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

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

Specifically, the bill:

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

Background

Native American Child Maltreatment

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

Legislative History

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

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

Resources

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

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

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

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

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

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

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

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

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

NCUIH staff

NCUIH staff

 

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

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

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

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

Full Letter

Dear Speaker Johnson and Leader Jeffries,

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

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

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

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

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

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

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

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

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

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

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

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

Recent Senate Support for SDPI Reauthorization and NCUIH Advocacy

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

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

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

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

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

Full Letter

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

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

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

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

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

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

Background and NCUIH Advocacy

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

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

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

NCUIH is grateful for the support of the following organizations:

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

Full Letter Text

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

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

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

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

Background on 100% FMAP for UIOs:

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

NCUIH Advocacy

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

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

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

Background on the FDPIR

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

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

NCUIH’s Advocacy

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

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

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

November Policy Updates: Annual Policy Assessment, Vaccine Toolkit, Medicaid Advocacy on the Hill, and more!

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RSV & flu Vaccine Toolkit, Policy Assessment, and Annual Report: Explore vaccination resources for Native communities and highlights from NCUIH’s latest Annual Report.

🔍 FY 2027 Area Budget Consultations: UIO Engagement Matters!

📜 Appropriations Update: Congress is back to address funding priorities, including the NDAA and expiring Continuing Resolution.

🗳 2024 Election Results Analysis: An overview of the House and Senate and key race outcomes.

💡 FMAP and SDPI Updates: Advocacy efforts continue for Medicaid parity, with renewed momentum for year-end SPDI reauthorization.

🎤Advocacy: NCUIH Joins CMS Tribal Technical Advisory Group in Key Medicaid Discussions before CMS Leadership and Senate Committees: Traditional Healing Waivers, Medicaid Fraud, and 100% FMAP for UIOs.

📅 Upcoming Federal Agency Comments: Key comment deadlines from SAMHSA, IHS, and SSA on policies affecting Native health.

📬 ICYMI: Updates on IHS Tribal Consultation policy and NIH’s policies on Tribal biospecimens.

🔎 NCUIH in Action: Recap of NCUIH’s role at the NCAI Annual Convention, White House Traditional Healing Summit, and American Cancer Society Cancer Action Network Panel discussions.

📆 Important Dates and Events: Upcoming events, from federal Tribal Advisory Committees to the White House

Hot off the Press: RSV and Flu Vaccine Toolkit, Annual Policy Assessment, and 2024 Annual Report

NCUIH

New Release: RSV and Flu Vaccine Toolkit

NCUIH has launched a comprehensive RSV and flu vaccine toolkit to support Urban Indian Organizations (UIOs) in promoting respiratory syncytial virus (RSV) and flu vaccinations within Native communities. The toolkit offers valuable resources, educational materials, and outreach strategies to help UIOs raise awareness and increase vaccination uptake in American Indian and Alaska Native (AI/AN) populations. The toolkit features social media graphics and customizable posts, posters to download and print, and messaging templates for use in newsletters or flyers. By using these materials, we hope you will reach more people in your community and encourage greater RSV and flu vaccine uptake during this critical time.

  • Access the toolkit here.

2024 Annual Policy Assessment

NCUIH is pleased to announce the release of its 2024 Policy Assessment. In September, NCUIH hosted five focus groups to identify UIO policy priorities for 2025 as they relate to the IHS designated facility types (full ambulatory, limited ambulatory, outreach and referral, and outpatient and residential). Together, these focus groups allow NCUIH to work with UIOs to identify policy priorities in 2025 and barriers that impact the delivery of care to Native patients and their communities.

  • Access the assessment here.

Annual Report Now Available!

NCUIH’s 2024 Annual Report is now live on our website, providing an in-depth look at our efforts and accomplishments over the past year. This report highlights:

  • Key Achievements in advocacy, policy, and health initiatives supporting urban Native communities.
  • Partnerships and Collaborations that have strengthened resources for Urban Indian health.
  • Data and Insights showcasing trends, challenges, and successes in Urban Indian health initiatives, including outcomes of vaccination and public health campaigns.
  • Future Goals and Strategic Initiatives to further advance health equity, access to care, and wellness for Native communities across the country.

