Senator Warren and Representative Raskin Re-Introduce NCUIH-Endorsed CARE ACT, Invests $1 Billion a Year to Address Substance Use Crisis in Native Communities

On May 9, 2024, Senators Elizabeth Warren (D-MA) and Tammy Baldwin (D-WI) as well as Representatives Jamie Rasin (D-MD), Ann Kuster (D-NH), David Trone (D-MD) and Brittany Pettersen (D-CO) re-introduced the Comprehensive Addiction Resources Emergency (CARE) Act (S.4286 / H.R. 8323) to provide resources that combat the substance use epidemic, including in American Indian and Alaska Native communities. It is currently co-sponsored by 16 other Democratic senators and 73 Democratic representatives and supported by over 100 organizations. The bill is modeled after the Ryan White Comprehensive AIDS Resources Emergency Act, that supports federal research and programming that prevents substance use disorder and expands access to evidence-based treatments and recovery support services.

This legislation provides $125 billion in federal funding for Fiscal Years 2025-2035 and specifically nearly $1 billion a year for Tribal governments and organizations. The funding awards grants to fund core medical services, recovery and support services, early intervention and engagement services, harm reduction services, and administrative expenses.

The $1 billion is allocated to:

  • $790 million in grants to Tribal governments for substance use prevention and treatment.
  • $7.5 million for Tribal nations and regional Tribal epidemiology centers.
  • $50 million to Tribal Colleges and Universities as well as Indian-Health Service funded organizations that train Native health professionals.
  • $150 million to Native non-profits and clinics, including urban Indian organizations and Native Hawaiian organizations, specifically to test culturally informed care models.

Resources

Background on Substance Use in Urban Native Communities

NCUIH has long advocated for resources to address the ongoing substance use crisis that disproportionately affects Native people. Between 1999 and 2015, the drug overdose death rates for Native populations increased by more than 500 percent. In 2022, the CDC reported that the American Indian and Alaska Native populations had the highest rate of overdose deaths in the United States. They reported 56.6 deaths per 100,000 persons in 2021. Additionally, a 2020 report from the CDC highlighted that American Indian and Alaska Native people living in rural and urban areas need substance use disorder (SUD) treatment at virtually the same rate.

Next Steps

The bill has been referred to the Senate subcommittee on Health, Education, Labor, and Pensions and awaits consideration.  NCUIH will continue to monitor the bill’s progress

DOJ and DOI Responses to the Not Invisible Act Commission’s Recommendations Includes MMIP Resources for Urban Indian Communities

On March 5, 2024, the Department of Justice (DOJ) and the Department of Interior (DOI) (“the agencies”) released their response to the Not Invisible Act Commission’s (“Commission”) findings and recommendations on how to combat the missing or murdered Indigenous people (MMIP) and human trafficking (HT) crisis. The Commission’s findings and recommendations and the responses by the DOJ and DOI mention urban Indian organizations (UIOs) and urban American Indian and Alaska Native people and communities. Importantly, the agencies state that UIOs are eligible for funding under Office on Violence Against Women (OVW) programs.

Key Responses by the Agencies

UIOs are referenced in sections pertaining to law enforcement and investigative resources, coordinating resources, victim and family resources and services, and Alaska-specific issues. The following are key responses by the agencies to the Commission’s findings and recommendations.

Law Enforcement and Investigative Resources

In response to the Commission’s recommendation of the DOJ Office of Victims of Crime (OVC) and the Department of Health and Human Services (HHS) Office on Trafficking Persons (OTIP), the agencies stated that the Office of Justice Programs (OJP)/OVC’s Project Beacon: Increasing Access to Services for Urban American Indian and Alaska Native Victims of Human Trafficking, “currently funds five urban Indian centers that are working to increase their capacity to provide comprehensive services to Native victims through strategic collaborative partnerships with both Tribal and non-Tribal organizations and agencies.” The agencies also said that the DOJ “will work with other agencies as appropriate to further explore the recommendation regarding tracking and aggregating racially biased policing in and around Indian Country, of Indians in urban areas, and in Alaska”, which was a specific recommendation of the Commission.

Coordinating Resources

The Commission recommended that either the OVW or the OVC provide technical assistance to small-staff advocacy organizations by employing “user-friendly, virtual tutorials” to “enhance the [grant funding] application experience and…accommodate the diverse circumstances in Tribal and urban Indian communities (including communities lacking access to broadband.”

As part of their response, the agencies stated “DOJ’s OVW offers live and recorded pre-application webinars to go over application requirements in detail and answer questions about the application process.”

Victim and Family Resources and Services

The Commission found that “[t]here has been a historical lack of services for [American Indian and Alaska Native] victims and families of MMIP and HT that are Native-led, culturally specific, and trauma-informed” and that “[u]rban areas bear the burden of providing culturally-relevant resources to an extremely diverse population: 70 % of [American Indian and Alaska Native] people live in urban areas. Further, the system actors with whom urban Indian organizations interact are less likely to have any training or competence in providing culturally relevant services” which “exacerbates the trauma experienced within [American Indian and Alaska Native] communities.” The Commission recommended that “[s]ervices…be provided through an integrated care model utilizing a public health and safety approach, and include Native-led, culturally specific practices and care. Baseline funding to implement, strengthen, and seek TTA to provide continuum of care models for survivors and families of MMIP and HT, such as, First Nations Mental Wellness Continuum Framework, must be provided to [American Indian and Alaska Native] Tribal nations, Indigenous-led Community Based Organizations (CBO) and urban Indigenous organizations.”

