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

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

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

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

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

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

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

Technical Assistance and Research Fellow Reflects on Her Summer 2024 Internship Experience

Photo of Tyla Hall

Tyla Hall, National Council of Urban Indian Health (NCUIH) Technical and Research Center (TARC) Intern

This summer I had the opportunity to intern at the National Council of Urban Indian Health (NCUIH) and work with the Technical Assistance and Research Center (TARC) team. Over the 10 weeks, I assisted in numerous projects, attended many internal briefs, and gained a wide range of knowledge.

I was excited to intern at NCUIH as I am going into my senior year at the University of Florida. This upcoming spring I will graduate with a Bachelor of Science in Business Administration with a concentration in Information Systems. After meeting with Dr. Kimberly Fowler and learning more about what the TARC team does I knew that not only was I going to gain the experience needed to work in this industry, but I was also going to enjoy it.

My favorite project was creating an infographic based on the “Thematic Analysis of Traditional Foods Programs at Urban Indian Organizations”. Working with Nahla Holland and Margot Bailowitz, we created a vision of how the infographic should look and what information we wanted to convey. I loved that I was given a lot of stylistic freedom in making this infographic as I would consider myself a creative person and it’s not often that I can showcase this trait in technical fields. After creating multiple drafts, we met with the Communications and Graphic Design team, where even more drafts were made. This project taught me many things, like how to communicate with different departments and how much effort goes into something we view as simple. But most importantly, I learned how to take constructive criticism from multiple people. I was appreciative of the feedback I received as it allowed me to deliver the best results.

Celebrating Native American Heritage Month: NCUIH’s Commitment to Indigenous Health

Celebrating Native American Heritage Month: NCUIH's Commitment to Indigenous Health

November marks the observance of Native American Heritage Month, a time to honor and celebrate the rich cultures, histories, and contributions of Native American and Indigenous communities. At the National Council of Urban Indian Health (NCUIH), this month holds profound significance as it aligns with our ongoing commitment to supporting the health and well-being of Indigenous populations across the country. NCUIH celebrates Native American heritage every day by holding the federal government responsible for their unmet federal trust responsibility to Native people.

Preserving Heritage through Health Initiatives:

NCUIH plays a pivotal role in advocating for the right to healthcare in urban Indian communities, emphasizing preserving cultural heritage as a crucial aspect of overall well-being. By addressing healthcare disparities and championing policies that prioritize the unique needs of Native Americans, our organization contributes to the preservation of Indigenous heritage.

Cultural Competency in Healthcare:

One of NCUIH’s key initiatives involves promoting cultural competency within the healthcare system. We believe that healthcare services should not only be accessible but also culturally sensitive and responsive to the diverse needs of Native American communities. Through advocacy and collaborative efforts, NCUIH strives to ensure that healthcare providers recognize and respect the cultural contexts that influence the health choices of Indigenous individuals.

Addressing Health Disparities in Urban Native Settings:

As urbanization continues to impact Native American communities, NCUIH works tirelessly to address health disparities that often arise in urban settings. Our initiatives focus on improving healthcare access and mental health services and addressing social determinants of health that disproportionately affect urban Indian populations. By doing so, we contribute to the holistic well-being of individuals while preserving the cultural fabric that defines their identity.

Advocacy for Equitable Policies:

Native American Heritage Month serves as a reminder of the resilience and strength of Indigenous communities throughout history. NCUIH channels this spirit into advocacy efforts aimed at influencing policies that impact the health and wellness of urban Indians. By actively engaging with policymakers, we strive to create an environment where health policies are inclusive and considerate of the unique challenges urban populations face. Read more about our policy priorities here.

The Call to Action:

As we celebrate Native American Heritage Month, NCUIH invites individuals and organizations to join us in our commitment to the health and well-being of indigenous communities. By fostering awareness, advocating for equitable policies, and supporting culturally competent healthcare, we can collectively contribute to preserving and celebrating Native American heritage. Now is a poignant time to reflect on the importance of organizations like NCUIH in ensuring that the health needs of indigenous populations are acknowledged and met. Together, let us honor the resilience and contributions of Native American communities by continuing to advocate for their health and well-being.

Help support our vital work by making a tax-deductible donation here.

