PRESS RELEASE: NCUIH Releases Financing Toolkit for Providers to Address Behavioral Health Disparities in American Indian and Alaska Native Communities

/in , /by

FOR IMMEDIATE RELEASE

WASHINGTON, D.C. (October 9, 2024) – The National Council of Urban Indian Health (NCUIH) has released a new resource to combat the significant mental health challenges facing American Indian and Alaska Native (AI/AN) communities. The toolkit, Investing in Wellness: Financing Strategies for Behavioral Health in Indian Country, developed in response to the alarming statistic that 19 percent of AI/AN individuals reported experiencing a mental illness in the past year, seeks to provide sustainable funding solutions and resources to enhance behavioral health care access in Indian Country.

The toolkit comes at a time when behavioral health issues among AI/AN communities have not received equal policy attention or funding. Existing funding models often rely on short-term grants that inadequately address the persistent and complex needs of these communities. “The Investing in Wellness toolkit is essential for bridging the funding gap in behavioral health services,” said NCIUH CEO Francys Crevier, J.D. (Algonquin). “We aim to equip leaders with practical financing strategies tailored specifically for American Indian and Alaska Native health care systems, ultimately improving access to prevention, treatment, and recovery services. By focusing on the patient journey and incorporating traditional healing practices into behavioral health programming, the toolkit aligns with the growing advocacy for holistic approaches in treatment.”

Key strategies outlined in the toolkit include:

  • Enhancing Behavioral Health Care Access Through Optimizing Medicaid Reimbursement
  • Traditional Healing as a Financially Sustainable Strategy for Improving Behavioral Health
  • Cultivating Funding Opportunities for Behavioral Health Programming
  • Investing in Prevention, Crisis Care, and Integrated Services
  • Strategies to Build, Expand, and Sustain Behavioral Health

The development of this toolkit was guided by a community-based participatory approach, ensuring that the needs and voices of AI/AN communities were central to its creation. “Culturally sensitive care is an important part of any treatment regimen. The Investing in Wellness toolkit notably supports traditional healing practices, such as therapeutic talking circles and natural remedies, as proven ways to support person-centered health and wellness,” said Alaina McBournie, senior manager for the substance use prevention and treatment initiative at The Pew Charitable Trusts. “Pew is proud to partner with NCUIH to help expand access to lifesaving services for American Indian and Alaska Native people.”

View Toolkit

About NCUIH

The National Council of Urban Indian Health is a national non-profit organization devoted to the support and development of quality, accessible, and culturally competent health and public health services for American Indian and Alaska Native people living in urban areas. NCUIH advocates for the 41 Title V Urban Indian Organizations under the Indian Health Service in the Indian Health Care Improvement Act.

NCUIH respects and supports Tribal sovereignty and the unique government-to-government relationship between our Tribal Nations and the United States. NCUIH works to support those federal laws, policies, and procedures that respect and uplift Tribal sovereignty and the government-to-government relationship. NCUIH does not support any federal law, policy, or procedure that infringes upon or in any way diminishes Tribal sovereignty or the government-to-government relationship.

###

NCUIH Contact: Meredith Raimondi, Vice President of Policy and Communications, mraimondi@ncuih.org, 202-417-7781

NCUIH Supports Native Community and Voter Engagement at Native Health’s National Voter Registration Day Event in Phoenix

/in /by

On September 19, 2024, Native Health in Pheonix, Arizona hosted Frybread for the Future Fest, an event focused on building community and registering Arizona residents to vote. Over 500 people were in attendance and approximately 30 eligible voters registered to vote. During the event, which was hosted at the site of the former Phoenix Indian Boarding School, participants were able to check their voter registration, browse an Indigenous Market, speak with staff from Native Health and Inter-Tribal Council of Arizona, get free Native Vote swag, and enjoy homemade frybread and ice cream. The event also had traditional performances by local Tribal members. Native Health hosts hundreds of similar events each year, which play an important role in building community and provide a space for community members to stay connected to traditional cultural practices.

NCUIH staff, Chelsea Guitierrez and Emily Larsen

NCUIH staff, Chelsea Guitierrez and Emily Larsen, provided support for the event, assisting in set-up, handing out t-shirts, and clean up.

Native Health Designated as First IHS Voter Registration Site

On March 5, 2023, President Biden announced agency actions to make the voting process more accessible in alignment with recommendations made by the Native American Rights Fund (NARF). This included a new initiative at the Indian Health Service (IHS) piloting “high-quality voter registration services across five different IHS facilities before the end of 2023”. The first facility to be announced under this pilot program was Native Health.

