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.

55 Senators Request Protection and Prioritization of Special Diabetes Program for Indians Funding

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On November 12, 2024, 55 Senators sent a letter to Senate Leadership requesting the vital Special Diabetes Program (SDP) and Special Diabetes Program for Indians (SDPI) be reauthorized before funding expires on December 31, 2024.

Senator Collins (R-ME) and Senator Shaheen (D-NH) led the letter that calls for a renewal of SDPI at $160 million or more per year. It also emphasizes that while Congress has reauthorized the program every year since 1997, it was flat funded until the 2024 reauthorization, highlighting the importance of reauthorizing the program at $160 million or more per year.

SDPI provides culturally informed care, funds life-saving efforts to fight diabetes at Indian Health Service facilities (including 31 Urban Indian Organizations) and is critical to improving long-term health outcomes in Indian Country. The highly successful, bipartisan program is a proven success, and reauthorization should be a top priority for Congress.

NCUIH is grateful for the support of the following Senators:

  • Susan Collins (R-ME)
  • Jeanne Shaheen (D-NH)
  • Steve Daines (R-MT)
  • Shelley Moore Capito (R-WV)
  • Joni Ernst (R-IA)
  • Amy Klobuchar (D-MN)
  • Maria Cantwell (D-WA)
  • James Risch (R-ID)
  • Catherine Cortez Masto (D-NV)
  • Dan Sullivan (R-AK)
  • Debbie Stabenow (D-MI)
  • Raphael Warnock (D-GA)
  • Mazie Hirono (D-HI)
  • Tammy Duckworth (D-WI)
  • Jack Reed (D-RI)
  • Cynthia Lummis (R-WY)
  • Kevin Cramer (R-ND)
  • Christopher Coons (D-DE)
  • Mike Crapo (R-ID)
  • Richard Blumenthal (D-CT)
  • Elizabeth Warren (D-MA)
  • Thomas Carper (D-DE)
  • Ben Ray Lujan (D-NM)
  • Peter Welch (D-RI)
  • Tina Smith (D-MN)
  • Mark Kelly (D-AZ)
  • Robert Casey Jr. (D-PA)
  • Kyrsten Sinema (D-AZ)
  • Alex Padilla (D-CA)
  • Tammy Baldwin (D-WI)
  • Angus King (I-ME)
  • Thom Tillis (R-NC)
  • Sheldon Whitehouse (D-RI)
  • Jerry Moran (D-KS)
  • Jeffrey Merkley (D-OR)
  • Cory Booker (D-NJ)
  • Gary Peters (D-MI)
  • Mark Warner (D-VA)
  • Lisa Murkowski (R-AK)
  • Ron Wyden (D-OR)
  • Charles Grassley (R-IA)
  • Deb Fischer (R-NE)
  • Markwayne Mullin (R-OK)
  • Jacky Rosen (D-NV)
  • Michael Rounds (R-SD)
  • John Hoeven (R-ND)
  • Michael Bennet (D-CO)
  • Chris Van Hollen (D-CT)
  • Margaret Wood Hassan (D-NH)
  • Edward Markey (D-MA)
  • Brian Schatz (D-HI)
  • Patty Murray (D-WA)
  • John Boozman (R-AR)
  • Todd Young (R-IN)
  • Roger Wicker (R-MS)

 

Full Letter Text

Dear Leader Schumer and Leader McConnell:

We write today to thank you for your longstanding support of the Special Diabetes Program (SDP) and to ask for your commitment to reauthorize this vital program prior to the funding cliff on December 31, 2024. As part of the March 8 funding package, you helped deliver the first funding increase for the SDP in 20 years, and we look forward to working with you to continue that momentum before the end of the year.

For 27 years, the Special Diabetes Program – comprised of the Special Statutory Funding Program for Type 1 Diabetes Research and the Special Diabetes Program for Indians (SDPI) – has delivered meaningful resources and research breakthroughs for the 38.4 million Americans with diabetes and 97.6 million with prediabetes. It is essential that 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.