The report is a valuable resource for understanding the impact of NCUIH’s work and our continued commitment to supporting UIOs and Native health. Visit our website to read the full report and explore how NCUIH is working to drive positive change in Native communities.

Area Budget Formulation – Your Engagement Matters!

NCUIH

Why Should UIOs Attend?  

  • Each Area submits its recommendation to the National Workgroup.
  • We believe that your attendance at Budget Formulation is directly linked to the recommendations and rankings for each area.
  • The average of all these amounts is used to calculate the Urban Line item.
  • If you are unable to attend your Area Budget Consultation when it is announced, please contact NCUIH. You may be able to submit testimony and/or slides to ensure your UIO’s contribution to the Area.

Upcoming Area Budget Consultation Meeting Dates:

  • Great Plains: 12/12/2024 (in-person). More information here.
  • Portland: TBD

Technical Assistance: If your UIO would like to schedule a one-on-one session with NCUIH to prepare for your respective Area budget consultation, please don’t hesitate to reach out to policy@ncuih.org.

Appropriations Update: Fiscal Year 2025

Illustration of the U.S. Capitol

Congress Returns for Lame Duck Session

On November 12, Congress resumed its legislative session, entering a period where lawmakers face several high-stakes decisions before the year’s end.

Top Priorities for the Lame Duck Session:

  1. Government Funding
  2. National Defense Authorization Act (NDAA)
  3. Public Health Extenders

Current Situation:

The current Continuing Resolution (CR) is set to expire on December 20, 2024. Congress must decide on a path forward to avoid a government shutdown.

What’s at Stake:

Congressional discussions are underway on two main options:

  • Full-Year Spending Package: A comprehensive budget for Fiscal Year 2025, providing funding stability for the next year.
  • Short-Term Continuing Resolution: Extends funding through the start of the new Congress and Administration, delaying a full-year budget decision.

Key Players & Positions:

  • House Majority Leaders favor a short-term extender, aiming to pass minimal budget extensions until the next Congress.
  • Senate Democrats are expected to push for a more comprehensive spending package.

What’s Next:

Congressional leaders continue to negotiate a plan before the December deadline.

2024 Election Results Analysis

Illustration of a hand being raised with stars and stripes surrounding it

Senate:

Republicans have secured control of the Senate with 53 seats, while Democrats hold 47 seats. Senator John Thune (R-SD) has been elected as the new Senate Majority Leader.

House of Representatives:

Republicans have achieved a majority in the House, securing 219 seats, while Democrats hold 213 seats, with several races still pending.

Key Race Outcomes:

  • Rep. Tom Cole (R-OK), Rep. Sharice Davids (D-KS), Rep. David Valadao (R-CA), and Rep. Don Bacon (R-NE) have all been re-elected.

FMAP and SDPI Updates: Fiscal Year 2025

Illustration of two hands fighting over a glowing dollar sign and two hands pointing at it

Federal Medical Assistance Percentage (FMAP) Update:

NCUIH remains committed to advocating for the inclusion of the Urban Indian Health Parity Act in any year-end legislative packages.

How UIOs Can Help:

  • Sign Letter of Support: NCUIH is leading a partnership sign on letter asking House and Senate Leadership to include 100% FMAP for UIOs in any end-of-year health extender. To support this advocacy letter, sign on to the letter through this form by COB Friday November 29, 2024.  Please share the letter with any partner organizations who might want to support this issue. Please reach out to policy@ncuih.org with any questions.
  • Seek Tribal Support: We are also seeking Tribal letters of support. If you know of any Tribes willing to provide a letter, please connect with us at policy@ncuih.org.
  • Important Reminder: Even without 100% FMAP, UIOs can collaborate with their states to negotiate improved reimbursement rates.

Special Diabetes Program for Indians (SDPI) Update:

The SDPI was reauthorized in the March 2024 Consolidated Appropriations Act and is funded through December 31, 2024.

