VA Expands Health Care Eligibility for Veterans under the PACT Act, Native Veterans Encouraged to Check Eligibility for Benefits

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On September 28, 2022, the Department of Veterans Affairs (VA) announced that it will expand and extend eligibility for VA health care for certain Veterans of the Vietnam, Gulf War, and post-9/11 eras pursuant to the Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics (PACT) Act (S. 3373). As a result of the PACT Act, generations of Veterans will now have access to VA health care and benefits they earned and deserve, including American Indian/Alaska Native (AI/AN) Veterans who serve in the military at a higher rate than any other population. For more information on how to apply for health care or learn more about what the PACT Act means for Veterans or their families visit: VA.gov/PACT.

Expansion Details:

Beginning on October 1, 2022, post-9/11 Veterans who did not previously enroll in VA health care will have a 1-year window to enroll if they:

  • Served on active duty in a theater of combat operations during a period of war after the Persian Gulf War, or
  • Served in combat against a hostile force during a period of hostilities after Nov. 11, 1998, and
  • Were discharged or released from active service between Sept. 11, 2001, and Oct. 1, 2013.

The following groups of Veterans will also be eligible for care beginning October 1:

  • Gulf War Veterans who served on active duty in a theater of combat operations during a period of war after the Persian Gulf War. This includes Veterans who, in connection with service during such period, received the Armed Forces Expeditionary Medal, Service Specific Expeditionary Medal, Combat Era Specific Expeditionary Medal, Campaign Specific Medal, or any other combat theater award established by federal statute or executive order.
  • Vietnam-era Veterans who served in the following locations and time periods : The Republic of Vietnam between Jan. 9, 1962, and May 7, 1975 Thailand at any U.S. or Royal Thai base between Jan. 9, 1962, and June 30, 1976; Laos between Dec. 1, 1965, and Sept. 30, 1969; Certain provinces in Cambodia between April 16, 1969, and April 30, 1969; Guam or American Samoa (or their territorial waters) between Jan. 9, 1962, and July 31, 1980 ; Johnston Atoll (or on a ship that called there) between Jan. 1, 1972, and Sept. 30, 1977

Background on the PACT ACT

On August 10, 2022, President Biden signed the bipartisan PACT Act into law, authorizing one of the largest expansions of VA health care and benefits in U.S. history.  Before the PACT Act’s passage, many Veterans’ claims for healthcare services and other benefits were denied by VA because Veteran claimants had difficulty proving a connection between their ailment and their service. The PACT Act is intended to remove barriers to Veterans getting care, expanding the number of Veterans who are eligible for care and streamlining the process for proving a service connection for certain conditions related to toxic exposure.

The PACT Act will bring the following changes:

  • Expands and extends eligibility for VA health care for Veterans with toxic exposures and Veterans of the Vietnam, Gulf War, and post-9/11 eras
  • Adds more than 20 new presumptive conditions for burn pits and other toxic exposures
  • Adds more presumptive-exposure locations for Agent Orange and radiation
  • Requires VA to provide a toxic exposure screening to every Veteran enrolled in VA health care
  • Helps VA improve research, staff education, and treatment related to toxic exposures

AI/AN Veterans

There is an urgent need to ensure that all AI/AN Veterans have access to the benefits they earned through their service.  According to a 2020 VA Report, AI/AN Veterans served in the Pre-9/11 period at a higher percentage than other Veteran populations.  Despite a distinguished record of service, VA’s statistics also show that AI/AN Veterans were more likely to be unemployed, were more likely to lack health insurance, and were more likely to have a service-connected disability when compared to Veterans of other races.  In addition, in Fiscal Year 2017, AI/AN Veterans used Veterans Benefits Administration benefits or services at a lower percentage than veterans of other races.

NCUIH and the VA

The National Council of Urban Indian Health (NCUIH) has continued to advocate on behalf of AI/AN veterans living in urban areas and to strengthen its partnership with VA. Thanks to NCUIH’s work with VA, urban Indian organizations (UIOs) are now eligible to enter the VA Indian Health Service/Tribal Health Program (THP)/UIO Reimbursement Agreements Program, which provides VA reimbursement to IHS, THP, and UIO health facilities for services provided to eligible AI/AN Veterans. In October 2021, Sonya Tetnowski, President of NCUIH and CEO of the Indian Health Center of Santa Clara Valley, Army Veteran, and member of the Makah Tribe was appointed to the VA’s first-ever Advisory Committee on Tribal and Indian Affairs to represent the voice of urban Indians.

NCUIH Attends Swearing-In of New IHS Director Roselyn Tso

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Group photo of Francys Crevier, Roselyn Tso, Walter MurilloOn September 27, 2022, NCUIH attended the swearing-in of the new Indian Health Service (IHS) Director Roselyn Tso (Navajo). NCUIH’s CEO Francys Crevier (Algonquin) and Board President-Elect and CEO of Native Health in Phoenix, Arizona Walter Murillo (Choctaw) were in attendance. Prior to Director Tso’s swearing-in, IHS was without a permanent director for 21 months.

