NCUIH Supports Tribal Proposal to Remove Urban Limitations in USDA Food Distribution Programs

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On October 13, 2023, the National Council of Urban Indian Health (NCUIH) submitted written comments and requests to the U.S. Department of Agriculture (USDA) Food and Nutrition Service (FNS) in response to the August 14, 2023, request for comments regarding the Proposed Rule on Food Distribution Programs: Improving Access and Parity. NCUIH’s comments address food insecurity in urban American Indian and Alaska Native communities.

NCUIH recommended that FNS:

In its comments, NCUIH recommended that FNS:

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

By removing the urban place requirements and encouraging tribal and state collaboration with UIOs, FNS can make significant steps toward eliminating food insecurity for urban American Indians and Alaska Natives. The FDPIR benefits would extend to these populations.

Background on the FDPIR

The FDPIR provides USDA Foods to income-eligible households living on Indian reservations, and to American Indian households residing in approved areas near reservations or in Oklahoma. Many households participate in FDPIR as an alternative to the Supplemental Nutrition Assistance Program (SNAP) because they do not have easy access to SNAP offices or authorized food stores. The FNS, an agency of the USDA, administers FDPIR at the federal level. The program is administered locally by either Indian Tribal Organizations (ITOs) or an agency of a state government. Currently, there are approximately 276 Tribes receiving benefits under FDPIR through 102 ITOs and 3 state agencies. Currently, per FDPIR regulations at § 253.4(d), any urban place outside of the reservation boundaries may not be served unless an ITO or State agency requests to serve the urban place with a justification.

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

Next Steps

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

October Policy Updates: Events, Legislative & Federal Updates, and Funding Opps

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October is almost over! Thank you for attending our focus groups this past month and informing us of important issues.

From October 3-5, NCUIH held UIO Focus Groups with UIOs in order to set our policy priorities for 2024. Access our survey to provide additional input here.

Responses from focus group attendees and non-attendees are both valuable. Your responses to this survey will directly impact the quality of advocacy and support that NCUIH can provide.

Legislative Updates: Continuing Resolution, SDPI, & Indigenous Peoples Day

Illustration of Congress with empty speech bubbles

Continuing Resolution (CR): On Sept. 30, President Biden signed a temporary bill that will keep the federal government funded until November 17, narrowly averting a shutdown. ​

  • IHS to Maintain Continuity of Operations with Advance Appropriations

    Did you know?: Due to Indian Country’s success of securing advance appropriations for IHS, funding will be maintained for almost all IHS programs in the event of a shutdown.

    Go deeper: Read IHS Director Roselyn Tso’s October 1 Dear Tribal Leader and Urban Indian Organization Leader letter sharing information regarding the current status of fiscal year (FY) 2024 appropriations for IHS in response to the recently enacted CR.

Special Diabetes Program for Indians (SDPI)​: Extended through Nov. 17. The CR also included $19.7 million in funding for the CR time period. NCUIH is monitoring several bills that contain a reauthorization for SDPI:

  • Special Diabetes Program Reauthorization Act of 2023 (H.R. 3561/S. 1855): Would reauthorize the SDPI program at $170 million per year for two years.

  • Lower Costs, More Transparency Act (H.R. 5378): Large health care package that includes reauthorization of SDPI.

S.3022 – IHS Workforce Parity Act of 2023: NCUIH has endorsed this legislation that would allow healthcare providers working part-time to access IHS scholarship and loan repayment programs.​ Providers working at UIOs will be eligible for proposed changes.

  • Next Steps: NCUIH is working with the sponsors (Senator Cortez Masto and Senator Mullin) of this legislation to help ensure its passage through the Senate.

S.2970/H.R. 5822 – Indigenous Peoples’ Day Act: NCUIH has endorsed this legislation to replace the official holiday recognized on the second Monday of October as Indigenous Peoples’ Day.

  • Next Steps: NCUIH is working with the sponsors (Senator Martin Heinrich and Rep. Norma Torres) of this legislation to help ensure its passage through the chambers.

NCUIH Requests Full IHS Funding for FY 2025, Increased Access to Food Distribution Programs for Urban Indians, & Access to Behavioral Health Resources

IHS

On September 29, NCUIH submitted comments to the Office of Management and Budget (OMB) regarding the formulation of the President’s FY 2025 Budget​.

  • The bottom line: NCUIH expressed its support for the Tribal Budget Formulation Workgroup’s request for full mandatory funding for the IHS at $53.85 billion and the Urban Indian Health Line Item at $965.3 million in the President’s FY2025 Budget. NCUIH also recommended that the President’s Budget propose setting the Federal Medical Assistance Percentage (FMAP) at 100% for Medicaid services provided at UIOs, request $80 million for the Behavioral Health and Substance Use Disorder Resources for Native Americans Program, and propose permanent reauthorization of the SDPI at $250 million if not reauthorized in the FY 2024 budget.

On October 13, NCUIH submitted comments to the U.S. Department of Agriculture (USDA) in response to the Food and Nutrition Service (FNS) Proposed Rule Improving Access and Parity in Food Distribution Programs.

  • The bottom line: NCUIH requested that ​the agency honor the request of Tribal Leaders and remove certain urban place restrictions in the Food Distribution Program on Indian Reservations (FDPIR) regulations.

