NCUIH Testifies Before House Oversight Committee on Improving Healthcare Delivery for Native People

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The National Council of Urban Indian Health (NCUIH) Board Member and Chief Operations Officer (COO) of the NATIVE Project, Maureen Rosette (Chippewa Cree Nation), testified before the House Natural Resources Subcommittee on Indian and Insular Affairs oversight hearing titled “Challenges and Opportunities for Improving Healthcare Delivery in Tribal Communities.”

NCUIH Testifies at Congressional Hearing on Tribal Healthcare Delivery and Funding for IHS

Maureen Rosette, NATIVE Project and NCUIH

NCUIH Board Member and COO of the NATIVE Project, Maureen Rosette (Chippewa Cree Nation), testifies before the House Natural Resources Subcommittee on Indian and Insular Affairs.

On Wednesday, March 29, NCUIH Board Member and NATIVE Project COO, Maureen Rosette, testified before the Subcommittee on Indian and Insular Affairs in their oversight hearing titled “Challenges and Opportunities for Improving Healthcare Delivery in Tribal Communities.”

  • Additional witnesses included: Ms. Janet Alkire, Board Member
    of the National Indian Health Board, Ms. Jerilyn Church, Executive Director of the Great Plains Tribal Leaders Health Board, and Ms. Laura Platero, Executive Director of the Northwest Portland Area Health Board.

What they’re saying:

  • In her opening remarks, Chairwoman Harriett Hageman (R-WY- AL) reaffirmed the trust and treaty obligation to Native health care, stating that “the federal government has taken upon itself to provide for the care of American Indians and Alaska Natives.”

  • Rosette emphasized the importance of the Indian Health Service (IHS) and urban Indian organizations (UIOs) to the Indian health system in providing health care to Native people.

“I lived and grew up on my reservation and I was a consumer of my own Tribally-operated health program at the age of 28. I moved to Spokane to go to law school. I had no health insurance. I had two little kids, a three-year-old and a five-year-old and we had no health insurance. At the time, if NATIVE Project had medical services, we would at least had access to health care, but we didn’t at the time. I just hoped and prayed that none of us got sick. Now, I have insurance and can go anywhere I want, but our family has chosen to be consumers of NATIVE Project because of the excellent healthcare we get there. And it’s culturally appropriate, that’s what we want. Today, there are 41 UIOs, which are a fundamental and necessary component of the Indian health system, and we work hand in hand with IHS to help provide the resources necessary to provide healthcare to Native people.”

-Maureen Rosette, NCUIH Board Member and NATIVE Project COO

The importance of care for Native people by Native people was also reiterated in the hearing including by Ms. Laura Platero:

“While American Indian and Alaska Native people were disproportionality impacted by COVID-19, due to underlying health disparities and the lack of infrastructure in many communities, Tribal innovation and response to COVID prevailed. When Tribes are given the resources and the control of those resources, they know how to respond to meet the needs of their community.”

-Laura Platero, Executive Director, Northwest Portland Area Indian Health Board

The bottom line: The IHS including UIOs are a critical resource for Native people to access healthcare services.

Proposed Cuts to IHS Funding Risks Native Lives

Witnesses and Members of Congress at hearing on Indian Health Service oversight.

Witnesses and Members of Congress at hearing on Indian Health Service oversight.

Rosette, along with fellow witnesses, provided valuable insight into the realities that Native communities experience at home in their call for more reliable funding for IHS.

  • Addressing Challenges: The shortage of healthcare professionals and facilities in rural and urban areas, coupled with the difficulty recruiting and retaining them, makes it difficult for patients to access quality healthcare. The lack of adequate resources, poor infrastructure, and low salaries have resulted in a shortage of healthcare professionals in these areas. Native leaders spoke about the importance of supporting Native healthcare administrators in their effort to be innovative and creative care providers for their people.

“Congress must live up to its treaty commitments, bring IHS facilities to modern standards, and increase IHS funding. After this hearing, I will return home to our financially starved IHS hospital covered in snow and running on boiler heat in below-freezing temperatures. I will give all my time and energy to help my people in need, working my vision for a new medical facility… I will be waiting for this subcommittee and Congress to finally take action, Congress must pay its overdue debts and provide American Indians and Alaska Natives the healthcare we deserve and the healthcare we were promised.”