Director Tso is a citizen of the Navajo Nation. She began working for IHS in 1984 and most recently served as the Director of the Navajo Area and Director of the Office of Direct Services and Contracting Tribes until her confirmation. Prior to her work in IHS, much of her professional career was spent in Portland, where she served in several capacities, including working with the three urban programs in the Portland Area that provide services ranging from community health to comprehensive primary health care services. Director Tso holds a Bachelor of Arts in interdisciplinary studies and a master’s degree in organizational management from Marylhurst University in Portland, Oregon. As the IHS Director, Tso is responsible for administering a nationwide health care delivery program that is responsible for providing comprehensive health care services to AI/ANs through IHS, Tribes, Tribal organizations, and urban Indian organizations (UIOs).

The absence of an IHS Director had prevented Tribes, Tribal organizations, and UIOs from addressing the health care needs of their Native American populations, which directly falls under the responsibility of IHS. Since the resignation of Rear Admiral Weahkee, there have been countless requests from Indian Country calling on Congress and the Administration to nominate a new IHS director to address the growing health disparities experienced by AI/ANs. NCUIH has previously stressed the importance of appointing a permanent IHS Director and called for the elevation of the role to Assistant Secretary.

“We are delighted by the recent swearing-in of Roselyn Tso as the Director of the Indian Health Service. We look forward to working with Ms. Tso to achieve the highest health status for all American Indians and Alaska Natives and move us closer to fulfilling the federal government’s trust responsibility to our people. We will continue to advocate for the elevation of this position to Assistant Secretary for Indian Health within HHS to bring better representation for the health needs of Natives,” – Francys Crevier (Algonquin), CEO, NCUIH.

Next Steps

NCUIH looks forward to building a working relationship with Director Tso as we continue to work towards our shared goal of improving the health of urban American Indians and Alaska Natives.

NCUIH Submits Comments on Executive Order 14053 About Missing and Murdered Indigenous People

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On September 8, the National Council of Urban Indian Health (NCUIH) submitted comments on Executive Order 14053 “Improving Public Safety and Criminal Justice for Native Americans and Addressing the Crisis of Missing or Murdered Indigenous People.” This comment was in response to the Department of Homeland Security’s (DHS) correspondence dated May 25, 2022, seeking input and recommendations on the policy directives outlined.

NCUIH requested the following:

  • NCUIH requested that DHS honor E.O. 14053 by including urban Indian organizations (UIOs) in policies, procedures, and projects to address Missing and Murdered Indigenous People (MMIP).
    • Working with UIOs is specifically required by E.O. 14053 itself
    • According to the National Missing and Unidentified Persons System (NamUs), as of August 1, 2021, most missing and unidentified cases involving American Indian/Alaska Native (AI/AN) persons occurred off tribal land. AI/AN individuals living in urban areas face many, if not all, of the same violent crime and MMIP issues as AI/ANs living on reservations or tribal Iand.
    • In particular, UIOs can be critical partners in DHS’ efforts to address cross-border and jurisdiction issues.
    • We note that UIOs have already been working on addressing human trafficking through programs and services to victims and their families. For example, First Nations Community Healthsource in Albuquerque, New Mexico, has an Education and Advocacy against Sex Trafficking (EAST) program dedicated to supporting AI/AN victims of sex trafficking in the area and surrounding Tribal communities.
  • NCUIH recommended that DHS hosts an Urban Confer Regarding DHS’ Plan to Address MMIP.
    • To assist DHS collaboration with UIOs in fulfillment of the goals and directives of E.O. 14053, NCUIH recommends that DHS host an Urban Confer with UIOs regarding E.O. 14053. Urban Confers are an established mechanism for dialogue between the federal government and UIOs that are a response to decades of deliberate federal efforts (i.e., forced assimilation, termination, relocation) that resulted in seventy percent (70%) of AI/AN people living outside of Tribal jurisdictions, thus making Urban Confer integral to address the care needs of most AI/AN persons.

Background

EO 14053

EO 14053 is a landmark pledge “to strengthen public safety and criminal justice in Indian Country and beyond, to reduce violence against Native American people, and to ensure swift and effective Federal action that responds to the problem of missing or murdered Indigenous people.” NCUIH is particularly encouraged by DHS’s efforts to communicate with Tribes as DHS continues to grow its efforts to support public safety in Tribal communities. NCUIH agrees with the Biden-Harris Administration that challenges faced by Tribes are best met by Tribally-driven solutions and appreciates that the DHS hosted several Tribal Consultation sessions from July to August 2022 seeking input and recommendations concerning DHS’ efforts to address the unacceptably high rate of violent crime in AI/AN communities. These efforts advance President Biden’s directive in E.O. 14053, to engage in “[c]onsistent engagement, commitment, and collaboration,” with AI/AN people and communities to “drive long-term improvement to public safety for all Native Americans” is essential to ensure AI/AN voices are included in issues that directly affect their communities at dipropionate rates.