Current Advocacy Efforts:

  • Congressional Letter: On November 12, 2024, 55 Senators sent a Dear Colleague Letter requesting Senate Leadership prioritize reauthorizing SDPI in an end-of-year funding package.
    A Dear Colleague letter is also circulating through the U.S House of Representatives.
  • NCUIH’s Support: On November 19, 2024, NCUIH also sent a letter to Congressional leadership to advocate for SDPI’s continued funding and support.

NCUIH Joins CMS Tribal Technical Advisory Group in Key Medicaid Discussions before CMS Leadership and Senate Committees: Traditional Healing Waivers, Medicaid Fraud, and 100% FMAP for UIOs

Centers for Medicare & Medicaid Services (CMS) Tribal Technical Advisory Group (TTAG) Hybrid Face-to-Face Meeting

NCUIH

NCUIH President and TTAG Representative Walter Murillo (Choctaw) speaks before the CMS TTAG.

On November 6-7, NCUIH President and TTAG Representative Walter Murillo, represented NCUIH at the CMS TTAG meeting in Washington D.C., the meeting covered:

  • Traditional Healing Waivers: The CMS’ State Demonstrations Group presented approvals for waivers related to Traditional Health Care practices, with CMS collaborating with states on monitoring and evaluation processes.
  • Arizona Medicaid Fraud: Mr. Murillo spoke before CMS leadership to address the severe impact of Medicaid fraud involving human trafficking and fraudulent billing in Arizona, which has strained IHS, Tribal, and UIO resources. He urged CMS to take corrective action to protect Native beneficiaries.

Senate Hill Staff Briefing on CMS TTAG Legislative Priorities

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NCUIH CEO Francys Crevier (Algonquin) speaks before the CMS TTAG Senate briefing.

On November 21, the CMS TTAG hosted a briefing for the Senate Committee on Indian Affairs (SCIA), the Senate Health, Education, Labor and Pensions (HELP) Committee, and the Senate Finance Committee majority and minority staff on TTAG legislative priorities—primarily Medicaid or Medicare issues.

NCUIH CEO Francys Crevier discussed the policy priority of 100% FMAP for UIOs and requested that, during this lame duck, this legislative fix be included in any end-of-year health extender package or omnibus.

Upcoming Federal Agency Comment Opportunities

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November 27 – Substance Abuse and Mental Health Services Administration (SAMHSA) Tribal Behavioral Health (TBH) Grant Program

  • Overview: SAMHSA is redesigning the Tribal Behavioral Health program Notice of Funding Opportunity (NOFO) to streamline the application process and allow Tribes to select from two prevention priorities:
    – One NOFO focused on suicide prevention
    – One NOFO focused on substance use prevention
  • SAMHSA held a Tribal Consultation on November 21.
  • Comment Deadline: November 27, 2024. Email to otap@samhsa.hhs.gov.

December 6 – U.S. Department of Health and Human Services (HHS) Request for Information (RFI) on 2026-2030 National HIV/AIDS and Related Strategic Plans

  • Request for Input: The Office of Infectious Disease and HIV/AIDS Policy is gathering feedback on upcoming strategic plans:
    – National HIV/AIDS Strategy for the United States: 2026-2030
    – Sexually Transmitted Infections National Strategic Plan for the United States: 2026-2030
    – Vaccines National Strategic Plan for the United States: 2026-2030
    – Viral Hepatitis National Strategic Plan for the United States: 2026-2030
  • Comment Deadline: December 6, 2024. Submit electronically here.

December 6 – IHS Health Information Technology (HIT) Modernization Site Readiness and Training

  • Tribal Consultation and Urban Confer Recap: The final IHS Tribal Consultation and Urban Confer session on HIT Modernization was held on November 7 regarding Site Readiness and Training.

Key Questions for Feedback:

– What elements of the site readiness and training approach should the IHS consider to support UIOs pre- and post-go-live?

– What challenges might your organization face in assessing readiness for deployment?

– What are the site-level needs that the IHS should consider when designing and deploying Public Health Analytics and Technology (PATH) Electronic Health Records (EHR) training?

