PRESS RELEASE: National Council of Urban Indian Health Calls for Protection of Indian Health System Funding

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FOR IMMEDIATE RELEASE

WASHINGTON, D.C. (January 31, 2025) – The National Council of Urban Indian Health (NCUIH) today urged Congress, the Office of Management and Budget (OMB), and the Department of Health and Human Services (HHS) to exempt the Indian Health System from any future funding restrictions or pauses. This call to action comes in response to recent events that temporarily froze resources critical to the operation of Tribal health care and Urban Indian Organization (UIO) facilities. While the recent OMB memorandum (M-25-13) has been rescinded, NCUIH remains concerned about potential future impacts on the Indian health system. The organization emphasizes that any disruption to funding could have severe consequences for American Indian and Alaska Native communities.

Key points from NCUIH’s communications include:

  1. Federal Trust Responsibility: NCUIH stresses the U.S. Government’s legal obligation to provide health services to Native people, as established by the Indian Health Care Improvement Act.
  2. Preventing Service Disruptions: Recent funding uncertainties forced UIOs to consider staffing cuts, service suspensions, and even facility closures.
  3. Historical Context: Past experience shows any disruption in funding can have grave consequences on the Indian health system. During the 2019 government shutdown, funding disruptions led to reduced services and facility closures, resulting in tragic consequences including fatal opioid overdoses in some communities.
  4. Specific Exemption Request: NCUIH is calling for a specific exemption for the entire Indian Health System, including the Tribal organizations, and UIOs, from any future funding restrictions.

Walter Murillo (Choctaw), Board President of NCUIH stated, “Even a temporary halt in funding could immediately deprive Native communities of necessary health services. As leaders of Urban Indian Organizations, we’re on the front lines of providing essential healthcare to Tribal citizens. We’re calling for a specific exemption for the entire Indian Health System from any future funding restrictions or pauses. This isn’t just about honoring agreements; it’s about fulfilling the federal government’s trust responsibility to provide healthcare for Tribal citizens, regardless of where they live.”

NCUIH is actively engaging with Congress, the OMB, and HHS to secure this specific exemption and prevent any future disruptions to critical health care services for Tribal citizens. The organization has sent letters to both Congress and HHS detailing the critical need for uninterrupted funding to the Indian Health System.

About NCUIH

The National Council of Urban Indian Health (NCUIH) is a national representative 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 high quality and accessible health and public health services for American Indian and Alaska Native people 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

OMB Announces Temporary Pause on Federal Financial Assistance Programs: Implications for Urban Indian Organizations

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FOR IMMEDIATE RELEASE

Washington, D.C. (January 28, 2025)– On January 27, 2025, Matthew J. Vaeth, Acting Director of the Office of Management and Budget (OMB) at the Executive Office of the President released a memorandum addressed to all heads of Executive Departments and Agencies with the subject line “Temporary Pause of Agency Grant, Loan, and Other Financial Assistance Programs.” The memorandum requires that Agency leadership “to the extent permissible under applicable law…temporarily pause all activities related to obligation or disbursement of all Federal financial assistance.”

Each Agency must “identify and review all Federal financial assistance programs and supporting activities consistent with the President’s policies and requirements.” To determine whether such programs and supporting activities are “consistent with the President’s policies and requirements” Department and Agency heads should refer to the series of thirty-four (34) executive orders released by the President since he took office on January 20, 2025. Relevant topics “includ[e], but are not limited to, foreign aid, nongovernmental organizations, DEI, woke gender ideology, and the green new deal.” The temporary pause becomes effective today, January 28, 2025, at 5:00 p.m. There is presently no scheduled end date for the pause. All activities related to open Notice of Funding Opportunities are subject to the pause. OMB may “grant exceptions allowing Federal agencies to issue new awards or take other actions case-by-case basis.”

Application to Urban Indian Organizations and Next Steps

Urban Indian Organizations (UIOs) receive federal funding from various sources, some, if not all, of which will be affected by the pause. Urban Indian Organizations (UIOs) are advised to discuss the potential implications of this memorandum with their finance and legal departments. Please note that federal agencies may be unable to respond to inquiries or questions. The Department of Health and Human Services has issued a pause on issuing documents and public communications until February 1, 2025.