E.O. 14053 specifically directs the federal government to “build on existing strategies to identify solutions directed toward the particular needs of urban Native Americans,” because “approximately 70 percent of American Indian and Alaska Natives live in urban areas and part of this epidemic of violence is against Native American people in urban areas.” Furthermore, E.O. 14053 also instructs the federal government to “work closely with Tribal leaders and community members, Urban Indian Organizations, and other interested parties to support prevention and intervention efforts that will make a meaningful and lasting difference on the ground.” Despite E.O. 14053 recognizing that the federal government must develop solutions for AI/ANs living in urban areas and that UIOs must be included in the development of these solutions to address the unacceptably high rate of violent crime and MMIP, DHS has not made any efforts to work with UIOs to date.

  • NCUIH Efforts on MMIP On May 19, 2022, the National Council of Urban Indian Health (NCUIH) submitted comments on Executive Order (EO) 14053— Improving Public Safety and Criminal Justice for Native Americans and Addressing the Crisis of Missing or Murdered Indigenous People.  NCUIH outlined recommendations for HHS including communication and collaboration with UIOs, engagement with UIOs as critical stakeholders in HHS’ comprehensive plan to address the MMIP Crisis and violent crime, and the establishment of an agency-wide Urban Confer policy.
  • May 5, National MMIP Awareness Day, Secretary of the Interior Deb Haaland and Deputy Attorney General Lisa Monaco hosted an event to announce the U.S. Department of the Interior (DOI)’s Not Invisible Act Commission (Commission). The Commission is led by the Departments of the Interior and Justice and is aimed at reducing violent crime against American Indians and Alaska Natives. Members of the Commission include Sonya Tetnowski (Makah), the National Council of Urban Indian Health’s President-Elect and the Chief Executive Officer of the Indian Health Center of Santa Clara Valley. NCUIH supported the nomination of Ms. Tetnowski who also serves on the S. Department of Veterans Affairs (VA) Advisory Acommittee on Tribal and Indian Affairs Commision Member Tetnowski said “I am honored and proud to be appointed to the Not Invisible Act Commission. In this role, I will work hard to shed light on the devastating impact of violence against American Indians and Alaska Natives (AI/ANs) living in urban areas.
  • On April 15, 2022, NCUIH submitted written comments and recommendations in response to the Department of Justice’s (DOJ) Dear Tribal Leader Letter seeking stakeholder input on DOJ’s efforts to address the unacceptably high rates of violent crime in American Indian and Alaska Native communities and the missing and murdered Indigenous persons (MMIP) crisis. In its comments, NCUIH noted the need for the federal government to also work with Urban Indian Organizations (UIOs) to address these issues. NCUIH further offered to assist DOJ in establishing strong working relationships with UIOs as it works to address these pressing public safety issues.

Next Steps

NCUIH will continue to advocate for and comment on UIO inclusion in addressing the MMIP crisis.

NCUIH Submits Comment on Consistent Application of the Indian Child Welfare Act

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On September 7, the National Council of Urban Indian Health(NCUIH) submitted written comments to the Bureau of Indian Affairs (BIA) and the Administration for Children and Families (ACF) on the BIA and ACF’s efforts to promote the consistent application of the Indian Child Welfare Act (ICWA) and protect children, families, and Tribes.

In the submitted comments, NCUIH made the following specific comments, requests, and recommendations to ACF and BIA in response to the July 8, 2022 correspondence:

  • Ensure that urban child welfare and judicial systems are aware of and able to implement ICWA appropriately
    • According to the National Indian Child Welfare Association (NICWA), American Indian/Alaska Native(AI/AN) children continue to be overrepresented in the state foster care system at a rate 7 times higher than their non-Native peers. Because more than 70% of AI/AN people live in urban settings, this overrepresentation undoubtedly includes AI/AN children living in urban areas.
    • To properly implement ICWA, state courts must determine whether a child is an “Indian Child” for the purposes of ICWA as a threshold determination in the proceedings. There are states with experience in the application of ICWA and making applicability determinations. However, some state courts and child protective agencies may not be aware of this requirement or may make incorrect assumptions about a child’s “Indian child” status based on physical appearance or distance from their Tribe. This process needs to be standardized across all states to ensure the safety of these children
    • An AI/AN child’s physical location should not affect whether they receive ICWA’s protections. Specifically, NCUIH requests that ACF and BIA provide technical assistance on ICWA to state social service and child welfare agencies and courts located in urban areas.
  • Actively inform urban child welfare and judicial systems about urban Indian organizations (UIOs) as a potential resource for ICWA proceedings
    • NCUIH recommended that, as part of their efforts to strengthen and implement ICWA, ACF and BIA actively inform state child welfare and judicial systems located in urban areas about UIOs as a potential ICWA resource.
    • While UIOs are healthcare organizations, they often provide culturally competent services that state child welfare services and courts can refer parents to in accordance with ICWA’s “active efforts” requirements. For example, various UIOs provide the following services: family support services, parenting classes and groups, gender-based violence programs, and breastfeeding support.
    • Because UIOs are AI/AN organizations, they may be able to provide useful contacts or other information when a state child welfare agency throughout the child welfare process, including during the initial “Indian child” determination phase.
    • The UIO connection may be particularly useful in areas, such as Chicago, where there is an active UIO but no federally recognized Tribes nearby, and urban systems may not know where to start with the ICWA process.