-Janet Alkire, National Indian Health Board

Advanced funding for IHS is needed to provide stable and predictable funding to ensure the continuity of care for American Indian and Alaska Native people.

“Advance Appropriations will now allow IHS to make long-term cost-saving purchases and minimize the administrative burdens for the agency and UIOs. It will also improve accountability and increase staff recruitment and retention at IHS. When IHS distributes its funding on time, our UIOs can pay their doctors and providers- giving Native people the access to care and services they need to be thriving communities.”

-Maureen Rosette, NCUIH Board Member and NATIVE Project COO

What they’re saying:

Maureen Rosette, NATIVE Project and NCUIH

“GOP proposed cuts to IHS would have to reduce outpatient services by nearly 1.6 million visits. 1.6 million visits will go away. Dental visits would be reduced by 120,000, mental health visits by nearly 90,000 and outpatient services by 4,000.”

–Rep. Leger Fernandez. (D-NM-3)

Go deeper:

Next Steps: The Committee is expected to review the testimony as they propose oversight legislation related to the Indian Health Service this year. NCUIH will continue to advocate for full and flexible funding for the Indian Health Service.

NCUIH Participates in SAMHSA’s Native Veterans Expert Panel Discussion

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Expert Panel veterans

On February 15-16, 2023, the National Council of Urban Indian Health (NUCIH) Federal Relations Manager, Alexandra Payan, represented NCUIH at the Substance Abuse and Mental Health Services Administration’s (SAMHSA) American Indian and Alaska Native (AI/AN) Veterans Expert Panel Discussion. The purpose of this two-day meeting was to have a collaborative conversation around the development of a virtual training tool related to AI/AN military and veteran suicide prevention. The proposed tool will be available for states, territories, and communities to use as they work to implement their efforts. NCUIH was invited to participate in the Expert Panel Discussion to provide insight on the unique needs of AI/AN veterans who reside in urban areas.

Expert Panel’s Work to Support the Governor’s Challenge

Expert Panel with CAPT HearodThe Expert Panel Discussion was an opportunity to ensure broad representation of AI/AN veterans in the Governor’s Challenge to Prevent Suicide Among Service Members, Veterans, and their Families (Governor’s Challenge). Through collaboration with the VA, SAMHSA and SAMHSA’s SMVF Technical Assistance Center, the Governor’s Challenge seeks to provide a forum for teams to consider how existing policies, practices, infrastructure, and resources influence the effectiveness of the systems that support SMVF. Teams develop state and territory-wide plans based on a comprehensive public health approach and the National Strategy for Preventing Veteran Suicide (National Strategy).  During the Expert Panel Discussion, the team engaged in initial steps to develop a virtual toolkit aimed at addressing suicide in AI/AN veteran communities to supplement the Governor’s Challenge. Once created, the virtual toolkit will serve as instruments of change, providing a best-practice public health model that demonstrates meaningful results in suicide prevention for AI/AN veterans.

Urban Indian Organizations and Native Veteran Support

Sadly, AI/AN veterans have a higher prevalence of mental health disorders compared with White veterans and among all veterans the prevalence of suicidal ideation is highest for those reporting a diagnosis of depression, anxiety, or post-traumatic stress disorder. While there is limited data and research on suicide among AI/AN veterans, the 2020 National Veteran Suicide Prevention Annual Report documents growing AI/AN veteran suicide rates from 2005-2018.

UIOs are essential partners in serving AI/AN veterans and reducing AI/AN veteran suicides. UIOs are critical in improving care and access to services for AI/AN veterans because of their deep ties to the AI/AN community in urban areas. UIOs currently serve seven of the ten urban areas with the largest AI/AN veteran populations, including Phoenix, Arizona; Los Angeles, California; Seattle, Washington; Dallas, Texas; Oklahoma City, Oklahoma; New York City, New York; and Chicago, Illinois. Many AI/AN veterans prefer to receive care at IHS facilities, or may only have access to an IHS, Tribal, or UIO facility.

