PRESS RELEASE: NCUIH Announces Partnership with CDC’s Project Firstline


Contact: Meredith Raimondi,, 202-932-6615

Project Firstline aims to provide health workers foundations for infection control; trainings to equip with skills and best practices in fight against COVID-19.

Washington, D.C. (October 28, 2020) – The National Council of Urban Indian Health and the Centers for Disease Control and Prevention (CDC) are collaborating on an infection control training initiative for frontline healthcare personnel, including Urban Indian Organization health workers.

“We are thrilled that CDC’s Project Firstline is inclusive of the frontline health heroes serving American Indians and Alaska Natives since day one of the COVID-19 pandemic,” said Francys Crevier (Algonquin), NCUIH CEO. “The trainings offered through Project Firstline will be beneficial for urban Indian health workers to enhance their skills and practices as they continue the fight against COVID-19 that is ravaging our communities.”

CDC’s Project Firstline is a collaborative of diverse healthcare and public health partners that will provide infection control training for millions of healthcare workers in the United States, as well as members of the public health workforce.

Project Firstline aims to provide every person working in a U.S. healthcare facility the foundation for infection control trainings to protect the nation from infectious disease threats, such as coronavirus disease 2019 (COVID-19).

NCUIH is currently accepting applications for the Project Firstline IPC Champions Grant until October 30, 2020, and for UIO Staff Professional Development Scholarships on a rolling basis. Learn more about NCUIH’s commitment to CDC’s Project Firstline here.

PRESS RELEASE: NCUIH Urges Congress to Take Immediate Action to Provide COVID-19 Resources for Indian Country at Hearing Today

The last COVID-19 package was six months ago.


Meredith Raimondi

Washington, DC (September 30, 2020) – On September 30, Francys Crevier (Algonquin), Chief Executive Officer of the National Council of Urban Indian Health (NCUIH), testified before the House Interior Appropriations Subcommittee to provide updates on urban Indian health impacts of COVID-19. In addition to Ms. Crevier, the Subcommittee heard from Kevin J. Allis, CEO of the National Congress of American Indians (NCAI), and Carolyn Angus-Hornbuckle, COO and Director of Public Health Policy and Programs at the National Indian Health Board (NIHB). The hearing highlighted the non-partisan commitment of this subcommittee to upholding and honoring trust responsibilities to Indian Country.

“[I]t is my duty today to convey to you the severity of this crisis and how it is impacting the Indian Health System including our 41 [urban Indian organizations]. The last time a law was enacted was six months ago, the CARES Act of March 27, 2020, where Indian Country received a mere 0.5% of the total funding. The pandemic continues to wreak havoc on Indian Country as our people are disproportionately contracting and dying every single day from COVID-19. Since mid-July alone, when I last testified, IHS has seen a 51% increase in infections. Positive rates among Natives are 3.5 times higher than rates for non-Hispanic Whites and hospitalization rates are 4.7 times higher. Last week, CDC reported Native children were among the 78% of pediatric deaths. Black and brown children are dying and no one is paying attention,” stated Francys Crevier, CEO of NCUIH.

“The need to examine and address the ongoing situation in Indian Country is apparent. Congress needs to understand the full impact of the pandemic on Native Americans, and how to better meet the needs of the communities you are testifying on behalf of in future relief packages. Since the beginning of the pandemic, I’ve advocated for personal protective equipment, or PPE, complete test kits, and other supplies to be made available to Indian health facilities and to Tribal governments. Without these items, Native Americans are unable to ensure their safety while receiving essential government services, such as health care, welfare checks, law enforcement services, and domestic violence assistance,” stated House Appropriations Subcommittee on Interior, Environment, and Related Agencies Chair Betty McCollum.

“I recognize that COVID-19 has hit Indian Country disproportionately harder than the rest of the nation, that the situation is dire, and that additional funding is needed not only to keep tribal governments and communities functioning but to save lives. If there was ever a time for the Subcommittee to hold firm in its non-partisan commitment to tribes, this is it,” stated House Appropriations Subcommittee on Interior, Environment, and Related Agencies Ranking Member David Joyce.