Research and Data Intern Reflects on Her Summer 2023 Internship Experience

Photo of Alicia Evan

Alicia Evan, National Council of Urban Indian Health Technical and Research Center (TARC) Intern

This summer I got to work as the National Council of Urban Indian Health (NCUIH) Technical and Research Center (TARC) Intern. I worked alongside Deidre Greyeyes, Nahlah Holland, Isaiah O’Rear, and Alexander Zeymo.

To get my internship rolling, I jumped right into the Knowledge Resource Center (KRC) where Nahla taught me about one-pagers and their purpose. After getting a few one-pagers completed and under my belt, I was tasked with the job of compiling three years’ worth of GPRA Data, from 2018 to 2020. I took the pdfs and created an excel document formatted to display the data in a way that was easy to read and relevant to our goals. At the end, we achieved those goals by creating graphs to showcase the trends and significant increases or decreases in values from year to year. We presented our findings to the Data Standards Committee meeting at the end of August. After completing that project, I dove headfirst into my next task where I created an infographic based on the Traditional Healing Meta Analysis Report. The infographic showcased the benefits of common traditional healing methods practiced at Urban Indian Organizations. This infographic will go on the final study poster presented by the data team. I wrapped up my summer by looking at another data set where I got to look at values given by UIOs that did not report values for the GPRA data. Though the measures did not line up perfectly, it was still interesting to see and compare another data set and how measures were taken and defined.

This summer I learned a lot about the importance of data collection, got to take a look at large-scale research projects behind the scenes, and dabbled in graphic design. Before this summer, I had never worked a remote job before. There was an adjustment period in getting used to the teams’ platform, but I feel like I improved and got a better feel for remote work by the end. I could not have done any of this without my wonderful team who so kindly guided me through each project and were always there when I needed them on a regular day-to-day basis. I strengthened my teamwork and communication skills while practicing managing my time as meeting deadlines played a crucial role in each project. Overall, I had an amazing time this summer and I would not have wanted my time with NCUIH to go any other way.

Technical Assistance and Research Fellow Reflects on Her Summer 2023 Internship Experience

As schools and colleges head back into another year, The National Council of Urban Indian Health (NCUIH) will send off their Technical Assistance and Research Center (TARC) summer Intern. Over the past nine weeks, Amiya Fellows has assisted in research projects, attended external and internal webinars, worked collaboratively with NCUIH staff, and supported organizational projects within NCUIH’s systems. Amiya is entering her second year of college, pursuing her bachelor’s in healthcare administration at Tennessee State University. She is a member of the Honors College, Alpha Lambda Delta Honors Society, and participates in various volunteer work with different organizations. 

Amiya reflected on her time at NCUIH, “After my first year at TSU, I received a call from my advisor that I was offered this internship. I was so excited to hear this unexpected news and to be able to work within my field. My time here at NCUIH has been nothing short of amazing and I have enjoyed every day here. Before this internship, I knew the bare minimum about Indian country, and learning about this population feels like I’ve entered an entirely new world from mine, which makes me wonder what other worlds I am missing out on. It also created a challenge because not only am I learning different ways to help this population, and experiencing public health hands-on, but I’m also learning about this population in general. This was eye-opening yet enjoyable. Finding NCUIH has reassured me that public health is the path for me. I am so blessed to be able to take the experiences and lessons I learned here and expand upon them in the future. 

During my time here as a TARC intern, I was able to support various public health projects at NCUIH on topics such as AIDS/HIV among urban American Indians/Alaska Natives, Infection Prevention Control, Missing and Murdered Indigenous People, Maternal Mortality Review Committee, and Emergency Preparedness as a member of their workgroups. I completed the adult Mental Health First Aid (MHFA) certification course, created 18 newsletters, created eight one-pagers for archiving on the Knowledge Resource Center, and identified and organized resources on the NCUIH Technical Assistance Portal site. I have also helped with various organizational tasks within NCUIH. The newsletters and social media posts have helped my writing skills by learning how to get to the point while also attracting an audience since most of my writing thus far has been for professors to read. I have learned how to read the key points in peer-reviewed educational articles, so I can read through them quicker but still get the information I need. Learning these skills will help me when I return to college in August, and I will use these skills as I continue my education. I had a wonderful time learning about Indian Country and working alongside the understanding and passionate community within NCUIH. I couldn’t have asked for a better experience!” 