NCUIH Advocacy on Voting Efforts

In partnership with the National Urban Indian Family Council (NUIFC), NCUIH has been working with UIOs, like Native Health, to Get Out The Vote and increase Native voter participation in the 2024 election cycle. Voter information, including a social media toolkit can be found here.

NCUIH Requests IHS Support All Facility Types and Integrate Social Services into the New IHS Electronic Health Record System

/in /by

On September 6, 2024, the National Council of Urban Indian Health (NCUIH) submitted written comments to the Indian Health Service (IHS) Director, Roselyn Tso, regarding the IHS’ January 18, 2024, Dear Tribal Leader and Urban Indian Organization Leader letter (DTLL/DULL) about the August 8, 2024, joint Tribal Consultation and Urban Confer (TC/UC) session on Health Information Technology (HIT) Modernization: Multi-Tenant Domain Considerations. In its comments, NCUIH requested that IHS support all facility types to address inefficiencies during the implementation process and ensure social services are integrated into IHS’ new electronic health record (EHR) system.

Background on IHS HIT Modernization

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

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

NCUIH’s Requests

In its comments following the TC/UC, NCUIH recommended:

  • IHS should increase the value proposition for urban Indian organizations (UIOs) to participate in the PATH EHR:
    • Integrate social services into the PATH EHR
    • Support the unique interoperability needs of UIOs
    • Ensure security of patient health information
  • IHS should address the following challenges and risks that UIOs may face when transitioning from their current EHRs to the shared PATH EHR:
    • Lack of support for all UIO facility types
    • Failure to be included in pilot site and implementation cohort selection

NCUIH Advocacy on HIT Modernization

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

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

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

FAQ on TEFCA for Urban Indian Organizations

/in /by

1. What is TEFCA?

  • TEFCA was created by the Department of Health and Human Services (HHS) Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC) under the authority of the 21st Century Cures Act.
  •  The goals of TEFCA are:
    1. (1) to establish a universal governance, policy, and technical floor for nationwide interoperability;
    2. (2) to simplify connectivity for organizations to securely exchange information to improve patient care, enhance the welfare of populations, and generate health care value; and
    3. (3) to enable individuals to gather their health care information.
  • TEFCA is made up of two parts:
    • (1) The Trusted Exchange Framework (TEF), a set of principles to follow when participating in secure data exchange under TEFCA.
    • (2) The Common Agreement (CA), a standardized agreement that enables data sharing between TEFCA participants.
  • Combined, they are referred to as the “TEFCA,” which supports a nationwide exchange of Electronic Health Information (EHI) across disparate Health Information Networks (HINs). HINs are entities that serve as a network for health information across health care entities, electronic health record platforms, and other entities that store and share electronic health information.

2. What entities are involved in TEFCA?

  • The entities involved in TEFCA are:
    • The HHS Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC): the federal agency responsible for implementing TEFCA.
    • The Recognized Coordinating Entity (RCE): the entity responsible for the development, implementation, and maintenance of the Common Agreement and for the review of applications from HINs seeking to join TEFCA and become QHINs.
    • Qualified Health Information Network (QHIN): an HIN that has completed the application and onboarding process required by the RCE and is now “qualified” to share information within the TEFCA framework.
      • QHINs currently part of TEFCA include eHealth Exchange, Epic Nexus, Health Gorilla, KONZA, MedAllies, CommonWell Health Alliance, and Kno2.
    • Participants: persons or entities who are contracted with a QHIN and have agreed to participate in TEFCA under the Common Agreement. Participants can include health information networks; health information exchanges; individuals; providers; federal agencies; public health agencies; health plans and other payers; and health IT developers (e.g., electronic health records systems).
    • Subparticipants: persons or entities who use services provided by a Participant through sending and receiving Electronic Health Information. Subparticipants are often healthcare providers, health systems, ambulatory providers, and health IT developers.
    • Principal: a QHIN, Participant, or Subparticipant that is acting as a Covered Entity, Government Health Care Entity, Non-HIPAA Entity (NHE) Health Care Provider, a Public Health Authority, a government agency that makes a Government Benefits Determination, or an Individual Access Services Provider.
    • Delegate: a QHIN, Participant, or Subparticipant that has a written agreement, directly or indirectly, with a Principal authorizing the Delegate to conduct TEFCA Exchange activities for or on behalf of the Principal.