Ms. Crevier’s testimony focused on the current status of UIOs, including:

  • The need for additional resources for testing and contact tracing with $2 billion for IHS and $64 million for UIOs;
  • Equitable distribution of a COVID-19 vaccine once approved, with a minimum 5% set-aside for the I/T/U system;
  • $80 million in facilities funding for UIOs;
  • $1 million for a UIO infrastructure study;
  • $7.3 million annually for 3 years in behavioral health funds for UIOs; and
  • $20 million in telehealth and health information technology funds for UIOs; and a spend-faster anomaly to insulate UIOs and the entire I/T/U system from the dire consequences of a potential government shutdown.

Next Steps

The House released a new COVID-19 package this week. Discussions between the White House and Congressional leadership are ongoing, however, time is running out before Congress departs until after the election.

UIOs Included in Community Care Act to Provide COVID-19 Resources to Underserved Communities

On September 9, 2020, Representatives Lee (CA-13), Bass (CA-37), Kelly (IL-2), Chu (CA-27), Castro (TX-20), Haaland (NM-1), and Davids (KS-3) introduced the COVID Community Care Act. The bill, if passed, would establish a contact tracing program through community-based organizations and nonprofits. The bill would also provide $8.4 billion in grants to community based programs and nonprofits to conduct contact tracing with $400 million dollars going to fund COVID-19 programs administered by IHS, Tribal organizations, and urban Indian organizations (UIOs).

The COVID Community Cares Act also requires that the Secretary of Health and Human Services participate in an urban confer with UIOs before implementing the program. The bill will provide this funding to organizations that conduct contact tracing in areas with higher rates of COVID-19, a high percentage of minority residents, or those who have historically lacked access to healthcare. In order to access the funds, those hired must have experience and relationships with the people living in the community being served. The COVID Community Care Act aims to ensure that communities subject to institutionalized racism have the tools to protect themselves from the coronavirus. The bill is supported by both co-chairs of the Congressional Native American Caucus.

Project Firstline Update

Project Firstline: UIO Funding Opportunity Pre-Application Webinar Today @ 1:00 PM Eastern

NCUIH and the Centers for Disease Control and Prevention (CDC) are collaborating on an infection prevention and control (IPC) training initiative for UIO healthcare workers designed to protect the nation from infectious disease threats such as COVID-19.

Register for Pre-Application Webinar
Wednesday September 9, 1:00pm ET

UIO Infection Prevention & Control “Champion” Funding Opportunity

5 Awards Up to $40,000
Application Deadline 9/30/2020
Click to View Sample Application Packet & Requirements
Click to Apply

Goal of the Champion Initiative

Identify and implement sustainable UIO systemic changes in infection prevention and control critical to a culture of safety and create organizations that are flexible and responsive to ongoing needs during the pandemic and beyond.

Visit our project website to learn more.

Opportunity Overview for UIO IPC Systems Champions (IPCSC)

  • Maximum of 5 UIOs will be selected
  • Competitive awards of up to $40,000
  • Duration of participation is 8 months (November 1, 2020 to July 1, 2021)
  • Application deadline: September 30, 2020 at 11:59PM Eastern Standard Time
  • Participation requires a commitment to complete the core set of required activities
  • Selected Systems Champions will support information gathering, training module and modality development, pilot testing of materials, and participation in frontline staff training within their organization, including potential participation in CDC-supported Project Echo activities
  • NCUIH staff bring expertise, experience and support in multiple performance improvement methodologies, including LEAN, Six Sigma, and Just Culture
  • Participants are provided access to CDC and other subject matter and training experts
  • Option to participate in additional infection prevention and control train-the-trainer opportunities offered by CDC

NCUIH, NIHB, and NCAI Send Joint Letter Urging Congress to Prioritize Indian Country in COVID-19 Vaccine Efforts

On July 30, 2020, the National Council of Urban Indian Health (NCUIH), the National Indian Health Board (NIHB), and the National Congress of American Indians (NCAI) sent a letter to the leadership of the House and Senate Appropriations committees requesting a 5% direct set aside to the Indian health service, Tribal Nations, and urban Indian organization (I/T/U) system for vaccine distribution, administration, monitoring, and tracking in the next COVID-19 relief package. This set aside is vital because in previous pandemics American Indians and Alaska Natives (AI/ANs) had death rates four times higher than the national average, yet were some of the last to receive access to a vaccine. During this current pandemic AI/ANs have the highest COVID-19 hospitalization rate. This vaccine set aside will help ensure that history does not repeat itself during the coronavirus pandemic. The 5% set aside is reflective of the size of the AI/AN population and will ensure equitable access to any future COVID-19 vaccine.