The agencies responded by saying that the Bureau of Indian Affair’s (BIA) Tiwahe Program framework “is an Indigenous approach to thinking about well-being within a system, with the well-being of individuals, communities, Tribes, and the natural environment working in an interlinked and interdependent ways.” UIOs are one type of entity that can use this framework. Additionally, the OVC’s Tribal Victim Services Set-Aside Formula Grant Program (TVSSA) and other OJP/OVC funding opportunities provide “funding to support comprehensive, culturally appropriate, trauma-informed, victim-sensitive services” to both urban and Tribal community located American Indian and Alaska Native crime victims. Lastly, UIOs themselves are eligible for funding through OVW grant programs, including those supporting culturally specific services for survivors of domestic violence, dating violence, sexual assault, and stalking.

Alaska-Specific Issues

The Commission recommended that “[t]he MMIP Regional Outreach Program through the [Executive Office of the United States (U.S.) Attorneys (EOUSA)] must be expanded to include more than one coordinator and [Assistant U.S. Attorney (AUSA)] to serve Alaska.”

As part of their response, the agencies stated “[a]s program regions are fully staffed, the regional AUSAs and coordinators will begin regional outreach to federal, Tribal, state, and local law enforcement; victim- and MMIP-related governmental and nongovernmental organizations; and urban Indian organizations to provide information about the program’s resources, roles, and services provided and develop a regional resource list.”

Background on the Commission

The National Council of Urban Indian Health (NCUIH) along with other national Native organizations worked in support of the Not Invisible Act legislation, which was enacted in October 2020. The Act required the Secretary of the Interior, in coordination with the Attorney General to establish and appoint a joint commission on violent crime against American Indian and Alaska Native people. Secretary of the Interior Haaland was the lead sponsor of the Not Invisible Act when she served in Congress. The bill was passed unanimously by voice vote in both chambers of Congress.

Commissioner Sonya Tetnowski is a citizen of the Makah Tribe and CEO of the Indian Health Center of Santa Clara Valley. She currently serves as the President California Consortium of Urban Indian Health (CCUIH) and previously served as NCUIH’s Board President. Ms. Tetnowski works daily in support of the health and wellness services to American Indians and Alaska Natives living in urban areas. Violence against American Indians and Alaska Natives is a public health crisis and is considered a social determinant of health (SDOH). NCUIH is committed to the reduction of violence impacting Native communities.

NCUIH Requests that CMS Include UIOs in its Proposed Framework on Reimbursement for Traditional Healing Services

On March 27, 2024, and April 29, 2024, the National Council of Urban Indian Health (NCUIH) submitted comments to the Centers for Medicare and Medicaid Services (CMS) Director of the State Demonstrations Group, Jacey Cooper, regarding the Proposed Framework for Traditional Health Care Practices in Section 1115 demonstrations (“Proposed Framework”) in response to CMS’s request for feedback. CMS sought advice and input on the scope of coverage of Traditional Health Care Practices that could be provided at Indian Health Service (IHS) and Tribal facilities, recommendations on provider qualifications, and monitoring and evaluation criteria. As part of its responses, NCUIH requested that CMS include urban Indian organizations (UIOs) in the Proposed Framework because UIOs are critical to providing Traditional Healing services to urban American Indian and Alaska Native populations.

Background

During a March 6, 2024, presentation, CMS provided an overview of the Section 1115(a) demonstration process and a high-level overview of the four pending demonstration proposals to cover Traditional Health Care Practices- Arizona, California, New Mexico, and Oregon. CMS discussed the development of a Proposed Framework for potential coverage of Traditional Health Care Practices, consistent with the authorities in the Indian Health Care Improvement Act. The presented Proposed Framework does not include UIOs as eligible facilities. CMS solicited feedback following the March 2024 presentation and an April 3, 2024, webinar on the Proposed Framework.

For more information on Section 1115 Demonstrations, please click here.

Funding is a Barrier for UIOs to Provide Traditional Healing Services to Native People

Inclusion of UIOs in CMS’ Proposed Framework is critical, as UIOs fill an essential gap in care for American Indian and Alaska Native people living off reservations by providing culturally sensitive and community-focused care options, including traditional healing services and programs. Funding continues to be a barrier for UIOs to provide traditional healing services to their Native patients. They have to work to stretch already limited dollars to include these vital services because healthcare funding sources, including Medicaid, do not adequately reimburse for traditional healing services.

NCUIH’s Requests and Recommendations

In its March 27 comments, NCUIH requested that CMS:

  • Include services delivered at UIOs to American Indian and Alaska Native Medicaid beneficiaries in the Proposed Framework.
  • Host Urban Confers or UIO Listening Sessions Consistently Throughout the Development of the Proposed Framework.