Diabetes is one of our country’s most costly 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, blindness in working-age adults, 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. Diabetes costs our nation $412.9 billion in 2022. 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, research funded by the SDP is leading directly to the development of new insights and therapies that are improving the lives of those with diabetes and accelerating progress toward curing and preventing the disease. This progress was highlighted at a bipartisan Senate Appropriations Committee hearing in July 2024, titled “Accelerating Breakthroughs: How the Special Diabetes Program Is Creating Hope for those Living with Type 1 Diabetes.”

In particular, in recent years, federal funding from the SDP has contributed to landmark research that culminated in the first early, preventive treatment that can delay clinical diagnosis of Type 1 diabetes 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 Type 1 diabetes 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:

  • Environmental Factors Influencing T1D: Researchers are conducting a groundbreaking 15-year study to determine what environmental factors influence the onset of T1D. They believe that by identifying specific triggering factors, new strategies can be developed to prevent the initial onset of the disease.
  • 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.
  • 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.
  • 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 American Indian and Alaskan Natives, resulting in a reduction of vision loss and blindness.
  • Diabetes Prevention in the American Indian and Alaskan Native (AI/AN) Community: SDPI 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 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.

These are only a few of the many groundbreaking discoveries made possible by the Special Diabetes Program. New technology, therapies, and data sets are improving the lives of the more than 133 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 again for your support for renewing the Special Diabetes Program through December 2024 at $160 million per year, per component. While 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.

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

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

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🔍 FY 2027 Area Budget Consultations: NCUIH held a prep session to help UIOs get ready for the upcoming IHS FY 2027 Area Budget Consultations.

📜 Appropriations & Legislative Updates: Updates on Congress’s work toward FY 2025 appropriations and actions to support mandatory funding for key IHS costs.

🧡 President Biden Apologizes for Indian Boarding Schools: President Biden issued a formal apology for the federal government’s role in the Indian Boarding School era.

🍎 Traditional Foods & USDA Dietary Guidelines: NCUIH recommends incorporating research on Traditional Foods in USDA’s 2025-2030 Dietary Guidelines.

📆 Federal Comment Deadlines: Key upcoming federal deadlines for public comment on health policies affecting Native communities.

🌱 Medicaid Coverage for Traditional Healing: CMS approved Medicaid coverage for traditional healing services in select states, a first for at Indian healthcare facilities.

💼 NCUIH in Action & Recent Events: NCUIH leadership has been active at recent events, advocating for health equity and policy support for urban Native communities.

📅 Upcoming Events & Dates: Upcoming conventions, consultations, and meetings for urban Indian and Tribal health initiatives.

🤝 NIHB MMPC Membership & Medical-Legal Partnerships: Membership is open for NIHB’s MMPC, and UIOs are encouraged to explore Medical-Legal Partnerships.

Area Budget Formulation – Your Engagement Matters!

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On October 16, NCUIH held a prep session with UIOs on the IHS FY 2027 Area Budget Consultations beginning in November.

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:

  • California: 11/12/2024 (hybrid). Register here.
  • Albuquerque: 11/13/2024 (virtual). Register here.
  • Oklahoma City: 11/14/2024-11/15/2024 (hybrid). Register here.
  • Phoenix: 11/19/2024-11/20/2024 (hybrid). Register here.
  • Bemidji: 11/19/2024-11/20/2024 (in-person). More information here.

NOTE: We have not and occasionally do not get advance notice of when your Area Budget Consultations will take place. If you have received information for your Area already and you’re able to share with NCUIH, we would appreciate it. Please send any details to policy@ncuih.org.

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

Appropriations Updates

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Fiscal Year 2025:

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

Take Action to Support Mandatory Funding for IHS CSCs and 105(l) leases: 

NCUIH sent out an action alert urging advocates to contact Congress to support mandatory funding for IHS Contract Support Costs (CSCs) and 105(l) lease funding.