On October 19, the Substance Abuse and Mental Health Services Administration (SAMHSA) hosted a virtual listening session with UIOs to discuss the Behavioral Health and Substance Use Disorder Resources for Native Americans (Section 1201 Program). This is a new program, authorized but not appropriated, under the 2023 Omnibus Funding bill. ​

  • Why it matters: This meeting provided the opportunity for SAMHSA to engage with UIOs regarding development of the program, including the funding formula and reporting requirements.​

Upcoming Events and Important Dates: SDPI Funding Opportunity, Urban Confer on Health IT Modernization

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Upcoming Opportunities:

2024 Special Diabetes Program for Indians 2.0 (SDPI-2) – IHS

The IHS Division of Diabetes Treatment and Prevention announced a new 2024 funding opportunity for all federally recognized Tribes, Tribal organizations, UIOs, and/or federal health care facilities that currently do not have a 2023 SDPI grant.

The 2024 SDPI-2 will be a 4-year program to address diabetes treatment and prevention efforts in American Indian and Alaska Native (AI/AN) communities. Applications are due by November 29, and additional application information is available on the IHS website.

Estimated Total Program Funding: $10,000,000
Expected # of Awards: 15
Award Range: $25,000 – $600,000

Upcoming Comments and Submissions:

  • October 31: Comment deadline to the Department of Health and Human Services (HHS) – Healthy People 2030 Leading Health Indicators Initiative

Upcoming Events:

  • October 25: White House Conference on Hunger, Nutrition, and Health Monthly Update. Register here.

  • November 8: Tribal Consultation/Urban Confer: Health Information Technology Modernization – The Path Forward. Register here.

  • November 12-17: National Congress of American Indians 2023 Annual Conference​. Register here.

  • November 16: Urban Program Executive Directors/Chief Executive Officers Monthly Conference Call​

  • December 20: Next NCUIH Monthly Policy Workgroup meeting. NOTE: The November meeting is canceled.

NCUIH in Action

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NCUIH VP of Policy and Communications Meredith Raimondi, with Deputy Administrator and Director of Center for Medicaid and CHIP services at CMS Dan Tsai.

On October 18-19, Meredith Raimondi, VP of Policy and Communications, and Chandos Culleen, Director of Federal Relations, attended the Centers for Medicare & Medicaid Services (CMS) Tribal Technical Advisory Group (TTAG) Face-to-Face meeting in Washington DC as technical advisors.

Francys presenting

NCUIH CEO Francys Crevier (Algonquin) speaking at the National Urban Indian Family Coalition conference.

On October 19, NCUIH CEO Francys Crevier (Algonquin) presented at the National Urban Indian Family Coalition about our partnership on the Democracy is Indigenous Integrated Voter Engagement project. She highlighted the important work that NCUIH and UIOs are doing around voter registration and Native youth civic engagement.

Learn more and find resources here.

Thank you for all your hard work and advocacy!

HHS Provides Updates on COVID-19, Vaccine Recommendations, and No-Cost Vaccine Access Program

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On September 19, 2023, the Department of Health and Human Services (HHS) Office of Intergovernmental and External Affairs (IEA) held a briefing on COVID-19 Vaccine Updates. This call was led by Secretary Xavier Becerra and included updates from the Director of the Centers for Disease Control and Prevention (CDC), Dr. Mandy Cohen, and the Director of the Center for Biologics Evaluation and Research (CBER) at the Food and Drug Administration (FDA), Dr. Peter Marks, on the new COVID vaccine, CDC’s Bridge Access Program which provides no-cost COVID-19 vaccines, ongoing mitigation measures, and Strategic National Stockpile (SNS).

Vaccine Recommended as Best Measure Against Long COVID

Currently, there is an underlying immunity due to 97% of people across the United States either having been vaccinated or had COVID previously. However, based on data it, appears that this protection decreases over time. The most protection is provided in the first 4-6 months after receiving the vaccine, and it can take up to two weeks for your immune system to build up the immunity needed to fight off the virus.

The CDC is concerned as we are still seeing hundreds of people die every week, with people over 65 at the highest risk for negative outcomes. Secretary Beccera highlighted the need for assistance from the public because people are dying in numbers we weren’t seeing as recently as a month ago. Regarding long COVID, the CDC shared there is still much to be learned. In the meantime, the recommendation continues to be to receive the vaccine as it’s the best way to reduce any risk of getting long COVID. Both the CDC and FDA recommend that everyone over the age of 6 months receive not only the updated COVID vaccine, but the flu and RSV (Respiratory Syncytial Virus) vaccines as well.  Dr. Cohen mentioned that the Maternal RSV vaccine will be available soon, specifically for expecting mothers which, as of September 22, is officially recommended by the CDC. There is a strong emphasis from HHS, CDC, and the FDA to get vaccinated as this is the first time we have ever had immunizations for all three major respiratory viruses.

Updated COVID Vaccine Available at No-Cost through Bridge Access Program

The FDA has approved a new COVID vaccine, updated to match the strain that is currently circulating. The FDA recommendation is for those ages 5 years and older to receive a single dose, regardless of whether an individual has previously been vaccinated. For ages 6 months to 4 years, children are eligible to receive two doses of either Moderna or Pfizer. An important note for the immunocompromised is that a second or additional vaccine may be necessary. If someone currently has COVID but wants to receive the new vaccine, it is recommended to wait two months from the time since having COVID or receiving a previous vaccination. Dr. Marks reiterated confidence in the safety and effectiveness of these updated vaccines, while recognizing they may need to be updated on an annual basis, similar to what is done for the seasonal influenza vaccine.

Even though we are outside of the Public Health Emergency (PHE), Dr. Cohen emphasized that the updated COVID vaccine will still be available for free. This is either through insurance or through the CDC’s Bridge Access Program for those uninsured or underinsured where vaccines can be received at pharmacies such as CVS or Walgreens. Follow this link to find sites where free vaccines can be obtained, as well as additional resources. Secretary Beccera explained that this bridge program has received substantial funding from HHS, and that HHS has been in contact with private plans, as well as Medicaid and Medicare, so that there are no issues with receiving the vaccine at no cost.