UIOs are uniquely positioned to assist agencies, such as the VA, SAMHSA, and HHS, in improving health care access for AI/AN people. Several UIOs already provide mental health and substance abuse disorder services and all UIOs provide numerous other social and community services to AI/ANs living in urban areas. NCUIH looks forward to continuing to work with SAMHSA, VA, and other agencies to improve the quality of care available to Native veterans in urban areas.

NCUIH’s work with the VA and Native Veterans in Urban Areas

NCUIH continues to work on behalf of Native veterans living in urban areas to ensure that they have access to the high-quality, culturally competent care the country owes to them for their military service and as a result of the trust responsibility.

For more information on NCUIH’s efforts please visit:

NCUIH to Testify before the House Natural Resources Subcommittee on Indian and Insular Affairs

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NCUIH Testimony at House Natural Resources Subcommittee on Indian and Insular Affairs

On Wednesday, March 29 at 10:00 a.m. EDT, NCUIH Board Member and Chief Operations Officer of the NATIVE Project, Maureen Rosette (Chippewa Cree Nation), will be testifying before the House Natural Resources Subcommittee on Indian and Insular Affairs oversight hearing titled “Challenges and Opportunities for Improving Healthcare Delivery in Tribal Communities.” During the hearing, NCUIH will advocate for stable and reliable funding for IHS by maintaining advance appropriations to improve healthcare delivery to American Indians and Alaska Natives, while also highlighting the important work UIOs are doing to provide care to their communities.

Tune In!

Livestream

NCUIH Staff Member Visits Oklahoma City Indian Clinic

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NCUIH’s Federal Relations Manager, Alexandra Payan, recently visited the Oklahoma City Indian Clinic (OKCIC),  which has provided extensive health and social services to AI/ANs living in Oklahoma City for almost 50 years. Ms. Payan toured the facilities and met with OKCIC Executive Director, Robyn Sunday-Allen and Vice-President of Policy, Diabetes and Prevention, Michelle Dennison. Ms. Sunday-Allen also serves as Vice-President of NCUIH’s Board of Directors. Ms. Payan and OKCIC leadership discussed upcoming projects for the OKCIC, including breaking ground on the new women’s health and pediatric facility OKCIC purchased last year and continued expansion for the growing facility that serves over 22,000 patients from over 200 federally recognized Tribes each year. During the tour, Ms. Payan was also able to see the facility’s demonstration kitchen where they host classes for all ages through their healthy eating/nutrition program.

NCUIH is excited to see the great work OKCIC is doing for their community and looks forward to the many new projects ahead!

OKCIC’s Demonstration Kitchen

OKCIC’s Demonstration Kitchen

OKCIC’s Michelle Dennison and NCUIH’s Alexandra Payan

OKCIC’s Michelle Dennison and NCUIH’s Alexandra Payan

HRSA Hosting Tribal Listening Session Regarding Historical Trauma and its Impact on the American Indian/Alaska Native Workforce

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On April 5, 2023, Health Resources & Services Administration’s (HRSA) Office of Intergovernmental and External Affairs (IEA) will host a tribal listening session on understanding historical trauma and its impacts on the American Indian/Alaska Native (AI/AN) workforce. HRSA’s goal is to advance tribal health systems and resources, partnering with federal agencies and other organizations to increase access to HRSA programs aimed to advance healthcare. Working with the tribal communities, HRSA aims to increase opportunities to access and optimize the quality and performance of the tribal health system increasing the capacity of Indian Country to respond to the impact of negative health outcomes among AI/AN communities. To help tribal organizations maximize the impact of key government programs, HRSA has prioritized increasing urban Indian health participation in the Health Center Program.

Background

The mission of HRSA IEA is to provide accessibility and awareness of HRSA programs designed to increase healthcare access and address emerging public health issues. HRSA IEA serves as the principal Agency lead on intergovernmental and external affairs, regional operations, and tribal partnerships.  HRSA IEA extends the reach of its programs by leveraging knowledge of national and regional contact located in various states, tribes, and territories. HRSA IEA also maintains partnerships across federal, state, and tribal networks to promote Department of Health and Human Services (HHS) policy priorities.

