NCUIH-Endorsed Bipartisan Native American Child Protection Act Passes Senate, Heading to President Biden’s Desk with Key Provisions for Urban Indian Organizations

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On December 19, 2024, the National Council of Urban Indian Health (NCUIH)-endorsed legislation, the Native American Child Protection Act (H.R. 663), has passed the Senate and is now headed to President Biden’s desk to sign into law. The bill previously passed the House on September 18, 2023 with a vote of 378-32. Representative Ruben Gallego (D-AZ-3) and Representative Dan Newhouse (R-WA-4), reintroduced this bipartisan legislation on January 31, 2023, which revises key programs established by the Indian Child Protection and Family Violence Prevention Act. NCUIH successfully advocated for the inclusion of Urban Indian Organizations (UIOs) in key provisions of the bill, such as grants for treatment programs for Native Americans who have been victims of child sexual abuse, a National Indian Child Resource and Family Services Center providing technical assistance and training, and membership on an Advisory Board to assist the Center.

Specifically, the bill:

  1. Makes UIOs eligible for the Indian Child Abuse Treatment Grant Program.
  2. Creates a National Indian Child Resource and Family Services Center (the Center) that will provide technical assistance and training to Tribes, Tribal organizations, and UIOs.
  3. Allows UIO representatives with expertise in child abuse and child neglect to sit on a 12-member Advisory Board to advise and assist the Center.
  4. Requires the development of model intergovernmental agreements between Tribes and states to prevent, investigate, treat, and prosecute family violence.
  5. Revises the Indian Child Protection and Family Violence Prevention Program to allow funding to be used for additional activities such as operational costs for child protective services.

Background

Native American Child Maltreatment

According to a 2021 Administration for Children and Families Report, Native American children experience the highest child abuse/victimization rate in the U.S. at 15.1 cases for every 1,000 children. The youngest children are the most vulnerable to maltreatment, with the rate of victims younger than one year is 56.6 per 1,000 children, which is the highest rate among all races or ethnicities. Among types of maltreatment, Native American children are most likely to experience neglect at 83.5%.

Legislative History

The programs revised by the Native American Child Protection Act were originally established in 1990 under the Indian Child Protection and Family Violence Prevention Act. The programs include the Indian Child Abuse Treatment Grant Program, the National Indian Child Resource Center, and the Indian Child Protection and Family Violence Prevention Program. These programs have yet to be fully funded and have not been reauthorized by Congress.

In 2021, the Senate held a legislative hearing on the bill where Heidi Todacheene, Senior Advisor of the Office of the Assistant Secretary for Indian Affairs at the Department of the Interior, acknowledged the first inclusion of UIOs in the legislation, noting that the bill expands “services to be extended to the Urban Indian organizations, and as you know those are critical services to help Tribal communities, especially in places where American Indian, Alaskan Natives don’t have access to some of the services on reservations.”

Resources

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Congressional Health Package Proposes Reauthorizing Special Diabetes for Indians for Two Years with an Increase to $200 Million, Community Health Clinics Reauthorization for 2 Years

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Today, the long-awaited proposed final health package from Congress has been released. The proposal is currently considered to be “leaked” text and changes are possible before passage.

The proposal includes a two-year reauthorization of the Special Diabetes Program for Indians at $149.58 million from Jan 1, 2025, to September 30, 2025, and $200 million for FY2026. The Special Diabetes Program for Indians was historically funded at approximately $150 million for nearly 20 years, and this would represent a significant step forward for the program. Tribal leaders and the National Indian Health Board, along with Urban Indian Organizations and the National Council of Urban Indian Health, have fought tirelessly to increase resources for the highly successful program.

The proposal includes an extension of funding for Community Health Centers at $3.4 billion from January 1, 2025, to September 30, 2025, and $4.6 billion for FY2026. The text also contains the Supporting America’s Children and Families Act (H.R. 9076) which reauthorizes child welfare programs and strengthens the State and Tribal child support enforcement program and includes a 3% Tribal set-aside.

Despite bipartisan support and advocacy from Native and non-Native organizations, the Urban Indian Health Parity Act, which provides 100% Federal Medical Assistance Percentage for services at Urban Indian Organizations, was not included in the proposed package.

The deal on health care was reached through bipartisan efforts and is expected to be included in a continuing resolution. The package also contains provisions on Pharmacy Benefit Managers (PBMs), hospital costs, telehealth, and other health extenders. The full and final continuing resolution text is forthcoming; however, flat funding is expected across the board and will likely run until March 14, 2025. Flat funding amounts would be $6.96 billion for the Indian Health Service (IHS) and $90.4 million for Urban Indian Health. The measure will need to be voted on by December 20 to avoid a government shutdown, however Urban Indian Organizations (UIOs) and portions of IHS are protected by advance appropriations.