NCUIH sends its best wishes to Amiya as she continues to pursue her educational and professional goals!

MEDIA MENTION: White House wants Native American health care funding baked into law

In this photo taken Oct. 14, 2008, people sit in the Indian Health Services waiting room on Standing Rock Reservation in Fort Yates. N.D. (AP Photo/Will Kincaid)

In this photo taken Oct. 14, 2008, people sit in the Indian Health Services waiting room on Standing Rock Reservation in Fort Yates. N.D. (AP Photo/Will Kincaid)

On the Standing Rock Indian Reservation, which straddles the border between North and South Dakota, people line up at 6 a.m. in the freezing winter, hoping to get one of just four dental appointments.

“If you don’t get those four, you’re out, you don’t get it,” said Janet Alkire, chairwoman of the Standing Rock Sioux Tribe, who described the scene at an April hearing of the House Natural Resources Subcommittee on Indian and Insular Affairs.

And the lack of adequate medical care extends well beyond dental care, she told lawmakers.

“Our babies cannot be born on our reservation,” she said. “Mothers have to leave their support networks, their families, sometimes the dads, definitely the grandmothers, behind and travel over 75 miles to deliver a baby.”

Through the Indian Health Service, the federal government provides free medical care for Native Americans, which the United States promised in various treaties with indigenous nations when it forced them from their lands in the mid-19th century.

However, many Native Americans complain that the U.S. government breaks this promise by underfunding the Indian Health Service.

In order to solve this problem, the Biden administration wants to take Indian Health Service funding out of the annual budget negotiation process and instead have it baked into law. Its plan would culminate in around $44 billion in funding in fiscal 2033 — six times greater than current funding levels, but still short of what experts and advocates say is needed.

Indian Health Service funding has increased 68 percent in the past decade, culminating in $7.1 billion for the agency for fiscal 2023. But the agency’s funding is significantly less than other federal health care programs. In 2017, Indian Health Service spending per capita was less than half of that of the Veterans Health Administration and less than a third compared to Medicare, according to a report by the Government Accountability Office.

The National Tribal Budget Formulation Workgroup, a group of Native American advocates and tribal representatives that advises the Indian Health Service on its annual budget request, estimates that nearly seven times more funding for the agency is needed to meet Native health care needs.

In her testimony, Alkire described the impact of this lack of adequate funding.

“The IHS hospital at Standing Rock is more than 60 years old,” she said. “It is falling apart and lacks space for life-saving equipment.”

“We recently purchased a CT scan (machine) with our own limited funds,” Alkire added. “There was no room, and we had to build it in the back entry to the building. But we do what we have to do, right?”

Such problems are not limited to that specific hospital. According to the Workgroup’s report on its fiscal 2024 budget recommendations, Indian Health Service hospitals have only 52 percent of the space needed based on the size of the population the agency cares for. Hospitals in Indian Country are also nearly four times older than the national average, the report says.

In its fiscal 2024 budget proposal, released in March, the Biden administration called for full mandatory funding for the Indian Health Service by fiscal 2025. The agency currently receives most of its funding through discretionary spending, which must be debated by Congress each year through the appropriations process. Programs like Medicare and Medicaid receive mandatory funding, meaning they’re automatically given a certain amount each year as determined by law.

The White House is asking for $9.7 billion in total Indian Health Service funding for fiscal 2024, including $1.6 billion in proposed mandatory funding for certain expenses. By fiscal 2025, the administration wants all Indian Health Service funding to be mandatory, with automatic spending increases to address increasing costs, existing backlogs and key operational needs.

In its congressional budget justification, the Indian Health Service says mandatory funding is necessary to get the full amount of funding it needs, as otherwise it’s limited by discretionary budget caps. The debt ceiling deal signed by Biden last week keeps nondefense discretionary spending flat next year and only allows for a 1 percent increase in fiscal 2025.

White House press secretary Karine Jean-Pierre said this change is part of the Biden administration’s goal to lift up groups that have been historically underserved.

“There are communities, whether it’s Indian Country, Native Americans, whether it’s rural America, whether it’s urban America, where people have felt left behind,” she said in April. “This is a story that is part of (Biden’s) economic policy, which is not leaving anybody behind, making sure that people get the assistance, they get the help that they sorely need.”