Additional Information

The memorandum requires Federal Agencies to:

  1. Immediately identify and notify OMB of any legally mandated actions or deadlines for assistance programs that will arise during the pause.
  2. Submit detailed information of any programs, projects, or activities subject to this pause no later than February 10,
  3. Carry out the following activities for each Federal financial assistance program:
    1. Assign responsibility and oversight to a senior political appointee to ensure Federal financial assistance conforms to Administration priorities;
    2. Review currently pending Federal financial assistance announcements to ensure Administration priorities are addressed, and, subject to program statutory authority, modify unpublished Federal financial assistance announcements, withdraw any announcement already published, and, to the extent permissible by law, cancel awards already awarded conflict with Administration priorities; and
    3. Ensure adequate oversight of Federal financial assistance programs and initiate investigations when warranted to identify underperforming recipients, and address identified issues up to and including cancellation of awards.

The memorandum defines “financial assistance program” as the term is defined in 2 CFR 200.1 meaning “assistance that recipients or subrecipients receive or administer in the form of:(i) Grants;(ii) Cooperative agreements;(iii) Non-cash contributions or donations of property (including donated surplus property);(iv) Direct appropriations; (v) Food commodities; and (vi) Other financial assistance,” but clarifies that the memorandum does not apply to Social Security benefits or Medicare.

Follow-up instructions provided by OMB on Federal Financial Assistance program analysis require all Federal agencies that provide Federal financial assistance complete a spreadsheet with information on any program that has funding or activities planned through March 15th. Agency heads must submit the completed spreadsheet to OMB no later than February 7th, 2025.

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 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.

 

Representative Stanton and Representative Joyce Reintroduce NCUIH-Endorsed Legislation to Elevate Native Health Care Within the Federal Government

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On January 28, 2025, Representatives Greg Stanton (D-AZ-4) and David Joyce (R-OH-14) reintroduced the Stronger Engagement for Indian Health Needs Act of 2025 (H.R.741), a National Council of Urban Indian Health (NCUIH)-endorsed bill. The legislation, which was considered during a House Subcommittee on Indian and Insular Affairs hearing on February 5, 2025, aims to elevate the Indian Health Service (IHS) Director to the position of Assistant Secretary for Indian Health within the Department of Health and Human Services (HHS). This change would increase the Director’s authority and ability to address the health care needs of American Indian and Alaska Native (AI/AN) communities.

“It is time for the government to recognize the importance of Indian health and uphold the federal trust responsibility to provide healthcare to all Native people. The elevation of the IHS Director to Assistant Secretary will uplift our voices in the Administration and is a critical step in improving health outcomes in Indian Country. We thank Representatives Greg Stanton and David Joyce, and we urge Congressional leaders to support this vital legislation,” said Walter Murillo, President of the National Council of Urban Indian Health and Chief Executive Officer of Native Health.

Support for the Legislation in House Hearing

In the House Subcommittee on Indian and Insular Affaris hearing on February 5, 2025, Rep. Stanton highlighted the need for this bill to pass,  “As an Assistant Secretary, the head of IHS would have expanded authorities improving continuity and quality of care provided by its employees. This is crucial for our native populations in Arizona and across the whole country, Indian Health is chronically underfunded in 2023 the average expenditure for Native American patients under IHS was about 1/3 of health care expenditure for non native individuals. That’s unacceptable. Basically, it is not  because Native people are less sick, this means they are simply receiving less care.

Report after report from the National Institutes of Health and the US Commission on Civil Rights cite that understaffing and underfunding of Indian Health System leaves many basic needs of our Native American community on them, leading to lower life expectancy and disproportionate rates of disease. The recent Supreme Court ruling in Becerra versus San Carlos Apache only adds to the uncertainty of IHS physical future, making action now to add leadership to the IHS so important. And this is a bipartisan issue. The late great senator, John McCain from Arizona, introduced this legislation originally in 1994 during his time in the Senate. This bill passed five times as a standalone bill, once more in the Indian Health Care Improvement Act of 2007 and there is precedent for doing an action like this. For example, in 2016 Congress elevated the director of the Substance Abuse and Mental Health Administration to an assistant secretary to respond to the opioid crisis.”

Next Steps

The bill was referred to both the House Committee on Energy and Commerce and the House Subcommittee on Indian and Insular Affairs. NCUIH will continue to monitor the legislation’s progress.