December 13 – Social Security Administration (SSA) Tribal Consultation on Call to Action Plan

  • Tribal Consultation Recap: SSA’s Tribal Consultation on November 14 sought input on the SSA Tribal Consultation Call to Action Plan and is seeking additional comments the Action Plan that seeks to expand partnerships across federal agencies to UIOs.
  • Key Initiative: The action plan emphasizes “Providing Tribal Consultation with Tribal Leaders and Urban Indian Organizations.”
  • Comment Deadline: December 13, 2024. Email to aian.ec@ssa.gov.

December 16 – IHS Headquarters Office of Director Structure Reorganization

  • Tribal Consultation and Urban Confer Recap: IHS held an Urban Confer on November 13 and Tribal Consultation on November 14 seeking comments and recommendations on the proposed reorganization of the IHS Headquarters Office under the Deputy Director for Intergovernmental Affairs (DDIGA). NCUIH hosted a prep session for UIOs on November 12.
  • One IHS Initiative: Aims to improve coordination and efficiency across the agency.
  • This reorganization may have significant impacts on how UIOs engage with IHS and the broader system.
  • Comment Deadline: December 16, 2024 (tentative). Email consultation comments to consultation@ihs.gov and confer comments to urbanconfer@ihs.gov with the subject line: Proposed Reorganization of DDIGA Offices.

ICYMI: Recent Dear Tribal and Urban Leader Letters

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

October 30 DTLL/DULL– National Institutes of Health (NIH) Tribal Consultation on “Disposition of Biospecimens Collected from Tribal Populations”

  • Overview: NIH has proposed options for managing deidentified biospecimens collected from Tribal and international Indigenous populations, including returning them to Tribal authorities.
  • Objective: The consultation aims to finalize options that honor Tribal sovereignty and cultural considerations, particularly when a Tribe has requested the return or transfer of biospecimens.
  • Virtual Tribal Consultation: Thursday, December 5, 2024, from 11:00 AM to 1:00 PM ET. Register here.
  • Written Testimony Deadline: January 20, 2025. Email to NIHTribalConsultation@nih.gov.

November 12 DTLL – IHS Publishes Updated IHS Tribal Consultation Policy

  • Overview: This updated policy aims to reaffirm the IHS’ commitment to engage in regular, meaningful, and robust Tribal consultation.
  • The updated policy reiterates that statutes and policies exist that require the IHS to confer with UIOs on the IHS budget formulation.

NCUIH in Action

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NCUIH President Walter Murillo (Choctaw) addressing the General Assembly at the NCAI Annual Convention & Marketplace.

NCUIH at the National Congress of American Indians (NCAI) Annual Convention & Marketplace

On October 28-November 1, NCUIH represented UIOs at the 2024 National Congress of American Indians (NCAI) Annual Convention & Marketplace. During the convention, NCUIH presented key policy updates and introduced our Behavioral Health Financing Toolkit to the Health Subcommittee, co-chaired by NCUIH President Walter Murillo.

In addition to policy presentations, Mr. Murillo addressed the convention’s General Assembly, underscoring NCUIH’s commitment to advancing Urban Indian health and engaging Tribal leaders on critical health issues impacting all Native communities.

2nd Annual Traditional Healing Summit

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NCUIH Board Member and Native American Health Center CEO Natalie Aguilera (Choctaw) with IHS Director Roselyn Tso (Navajo) at the White House Traditional Healing Summit.

On November 18-19, NCUIH Board Member and Native American Health Center CEO Natalie Aguilera, and NCUIH staff participated in the 2nd Annual Traditional Healing Summit hosted by HHS, in coordination with the White House Council on Native American Affairs.

House Democratic Caucus Native American Heritage Month Reception

NCUIH staff joined the House Democratic Caucus for a reception in celebration of Native American Heritage Month.

On November 18, NCUIH staff joined the House Democratic Caucus Chair Pete Aguilar, Rep. Sharice Davids, Rep. Teresa Leger Fernández, Rep. Raúl Grijalva, Rep. Betty McCollum, Rep. Mary Peltola, Rep. Raul Ruiz, and Rep. Jill Tokuda for a reception in celebration of Native American Heritage Month.