Background

Congress enacted ICWA in 1978 to re-establish tribal authority over the adoption of Native American children (25 U.S.C. § 1903.) The goal of the Act was to strengthen and preserve Native American family structure and culture. Studies conducted in advance of ICWA’s drafting showed that between 25% and 35% of all Native children were being removed from their home by state child welfare and private adoption agencies. Of those, 85% were placed with non-Native families, even when fit and willing relatives were available. ICWA was established as a safeguard that requires:

  1. Recognition of Tribal jurisdiction over decisions for their Indian children;
  2. Establishment of minimum Federal standards for the removal of Indian children from their families;
  3. Establishment of preferences for placement of Indian children with extended family or other Tribal families; and
  4. Institution of protections to ensure that birth parents’ voluntary relinquishments of their children are truly voluntary.

According to NICWA, ICWA “[l]essens the trauma of removal by promoting placement with family and community . . . [p]romotes the best interest of Indian children by keeping them connected to their culture, extended family, and community, which are proven protective factors . . . [and] [p]romotes placement stability by ensuring that voluntary adoptions are truly voluntary.”

Next Steps

NCUIH will continue to advocate for  the appropriate application of ICWA to all welfare proceedings involving AI/AN children, regardless of whether the child is located in an urban or rural community.

 

 

USDA Publishes 2022 Tribal Resource Guide

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On August 16, 2022, the United States Department of Agriculture (USDA) released the 2022 edition of the USDA Resource Guide for American Indians and Alaska Natives (Resource Guide). The Resource Guide provides information regarding USDA resources and services available to tribal governments, citizens, and organizations. The Resource Guide covers four categories of USDA programs: 1) agriculture, food sovereignty, and traditional foods; 2) Indian Country economic development; 3) conservation and forestry; and 4) research, extension, and outreach. Additionally, the USDA released the Native Youth Resource Guide (Youth Guide). The Youth Guide summarizes USDA scholarship opportunities, internship programs, cultural summer camps for Native youth, afterschool activities, and resources for employment in the federal government.

Background

The USDA is a federal executive department responsible for food, agriculture, natural resources, rural development, nutrition, and related issues within the United States. The USDA plays an important role in the development of tribal nations and self-governance.  Funding from the USDA helps grow new tribal agricultural ventures, promote traditional food ways, and benefit Indigenous health through foods tailored to American Indian/Alaska Native dietary needs. As a federal agency, the USDA helps advance the federal trust responsibility to Native American communities.

The newly published Resource Guides seek to provide transparency to tribal nations. “These guides can introduce our tribal nation partners to the many USDA funding opportunities and resources that can benefit them and their communities,” remarked Secretary of Agriculture, Tom Vilsack. NCUIH recommends tribal nations use the Resource Guides to help facilitate growth within Indian Country.

Senate Confirms Roselyn Tso as Director of the Indian Health Service

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Tso’s confirmation comes after almost two years without a permanent IHS Director.

Today, September 21, 2022, Roselyn Tso (Navajo) was confirmed as the Director of the Indian Health Service (IHS) by voice vote in the Senate. Her confirmation comes after 21 months without a permanent IHS Director. Elizabeth Fowler (Comanche) has been serving as the Acting Director of IHS since the resignation of the previous Director, Rear Admiral Michael Weahkee (Zuni), in January 2021. The National Council of Urban Indian Health (NCUIH) welcomes Ms. Tso’s confirmation and continues to urge for the elevation of the role to Assistant Secretary within the Department of Health and Human Services (HHS) to bring better representation for the health needs of American Indians/Alaska Natives (AI/ANs).

“We are thrilled to have a confirmed leader for the Indian Health Service, and we graciously thank Liz Fowler for her tireless service during a pandemic that has been devastating our people. We look forward to working with Roselyn Tso to carry out the mission of IHS in fulfilling the trust responsibility to provide health care equity for all American Indians and Alaska Natives. We continue to work with Congress and this Administration to elevate this position within HHS where it belongs to lift Native voices and improve health outcomes,” – Francys Crevier (Algonquin), CEO, NCUIH.

Background

Roselyn Tso

Ms. Tso is a citizen of the Navajo Nation. She began working for IHS in 1984 and most recently served as the Director of the Navajo Area and Director of the Office of Direct Services and Contracting Tribes until her confirmation. Prior to her work in IHS, much of her professional career was spent in Portland, where she served in several capacities, including working with the three urban programs in the Portland Area that provide services ranging from community health to comprehensive primary health care services. Ms. Tso holds a Bachelor of Arts in interdisciplinary studies and a master’s degree in organizational management from Marylhurst University in Portland, Oregon. As the IHS Director, Ms. Tso is responsible for administering a nationwide health care delivery program that is responsible for providing comprehensive health care services to AI/ANs through IHS, Tribes, Tribal organizations, and urban Indian organizations (UIOs).