NCUIH will continue to analyze the 553-page text and provide further updates.

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NCUIH Visits Urban Indian Center of Salt Lake and Presents Traditional Healing and Foods Report at Association of American Indian Physicians Conference

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On September 6, 2024, NCUIH’s Interim Federal Relations Director Alexandra Payan, Research Associate Nahla Holland (Eastern Pequot Tribal Nation), and Manager of Technical Assistance Lyzbeth Best, visited the Urban Indian Center of Salt Lake (UICSL). During this visit they received a tour of UICSL’s central location and learned more about their new clinic location in Murray, UT. The visit wrapped up a trip to Salt Lake City, UT for the Association of American Indian Physicians (AAIP) where NCUIH presented their report on Traditional Healing and Traditional Foods at Urban Indian Organizations (UIOs). UICSL assisted in this presentation by providing information on how the UIO provides several Traditional Healing services to their American Indian and Alaska Native community.

NCUIH staff

NCUIH staff

 

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Bipartisan Group of 198 Representatives Request Reauthorization of the Special Diabetes Program for Indians to Combat Diabetes in Native Communities

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On December 6, 2024, 198 House Representatives sent a Dear Colleague letter to Speaker Mike Johnson and House Minority Leader Hakeem Jefferies, requesting the reauthorization of Special Diabetes Program (SDP) and the Special Diabetes Program for Indians (SDPI) before the programs expire on December 31, 2024.

The letter was led by the Congressional Diabetes Caucus leadership, Rep. Diana DeGette (D-CO-1) and Rep. Gus Bilirakis (R-FL-12). The letter outlines that the programs have been historically bipartisan, received their first increase in funding in the March funding package in nearly 20 years, and the growing costs of medical care related to diabetes.

SDPI is a highly effective program that funds life-saving efforts to fight diabetes and improve long-term health outcomes. SDPI has provided grants to 31 Urban Indian Organizations (UIOs) that enables them to provide necessary services to reduce the incidence of diabetes-related illness among urban Native communities.

Full Letter

Dear Speaker Johnson and Leader Jeffries,

Thank you for your long-standing support of the Special Diabetes Program (SDP), an essential resource in our nation’s investment in diabetes research, treatment, education and prevention programs. We write today to ask for your continued commitment to this vital program by ensuring its reauthorization prior to its expiration on December 31, 2024.

Diabetes is one of our country’s most expensive diseases in both human and economic terms, affecting people of all ages and races, and in every region of our country. It is a leading cause of kidney disease, adult blindness, lower-limb amputations, heart disease, and stroke. Approximately one in four health care dollars and one in three Medicare dollars are spent treating people with diabetes. The total cost of diabetes in the United States was $412.9 billion in 2022, and medical expenditures for individuals diagnosed with diabetes are roughly 2.6 times higher than expenditures for those without the disease. Although the costs and prevalence of diabetes continue to increase, the SDP is making meaningful progress.

The SDP is comprised of two partner components: the Special Statutory Funding Program for Type 1 Diabetes Research (SDP) and the Special Diabetes Program for Indians (SDP-I). Since the program’s inception, it has delivered meaningful and impactful resources and research breakthroughs for the 38.4 million Americans with diabetes and 97.6 million with prediabetes, as well as their loved ones, who are impacted by the disease. It is essential we continue to invest in the research necessary to develop a cure for diabetes, as well as support the programs that help prevent and treat the disease and its complications.

Research funded by the program is leading to new insights and treatment options that improve the lives of diabetes patients and accelerate progress toward curing and preventing the disease. In recent years, this funding contributed to landmark research that culminated in the first early, preventive treatment that can delay clinical diagnosis of Type 1 diabetes (T1D) in those at high risk of developing the disease. SDP-funded research is also advancing knowledge of how insulin-producing beta cells are lost with T1D and how they can be protected or replaced in people, which is helping scientists accelerate new cell replacement therapies. The SDP has also allowed researchers to continue to make progress in other areas, such as:

Therapies to Delay T1D Onset: The SDP enabled the creation of TrialNet, the largest clinical network for T1D, which conducted the clinical trials that supported the 2022 FDA approval of the first disease modifying therapy for T1D, which can delay onset by nearly three years. Other therapies to delay and ultimately prevent onset are in the research pipeline.