NCUIH Panel at the American Cancer Society Cancer Action Network Priorities and Partners Meeting

NCUIH CEO Francys Crevier (Algonquin) speaks at the ACS CAN Priorities and Partners Meeting Panel.

NCUIH CEO Francys Crevier (Algonquin) speaks at the ACS CAN Priorities and Partners Meeting Panel.

On November 20, NCUIH CEO Francys Crevier represented UIOs at an American Cancer Society Cancer Action Network (ACS CAN) Priorities and Partners Meeting Panel: High Risk Cancer and Policy Solutions alongside Panel Moderator Faith Nyong, PhD, Ascension Mercy, and panelists: Cyndie Navarro-Davila, Director of State and Local Campaigns – Health Equity at ACS CAN; Rod Lew, Executive Director of Asian Pacific Partners for Empowerment Advocacy and Leadership (APPEAL); Lauren Davis, Patient Advocacy Relations at Genentech; and Dr. Scout, Executive Director of National LGBTQI Cancer Network.

Ms. Crevier emphasized UIOs’ critical role in lifesaving care and highlighted the need for mandatory IHS funding and 100% FMAP for UIOs to ensure equitable health care for urban Native patients.

Upcoming Events and Important Dates

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December 9 – White House Tribal Nations Summit

December 15-18 – IHS Tribal Self-Governance Advisory Committee (TSGAC) Meeting in Washington, D.C.

December 19 – Office of Urban Indian Health Programs (OUIHIP) Monthly Conference Call for UIO Executive Directors and CEOs

NCUIH Releases 2024 Annual Policy Assessment

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The Policy Assessment informs Urban Indian Organizations policy priorities for 2025, identifies barriers to closing funding gaps, opportunities to strengthen the workforce, and building community resources for Urban Native communities.

The National Council of Urban Indian Health (NCUIH) is pleased to announce the release of its 2024 Policy Assessment. NCUIH hosted five focus groups to identify Urban Indian Organization (UIO) policy priorities for 2025, as they relate to the Indian Health Service (IHS) designated facility types (full ambulatory, limited ambulatory, outreach and referral, and outpatient and residential). The focus groups were held on September 3, 4, and 5, 2024.

Together these focus groups allow NCUIH to work with UIOs to identify policy priorities in 2025 and identify barriers that impact delivery of care to Native patients and their communities. Of the 41 UIOs, 18 attended the focus groups and/or participated in a survey. This is the fifth year that NCUIH has conducted the assessment via focus groups sessions.

Read the 2024 Policy Assessment

Overview of the Policy Assessment

During the focus group sessions, UIO leaders had the opportunity to share their opinions on the successes and challenges they experienced in 2024. UIO leaders also provided input on the policy areas they would like to see the greatest policy support from NCUIH. Some of the key policy priority areas identified included increasing funding for IHS and urban Indian health line items, securing 100% Federal Medical Assistance Percentage (FMAP) for UIOs, receiving Medicaid reimbursement for traditional healing services, and addressing cancer disparities in their communities.

Key Findings from the Policy Assessment are as follows:

  • Enhancing Infrastructure to Support Urban Indian Organizations
  • Achieving Parity: Extending 100% FMAP to Urban Indian Organizations
  • Supporting Traditional Healing Services at UIOs through Medicaid Reimbursement
  • Strengthening the Workforce to Support Urban Indian Organizations
  • Expanding Housing Support: Addressing Affordable Housing needs in Urban American Indian and Alaska Native (AI/AN) Communities
  • Alleviating Food Insecurity in Urban AI/AN Communities
  • Combating Cancer Disparities: Improving Prevention, Screening, and Treatment for Urban AI/AN Communities

Next Steps

NCUIH will use this assessment to develop a comprehensive document of the 2024 Policy Priorities.