Native American advocates have been pushing for mandatory Indian Health Service funding for years. One such group, the National Council of Urban Indian Health, advocates for the health care needs of Native Americans living in urban areas. The council’s vice president of policy and communications, Meredith Raimondi, said unpredictable funding creates barriers to providing health care.

“If you’re a health care clinic and you’re trying to hire staff, and you don’t know what your funding is going to be next year, it’s a lot harder to plan and retain staff. It’s harder to buy lab equipment. It’s harder to know if you can pay (for) your lab testing and your vendors,” Raimondi said. “So it makes it extremely hard to deliver health care at a time when our health care needs are at an all time high.”

Making Indian Health Service funding mandatory would require an amendment to the Indian Health Care Improvement Act, which authorizes funding for the agency.

Congress appears divided on the issue.

In an interview, Sen. Brian Schatz (D-Hawaii), who chairs the Senate Committee on Indian Affairs, said he supports making Indian Health Service funding mandatory. But Rep. Harriet Hageman (R-Wyo.), chair of the House Natural Resources Subcommittee on Indian and Insular Affairs, criticized the idea at a May hearing, suggesting the agency’s problems are actually the result of poor management.

“We need to see significant progress before how IHS is funded can significantly change,” Hageman said.

She said it’s important to focus on cutting the federal deficit.

“I just did a poll this week as to some of the issues that are the most important to my constituents in the state of Wyoming, and the budget and government and federal spending is at the top of the list,” Hageman said.

However, Ranking Member Rep. Teresa Leger Fernández (D-N.M.) pointed out that Biden’s proposed budget would actually reduce the deficit. Biden has proposed cutting the deficit by nearly $3 trillion over the next 10 years, largely by raising taxes on the wealthiest Americans.

“There are ways to reduce the deficit while also investing in what is important,” Leger Fernández said.

Raimondi said Native health care shouldn’t be cut to lower the deficit.

“Native Americans who gave up their land and who entered into treaties and have a trust relationship with the federal government are owed health care, regardless of whether or not the federal government needs to fix its deficit or cut costs,” Raimondi said.

Biden also requested full mandatory funding for the Indian Health Service last year, the first time that a president did so, according to that year’s Indian Health Service congressional budget justification. While this ultimately did not come to fruition, the last budget did make a significant change by providing advance appropriations for the agency, meaning some funding for fiscal 2024 was provided a year in advance. Prior to this change, the Indian Health Service was the only major federal health care provider to be funded solely by regular yearly appropriations.

This change means the agency will have more protection from government shutdowns. The 2018-2019 shutdown, which lasted 35 days, caused major disruptions to the agency’s services. At least five Indian Health Service patients died during the shutdown, according to the National Council of Urban Indian Health.

Raimondi said advance appropriations are an important step, but they still have to be passed by Congress each year. She said mandatory funding is needed to ensure proper health care for Native Americans.

“You need to have the mandatory funding so it’s not subject to the whim of political fights,” Raimondi said. “And so that we know that American Indian and Alaska Native people will have access to the health care that they deserve and earned.”

PRESS RELEASE: NCUIH Testifies at Two Congressional Hearings Regarding Critical Funding for Urban Indian Health

Congressional leaders emphasized the need to increase resources for urban Indian health and provide opioid funding for urban Indian communities.

FOR IMMEDIATE RELEASE

NCUIH Contact: Meredith Raimondi, Vice President of Public Policy, mraimondi@ncuih.org, 202-417-7781

WASHINGTON, D.C. (April 5, 2022) – The National Council of Urban Indian Health (NCUIH) President-Elect and CEO of the Indian Health Center of Santa Clara Valley, Sonya Tetnowski (Makah Tribe), testified before the House Interior Appropriations Subcommittee as part of American Indian and Alaska Native (AI/AN) Public Witness Day hearing regarding Fiscal Year (FY) 2023 funding for Urban Indian Organizations (UIOs). Maureen Rosette (Chippewa Cree Nation), NCUIH board member and Chief Operating Officer of NATIVE Project, testified before the House Natural Resources Oversight & Investigations Subcommittee for a hearing entitled, “The Opioid Crisis in Tribal Communities.” In their testimonies, NCUIH leaders highlighted the critical health needs of urban Indians and the needs of the Indian health system.