On March 9, 2022, President Biden announced the nomination of Ms. Tso as Director of IHS. On July 13, 2022, the Senate Committee on Indian Affairs (SCIA) voted to advance her nomination in a business meeting after she appeared before the Committee for her nomination hearing on May 25, 2022.

SCIA Hearing: Confirmation Needed to Address Health Disparities & Tribal Needs

The absence of a confirmed IHS Director has prevented Tribes, Tribal organizations, and UIOs from addressing the health care needs of their Native American populations, which directly falls under the responsibility of IHS. Since the resignation of Rear Admiral Weahkee, there have been countless requests from Indian Country calling on Congress and the Administration to nominate a new IHS director to address the growing health disparities experienced by AI/ANs. NCUIH has previously stressed the importance of appointing a permanent IHS Director and called for the elevation of the role to Assistant Secretary.

During the SCIA hearing to consider her nomination as Director of IHS, Ms. Tso highlighted how Native communities have been disproportionately impacted by COVID-19, which has been made worse given the absence of a confirmed Director. She stated, “I am reminded of the many health disparities facing American Indians and Alaskan Natives – health disparities that in many cases were made worse by COVID-19. For example, sadly, today, too many Navajo families still do not have access to running water in their homes. Access to clean, safe drinking water is essential to the health and well-being of our people.”

In addition, Ms. Tso stated during the hearing that she intends to utilize IHS resources to not only address the disparities caused by COVID-19, but to also “improve the physical, mental, social, and spiritual health and well-being of all American Indians and Alaskan Natives served by the Agency.” To achieve this goal, Ms. Tso said she would prioritize strengthening and streamlining business operations to create a more unified health care system, develop centralized systems to improve patient outcomes, accountability, and transparency, and finally address the needs and challenges experienced by the workforce. To conclude her testimony, Ms. Tso said that if confirmed as the Director of IHS, she would update agency policies and programs, as well as utilize the oversight authority of IHS to best serve each Tribal community.

Today’s full Senate consideration for the nomination of Ms. Tso as Director of IHS is the last step in her confirmation process.

Department of Veterans Affairs Seeking Nominations for IHS Billings Area Committee Member for the Advisory Committee on Tribal and Indian Affairs

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On September 16, 2022, the Department of Veterans Affairs (VA) issued a notice 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 Indian Health Service, Billings Area. The Committee is composed of 15 members with at least one member of the Committee representing urban Indian organizations (UIOs) nominated by a national urban Indian organization.  Appointed members of the Committee are invited to serve a two-year term. Nominations for membership on the Committee must be received no later than 5:00 p.m. EST on October 7, 2022, and should be mailed to the Office of Tribal Government Relations, 810 Vermont Ave. NW, Suite 915H (075), Washington, DC 20420 or emailed to tribalgovernmentconsultation@va.gov.

NCUIH and the VA

The National Council of Urban Indian Health (NCUIH) has continued to strengthen its partnership with the VA and has ensured UIO input is included in VA efforts. In October 2021, Sonya Tetnowski, President of NCUIH and CEO of the Indian Health Center of Satna Clara Valley, Army Veteran, and member of the Makah Tribe was appointed to the VA’s first-ever Advisory Committee on Indian Affairs. On January 25, 2022, during the first meeting of the Committee,  Ms. Tetnowski highlighted that American Indian/Alaksa Native (AI/AN) Veterans face significant barriers in accessing health care and other benefits. In an effort to ensure the Committee can represent the needs of all AI/AN Veterans, NCUIH recommends that UIOs consider working with Tribes and Tribal Organizations to nominate a Committee member.

Committee Objectives and Scope

In accordance with Public Law 116-315, the Committee provides advice and guidance to the Secretary of Veterans Affairs on all matters relating to Indian Tribes, tribal organizations, Native Hawaiian organizations and Native American Veterans.  According to the Office of Tribal Government Relations Director, Stephanie Birdwell, the Committee “…gives tribal leaders as well as American Indian, Native Hawaiians and Alaska Native Veterans a place at the table with the highest levels of leadership within the VA…” and “[i]t offers an unprecedented voice in how programs, policies, and services may be delivered and provided.”

Committee responsibilities include, but are not limited to:

  • Identifying evolving issues of relevance to Indian tribes, tribal organizations and Native American Veterans relating to programs and services of the Department;
  • Proposing clarifications, recommendations and solutions to address issues raised at tribal, regional and national levels, especially regarding any tribal consultation reports;
  • Providing a forum for Indian tribes, tribal organizations, UIOs, Native Hawaiian organizations and the Department to discuss issues and proposals for changes to Department regulations, policies and procedures;
  • Identifying priorities and providing advice on appropriate strategies for tribal consultation and UIOs conferring on issues at the tribal, regional, or national levels;
  • Ensuring that pertinent issues are brought to the attention of Indian tribes, tribal organizations, UIOs and Native Hawaiian organizations in a timely manner, so that feedback can be obtained;
  • Encouraging the Secretary to work with other Federal agencies and Congress so that Native American Veterans are not denied the full benefit of their status as both Native Americans and Veterans;
  • Highlighting contributions of Native American Veterans in the Armed Forces;
  • Making recommendations on the consultation policy of the Department on tribal matters;
  • Supporting a process to develop an UIO confer policy to ensure the Secretary confers, to the maximum extent practicable, with urban Indian organizations; and
  • With the Secretary’s written approval, conducting other duties as recommended by the Committee.