Resources

HHS Responds to Not Invisible Action Commission Findings and Recommendations with Plan to Support Urban Indian Communities in Combating the Missing and Murdered Indigenous People Crisis

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On November 15, 2024, the U.S. Department of Health and Human Services (HHS) released HHS’ supplemental response to the Not Invisible Act Commission’s (“Commission”) findings and recommendations on how to combat the missing and murdered Indigenous people (MMIP) and human trafficking crisis. The Commission’s findings and recommendations and the supplemental response by HHS mention urban Indian organizations (UIOs) and urban American Indian and Alaska Native people and communities. Importantly, HHS states that the National Center for Child Fatality Review and Prevention—“which provides technical assistance to state and local entities in conducting child death reviews, inclusive of AI/AN populations”—plans to “engage experts at Urban Indian Health Centers to create and implement a plan for also engaging [American Indian and Alaska Native] families living off Tribal lands.”

Read the HHS Full Supplemental Response here.

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 Resources:

NCUIH Calls for Improved EHR Training and Support for Urban Indian Organizations During IHS Health Information Technology Modernization Implementation

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On December 6, 2024, the National Council of Urban Indian Health (NCUIH) submitted written comments to the Indian Health Service (IHS) Director, Roselyn Tso, regarding IHS January 18, 2024, Dear Tribal Leader and Urban Indian Organization Leader letter (DTLL/DULL) and the November 7, 2024, joint Tribal Consultation and Urban Confer (TC/UC) session on Health Information Technology (HIT) Modernization Site Readiness and Training. In its comments, NCUIH recommended that IHS support Urban Indian Organizations (UIOs) pre- and post-go-live of the new electronic health record (EHR) by providing training that does not disrupt facilities’ operations and reflects real-life scenarios

Background on HIT Modernization

On November 8, 2023, TC/UC on HIT Modernization, IHS announced that it selected General Dynamics Information Technology, Inc. (GDIT) to build, configure, and maintain a new IHS EHR system utilizing Oracle Cerner technology. The new EHR, named Patients at the Heart (PATH), will replace the Resource and Patient Management System (RPMS).

For more information about HIT Modernization implementation, please click here.

NCUIH’s Requests

In its comments following the TC/UC, NCUIH submitted the following requests and recommendations to IHS:

  • Support UIOs pre- and post-go-live by providing training that does not disrupt facilities’ operations and reflects real-life scenarios
  • Ensure HIT Modernization implementation is equitable and inclusive for all facility types and sizes pre- and post-go-live
  • Continue to engage with UIOs through Urban Confer sessions to understand the site-level needs that IHS should consider when designing and deploying the PATH EHR
  • Continue to provide an updated timeline of the PATH EHR implementation

NCUIH Advocacy on HIT Modernization

NCUIH has previously submitted several comments to IHS on HIT Modernization:

NCUIH also submitted written testimony  to the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies regarding the fiscal year (FY) 2024 funding for UIOs in which NCUIH requested increased funding for EHR Modernization. Specifically, NCUIH requested support for the IHS’ transition to a new EHR system for IHS and UIOs by supporting the President’s budget request of $913 million in FY 2024 appropriations.

NCUIH will continue to closely follow IHS’s progress and policies with HIT Modernization.

NCUIH Requests SAMHSA Engage with Urban Indian Organizations in Redesign of Tribal Behavioral Health Grant Program

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On November 27, 2024, the National Council of Urban Indian Health (NCUIH) submitted written comments to the Substance Abuse and Mental Health Service Administration’s (SAMHSA) October 2024 Dear Tribal Leader Letter on redesigning the Tribal Behavioral Health (TBH) grant program to streamline the program and enable applicants to focus on priorities that align with their needs. In its comments to SAMHSA, NCUIH requested that SAMHSA engage with Urban Indian Organizations (UIOs) by hosting an Urban Confer or UIO listening session throughout the redesign process because UIOs are eligible for the TBH grant program through the Native Connections grant.

Background on the TBH Grant Program

The purpose of this program is to prevent and reduce suicidal behavior and substance use/misuse, reduce the impact of trauma, and promote mental health among American Indian and Alaska Native youth, up to and including age 24, by building a healthy network of systems, services, and partnerships that impact youth. In fiscal year 2023 and fiscal year 2024, 4 UIOs were awardees of the TBH grant program.

Indian Health Service Releases its Strategic Plan for Fiscal Years 2025-2029, Urban Indian Organizations Included in Key Health Care Goals

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On December 5, 2024, the Indian Health Service (IHS) published a Dear Tribal Leader and Urban Indian Organization (UIO) Leader letter (DTLL/DULL), regarding the release of the final IHS Strategic Plan for Fiscal Years (FYs) 2025-2029 (Strategic Plan). Prior to this release, the National Council of Urban Indian Health (NCUIH) submitted comments to IHS on June 28, 2024, regarding the Draft Strategic Plan. While IHS did not incorporate NCUIH’s suggestions, IHS does include Urban Indian Organizations (UIOs) in the Strategic Plan in sections concerning ensuring comprehensive, culturally respectful health care services; advancing data-driven/evidence-based decision-making; promoting proactive intergovernmental and external relationships; and respecting self-determination.

