diabetes Program for Indian (SDPI) at a Minimum of $250 Million Annually

HONORING THE PROMISES TO NATIVE VETERANS

Improving American Indian and Alaska Native Veteran Health Outcomes

  • Support the Unique Health Care Needs of Native Veterans by Passing the Elizabeth Dole Home Care Act (H.R. 542/S. 141).
  • Engage with Urban Indian Organizations to Successfully Implement the Interagency Initiative to Address Homelessness for Urban American Indians and Alaska Native Veterans.
  • Increase Urban American Indians and Alaska Native Access to the Department of Veterans Affairs Resources that Address Social Determinants of Health (SDOH).

REVITALIZING NATIVE HEALTH: EMBRACING TRADITIONAL HEALING AND BEHAVIORAL WELLNESS

Improving Behavioral Health for All American Indians and Alaska Natives

  • Increase Funding for Behavioral Health and Substance Use Disorder Resources for American Indian and Alaska Native People.
  • Respond to the Significant Increase in Overdose Deaths in Indian Country.

Improving Health Outcomes Through Traditional Healing and Culturally Based Practices

  • Improve Funding Access for Urban Indian Organizations to Expand Traditional Healing and Culturally Based Practices.

“NOT ONE MORE”: HEALING GENERATIONAL TRAUMA AND PROTECTING NATIVE LIVES

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 American Indian and Alaska Native People Today.

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

  • Pass the Bridging Agency Data Gaps and Ensuring Safety (BADGES) for Native Communities Act (H.R. 1292/S. 465).
  • 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 Urban Indian Organizations in Prevention and Intervention Efforts.

ADDRESSING WORKFORCE RECRUITMENT AND RETENTION CHALLENGES

Improving the Indian Health Workforce

  • Inclusion of Urban Indian Organizations in National Community Health Aide Program (CHAP).
  • Improve the Indian Health Workforce Through the Placement of Residents at Urban Indian Organizations through the Department of Veterans Affairs Pilot Program on Graduate Medical Education and Residency Program (PPGMER).
  • Enable Urban Indian Organizations to Fill Critical Workforce Needs through University Partnerships by Passing the Medical Student Education Authorization Act of 2023 (H.R. 3046/S. 1403).
  • Extend Federal Health Benefits to Urban Indian Organizations.
  • Improve Recruitment and Retention of Physicians at Urban Indian Organizations by Passing the IHS Workforce Parity Act (S. 3022).
  • Increase Tax Fairness for Loan Repayment for Urban Indian Organization Staff by Reintroducing the Indian Health Service Health Professions Tax Fairness Act.
  • Permit U.S. Public Health Service Commissioned Officers to be Detailed to Urban Indian Organizations.

IMPROVING THE INDIAN HEALTH SERVICE

Data is Dollars: Improving Data in Indian Health

  • Improve Reporting for Urban Indian Organization Data.

Bridging the Gap: Enhancing Patient Care by Advancing Health Information Technology

  • Improve Health Information Technology, Including Electronic Health Records Systems.

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

  • Pass the Stronger Engagement for Indian Health Needs Act (H.R. 2535) to elevate the IHS Director to Assistant Secretary for Indian Health.
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The Network for Community-Engaged Primary Care Research’s Resources for COVID-19 Education

Reliable information is our strongest weapon against vaccine misinformation and the ongoing battle against COVID-19. NCUIH is partnering with the Network for Community-Engaged Primary Care Research, a collaborative effort between the Morehouse School of Medicine and OCHIN. It is at the forefront of disseminating essential educational materials to health care SafetyNet providers and communities nationwide. These resources aim to combat misinformation, empower patients, clinicians, and staff, and foster a deeper understanding of COVID-19 and its long-term effects.

  1. “Best Practices for Engagement and Dealing with COVID-19 Misinformation.” This comprehensive guide offers best practices for engagement and navigating the complex landscape of COVID-19 misinformation. Tailored for clinicians, quality improvement staff, caregivers, and health partners, it is a crucial resource for those on the front lines.
  2. COVID-19 Vaccines: “Types and How They Work – Q&A for Children and Teens:” This resource provides valuable information for patients To address vaccine hesitancy and concerns. It offers clear insights into COVID-19 vaccines and addresses common concerns about children and teens.
  3. “Why Do Researchers Do Different Kinds of Clinical Studies?” Understanding the research process is key to fostering trust. This infographic breaks down the different types of clinical studies, providing transparency and demystifying the vital work researchers undertake.
  4. Brochures
    • Vaccine Misinformation: This brochure elucidates the ingredients in mRNA COVID-19 vaccines, offering a transparent look at the vaccine-making process to combat vaccine misinformation.
    • COVID-19 Effects: Geared towards patients, this brochure details the impact of COVID-19 on vital organs, including the lungs, blood, and heart. It serves as a crucial educational tool to enhance public awareness about the severity of the virus.
    • Long COVID: Long COVID is addressed in this dedicated trifold brochure, providing patients with information about the condition and ongoing research efforts. This resource contributes to a better understanding of the potential long-term consequences of the virus.

In the fight against COVID-19, knowledge is power. Download and share these materials to empower your patients with the knowledge needed to make informed decisions about their health.

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