In its April 29, comments NCUIH recommended that CMS:

  • Include Traditional Healing services provided at UIOs in the Proposed Framework.
    • Allow Tribes, UIOs, and States the flexibility to develop a solution which serves all American Indian and Alaska Native beneficiaries.
    • Ensure the Proposed Framework reflects the requests of Tribes and UIOs.
    • Ensure the Proposed Framework does not create inequities in care.
  • Respect confidentiality for Traditional Healers and Traditional Healing practices.
  • Engage with UIOs by hosting an Urban Confer and continue to engage with Tribes.

NCUIH will continue to monitor the development of the Proposed Framework and advocate for UIO inclusion.

20 Senators Request Increased Resources and Stable Funding for Urban Indian Health in FY 2025

On May 14, 2024, 20 Senators requested up to $965.3 million for urban Indian health in Fiscal Year (FY) 2025 and advance appropriations for the Indian Health Service (IHS).

Sen. Tina Smith (D-MN) and 19 other Senators sent a letter to Chairman Jeff Merkley (D-OR) and Ranking Member Lisa Murkowski (R-AK) of the Senate Interior Appropriations Committee requesting up to $965.3 million for urban Indian health as part of the Tribal Formulation Workgroup’s topline request of $53.85 billion for IHS in FY 2025. The letter also requests the Appropriations Committee maintain advance appropriations for IHS for FY26. The letter emphasizes the critical role that Urban Indian Organizations (UIOs) play in the health care delivery to American Indian and Alaska Native patients and the importance of providing UIOs with the necessary funding to continue to provide quality, culturally competent care to their communities. On May 1, 2024, a group of 52 Representatives sent a letter to the House Interior Appropriations Committee with the same requests.

The letter also notes that chronic underfunding of IHS and urban Indian health has contributed to the health disparities among American Indian and Alaska Native people living in urban areas that suffer greater rates of chronic disease, infant mortality, and suicide compared to other populations.

This letter sends a clear and powerful message to Chairman Merkley and Ranking Member Murkowski and the members of the Senate that funding for urban Indian health must be significantly increased to fulfill the federal government’s trust responsibility to provide quality healthcare to all American Indian and Alaska Native people.

NCUIH is grateful for the support of the following Senators:

  1. Tina Smith
  2. Tammy Baldwin
  3. Maria Cantwell
  4. Ben Luján
  5. Edward Markey
  6. Alex Padilla
  7. Jack Rosen
  8. Jon Tester
  9. Chris Van Hollen
  10. Elizabeth Warren
  11. Amy Klobuchar
  12. Catherine Cortez Masto
  13. Laphonza Butler
  14. Kyrsten Sinema
  15. Ron Wyden
  16. Mark Kelly
  17. Kirsten Gillibrand
  18. Richard Blumenthal
  19. Tammy Duckworth
  20. Michael Bennet

Full Letter Text

Dear Chairman Merkley and Ranking Member Murkowski,

We write to thank you for your proven commitment to the Indian health system, including Urban Indian Organizations (UIOs), and to request you continue your support by funding urban Indian health at the highest level possible, up to $965.3 million, and retaining advanced appropriations for the Indian Health Service (IHS) in the Fiscal Year (FY) 2025 Interior, Environment, and Related Agencies Appropriations Act.

These requests reflect the full need for urban Indian health determined by the Tribal Budget Formulation Workgroup, which is comprised of Tribal leaders representing all twelve IHS service areas. The Workgroup recommended this funding amount for urban Indian health as a part of a $53.85 billion topline recommendation for the Indian Health Service.

UIOs are an important part of the IHS, which oversees a three-prong system for the provision of health care: Indian Health Service, Tribal Programs, and Urban Indian Organizations (I/T/U).UIOs are on the front lines in working to provide for the health and well-being of American Indians and Alaska Natives living outside of Tribal jurisdictions. They serve patients from over 500 federally recognized Tribal Nations in 38 urban areas across the country. UIOs are not eligible for other federal line items that IHS and Tribal facilities are, like hospitals and health clinics, money, purchase and referred care dollars, or IHS dental services dollars. Therefore, this funding request is essential to providing quality, culturally-competent health care to AI/AN people living in urban areas.

Chronic underfunding of IHS and urban Indian health has contributed to the health disparities among AI/AN people. Additionally, AI/AN people living in urban areas suffer greater rates of chronic disease, infant mortality, and suicide compared to all other populations. Urban Native populations are less likely to receive preventive care and are less likely to have health insurance. Additional funding is critical to addressing this disparity.

In order to fulfill the federal government’s trust responsibility to all AI/AN people to provide quality healthcare, funding for urban Indian health must be significantly increased. It is also imperative that such an increase not be paid for by diminishing funding for already hard-pressed IHS and Tribal providers. The solution to address the unmet needs of urban Native and all AI/AN people is an increase in the overall IHS budget.

Thank you for your continued support of urban Indian health and your consideration of this important request.