3. What role do UIOs play in TEFCA?

  • Under the TEFCA framework, a UIO whose EHR provider has contracted with a QHIN is considered a “Subparticipant.” The UIO’s EHR provider is a “Participant.”
  • In some cases, a UIO’s EHR provider may choose to become a QHIN and join TEFCA. This would then label any UIO that join TEFCA through this provider a “Participant.”
  • Additionally, a UIO can join TEFCA under any QHIN of their choosing and become a “Participant.” It does not have to be done through their EHR system.

4. How do UIOs become Participants/Subparticipants in TEFCA?

  • Each QHIN must agree to the terms of the Common Agreement.
  • The Common Agreement contains Terms of Participation which must be signed by each Participant and Subparticipant. These have also been referred to as “flowdown provisions.”
  • For example, if the EHR system a UIO uses is connected to an HIN that completes the process to become a QHIN under TEFCA, and the UIO’s EHR system then agrees to the terms of the ToP and becomes a Participant under TEFCA, then the UIO may have the option to sign the ToP to become a Subparticipant under TEFCA.
  • The signing of the ToP is also required if a UIO joins as a Participant under an EHR system that is acting as a QHIN, or directly through any QHIN currently part of TEFCA.
  • Signature of the ToP is only required if a UIO wants to join TEFCA’s nationwide health information exchange. UIOs are not required to join TEFCA, even if their EHR becomes a Participant in TEFCA or joins TEFCA as a QHIN.
  • If UIOs do not sign the ToP, they can still utilize health information technology, like the EHR system, but will not be able to participate in nationwide health information exchange through TEFCA.
  • If the EHR a UIO uses has joined a QHIN as a Participant, but the UIO has not been given the option to join the QHIN as a Subparticipant, it is recommended that the UIO reach out to their EHR for more information. UIOs can also reach out to QHINs directly for information about joining TEFCA.
  • Today, participation is voluntary, allowing UIOs flexibility to make the decision to join TEFCA. However, if any UIOs signed a previous sub-agreement to join TEFCA before July 1, 2024, they must agree to the updated ToP by December 27, 2024, to continue to participate in TEFCA.

5. How does health information exchange work under TEFCA?

  • Requests are made through QHIN-to-QHIN exchange and must be for one or more of the reasons outlined in the Exchange Purposes (XPs) and must follow the requirements outlined in the XP Standard Operating Procedure (SOP). These purposes include treatment, payment, health care operations, public health, government benefits determination, and individual access services (IAS).
  • For example, a UIO (as a Participant or Subparticipant) may initiate a QHIN Query to supplement or update a patient’s records they maintain. The UIO, now acting as a Principal, would request the Delegate contact their QHIN to initiate the query, under the specified XP code, to other QHINs who may be connected to entities (either a Participant or Subparticipant) that may have records for that patient. These entities could include a state health department, tribally operated hospital, or any facility that has been connected to TEFCA through their own QHIN.
  • The technical infrastructure that supports exchange of information is maintained by QHINs. Data is not stored by the QHIN, it is only exchanged between the two entities. Neither Participants nor Subparticipants actively participate in the process. Participants and Subparticipants only make requests or respond to requests made by other TEFCA entities.

6. Is TEFCA currently in effect?

  • Yes, TEFCA has been live since the fourth quarter of 2023 when the first QHINs went live with health information exchange.

7. Are there any anticipated changes to TEFCA?

  • TEFCA will continue to evolve, and we can anticipate changes in participation, exchange purposes, governance and documentation moving forward. Additional QHINs are already in the process of being approved.
  • Documents are still being updated to assist with implementation of TEFCA. The most recent updates were
    July 1, 2024, and August 6, 2024, but more updates will be provided later this fall. These updates can be found on the Sequoia Project’s website.
  •  In addition, the Sequoia Project holds webinars to provide an overview of updates, which includes a Q&A session for any potential questions.

September Policy Updates: Election Resources, FY25 Appropriations, Legal Developments, and More!

/in /by

️💵 Area Budget Formulation on the Horizon: Your engagement in the FY27 Budget Formulation Cycle is crucial.

🗳️ Election 2024: State-specific graphics now available to boost voter participation in the 2024 election.

💰 Appropriations Update: Updates on FY25 funding and the potential for a Continuing Resolution to prevent a government shutdown.

📝 Federal Comments: Review NCUIH’s recent recommendations to federal agencies on Medicaid, HIT Modernization, and syphilis outbreak response. Share your input on the USDA Dietary Guidelines by October 1.

🏛 Legislative Updates: Updates on FMAP, SDPI reauthorization, Telehealth Modernization Act, and BADGES for Native Communities Act.

