FAQ on TEFCA for Urban Indian Organizations

1. What is TEFCA?

  • TEFCA was created by the Department of Health and Human Services (HHS) Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC) under the authority of the 21st Century Cures Act.
  •  The goals of TEFCA are:
    1. (1) to establish a universal governance, policy, and technical floor for nationwide interoperability;
    2. (2) to simplify connectivity for organizations to securely exchange information to improve patient care, enhance the welfare of populations, and generate health care value; and
    3. (3) to enable individuals to gather their health care information.
  • TEFCA is made up of two parts:
    • (1) The Trusted Exchange Framework (TEF), a set of principles to follow when participating in secure data exchange under TEFCA.
    • (2) The Common Agreement (CA), a standardized agreement that enables data sharing between TEFCA participants.
  • Combined, they are referred to as the “TEFCA,” which supports a nationwide exchange of Electronic Health Information (EHI) across disparate Health Information Networks (HINs). HINs are entities that serve as a network for health information across health care entities, electronic health record platforms, and other entities that store and share electronic health information.

2. What entities are involved in TEFCA?

  • The entities involved in TEFCA are:
    • The HHS Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC): the federal agency responsible for implementing TEFCA.
    • The Recognized Coordinating Entity (RCE): the entity responsible for the development, implementation, and maintenance of the Common Agreement and for the review of applications from HINs seeking to join TEFCA and become QHINs.
    • Qualified Health Information Network (QHIN): an HIN that has completed the application and onboarding process required by the RCE and is now “qualified” to share information within the TEFCA framework.
      • QHINs currently part of TEFCA include eHealth Exchange, Epic Nexus, Health Gorilla, KONZA, MedAllies, CommonWell Health Alliance, and Kno2.
    • Participants: persons or entities who are contracted with a QHIN and have agreed to participate in TEFCA under the Common Agreement. Participants can include health information networks; health information exchanges; individuals; providers; federal agencies; public health agencies; health plans and other payers; and health IT developers (e.g., electronic health records systems).
    • Subparticipants: persons or entities who use services provided by a Participant through sending and receiving Electronic Health Information. Subparticipants are often healthcare providers, health systems, ambulatory providers, and health IT developers.
    • Principal: a QHIN, Participant, or Subparticipant that is acting as a Covered Entity, Government Health Care Entity, Non-HIPAA Entity (NHE) Health Care Provider, a Public Health Authority, a government agency that makes a Government Benefits Determination, or an Individual Access Services Provider.
    • Delegate: a QHIN, Participant, or Subparticipant that has a written agreement, directly or indirectly, with a Principal authorizing the Delegate to conduct TEFCA Exchange activities for or on behalf of the Principal.

3. What role do UIOs play in TEFCA?

  • Under the TEFCA framework, a UIO whose EHR provider has contracted with a QHIN is considered a “Subparticipant.” The UIO’s EHR provider is a “Participant.”
  • In some cases, a UIO’s EHR provider may choose to become a QHIN and join TEFCA. This would then label any UIO that join TEFCA through this provider a “Participant.”
  • Additionally, a UIO can join TEFCA under any QHIN of their choosing and become a “Participant.” It does not have to be done through their EHR system.

4. How do UIOs become Participants/Subparticipants in TEFCA?

  • Each QHIN must agree to the terms of the Common Agreement.
  • The Common Agreement contains Terms of Participation which must be signed by each Participant and Subparticipant. These have also been referred to as “flowdown provisions.”
  • For example, if the EHR system a UIO uses is connected to an HIN that completes the process to become a QHIN under TEFCA, and the UIO’s EHR system then agrees to the terms of the ToP and becomes a Participant under TEFCA, then the UIO may have the option to sign the ToP to become a Subparticipant under TEFCA.
  • The signing of the ToP is also required if a UIO joins as a Participant under an EHR system that is acting as a QHIN, or directly through any QHIN currently part of TEFCA.
  • Signature of the ToP is only required if a UIO wants to join TEFCA’s nationwide health information exchange. UIOs are not required to join TEFCA, even if their EHR becomes a Participant in TEFCA or joins TEFCA as a QHIN.
  • If UIOs do not sign the ToP, they can still utilize health information technology, like the EHR system, but will not be able to participate in nationwide health information exchange through TEFCA.
  • If the EHR a UIO uses has joined a QHIN as a Participant, but the UIO has not been given the option to join the QHIN as a Subparticipant, it is recommended that the UIO reach out to their EHR for more information. UIOs can also reach out to QHINs directly for information about joining TEFCA.
  • Today, participation is voluntary, allowing UIOs flexibility to make the decision to join TEFCA. However, if any UIOs signed a previous sub-agreement to join TEFCA before July 1, 2024, they must agree to the updated ToP by December 27, 2024, to continue to participate in TEFCA.