  • Ways to advocate: Call or email your Representative using the template language provided in the action alert. Contact Congress.
  • Why Participate: Shifting these costs to mandatory funding is important to avoid   funding impacts for other IHS programs and will enable true increases in funding for essential services.

President Biden Formally Apologizes for Federal Government Involvement in Indian Boarding Schools

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

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

Why it matters:

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

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

NCUIH Provides Key Recommendations on USDA Dietary Guidelines and HHS Proposed Healthy People 2030 Objectives

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

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

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

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

Upcoming Federal Agency Comment Opportunities

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

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

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

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

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

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

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

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

Legislative Updates: SDPI and 100% FMAP for UIOs

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SDPI Updates: FY 2025 Reauthorization 

Current Status:

  • The Special Diabetes Program for Indians (SDPI) was reauthorized in the March 2024 Consolidated Appropriations Act through December 31, 2024.
  • A Dear Colleague Letter is currently circulating through the U.S House of Representatives and U.S. Senate requesting Congressional Leadership prioritize reauthorizing SDPI in an end of year funding package. The letter does not include a specific amount request.

What UIOs Can Do:

  • Take Action to Support Mandatory Funding for IHS CSCs and 105(l) leases: 
  • NCUIH sent out an action alert urging advocates to contact Congress to request they sign on to the Representative DeGette (D-CO-01) and Representative Bilirakis (R-FL-12) letter to House leadership.
  • Ways to advocate: Call or email your Representative using the template language provided in the action alert.

FMAP Update:

Current Landscape and Strategy:

  • NCUIH remains focused on having the Urban Indian Health Parity Act (H.R. 6533) included in any lame duck legislation.

What UIOs Can Do:

  • If you would like to write a letter to/or meet with your Member of Congress to support this legislation, NCUIH is happy to help. Email policy@ncuih.org.
  • We also are looking for Tribal letters of support. Please reach out to policy@ncuih.org if you know of any Tribes that would be willing to send a letter.

Recent Highlights: CMS Approves Medicaid Coverage for Traditional Healing Services in Four States, USDA Final Rule on Food Distribution Improves Access to Urban Native Communities

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CMS Approves Medicaid Coverage for Traditional Healing Services

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

Urban Indian Organizations and State-Specific Waivers:

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

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

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

Why it matters:

  • Prior to this final rule, FDPIR regulations restricted any urban place outside of the reservation boundaries from receiving FDPIR services unless an Indian Tribal Organization (ITO) or State agency requests to serve the urban place with a justification.
  • This final rule codifies the removal of references to urban places and the associated requirement that an FDPIR ITO or State Agency must provide justification to FNS to serve urban places off the reservation.
  • By removing the urban place requirements and encouraging Tribal and state collaboration with urban areas, FNS can make significant steps toward eliminating food insecurity for urban American Indians and Alaska Natives. This change takes a significant step towards addressing food insecurity in these populations.

ICYMI: VA Announces Copayment Exemption for Almost 6000 Native Veterans, Recent Dear Tribal and Urban Leader Letters

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

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

By the numbers:

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

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

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

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

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

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

    – 65 DTLLs and DULLs

    – 23 Tribal Consultations and Urban Confers

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

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

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

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

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

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

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

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

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

NCUIH in Action

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Mazie K.Hirono, Senator from Hawaii presents at American Cancer Society Cancer Action Network

Sept. 27 – NCUIH represented UIOs at a Lunch and Learn about the introduction of American Cancer Society Cancer Action Network and Senator Hirono’s Health Equity and Accountability Act.

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NCUIH CEO, Francys Crevier at American Indian Health and Family Service Gala

Oct. 4 – NCUIH CEO, Francys Crevier, was a keynote speaker at the 3rd Annual American Indian Health and Family Services Charity Gala in Detroit, focusing on expanding health care access for Native and underserved urban communities.