Indian Health Service Report Finds that Urban Indian Organization Staff Must Increase by 136% to Meet Patient Demand by 2032

On April 23, 2024, the Indian Health Service (IHS) Office of Urban Indian Health Programs (OUIHP) released the Urban Indian Organization (UIO) Infrastructure Study Report to Congress Fiscal Year 2023 (“UIO Infrastructure Study”). The report establishes future facility needs for the majority of the 41 UIOs and estimates the operational resources needed to serve each UIO Service Area’s future urban American Indian and Alaska Native population.

Key Findings

Some key findings address UIOs’ future services, staffing needs, operational budget, and facility requirements.

Regarding future services provided at UIOs, the UIO Infrastructure Study stated that “the majority of UIOs emphasize primary medical care services and aspire to be the culturally appropriate medical home for their patient population and community.” UIOs that offer primary care and provided data plan to have staff and resource capacity to support approximately 1,376,000 primary care visits in 2032, an increase from the current rate of approximately 463,000 provider visits per year. “Most UIOs see themselves offering a broader spectrum of outpatient services in the future to provide their patients with a one-stop shop of services.”

To reach the UIOs’ 2032 goals, the 39 UIOs that provided staffing data would need to grow from 3,420 Full-Time Equivalents (FTEs) to 6,275 FTEs, which is a 78% increase. “For overall patient service demand, the number of FTEs would need to grow to 8,083.” To fund the 2032 vision, IHS “contract and grant funding provided annually would need to increase by $1.37 billion for the Urban Indian population portion and overall would need to increase by $1.81 billion.” Lastly, UIOs need an additional 2.75 million building gross spare feet (BGSF) which would require $2.95 billion for facility design and construction and $4.4 billion to replace the entire inventory of UIOs’ space.

Background

In 2021, Congress allocated $1 million in funds for IHS to conduct an Urban Indian Infrastructure study through the Consolidated Appropriations Act, 2021. The purpose of the Infrastructure Study is to further understand the most critical deficiencies facing UIOs. IHS contracted with The Innova Group, a healthcare consultancy entity, to conduct the Infrastructure Study. On March 15, 2022, Congress provided $800,969 in additional funding to IHS for the Infrastructure Study through the Consolidated Appropriations Act, 2022.

NCUIH’s Advocacy

On August 23, 2022, NCUIH submitted comments to IHS in response to the June 16, 2022, Dear Urban Indian Organization Leader letter regarding the use of funding available for the Urban Indian Infrastructure Study.

NCUIH continues to advocate for transparency in the process of the UIO Infrastructure Study and greater support to address the critical infrastructure needs at UIOs. NCUIH will continue to keep UIOs informed as more information is made available from IHS.

New Medicaid Rule Emphasizes Mandate that States Must Consult with Tribes and UIOs

On May 10, 2024, the Centers for Medicare and Medicaid Services (CMS) issued a final rule regarding ensuring access to Medicaid services. This final rule addresses access to care, quality and health outcomes, and better addressing health equity issues in the Medicaid program across fee-for-service (FFS), managed care delivery systems, and in home and community-based services (HCBS) programs. While the final rule was not responsive to comments submitted by the National Council of Urban Indian Health (NCUIH), CMS stated that states with one or more urban Indian organizations (UIOs) that furnish health care services must consult with the UIO(s) on a regular, ongoing basis. UIOs are also eligible to be on states’ Medicaid Advisory Committees (MACs).

Background

On May 3, 2023, CMS issued the proposed rule on ensuring access to Medicaid services. The proposed rule included both proposed changes to current requirements and newly proposed requirements that would advance CMS’s efforts to improve access to care, quality, and health outcomes, and better promote health equity for Medicaid beneficiaries across FFS and managed care delivery systems, including for home and community-based services provided through those delivery systems. These proposed requirements were intended to increase transparency and accountability, standardize data and monitoring, and create opportunities for states to promote active beneficiary engagement in their Medicaid programs.

NCUIH’s Advocacy and CMS’ Response

On July 3, 2023, NCUIH submitted written comments and recommendations to CMS Administrator, Chiquita Brooks-LaSure, in response to the May 2, 2023, request for comment on the CMS proposed rule regarding ensuring access to Medicaid services. In its comments, NCUIH asked that CMS:

  • Ensure UIO and American Indian and Alaska Native representation on each state Medicaid Advisory Committee (MAC) and Beneficiary Advisory Group (BAG)—now called the Beneficiary Advisory Council (BAC).
  • Ensure the rule does not impose additional burdensome reporting requirements on providers.
  • Engage with the Tribal Technical Advisory Committee (TTAG) to consider regulations or guidance to enforce the state consultation and confer requirements.
  • Support 100% Federal Medical Assistance Percentage (FMAP) for Medicaid services provided at UIOs to ensure American Indian and Alaska Native Medicaid beneficiaries receive appropriate, quality culturally competent care.

NCUIH will continue to advocate for CMS to ensure UIO American Indian and Alaska Native beneficiaries have continued access to Medicaid services.

May Policy Updates: Highlights from the Annual Conference, Congressional Testimony, Upcoming Events, and More!

In this Edition:

📸 Annual Conference & Hill Day Recap: View photos and key updates from Annual Conference and Hill Day activities.

🏢 Federal Agency Roundtables: Insights from CMS, SAMHSA, HRSA, CDC, and SSA, plus IHS listening sessions.