NCUIH thanks the members of the subcommittees for the opportunity to testify on the needs of urban Indians and encourages Congress to continue to prioritize urban Indian health in FY 2023 and years to come.

House Appropriators Demonstrate Strong Commitment to Indian Health

NCUIH President-Elect Tetnowski testified before the House Appropriations Subcommittee along with Ms. Fawn Sharp for the National Congress of American Indians, Mr. Jason Dropik for the National Indian Education Association, and Mr. William Smith for the National Indian Health Board. The House Appropriations Committee uses testimony provided to inform the FY 2023 Appropriations decisions.

NCUIH requested the following:

  • $49.8 billion for the Indian Health Service (FY22 Enacted: $6.6 billion) and $949.9 million for Urban Indian Health (FY22 Enacted: $73.4 million) for FY 2023 as requested by the Tribal Budget Formulation Workgroup
  • Advance appropriations for the Indian Health Service (IHS)
  • Support of mandatory funding for IHS including UIOs

Full Funding for the Indian Health System a Priority for Congress

Many Members of Congress on both sides of the aisle noted the need to increase resources for Indian health in order to meet the trust responsibility. The federal trust obligation to provide health care to Natives is not optional and must be provided no matter where they reside,” said Ms. Tetnowski in her testimony, “Funding for Indian health must be significantly increased if the federal government is, to finally, and faithfully, fulfill its trust responsibility.”

Ranking Member David Joyce (R-OH-14) agreed with Ms. Tetnowski, “There is still much to do to fulfill the trust responsibility.” Representative Mike Simpson (R-ID-02), also emphasized that more must be done so “there’s not disparity between Indian Health Services and other health services delivered by the federal government.”

President Sharp stated, “This subcommittee’s jurisdiction includes some of the most critical funding for Indian Country. As detailed in the 2018 Broken Promises Report, chronically underfunded and inefficiently structured federal programs have left some of the most basic obligations of the United States to tribal nations unmet for centuries. We call on this subcommittee in Congress to get behind the vision of tribal leaders for right these wrongs by providing the full and adequate funding for Indian country.”

The Case for Mandatory and Advance Appropriations for IHS

The Indian health system, including IHS, Tribal facilities and UIOs, is the only major federal provider of health care that is funded through annual appropriations. For example, the Veterans Health Administration at the Department of Veterans Affairs receives most of its funding through advance appropriations. If IHS were to receive advance appropriations, it would not be subject to government shutdowns, automatic sequestration cuts, and continuing resolutions (CRs) as its funding for the next year would already be in place. According to the Congressional Research Service, since FY 1997, IHS has once (in FY 2006) received full-year appropriations by the start of the fiscal year.

“During the most recent 35-day government shutdown at the start of FY 2019, the Indian health system was the only federal healthcare entity that shut down. UIOs are so chronically underfunded that several UIOs had to reduce services, lose staff, or close their doors entirely, forcing them to leave their patients without adequate care. Advance appropriations is imperative to provide certainty to the IHS system and ensure unrelated budget disagreements do not put lives at stake,” said Ms. Tetnowski.

Many Members of Congress were interested in hearing more about the differences between mandatory and advance appropriations. In her opening remarks, Chair Pingree pointed out that the mandatory funding proposal, if implemented, would remove the jurisdiction from the Appropriations Committee to the authorizing committees. Both NCAI President Sharp and NIHB Chair Smith also expressed support for the mandatory funding proposal from President Biden. Mr. Smith testified the President’s proposal is “a bold vision to end chronic underfunding and building a comprehensive Indian health care system. We urge Congress to support the request and work together with administrations and the tribes to see that as passed into law.”

Rep. Simpson sought to clarify whether both Advance Appropriations and Mandatory Appropriations remain priorities for Indian Country. President Sharp explained that “both [advance and mandatory funding] are critically important” in fulfillment of the trust responsibility while noting that basic health should be a mandatory expenditure of the United States government. President-Elect Tetnowski also stated that, “Advance appropriations would ensure that we weren’t shut down during any type of government closure. IHS is currently the only health care [provider] in the Federal government that does not have advanced appropriations.”