Other COVID Related Updates

HHS’ Project NextGen will begin working with scientists to explore what next steps may be necessary to continue combatting the spread of the virus. Related to this, Secretary Beccera gave an update on the Strategic National Stockpile (SNS), which is a resource to supplement state and local supplies during public health emergencies. It can be utilized as a short-term buffer when the supply of these materials is not immediately available or is not sufficient to match immediate need. Currently, the SNS is being prepared so that there isn’t an emergency situation where there aren’t enough masks, vaccines, or tests available. Secretary Becerra explained that they have learned from the pandemic as to what they need to do to be prepared, especially in addressing supply chain issues.

Opportunity for Urban Indian Representation on Department Of Labor Native American Employment and Training Council

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The Department of Labor (DOL) is seeking nominations from representatives of tribal governments and American Indian, Alaska Native, and Native Hawaiian organizations that have expertise in the areas of workforce development, secondary and post-secondary education, health care, human services, veteran services, business and economic development, and job sectors growth to join the Native American Employment and Training Council (NAETC). The NAETC provides guidance to the Secretary of Labor on Native American programs under Section 166 of the Workforce Innovation and Opportunity Act (WIOA) and advises the Secretary on matters that promote the employment and training needs of Native Americans. Urban Indian organizations (UIOs) interested in joining the NAETC are encouraged to submit nominations.

Nominations must be submitted electronically to NAETC@dol.gov (using subject line “Nomination—Native American Employment and Training Council”) by October 18, 2023. The DOL will not accept nominations by mail, express delivery, hand delivery, messenger, courier service, or facsimile.

Requirements for Nomination Submission

The DOL is seeking representatives from each of the six DOL Employment and Training Administration (ETA) regions (Boston, Philadelphia, Atlanta, Dallas, Chicago, and San Francisco, including representatives for Hawaii, Alaska, and Oklahoma and “Other Disciplines”). In nominating representatives for “Other Disciplines,” prospective nominees may represent various areas of expertise, such as technical experts (e.g., registered apprenticeships), education (tribal colleges or universities), health care, human services, elected tribal leaders, business, data analysis, economic development, or other sectors.

Nominations must include:

  • Nominee’s Name, title, organization, address, email, and phone number;
  • Nominator’s name, organization, address, email, and phone number;
  • Nomination category (e.g., ETA Region, Native Hawaiian representative, Alaska Native representative, Oklahoma representative, or representative for Other Disciplines). Those nominating a regional representative must reside in the same region as the nominee. If nominated for Other Disciplines, specify discipline;
  • A biography and current resume of the nominee; and
  • A cover letter that provides the reason(s) for nominating the individual or a self-nomination, and the particular expertise of the nominee in the areas of workforce development, secondary and post-secondary education, health care, human services, veteran services business and economic development and job sectors growth. In addition, the cover letter must state that the nomination is being made in response to the Federal Register notice and that the nominee (if nominating someone other than oneself) has agreed to be nominated.

In submitting nominations, consideration should be given to the availability of the nominee to attend and actively participate in Council meetings (not less than twice each year), willingness to serve on Council subcommittees and workgroups, and provide feedback to the grantee community. Communication between the Council member and his or her constituency is essential to the partnership between the DOL and the Indian and Native American communities.

For further information, contact Nathaniel Coley, Division of Indian and Native American Programs, (202) 693–4287 or email at Coley.Nathaniel.d@dol.gov.

Background

Section 166(i)(4) of WIOA requires the Secretary of Labor (Secretary) to establish and maintain the NAETC. The statute requires the Secretary to formally consult at least twice annually with the NAETC on the operation and administration of the WIOA Section 166 Indian and Native American employment and training programs. In addition, the NAETC advises the Secretary on matters that promote the employment and training needs of Indians and Native Americans, as well as to enhance the quality of life in accordance with the Indian Self-Determination and Education Assistance Act. The NAETC also provides guidance to the Secretary on how to make DOL discretionary funding and other special initiatives more accessible to Tribes, tribal organizations, Alaska Native entities, Indian-controlled organizations serving Indians, or Native Hawaiian organizations.

House Passes NCUIH-Endorsed Bipartisan Native American Child Protection Act, Includes Urban Indian Organizations in Grant Program

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On September 18, 2023, the House passed the National Council of Urban Indian Health (NCUIH)-endorsed legislation, the Native American Child Protection Act (H.R. 663) with a vote of 378-32. The original sponsors, Representative Ruben Gallego (D-AZ- 3) and Representative Dan Newhouse (R-WA-4), reintroduced this bipartisan legislation on January 31, 2023, which would reauthorize the Indian Child Protection and Family Violence Prevention Act programs through Fiscal Year 2028. The bill includes urban Indian organizations (UIOs) as eligible entities and encourages culturally appropriate treatment services and programs.

Specifically, the bill:

  1. Makes UIOs eligible for the Indian Child Abuse Treatment Grant Program.
  2. Creates a National Indian Child Resource and Family Services Center (the Center) that will provide technical assistance and training to Tribes, Tribal organizations, and UIOs.
  3. Establishes an advisory board to advise and assist the Center, that will consist of 12 members, appointed by the Secretary, from Indian Tribes, Tribal Organizations, and Urban Indian Organizations, with expertise in child abuse and child neglect.
  4. Requires the development of model intergovernmental agreements between Tribes and states to prevent, investigate, treat, and prosecute family violence.
  5. Revises the Indian Child Protection and Family Violence Prevention Program to allow funding to be used for additional activities such as operational costs for child protective services.

