October Policy Updates: Budget Consultations, Historic Apology, Traditional Healing Coverage, and More

Fiscal Year 2025:

• We are currently in a Continuing Resolution (CR) which is set to expire on December 20, 2024.
• Congress is in recess and will not return until November 12. When Congress returns, they will be faced with the challenge of passing a full year spending bill before the CR deadline.

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 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.

On October 28, President Joe Biden visited the Gila River Indian Reservation in Arizona to deliver a historic formal apology on behalf of the federal government for its 150-year policy of forcibly placing Native children in Indian Boarding Schools.

“For 150 years, the government attempted to wipe out our Native cultures by removing and relocating thousands of Native children to boarding schools. The President’s historic apology is a painful reminder of this country’s history and our community’s immense resilience,” said Francys Crevier, J.D. (Algonquin), CEO of NCUIH. “Congress needs to act now and pass the Truth and Healing Commission on Indian Boarding Schools Act, so we can learn from our past and make sure these wrongs are never repeated.”

Why it matters:

• President Biden’s apology follows the Department of Interior’s (DOI) investigative report, which confirms that at least 973 American Indian, Alaska Native, and Native Hawaiian children died while attending federally operated or supported schools and identifies at least 74 marked and unmarked burial sites at 65 different school grounds.
• This act of recognition can foster healing and reconciliation, which are crucial for improving mental and physical health. By validating the experiences of Indigenous peoples and addressing the traumas associated with these institutions, the apology may encourage increased access to health care resources, culturally competent care, and a greater focus on mental health support. Ultimately, such measures can help bridge the gap in health disparities and promote overall well-being within these communities.

Next Steps: Congress must swiftly pass the Truth and Healing Commission on Indian Boarding School Policies in the United States Act (S. 2907/H.R. 5444).

On October 1, NCUIH submitted comments to the United States Department of Agriculture (USDA) regarding its 2025-2030 Dietary Guidelines for America Dietary Guidelines for Americans as the 2025 Dietary Guidelines Advisory Committee (DGAC) conducts its scientific review process.

• Go deeper: NCUIH recommended that the DGAC incorporate research on Traditional Foods into the 2025-2030 Dietary Guidelines and engage with American Indian and Alaska Native communities through Tribal Consultation and Urban Confer.

On October 31, NCUIH submitted comments to the HHS Office of Disease Prevention and Health Promotion (ODPHP) on Proposed Healthy People (HP) 2030 Objectives

• Go deeper: NCUIH recommended that HHS ODPHP engaged with the AI/AN community through Tribal Consultation and Urban Confer, ensure the ODPHP is engaging with the HHS Secretary’s Tribal Advisory Committee, and ensure that an IHS representative is on each of the HP 2030 Objective Workgroups.

Upcoming Federal Agency Comment Opportunities

December 6 – Health and Human Services (HHS) Request for Information for the 2026-2030 National HIV/AIDS Strategy and the National Strategic Plans

• The HHS Office of Infectious Disease and HIV/AIDS Policy is seeking feedback on the development of the following:
• National HIV/AIDS Strategy for the United States: 2026-2030 (NHAS)
• Sexually Transmitted Infections National Strategic Plan for the United States: 2026-2030 (STI Plan)
• Vaccines National Strategic Plan for the United States: 2026-2030 (Vaccines Plan)
• Viral Hepatitis National Strategic Plan for the United States 2026-2030 (Viral Hepatitis Plan)

December 6 – IHS Tribal Consultation and Urban Confer on Health Information Technology (HIT) Modernization

• IHS will be hosting a joint Tribal Consultation and Urban Confer to discuss and get feedback on the HIT Modernization implementation process regarding site readiness and training.

December 16 – IHS Tribal Consultation and Urban Confer on the proposed reorganization of the IHS Headquarters Office of the Director

• IHS released a DTLL/DULL on Oct. 10 announcing that IHS will be hosting an Urban Confer on November 13 at 3:00 pm EST and a Tribal Consultation on November 14 at 2:00 pm EST. Register here.
• IHS is seeking feedback on the draft IHS Headquarters Office of the Director Organizational Chart that details the proposed Deputy Director for Intergovernmental Affairs (DDIGA) reorganization. This reorganization may have significant impacts on how UIOs engage with IHS and the broader system, and your input will be vital to ensure UIO priorities are heard.
• NCUIH will be hosting a prep session for UIOs on November 12 at 12:00 pm EST. Join the meeting here.
• The comment submission deadline is Monday, December 16, 2024.

December 16 – Social Security Administration (SSA) Tribal Consultation on SSA Call to Action Plan

• SSA is hosting a Tribal Consultation on November 14 and is seeking additional comments on the SSA Tribal Consultation Call to Action Plan that seeks to expand partnerships across federal agencies to UIOs
• One of the action plan’s key initiatives is: “Provide Tribal Consultation with Tribal Leaders and UIOs”

CMS Approves Medicaid Coverage for Traditional Healing Services

On October 16, CMS announced that they approved section 1115 demonstration amendments that allow, for the first time ever, Medicaid and Children’s Health Insurance Program (CHIP) coverage of traditional health care practices provided by IHS facilities, Tribal facilities, and UIOs in four states: California, Arizona, New Mexico, and Oregon.