Resources

Congressional Leaders Express Support for Expanding Opioid Funding to Urban Indians

“Opioid overdose deaths during the pandemic increased more in Native American communities than in communities for any other racial or ethnic group,” said Representative Katie Porter (D-CA-45), “to address this crisis, we need to provide more resources for tribal governments and urban Indian health organizations to treat the opioid epidemic.” 

Urban Indians Left out of Opioid Grant Funding

Funding to assist AI/AN communities to address the opioid crisis have repeatedly left out urban Indians. UIOs were not eligible for the funding designated to help Native communities in the State Opioid Response (SOR) Grant reauthorization included in the recently passed FY 2022 Omnibus (H.R. 2471) despite inclusion of UIOs in the SOR bill (H.R. 2379) that passed the House on October 20, 2021. The final language in the omnibus (H.R. 2471) did not explicitly include “Urban Indian Organizations” as eligible and did not use the language from H.R. 2379. While this was likely a result of legislative text being copied from previous legislation, this prohibits urban Indian health providers from being able to access the critical funding needed to combat the opioid crisis.

“During the last government shutdown, one UIO suffered 12 opioid overdoses, 10 of which were fatal. This represents 10 relatives who are no longer part of our community,” Ms. Rosette emphasized, “These are mothers, fathers, uncles, and aunties no longer present in the lives of their families. These are tribal relatives unable to pass along the cultural traditions that make us, as Native people, who we are.”

Responding to a question from Rep. Stansbury (D-NM-01) on what the committee can do to help support UIO’s work on the ground to address the opioid crisis in Native communities, Ms. Rosette reiterated, “Funding is always an obstacle for us. Grants, like the state opioid response grant, would allow us to provide culturally appropriate treatment to our community, but we were not included. You have to specifically say “urban” along with “tribal” otherwise we are not allowed to get the funding.”

Opioid Epidemic in AI/AN Communities

Since 1974, AI/AN adolescents have consistently had the highest substance abuse rates than any other racial or ethnic group in the U.S. Urban AI/AN populations are also at a much higher risk for behavioral health issues than the general population. For instance, 15.1% of urban AI/AN persons report frequent mental distress compared to 9.9% of the general public.

Additionally, the opioid crisis and COVID-19 pandemic are intersecting with each other and presenting unprecedented challenges for AI/AN families and communities. On October 7, 2021, the American Academy of Pediatrics published a study on caregiver deaths by race and ethnicity. According to the study, 1 of every 168 AI/AN children experienced orphanhood or death of caregivers due to the pandemic and AI/AN children were 4.5 times more likely than white children to lose a parent or grandparent caregiver. Unfortunately, this has exacerbated mental health and substance use issues among our youth. In the age group of 15-24, AI/AN youth have a suicide rate that is 172% higher than the general population in that age group.

Resources

Next Steps

NCUIH will continue to advocate for full funding of Indian Health Service and urban Indian health at the amounts requested by Tribal leaders as well as for additional resources for the opioid response for Native communities.

Native American Heritage Month UIO Spotlight: All Nations Health Center

Native American Heritage Month is more than just a 30-day celebration, it’s a reminder that important work is happening every day to ensure Native communities everywhere have equitable access to services and representation.

NCUIH would like to introduce an Urban Indian Organization (UIO) and NCUIH member, All Nations Health Center in Missoula, Montana, who are at the frontlines of this important work and are representative of the imperative efforts of over 40 Urban Indian Organizations across the country.

We asked Executive Director, Skye McGinty (Little Shell Chippewa), MA, MBA, a few questions about their experiences in the UIO community, through the lens of All Nations, and what are some important things to keep in mind during Native American Heritage Month for both Native and Non-Native community members.

A picture of the All Nations team at their 3rd Annual 5K Fun Run and Walk.

 

Q: What do you wish the public knew about your services? Are there any misconceptions?

A: In late 2020, we changed our name from Missoula Urban Indian Health Center to All Nations Health Center to better reflect the culture of our clinic and our mission to provide holistic health services to the communities who live in and around Missoula. The biggest misconception in our community is that our services are only for Native people. While we do have an Indigenous perspective on the delivery of health services and our primary focus is on the Native population, we serve non-Natives, too. We hear time and time again from our non-Native clients that the kinds of services we provide and the way we deliver them is special and different compared to what you might experience in a Western medicine setting. If we could clear up any misconceptions, it’s that we provide services to truly all nations, and our Indigenous providers and services are for everyone.