Bill Garners Bipartisan Support for Native Children

On the House floor, Representative Mike Collins (R-GA-10) noted the importance of the bill for Native children, “Advocates cite that the Indian Child Protection and Family Violence Prevention Act is the only federal statute that sets aside funding for Tribal governments dedicated to child abuse prevention and victim treatment funding for Tribal governments… abuse, neglect, and violence have no place in any community.”

Representative Ruben Gallego (D-AZ-3) highlighted the federal trust responsibility to Native children, stating “That bill [Indian Child Protection and Family Violence Prevention Act] was part of a promise to answer for the tragic abuse that happened at the federally run Native American boarding schools, but the programs have never been fully funded, were never authorized, and eventually expired. This is a failure by the federal government and the continuation of centuries of broken promises.”

Background

Native American/Alaska Native Child Maltreatment

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

Legislative History

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

This legislation previously passed the House with a majority recorded by voice vote in the 116th Congress (H.R. 4957). On July 14, 2021, the Senate Committee on Indian Affairs held a legislative hearing on H.R. 4957 where then Senior Advisor of the Office of the Assistant Secretary for Indian Affairs at the Department of Interior, Heidi Toadacheene, spoke in support of the act. In acknowledgment of the first inclusion of urban Indian organizations in the legislation, Assistant Secretary Toadacheene said in her testimony, “… services to be extended to the urban Indian organizations, and as you know those are critical services to help tribal communities, especially in places where American Indian, Alaskan Natives don’t have access to some of the services on reservations.”

Next Steps

This bill has been received in the Senate. NCUIH will continue to monitor the bill’s progress.

Resources

FY 2024 Appropriations Update: IHS to Maintain Continuity of Operations with Advance Appropriations

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On October 1, 2023, Indian Health Service (IHS) Director, Roselyn Tso, sent a Dear Tribal Leader and Urban Indian Organization Leader letter sharing critical information regarding the current status of fiscal year (FY) 2024 appropriations for the IHS. This letter is in response to the recently enacted “Continuing Appropriations Act, 2024 and Other Extensions Act” (the continuing resolution) which funds the Federal Government through November 17, 2023. The letter notes that because IHS received its first ever advance appropriations in the Consolidated Appropriations Act, 2023 (Public Law 117-328), which provides $5.1 billion in FY 2024 for nearly all programs in the IHS Services and Facilities accounts, the IHS has authorization and funding to continue operations and the provision of direct health care services. The FY 2024 advance appropriations and carryover funds from previously appropriated funds, including COVID supplemental funds, are not limited to the pro-rata percentage applied by the continuing resolution, and the IHS has access to this full funding amount as of October 1.

In the coming days, the IHS will begin distributing FY 2024 advance appropriations to IHS programs, Tribal Health Programs, and Urban Indian Organizations (UIOs). You can find additional information on IHS advance appropriations at the link that follows: IHS Blog: IHS Provides an Update on Advance Appropriations Implementation.

Payment Processes

HHS financial systems will re-open after October 1, 2023, for FY 2024 activities. All of the timelines and requirements to receive a payment remain the same. For example, funds will be paid out according to performance periods. If your UIO contract performance period is October – September, the earliest you could receive a payment for FY 2024 is October 2023. If your performance period is November – October, the earliest you could receive a payment for FY 2024 is November. Additionally, UIOs must have a signed Federal Acquisition Regulation (FAR) contract in place to receive a FY 2024 payment.

Activities that did not receive FY 2024 advance appropriations include the following:

  • Electronic Health Record Modernization
  • Indian Health Care Improvement Fund
  • Health Care Facilities Construction
  • Sanitation Facilities Construction
  • Contract Support Costs
  • Section 105(l) Leases (Payments for Tribal Leases)

Background on IHS Advance Appropriations

The FY 2023 Consolidated Appropriations Act (Public Law 117-328) included a total of $5.1 billion in FY 2024 advance appropriations for IHS, including the urban Indian health line item. The full year funding level will be available for programs on Oct. 1, 2023, regardless of whether Congress enacts a continuing resolution or full year bill. Advance appropriations provide long overdue funding stability and predictability for the IHS. Congress will determine a final appropriations level for the IHS in the FY 2024 appropriations process and has the ability to significantly increase the IHS budget, in-line with the recommendations of the National Tribal Budget Formulation Workgroup, through additional discretionary appropriations.

NCUIH Advocacy

After tireless advocacy from the National Council of Urban Indian Health (NCUIH) and our partners across Indian Country, Congress included advance appropriations for IHS in the FY 2023 final spending bill to provide stable funding for FY 2024. The current advanced appropriation expires in FY 2025, and NCUIH is continuing its advocacy to secure advanced appropriations for IHS for future years. NCUIH endorsed the bipartisan, bicameral Indian Program Advance Appropriations Act (H.R.4832/S.2424) which was reintroduced by Sen. Lujan (D-NM), Sen. Mullin (R-OK), Rep. McCollum (D-MN-04), and Rep. Cole (R-OK-04) on July 24, 2023. This bill would authorize advance appropriations for several accounts under the Bureau of Indian Affairs and Bureau of Indian Education within the Department of Interior and IHS within the Department of Health and Human Services.

On March 9, 2023, NCUIH CEO Francys Crevier (Algonquin), testified before and submitted public witness written testimony to the House Appropriations Subcommittee on Interior, Environment, and Related Agencies regarding FY 2024 funding and requested that advance appropriations for IHS be maintained. NCUIH also worked closely with Representatives Gallego and Grijalva on leading a Congressional letter to the House Committee on Appropriations for FY 2024, urging to maintain advance appropriations for IHS until such time that authorizers move IHS to mandatory spending. On April 4, 2023, a group of 12 Senators sent a letter to the Senate Interior Appropriations Committee with the same requests. Due to this advocacy, advance appropriations for IHS was maintained for FY 2025 in both the House and Senate Interior Appropriations proposed FY 2024 spending bills.