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NCUIH CEO, Francys Crevier, J.D. (Algonquin)

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NCUIH President-Elect Robyn Sunday Allen (Cherokee)

On Oct. 24, NCUIH President-Elect Robyn Sunday Allen (Cherokee), NCUIH CEO Francys Crevier (Algonquin), and NCUIH Vice-President of Policy and Communications Meredith Raimondi joined panel discussions at the Pfizer Health Equity in Action Summit and are continuing the conversation on health equity for Urban Indians.

Upcoming Events and Important Dates

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

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

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

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

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

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

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

One Last Thing: NIHB MMPC Membership is Open, RFI on UIO Medical-Legal Partnerships

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NIHB MMPC Membership is Open

What is the Medicare, Medicaid, and Health Reform Policy Committee (MMPC)?

  • Standing committee of the National Indian Health Board (NIHB) and is chaired by a member of the NIHB Board of Directors.
  • IHS provides funding support for MMPC.
  • Develops recommendations to CMS for the benefit of the IHS/Tribal/Urban system.
  • Provides technical support to the CMS Tribal Technical Advisory Group (TTAG)
  • The MMPC has monthly virtual and triannual face-to-face meetings. These meetings are usually held a day ahead of the CMS TTAG meetings.

MMPC Membership:

  • Membership in MMPC is open to individuals authorized to represent a Tribe, Tribal Organization, Urban Indian Program, or the IHS (known collectively as the “I/T/U”).
  • Sign up to join here.

Medical-Legal Partnerships (MLPs) 

About MLPs:

  • Medical-legal partnerships integrate the unique expertise of lawyers into health care settings to help clinicians, case managers, and social workers address structural problems at the root of so many health inequities.

Questions to consider:

  • Is your UIO connected to Medical-Legal Partnership (MLP) or engaging in screening and referrals for legal services?
  • Is your UIO interested in being a MLP grantee?

Reach out to policy@ncuih.org for more information on MLP.

PRESS RELEASE: President Biden Formally Apologizes for Federal Government Involvement in Indian Boarding Schools

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FOR IMMEDIATE RELEASE

Gila River Indian Reservation, Arizona (October 28, 2024) – President Joe Biden delivered a historic formal apology on behalf of the federal government for its 150-year policy of forcibly placing Native children in Indian Boarding Schools.

“The Federal Indian Boarding School policy and the pain it has caused will always be a significant mark of shame, a blot on American history,” said President Biden in historic remarks. “It’s a sin on our [Nation’s] soul.”

President Joe Biden at Gila River Indian Reservation, Arizona

Picture source: https://x.com/WhiteHouse/status/1849949471888519514/photo/1

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

President Biden’s apology follows the Department of Interior’s (DOI) investigative report, which confirms that at least 973 American Indian, Alaska Native, and Native Hawaiian children died while attending federally operated or supported schools and identifies at least 74 marked and unmarked burial sites at 65 different school grounds. It estimates that the U.S. government appropriated more than $23.3 billion between 1971 and 1969 for the federal Indian boarding school system and other similar institutions and associated assimilation policies (dollars adjusted for inflation based on Fiscal Year 2023).

This act of recognition can foster healing and reconciliation, which are crucial for improving mental and physical health. By validating the experiences of Indigenous peoples and addressing the traumas associated with these institutions, the apology may encourage increased access to health care resources, culturally competent care, and a greater focus on mental health support. Ultimately, such measures can help bridge the gap in health disparities and promote overall well-being within these communities.

NCUIH is particularly grateful to the Native American Boarding School Healing Coalition (NABS) for its unrelenting leadership in securing the DOI’s report and introducing critical legislation in Congress.