🔙 ICYMI: Stay informed with the latest Dear Tribal Leader Letters and Federal Tribal Advisory Committee Meetings

🚀 NCUIH in Action: Highlights from the VAWA celebration at the White House with President Biden, National Voter Registration Day at Native Health Phoenix and, and engagement with Members of Congress.

📅 Important Dates: Mark your calendars for upcoming meetings and events.

⚖ Legal Update: Monitoring the Becerra v. San Carlos Apache case as IHS develops new contract support costs methodology.

On the Horizon: Area Budget Formulation – Your Engagement Matters!

NCUIH

IHS is beginning the FY27 Budget Formulation Cycle and UIOs are invited by their Area Offices to participate in this important opportunity to impact the budget recommendations for your area.

  • Why is UIO engagement important?: UIO input in Area Budget Formulation meetings can drastically influence budget requests for the urban line item and priority areas.
  • Go Deeper: It is critically important that UIOs attend their Area Budget Formulation meeting and advocate for additional support for urban Native communities.
  • Last Year: A number of areas prioritized funds for the Urban line item to help UIOs as seen in the chart above.
  • Date Anticipation: FY 2026 Area Budget Consultations set to begin in October, 2024

Empowering Native Votes: State-Specific Graphics Now Available for UIOs

NCUIH

Introducing the new Urban Voices Amplified: Empowering Native Votes Toolkit, developed by the NCUIH with support from the National Urban Indian Family Coalition. This resource is designed to provide Urban Indian Organizations with crucial voter information, helping American Indian and Alaska Native communities stay informed about important deadlines for the 2024 election.

Toolkit Highlights: 

  • State-specific graphics, including key voter registration deadlines and election dates.
  • Resources to help individuals register or update their voter information.

Access the Toolkit: Download the Toolkit and share it with your community to support voter participation.

Appropriations Updates

Illustration of the U.S. Capitol

Fiscal Year 2025:

On Wednesday, September 25, Congress passed a Continuing Resolution, or short-term government funding bill, which would fund the government until Dec. 20, and prevent a government shutdown.

  • The bill does not include the controversial SAVE Act, a GOP measure that requires voters to show proof of citizenship.

FY 2025 Funding for Veterans:

On Thursday, September 19, 2024, Congress passed supplemental funding bill (HR 9468) to address the close to $3 billion budget shortfall for Veteran’s benefits.

  • This funding ensures that all veterans will continue to receive their pension and benefits without lapse.
  • There are no Native specific programs in this bill.

Take Action to Support Mandatory Funding for IHS CSCs and 105(l) leases: 

NCUIH sent out an action alert urging advocates to contact Congress to support mandatory funding for IHS Contract Support Costs (CSCs) and 105(l) lease funding.

  • Ways to advocate: Call or email your Representative, and post on social media using the template language provided in the action alert. Contact Congress.
  • Why Participate: Shifting these costs to mandatory funding is important to avoid   funding impacts for other IHS programs and will enable true increases in funding for essential services.

NCUIH Provides Key Recommendations on Medicaid, Health IT Modernization, and Syphilis Outbreak Response to Federal Agencies

Illustration of a virus surrounded by caution tape

On September 9, NCUIH submitted comments to the Centers for Medicare and Medicaid Services (CMS) on its Outpatient Prospective Payment System (OPPS) Proposed Rule, specifically regarding Medicaid clinic services four walls exceptions and All-Inclusive Rate add-on payment for high-cost drugs provided by IHS and Tribal outpatient facilities.

On September 6, NCUIH submitted comments to IHS in response its joint Tribal Consultation and Urban Confer on Health IT (HIT) modernization multi-tenant domain considerations

  • Go deeper: NCUIH recommended that IHS support the unique interoperability needs of UIOs and ensure security of patient health information. NCUIH also recommended that IHS address the challenges and risks that UIOs may face when transitioning EHRs.

On September 5, NCUIH submitted comments to HHS Office of the Assistant Secretary for Health (OASH) regarding the syphilis and congenital syphilis outbreak in Indian Country.

  • Go deeper: NCUIH recommended that HHS and the National Syphilis and Congenital Syphilis Syndemic Federal Task Force work with UIOs as part of their strategy and continue to seek Tribal feedback.

Upcoming Federal Agency Comment Opportunity

October 1 – United States Department of Agriculture (USDA) Dietary Guidelines for America

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

Legislative Updates: 100% FMAP for UIOs, SDPI, Telehealth Modernization, and MMIP

NCUIH

Recent update on 100% Federal Medical Assistance Percentage (FMAP) for UIO Medicaid Services: 

Next Steps:

  • NCUIH remains focused on having the Urban Indian Health Parity Act (H.R. 6533) included in any lame duck legislation (the period between the November election and the start of the new Congress).