NCUIH Joins NIHB and 15 Tribal Partners in Letter to Congress Requesting Immediate Reauthorization of SDPI

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On September 12, 2023, the National Indian Health Board (NIHB), the National Council of Urban Indian Health (NCUIH), and 15 Tribal partner organizations sent a letter to House and Senate leadership requesting the reauthorization of the Special Diabetes Program for Indians (SDPI) be brought for consideration for a floor vote by September 30, 2023. The letter emphasizes that SDPI serves 780,000 American Indians and Alaska Natives across 302 programs in 35 states and is scheduled to expire on September 30, 2023.

SDPI provides culturally informed care, funds life-saving efforts to fight diabetes at Indian Health Services facilities (including 31 UIOs), 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.

Read the Full Letter

Full Letter Text

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

On behalf of the undersigned Tribal partner organizations and the 574+ sovereign federally recognized American Indian and Alaska Native (AI/AN) Tribal nations we serve, we write today to thank you for your longstanding support of the Special Diabetes Program for Indians (SDPI) and ask for your commitment to reauthorize this vital program before it expires at the end of this month. Please bring the SDPI forward for consideration for a floor vote by September 30, 2023.

The Special Diabetes Program for Indians serves 780,000 American Indians and Alaska Natives across 302 programs in 35 states.1 SDPI focuses on a culturally informed and community-directed approach to treat and prevent Type 2 diabetes in Tribal communities. American Indians and Alaska Natives disproportionately suffer from Type 2 diabetes, but thanks to the success of SDPI, that statistic is improving.

As part of the Balanced Budget Act of 1997, Congress established the SDPI program to address the growing epidemic of diabetes in AI/AN communities. At a rate approximately twice the national average, AI/ANs have the highest prevalence of diabetes. Further, AI/ANs are 1.8 times more likely to die from diabetes. In some Tribal communities, over 50 percent of adults have been diagnosed with Type 2 diabetes. However, from 2013 to 2017, diabetes incidence in AI/ANs decreased each year for the first time, thanks to the success of the SDPI program. American Indians and Alaska Natives are the only racial/ethnic group that has seen a decrease in prevalence.2 SDPI has also resulted in significant savings in Medicare due to a reduction in End Stage Renal Disease (ESRD). Between 1996 and 2013, incidence rates of ESRD in AI/AN individuals with diabetes declined by 54 percent. This reduction alone is estimated to have saved $520 million between 2006-2015.3

SPDI is bipartisan and widely supported in Congress but has yet to be reauthorized. Earlier this year, the Congressional Diabetes Caucus led bipartisan sign-on letters requesting support to reauthorize SDPI. The letters received 60 Senate signers and 240 House signers. And while these letters may show how bipartisan this program is, they do not reauthorize the most effective federally funded program.

More recently, legislation was passed out of committee in both the House (H.R. 3561) and Senate (S. 1855) that would reauthorize the SDPI program at $170 million per year for two years but awaits consideration by the full House and Senate. Failure to reauthorize SDPI will create unnecessary program uncertainty and impact the continuity of care for the patients who depend on this highly effective program. Despite the lack of funding, the Special Diabetes Program for Indians continues to prove how successful and widely bipartisan it is.

Unless the Speaker of the House and the Senate Majority Leader bring legislation to the floor for a vote, the program will expire on September 30, 2023, resulting in diminished type 2 diabetes care for thousands of AI/ANs. This program is highly successful, bipartisan, and has proven to be a worthwhile financial investment of taxpayer dollars.

The future of this successful program is in the hands of Congress. Passing legislation to reauthorize the SDPI program must be a top priority in September. The undersigned organizations urge House and Senate leadership to schedule the legislation for a floor vote and reauthorize the Special Diabetes Program for Indians by September 30, 2023.

Sincerely,
Alaska Native Health Board
Albuquerque Area Indian Health Board, Inc.
American Indian Higher Education Consortium
California Rural Indian Health Board
Great Plains Tribal Leaders’ Health Board
Inter Tribal Association of Arizona
Midwest Alliance of Sovereign Tribes
National Congress of American Indians
National Council of Urban Indian Health
National Indian Child Welfare Association
National Indian Education Association
Northwest Portland Area Indian Health Board
Rocky Mountain Tribal Leaders Council
Self-Governance Communication and Education Tribal Consortium
Southern Plains Tribal Health Board
United South and Eastern Tribes Sovereignty Protection Fund
National Indian Health Board

Background

In March 2023, the House Diabetes Caucus Leaders and Senate Diabetes Caucus Leaders sent a letter to House and Senate leadership advocating for the reauthorization of SDPI and outlining the program’s positive impacts on reducing diabetes in AI/AN communities. The House Diabetes Caucus letter closed with 238 signatures, and the Senate Diabetes Caucus letter closed with 60 signatures.

SDPI includes research-based interventions for diabetes prevention and cardiovascular disease (CVD) risk reduction AI/AN community-based programs and healthcare settings. AI/ANs have the highest diabetes prevalence rates of all racial and ethnic groups in the United States. AI/AN adults are almost three times more likely than non-Hispanic white adults to be diagnosed with diabetes. The program has demonstrated success with a 50% reduction in diabetic eye disease rates, drops in diabetic kidney failure, and a 50% decline in End Stage Renal Disease. SDPI is, therefore, a critical program to address the disparate high rates of diabetes among AI/ANs.