Background

The Strategic Plan will establish IHS’ direction for FY 2025-2029. It is developed based on feedback received from Headquarters Offices, the Strategic Plan Workgroup, and other stakeholders, and builds on the work of Headquarters Offices to determine appropriate measures. IHS hosted a virtual Tribal Consultation on May 29, 2024, regarding the Draft Strategic Plan following a May 2, 2024, DTLL. IHS hosted an Urban Confer on May 30, 2024 as it developed the Strategic Plan. The Strategic Plan includes four Goals with corresponding Strategic Objectives:

  • Strategic Goal 1: Be a leading health care organization
  • Strategic Goal 2: Ensure comprehensive, culturally respectful health care services
  • Strategic Goal 3: Optimize operations through effective stewardship
  • Strategic Goal 4: Promote proactive intergovernmental and external relationships

NCUIH believes that the Plan is an important vehicle to articulate leadership priorities, provide direction for program management functions, engage external partners and entities, and measure IHS’ progress towards meeting the goals and objectives contained in the Strategic Plan. NCUIH will continue to participate in the implementation and exercise of the Strategic Plan and inform UIOs of upcoming opportunities related to implementation of the Strategic Plan.

Scientific Report of the 2025 Dietary Guidelines Advisory Committee Discusses Importance of Foods and Beverages Integral to American Indian and Alaska Native People

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On December 11, 2024, the Scientific Report of the 2025 Dietary Guidelines Advisory Committee (Scientific Report) was officially submitted to the Secretaries of the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Agriculture (USDA). The Report includes NCUIH’s September 30, 2024, recommendation to incorporate research on Traditional Foods into the 2025-2030 Dietary Guidelines by conducting a simulation that analyzed expert-identified foods and beverages integral to and consumed by American Indian and Alaska Native people with positive results.

  • Read the full report here.

The DGAC is accepting written comments on the Scientific Report until Saturday, February 8, 2025. DGAC will also accept oral comments via virtual format on January 16, 2025, at 1 PM ET. Click here for more information on the comment opportunities on this Scientific Report.

Background

Under section 301 of Public Law 101-445 (7 U.S.C. 5341, the National Nutrition Monitoring and Related Research Act of 1990, title III), the Secretaries of HHS and USDA are directed to publish the Dietary Guidelines for Americans (Dietary Guidelines) jointly at least every five years. The law instructs that this publication shall contain nutritional and dietary information and guidelines for the general public; shall be based on the preponderance of scientific and medical knowledge current at the time of publication; and shall be promoted by each Federal agency in carrying out any Federal food, nutrition, or health program. The current edition of the Dietary Guidelines (2020-2025) provides guidance on the entire lifespan, from birth to older adulthood, including pregnancy and lactation. The Dietary Guidelines for Americans, 2025-2030 will continue to provide food-based dietary guidance across the entire lifespan to help meet nutrient needs, promote health, and reduce the risk of chronic disease. HHS and USDA appointed the 2025 Dietary Guidelines Advisory Committee (2025 DGAC) to conduct an independent scientific review that will help inform the Departments’ development of the next edition of the Dietary Guidelines.

Discussion of American Indian and Alaska Native Diets and Traditional Foods

The report conducted analyses for overall U.S. diets. The simulations considered foods and beverages that the CDC’s National Health and Nutrition Examination Survey reported as consumed. To be responsive to public comments that called for the Dietary Guidelines to be inclusive of American Indian and Alaska Native populations by considering American Indian and Alaska Native Traditional Foods, a separate simulation was conducted to simulate food and beverages identified by experts as included in select American Indian and Alaska Native diets.

The simulations “confirmed that nutrient requirements could be met using the foods identified as integral and included in those diets with limited exceptions; that finding was consistent across the U.S. population, not just the select American Indian and Alaska Native diets.” This positive news allows for the “inclusion of foods and beverages identified by experts as integral to and consumed by select American Indian and Alaska Native groups, who continue to experience significant health disparities.” The finding also advances the DGAC’s goals for health equity and “ensuring that the Dietary Guidelines are relevant and actionable across all segments of the U.S. population.” The Scientific Report states that more research is needed on the dietary patterns and preferences of American Indian and Alaska Native populations to address knowledge gaps regarding American Indian and Alaska Native diets.