🏛 Federal Addresses: Updates from OMB, CMCS, DOJ, and DOI.

📆 Upcoming Events: Key dates like the VA Urban Confer, IHS Strategic Plan Urban Confer, and more.

💬 NCUIH in Action: Highlights from our representation at the NIHB Tribal Leaders Reception and the Taskforce on Maternal Mental Health launch.

📝 Federal Agency Comments: NCUIH’s advocacy on the CMS Traditional Healing Framework, VA-UIO Reimbursement Program, and more.

🔜 Consultations & Comment Opportunities: Participate in upcoming consultations on the IHS HIT Modernization Program and ICWA.

📅 Significant Dates: Track events like the NIHB National Tribal Health Conference and the NCAI Mid-Year Conference.

NCUIH Annual Conference and Hill Day

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The NCUIH Annual Conference crescendoed with a Capitol Hill Advocacy Day, where the National Council of Urban Indian Health and leaders from Urban Indian Organizations visited 53 Congressional offices. This event was significant as it provided a platform for these leaders to directly engage with policymakers, amplifying the voice of Urban Indian Organizations and highlighting their priorities. This direct interaction helps ensure that their unique needs and challenges are understood and considered in legislative decision-making.

We are also proud to have hosted 5 Federal Agency Roundtables:

  • Centers for Medicare & Medicaid Services (CMS)
  • Substance Abuse and Mental Health Services Administration (SAMHSA)
  • Health Resources and Services Administration (HRSA)
  • Centers for Disease Control and Prevention (CDC)
  • Social Security Administration (SSA)

3 Listening Sessions:

  • Indian Health Service (IHS)
  • Indian Health Service Division of Behavioral Health (IHS DBH)
  • Indian Health Service HIV Program

and 1 Urban Confer with the VA on the Reimbursement Agreement Program: 

  • Department of Veterans Affairs (VA)

Sonya Tetnowski (Makah), MBA-F, Former NCUIH Board President, and The Honorable Denis Richard McDonough, Secretary of Veterans Affairs.

Sonya Tetnowski (Makah), MBA-F, Former NCUIH Board President, and The Honorable Denis Richard McDonough, Secretary of Veterans Affairs.

Featured Federal Agencies:

  • Office of Management and Budget (OMB)
  • Center for Medicaid & CHIP Services (CMCS)
  • Department of Justice (DOJ)
  • Department of the Interior (DOI)

Rori Collins, JD, Esq. (Nenana Native Village) NCUIH Public Policy Counsel, Walter Murillo (Choctaw), NCUIH Board President, Alexandra Payan, JD, NCUIH Federal Relations Manager, Daniel Tsai, Deputy Administrator and Director of CMCS, Francys Crevier (Algonquin), NCUIH CEO, Kitty Marx, CMS Division of Tribal Affairs.

Rori Collins, JD, Esq. (Nenana Native Village) NCUIH Public Policy Counsel, Walter Murillo (Choctaw), NCUIH Board President, Alexandra Payan, JD, NCUIH Federal Relations Manager, Daniel Tsai, Deputy Administrator and Director of CMCS, Francys Crevier (Algonquin), NCUIH CEO, Kitty Marx, CMS Division of Tribal Affairs.

Rori Collins, JD, Esq. (Nenana Native Village) NCUIH Public Policy Counsel, Meredith Raimondi, NCUIH VP of Policy and Communications, Bryan Newland (Ojibwe), Assistant Secretary of the Interior or Indian Affairs.

Rori Collins, JD, Esq. (Nenana Native Village) NCUIH Public Policy Counsel, Meredith Raimondi, NCUIH VP of Policy and Communications, Bryan Newland (Ojibwe), Assistant Secretary of the Interior or Indian Affairs.


NCUIH Requests Full Funding for the Indian Health System for FY 2025

Todd Wilson (Crow), Executive Director of Helena Indian Alliance-Leo Pocha Clinic Testifies during American Indian and Alaska Native Public Witness Day.

Todd Wilson (Crow), Executive Director of Helena Indian Alliance-Leo Pocha Clinic Testifies during American Indian and Alaska Native Public Witness Day.

NCUIH Testimony at House Interior Appropriations Subcommittee American Indian and Alaska Native Public Witness Hearing

On May 8, 2024, Todd Wilson (Crow), Executive Director of Helena Indian Alliance-Leo Pocha Clinic and NCUIH board member, was NCUIH’s witness for the House Appropriations Committee’s AI/AN Witness Day.

  • Go deeper: Testimony advocated for full funding for IHS at $53.8 billion and Urban Indian Health line item at $965.3 million for Fiscal Year (FY) 2025 (as requested by the Tribal Budget Formulation Workgroup), maintaining advance appropriations for IHS until mandatory funding is authorized, and protecting IHS from sequestration.

Congressional Dear Colleague Letters

NCUIH helped draft the Dear Colleague Letters requesting the TBFWG’s FY 2025 requests for the Urban Indian Health line item ($965.3 million) and IHS ($53.85 billion).