Next Steps

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

About NCUIH

The National Council of Urban Indian Health (NCUIH) is a national representative advocating for the 41 Urban Indian Organizations contracting with the Indian Health Service under the Indian Health Care Improvement Act. NCUIH is devoted to the support and development of quality, accessible, and culturally competent health and public health services for American Indians and Alaska Natives living in urban areas.

NCUIH respects and supports Tribal sovereignty and the unique government-to-government relationship between our Tribal Nations and the United States. NCUIH works to support those federal laws, policies, and procedures that respect and uplift Tribal sovereignty and the government-to-government relationship. NCUIH does not support any federal law, policy, or procedure that infringes upon or in any way diminishes Tribal sovereignty or the government-to-government relationship.

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NCUIH Contact: Meredith Raimondi, Vice President of Policy and Communications, mraimondi@ncuih.org

Action Alert: Tell Congress to Reauthorize the Special Diabetes Program for Indians

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Contact Congress to Ensure the Special Diabetes Program for Indians is Reauthorized Before December 31, 2024.
We need your help contacting Congress today!

Representative DeGette (D-CO-01) and Representative Bilirakis (R-FL-12) are leading a letter to House leadership in support of reauthorizing the Special Diabetes Program for Indians (SDPI) prior to its expiration at the end of December.

Why is SDPI important?

  • SDPI supports research-based interventions for diabetes prevention and cardiovascular disease risk reduction in American Indian and Alaska Native community-based programs and healthcare settings.
  • SDPI serves 780,000 American Indian and Alaska Native people across 302 programs in 35 states.
  • Currently, 31 urban Indian organizations (UIOs) receive SDPI funding that enables UIOs to provide necessary services that reduce the incidence of diabetes-related illness among urban Indian communities.
  • SDPI’s integrated approach to diabetes healthcare and prevention programs in Indian Country has become a resounding success and is one of the most successful public health programs ever implemented.

Why is this urgent? 

  • Funding for SDPI expires on December 31, 2024.
  • As Congress heads into the end of the 118th Congress, the top priority is finalizing and passing an omnibus funding bill for Fiscal Year 2025. This is the best opportunity for reauthorizing SDPI before it expires at the end of December 2024.

To ensure that SDPI receives as much support as possible, we encourage you to contact your member of congress to support reauthorization of SDPI. Please find a template email below with instructions. Thank you for your leadership. Your outreach on this is invaluable to providing greater health equity for American Indian and Alaska Native people.

Sincerely,
The National Council of Urban Indian Health

Ways to Advocate

Contact Congress!

Step 1: Copy the email below.
Step 2: Find your Representative here.
Step 3: Go to their website and click contact.
Step 4: Paste the email into the form and send. Please contact Meredith Raimondi (policy@ncuih.org) with questions.

Email to Your Representative!

Dear Representative [NAME],

As an urban Indian health advocate, I respectfully request you sign on to the DeGette-Bilirakis letter to House Leadership in support of reauthorizing the Special Diabetes Program for Indians (SDPI) prior to its expiration on December 31, 2024.

SDPI supports research-based interventions for diabetes prevention and cardiovascular disease risk reduction in American Indian and Alaska Native community-based programs and healthcare settings, including 31 Urban Indian Organizations. SDPI’s integrated approach to diabetes healthcare and prevention programs in Indian Country has become a resounding success and is one of the most successful public health programs ever implemented.

As Congress works on final appropriations for Fiscal Year 2025, this is a critical moment to take a significant step towards fulfilling the trust responsibility to ensure healthcare access 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.  Your support in signing this letter will be instrumental in achieving this goal.

You can sign on to the letter by contacting David Steury (David.steury@mail.house.gov) or Chris Jones (Chris.Jones@mail.house.gov).

Thank you for your leadership and your commitment to Indian Country.

Sincerely,
[NAME]

NCUIH respects and supports Tribal sovereignty and the unique government-to-government relationship between our Tribal Nations and the United States. NCUIH works to support those federal laws, policies, and procedures that respect and uplift Tribal sovereignty and the government-to-government relationship. NCUIH does not support any federal law, policy, or procedure that infringes upon, or in any way diminishes, Tribal sovereignty or the government-to-government relationship.