The 31 UIOs currently receiving SDPI funding have used these funds to purchase blood sugar monitoring devices, medication, wound care, endocrinology, and retinal imaging services. Other projects include a robust preventative education and support system and a Garden Project to teach classes about creating and maintaining a healthy diet.

Department of Veterans Affairs Seeks Nominations for Membership on the Advisory Committee on Tribal and Indian Affairs for California and Nashville Areas

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The Department of Veterans Affairs (VA) Office of Tribal Government Relations (OTGR) is seeking nominations of qualified candidates to be considered for appointment as a member of the Advisory Committee on Tribal and Indian Affairs (“the Committee”) to represent the following Indian Health Service (IHS) Areas: California; Nashville. Nominations for membership on the Committee must be received no later than 5:00 PM Eastern on October 20, 2023, and should be mailed to OTGR at 810 Vermont Ave. NW, Suite 915H (075) or emailed to tribalgovernmentconsultation@va.gov. UIOs are encouraged to work with local Tribes and Tribal organizations to identify local American Indian and Alaska Native veterans for nomination. The Committee is an important opportunity to uplift the voices of American Indian and Alaska Native veterans no matter where they reside.

Please see NCUIH’s previous blog for more information on the Committee and nomination requirements.

For further information, contact Peter Vicaire (Peter.Vicaire@va.gov), Office of Tribal Government Relations, 810 Vermont Ave. NW, Ste. 915H (075), Washington, DC 20420. A copy of the Committee charter can be obtained by contacting Peter Vicaire at 612–558–7744 or accessing the website managed by OTGR at: https://www.va.gov/​TRIBALGOVERNMENT/​index.asp.

September Policy Updates: Government Shutdown, SDPI Call to Action & More Important News

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September is almost over and Congress is running out of time to pass its budget!

Here’s what’s happening next week:

NCUIH UIO Focus Groups

  • October 3: Full Ambulatory​ at 1:00-2:30 pm EDT [Register Here]
  • October 3: Outpatient and Residential​ at 3:00-4:30 p.m. EDT​ [Register Here]
  • October 4: Limited Ambulatory​ at 1:00-2:30 p.m. EDT​ [Register Here]
  • October 4: Outreach and Referral​ at 3:00-4:30 p.m. EDT​ [Register Here]
  • October 5: Makeup Session​ at 1:00-2:00 p.m. EDT [Register Here]

US Government Shutdown: What You Need to Know

tell congress to protect indian country

The big picture: Government funding is set to expire on September 30. If Congress can not reach a funding agreement before that date, there will be a government shutdown.

Go deeper: Congress has thus far failed to reach an agreement on government funding. The House and Senate are both strategizing on ways to prevent a shutdown but no clear consensus or path forward exists as of Thursday afternoon.

Why it matters: If the Government were to shutdown, it would have profound impacts such as:

  • Tribal law enforcement and courts, Tribal housing programs, and primary, secondary, and higher education will switch to emergency operating plans.
  • No funding for Contract Support Costs, payment for Tribal leases, and Health Care Facilities construction.
  • The Department of Health and Human Services wouldn’t be able to award Head Start Grants during a shutdown.

The bottom line: Due to NCUIH and other Native organization’s success of including advance appropriations for the Indian Health Service, if there is a shutdown, funding will be maintained for almost all programs in the Services and Facilities accounts, including funding for urban Indian organizations.

Take Action: Join NCUIH in our urgent opposition to budget cuts for Indian Country and the federal shutdown. We have prepared a social media toolkit with a set of resources and guidelines that you can use to communicate the urgency of this issue.

NCUIH Report Finds States Again Shoulder the Cost of an Unmet Federal Trust Responsibility

FMAP

The big picture: On September 15, NCUIH released a policy report on the importance of setting the federal medical assistance percentage (FMAP) at 100% for services provided to Medicaid beneficiaries at urban Indian organizations (100% FMAP for UIOs).

By the numbers: With Medicaid beneficiaries making up 46% of the UIO Native patient population, 100% FMAP for UIOs is critical to expanding community health programming and youth services, ultimately leading to improved long-term health outcomes.

Go deeper: The report reflects the findings from case studies of two states, Washington and Montana, that successfully utilized the American Rescue Plan Act’s (ARPA) temporary authorization of 100% FMAP for UIOs to increase funding support for their UIOs.

Why it matters: The reports’ findings demonstrate that 100% FMAP for UIOs results in:

  • Increased services for Native patients ⬆️
  • Significant cost savings for states 💲
  • Flexibility for states to support UIOs in their health care delivery 🏥

What they’re saying: “This report showcases what we already knew: when the federal government faithfully honors its Trust responsibility to Native people, health access in our communities improves,” said Francys Crevier, CEO of NCUIH. “This provision has broad support across Indian Country because it directly impacts our people. Congress must act now to permanently reauthorize 100% FMAP for UIOs.”

Action Alert: Special Diabetes Program for Indians Expires in 2 Days – Contact Congress Now

IHS

We need your help contacting Congress to support the reauthorization of the Special Diabetes Program for Indians (SDPI)! With the program ending in 2 days, it remains critical that Congress reauthorizes SDPI to ensure there is no lapse in funding.

NCUIH is monitoring several bills that contain a reauthorization for SDPI:

  • The Special Diabetes Program Reauthorization Act of 2023 (H.R. 3561/S. 1855), which would reauthorize the SDPI program at $170 million per year for two years, has passed out of committee in both the House on May 24 and Senate on June 15. It currently awaits consideration by the full House and Senate.
  • The Lower Costs, More Transparency Act (H.R. 5378), which is a large health care package that includes reauthorization of SDPI, was pulled unexpectedly pulled from House consideration for floor vote last week.