AI/AN Historical Trauma

Historical trauma is the cumulative psychological and emotional wounding across generations. For Tribal nations and the AI/AN community, historical trauma began during the eras of colonization, forced removal, and government sponsored boarding schools aimed to destroy AI/AN people and culture. Today, the impact of historical trauma  is manifested in many ways among AI/ANs including high rates of chronic diseases, suicides, domestic violence, alcoholism, and other social problems such as the lack of culturally competent care often leading to poor communication between physicians and patient that increase rick of misdiagnosis and loss of public trust. These ailments are negatively attributed across social determinants of health thereby impairing the ability to readily participate in the workforce.

NCUIH’s Role

NCUIH has advocated extensively for policy related to healing and reconciliation of historical trauma which continues to afflict AI/AN communities. For example, NCUIH endorsed the Truth and Healing Commission on Indian Boarding School Policies in the United States Act. This bill would create a Truth and Healing Commission on Indian Boarding School Polices in the United States where impacts and ongoing effects of Indian Boarding School Policies are examined. The Commission will also provide a space for AI/AN people to speak about their personal experiences in government-run boarding schools and allow them to provide recommendations to the government.

CMS Provides New Fact Sheet Regarding CMS Waivers, Flexibilities, and the Transition Forward from the COVID-19 Public Health Emergency

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On February 27, 2023, Centers for Medicare & Medicaid Services (CMS) issued a new fact sheet regarding the ending of the federal Public Health Emergency for COVID-19 (PHE). The PHE was declared by the Department of Health and Human Services (HHS) under Section 319 of the Public Health Services Act and is scheduled to expire at the end of the day on May 11, 2023. The fact sheet is intended to provide clarity of the following services for receiving health care at the end of the PHE:  

  • COVID-19 vaccines, testing, and treatments  
  • Telehealth services 
  • Health Care Access: Continuing flexibilities for health care professionals 
  •  Inpatient Hospital Care at Home: Expanded hospital capacity by providing inpatient care in a patient’s home. 
What Won’t Be Affected 

There are significant flexibilities and actions that will not be affected during the transition to the ending of the PHE. HHS is committed to ensuring that COVID-19 vaccines and treatments will be widely accessible to all who need them. There will also be continued access to pathways for emergency use authorizations (EUAs) for COVID-19 products through the Food and Drug Administration (FDA), and telehealth flexibilities will continue to exist for those participating in Medicare or Medicaid. 

Medicaid Continuous Enrollment 

The continuous enrollment condition for individuals enrolled in Medicaid is no longer linked to the end of the PHE. Under the Families First Coronavirus Response Act, states claiming a temporary 6.2 percentage point increase in the Federal Medical Assistance Percentage (FMAP) have been unable to terminate enrollment for most individuals enrolled in Medicaid as of March 18, 2020, as a condition of receiving the temporary FMAP increase.  As part of the Consolidated Appropriations Act, 2023, the continuous enrollment condition will end on March 31, 2023. The temporary FMAP increase will be gradually reduced and phased down beginning April 1, 2023 and will end on December 31, 2023. 

NCUIH Joins Partnership for Medicaid in Letter to Senate on Addressing Healthcare Shortages

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On March 20, 2023, the National Council of Urban Indian Health (NCUIH) signed on to a Partnership for Medicaid letter to Chair Bernard Sanders and Ranking Member Bill Cassidy of the Senate Committee on Health, Education, Labor, and Pensions (HELP). This letter is in response to the Senate HELP request for information (RFI) following its February hearing on understanding the root causes of our current health care shortages and exploring potential legislative solutions.

Read the letter

The Letter Identifies Drivers of Workforce Shortages:

  • State provider payment rates are insufficient to achieve the goal of being able to recruit and retain enough providers to serve Medicaid beneficiaries.
  • Insufficient supply/Increased demand of providers for populations served by the Medicaid program.

The Letter Recommends:

  • Grants administered by relevant federal agencies such as the Department of Labor (DOL) and the Department of Health and Human Services (HHS) to strengthen the healthcare workforce, including the direct care workforce.
  • Expand loan repayment programs to include more health workers, especially those who come from disadvantaged backgrounds and/or racial or ethnic minorities.
  • Ensure broad eligibility for federal programs intended to increase providers in underserved areas.
  • Safety from Violence for Healthcare Employees (SAVE) Act (H.R. 7961), legislation that would protect caregivers from workplace violence.