5. How does health information exchange work under TEFCA?

  • Requests are made through QHIN-to-QHIN exchange and must be for one or more of the reasons outlined in the Exchange Purposes (XPs) and must follow the requirements outlined in the XP Standard Operating Procedure (SOP). These purposes include treatment, payment, health care operations, public health, government benefits determination, and individual access services (IAS).
  • For example, a UIO (as a Participant or Subparticipant) may initiate a QHIN Query to supplement or update a patient’s records they maintain. The UIO, now acting as a Principal, would request the Delegate contact their QHIN to initiate the query, under the specified XP code, to other QHINs who may be connected to entities (either a Participant or Subparticipant) that may have records for that patient. These entities could include a state health department, tribally operated hospital, or any facility that has been connected to TEFCA through their own QHIN.
  • The technical infrastructure that supports exchange of information is maintained by QHINs. Data is not stored by the QHIN, it is only exchanged between the two entities. Neither Participants nor Subparticipants actively participate in the process. Participants and Subparticipants only make requests or respond to requests made by other TEFCA entities.

6. Is TEFCA currently in effect?

  • Yes, TEFCA has been live since the fourth quarter of 2023 when the first QHINs went live with health information exchange.

7. Are there any anticipated changes to TEFCA?

  • TEFCA will continue to evolve, and we can anticipate changes in participation, exchange purposes, governance and documentation moving forward. Additional QHINs are already in the process of being approved.
  • Documents are still being updated to assist with implementation of TEFCA. The most recent updates were
    July 1, 2024, and August 6, 2024, but more updates will be provided later this fall. These updates can be found on the Sequoia Project’s website.
  •  In addition, the Sequoia Project holds webinars to provide an overview of updates, which includes a Q&A session for any potential questions.
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September Policy Updates: Election Resources, FY25 Appropriations, Legal Developments, and More!

💵 Area Budget Formulation on the Horizon: Your engagement in the FY27 Budget Formulation Cycle is crucial.

🗳Election 2024: State-specific graphics now available to boost voter participation in the 2024 election.

💰 Appropriations Update: Updates on FY25 funding and the potential for a Continuing Resolution to prevent a government shutdown.

📝 Federal Comments: Review NCUIH’s recent recommendations to federal agencies on Medicaid, HIT Modernization, and syphilis outbreak response. Share your input on the USDA Dietary Guidelines by October 1.

🏛 Legislative Updates: Updates on FMAP, SDPI reauthorization, Telehealth Modernization Act, and BADGES for Native Communities Act.

🔙 ICYMI: Stay informed with the latest Dear Tribal Leader Letters and Federal Tribal Advisory Committee Meetings

🚀 NCUIH in Action: Highlights from the VAWA celebration at the White House with President Biden, National Voter Registration Day at Native Health Phoenix and, and engagement with Members of Congress.

📅 Important Dates: Mark your calendars for upcoming meetings and events.

Legal Update: Monitoring the Becerra v. San Carlos Apache case as IHS develops new contract support costs methodology.

On the Horizon: Area Budget Formulation – Your Engagement Matters!

NCUIH

IHS is beginning the FY27 Budget Formulation Cycle and UIOs are invited by their Area Offices to participate in this important opportunity to impact the budget recommendations for your area.

  • Why is UIO engagement important?: UIO input in Area Budget Formulation meetings can drastically influence budget requests for the urban line item and priority areas.
  • Go Deeper: It is critically important that UIOs attend their Area Budget Formulation meeting and advocate for additional support for urban Native communities.
  • Last Year: A number of areas prioritized funds for the Urban line item to help UIOs as seen in the chart above.
  • Date Anticipation: FY 2026 Area Budget Consultations set to begin in October, 2024

Empowering Native Votes: State-Specific Graphics Now Available for UIOs

NCUIH

Introducing the new Urban Voices Amplified: Empowering Native Votes Toolkit, developed by the NCUIH with support from the National Urban Indian Family Coalition. This resource is designed to provide Urban Indian Organizations with crucial voter information, helping American Indian and Alaska Native communities stay informed about important deadlines for the 2024 election.