 

Q: Why do you think organizations specific to serving Native communities are important?

A: It’s vital that Native people have access to services where their lived experiences are honored, they are reflected in the makeup of the staff, and strengthening their resiliency is at the top of the list of priorities. Native organizations provide that safety and honoring in ways that other organizations can’t. Good allyship from non-Native organizations is critical to moving the needle on issues that most deeply impact our Indigenous communities, but Native organizations already have the knowledge to reach our communities and make lasting, positive impacts. It’s imperative that we as Native people are leading the services that we provide to our communities.

 

Q: What’s the biggest challenge you face as an organization?

A: Aside from the obvious answer of COVID, our organization struggles with consistent levels of federal and state funding. Like many UIOs, our budget largely consists of a patchwork of different federal, state, and local grant initiatives. It’s hard to plan for sustainability when continuation applications, reporting requirements, and new grants are all due. Combined with the fact that UIOs have largely been left out of language in legislation that impacts our ability to be self-sustaining, finding reliable funding sources remains our largest challenge.  

 

Q: What excites you about the future of your facility?

A: I am most excited about having a truly integrated model of care for our patients in our new facility. Right now, our services are spread out among three facilities, and with the launch of our capital campaign, we’ll be able to consolidate all services in one brand new patient-centered medical home. I’m excited to bring on new providers to complement our current service offerings and to expand into new services that are comprehensive, holistic, and informed by Indigenous knowledge.

 

NCUIH is excited to share the experience of All Nations and recognize the many other essential UIOs providing vital services to their communities across the country. You can check out the full list of UIO NCUIH Members here. We hope this Native American Heritage Month, we can all re-center the needs of our urban Native communities across Indian Country. Sharing challenges, celebrating how far we’ve come, and looking forward to the future are all incredible ways to stay involved this month and always.

 

Looking for a way to engage with NCUIH and help raise awareness and much-needed funds towards social health equity? Register today for the #MoveWithNCUIH Native American Heritage Month Virtual 5k! Together we will walk, run, bike, swim (or however you choose to move) from a safe distance and celebrate our efforts virtually with one another.

 

Sign-up to #MoveWithNCUIH today!

PRESS RELEASE: Bipartisan Padilla-Moran-Lankford NCUIH Amendment for Urban Indian Health Passes Senate

The technical fix will be critical to improving health infrastructure for off-reservation American Indians and Alaska Natives.

FOR IMMEDIATE RELEASE – 8.2.21

Media Contact: National Council of Urban Indian HealthMeredith Raimondi, Director of Congressional Relations MRaimondi@ncuih.org 202-417-7781

Washington, D.C. (August 2, 2021) – On Monday, the Senate voted on amendments to the bipartisan infrastructure package including the Padilla-Moran-Lankford Urban Indian Health Amendment, which passed 90-7. The National Council of Urban Indian Health (NCUIH) has worked closely on a bipartisan basis for the past year on this technical legislative fix to support health care for tribal members who reside off of reservations. This amendment would allow existing resources to be used to fund infrastructure projects within the Indian health system.

“We applaud Senators Padilla, Moran, Lankford, Rounds, Smith, Feinstein, Schatz, and Schumer for their steadfast and tireless leadership on behalf of Indian Country. This technical fix will be critical to expanding health care infrastructure for Native communities who have been devastated by the COVID-19 pandemic. We also thank the National Congress of American Indians for their partnership in advocating for improved outcomes for all of Indian Country,” said Francys Crevier (Algonquin), CEO of NCUIH.

Next Steps

The Senate will continue to debate amendments to the bipartisan infrastructure plan. In the meantime, NCUIH will continue to advocate for $21 billion for Indian health infrastructure in the budget reconciliation package from the a joint letter led by the National Congress of American Indians (NCAI) on April 13, 2021.