Download Letter

Re:  COVID-19 Vaccine Distribution

Dear Chair Shelby, Chair Lowey, Ranking Member Leahy, and Ranking Member Granger:

On behalf of the undersigned national organizations collectively serving all 574 sovereign federally-recognized American Indian and Alaska Native (AI/AN) Tribal Nations and all 41urban Indian organizations (UIOs), we write to strongly urge you to ensure that the next COVID-19 pandemic relief package includes direct set-aside funding to Indian Health Service (IHS), Tribal Nations, and urban Indian organizations (collectively “I/T/U”) for COVID-19 vaccine distribution, administration, monitoring, and tracking.

Under both the 1918 Spanish Flu pandemic, and the 2009 H1N1 pandemic, AI/AN people had death rates four times higher than the nation. Unfortunately, under each of those public health crises – and despite their profound impact on Tribal communities and AI/AN People – access to and/or a distribution plan for vaccines were afforded last, if at all, to AI/AN communities. This is because under both of those previous pandemics, Congress failed to enact direct set-asides for the I/T/U system for vaccine access and distribution and the Administration failed to create specific plans to safeguard Tribes or their citizens. Neither Congress nor the Administration did any planning around vaccination, health promotion, disease prevention or other impacts in Indian Country during the H1N1 pandemic and other previous pandemics. Congress has the opportunity to ensure this sordid history does not repeat itself with the COVID-19 pandemic. Congress can achieve that by including a minimum 5% direct, statutory set-aside in funds for the entire I/T/U system for COVID-19 vaccine distribution. A 5% set-aside is reflective of the size of the national AI/AN population, and of numerous statutory funding set-asides Congress has previously enacted for issues like the opioid crisis, suicide, chronic disease, and many others. We strongly urge you to ensure that a statutory set-aside for COVID-19 vaccine distribution is included for the full I/T/U system in this next COVID-19 pandemic relief package.

The federal government has treaty obligations to fully fund health services in Indian Country in perpetuity. These obligations were established through the over 350 Treaties signed between sovereign Tribes and the United States, and reaffirmed in our U.S. Constitution, Supreme Court case law, and federal legislation and regulations. These obligations must be honored under the COVID-19 pandemic and beyond. To that end, we greatly appreciate the $1.032 billion allocated to IHS under the CARES Act, and $750 million Tribal and urban Indian set-aside for COVID-19 testing under the Paycheck Protection Program and Health Care Enhancement Act. These were critical, but not nearly sufficient, investments to stem the tide of the pandemic in Indian Country. As Congress negotiates funding for COVID-19 vaccine distribution, it must ensure direct funding and access to vaccines reach the full I/T/U system.

Indeed, Indian Country has been disproportionately impacted by this pandemic. This is a systemic reality rooted in large part in the chronic underfunding of IHS, including a long term shocking lack of investment in health and public health infrastructure.  Per capita spending for those utilizing the I/T/U system reached only 40% of national health spending in 2018 ($3,779 vs $9,409), and, unsurprisingly, AI/AN people experience among the starkest disparities in the underlying conditions that increase the risk for a more serious COVID-19 illness. These include Type 2 diabetes, liver disease, heart disease, cancer, obesity and asthma.  According to the Centers for Disease Control and Prevention (CDC) AI/AN People have the highest COVID-19 hospitalization rate at 281 per 100,000 – a rate 5.3 times higher than for non-Hispanic Whites.[1] Aggregated national data on death rates show that AI/AN People are experiencing the second highest COVID-19 death rate, at 60.5 deaths per 100,000.[2]

In closing, we thank the Committee for the continued commitment to Indian Country and urge you to prioritize Indian Country in COVID-19 vaccine distribution and access. We patiently remind you that federal treaty obligations to the Tribes and AI/AN People exist in perpetuity, and must not be forgotten during this pandemic.   We urge you to make a commitment and follow through on it: determine that American Indians and Alaska Natives will receive the vaccine, will have funds sufficient to acquire and distribute it and the full faith and confidence of the United States Government will ensure distribution to this nation’s first citizens will be reliable, swift and early. As always, we stand ready to work with you in a bipartisan fashion to advance health in Indian Country.