NCUIH Contact:Meredith Raimondi, Vice President of Policy and Communications, mraimondi@ncuih.org

PRESS RELEASE: NCUIH Celebrates CMS Approval of Medicaid Coverage for Traditional Healing Services, Emphasizes Importance for Urban Indian Organizations

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FOR IMMEDIATE RELEASE

“This approval is a testament to the tireless advocacy of Tribal leaders, Urban Indian Organizations, and our partners,” said Francys Crevier, J.D. (Algonquin), CEO of NCUIH. “It marks a historic milestone in our ongoing efforts to ensure that American Indian and Alaska Native people in urban areas have access to culturally appropriate, holistic care that honors our Traditional Healing practices”.

“As we’ve long advocated, the ability to provide and be reimbursed for culturally relevant services offers a greater opportunity to deliver whole-person care,” Crevier added. “This CMS approval is a crucial step towards health equity and honoring the rich traditions of our diverse Native communities, including those in urban areas”.

– NCUIH CEO, Francys Crevier (Algonquin)

Washington, D.C. (October 18, 2024) – The National Council of Urban Indian Health (NCUIH) enthusiastically welcomes Wednesday’s announcement by the Centers for Medicare & Medicaid Services (CMS) approving Medicaid coverage for Traditional Healing services in four states: California, Arizona, New Mexico, and Oregon.

This landmark decision represents a significant step forward in recognizing the value of culturally-based traditional health care practices for American Indian and Alaska Native people, including those living in urban areas.

Urban Indian Organizations and State-Specific Waivers

While the CMS approval is a significant step forward, it’s important to note that the implementation and coverage for Urban Indian Organizations (UIOs) varies by state:

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

Next Steps

NCUIH will continue to work closely with CMS, state Medicaid programs, and UIOs to ensure smooth implementation of this new coverage and to advocate for equitable inclusion of UIOs in all states.

 

About NCUIH

The National Council of Urban Indian Health (NCUIH) is a national representative advocating for the 41 Urban Indian Organizations contracting with the Indian Health Service under the Indian Health Care Improvement Act. NCUIH is devoted to the support and development of quality, accessible, and culturally competent health and public health services for American Indians and Alaska Natives living in urban areas.

NCUIH respects and supports Tribal sovereignty and the unique government-to-government relationship between our Tribal Nations and the United States. NCUIH works to support those federal laws, policies, and procedures that respect and uplift Tribal sovereignty and the government-to-government relationship. NCUIH does not support any federal law, policy, or procedure that infringes upon or in any way diminishes Tribal sovereignty or the government-to-government relationship.

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NCUIH Contact: Meredith Raimondi, Vice President of Policy and Communications, mraimondi@ncuih.org

Stay Informed: NCUIH Launches Updated Regulations Tracker for Indian Health Advocacy

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The National Council of Urban Indian Health (NCUIH) recently published an updated regulations tracker (https://ncuih.org/policy/regulation-tracker/) on NCUIH’s website (https://ncuih.org/). The tracker includes relevant regulations and other agency actions that impact Urban Indian Organizations (UIOs) or the health of American Indian and Alaska Native people living in urban areas. It contains information from the Federal Register (https://www.federalregister.gov/), Dear Urban Indian Organization Leader Letters (DULLs), Dear Tribal Leader Letters (DTLLs), and other publications that may be helpful to UIO leaders and other advocates for American Indian and Alaska Native health. The tracker is updated on an ongoing basis.