Advocacy Highlights: CMS Traditional Healing Framework & VA-UIO Reimbursement Agreement Program

NCUIH

On April 29, NCUIH submitted comments to CMS on the Traditional Healing Framework Section 1115 Demonstrations.

  • The bottom line: NCUIH requested that CMS include Traditional Healing services provided at UIOs in the Proposed Framework; allow Tribes, UIOs, and States the flexibility to develop a solution that serves all American Indian and Alaska Native beneficiaries; ensure the Proposed Framework reflects the requests of Tribes and UIOs; ensure the Proposed Framework does not create inequities in care; respect confidentiality for Traditional Healers and Traditional Healing practices; and engage with UIOs by hosting an urban confer and continue to engage with Tribes.

On May 15, NCUIH submitted comments to the VA on the VA-UIO Reimbursement Agreement Program. Urban confer was held on May 1, 2024, at the NCUIH conference.

  • The bottom line: NCUIH requested that the VA continue to engage with and provide updates to UIO on the revised agreement through its development; improve the UIO reimbursement rates under the revised agreement; ensure Changes to the Scope of Services Include Services Provided at UIOs; and provide technical assistance to UIOs to support UIO participation.

Upcoming Federal Comment Opportunities: 

June 7 – IHS Health Information Technology (HIT) Modernization Program: Deployment and Cohort Planning

  • IHS held a Tribal Consultation and Urban Confer on May 9 providing information and updates on the EHR implementation process.
  • IHS is seeking comments on the topic of EHR deployment and cohort planning.

June 14 – DOJ, DOI, HHS – Strengthening ICWA

  • DOJ, DOI, and HHS held a joint Tribal Consultation on May 14, 2024.
  • The agencies are seeking feedback on ICWA and what steps the agencies can take to promise federal protections for Indian children and their parents and caregivers.

June 28 – IHS Urban Confer regarding IHS’ Strategic Plan for FY 2024-2028

  • IHS will host a virtual Urban Confer on May 30.
  • The draft IHS Strategic Plan for FYs 2024-2028 will establish the Agency’s direction for the next 5 years.
  • IHS is seeking input to establish goals, objectives, strategies, and performance measures to improve Agency operations, strengthen Tribal partnerships, and deliver quality health care to American Indians and Alaska Natives in urban communities.

July 1 – USDA Dietary Guidelines for America

  • USDA is seeking public comment as the 2025 Dietary Guidelines Advisory Committee conducts its scientific review process.

July 10 – VHA-IHS MOU Operational Plan for FY24 and Joint Tribal Consultation and Urban Confer

  • The VA and IHS sent a Dear Tribal and Urban Leader Letter seeking feedback on the VHA-IHS MOU Operational Plan for FY 2024.
  • VA and IHS are tentatively planning to host an Urban Confer the week of June 10, 2024.

NCUIH in Action: Partner Advocacy, Democracy is Indigenous, and Medicaid Unwinding

Meredith Raimondi, NCUIH VP of Policy and Communications, Anthony (A.C.) Locklear, JD, Federal Relations Director at National Indian Health Board, and Mary Jomia, NCUIH Public Policy Manager.

Meredith Raimondi, NCUIH VP of Policy and Communications, Anthony (A.C.) Locklear, JD, Federal Relations Director at National Indian Health Board, and Mary Jomia, NCUIH Public Policy Manager.

Meredith Raimondi, NCUIH VP of Policy and Communications, Anthony (A.C.) Locklear, JD, Federal Relations Director at National Indian Health Board, and Mary Jomia, NCUIH Public Policy Manager.On May 7, NCUIH represented UIOs at the National Indian Health Board (NIHB) Tribal Leaders Reception with HHS Secretary Tribal Advisory Committee (STAC) members.

NCUIH Interim Director of Congressional Relations Jeremy Grabiner, Urban Indian Center of Salt Lake Specialist Ralyn Montoya, National Urban Indian Family Coalition Executive Director Janeen Comenote, Kansas City Indian Center's Executive Director Gaylene Crouser and Coordinator Jason Swartley, at the Democracy is Indigenous Mid-Year Gathering.

NCUIH Interim Director of Congressional Relations Jeremy Grabiner, Urban Indian Center of Salt Lake Specialist Ralyn Montoya, National Urban Indian Family Coalition Executive Director Janeen Comenote, Kansas City Indian Center’s Executive Director Gaylene Crouser and Coordinator Jason Swartley, at the Democracy is Indigenous Mid-Year Gathering.

On May 14 and 15, NCUIH attended the National Urban Indian Family Coalition’s Democracy is Indigenous Mid-Year Meeting. NCUIH and partner Urban Indian Organizations shared the work they are doing to address voting access as social determinant of health. NCUIH also shared resources for voting which can be found at NCUIH.org/Vote.

Carolyn Kowalyk, NCUIH Public Health Associate, at SAMHSA’s Taskforce on Maternal Mental Health Launch of the National Strategy and Report to Congress event.

Carolyn Kowalyk, NCUIH Public Health Associate, at SAMHSA’s Taskforce on Maternal Mental Health Launch of the National Strategy and Report to Congress event.