National Indian Health Board

National Congress of American Indians

National Council of Urban Indian Health


Lisa Murkowski, Chair, Senate Appropriations Subcommittee on Interior, Environment, and Related Agencies

Tom Udall, Ranking Member, Senate Appropriations Subcommittee on Interior, Environment, and Related Agencies

Betty McCollum, Chair, House Appropriations Subcommittee on Interior, Environment, and Related Agencies

David Joyce, Ranking Member, House Appropriations Subcommittee on Interior, Environment, and Related Agencies

[1] Centers for Disease Control and Prevention. COVID-19 Data Visualization.

[2] APM Research Lab. The Color of Coronavirus: COVID-19 Deaths by Race and Ethnicity in the U.S.

COVID-19 Presents Significant Risks for American Indian and Alaska Native People

The Kaiser Family Foundation posted this article to its blog on May 14, 2020.  They stated,

“[t]he COVID-19 emergency presents significant risks for the over 5 million individuals who self-identify as American Indian and Alaska Native (AIAN) alone or in combination with another race. AIAN people live across the country, but are concentrated in certain states, with roughly half living in seven states (CA, OK, AZ, TX, NM, WA, and NY). Under treaties and laws, the federal government has a unique responsibility to provide health care services to AIAN people. AIAN people face disproportionate risks from the COVID-19 outbreak given significant underlying disparities in health, social, and economic factors. Addressing their needs as part of COVID-19 response efforts will be key for preventing further widening of these disparities and fulfilling the federal government’s federal trust responsibility.

The arrticale cotnaisn 3 charts and disucsses barriers to treatment, new finanncial burdens from COVID 19, and contains several links to support its discussin of underlying disparities. They note,  “AIAN individuals are more likely to lack access to clean water and plumbing and to live in substandard and crowded housing situations, limiting the ability to practice frequent hand washing and social distancing.”

IHS Announces Phase 4 COVID-19 Funding Allocation Decisions

Includes $50 million to UIOs for testing

On May 19, 2020 the Indian Health Service (IHS) announced the most recent round of COVID-19 funding determinations in a Dear Tribal Leader and Urban Indian Organization Leader Letter (DULL).  The DULL outlines the total allocations for the $750 million appropriation for Indian Country Health Care Providers in the Paycheck Protection Program and Health Care Enhancement Act (PPPHCEA).  The Act was signed into law on April 24, 2020 and provided the funding to the Department of Health and Human Services (HHS) under the Public Health and Social Services Emergency Fund, to be used in support of testing and testing related activities for Tribal Health Programs (THPs) and Urban Indian Organizations (UIOs).

IHS’s funding determinations include $50 million for UIOs, which will be distributed through the existing Indian Health Care Improvement Act (IHCIA) contracts. As outlined in the Act, the funds are to be used for the purchase, administration, process, and analysis of COVID-19 testing, including the support for workforce, epidemiology, and use by employers in other settings. UIOs IHCIA contracts will receive modified scopes of work and bilateral modifications to their IHCIA contracts consistent with the funding purposes for which the funds were appropriated.

Other funding determinations announced in the DULL include $550 million to IHS Federal health programs and THPs, of which $50 million is to be used for new Purchased/ Referred Care (PRC) funds. $100 million will be used to purchase tests, testing supplies, and PPE for the IHS National Supply Service Center (NSSC). UIOs are eligible to receive supplies from the NSSC. The final $50 million is allocated for nation-wide coordination, epidemiological, surveillance, and public health support.

This third round of COVID-19 funding comes after the April 29, 2020 Urban Confer and Tribal Consultation calls regarding this funding as well as weekly IHS-hosted UIO Leader COVID-19 calls advocated for by the National Council of Urban Indian Health (NCUIH). NCUIH continues to advocate on behalf of UIOs and the urban Indian populations they serve during this public health crisis.