View the Tracker

NCUIH Urges HHS to Collaborate with Urban Indian Organizations and Tribes on Syphilis and Congenital Syphilis Education, Stigma Reduction, and Data Sharing

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On September 4, 2024, the National Council of Urban Indian Health (NCUIH) submitted written comments to the U.S. Department of Health and Human Services (HHS) Assistant Secretary for Health, Admiral Rachel L. Levine, in response to the HHS Office of the Assistant Secretary for Health (OASH) July 2, 2024, Dear Tribal Leader Letter (DTLL). In its comments, NCUIH requested that HHS and the National Syphilis and Congenital Syphilis Syndemic Federal Task Force (Task Force) partner with urban Indian organization (UIOs) to reduce stigma and increase education on syphilis and congenital syphilis and facilitate dissemination of timely data on syphilis and congenital syphilis to Tribes and UIOs.

Background

Disproportionate Impact of Syphilis on American Indian and Alaska Native Communities

The rates of primary and secondary syphilis have risen every year since 2001. Congenital syphilis rates have also risen. Racial and ethnic minorities, including American Indian and Alaska Native people, have been disproportionately affected by the surge of cases. According to the Centers for Disease Control and Prevention’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention, American Indian and Alaska Native people experience the greatest relative disparity in primary and secondary syphilis cases, representing “2.8% of reported P&S syphilis cases . . . despite being 0.7% of the US population, or a burden 4.0 times what would be expected based on their proportion of the population.” American Indian and Alaska Native mothers also experienced the greatest relative disparity in congenital syphilis cases, representing “4.6% of reported congenital syphilis cases . . . despite being 0.7% of live births, or a burden 6.6 times what would be expected based on their proportion of live births.”

HHS Task Force: A Collaborative Response to Rising Syphilis Cases

HHS established the Task Force as part of the agency’s commitment to addressing these escalating cases. The Task Force is a cross-agency collaborative effort, with participants from HHS agencies and offices, including the Indian Health Service (IHS), as well as the Department of Agriculture, Department of Justice, Department of Veterans Affairs, and the White House, including both the Office of National Drug Control Policy and the Office of National AIDS Policy.

The Task Force identified 14 priority jurisdictions that account for nearly 75 percent of congenital syphilis cases and over 55 percent of primary and secondary syphilis cases nationwide to focus on targeted interventions. Additionally, these 14 priority jurisdictions represent over 65 percent of primary and secondary syphilis and over 70 percent of congenital syphilis cases among individuals that identify as American Indian and Alaska Native. 21 UIOs serve American Indian and Alaska Native patients in 8 of the 14 priority jurisdictions.

NCUIH’s Requests

In its comments, NCUIH recommended:

  • HHS and the Task Force must work with UIOs as part of their strategy to reduce the cases of syphilis and congenital syphilis in American Indian and Alaska Native communities
    • HHS and the Task Force should Host Urban Confers or UIO listening sessions and continue to seek Tribal feedback
    • HHS and the Task Force should partner with UIOs to reduce stigma and increase education on syphilis and congenital syphilis
  • HHS and the Task Force should facilitate dissemination of timely data on syphilis and congenital syphilis to Tribes and UIOs

NCUIH will continue to monitor as OASH addresses the syphilis and congenital syndemic impacting American Indian and Alaska Native people.

PRESS RELEASE: NCUIH Releases Financing Toolkit for Providers to Address Behavioral Health Disparities in American Indian and Alaska Native Communities

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FOR IMMEDIATE RELEASE

WASHINGTON, D.C. (October 9, 2024) – The National Council of Urban Indian Health (NCUIH) has released a new resource to combat the significant mental health challenges facing American Indian and Alaska Native (AI/AN) communities. The toolkit, Investing in Wellness: Financing Strategies for Behavioral Health in Indian Country, developed in response to the alarming statistic that 19 percent of AI/AN individuals reported experiencing a mental illness in the past year, seeks to provide sustainable funding solutions and resources to enhance behavioral health care access in Indian Country.