NCUIH Comments on the IHS Urban Indian Infrastructure Study

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On August 23, 2022, the National Council of Urban Indian Health (NCUIH) submitted comments regarding additional funding for the Urban Indian Infrastructure Study (Infrastructure Study) provided by the Consolidated Appropriations Act, 2022. The additional fiscal year (FY22) funding for the Infrastructure Study is approximately $800,696. NCUIH supports the appropriation of the additional funding and it recommended that IHS disseminate the findings of the FY21 Infrastructure Study, already in progress, to UIOs prior to making any decisions regarding the use of the additional funding. NCUIH also requested that the Office of Urban Indian Health Programs (OUIHP) create a timeline of when the Infrastructure Study will be released to UIOs, the contracting process necessary to use additional funding, and the deadline for obligation of the additional funding. Lastly, NCUIH requested that IHS host an additional Urban Confer after the release of updates about the scope and results of the FY21 Infrastructure Study.

Background

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

On March 15, 2022, Congress provided $800,969 in additional funding to IHS for the Infrastructure Study through the Consolidated Appropriations Act, 2022. As of September 2022, the results from the Infrastructure Study have not been released by IHS and The Innova Group. On June 16, 2022, IHS requested input regarding the additional funding from 2022 and how these funds can be utilized by IHS. On June 23, 2022, UIO Leaders and NCUIH attended an Urban Confer where IHS explained that the Infrastructure Study will be completed by December 31, 2022, with results to be released in January 2023.

NCUIH’s Recommendations to IHS

NCUIH made the following recommendations regarding the Infrastructure Study:

  • Provide UIOs with the findings from the first Infrastructure Study prior to making any decisions regarding use of the additional funds
    • It is crucial that UIOs are aware of the scope, results, and usefulness of the Infrastructure Study before they make any recommendations regarding the use of the further funding.
    • Given the timeline presented during the Urban Confer, there should be an 8-month window in which UIOs and IHS will be able to review the Infrastructure Study results following their release in January 2023 and decide as to the best use of the additional funding
  • OUIHP should provide a timeline of the Planning Process to UIOs
    • NCUIH requested a timeline be released to UIOs delineating when the initial Infrastructure Study will be released, the contracting process necessary to use the additional funding, and the deadline for the obligation of the additional funding.
    • The requested timeline will provide clarity to UIOs. With a clearer picture in mind, the planning process and use of the additional FY22 funds for the Infrastructure Study becomes more cooperative between UIOs and IHS.
  • IHS should host an additional Urban Confer after releasing the results of the Infrastructure Study.
    • NCUIH notes that informed feedback from UIOs creates a scenario where the additional funding can be best used to support the needs of UIOs.

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

 

 

NCUIH Board Approves Resolution on Advance Appropriations

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On August 22, 2022, the National Council of Urban Indian Health (NCUIH) Board of Directors approved a resolution in support of advance appropriations for the Indian Health Service (IHS). Attaining advance appropriations has been a long-standing priority for NCUIH and Indian Country to ensure stable and predictable funding for IHS and American Indian/Alaska Native (AI/AN) healthcare.

Full Text of Resolution:

WHEREAS the National Council of Urban Indian Health (NCUIH) is the national representative of forty-one (41) urban Indian organizations (UIOs) receiving grants under Title V of the Indian Health Care Improvement Act (IHCIA) and the American Indians and Alaska Natives (AI/ANs) they serve;

WHEREAS NCUIH was established in 1998 to support the development of quality, accessible, and culturally sensitive health care programs for AI/ANs living in urban communities;

WHEREAS the United States has a unique and special relationship with AI/ANs as established through the U.S. Constitution, Treaties with Indian Tribes, U.S. Supreme Court decisions and Federal legislation;

WHEREAS this special relationship includes a trust responsibility to AI/AN citizens as established through Treaties with Indian Tribes, U.S. Supreme Court decisions, and Federal legislation;

WHEREAS the trust relationship requires the United States to provide federal health services to maintain and improve the health of AI/ANs, no matter where they live;

WHEREAS it is the declared policy of the United States, as provided in the ICHIA, “to ensure the highest possible health status for Indians and urban Indians and to provide all resources necessary to effect that policy;”

WHEREAS the Indian Health Service (IHS) is chronically underfunded by the federal government, and UIOs historically receive only one percent of appropriated funds for IHS;

WHEREAS the Indian health system, including IHS, Tribal, and UIO (I/T/U) facilities, is the only major federal provider of health care that is funded through annual appropriations;

WHEREAS according to the Congressional Research Service, since FY1997, IHS has only once, in FY2006, received full-year appropriations by the start of the fiscal year;

WHEREAS if IHS were to receive advance appropriations, it would not be subject to government shutdowns, automatic sequestration cuts, and continuing resolutions (CRs) as its funding for the next year would already be in place;