Read the DULL


On May 29, for the first time, the Federal Emergency Management Agency (FEMA) met exclusively with a group of Urban Indian Organization (UIO) leaders. The call took place via Zoom video conference. The purpose of the call was to provide UIOs an opportunity to learn about programs open to nonprofits, get questions answered, and open the lines of communication with FEMA officials. FEMA is one of the major operational components that make up the Department of Homeland Security, which is facilitating a whole-of-government response in confronting COVID-19, keeping Americans safe, and helping detect and slow the spread of the virus.

The following officials from FEMA participated in the call: Acting Director Public Assistance Division Tod Wells; Attorney-Advisor, Federal Indian Law Subject Matter Expert Dorn Lawin; Tribal Affairs Specialist Margeau Valteau; and Tribal Integration Advisor Jessica Specht. Dr. Rose Weahkee, Director of the Office of Urban Indian Health Programs at the Indian Health Service, was also in attendance. FEMA sent NCUIH responses to the questions UIO leaders asked in a document that can be found here.

UIO Funding Opportunities COVID-19

Updated: 11/12/2020

Download PDF with Links

HHS Announces Additional $500 Million to Indian Health Service for Provider Relief Fund

  • IHS and tribal hospitals will receive a $2.81 million base payment plus three percent of their total operating expenses
  • IHS and tribal clinics and programs will receive a $187,000 base payments plus five percent of the estimated service population multiplied by the average cost per user
  • Urban Indian Organizations – will receive $181,000 base payment plus 6% of the estimated service population multiplied by the average cost per user.
  • View Opportunity:

U.S. Department of Agriculture Rural Distance Learning & Telemedicine Grants

  • Program Fact Sheet– 2nd window of funding that includes $25 million from CARES Act for DLT to support telecommunications for rural areas.
  • Grant funds may be used for:
    • Broadband facilities
    • Audio, video and interactive video equipment
    • Terminal and data terminal equipment
    • Computer hardware, network components and software
    • Inside wiring and similar infrastructure that further DLT services
  • Acquisition of instructional programming that is a capital asset
  • Acquisition of technical assistance and instruction for using eligible equipment
  • View Opportunity:

Deadline: July 13, 2020

SAMHSA COVID-19 Emergency Response for Suicide Prevention Grants

  • The purpose of this program (COVID-19 ESRP) is to support states and communities during the COVID-19 pandemic in advancing efforts to prevent suicide and suicide attempts among adults age 25 and older in order to reduce the overall suicide rate and number of suicides in the U.S.  A minimum of 25 percent of direct services funding be used to support this domestic violence victims population. 50 awards anticipated.
  • View Opportunity:

Deadline: May 22, 2020 on rolling basis

Administration for Children and Families (ACF)- CARES Act Allocation

COVID-19 Funding Guidance for Tribes, Tribal Organizations, and Urban Indian Organizations

CDC – Urban Indian Prevention, Response and Control of COVID-19 Initiative

  • $8 million UIO set-aside for public health via NCUIH contracts
  • View Opportunity
  • Deadline: May 1, 2020

Health Resources and Services Administration (HRSA)-Rural Tribal COVID-19 Response Program

  • Coronavirus Aid, Relief, and Economic Security (CARES) Act, $15 million for tribes, tribal organizations, UIOs, or health service providers to tribes to carry out telehealth and rural health activities
  • View Opportunity
  • Deadline: May 6, 2020

CDC – Comprehensive Suicide Prevention

NIH- National Institute of Allergy and Infectious Diseases from the Families First Coronvirus Response Act

  • $836 million, includes training to prevent and reduce exposure to health workers.
  • No distribution fund has been created yet.

$100 billion- Public Health Social Service Emergency Fund will be distributed to current Medicare providers based on revenues.