Urban Indian Organizations and State-Specific Waivers:

1. Arizona (AHCCCS):  Traditional Healing is covered for IHS and Tribal facilities. UIOs are not explicitly included as covered facilities. However, Traditional health care practitioners or providers at UIOs contracting with an IHS or Tribal facility could be included.
2. California (CalAIM): California will have expenditure authority to provide coverage for traditional health care practices received through IHS, Tribal, or UIO facilities by Medicaid and CHIP beneficiaries who are able to receive services delivered by or through these facilities. The state will initially provide this coverage only to beneficiaries eligible to participate in the Drug Medi-Cal Organized Delivery system. However, California will have authority to expand coverage to all Medicaid beneficiaries who receive services delivered by or through an IHS, Tribal, or UIO facility.
3. New Mexico (Turquoise Care): The state will have expenditure authority to provide coverage for Traditional Healing practices received through IHS, Tribes, or UIO facilities.
4. Oregon (OHP): Traditional health care practices received through IHS, Tribal, or UIO facilities will be covered when provided to a Medicaid or CHIP beneficiary who is able to receive services delivered by or through these qualifying providers. State expenditures for Traditional Healing delivered at UIOs will receive the applicable state service match.

USDA Publishes Final Rule on Food Distribution Programs: Improving Access and Parity

On October 31, the U.S. Department of Agriculture (USDA) Food and Nutrition Service (FNS) published a final rule revising the Food Distribution Program on Indian Reservations (FDPIR), removing the urban place requirement which “limits the operation of FDPIR in approved near areas and/or service areas that have a population of 10,0000 people or more.” NCUIH had previously submitted comments on October 13, 2023, in response to the agency’s request for comments.

Why it matters:

• Prior to this final rule, FDPIR regulations restricted any urban place outside of the reservation boundaries from receiving FDPIR services unless an Indian Tribal Organization (ITO) or State agency requests to serve the urban place with a justification.
• This final rule codifies the removal of references to urban places and the associated requirement that an FDPIR ITO or State Agency must provide justification to FNS to serve urban places off the reservation.
• 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.

Department of Veterans Affairs Announces Copayment Exemption for Almost 6000 Native Veterans  

During the September 24-26 Department of Veterans Affairs (VA) Advisory Committee on Tribal and Indian Affairs (ACTIA) meeting, the VA provided an update on the agency’s copayment exemption for Native Veterans, which exempts eligible Native Veterans from copayments for health visits received on or after January 5, 2022.

By the numbers:

• Since implementing the copayment exemption, 5,968 Native Veterans have been approved for the copayment exemption.
• Total Copayments Exempted and/or Reimbursed: 234,173
• Total Dollar Amount of Copayments Exempted and/or Reimbursed: $4,136,044.40

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

October 1 DTLL/DULL– IHS Director writes to Tribal Leaders and UIO Leaders to share information regarding the status of FY2025 appropriations for IHS.

• On September 25, 2024, Congress enacted the Continuing Appropriations and Extensions Act, 2024, that funds the federal government through December 20, 2024.
• The FY2025 Continuing Resolution does not impact the IHS advance appropriations as they were already appropriated in FY24 for FY25.
• IHS will have begun distributing FY25 advance appropriations to IHS programs, Tribal Health Programs, and Urban Indian Organizations.
• The activities that did not receive advance appropriations include health care and sanitation construction, EHR systems, and the Indian Health Care Improvement Fund.
• Contract Support Costs and Payments for Tribal Leases will be funded.

October 4 DTLL/DULL – IHS Director writes to Tribal leaders and UIO leaders to share the Director’s Year 2 Accomplishments Report.

• The Report details the progress IHS has achieved in the past year. Highlights include:

  – 65 DTLLs and DULLs

  – 23 Tribal Consultations and Urban Confers

  – Increasing access to care and services for Native Veterans experiencing or at risk of experiencing homelessness through efforts with VA and UIOs.

  – The Native Project expanding plans for their youth center, freeing up room to provide wellness, behavioral and medical services at its existing health care clinic. 

  – Securing more naloxone for federal, Tribal, and urban sites struggling to meet the demand.

  – Awarding $24.5 million in grants to 23 Tribal nations, Tribal organizations, and UIOs to develop and improve access to public health services.

  – Announcing the award of an additional $1.19 million through six cooperative agreements to enhance Tribal and urban Indian health system local capacity to provide dementia care and services.

October 9 DTLL – IHS writes to Tribal leaders to provide updated Facility Master Plans and other identified health care facility needs to be considered for inclusion in the 2026 IHS and Tribal Health Care Facilities’ Needs Assessment Report to Congress.

• The HHS Secretary is required to submit an updated report of IHS and Tribal health care facilities’ needs to Congress every 5 years. The next report is due in 2026. The report includes renovation and expansion needs of identified Tribes, Tribal Organizations, and IHS. IHS is requesting Tribal leaders’ assistance is identifying potential facility needs.

October 10 DTLL/DULL – SSA writes to Tribal leaders and UIO leaders to share updates on SSA’s activities and three opportunities that require registration. The three opportunities that require registration are:

• Rescheduled Virtual Tribal Consultation
• Free Virtual National Policy Training
• Free Virtual Discussion for Services for Tribal Communities

Oct. 27-Nov. 1 – National Congress of American Indians Annual Marketplace and Convention in Las Vegas, NV.

Nov. 5 (Election Day) – Medicare, Medicaid, and Health Reform Policy Committee (MMPC) Face-to-Face Meeting.

Nov. 6-7 – CMS Tribal Technical Advisory Group (TTAG) Face-to-Face Meeting in Washington, D.C.

Nov. 7 – IHS Hybrid Joint Tribal Consultation and Urban Confer on HIT Modernization Site Readiness and Training. Register here.

Nov. 12 – NCUIH Urban Confer Prep Session for UIOs on Proposed Reorganization of the IHS HQ Office of the Director. Join the meeting here.

Nov. 13 – IHS Virtual Urban Confer Session on Proposed Reorganization of IHS HQ Office of the Director. Register here.

Nov. 14 – SSA Tribal Consultation Call to Action Plan.