Diabetes Prevention in the American Indian and Alaskan Native (AI/AN) Community: SDP-I has been one of the most successful programs ever created to reduce the incidence and complications due to Type 2 diabetes. Communities with SDPI-funded programs have seen substantial growth in diabetes prevention resources, and, for the first time, from 2013 to 2017, diabetes incidence in the AI/AN Page 2 population decreased each year. In addition, the average blood sugar level, as measured by the hemoglobin A1C test, decreased from 9.0 percent in 1996 to 8.1 percent in 2014 in the American Indian and Alaskan Native population, resulting in reduced risk of eye, kidney, and nerve complications.

Artificial Pancreas (AP) Systems:  SDP-funded research laid early groundwork for developing AP systems, which have shown the ability to reduce costly and burdensome complications and improve the quality of life for those with the disease. SDP funds led to the first fully automated insulin-dosing system being made available to patients in 2017, some five to seven years earlier than expected. Positive results from clinical trials since then have led to another FDA-approved AP system and next-generation AP devices that have outperformed first-generation devices in adolescents and young adults. According to one study, the use of AP systems in adults could save Medicare roughly $1 billion over 25 years.

Eye Therapies:  SDP-funded research discovered that combining a drug with laser therapy can reverse vision loss in people living with diabetes. The SDP also filled a critical research gap by funding a head-to-head comparison of three drugs for the treatment of diabetic eye disease. In the SDP era, diabetic eye disease rates have decreased by more than 50 percent for the AI/AN population, resulting in a reduction of vision loss and blindness.

Environmental Factors Influencing T1D:  Researchers are conducting a groundbreaking 15-year study to determine what environmental factors influence the onset of T1D. They believe by identifying specific triggering factors, new strategies can be developed to prevent the initial onset of the disease.

These are only a few of the many groundbreaking discoveries made possible by the SDP. New technology, therapies, and data sets are improving the lives of the 136 million Americans living with or at risk of developing diabetes, while also greatly reducing the long-term health care expenditures related to its complications. Long-term, sustained investment in this program would provide the stability researchers need to continue large-scale trials, conduct outreach and education, and determine where best to allocate resources – all of which play an important role in helping to better treat, prevent, and ultimately cure diabetes.

We thank you for your steadfast support of the SDP in the March funding package when you helped deliver the first funding increase for the program in nearly 20 years. Congress has reauthorized the SDP with bipartisan support on a regular basis since the program’s inception in 1997, prior to this action, funding had remained flat since fiscal year 2004. During this time, the cost of research has increased, as has the size of the Indian Health Service population and the cost of medical care. We greatly appreciate your recognition of these considerations. Extending the SDP beyond December 2024 will continue our momentum and provide renewed hope for the diabetes community.

As we face yet another expiration of this program at the end of this year, we look forward to working with you to ensure the SDP can continue to support Americans living with or at risk of developing diabetes.

Recent Senate Support for SDPI Reauthorization and NCUIH Advocacy

On November 12, 2024, 55 Senators sent a letter to Senate Leadership requesting that SDP and SDPI be reauthorized before funding expires on December 31, 2024.

On October 23, 2024, NCUIH sent a policy alert to UIO leaders to contact Congress and urge members to sign onto the House and Senate Dear Colleague letters in support of SDPI reauthorization. On November 19, 2024, the National Council of Urban Indian Health (NCUIH) sent a letter to Senate Majority Leader Chuck Schumer, Senate Minority Leader Mitch McConnell, Speaker of the House Mike Johnson, and House Minority Leader Hakeem Jeffries requesting the reauthorization of SDPI at a minimum of $160 million per year.

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NCUIH Urges Congressional Leadership to Reauthorize the Special Diabetes Program for Indians to Combat Diabetes in Native Communities

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On November 19, 2024, the National Council of Urban Indian Health (NCUIH) sent a letter to Senate Majority Leader, Chuck Schumer, Senate Minority Leader, Mitch McConnell, Speaker of the House, Mike Johnson, House Minority Leader, Hakeem Jeffries requesting the reauthorization of the Special Diabetes Program for Indians (SDPI) at a minimum of $160 million per year. The program is set to expire on December 31, 2024.

SDPI is a highly effective program that funds life-saving efforts to fight diabetes and improve long-term health outcomes. SDPI has provided grants to 31 Urban Indian Organizations (UIOs) that enables them to provide necessary services to reduce the incidence of diabetes-related illness among urban Native communities.

Full Letter

Dear Speaker Johnson, Minority Leader Jeffries, Majority Leader Schumer, and Minority Leader McConnell:

On behalf of the National Council of Urban Indian Health, a national representative advocating for the 41 Urban Indian Organizations (UIOs) contracting with the Indian Health Service (IHS) under the Indian Health Care Improvement Act (IHCIA), we echo the 55 bipartisan senators in requesting your support to reauthorize the Special Diabetes Program for Indians (SDPI) before the program expires on December 31, 2024 at a minimum of $160 million per year. This bipartisan, highly effective program funds life-saving efforts to fight diabetes and is critical to improving long-term health outcomes in Indian Country.