WHEREAS during the thirty-five (35) day government shutdown at the start of FY 2019, the Indian healthcare system was the only federal healthcare entity that was required to continue operations without appropriated funds;

WHEREAS during the FY 2019 shutdown, several UIOs did not have adequate funding to maintain normal operations, and were required to reduce services, lose staff, or close their doors entirely, putting the health and wellbeing of their patients at risk;

WHEREAS in a UIO shutdown survey, five (5) out of thirteen (13) UIOs indicated that they could only maintain normal operations for 30 days without federal funding;

WHEREAS advanced appropriations would uphold the trust responsibility by protecting the Indian healthcare system from future government shutdowns and not counting against spending caps; and

WHEREAS advanced appropriations are imperative to provide certainty to the Indian health system and ensure unrelated budget disagreements do not put AI/AN lives at stake.

NOW THEREFORE BE IT RESOLVED, that NCUIH requests that Congress amend the Indian Health Care Improvement Act to authorize Advanced Appropriation for IHS, including Tribal facilities and UIOs; and

BE IT FURTHER RESOLVED, that this resolution shall be the policy of NCUIH until it is withdrawn or modified by subsequent resolution.

CERTIFICATION

The foregoing resolution was adopted by NCUIH on August 22nd, 2022 with a quorum present.

 

Background on Advance Appropriations for IHS

Advance appropriations are appropriations that become available one year or more after the year for which the appropriations act is passed. The Indian healthcare system, which includes IHS facilities, Tribal facilities, and urban Indian organizations (UIOs), is the only major federal healthcare provider funded through annual appropriations. Funding through annual appropriations leads to funding uncertainty because the availability and amount of the appropriation is subject to the annual budget negotiation process. If IHS were to receive advance appropriations, it would not be subject to government shutdowns, automatic sequestration cuts, and continuing resolutions (CRs) as its funding for the next year would already be in place.

Lapses in federal funding risk American Indian and Alaska Native lives. Every year, on average, Congress passes five continuing resolutions to keep the government open while Congress reaches a budget agreement, and there were long government shutdowns in 1996, 2013, and 2019. During the Fiscal Year (FY) 2019 shutdown, several UIOs did not have adequate funding to maintain normal operations and were required to reduce services, lose staff, or close their doors entirely, putting the health and well-being of their patients at risk. In a UIO shutdown survey, five out of thirteen UIOs indicated that they could only maintain normal operations for 30 days without federal funding. One UIO suffered seven opioid overdoses, five of which were fatal. Presently, it is unlikely that Congress will reach a budget agreement before the September 30 deadline. If Congress does not reach a budget agreement, Congress will need to pass a continuing resolution to avoid a government shutdown.

NCUIH Resources on Advance Appropriations for IHS:

NCUIH and Indian Country Advocacy

NCUIH, along with three other national Native organizations the National Indian Health Board (NIHB), National Congress of American Indians (NCAI), United South and Easter Tribes (USET), have been advocating on behalf of advance appropriations for almost a decade. NIHB, NCAI, and USET have all passed resolutions in support of advance appropriations. However, these resolutions don’t explicitly mention UIOs or urban Indians. NCUIH’s resolution provides context for why advance appropriations are essential for UIOs and urban Indian populations and explicitly includes UIOs in the request for advance appropriations.

On January 17, 2019, NCUIH sent a letter to the Vice Chairman of the Senate Committee on Indian Affairs (SCIA), Tom Udall, in support of IHS advance appropriations legislation. On March 9, 2022, NCUIH joined NIHB and over seventy Tribal nations and national Indian organizations in sending a series of joint letters to Congress requesting advance appropriations for IHS in the FY 2022 omnibus. On June 16, 2022, NIHB and NCAI published a legislative action alert requesting that SCIA support and include IHS advance appropriations in the current FY 2023 appropriations bill. Most recently, NCUIH sent letters to Speaker Pelosi, House Minority Leader McCarthy , Senate Majority Leader Schumer, Senate Minority Leader McConnell, Senate Interior Appropriations Committee,  and SCIA to support advance appropriations for IHS.

Federal and Congressional Support

There has also been strong long-standing support from Congress on this issue. On January 12, 2022, the Native American Caucus sent a letter to House Appropriations Committee Chair DeLauro and Ranking Member Granger requesting that advance appropriations for IHS for FY 2023 be included in the final FY 2022 appropriations bill. On June 3 the Native American Caucus sent another letter encouraging the Committee to work towards shifting IHS from discretionary to mandatory funding and requesting that, while this shift is underway, the Committee include advanced appropriations for IHS  in the final FY 2023 Appropriations bill.

On April 25, 2022, a bipartisan group of 28 Representatives requested up to $949.9 million for urban Indian health in FY 2023 and advance appropriations for IHS until such time that authorizers move IHS to mandatory spending, and 12 Senators sent a letter with the same requests. Last year, for the first time ever, the Senate Appropriations Committee included an additional $6.58 billion in advance appropriations to IHS for FY 2023 in its FY 2022 Interior, Environment, and Related Agencies bill.