What UIOs Can Do:

  • If UIOs would like to write a letter or meet with their Member of Congress to support this legislation, NCUIH is available to assist. Email policy@ncuih.org.
  • We also are looking for Tribal letters of support. Please reach out to policy@ncuih.org if you know of any Tribes that would be willing to send a letter.

Special Diabetes Program for Indians (SDPI) Update

The Special Diabetes Program for Indians was reauthorized in the March 2024 Consolidated Appropriations Act through December 31, 2024. The total funding for the 2024 calendar year was $158 million, which marked the first increase for the program since 2002. Congress must pass legislation to reauthorize and appropriate funding for the program for it to continue into FY 2025 and beyond.

NCUIH continues to advocate to Congressional leadership to ensure reauthorization of this critical program in any end of year funding package.

What UIOs Can Do:

  • If UIOs would like to write a letter or meet with their Member of Congress to support this program, NCUIH is available to assist. Email policy@ncuih.org.

Telehealth Modernization Act (H.R. 7623)

On September 18, 2024, the Energy and Commerce full committee passed out of markup the Telehealth Modernization Act of 2024 (H.R. 7623).

  • This bill permanently extends telehealth flexibilities for Medicare beneficiaries and extends these flexibilities to federally qualified health centers and rural health clinics.
  • The bill awaits further passage in the House and has not received any action in the Senate.

BADGES for Native Communities Act (S. 465)

On September 25, 2024, the Senate Committee on Indian Affairs passed out of committee the Bridging Agency Data Gaps and Ensuring Safety (BADGES) for Native Communities Act.

  • This bill requires law enforcement agencies to report on cases of missing or murdered Native people.
  • The bill now awaits further consideration from the Senate.

Recent Tribal Leader Letters and Dear Urban Leader Letters, Federal Tribal Advisory Committee Meetings

Typewriter gif

Recent Dear Tribal and Urban Leader Letters (DTLL/DULL)

September 10 DTLL – IHS Tribal Consultation on Contract Support Costs (CSC) Methodology for Program Income

  • IHS is initiating Tribal Consultation to seek and obtain Tribes’ recommendations on funding methodologies for the payment of eligible CSCs incurred by Tribes and Tribal Organizations related to expenditures of program income.
  • There will be a total of five Tribal consultation sessions in September and October. Future Sessions:
    • – IN PERSON: Tuesday, October 1, 2024, from 9:30 a.m. – 12:30 p.m. ET in Washington D.C. Register here.
    • – IN PERSON: Thursday October 3, 2024, from 9:30 a.m. – 12:30 p.m. PT in Seattle, Washington. Register here.
    • – VIRTUAL: Wednesday, October 9, 2024, form 1:00 p.m. – 5:00 p.m. ET Register here.
  • Written comments are due by October 11, 2024, and can be emailed to consultation@ihs.gov with the subject line: CSC Methodology for Program Income.
  • This letter also provides an update on the Agency’s ongoing efforts that the IHS has taken to implement the United States Supreme Court’s decision in Becerra v. San Carlos Apache Tribe.

September 4 DTLL – HHS Tribal Data Access Policy Consultation

  • HHS is hosting Tribal Consultation on the Draft HHS Tribal Epidemiology Center Data Access Policy and Draft HHS Tribal Data Access Policy, to provide updates on the policies, and make them aware that the Tribal Data Access Website is now live.
  • Tribal Consultation will take place Tuesday, October 1, 2024, 3:00 p.m.-5:00 p.m. ET via Zoom. Register here.
  • Written comments are due by October 31, 2024, and can be emailed to consultation@hhs.gov with the subject line (please separate your comments by each draft): HHS Tribal Data Access Policy or HHS TEC Data Access Policy.

Important Events

NCUIH

At the Tribal Leaders Diabetes Committee (TLDC) meeting: NCUIH Senior Policy Analyst Carolyn Kowalyk, staffed NCUIH Board Treasurer Adrianne Maddux, who serves as NCUIH’s Technical Advisor for TLDC.

September 17-18: IHS Tribal Leaders Diabetes Committee (TLDC) Quarterly Meeting in Washington, D.C.