Toolkit Highlights: 

  • State-specific graphics, including key voter registration deadlines and election dates.
  • Resources to help individuals register or update their voter information.

Access the Toolkit: Download the Toolkit and share it with your community to support voter participation.

Appropriations Updates

Illustration of the U.S. Capitol

Fiscal Year 2025:

On Wednesday, September 25, Congress passed a Continuing Resolution, or short-term government funding bill, which would fund the government until Dec. 20, and prevent a government shutdown.

  • The bill does not include the controversial SAVE Act, a GOP measure that requires voters to show proof of citizenship.

FY 2025 Funding for Veterans:

On Thursday, September 19, 2024, Congress passed supplemental funding bill (HR 9468) to address the close to $3 billion budget shortfall for Veteran’s benefits.

  • This funding ensures that all veterans will continue to receive their pension and benefits without lapse.
  • There are no Native specific programs in this bill.

Take Action to Support Mandatory Funding for IHS CSCs and 105(l) leases: 

NCUIH sent out an action alert urging advocates to contact Congress to support mandatory funding for IHS Contract Support Costs (CSCs) and 105(l) lease funding.

  • Ways to advocate: Call or email your Representative, and post on social media using the template language provided in the action alert. Contact Congress.
  • Why Participate: Shifting these costs to mandatory funding is important to avoid   funding impacts for other IHS programs and will enable true increases in funding for essential services.

NCUIH Provides Key Recommendations on Medicaid, Health IT Modernization, and Syphilis Outbreak Response to Federal Agencies

Illustration of a virus surrounded by caution tape

On September 9, NCUIH submitted comments to the Centers for Medicare and Medicaid Services (CMS) on its Outpatient Prospective Payment System (OPPS) Proposed Rule, specifically regarding Medicaid clinic services four walls exceptions and All-Inclusive Rate add-on payment for high-cost drugs provided by IHS and Tribal outpatient facilities.

On September 6, NCUIH submitted comments to IHS in response its joint Tribal Consultation and Urban Confer on Health IT (HIT) modernization multi-tenant domain considerations

  • Go deeper: NCUIH recommended that IHS support the unique interoperability needs of UIOs and ensure security of patient health information. NCUIH also recommended that IHS address the challenges and risks that UIOs may face when transitioning EHRs.

On September 5, NCUIH submitted comments to HHS Office of the Assistant Secretary for Health (OASH) regarding the syphilis and congenital syphilis outbreak in Indian Country.

  • Go deeper: NCUIH recommended that HHS and the National Syphilis and Congenital Syphilis Syndemic Federal Task Force work with UIOs as part of their strategy and continue to seek Tribal feedback.

Upcoming Federal Agency Comment Opportunity

October 1 – United States Department of Agriculture (USDA) Dietary Guidelines for America

  • USDA is seeking public comment as the 2025 Dietary Guidelines Advisory Committee conducts its scientific review process. Learn more here.

Legislative Updates: 100% FMAP for UIOs, SDPI, Telehealth Modernization, and MMIP

NCUIH

Recent update on 100% Federal Medical Assistance Percentage (FMAP) for UIO Medicaid Services: 

Next Steps:

  • NCUIH remains focused on having the Urban Indian Health Parity Act (H.R. 6533) included in any lame duck legislation (the period between the November election and the start of the new Congress).

What UIOs Can Do:

  • If UIOs would like to write a letter or meet with their Member of Congress to support this legislation, NCUIH is available to assist. Email policy@ncuih.org.
  • We also are looking for Tribal letters of support. Please reach out to policy@ncuih.org if you know of any Tribes that would be willing to send a letter.

Special Diabetes Program for Indians (SDPI) Update

The Special Diabetes Program for Indians was reauthorized in the March 2024 Consolidated Appropriations Act through December 31, 2024. The total funding for the 2024 calendar year was $158 million, which marked the first increase for the program since 2002. Congress must pass legislation to reauthorize and appropriate funding for the program for it to continue into FY 2025 and beyond.