Background

“Urban Indian Organizations (UIOs) are a lifeline to Native Americans living in urban areas across California,” said Senator Alex Padilla (D-CA). “Yet, UIOs are prohibited from using Indian Health Service funding for facilities, maintenance, equipment, and other necessary construction upgrades. During the pandemic, many UIOs couldn’t get approval for ventilation upgrades, heaters, generators, and weatherization equipment. Removing this unjust burden on UIOs is a commonsense fix and would allow them to improve the quality of the culturally competent care that they provide.”

“Oklahoma has the second-largest Urban Indian patient population and is proudly served in both Tulsa and Oklahoma City clinics. We should continue to improve health care access for our Urban Indian population and broaden the flexibility for Urban Indian Organizations’ use of facilities renovation dollars, in addition to those for accreditation, to meet patient needs,” said Senator James Lankford (R-OK).

“The impacts of COVID-19 will be with our Native communities for a long time to come. It is critical that the Indian Health Care Center of Santa Clara Valley and other UIOs be able to provide a safe environment for the families and patients we serve. We are extremely grateful for Senator Padilla’s leadership in rectifying a longstanding barrier preventing us from using existing funding to make urgent upgrades,” said Sonya Tetnowski (Makah), CEO of Indian Health Care Center of Santa Clara Valley, President of California Consortium for Urban Indian Health (CCUIH), and President-elect of NCUIH.

“It is time to live out this Country’s commitment to each other to live with respect for one another and in community. With this legislation, Friendship House in San Francisco will build a home village site for our urban Native Americans, so that our people may contribute to saving and enriching our homeland, which we must now all share and care for or lose. We greatly appreciate Senator Padilla’s leadership on this issue,” said Abby Abinanti (Yurok), President of the Friendship House Association of American Indians Board of Directors.

UIOs lack access to facilities funding under the general IHS budgetary scheme, meaning there is no specifically allocated funding for UIO facilities, maintenance, sanitation, or medical equipment, among other imperative facility needs. While the whole IHS system has made the transition to telehealth, negative pressurizing rooms, and other facility renovations to safely serve patients during the pandemic, restrictions in the relevant statutory text did not allow UIOs to make those transitions. Section 509 currently permits the IHS to provide UIOs with funding for minor renovations and only in order to assist UIOs in meeting or maintaining compliance with the accreditation standards set forth by The Joint Commission (TJC).

These restrictions on facilities funding under Section 509 have ultimately prevented UIO facilities from obtaining the funds necessary to improve the safety and quality of care provided to American Indian/Alaska Native (AI/AN) persons in urban settings. Without such facilities funding, UIOs are forced to draw from limited funding pools, from which they must also derive their limited funding for AI/AN patient services. This lack of facility funding for UIOs is a breach of the federal trust obligation to AI/AN health care beneficiaries, necessitating congressional action to include UIOs in future legislative measures for IHS facility funding.

In May, Congressman Ruben Gallego (D-AZ) and Congressman Don Bacon (R-NE) introduced the Urban Indian Health Facilities Provider Act (H.R. 3496) in the House of Representatives which expands the use of existing IHS resources under Section 509 of the Indian Health Care Improvement Act (IHCIA) (25 U.S.C. § 1659) to increase the funding authority for renovating, constructing, and expanding Urban Indian Organizations (UIO). Senators Alex Padilla (D-CA), James Lankford (R-OK) along with co-sponsors Moran (R-KS), Feinstein (D-CA), and Smith (D-MN) on the Senate Indian Affairs Committee introduced the identical Senate bill (S. 1797).

Last month, NCUIH testified before the House Natural Resources Subcommittee for Indigenous Peoples of the United States (SCIP) and the Senate Committee on Indian Affairs (SCIA) in support of the Urban Indian Health Facilities Provider Act (H.R. 3496 / S. 1797). Sonya Tetnowski (Makah Tribe), NCUIH President-Elect and Chief Executive Officer of the Indian Health Center of Santa Clara Valley, testified before SCIP and Robyn Sunday-Allen (Cherokee), NCUIH Vice President and CEO of the Oklahoma City Indian Clinic, testified before SCIA.

This fix is broadly supported in Indian Country and the National Congress of American Indians passed a resolution in June to “Call for Congress to Amend Section 509 of the Indian Health Care Improvement Act (IHCIA) to Remove Facility Funding Barriers for Urban Indian Organizations”.