Full Letter Text

Dear Chairman Sanders and Ranking Member Cassidy:

The following are part of a nonpartisan, nationwide coalition comprised of organizations representing clinicians, health care providers, safety net plans, and counties dedicated to preserving and improving the Medicaid program. The undersigned organizations appreciate the opportunity to provide comments in response to your request for input from stakeholders to best understand views on the drivers of health care workforce shortages and ideas on potential solutions. In our view, workforce shortages, especially those seen in providers and professionals struggling to care for the Medicaid population, stem from insufficient payment rates, insufficient supply of providers, and increased demand for particular services most acutely in urban and rural underserved areas. These challenges impact the ability of health care providers and plans to provide needed services to our nation’s most vulnerable: low-income children, pregnant individuals, parents, individuals with disabilities, seniors, and other adult Medicaid beneficiaries across the country. Below, we provide recommendations for specific policy solutions within your Committee’s jurisdiction that would start to address some of these issues. We hope to continue working with the HELP Committee as you begin to shape these policy solutions into actionable legislation.

Drivers of Workforce Shortages

  • State provider payment rates are insufficient to achieve the goal of being able to recruit and retain enough providers to serve Medicaid beneficiaries. While Federal law mandates that state Medicaid payments be “sufficient to enlist enough providers so that care and services are available under the [state] plan,”existing Federal regulations fail to adequately measure and enforce adequate payment rates. As such, Medicaid has notably low reimbursement rates, that are often much lower than Medicare payment rates, and at times lower than the actual cost of providing care to Medicaid patients. This makes it more difficult for the program to enlist a sufficient number of providers who can meet patient demand, and thus negatively impacts access to care for Medicaid beneficiaries, who are disproportionately people of color.
  • Insufficient supply of providers for populations served by the Medicaid program. Even before the pandemic, many types of providers and clinicians, including the longterm care community, behavioral health providers, and primary care providers as well as clinicians, increasingly experienced worsening workforce issues, and the COVID-19 pandemic only accelerated this decline. For a variety of reasons, including cost of education, not enough people are pursuing careers in these important fields.

Increased demand for provider types serving the Medicaid program. Due to COVID-19 and other factors, certain types of providers are experiencing ongoing surges in demand, likely to continue for the foreseeable future. For example, our aging population will continue to significantly increase demand for long-term care services, for which Medicaid is the primary payer.More than two-thirds of older adults will need some personal assistance in their daily lives, and nearly half will have a high enough level of need that they will be eligible for private long-term care insurance or Medicaid at some point in their lives. Further, the COVID-19 pandemic has exacerbated an already significant mental health crisis in this country, increasing demand for mental health services and further stretching the existing capacity of mental health providers serving the Medicaid population.