Back in 2014, SCIA held its first hearing on advance appropriation bill Indian Health Service Advance Appropriations Act of 2013 (S. 1570). In a 2019 House Natural Resources Subcommittee for Indigenous Peoples (SCIP) hearing on advance appropriations bills H.R. 1128 and H.R. 1135, former IHS Principal Deputy Director, Rear Admiral Michael Weahkee, reaffirmed Indian Country’s repeated request for advance appropriations stating that  “[t]hrough the IHS’s robust annual Tribal Budget Consultation process, Tribal and Urban Indian Organization leaders have repeatedly and strongly recommended advance appropriations for the IHS as an essential means for ensuring continued access to critical health care services. The Department continues to hear directly from tribes advocating support for legislative language that would provide the authority of advance appropriations for the IHS. The issues that Tribes have identified present real challenges in Indian Country and we are eager to work with Congress on a variety of solutions.” More recently on July 28, 2022  IHS Acting Deputy Director Elizabeth Fowler reaffirmed IHS’s support for advance appropriations during a SCIP hearing on the Indian Health Service Advance Appropriations Act (H.R. 5549) stating that  “[IHS] remain[s] firmly committed to improving quality, safety, and access to health care for American Indians and Alaskan Natives. Mandatory funding and advanced appropriations are necessary and critical steps toward that goal… [I] urge the House to act on advanced appropriations through the appropriations process with or without the authorizing legislation that is the subject of this hearing.”
The U.S. Commission on Civil Rights report from 2018, “Broken Promises: Continuing Federal Funding Shortfall for Native Americans” serves as another benchmark of support by including advance appropriations for IHS as a key recommendation to the federal government to ensure greater funding stability for IHS.

History of Advance Appropriations Bills

Legislation on this effort has been introduced in 11 bills since 2013:​

  •  10/2013 – Indian Health Service Advance Appropriations Act of 2013 (R. 3229/S. 1570) ​
  • Sponsor: Rep. Don Young/Sen. Lisa Murkowski ​
  •  1/2015 – Indian Health Service Advance Appropriations Act of 2015 (R. 395)    ​
  • Sponsor: Rep. Don Young ​
  • 1/2017 – Indian Health Service Advance Appropriations Act of 2017 (R. 235) ​
  •  Sponsor: Rep. Don Young ​
  •  2/2019 – Indian Programs Advance Appropriations Act (R. 1128/S. 229) ​
  • Sponsor: Rep. Betty McCollum/Sen. Tom Udall ​
  • 2/2019 – Indian Health Service Advance Appropriations Act of 2019 (R. 1135/S. 2541) ​
  • Sponsor: Rep. Don Young/Sen. Lisa Murkowski​
  •  10/2021 – Indian Health Service Advance Appropriations Act (R. 5549) ​
  •  Sponsor: Rep. Don Young ​
  • 10/2021 – Indian Programs Advance Appropriations Act of 2021 (R. 5567/S. 2985) ​
  • Sponsor: Rep. Betty McCollum/Sen. Ben Ray Lujan​
    • 7/28/2022- Subcommittee for Indigenous Peoples (SCIP) held a hearing on the Indian Health Service Advance Appropriations Act (R.5549)​
  • Sponsor: Rep. Don Young
Next Steps

NCUIH will continue to advocate for Advance Appropriations for the 2022-23 Fiscal Year.

New Omicron Targeting Vaccine Formula Approved as Booster Dose for Individuals 12 years and Older

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On August 31, 2022, the US Food and Drug Administration (FDA) amended the previously issued emergency use authorizations (EUAs) for both the Moderna and the Pfizer-BioNTech (Pfizer) COVID-19 vaccines to authorize the use of bivalent formulations for boosters. The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) voted to recommend both the Moderna and Pfizer bivalent formulation boosters on September 1, 2022. This new formulation, which can be administered at least two months following the completion of a primary series or a previous booster dose, targets both the original virus and the current Omicron variants.  During a monthly call with Tribal and urban Indian organization (UIO) leaders, the Indian Health Service (IHS) stated that it started shipping the bivalent formulation the week of Labor Day and that these boosters will replace all booster formulations once rolled out. Currently, Omicron variants make up more than 99% of COVID-19 cases within the US.

As it stands, the monovalent (original) COVID vaccine is no longer the recommended booster for people ages 12 and up. In order for an individual to be considered ‘up to date’ on their COVID vaccination, they must have received the bivalent booster, regardless of previous booster status. Individuals who have previously caught COVID-19 can be vaccinated up to three months after the infection.

Background

American Indians and Alaska Natives (AI/ANs) have been disproportionately affected by the COVID-19 pandemic. At the height of the pandemic, AI/ANs were 3.5 times more likely to test positive, 3.2 times more likely to be hospitalized, and 2.2 times more likely to die to due COIVD-19.

Indian Country has had highly successful vaccine rollouts and UIOs have been instrumental in the success of vaccinating AI/AN populations in urban Areas. As of August 2022, AI/ANs have the highest vaccination administration rates in the US with 74.5% of AI/ANs having received at least one dose of one of the three previously available COVID-19 vaccines, per CDC data.