  • What was said: A discussion was held on how to disperse the rest of the $43 million of SDPI unobligated funds. The Committee agreed that an “administrative” supplement for eligible programs over the next two years would be ideal. IHS announced that there will be a comment period on this decision when a DTLL/DULL is released at the end of September.
  • What’s next: A Tribal Consultation and Urban Confer will be held this fall and the comments will be compiled and presented at the next quarterly TLDC meeting in December.

September 10-12: HHS Secretary’s Tribal Advisory Committee (STAC) Meeting

  • What was said: HHS submitted its proposed FY26 budget to Office of Management and Budget (OMB). FY26 Budget planning is now paused, HHS will adjust for new the administration.
  • HHS is taking steps to carry out Executive Order (EO) 14112: Reforming Federal Funding and Support for Tribal Nations. HHS is awaiting OMB to issue a funding needs assessment to guide the agency in ensuring federal notice of funding opportunities are developed in a manner consistent with EO 14112.
  • CMS is actively working on approving Medicaid demonstration requests for Traditional Healing reimbursement from four states (AZ, CA, OR, NM). CMS anticipates positive news soon.

NCUIH in Action

NCUIH

NCUIH CEO Francys Crevier (Algonquin) and Indian Health Center of Santa Clara Valley CEO and Chair of the Health Subcommittee for the VA Advisory Committee on Tribal and Indian Affairs Sonya Tetnowski (Makah).

On September 24, NCUIH CEO Francys Crevier (Algonquin) presented on the Veteran Affairs Advisory Committee on Tribal and Indian Affairs Panel, emphasizing the urgent need to address the health disparities faced by urban Native veterans. She called for improved housing resources, better care coordination between UIOs and the VA, and expanded technical assistance for Urban Indian Organizations. Crevier also acknowledged the critical leadership of Sonya Tetnowski, Army Veteran and former NCUIH Board President, who continues to champion Native Veteran voices in her role as Chair of the Advisory Committee’s Health Subcommittee.

NCUIH

NCUIH Vice President of Policy and Communications Meredith Raimondi and 46th President of the United States, Joseph R. Biden.

On September 12 – NCUIH represented UIOs at the White House event commemorating the 30th anniversary of the Violence Against Women Act (VAWA). This landmark legislation has made strides in protecting Native women and girls, and NCUIH is proud to have contributed to the VAWA reauthorization, ensuring urban Native communities are included in these vital protections. Our work continues to focus on culturally specific services, housing protections, and survivor-centered care.

NCUIH

NCUIH Public Policy Associate Chelsea Gutierrez and NCUIH Policy Analyst Emily Larsen.

On September 17, NCUIH provided support at the “Frybread for the Future” event at Native Health Phoenix UIO for National Voter Registration Day to emphasize the importance of the Native vote in the 2024 election.

NCUIH

NCUIH Interim Congressional Relations Director Jeremy Grabiner, Rep. Mike Quigley (D-IL-5), and AIHSC Staff.

On September 5, Rep. Mike Quigley (D-IL-5) visited the American Indian Health Service of Chicago (AIHSC). Rep. Quigley was able to tour the facility and talk to staff about the essential health care they are providing to Native communities in Illinois.

NCUIH

NCUIH Research Associate Nahla Holland (Eastern Pequot Tribal Nation) and NCUIH Federal Relations Manager Alexandra Payan alongside Association of American Indian Physicians Representatives.

On September 5-8, NCUIH presented its reports on UIO Traditional Healing and food programs at the Association of American Indian Physicians Conference.

  • Access NCUIH’s Traditional Healing report here.
  • Access NCUIH Traditional Foods reports here.
NCUIH

NCUIH Interim Congressional Relations Director Jeremy Grabiner and NAC Chair Emeritus Betty McCollum (D-MN-4).

On August 21, NCUIH represented UIOs at a meeting on the voter landscape & discussed UIO issues with Native American Caucus Chair Emeritus Betty McCollum (D-MN-4).

Upcoming Events and Important Dates

Calendar with events on it

  • October 1: HHS Tribal Data Access Policy Consultation
  • October 9: CMS Tribal Technical Advisory Group (TTAG) Conference Call
  • October 9: FY 2027 National Tribal Budget Formulation Process & Area Instructions Webinar

Monitoring the Bench: Becerra v. San Carlos Apache

Illustration of two gavels forming an x in front of the Supreme Court building

Following the decision in Becerra v. San Carlos Apache, several cases calculating contract support costs (CSCs) have been granted motions to stay. These rulings will pause the cases, preventing the Supreme Court ruling from going into effect while IHS works on their methodology for CSCs. In July and August of this year, the IHS CSCs workgroup met to discuss possible methodologies.