Recommendations

  • Grants administered by relevant federal agencies such as the Department of Labor (DOL) and the Department of Health and Human Services (HHS) to strengthen the healthcare workforce, including the direct care workforce.
    • The Committee should consider legislation that would authorize increased funding to relevant federal agencies within its jurisdiction to increase investments that support the recruitment, training, retention, and professional development of a diverse clinical and non-clinical workforce.
    • For example, the legislation can authorize funding to DOL to award grants to health care entities in health professional shortage areas to support the hiring, training, and retention of healthcare workers, including direct care workers.
    • The legislation could also authorize funding to HRSA to carry out grants for health care entities for pilot demonstrations to enhance the skills of healthcare workers including direct care workers mental health professionals and promote retention.
    • Last, the legislation could also increase funding for HRSA Title VII workforce development programs.
  • Expand loan repayment programs to include more health workers, especially those who come from disadvantaged backgrounds and/or racial or ethnic minorities.
    • The Committee should consider legislation that would expand loan repayment programs that provide for student loan repayment in exchange for service commitments for a range of different types of health care providers.
      • The Committee could look to S. 462 (The Mental Health Professionals Workforce Shortage Loan Repayment Act of 202313) as a guiding example. This bipartisan legislation would address the current lack of incentives for mental health providers working in the Substance Abuse treatment to serve in areas that struggle to recruit and retain physicians. It would also create new incentives to attract providers to serve in underserved areas. This legislation would repay up to $250,000 in eligible student loan repayment for mental health professionals who work in mental health professional shortage areas.
      • The Committee should consider these policy ideas and extend them to additional provider types experiencing severe shortage issues.
    • The Committee should also consider legislation that would incentivize current and former National Health Service Corps (NHSC) participants (physicians, nurses, and dentists) to enroll in demonstration programs to support entities, including long-term care facilities and hospitals at risk of losing obstetric services, experiencing severe staffing shortages.
      • The variety of settings experiencing severe staffing shortages also warrants consideration for expanding the NHSC to other qualified health specialties, including certain mental health professionals and direct care workers.
  • Ensure broad eligibility for federal programs intended to increase providers in underserved areas.
    • The Committee should consider utilizing expansive eligibility language in legislation intended to increase providers in underserved areas.
      • For example, Section 403 of the MISSION Act of 201814 directs the VA to expand its existing medical residency program to underserved non-VA facilities. The Act provides an expansive definition of “covered facility” for the purpose of the program by listing specific provider types and including “[s]uch other health care facility as the Secretary considers appropriate for purposes of this section” as a catch-all.
  • Safety from Violence for Healthcare Employees (SAVE) Act (H.R. 7961), legislation that would protect caregivers from workplace violence.
    • The bill, introduced by Reps. Madeleine Dean (D-Pa.) and Larry Bucshon, MD, (R-Ind.), would provide legal penalties, similar to federal protections that exist for flight crews, for individuals who knowingly and intentionally assault or intimidate hospital employees. Increasing threats and acts of violence against health care workers have further burdened a workforce already under immense strain from shortages, burnout, and trauma related to the COVID-19 pandemic. While Congress and the Department of Justice have addressed violence against airline workers, they have not done the same for the health care workforce.

The Coalition appreciates the opportunity to provide these comments and looks forward to working with the HELP Committee to identify bipartisan solutions to remedy our nation’s health care workforce shortages and develop these ideas into legislation. If you have questions or seek any additional information, please contact Elizabeth Cullen at the Jewish Federations of North America at Elizabeth.Cullen@jewishfederations.org.

Sincerely,
American Academy of Family Physicians
American Dental Association American Dental Education Association
American Health Care Association
America’s Essential Hospitals
ANCOR
Associations for Clinicians for the Underserved
National Association of Counties (NACO)
National Council of Urban Indian Health
National Health Care for the Homeless Council
The Jewish Federations of North America

About the Partnership for Medicaid

NCUIH is a member of the Partnership for Medicaid, which is a nonpartisan, nationwide coalition of organizations representing clinicians, health care providers, safety-net health plans, and counties. The goal of the coalition is to preserve and improve the Medicaid program. Members of this coalition include:

UPDATED: Contact Congress to Increase Funding for Urban Indian Health TODAY

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Dear Urban Indian Health Advocates,

We need your help contacting Congress to support increased healthcare resources for urban Native communities.

Representatives Ruben Gallego (D-AZ-3) and Raúl Grijalva (D-AZ-7) are again leading a letter to the Chair and Ranking Member of the Appropriations Subcommittee on Interior, Environment, and Related Agencies. This subcommittee appropriates funding for the Indian Health Service (IHS) and Urban Indian Organizations (UIOs).

The letter requests an increase for the urban Indian health line item to $973.59 million for Fiscal Year 2024 and retaining appropriations for IHS. Adequate funding for urban Indian health is necessary to fulfill the federal government’s trust responsibility to all American Indians and Alaska Natives.  The proposed amount is determined by the Tribal Budget Formulation Workgroup (TBFWG) as part of the request for full funding for IHS at $51.4 billion.

We encourage you to contact your Member of Congress and request that they sign the Gallego-Grijalva Urban Indian Health Letter by the deadline of March 17.

You can use the text below as a template to call and/or email to email your Member of Congress. You can find your representative here.

Sincerely,

The National Council of Urban Indian Health (NCUIH)

STEPS TO CONTACT CONGRESS 

  • Step 1: Copy the email below.
  • Step 2: Find your representative here.
  • Step 3: Paste the email into the form and send. Please contact Lycia Maddocks (LMaddocks@ncuih.org) with questions.