Through SDPI, the 31 Urban Indian Organization grant recipients receive the resources needed to address the disproportionate burden of diabetes in our communities. In 2021, the Centers for Disease Control (CDC) reported that American Indian and Alaska Native adults were 1.6 times more likely than non-Hispanic whites to die from diabetes. The CDC also reported in 2023 that American Indian and Alaska Native adults were 1.5 times more likely to be diagnosed with diabetes than non-Hispanic white Americans. Over the several decades SDPI has been funded, data has shown significant improvements from the program, and it is advancing health care quality and access for Tribal communities.

SDPI provides culturally competent care, funds life-saving efforts to fight diabetes at Indian Health Services facilities (including 31 Urban Indian Organizations) and is critical to improving long-term health outcomes in Indian Country. The Program for serves 780,000 American Indians and Alaska Native people across 302 programs in 35 states. SDPI enables UIOs to provide necessary services that reduce the incidence of diabetes-related illness among urban Indian communities. SDPI focuses on providing a culturally informed and community-directed approach to treating and preventing Type 2 diabetes for American Indian and Alaska Native people. The highly successful, bipartisan program is a proven success, and reauthorization should be a top priority for Congress.

Unless the Speaker of the House and the Senate Majority Leader prioritize reauthorizing this critical program, it will expire on December 31, 2024, resulting in diminished type 2 diabetes care for thousands of American Indian and Alaska Native people. This program is highly successful, bipartisan, and has proven to be a worthwhile financial investment of taxpayer dollars.

The future of this successful program is in the hands of Congress. Reauthorizing the SDPI program must be a top priority in December.

Background and NCUIH Advocacy

On October 23, 2024, NCUIH sent a policy alert to UIO leaders to contact Congress and urge members to sign onto the House and Senate Dear Colleague letters in support of SDPI reauthorization. On November 12, 2024, 55 Senators sent a letter to Senate Leadership requesting the vital Special Diabetes Program and Special Diabetes Program for Indians be reauthorized before funding expires on December 31, 2024. On December 6, 2024, 198 House Representatives sent a Dear Colleague letter to Speaker Mike Johnson and House Minority Leader, Hakeem Jefferies, for SDP and SDPI reauthorization.

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35 Organizations Sign NCUIH Letter to Congressional Leadership Requesting 100% FMAP for Urban Indian Organizations

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On December 6, 2024, the National Council of Urban Indian Health (NCUIH) and 35 health care advocates sent a letter to Congressional Leadership requesting the inclusion of 100% Federal Medical Assistance Percentage for Urban Indian Organizations (100% FMAP for UIOs) to be included in the end-of-year public health extenders package. Passing this priority will ensure parity for Urban Indian Organizations and is essential to upholding the federal trust responsibility and ensuring access to culturally competent care for American Indian and Alaska Native people.

NCUIH is grateful for the support of the following organizations:

  • National Council of Urban Indian Health
  • National Indian Health Board
  • National Congress of American Indians
  • United South and Eastern Tribes, Inc.
  • Montana Consortium for Urban Indian Health
  • California Consortium for Urban Indian Health
  • American Indian Council on Alcoholism, Inc
  • Native American Health Center
  • Indian Family Health Clinic
  • Hunter Health
  • Urban Indian Center of Salt Lake
  • American Indian Health and Family Services
  • The NATIVE Project
  • Urban Indian Center of Salt Lake
  • Native Health of Phoenix
  • Native Directions, Inc.
  • Indian Health Care Resource Center of Tulsa
  • Native American Rehabilitation Association of the Northwest, Inc.
  • Texas Native Health
  • Rhode Island Indian Council (New York Indian Council)
  • Oklahoma City Indian Clinic
  • Tucson Indian Center
  • Kansas City Indian Center
  • Nevada Urban Indians, Inc.
  • Fresno American Indian Health Project
  • Native American Connections
  • Native American LifeLines, Inc.
  • Kansas City Indian Center
  • UnidosUS
  • National Association of Rural Health Clinics
  • National Association of Pediatric Nurse Practitioners
  • National Health Care for the Homeless Council
  • American Nurses Association
  • National Council for Mental Wellbeing
  • Catholic Health Association of the United States
  • National Association of Community Health Centers

Full Letter Text

Dear Majority Leader Schumer, Minority Leader McConnell, Speaker Johnson, and Minority Leader Jefferies:

On behalf of the National Council of Urban Indian Health (NCUIH) and the undersigned organizations, we request that you support the inclusion of 100% Federal Medical Assistance Percentage for services provided to Medicaid beneficiaries at Urban Indian Organizations (100% FMAP for UIOs) in the proposed end-of-year health extender legislation. This issue has broad, bipartisan support and is urgently needed to improve the health care for American Indians and Alaska Native people residing in urban areas.  There is a bipartisan bill in the House led by Rep. Ruiz and Rep. Bacon and cosponsored by Rep. Davids and Rep. Cole. The bill is a priority for the Native American Caucus, and there is no known opposition to this bill.

The federal government has a trust responsibility to provide “[f]ederal health services to maintain and improve the health of the Indians.” The federal government owes that duty to all American Indians and Alaska Native people, no matter where they live, and Congress has declared it the policy of the United States “to ensure the highest possible health status for Indians and urban Indians and to provide all resources necessary to effect that policy.” When Congress first authorized 100% FMAP for the Indian healthcare system in 1976, it did so because it recognized that “Medicaid payments are . . . a much-needed supplement to a health care program which has for too long been insufficient to provide quality health care to” American Indians and Alaska Native people and because “the Federal government has treaty obligations to provide services to Indians, it has not been a State responsibility.” Unfortunately, UIOs were not included in this initial authorization and therefore, services provided at UIOs are not eligible for 100% FMAP. The proposed amendment will ensure that the federal government assumes full financial responsibility for 125 U.S.C. § 1601(1). 225 U.S.C. § 1602(1). 3H.R. 94-1026 (1976). Medicaid services provided at IHS, Tribal, and UIO providers, as is required by the federal trust responsibility.

Native organizations have been advocating for 100% FMAP for UIOs for more than two decades, introducing the first bill on this issue in 1999. Now is the time to secure 100% FMAP for UIOs and ensure comprehensive, culturally competent care is available to all American Indian and Alaska Native people, regardless of where they live. We remain grateful for your leadership and commitment to the Medicaid program and the population it serves.  If you have questions or seek any additional information on this issue, please contact Meredith Raimondi, Vice President of Public Policy and Communications, at mraimondi@ncuih.org.

Background on 100% FMAP for UIOs:

In November 2023, Representative Ruiz and Representative Bacon introduced H.R. 6533, the Urban Indian Health Parity Act, which would provide 100% FMAP for UIOs. The bill was cosponsored by Representative Cole (R-OK) and Representative Davids (D-KS).

NCUIH Advocacy

Since 1999, Native organizations have been advocating for 100% FMAP for UIOs and has remained a top priority for UIOs. NCUIH worked to include a temporary authorization of 100% FMAP for UIOs to increase funding support for their UIOs in the 2021 American Rescue Plan Act’s (ARPA). NCUIH also released a report highlighting the importance of 100% FMAP, which includes case studies of two states, Washington and Montana, that successfully utilized the ARPA provision.  The report also provides an extensive history of 100% FMAP in the Indian health care system.

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PRESS RELEASE: NCUIH Presents Good Medicine Awards to Outgoing Legislators Tester and Peltola

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FOR IMMEDIATE RELEASE

The “Good Medicine Award” recognizes exceptional leadership on behalf of Native communities in support of health care services.

WASHINGTON, D.C. (December 11, 2024)– On December 11, 2024, the National Council of Urban Indian Health presented two Good Medicine Awards to Members of Congress for their efforts to support the Indian Health Service and efforts to improve health outcomes for Native communities during their tenure in Congress.Senator Jon Tester (D-MT) and Representative Mary Sattler Peltola (D-AK) were recognized for their outstanding contributions and demonstrated leadership in advancing Native health care. Throughout their tenure in Congress, these individuals have gone above and beyond in their efforts to champion legislation, policies, and initiatives that promote the health, welfare, and rights of Native peoples, and have a proven track record of collaboration, bipartisan cooperation, and effectiveness in advancing legislative agendas that address critical issues relating to Native health.

NCUIH thanks Senator Tester and Representative Peltola for their proven dedication to upholding the federal trust and treaty obligation to provide healthcare services to all American Indian and Alaska Native people.