On May 14, NCUIH represented UIOs at the SAMHSA Taskforce on Maternal Mental Health Launch of the National Strategy and Report to Congress. Attendees heard from task force co-chairs and members, women with lived experience, HHS leaders, Congressional leaders, and others dedicated to addressing the maternal health crisis in the U.S.

  • Did you know?: The Taskforce on Maternal Mental Health is a subcommittee of the SAMHSA Advisory Committee on Women’s Services.

Meredith Raimondi, NCUIH VP of Policy and Communications, presenting at a Medicaid Unwinding panel discussion at the NIHB 2024 Tribal Health Conference.

Meredith Raimondi, NCUIH VP of Policy and Communications, presenting at a Medicaid Unwinding panel discussion at the NIHB 2024 Tribal Health Conference.

From May 19-23, NCUIH is attending the NIHB National Tribal Health Conference in Rapid City, SD. On May 21, NCUIH Vice President of Policy and Communications, Meredith Raimondi joined the American Cancer Society Cancer Action Network (ACSCAN), NIHB, and Georgetown Center for Children and Families in a panel discussion about the impact of the Medicaid unwinding and terminations on Native American communities. With 2.7 million Native people relying on Medicaid, the federal government must fulfill its trust obligation and safeguard their coverage.

Upcoming Events and Important Dates

Calendar with events on it

Recent Dear Tribal Leader Letters (DTLLs) and Dear Urban Leader Letters (DULLs)

Upcoming Events:

  • May 19-23: NIHB National Tribal Health Conference in Rapid City, SD
  • May 24: OUIHP-Urban Program Executive Directors/Chief Executive Officers Monthly Conference Call
  • May 29: White House Council on Native American Affairs (WHCNAA) Homeless Veterans Initiative Workgroup meeting.
  • May 30: IHS Urban Confer on the Development of the Strategic Plan for FYs 2024-2028. Join the meeting here.
  • June 1-6: National Congress of American Indians (NCAI) Mid Year Conference in Cherokee, NC. Register here.
  • June 11-12: Tribal Leaders Diabetes Committee in Scottsdale, AZ
  • June 11: MMPC Monthly Meeting

ICYMI:

Sonya Tetnowski (Makah), CEO of Indian Health Center of Santa Clara Valley presenting before the VA Advisory Committee on Tribal and Indian Affairs.

Sonya Tetnowski (Makah), CEO of Indian Health Center of Santa Clara Valley presenting before the VA Advisory Committee on Tribal and Indian Affairs.

On May 8-9, NCUIH represented UIOs at the HHS STAC meeting. Sonya Tetnowski (Makah), CEO of the Indian Health Center of Santa Clara Valley, presented about the VA Advisory Committee on Tribal and Indian Affairs

  • What’s next: The next VA TAC meeting will likely be in Washington D.C. around August-September 2024.

NCUIH Endorsed Tribal Border Crossing Parity Act Protects Tribal Sovereignty and Ends Blood Quantum Rule for Border Crossings

On March 27, 2024, Representative Fulcher and Representative Kilmer introduced the National Council of Urban Indian Health (NCUIH)-endorsed Tribal Border Crossing Parity Act. This bill would simplify the process for American Indian and Alaska Native people crossing the United States-Canada border and uphold Tribal sovereignty. If passed, the bill would allow Tribal members to use their Tribe-issued IDs as proof of citizenship in a federally recognized Tribe to cross the border, rather than having to provide proof of 50% blood quantum.

Currently, Tribally enrolled citizens who have shown proof of blood quantum and been issued a certificate from the Department of Interior, can freely cross the U.S.-Canadian border. While this policy dates back to the Jay Treaty of 1794, which allowed Native Americans to cross the border freely, without blood quantum requirements, Congress changed that requirement during the Termination Era. In 1952, the Immigration and Nationality Act required a 50% blood quantum and proof from the Department of Interior to cross freely. This creates an undue burden on Tribal members and violates Tribal sovereignty, as the blood quantum requirement infringes on the sovereignty of federally recognized Tribes to determine their own membership.  Tribal identification should be fully recognized as the best form of identification. The Tribal Border Crossing Parity Act will protect Tribal Sovereignty and ensure American Indian and Alaska Native people can freely exercise their treaty rights.

“The Tribal Border Crossing Parity Act is a healing step forward for the U.S. federal government toward truly honoring the trust and treaty obligation to Tribal Nations” said Francys Crevier, Chief Executive Officer at NCUIH. “The Jay Treaty of 1794 supported Indigenous People of North America to travel freely despite newly created colonizer lines, but during the Termination Era in 1952, Congress implemented a racist blood requirement that violated Tribal Sovereignty, the government-to-government relationship, and the original intent and spirit of the Jay Treaty, infringing on the rights of Tribal citizens. This legislation will correct some of the wrongs of the past and eradicate a racist law created in an attempt to terminate Tribal sovereignty.”

This bill is endorsed by the National Congress of American Indians, Kootenai Tribe of Idaho, and Prairie Band Potawatomi Nation.

