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