Photo of Senator Tester and Francys Crevier

Senator Jon Tester

During his 18 years in the United States Senate, Senator Tester has become widely known as one of the strongest supporters of Indian Country on Capitol Hill. Over the past nearly two decades, Senator Tester has fought fiercely to protect the Indian Health Service through legislation and appropriations. In 2023, Senator Tester supported advance appropriations for the Indian Health Service, protecting funding for the IHS regardless of the current year appropriations status. In 2024, he joined 20 colleagues in sending a letter to Senate leadership requesting full funding for the Indian Health System, including Urban Indian Health. Senator Tester’s consistent advocacy has protected access to culturally competent care for all American Indian and Alaksa Native people. Senator Tester has also been a fierce advocate for Native veterans and ensuring their easy access to Veterans Affairs services. He supported the Health Care Access for Urban Native Veterans Act, which greatly improved healthcare access for American Indian and Alaska Native veterans by providing Department of Veterans Affairs (VA) coverage for care that Native veterans receive from Title V Urban Indian Organizations (UIOs). In 2021, Senator Tester also supported the improved Memorandum of Understanding between the Indian Health Service and the VA. This has provided better access to culturally competent care and alleviated burdens on the VA system.  In addition, Senator Tester was monumental in the establishment of a U.S. Department of Veterans Affairs (VA) Copay Exemption for Native Veterans, leading to the exemption and/or reimbursement of over 234,000 copayments. This has saved Native veterans more than $4.1 million as of September 2024. Senator Tester has taken many actions throughout his career on behalf of American Indian and Alaska Native people and we are grateful for his service.

Representative Mary Sattler Peltola

Representative Mary Sattler Peltola

Although Representative Peltola only had one full term in Congress, her positive impact on Indian Country will last for decades. As co-chair of the Native American Caucus, she championed issues that upheld the Federal Trust Responsibility, including cosponsoring H.R. 7227, the Truth and Healing Commission on Indian Boarding Schools Policies Act. In May 2024, Representative Peltola also joined 51 of her colleagues in sending a letter to House Leadership requesting full funding for the Indian Health Service, including Urban Indian Health. The letter emphasized that the federal government has a trust responsibility to provide federal health services to maintain and improve the health of American Indian and Alaska Natives. Representative Peltola’s support has ensured that the Indian Health Service will be able to continue providing care to all American Indian and Alaska Native people.  Representative Peltola’s fierce leadership, voice, and dedication to upholding the trust responsibility to all American Indian and Alaska Native people will truly be missed and remembered.

About NCUIH

Organizations contracting with the Indian Health Service under the Indian Health Care Improvement Act. NCUIH is devoted to the support and development of quality, accessible, and culturally competent health and public health services for American Indians and Alaska Natives living in urban areas.

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

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USDA’s New Rule Expands Access to Food for Urban Native American Communities in Food Distribution Program on Indian Reservations

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On October 31, 2024, the United States Department of Agriculture (USDA) Food and Nutrition Service (FNS) issued a final rule on Food Distribution Programs: Improving Access and Parity. This final rule removes the urban place requirement for the Federal Distribution Program on Indian Reservations (FDPIR) and is responsive to comments submitted by the National Council of Urban Indian Health (NCUIH). By removing the urban place requirements and encouraging Tribal and state collaboration with urban areas, FNS can make significant steps toward eliminating food insecurity for urban American Indians and Alaska Natives. This change takes a significant step towards addressing food insecurity in these populations.

Background on the FDPIR

The FDPIR provides USDA Foods to income-eligible households living on Indian reservations, and to American Indian households residing in approved areas near reservations or in Oklahoma. Many households participate in FDPIR as an alternative to the Supplemental Nutrition Assistance Program (SNAP) because they do not have easy access to SNAP offices or authorized food stores. The FNS, an agency of the USDA, administers FDPIR at the federal level. The program is administered locally by either Indian Tribal Organizations (ITOs) or an agency of a state government. As of fiscal year (FY) 2024, 110 agencies administer FDPIR, including 107 ITOs and 3 state agencies. Prior to the final rule, per FDPIR regulations at § 253.4(d), any urban place outside of the reservation boundaries could not be served unless an ITO or State agency requested to serve the urban place with a justification.

Tribal leaders and the National Association of Food Distribution Programs on Indian Reservations Board submitted multiple resolutions to FNS to remove and/or adjust the definition of urban place to increase the population from 10,000. Resolutions cited the nutritional needs of Tribal members, their preferences for FDPIR benefits over SNAP, access to FDPIR nutrition education which is more tailored to meet Tribal needs, and a desire to remain connected to Tribal services. The FDPIR community expressed frustration with the administrative difficulties in applying for an “urban place waiver,” and with what is perceived to be an arbitrarily low population cap of 10,000.