Background

Bipartisan Group of 52 Congressional Leaders Request Full Funding for Indian Health Service and Increased Resources for Urban Indian Health

On May 1, 2024, 50 Congressional leaders joined Representatives Gallego and Grijalva in their letter to Chairman Simpson and Ranking Member Pingree of the House Interior Appropriations Committee requesting up to $53.85 billion for the Indian Health Service and $965.3 million for Urban Indian Health in FY25 and maintaining advance appropriations for IHS until authorizers move IHS to mandatory funding. The letter emphasizes that the federal government has a trust responsibility to provide federal health services to maintain and improve the health of American Indian and Alaska Natives.

The bipartisan group of 52 Congressional leaders reiterated their support for the Appropriations Committee’s work on the historic inclusion of advance appropriations in the FY23 and FY24 omnibus. Previously, IHS was the only federal health care provider funded through annual appropriations. Without advance appropriations, IHS is subject to the negative impacts of government shutdowns and continuing resolutions that can lead to serious disruptions in UIO’s ability to provide critical patient services. The inclusion of advance appropriations is a crucial step toward ensuring long-term stable funding for IHS.

This letter sends a powerful message to Chairman Simpson and Ranking Member Pingree, and members of Congress that in order to fulfill the federal government’s trust responsibility to all Natives to provide safe and quality healthcare, funding for the Indian Health Service must be significantly increased.

NCUIH is grateful for the support of the following Representatives:

  1. Ruben Gallego
  2. Raul M. Grijalva
  3. Dusty Johnson
  4. Sharice Davids
  5. Mary Sattler Peltola
  6. Teresa Leger Fernandez
  7. Raul Ruiz, M.D.
  8. Melanie Stansbury
  9. Gwen S. Moore
  10. Salud Carbajal
  11. Doris Matsui
  12. Shontel Brown
  13. Steven Horsford
  14. Greg Casar
  15. Grace F. Napolitano
  16. Nanette Diaz Barragan
  17. Pramila Jayapal
  18. Gabe Vasquez
  19. Katie Porter
  20. Adam Schiff
  21. Andrea Salinas
  22. Brittany Pettersen
  23. Earl Blumenauer
  24. Jared Huffman
  25. Mark Takano
  26. Jasmine Crockett
  27. Ro Khanna
  28. Jonathan L Jackson
  29. Julia Brownley
  30. Mike Levin
  31. Jimmy Panetta
  32. Ilhan Omar
  33. Lisa Blunt Rochester
  34. Jared Golden
  35. Chris Deluzio
  36. Jamaal Bowman
  37. Veronica Escobar
  38. Adam Smith
  39. Haley M. Stevens
  40. Cori Bush
  41. Val Hoyle
  42. Zoe Lofgren
  43. Jahana Hayes
  44. Steve Cohen
  45. Andre Carson
  46. Diana DeGette
  47. Kim Schrier
  48. Greg Stanton
  49. Jared Moskowitz
  50. Stephen F. Lynch
  51. Darren Soto
  52. Jesus G. “Chuy” Garcia

NCUIH Recommends NIH Collaboration with Urban Indian Organizations for Future HIV Research Initiatives

On March 28, 2024, the National Council of Urban Indian Health (NCUIH) submitted a response to a request for information (RFI) from the National Institutes of Health (NIH) Office of AIDS Research (OAR) to inform the development of the Fiscal Year (FY) 2026-2030 NIH Strategic Plan for HIV and HIV-Related Research (“Strategic Plan”). As part of its response, NCUIH urged NIH to prioritize research efforts that address the specific needs and challenges faced by American Indian and Alaska Native communities and requested that NIH partner with urban Indian organizations (UIOs) to improve research implementation.

Background

NIH OAR oversees and coordinates all HIV research activities across NIH, including both extramural and intramural research, research training, program evaluation, and HIV research infrastructure and capacity development. NIH supports a comprehensive portfolio of research representing a broad range of basic, clinical, behavioral, social, translational, and implementation science on HIV and associated coinfections and comorbidities. The Strategic Plan provides a framework for developing the NIH HIV research budget, articulates HIV research priorities, and provides information about NIH HIV research priorities to the scientific community, Congress, HIV-affected communities, and the public at large. The current strategic Plan is for FY 2021-2025.

The RFI requested responses to the FY 2026-2030 Strategic Plan’s four goals:

  • Goal 1: Enhance discovery and advance HIV science through fundamental research.
  • Goal 2: Advance the development and assessment of novel interventions for HIV prevention, treatment, and cure.
  • Goal 3: Optimize public health impact of HIV discoveries through translation, dissemination, and implementation of research findings.
  • Goal 4: Build research workforce and infrastructure capacity to enhance sustainability of HIV scientific discovery.

NCUIH’s Recommendations

In its response to OAR’s RFI, NCUIH requested that NIH:

  • Prioritize research efforts that address the specific needs and challenges faced by American Indian and Alaska Native communities in combating HIV.
  • Partner with UIOs to reach urban American Indian and Alaska Native populations.
  • Support the development of a diverse and inclusive HIV research workforce by recruiting and retaining American Indian and Alaska Native researchers.
  • Host UIO listening sessions as it develops the Strategic Plan

NCUIH will continue to monitor the development of the FY 2026-2030 NIH Strategic Plan for HIV and HIV-Related Research.