Take Action: Use NCUIH’s toolkit to contact your Member of Congress to to support the reauthorization of SDPI today!

Upcoming: NCUIH UIO Focus Groups

NCUIH UIO Focus Group

We are excited to announce our upcoming virtual web series, “NCUIH UIO Focus Groups: Setting Policy Priorities for 2024.” These focus groups are open to UIO leaders and their staff.

Why it matters: The focus groups will also provide an invaluable opportunity to reflect on the achievements and challenges of 2023, fostering a deeper understanding of the progress made and the areas that require further attention.

The big picture: Participants will be encouraged to share their personal experiences, insights, and feedback, ensuring that the perspectives of our UIO partners play a pivotal role in shaping the path forward.

What if I can’t make it?: If you cannot attend your facility-type session or the makeup session, NCUIH will schedule a one-on-one session with you. Please email policy@ncuih.org to request a one-on-one session.

Legislative & Federal Updates: NCUIH Requests VA inclusion of UIOs, Native American Child Protection Act Passed in the House

Illustration of Congress with empty speech bubbles

On September 15, NCUIH submitted comments to the Department of Justice (DOJ), Department of Interior (DOI), and Department of Health and Human Services (HHS) regarding the Indian Child Welfare Act (ICWA) and steps the agencies can take to promote federal protections for American Indian and Alaska Native (AI/AN) children and their parents and caregivers.

  • The bottom line: NCUIH recommended that the Agencies actively inform state courts and child welfare agencies about the need to utilize UIOs to meet their obligations under ICWA, assist Tribes in coordinating with UIOs to strengthen resources and efforts to ensure ICWA is properly implemented, and engage directly with UIOs to improve implementation of ICWA.
  • Why it matters: AI/AN children continue to be overrepresented in the state foster care systems, and because more than 70% of AI/AN people live in urban settings, this overrepresentation undoubtedly includes AI/AN children living in urban areas. ICWA is the gold standard of child welfare proceedings, and ICWA’s procedural protections ensure that an AI/AN child’s best interests are appropriately accounted for in child welfare proceedings. The federal government must consider the needs of AI/AN children and families living in urban areas in efforts to promote federal protections for AI/AN children and their parents and caregivers.

On August 21, NCUIH submitted comments to the Department of Veterans Affairs (VA) Center for Minority Veterans (CMV) in response to a request for data and information on minority veterans.​

  • The bottom line: NCUIH provided an analysis showing that VA’s data historically excludes large portions of the AI/AN veteran population. NCUIH recommended that the Agency ensure data on AI/AN Veterans accounts for those living in urban areas and for those identifying as AI/AN alone or in combination with other races, clarify that data collections concerning AI/AN veterans do not undermine the unique political status of AI/ANs, and engage directly with Tribes, UIOs, and the VA Advisory Committee on Tribal and Indian Affairs to improve outreach, education, engagement, enrollment, advocacy and access programs for AI/AN veterans. ​
  • Why it matters: Data and information on minority and historically underserved veterans can inform efforts to improve outreach, education, engagement, enrollment, advocacy, and access programs for minority and underserved veterans.

On September 18, 2023, NCUIH-endorsed legislation, the Native American Child Protection Act (H.R. 633) passed the House with a vote of 378-32.​

  • Why it matters: This bill reauthorizes through FY2028 and otherwise revises certain programs related to the prevention, investigation, treatment, and prosecution of family violence,  abuse, and neglect involving Indian children and families. The bill directs the Indian Child Resource and Family Services Centers to develop and provide advice, technical assistance, and training to UIOs. It also allows UIO representatives with expertise in child abuse and child neglect to sit on a 12-member Advisory Board.

Upcoming Events and Important Dates: IHS FY 2026 Tribal Budget Meeting, UIO Listening Session on Behavioral Health and Substance Use Disorder Resources

Calendar with events on it

Upcoming Opportunities:

  • The VA Office of Tribal Government Relations (OTGR) is seeking nominations of qualified candidates to be considered for appointment as a member of the Advisory Committee on Tribal and Indian Affairs (“the Committee”) to represent the following Indian Health Service (IHS) Areas: California; Nashville. Nominations for membership on the Committee must be received no later than 5:00 PM Eastern on October 20, 2023, and should be mailed to OTGR at 810 Vermont Ave. NW, Suite 915H (075) or emailed to tribalgovernmentconsultation@va.gov. UIOs are encouraged to work with local Tribes and Tribal organizations to identify local American Indian and Alaska Native veterans for nomination.

Upcoming Comments and Submissions:​

Upcoming Events:

Important Requests for Information from UIO Leaders

Request for Information envelope

We need input from Urban Indian leaders to help shape our advocacy and comments to federal agencies on policies affecting UIOs and American Indians/Alaska Natives living in urban areas.

Please email policy@ncuih.org with information on the following:

  • Food Security: Does or has your UIO worked with Tribes to address food insecurity in AI/AN communities? Would you be interested in doing so in the future?​
  • Advance Appropriations: Does your UIO have any questions for IHS regarding advance appropriations implementation?

NCUIH in Action: NCUIH Speaks at American Cancer Society’s Cancer Action Network “Expanding Cancer Health Equity” Summit on Capitol Hill

NCUIH at ACSCAN

(L to R) Angela Sailor, Director, Federal Strategic Alliances – Health Equity American Cancer Society Cancer Action Network, Michael Reese Wittke, Vice President, Policy & Advocacy National Alliance for Caregiving, Ginger Miller, Founder and CEO, Women Veterans Interactive Foundation, Evan Davis, Director of Government Affairs, International Association of Fire Fighter, Meredith Raimondi, Vice-President of Policy and Communications, National Council of Urban Indian Health.