NCUIH’s Advocacy

On October 13, 2023, the National Council of Urban Indian Health (NCUIH) submitted written comments and requests to the U.S. Department of Agriculture (USDA) Food and Nutrition Service (FNS) in response to the August 14, 2023, request for comments regarding the Proposed Rule on Food Distribution Programs: Improving Access and Parity. In its comments, NCUIH recommended that FNS:

  • Remove urban place requirements in Food Distribution Program on Indian Reservations (FDPIR)
  • Encourage Tribes and States to collaborate with urban Indian organizations (UIOs) on FDPIR expansion in urban areas.
  • Ensure data collection accounts for expanded FDPIR access in urban areas.

NCUIH will continue to advocate to eliminate food insecurity in American Indian and Alaska Native communities, regardless of their location.

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PRESS RELEASE: National Council of Urban Indian Health Announces New Partnership with Alzheimer’s Association

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National Council of Urban Indian Health Announces New Partnership with Alzheimer’s Association

FOR IMMEDIATE RELEASE

Washington, D.C. (December 5, 2024) – The National Council of Urban Indian Health (NCUIH) and the Alzheimer’s Association recently announced a new partnership aimed at promoting brain health and increasing support for American Indian and Alaska Native (AI/AN) people living in urban settings affected by Alzheimer’s and other dementia. NCUIH and the Alzheimer’s Association will work together to engage urban AI/AN communities to raise concern and awareness of Alzheimer’s disease and all other dementia and to provide care, support, and information about advance care planning for the people impacted by dementia.

“Our partnership with the Alzheimer’s Association aims to provide vital support to American Indian and Alaska Native communities facing the challenges of dementia,” said NCUIH CEO Francys Crevier, JD (Algonquin). “This collaboration underscores our shared commitment to culturally tailored resources and services that honor Indigenous peoples’ unique traditions, experiences, and resilience. Together, we are working to ensure that no elder or family feels alone in navigating this journey.”

AI/AN individuals are more likely to develop Alzheimer’s or other forms of dementia than white Americans, yet they often have less access to health services and timely diagnosis. Twenty-seven percent of AI/AN individuals live in poverty, proportionately more than any other group and double the rate of 14 percent of Americans generally.

“We are delighted to collaborate with the National Council of Urban Indian Health to extend our outreach to American Indians and Alaska Natives living in urban settings,” said Dr. Carl V. Hill, chief diversity, equity and inclusion officer at the Alzheimer’s Association. “This partnership will enable us to provide essential disease-related information, care, and support resources while encouraging increased participation in Alzheimer’s and dementia research.”

Along with the partnership, the Alzheimer’s Association will offer educational programs and webinars to urban AI/AN communities. It will work to connect affected individuals and families in these communities to care and support resources, including the Association’s free 24/7 Helpline, referrals to local resources, and care consultation. In addition, the Alzheimer’s Association will sponsor and participate in NCUIH’s 2025 annual conference in Washington, D.C., on April 22-24, 2025.

About NCUIH

The National Council of Urban Indian Health is a national representative advocating for the 41 Urban Indian Organizations contracting with the Indian Health Service under the Indian Health Care Improvement Act. NCUIH is devoted to the support and development of quality, accessible, and culturally competent health and public health services for American Indian and Alaska Native people living in urban areas.

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.

About the Alzheimer’s Association

The Alzheimer’s Association is a worldwide voluntary health organization dedicated to Alzheimer’s care, support, and research. Our mission is to lead the way to end Alzheimer’s and all other dementia — by accelerating global research, driving risk reduction and early detection, and maximizing quality care and support. Our vision is a world without Alzheimer’s and all other dementia®. Visit alz.org or call 800.272.3900.

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

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Culture is medicine. People are medicine.

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Front entrance to the Urban Indian Center of Salt Lake in Salt Lake City, Utah.

Front entrance to the Urban Indian Center of Salt Lake in Salt Lake City, Utah.

About the Urban Indian Center of Salt Lake

Established in 1974, the Urban Indian Center of Salt Lake (UICSL) provides care for the American Indian and Alaska Native (AI/AN) communities in the greater Salt Lake City area. Their extensive list of services includes medical, behavioral health, social, and Traditional Healing programming. Demonstrated throughout the programming at UICSL, community and cultural connections are focal points for wellness and healing. The strength found in cultural identity, and the bonds people create with each other are fundamental aspects of these programs and within Indigenous concepts of health.

Clinic and behavioral programs notice board highlighting different events and resources for UICSL patients.

Clinic and behavioral programs notice board highlighting different events and resources for UICSL patients.

Kristie, a registered dietitian, and Allyson, a therapist, presented on UICSL’s Traditional Healing programming with NCUIH at the Association of American Indian Physicians (AAIP) conference in the summer of 2024.