Email to Your Member of Congress

Dear Representative,

As an urban Indian health advocate, I respectfully request you sign on to the Gallego-Grijalva letter to the Chair and Ranking Member of the Appropriations Subcommittee on Interior, Environment, and Related Agencies. The letter requests an increase for the urban Indian health line item to $973.59 million for Fiscal Year 2024 and retaining appropriations for IHS. Adequate funding for urban Indian health is necessary to fulfill the federal government’s trust responsibility to all American Indians and Alaska Natives.  The proposed amount is determined by the Tribal Budget Formulation Workgroup (TBFWG) as part of the request for full funding for IHS at $51.4 billion.

It is the policy of the United States “to ensure the highest possible health status for Indians and urban Indians and to provide all resources necessary to effect that policy.” This requires that funding for Indian health must be significantly increased if the federal government is to finally fulfill its trust responsibility. At a minimum, funding must be maintained and protected as budget-cutting measures are being considered.

We respectfully ask that you join this year to help honor the federal trust obligation and support the overall health and well-being of American Indians and Alaska Natives.

To sign on to the letter, please contact Emma Reidy (Emma.Reidy@mail.house.gov) from Gallego’s office by this Friday, March 17.

Thank you for your leadership and commitment to upholding the United States’ trust and treaty responsibility.

Sincerely,

[YOUR NAME]

National Native Organizations Call on Administration to Urgently Fund New Behavioral Health Program for Native Communities from Omnibus

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On February 17, 2023, the National Council of Urban Indian Health (NCUIH), the National Indian Health Board (NIHB), Self-Governance Communication and Education Tribal Consortium, and the United South and Eastern Tribes Sovereignty Protection Fund sent a letter to request that the President include funding for the Native Behavioral Health Program authorized in the omnibus. Specifically, the organizations asked for the full authorized level of $80 million for the Native Behavioral Health Resources Program included in the Restoring Hope for Mental Health and Well-Being Act be funded in the President’s Fiscal Year (FY) 2024 Budget Request.

NCUIH particularly applauds Senator Tina Smith for her sponsorship and the co-sponsorship of Senator Cramer, Senator Tester, Senator Lujan, Senator Warren, and Senator Cortez Masto of the Native Behavioral Health Access Improvement Act of 2021, which was the foundation for the behavioral health provisions included in the Restoring Hope for Mental Health and Well-being Act. NCUIH also thanks Ranking Member Frank Pallone and Representative Raul Ruiz for championing this proposal to ensure that American Indians/Alaska Natives (AI/ANs) have greater access to resources necessary to address critical behavioral health needs and bring the federal government closer to fulfilling its trust obligations to AI/AN populations.

In particular, the letter outlines that the Restoring Hope for Mental Health and Well-Being Act includes a Native behavioral health provision that contains:

  • A funding authorization of no less than $125 million annually over a minimum of four fiscal years.
  • A mandate to deliver funding on a non-competitive basis.
  • The opportunity to receive funding through Indian Self-Determination Act contracts or compacts.
  • A requirement that any funding formulas be developed in consultation with Tribal Nations and conference with Urban Indian Health Organizations.
  • A requirement that reporting requirements be developed through a negotiated rulemaking process between the federal government, Tribal Nations, and Urban Indian Health Organizations.

This is in response to the high rates of behavioral health issues caused by centuries of generational trauma resulting from colonization and hostile acts of the United States Government. In fact, as outlined in the letter, Native people experience serious mental illnesses at a rate 1.58 times higher than the national average, and high rates of alcohol and substance abuse. In fact, between 1999 and 2015, the drug overdose death rates for Native populations increased by more than 500%. Native youth also experience the highest rates of suicide and depression, with the Native youth suicide rate being 2.5 times that of the national average.

Letter

Download Letter

Re: Native Behavioral Health Resources Program

Dear Director Young,

On behalf of the undersigned Tribal partner organizations, we write to urge the inclusion of the full authorized level of $80 million in the President’s Fiscal Year (FY) 2024 Budget Request to fund the Native Behavioral Health Resources Program as included in the Restoring Hope for Mental Health and Well-Being Act. Tribal Nations and our citizens continue to face high rates of behavioral health issues, caused by myriad factors, including centuries of generational trauma resulting from colonization and hostile acts of the United States government. Yet, in violation of federal trust and treaty obligations to provide comprehensive health care to Tribal Nations, we continue to lack substantial and sustained funding to address these challenges for current and future generations. As the collective trauma of living through the COVID-19 public health crisis only exacerbates and intensifies these issues, it is critical that Tribal Nations and the Indian Health System are equipped with the resources necessary to bring healing and recovery to our communities.