NCUIH continues to advocate to Congressional leadership to ensure reauthorization of this critical program in any end of year funding package.

What UIOs Can Do:

  • If UIOs would like to write a letter or meet with their Member of Congress to support this program, NCUIH is available to assist. Email policy@ncuih.org.

Telehealth Modernization Act (H.R. 7623)

On September 18, 2024, the Energy and Commerce full committee passed out of markup the Telehealth Modernization Act of 2024 (H.R. 7623).

  • This bill permanently extends telehealth flexibilities for Medicare beneficiaries and extends these flexibilities to federally qualified health centers and rural health clinics.
  • The bill awaits further passage in the House and has not received any action in the Senate.

BADGES for Native Communities Act (S. 465)

On September 25, 2024, the Senate Committee on Indian Affairs passed out of committee the Bridging Agency Data Gaps and Ensuring Safety (BADGES) for Native Communities Act.

  • This bill requires law enforcement agencies to report on cases of missing or murdered Native people.
  • The bill now awaits further consideration from the Senate.

Recent Tribal Leader Letters and Dear Urban Leader Letters, Federal Tribal Advisory Committee Meetings

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Recent Dear Tribal and Urban Leader Letters (DTLL/DULL)

September 10 DTLLIHS Tribal Consultation on Contract Support Costs (CSC) Methodology for Program Income

  • IHS is initiating Tribal Consultation to seek and obtain Tribes’ recommendations on funding methodologies for the payment of eligible CSCs incurred by Tribes and Tribal Organizations related to expenditures of program income.
  • There will be a total of five Tribal consultation sessions in September and October. Future Sessions:
    • – IN PERSON: Tuesday, October 1, 2024, from 9:30 a.m. – 12:30 p.m. ET in Washington D.C. Register here.
    • – IN PERSON: Thursday October 3, 2024, from 9:30 a.m. – 12:30 p.m. PT in Seattle, Washington. Register here.
    • – VIRTUAL: Wednesday, October 9, 2024, form 1:00 p.m. – 5:00 p.m. ET Register here.
  • Written comments are due by October 11, 2024, and can be emailed to consultation@ihs.gov with the subject line: CSC Methodology for Program Income.
  • This letter also provides an update on the Agency’s ongoing efforts that the IHS has taken to implement the United States Supreme Court’s decision in Becerra v. San Carlos Apache Tribe.

September 4 DTLLHHS Tribal Data Access Policy Consultation

  • HHS is hosting Tribal Consultation on the Draft HHS Tribal Epidemiology Center Data Access Policy and Draft HHS Tribal Data Access Policy, to provide updates on the policies, and make them aware that the Tribal Data Access Website is now live.
  • Tribal Consultation will take place Tuesday, October 1, 2024, 3:00 p.m.-5:00 p.m. ET via Zoom. Register here.
  • Written comments are due by October 31, 2024, and can be emailed to consultation@hhs.gov with the subject line (please separate your comments by each draft): HHS Tribal Data Access Policy or HHS TEC Data Access Policy.

Important Events

NCUIH

At the Tribal Leaders Diabetes Committee (TLDC) meeting: NCUIH Senior Policy Analyst Carolyn Kowalyk, staffed NCUIH Board Treasurer Adrianne Maddux, who serves as NCUIH’s Technical Advisor for TLDC.

September 17-18: IHS Tribal Leaders Diabetes Committee (TLDC) Quarterly Meeting in Washington, D.C.

  • What was said: A discussion was held on how to disperse the rest of the $43 million of SDPI unobligated funds. The Committee agreed that an “administrative” supplement for eligible programs over the next two years would be ideal. IHS announced that there will be a comment period on this decision when a DTLL/DULL is released at the end of September.
  • What’s next: A Tribal Consultation and Urban Confer will be held this fall and the comments will be compiled and presented at the next quarterly TLDC meeting in December.