Given that the Salt Lake City AI/AN community consists of members from many different Tribes, UICSL consciously allows everyone to practice their specific traditions and does not enforce the practice of any one tradition. For instance, some patients are court-mandated to attend UICSL programs who may or may not be comfortable practicing another Tribe’s tradition or customs. UICSL is mindful of making space for people to receive care in a method best suited for their background and comfort.

Special Diabetes Program for Indians (SDPI) Activities:

UICSL’s Special Diabetes Program for Indians (SDPI) incorporates standard medical interventions, nutrition, and traditional practices to best treat the patient, their community, and their needs.

A drum from the Calling Back Our Spirit workshop (Photo credit: UICSL).

A drum from the Calling Back Our Spirit workshop (Photo credit: UICSL).

The UICSL fitness program “In the Steps of Our Ancestors” is a running and walking group for all ages and all levels that runs regularly at the SLC Olympic Oval, rain or shine, as part of their SDPI program activities. This running group helps improve fitness and enhances participants’ social bonds and community connections. Participants might start barely able to finish one lap around the track but eventually, over time, go on to complete 5k races. The running groups create a sense of camaraderie where participants push each other to finish and cheer them on. Outside of the “In the Steps of Our Ancestors” group, UICSL offers an on-site gym with a physical trainer on staff. They conduct gym sessions and other exercise activities like All Nations Yoga in the park, archery, Zumba, Fitness Thursdays with an Indigenous focus, etc.

UICSL also offers cooking classes under SDPI to highlight the benefits and increase the consumption of more Traditional Foods. UICSL staff stress the importance of mindset when harvesting, preparing, and cooking with their patients so that the best intentions go into preparing nourishing meals. These cooking demonstrations happen on-site in the UISCL kitchen, and the produce is often sourced from a nearby community garden. UICSL partners with chefs from various Tribes, allowing for a multi-Tribal approach. These partnerships allow greater freedom for UICSL, the chef, and the participants in what is considered Traditional Foods and create a broader representation of cultural and Tribal traditions for the over 250 cooking class participants.

Overall, food is a focal point for the community at UICSL. They often hold highly attended feasts for their community and recently initiated a food voucher program, providing pre-loaded grocery cards to patients to alleviate some financial hurdles around regularly accessing healthy produce.

Other Traditional Healing Programs:
A ribbon tote bag created during the Reaching Out to Relatives support group (Photo credit: UICSL).

A ribbon tote bag created during the Reaching Out to Relatives support group (Photo credit: UICSL).

While many Traditional Healing programs fall under the SDPI umbrella, UISCL offers a variety of other programming that incorporates Traditional Healing to help address issues within the community. “Calling Back Our Spirit” utilizes the story of the drum and the traditions of drum making, drumming, and music to support intensive or general outpatient treatment for individuals with substance use disorder. The “Reaching out to Relatives” program illustrates the importance of connecting with oneself, one’s community, and cultural identity to promote mental health and larger healing. The community mental health support group teaches participants traditional crafts and the history behind their creations. The Medicine Pouch program is a community workshop for participants to learn more about traditional medicines and traditional wellness practices to utilize in their own lives. Participants craft medicine pouches and focus on creating positive experiences and maintaining balance throughout their lives through Indigenous frameworks.

Modern popular activities that promote happiness and wellness, such as gratitude, journaling, exercise, acts of kindness, and meditation, embody fundamental aspects of Indigenous views of health and wellness. UICSL helps promote these Indigenous practices through their programming to strengthen their community. For example,

  • Gratitude → offerings, ceremonies
  • Journaling → art, jewelry, songs
  • Exercise → dance
  • Acts of kindness → giveaways, gifting
  • Meditation → sweat lodge, prayer

In September 2024, UICSL celebrated its 50th anniversary by opening the doors to its new site in Murray, Utah, expanding its available services for patients! Future plans for UICSL include expanding its food prescription program, expanding staff, developing a nearby empty lot into a community garden, and opening an on-site pharmacy. For more information on UICSL, please visit https://uicsl.org/.

To see slides from the presentation, click here.

NCUIH and UICSL after their AAIP presentation. From left to right: Allyson Shaw, LCSW (UICSL), Kristie Hinton, R.D. (UICSL), Ryan Ward, MPH (UICSL) , Nahla Holland (NCUIH), Alexandra Payan, J.D. (NCUIH).

NCUIH and UICSL after their AAIP presentation. From left to right: Allyson Shaw, LCSW (UICSL), Kristie Hinton, R.D. (UICSL), Ryan Ward, MPH (UICSL) , Nahla Holland (NCUIH), Alexandra Payan, J.D. (NCUIH).

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