NCUIH’s Role

In the September 30, 2024, comment to HHS, NCUIH:

  • Recommended that the 2025 DGAC incorporate research on Traditional Foods into the 2025-2030 Dietary Guidelines.
  • Requested HHS and USDA engage with American Indian and Alaska Native communities through Tribal Consultation and Urban Confer.

NCUIH will continue to monitor the development of the 2025-2030 Dietary Guidelines.

HHS Secretary Approves Final Data Access Policies for Tribes and Tribal Epidemiology Centers

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On December 6, 2024, the Secretary of the Department of Health and Human Services (HHS) approved the final HHS data access policies for Tribes and Tribal Epidemiology Centers (TECs)– Tribal Data Access Policy (TDA) and Tribal Epidemiology Center Data Access Policy (TECDA), respectively. The policies are located on HHS’ Tribal Data Homepage along with information on how to request data from each HHS Division, a frequently-asked-questions on Tribal and TEC data access policies, and previous policy drafts. The policies establish HHS-wide data policies and cover the data under the custody and control of HHS which includes data collected from Urban Indian Organizations (UIOs).

Tribal Data Access Policy

The purpose of the TDA Policy is to establish an HHS wide policy for how HHS will provide Tribes with data (both in general and when acting in their capacities as public health agencies), including the scope of data available, the process to obtain data, and the expected timelines for processing Tribal requests for data. It also establishes an HHS-wide expectation for responding to requests from Tribes for data in the custody and control of HHS and its Staff and Operating Divisions (collectively referred to as “Divisions”).

Tribal Epidemiology Center Data Access Policy

The purpose of the TECDA Policy is to establish an HHS-wide policy governing data access for TECs, including the scope of data available, the process to obtain data, and the expected timelines for processing TECs’ requests for data. It establishes an HHS-wide expectation for responding to requests from TECs acting in their capacities as Public Health Authorities (PHAs) for data in the custody and control of HHS and its Staff and Divisions.

Health Resources and Services Administration Publishes List of Health Professional Shortage Areas as of October 15, 2024, Includes Urban Indian Organizations

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On November 5, 2024, the Health Resources and Services Administration (HRSA) published a notice informing the public of the availability of the complete lists of all geographic areas, population groups, and facilities designated as primary medical care, dental health, and mental health professional shortage areas (HPSAs) in a designated status as of October 15, 2024. These lists include Urban Indian Organizations (UIOs). HRSA’s HPSA Find tool on the Health Workforce Shortage Areas webpage can be used to find data on the geographic, population, and facility HPSA designations throughout the United States.

For further information on the HPSA designations listed on the website or to request additional designation, withdrawal, or reapplication for designation, please contact Dr. Shelby Hockenberry, Branch Chief, Shortage Designation Branch, Division of Policy and Shortage Designation, Bureau of Health Workforce, HRSA, 5600 Fishers Lane, Rockville, Maryland 20857, sdb@hrsa.gov, (301) 443-1993.

Background

Section 332 of the Public Health Service (PHS) Act, 42 U.S.C. 254e, provides that the Secretary shall designate HPSAs based on criteria established by regulation. HPSAs are defined in section 332 to include (1) urban and rural geographic areas with shortages of health professionals, (2) population groups with such shortages, and (3) facilities with such shortages. Section 332 further requires that the Secretary annually publish lists of the designated geographic areas, population groups, and facilities. Using the statute and regulations, HRSA automatically designates UIOs as HPSAs.

HPSA designation offers access to potential federal assistance for healthcare facilities and providers. Public or private nonprofit entities are eligible to apply for assignment of National Health Service Corps personnel to provide primary medical care, mental health, or dental health services in or to these HPSAs. National Health Service Corps health professionals enter into service agreements to serve in federally designated HPSAs. Entities with clinical training sites located in HPSAs are eligible to receive priority for certain residency training program grants administered by HRSA’s BHW. Other federal programs also utilize HPSA designations.

NCUIH Advocacy

As part of its advocacy, the National Council of Urban Indian Health (NCUIH) engages with HRSA to ensure that UIOs receive HPSA scores that accurately reflect the level of provider shortage for UIO service. UIOs have particularly highlighted how they are negatively impacted by the way their HRSA HPSA scores affect their ability to hire and retain staff participating in various loan repayment programs. NCUIH continues to engage with HRSA regarding the need to develop HPSA scores which reflect the level of need in the Indian health care system, as opposed to general geographic data.