What’s Next: IHS plans to conduct a national consultation before adopting the methodology.

Resource: NCUIH created an FAQ on the Supreme Court decision.

Thank you, Chandos Culleen!

NCUIH

We extend our deepest gratitude to Chandos Culleen, JD, NCUIH Senior Director of Federal Relations, for his invaluable contributions to advancing the health and well-being of Native people. We wish him all the best!

Summer 2024 Public Policy Intern Departs and Reflects on Time with NCUIH

/in , /by
Eli Allen (Cherokee), National Council of Urban Indian Health (NCUIH) Policy Intern

Eli Allen (Cherokee), National Council of Urban Indian Health (NCUIH) Policy Intern

The summer of 2024 marked my second year as a Public Policy Intern at NCUIH. As I prepare to enter my third year at UCLA, majoring in Geography and Environmental Studies, this internship has been both a fun and insightful experience.

Working at NCUIH has given me a firsthand look into the world of public policy, which is a timely and intricate process. I’ve gained a deep appreciation for the amount of time and effort that goes into crafting policies that directly impact urban Native Americans. Over this summer, I worked on several projects such as compiling NCUIH’s official actions on our top policy priorities such as Traditional Healing, Missing and Murdered Indigenous People, and Medicaid; provided an analysis of the Department of Justice Office of Violence Against Women’s Tribal Consultation Annual Report; created remarks and materials for senior leadership to effectively communicate complex concepts and strategies regarding urban Native healthcare; updated NCUIH’s Knowledge Resource Center (KRC), which is an online hub of informational tools to educate Urban Indian Organizations (UIOs), policymakers, federal officials, and the public on Urban Indian health; and attended calls and meetings with federal agency leaders, congressional offices, and Indian Country partner organizations. It’s been incredibly rewarding to witness the behind-the-scenes work that shapes change.

One of my favorite parts during my internship was spending the month of August in Washington, DC, working in person. This experience provided me with a new perspective on both work culture and the unique environment of DC. Being able to immerse myself in the daily work life of a public policy office gave me a valuable perspective that I wouldn’t have gained otherwise.

I am deeply grateful to the Vice President of Policy and Communications, Meredith Raimondi, the Public Policy Manager, Mary Jomia, and the entire NCUIH team for giving me the opportunity to work with them again this summer. The experiences and knowledge I’ve gained over these two summers will undoubtedly shape my future endeavors in public policy and advocacy.

Final Report on Federal Indian Boarding School Initiative Calls on Congress and Executive Branch to Remedy Present-Day Impacts in Urban Native Communities

/in /by

On July 30, 2024, the U.S. Department of the Interior (DOI) released the second and final volume of the Federal Indian Boarding School Initiative’s (Initiative) investigative report (the Second Volume). This Second Volume builds on the initial volume published in May 2022 to significantly expand on the number and details of institutions to include attendee deaths, the number of burial sites, participation of religious institutions and organizations, and federal dollars spent to operate these boarding schools. It also includes policy recommendations for consideration by Congress and the Executive Branch to continue to chart a path to healing and redress for Indigenous communities, including the lasting impact on urban American Indian and Alaska Native communities.

See NCUIH’s previous blog on the Initiative by clicking here.

Investigative Report Findings

Findings Confirm Almost 1000 Native Child Deaths and Unmarked Burial Sites at Federal Boarding Schools

The Second Volume updates the official list of federal Indian boarding schools and maps to include 417 institutions across 37 states or then-territories. It provides detailed profiles of each school and confirms that at least 973 American Indian, Alaska Native, and Native Hawaiian children died while attending federal operated or supported schools. It also identifies at least 74 marked and unmarked burial sites at 65 different school sites, and estimates that the U.S. government made appropriations available of more than $23.3 billion in Fiscal Year 2023 inflation-adjusted dollars between 1871 and 1969 for the federal Indian boarding school system as well as other similar institutions and associated assimilation policies.