On September 18, 2023, Meredith Raimondi, VP of Policy and Communications at NCUIH, delivered a powerful presentation at the American Cancer Society Cancer Action Network (ACS CAN) Annual Leadership Summit and Hill Day event, emphasizing the critical need for full and mandatory funding in the Indian health system. Raimondi highlighted the devastating health disparities Native people face, particularly in cancer incidence and mortality. Moreover, Raimondi stressed the importance of advance appropriations for IHS to ensure stability for Native cancer patients, citing the impact of government shutdowns on urban Indian clinics and the need for policy change. It was an honor for Meredith to stand alongside fellow policy professionals and advocate for vital health care improvements.

Raimondi at ACSCAN

Meredith Raimondi, NCUIH Vice-President of Policy and Communications, presents at the American Cancer Society Cancer Action Network (ACS CAN) Annual Leadership Summit and Hill Day.

Thank you for all your hard work and advocacy!

IHS Provides Update Following Confer on Urban Indian Interagency Workgroup

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On August 30, 2023, the Indian Health Service (IHS) sent a Dear Urban Indian Organization Leader Letter (DULL) to follow up on a virtual urban confer convened on July 13, 2022, to explore UIO leaders interest in forming an Urban Indian Interagency Workgroup. In the letter, IHS summarized the 16 comments IHS received from UIOs, such as:

  • “Establish a new Urban Indian Interagency Workgroup in conjunction with the White House Council on Native American Affairs to ensure more comprehensive and effective collaboration throughout the Federal Government;”
  • “Develop a Federal funding strategy to pilot test innovative approaches and programs that address the needs of Urban Indians;” and,
  • “Provide technical assistance to Federal agencies to establish urban confer policies to address social determinants of health, such as housing, poverty, and education.”

As a next step, IHS plans to provide the Urban Indian Interagency Workgroup confer recommendations to the U.S. Department of Health and Human Services’ (HHS) Office of Intergovernmental and External Affairs and the Office of the Secretary’s Intradepartmental Council on Native American Affairs.

Background

The formation of an Urban Indian Interagency Workgroup to identify the needs and develop strategies to better serve urban American Indian and Alaska Native (AI/AN) populations has been a priority for NCUIH. On February 3, 2022, Senator Van Hollen, along with Senators Alex Padilla (D-CA), Catherine Cortez Masto (D-NV), Tina Smith (D-MN), Dianne Feinstein (D-CA), Elizabeth Warren (D-MA), Ed Markey (D-MA), Mark Kelly (D-AZ), Amy Klobuchar (D-MN), Patty Murray (D-WA), Tammy Baldwin (D-WI), Jacky Rosen (D-NV), Jeff Merkley (D-OR), and Jon Tester (D-MT) sent a letter to the Biden Administration requesting the establishment of this workgroup. NCUIH worked closely with Senator Padilla on this letter and supports the effort to bring better representation for the needs of Ai/Ans who do not reside on Tribal land.

The Senate Appropriations Subcommittee directed IHS to continue to explore the formation of this interagency working group in its Fiscal Year 2023 Interior Appropriations bill, noting that “in addition to the Indian Health Service, the working group should consist of the U.S. Department of Health and Human Services, U.S. Department of Housing and Urban Development, U.S. Department of Agriculture, U.S. Department of Justice, U.S. Department of Education, U.S. Department of Veteran Affairs, U.S. Department of Labor, the Small Business Administration, the Economic Development Agency, FEMA, the U.S. Conference of Mayors, and others as identified by UIOs.”

The workgroup would help identify federal funding strategies to better address the needs of urban AI/ANs, advance the development of a wellness-centered framework to inform health services, strengthen support for practice-based traditional healing approaches, improve urban confer policies at HHS and associated agencies, and ensure that UIOs can regularly meet with federal agencies to address relevant topics of concern.

IHS hosted a virtual urban confer session on July 13, 2022, to explore the formation of an Urban Interagency Workgroup with other federal agencies.

NCUIH’s Recommendation to IHS

On September 12, 2022, NCUIH submitted comments to IHS regarding the formation of an Urban Interagency Workgroup with other federal agencies. NCUIH made the following recommendations in response to the urban confer:

  • Respect Tribal sovereignty and the government-to-government relationship in the formation of an interagency workgroup.
  • Create a committee within the White House Council on Native American Affairs (WHCNAA) focused on how federal agencies can better serve AI/Ans living in urban areas.
    • The White House Council on Native American Affairs (WHCNAA) was established to improve outcomes for AI/AN communities through a stronger relationship between the federal government and Native people.
    • Developing an Interagency Oversight Committee on Urban Indian Affairs within WHCNAA would allow cross-collaboration across all agencies and ensure that all other WHCNAA committees are accurately incorporating urban Indian communities into their work.
  • IHS should provide technical assistance to federal agencies to develop urban confer policies.
    • Urban confer policies or UIO-specific consultations do not supplant or otherwise alter Tribal consultations and the government-to-government relationship between Tribes and federal agencies. IHS should provide support and assistance to federal agencies as they begin the development of such policies.

NCUIH will continue to monitor for any further development on the formation of an Urban Interagency Workgroup. NCUIH will also continue to engage with IHS, the White House, and Congress on moving this proposal forward.

NCUIH Policy Blog:  NCUIH Submits Comments to the Indian Health Service on the Creation of an Urban Indian Interagency Workgroup

DULL: IHS initiating Urban Confer exploring the formation of an Urban Interagency Workgroup

Letter to the Biden Administration requesting the establishment of an Urban Interagency Workgroup

Fiscal Year 2023 Interior Appropriations bill