Between 1999 and 2015, the drug overdose death rates for American Indian and Alaska Native (AI/AN) populations increased by more than 500%. Addressing the challenges presented by the opioid crisis in Indian Country is further complicated by high rates of alcohol and substance abuse, suicide, and other serious mental health conditions. AI/AN populations experience serious mental illnesses at a rate 1.58 times higher than the national average, and Native youth experience the highest rates of youth suicide and depression in the country. Yet far too many facilities across the Indian Health System are unable to access the quality health care and services necessary to address these behavioral health issues. A survey conducted by the Indian Health Service (IHS) found that Tribal Nations rated the expansion of inpatient and outpatient mental health and substance abuse facilities as our number one priority. Currently, only 39% of IHS facilities provide 24-hour mental health crisis intervention services, and 10% of IHS facilities do not provide any crisis intervention services at all.

To combat the opioid epidemic and the broader behavioral health crisis in Indian Country, Tribal Nations and facilities across the Indian Health System require flexible and substantial funding to create behavioral health programs that are responsive to the unique circumstances facing our communities. Toward that end, along with Congressional partners, we urged at the end of the 117th Congress that the Restoring Hope for Mental Health and Well-Being Act include a Native behavioral health provision that contained the following:

  • A funding authorization of no less than $125 million annually over a minimum of four fiscal years;
  • A mandate to deliver funding on a non-competitive basis;
  • The opportunity to receive funding through Indian Self-Determination Act contracts or compacts;
  • A requirement that any funding formulas be developed in consultation with Tribal Nations and conference with Urban Indian Health Organizations; and
  • A requirement that reporting requirements be developed through a negotiated rulemaking process between the federal government, Tribal Nations, and Urban Indian Health Organizations.

Although only some of our priorities were adopted in the final bill and while centuries of underinvestment in mental and behavioral health across Indian Country will require sustained funding and thoughtful effort on the part of Congress and the Administration to properly address, funding the Native Behavioral Health Resources Program would represent a significant step toward this goal. We urge the Biden Administration to prioritize its trust and treaty obligations to Tribal Nations by supporting Tribal Nation access to federal mental health and substance use disorder programs, including the Native Behavioral Health Resources Program. We thank you for your attention to this matter and look forward to continued collaboration on improve health care throughout Indian Country.

Sincerely,
National Council of Urban Indian Health
National Indian Health Board
Self-Governance Communication and Education Tribal Consortium
United South and Eastern Tribes Sovereignty Protection Fund

Background

In response to these chronic health disparities and the dire need for behavioral health resources for Indian health care providers, the House Energy and Commerce Committee drafted bipartisan legislation creating the Native Behavioral Health Resources Program. This legislation was included in the House-passed Restoring Hope for Mental Health and Well-Being Act (H.R.7666), and ultimately included in the Consolidated Appropriations Act, 2023. This provision authorized to be appropriated $80 million for the Native Behavioral Health Resources Program.

NCUIH to Testify Before House Interior Appropriations

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NCUIH to Testify Before House Interior Appropriations

On Thursday, March 9, 2023 at 9:00 AM, the National Council of Urban Indian Health (NCUIH) Chief Executive Officer, Francys Crevier, JD (Algonquin) will testify in person before the House Interior Appropriations Subcommittee hearing as part of American Indian and Alaska Native Public Witness Days (March 8 and 9, 2023).

In the testimony, NCUIH will advocate for full funding for the Indian Health Service and Urban Indian Health as requested by the Tribal Budget Formulation Workgroup (TBFWG) for Fiscal Year (FY) 2024. Other requests include: maintaining advance appropriations for IHS until mandatory funding is enacted and appropriating at least $80 million for the Native Behavioral Health Resources Program.

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Learn more: https://appropriations.house.gov/events/hearings