Past Assessments and Priorities

NCUIH Advocates for Engagement with Native Communities in Shaping New Healthy People 2030 Objectives

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On October 31, 2024, the National Council of Urban Indian Health (NCUIH) submitted written comments in response to the Department of Health and Human Services (HHS) Office of Disease Prevention and Health Promotion (ODPHP) Announcement of Solicitation of Written Comments on Proposed Healthy People 2030 Objectives. In these comments, NCUIH urged the ODPHP to reconsider three recommendations previously proposed by NCUIH to ODPHP in written comments submitted on November 20, 2023. These recommendations are:

  • Engage with the American Indian and Alaska Native community through Tribal Consultation and Urban Confer.
  • Ensure ODPHP is engaging with the HHS Secretary’s Tribal Advisory Committee on Healthy People 2030 additional Objectives.
  • Ensure that an IHS representative is on each of the objective workgroups.

The federal trust responsibility requires that ODPHP incorporate the perspective of American Indian and Alaska Native communities in development of Healthy People 2030 objectives. NCUIH’s recommendations will help fulfill this requirement and ensure that the Healthy People 2030 objectives address the health needs and priorities of the Indian health system.

Background on Healthy People 2030

Healthy People 2030 identifies public health priorities to help individuals, organizations, and communities across the United States improve health and well-being. Healthy People 2030 is the initiative’s fifth iteration, and it builds on the knowledge gained from previous iterations, which span over four decades. On October 1, 2024, HHS published an Announcement of Solicitation of Written Comments on Proposed Healthy People 2030 Objectives. In this announcement, HHS solicited written comments from the public on the proposed addition of twelve (12) new objectives to the current set of Healthy People 2030 objectives. The twelve proposed objectives were developed by Healthy People topic area workgroups led by various agencies within the Federal Government. The new objectives are:

  1. Increase the proportion of people with chronic kidney disease and diabetes who receive glucose-lowering medications based on the most recent guidelines. This objective is new to Healthy People 2030.
  2. Increase the proportion of people with chronic kidney disease and severe albuminuria who receive glucose-lowering medications based on the most recent guidelines.
  3. Increase the proportion of medical schools that include environmental health content in a required learning experience.
  4. Increase the proportion of undergraduate nursing and graduate nurse practitioner training programs that include environmental health content in a required learning experience.
  5. Increase the proportion of physician assistant (PA) training programs that include environmental health content in a required learning experience.
  6. Increase the proportion of colleges and schools of pharmacy with Doctor of Pharmacy (PharmD) degree programs that include environmental health content in a required learning experience.
  7. Increase the proportion of colleges and schools of dentistry with Doctor of Dental Surgery (DDS) and/or Doctor of Dental Medicine (DMD) degree programs that include environmental health content in a required learning experience.
  8. Reduce deaths related to heat. This objective is currently a development objective, EH-D02.
  9. Increase the proportion of adults with communication disorders of voice, swallowing, speech, or language who have seen a health care specialist for evaluation or treatment in the past 12 months.
  10. Increase the proportion of pregnant women who receive 1 dose of the tetanus-diphtheria-acellular pertussis (Tdap) vaccine during pregnancy.
  11. Increase the proportion of adults who receive the recommended age-appropriate vaccine.
  12. Reduce the rate of hypertension in pregnancy (preexisting and pregnancy-associated hypertension) among delivery hospitalizations.

Past NCUIH Advocacy on Healthy People 2030

Prior to the comments submitted on October 31, NCUIH submitted two other written comments to HHS in order to ensure that the Healthy People 2030 objectives address the health needs and priorities of the Indian health system.

First, on October 31, 2023, NCUIH recommended that HHS Office of Minority Health’s (OMH) consider the health needs of American Indian and Alaska Native people living in urban areas when developing the Healthy People 2030 Leading Health Indicators Initiative (LHII) Notice of Funding Opportunity (NOFO) and urged OMH to facilitate partnerships between grantees and UIOs to ensure American Indians and Alaska Natives can be served by the LHII no matter where they reside.

Second, on November 20, 2023, NCUIH recommended that HHS ODPHP consider the unique needs of Native communities when advancing current objectives and developing future objectives to monitor, address, and advance Healthy People 2030’s overarching goals.

Next Steps

NCUIH will continue to monitor changes to Healthy People 2030 and engage with HHS to ensure that the initiative’s objectives address the health needs and priorities of the Indian health system.