September 10-12: HHS Secretary’s Tribal Advisory Committee (STAC) Meeting

  • What was said: HHS submitted its proposed FY26 budget to Office of Management and Budget (OMB). FY26 Budget planning is now paused, HHS will adjust for new the administration.
  • HHS is taking steps to carry out Executive Order (EO) 14112: Reforming Federal Funding and Support for Tribal Nations. HHS is awaiting OMB to issue a funding needs assessment to guide the agency in ensuring federal notice of funding opportunities are developed in a manner consistent with EO 14112.
  • CMS is actively working on approving Medicaid demonstration requests for Traditional Healing reimbursement from four states (AZ, CA, OR, NM). CMS anticipates positive news soon.

NCUIH in Action

NCUIH

NCUIH CEO Francys Crevier (Algonquin) and Indian Health Center of Santa Clara Valley CEO and Chair of the Health Subcommittee for the VA Advisory Committee on Tribal and Indian Affairs Sonya Tetnowski (Makah).

On September 24, NCUIH CEO Francys Crevier (Algonquin) presented on the Veteran Affairs Advisory Committee on Tribal and Indian Affairs Panel, emphasizing the urgent need to address the health disparities faced by urban Native veterans. She called for improved housing resources, better care coordination between UIOs and the VA, and expanded technical assistance for Urban Indian Organizations. Crevier also acknowledged the critical leadership of Sonya Tetnowski, Army Veteran and former NCUIH Board President, who continues to champion Native Veteran voices in her role as Chair of the Advisory Committee’s Health Subcommittee.

NCUIH

NCUIH Vice President of Policy and Communications Meredith Raimondi and 46th President of the United States, Joseph R. Biden.

On September 12 – NCUIH represented UIOs at the White House event commemorating the 30th anniversary of the Violence Against Women Act (VAWA). This landmark legislation has made strides in protecting Native women and girls, and NCUIH is proud to have contributed to the VAWA reauthorization, ensuring urban Native communities are included in these vital protections. Our work continues to focus on culturally specific services, housing protections, and survivor-centered care.

NCUIH

NCUIH Public Policy Associate Chelsea Gutierrez and NCUIH Policy Analyst Emily Larsen.

On September 17, NCUIH provided support at the “Frybread for the Future” event at Native Health Phoenix UIO for National Voter Registration Day to emphasize the importance of the Native vote in the 2024 election.

NCUIH

NCUIH Interim Congressional Relations Director Jeremy Grabiner, Rep. Mike Quigley (D-IL-5), and AIHSC Staff.

On September 5, Rep. Mike Quigley (D-IL-5) visited the American Indian Health Service of Chicago (AIHSC). Rep. Quigley was able to tour the facility and talk to staff about the essential health care they are providing to Native communities in Illinois.

NCUIH

NCUIH Research Associate Nahla Holland (Eastern Pequot Tribal Nation) and NCUIH Federal Relations Manager Alexandra Payan alongside Association of American Indian Physicians Representatives.

On September 5-8, NCUIH presented its reports on UIO Traditional Healing and food programs at the Association of American Indian Physicians Conference.

  • Access NCUIH’s Traditional Healing report here.
  • Access NCUIH Traditional Foods reports here.
NCUIH

NCUIH Interim Congressional Relations Director Jeremy Grabiner and NAC Chair Emeritus Betty McCollum (D-MN-4).

On August 21, NCUIH represented UIOs at a meeting on the voter landscape & discussed UIO issues with Native American Caucus Chair Emeritus Betty McCollum (D-MN-4).

Upcoming Events and Important Dates

Calendar with events on it

  • October 1: HHS Tribal Data Access Policy Consultation
  • October 9: CMS Tribal Technical Advisory Group (TTAG) Conference Call
  • October 9: FY 2027 National Tribal Budget Formulation Process & Area Instructions Webinar

Monitoring the Bench: Becerra v. San Carlos Apache

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

Following the decision in Becerra v. San Carlos Apache, several cases calculating contract support costs (CSCs) have been granted motions to stay. These rulings will pause the cases, preventing the Supreme Court ruling from going into effect while IHS works on their methodology for CSCs. In July and August of this year, the IHS CSCs workgroup met to discuss possible methodologies.

What’s Next: IHS plans to conduct a national consultation before adopting the methodology.

Resource: NCUIH created an FAQ on the Supreme Court decision.

Thank you, Chandos Culleen!

NCUIH

We extend our deepest gratitude to Chandos Culleen, JD, NCUIH Senior Director of Federal Relations, for his invaluable contributions to advancing the health and well-being of Native people. We wish him all the best!