The toolkit comes at a time when behavioral health issues among AI/AN communities have not received equal policy attention or funding. Existing funding models often rely on short-term grants that inadequately address the persistent and complex needs of these communities. “The Investing in Wellness toolkit is essential for bridging the funding gap in behavioral health services,” said NCIUH CEO Francys Crevier, J.D. (Algonquin). “We aim to equip leaders with practical financing strategies tailored specifically for American Indian and Alaska Native health care systems, ultimately improving access to prevention, treatment, and recovery services. By focusing on the patient journey and incorporating traditional healing practices into behavioral health programming, the toolkit aligns with the growing advocacy for holistic approaches in treatment.”

Key strategies outlined in the toolkit include:

  • Enhancing Behavioral Health Care Access Through Optimizing Medicaid Reimbursement
  • Traditional Healing as a Financially Sustainable Strategy for Improving Behavioral Health
  • Cultivating Funding Opportunities for Behavioral Health Programming
  • Investing in Prevention, Crisis Care, and Integrated Services
  • Strategies to Build, Expand, and Sustain Behavioral Health

The development of this toolkit was guided by a community-based participatory approach, ensuring that the needs and voices of AI/AN communities were central to its creation. “Culturally sensitive care is an important part of any treatment regimen. The Investing in Wellness toolkit notably supports traditional healing practices, such as therapeutic talking circles and natural remedies, as proven ways to support person-centered health and wellness,” said Alaina McBournie, senior manager for the substance use prevention and treatment initiative at The Pew Charitable Trusts. “Pew is proud to partner with NCUIH to help expand access to lifesaving services for American Indian and Alaska Native people.”

View Toolkit

About NCUIH

The National Council of Urban Indian Health is a national non-profit organization devoted to the support and development of quality, accessible, and culturally competent health and public health services for American Indian and Alaska Native people living in urban areas. NCUIH advocates for the 41 Title V Urban Indian Organizations under the Indian Health Service in the Indian Health Care Improvement Act.

NCUIH respects and supports Tribal sovereignty and the unique government-to-government relationship between our Tribal Nations and the United States. NCUIH works to support those federal laws, policies, and procedures that respect and uplift Tribal sovereignty and the government-to-government relationship. NCUIH does not support any federal law, policy, or procedure that infringes upon or in any way diminishes Tribal sovereignty or the government-to-government relationship.

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

NCUIH Supports Native Community and Voter Engagement at Native Health’s National Voter Registration Day Event in Phoenix

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On September 19, 2024, Native Health in Pheonix, Arizona hosted Frybread for the Future Fest, an event focused on building community and registering Arizona residents to vote. Over 500 people were in attendance and approximately 30 eligible voters registered to vote. During the event, which was hosted at the site of the former Phoenix Indian Boarding School, participants were able to check their voter registration, browse an Indigenous Market, speak with staff from Native Health and Inter-Tribal Council of Arizona, get free Native Vote swag, and enjoy homemade frybread and ice cream. The event also had traditional performances by local Tribal members. Native Health hosts hundreds of similar events each year, which play an important role in building community and provide a space for community members to stay connected to traditional cultural practices.

NCUIH staff, Chelsea Guitierrez and Emily Larsen

NCUIH staff, Chelsea Guitierrez and Emily Larsen, provided support for the event, assisting in set-up, handing out t-shirts, and clean up.

Native Health Designated as First IHS Voter Registration Site

On March 5, 2023, President Biden announced agency actions to make the voting process more accessible in alignment with recommendations made by the Native American Rights Fund (NARF). This included a new initiative at the Indian Health Service (IHS) piloting “high-quality voter registration services across five different IHS facilities before the end of 2023”. The first facility to be announced under this pilot program was Native Health.

NCUIH Advocacy on Voting Efforts

In partnership with the National Urban Indian Family Council (NUIFC), NCUIH has been working with UIOs, like Native Health, to Get Out The Vote and increase Native voter participation in the 2024 election cycle. Voter information, including a social media toolkit can be found here.