HHS- Provider Relief Fund Act

Fact Sheet on distribution Registration for claims reimbursement for Providers Treating Uninsured COVID-19 Patients

Fact Sheet: Impact of COVID-19 Pandemic on Third-Party Reimbursements for the Indian Health System

Download Fact Sheet: Impact of COVID-19 Pandemic on Third-Party Reimbursements for the Indian Health System

By: Shervin Aazami, Director of Congressional Relations, National Indian Health Board,; Julia Dreyer, Director of Federal Relations, National Council of Urban Indian Health,;

April 2020

Fact Sheet: Impact of COVID-19 Pandemic on Third-Party Reimbursements for the Indian Health System

Priority: Create a $1.7 billion third-party reimbursement relief fund for Indian Health Service (IHS), Tribes and Tribal organizations, and urban Indian organizations (UIOs)


The COVID-19 pandemic has upended many parts of the Indian health system. As states enforce shelter in place orders, require health care providers to cancel non-emergent procedures, and as social distancing guidelines continue, IHS, Tribal and UIO (collectively “I/T/U”) sites are seeing their patient volumes plummet. Some I/T/U facilities have the capacity to make the transition to telehealth-based service delivery for some routine and non-emergent procedures, but this is not an option for all sites or all procedures. Reduced patient visits and services being offered result in less third-party reimbursements from payers such as Medicare, Medicaid, the Veterans Health Administration (VHA), and private insurance.

  • Because of the chronic underfunding of IHS, most, if not all, of the more than 360 Tribal Nations that elect to administer their healthcare programs through Self-Governance agreements must supplement funds received from IHS with third-party reimbursements. For some Tribes, third-party collections can constitute over half of their operating budgets for healthcare.
  • Tribal Nations have experienced significant reductions in third-party reimbursement—ranging from $800,000 to over $5 million per Tribe over the last 30 days—as a result of suspended services and stay at home orders.
    • In Arizona, initial estimates for March 2020 show that IHS and Tribal third-party collections from Medicaid alone were down nearly $26 million compared to February 2020. These losses are likely underestimated because the Medicaid claims submission process can take up to 12 months in the state.
    • When extrapolated across the 360 Tribally-run health programs, losses are estimated to be higher than $1 billion for just one month.
  • Federally-operated IHS facilities are also heavily reliant on third-party collections to supplement its appropriation.
    • IHS has not publicly released information on third-party collections as a result of COVID-19, but IHS officials indicated they are experiencing reductions. IHS reported to the Government Accountability Office (GAO) in 2019 that it increasingly relies on third-party collections to pay for ongoing operations such as staff payroll, and expansion of on-site services.
    • Reductions in third-party collections are forcing IHS and Tribal sites to further expend limited Purchased/Referred Care (PRC) funds.
  • For UIOs, third party reimbursement dollars equal more than triple the annual appropriation to the Urban Indian Health line item in the IHS budget. Through mid-March 2020, UIOs reported an average of $500,000 in lost third-party reimbursements, while larger full ambulatory UIOs reported losses of more than $1.5 million.
Congress must establish a $1.7 billion relief fund for I/T/U facilities to replenish lost third-party reimbursement dollars. Without this relief, it will lead to even more rationed healthcare and jeopardizes the sustainability of some I/T/U facilities.

The IHS is the most chronically underfunded federal healthcare system, with $3,779 in per capita medical expenditures in FY 2018 compared to $9,409 in national per capita health spending that same year. Congress has long recognized the unique role of third-party reimbursements from Medicare, Medicaid, VHA, and private insurance in supplementing the chronic underfunding of IHS. For decades, these third-party payers have played a central role in maintaining the fiscal stability of IHS, Tribal, and urban Indian (collectively “I/T/U”) health systems, and in furthering the federal Trust and Treaty obligations to provide quality healthcare to all Tribal Nations and American Indian and Alaska Native Peoples.

Quick Facts
  •  In FY 2019, federally-operated IHS facilities alone collected $1.14 billion in third party reimbursements, with the vast majority ($995 million) derived from Medicare and Medicaid.
  •  For Tribally-operated health programs, third-party dollars can play an even more crucial role in financing healthcare services. Up to 50-60% of some Tribal healthcare budgets are derived from third-party payers like Medicare and Medicaid.
  •  UIOs are also heavily reliant on third-party dollars to supplement their healthcare resources. From 2014 to 2018, third-party reimbursements at UIOs increased 16% annually.
Benefit of Third-Party Reimbursement Dollars

Over the last several years, I/T/U facilities have experienced a significant increase in third-party reimbursements. At federally-operated IHS sites, third-party reimbursements from Medicare, Medicaid, and private insurance increased by 51% from 2013 to 2018. These dollars are then reinvested in the I/T/U system to bolster availability of healthcare services and expand care access.