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Summer 2024 Public Policy Intern Departs and Reflects on Time with NCUIH

Eli Allen (Cherokee), National Council of Urban Indian Health (NCUIH) Policy Intern

Eli Allen (Cherokee), National Council of Urban Indian Health (NCUIH) Policy Intern

The summer of 2024 marked my second year as a Public Policy Intern at NCUIH. As I prepare to enter my third year at UCLA, majoring in Geography and Environmental Studies, this internship has been both a fun and insightful experience.

Working at NCUIH has given me a firsthand look into the world of public policy, which is a timely and intricate process. I’ve gained a deep appreciation for the amount of time and effort that goes into crafting policies that directly impact urban Native Americans. Over this summer, I worked on several projects such as compiling NCUIH’s official actions on our top policy priorities such as Traditional Healing, Missing and Murdered Indigenous People, and Medicaid; provided an analysis of the Department of Justice Office of Violence Against Women’s Tribal Consultation Annual Report; created remarks and materials for senior leadership to effectively communicate complex concepts and strategies regarding urban Native healthcare; updated NCUIH’s Knowledge Resource Center (KRC), which is an online hub of informational tools to educate Urban Indian Organizations (UIOs), policymakers, federal officials, and the public on Urban Indian health; and attended calls and meetings with federal agency leaders, congressional offices, and Indian Country partner organizations. It’s been incredibly rewarding to witness the behind-the-scenes work that shapes change.

One of my favorite parts during my internship was spending the month of August in Washington, DC, working in person. This experience provided me with a new perspective on both work culture and the unique environment of DC. Being able to immerse myself in the daily work life of a public policy office gave me a valuable perspective that I wouldn’t have gained otherwise.

I am deeply grateful to the Vice President of Policy and Communications, Meredith Raimondi, the Public Policy Manager, Mary Jomia, and the entire NCUIH team for giving me the opportunity to work with them again this summer. The experiences and knowledge I’ve gained over these two summers will undoubtedly shape my future endeavors in public policy and advocacy.

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Final Report on Federal Indian Boarding School Initiative Calls on Congress and Executive Branch to Remedy Present-Day Impacts in Urban Native Communities

On July 30, 2024, the U.S. Department of the Interior (DOI) released the second and final volume of the Federal Indian Boarding School Initiative’s (Initiative) investigative report (the Second Volume). This Second Volume builds on the initial volume published in May 2022 to significantly expand on the number and details of institutions to include attendee deaths, the number of burial sites, participation of religious institutions and organizations, and federal dollars spent to operate these boarding schools. It also includes policy recommendations for consideration by Congress and the Executive Branch to continue to chart a path to healing and redress for Indigenous communities, including the lasting impact on urban American Indian and Alaska Native communities.

See NCUIH’s previous blog on the Initiative by clicking here.

Investigative Report Findings

Findings Confirm Almost 1000 Native Child Deaths and Unmarked Burial Sites at Federal Boarding Schools

The Second Volume updates the official list of federal Indian boarding schools and maps to include 417 institutions across 37 states or then-territories. It provides detailed profiles of each school and confirms that at least 973 American Indian, Alaska Native, and Native Hawaiian children died while attending federal operated or supported schools. It also identifies at least 74 marked and unmarked burial sites at 65 different school sites, and estimates that the U.S. government made appropriations available of more than $23.3 billion in Fiscal Year 2023 inflation-adjusted dollars between 1871 and 1969 for the federal Indian boarding school system as well as other similar institutions and associated assimilation policies.

DOI Recommends that the Federal Government Invest in Addressing Current Impacts of Boarding School System

The report includes eight recommendations for the federal government from Assistant Secretary Newland that aim to support a path to healing the nation, including:

  1. Issuing a formal acknowledgment and apology from the U.S. government regarding its role in adopting and implementing national federal Indian boarding school policies;
  2. Investing in remedies to the present-day impacts of the federal Indian boarding school system;
  3. Establishing a national memorial to acknowledge and commemorate the experiences of Indian Tribes, individuals, and families affected by the federal Indian boarding school system;
  4. Identifying and repatriating remains of children and funerary objects who never returned from federal Indian boarding schools;
  5. Returning former federal Indian Boarding school sites to Tribes;
  6. Telling the story of federal Indian boarding schools to the American people and global community;
  7. Investing in further research regarding the present-day health and economic impacts of the federal Indian boarding school system; and
  8. Advancing international relationships in other countries with similar but their own unique histories of boarding schools or other assimilationist policies.
Restoration and Preservation of Native Languages Remains a Priority, Native Language Strategy on the Horizon

In recognition of the damage that federal Indian boarding schools and associated policies had on Native languages, investing in their restoration and preservation has been an early priority of the Biden-Harris administration. In 2021, the Departments of the Interior, Education and Health and Human Services (HHS) launched an interagency initiative to preserve, protect and promote the rights and freedom of American Indians, Alaska Natives and Native Hawaiians to use, practice and develop Native languages. Since then, both Secretary Haaland and Assistant Secretary Newland have traveled with First Lady Jill Biden and other Administration leaders to learn more about how Tribal Nations are leveraging federal investments to revitalize Native languages. The Administration expects to roll out a new ten-year Native Language Strategy by the end of 2024.

Native Boarding School Survivors Experiences Shared in ‘Road to Healing’ Initiative

In late 2023, Secretary Haaland and Assistant Secretary Newland completed “The Road to Healing,” a historic 12-stop tour across the country that provided Indigenous survivors the opportunity to share with the federal government their experiences in federal Indian boarding schools for the first time. The Road to Healing events included opportunities to connect survivors with trauma-informed support through the HHS’ Indian Health Service and Substance Abuse and Mental Health Services Administration. The reflections of many of those individuals are included in Volume 2 and transcripts are available on the Federal Boarding School Initiative website.

DOI also launched an oral history project to document and make accessible to the public the experiences of generations of Indigenous then-children who attended the federal Indian boarding school system. The National Native American Boarding School Healing Coalition is currently interviewing survivors for what will be a collection of first-person narratives. DOI and the Smithsonian’s National Museum of American History are partnering to explore how best to share with the public the history of the federal Indian boarding school system and its role in U.S. development, with a proposed focus on the never-told-before experiences of survivors.

Addressing Urban American Indian and Alaska Native Communities

Over $20 Billion Recommended to Heal Native Community from Impacts of Federal Boarding Schools

To complete the Secretary’s objectives for the Initiative, and to begin the pursuit of this express policy of cultural revitalization, Assistant Secretary Newland provided eight recommendations based on the current findings. The second recommendation, “Invest in Remedies to the Present-Day Impacts of the Federal Indian Boarding School System,” specifically mention providing funding for urban American Indian and Alaska Native communities. The recommendations states that the U.S. could invest in healing Indian Tribes, the Native Hawaiian Community, and American Indian, Alaska Native, and Native Hawaiian individuals from the legacy impacts of forced assimilation on a scale that is, at a minimum, commensurate with the investments made in the Federal Indian boarding school system between 1871 and 1969. This funding would be in addition to annual appropriation to fund agencies to fulfill the U.S. government’s trust and treaty obligations. The funding would also be designed to remedy present-day harms caused by historical federal Indian boarding schools and policies of forced assimilation and designed to reach urban American Indian, Alaska Native and Native Hawaiian communities. The Secretary writes that consideration for this investment should be applied to all of the recommendations in the report and include five interdependent areas of focus: (1) Individual and Community Healing; (2) Family Preservation and Reunification; (3) Violence Prevention; (4) Redress Indian Education; and (5) Revitalization of First American Languages. Assistant Secretary Newland included urban American Indian and Alaska Native communities when outlining plans for providing funding for Individual and Community Healing and Violence Prevention.

On June 14, 2024, the United States Conference of Catholic Bishops approved by vote (181-2) “Keeping Christ’s Sacred Promise: A Pastoral Framework for Indigenous Ministry,” issuing a formal apology for the Catholic Church’s role in the U.S. of inflicting a “history of trauma” to Indian Tribes, Alaska Native Villages, and the Native Hawaiian Community and affirmed its official repudiation of The Doctrine of Discovery. The Conference also provided a series of recommendations to confront the following issues in Indian Country and the Native Hawaiian Community: Natural Resources; Housing and Access to Financing; Education; Health Care; Racism; and Concerns of Urban Natives.

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