DOI Recommends that the Federal Government Invest in Addressing Current Impacts of Boarding School System

The report includes eight recommendations for the federal government from Assistant Secretary Newland that aim to support a path to healing the nation, including:

  1. Issuing a formal acknowledgment and apology from the U.S. government regarding its role in adopting and implementing national federal Indian boarding school policies;
  2. Investing in remedies to the present-day impacts of the federal Indian boarding school system;
  3. Establishing a national memorial to acknowledge and commemorate the experiences of Indian Tribes, individuals, and families affected by the federal Indian boarding school system;
  4. Identifying and repatriating remains of children and funerary objects who never returned from federal Indian boarding schools;
  5. Returning former federal Indian Boarding school sites to Tribes;
  6. Telling the story of federal Indian boarding schools to the American people and global community;
  7. Investing in further research regarding the present-day health and economic impacts of the federal Indian boarding school system; and
  8. Advancing international relationships in other countries with similar but their own unique histories of boarding schools or other assimilationist policies.
Restoration and Preservation of Native Languages Remains a Priority, Native Language Strategy on the Horizon

In recognition of the damage that federal Indian boarding schools and associated policies had on Native languages, investing in their restoration and preservation has been an early priority of the Biden-Harris administration. In 2021, the Departments of the Interior, Education and Health and Human Services (HHS) launched an interagency initiative to preserve, protect and promote the rights and freedom of American Indians, Alaska Natives and Native Hawaiians to use, practice and develop Native languages. Since then, both Secretary Haaland and Assistant Secretary Newland have traveled with First Lady Jill Biden and other Administration leaders to learn more about how Tribal Nations are leveraging federal investments to revitalize Native languages. The Administration expects to roll out a new ten-year Native Language Strategy by the end of 2024.

Native Boarding School Survivors Experiences Shared in ‘Road to Healing’ Initiative

In late 2023, Secretary Haaland and Assistant Secretary Newland completed “The Road to Healing,” a historic 12-stop tour across the country that provided Indigenous survivors the opportunity to share with the federal government their experiences in federal Indian boarding schools for the first time. The Road to Healing events included opportunities to connect survivors with trauma-informed support through the HHS’ Indian Health Service and Substance Abuse and Mental Health Services Administration. The reflections of many of those individuals are included in Volume 2 and transcripts are available on the Federal Boarding School Initiative website.

DOI also launched an oral history project to document and make accessible to the public the experiences of generations of Indigenous then-children who attended the federal Indian boarding school system. The National Native American Boarding School Healing Coalition is currently interviewing survivors for what will be a collection of first-person narratives. DOI and the Smithsonian’s National Museum of American History are partnering to explore how best to share with the public the history of the federal Indian boarding school system and its role in U.S. development, with a proposed focus on the never-told-before experiences of survivors.

Addressing Urban American Indian and Alaska Native Communities

Over $20 Billion Recommended to Heal Native Community from Impacts of Federal Boarding Schools

To complete the Secretary’s objectives for the Initiative, and to begin the pursuit of this express policy of cultural revitalization, Assistant Secretary Newland provided eight recommendations based on the current findings. The second recommendation, “Invest in Remedies to the Present-Day Impacts of the Federal Indian Boarding School System,” specifically mention providing funding for urban American Indian and Alaska Native communities. The recommendations states that the U.S. could invest in healing Indian Tribes, the Native Hawaiian Community, and American Indian, Alaska Native, and Native Hawaiian individuals from the legacy impacts of forced assimilation on a scale that is, at a minimum, commensurate with the investments made in the Federal Indian boarding school system between 1871 and 1969. This funding would be in addition to annual appropriation to fund agencies to fulfill the U.S. government’s trust and treaty obligations. The funding would also be designed to remedy present-day harms caused by historical federal Indian boarding schools and policies of forced assimilation and designed to reach urban American Indian, Alaska Native and Native Hawaiian communities. The Secretary writes that consideration for this investment should be applied to all of the recommendations in the report and include five interdependent areas of focus: (1) Individual and Community Healing; (2) Family Preservation and Reunification; (3) Violence Prevention; (4) Redress Indian Education; and (5) Revitalization of First American Languages. Assistant Secretary Newland included urban American Indian and Alaska Native communities when outlining plans for providing funding for Individual and Community Healing and Violence Prevention.

On June 14, 2024, the United States Conference of Catholic Bishops approved by vote (181-2) “Keeping Christ’s Sacred Promise: A Pastoral Framework for Indigenous Ministry,” issuing a formal apology for the Catholic Church’s role in the U.S. of inflicting a “history of trauma” to Indian Tribes, Alaska Native Villages, and the Native Hawaiian Community and affirmed its official repudiation of The Doctrine of Discovery. The Conference also provided a series of recommendations to confront the following issues in Indian Country and the Native Hawaiian Community: Natural Resources; Housing and Access to Financing; Education; Health Care; Racism; and Concerns of Urban Natives.

August Policy Updates: Focus Groups, Traditional Foods Report, FY25 Funding and more!

/in /by

🔍 Policy Priorities: Join September UIO focus groups to shape 2025 policies.

🍲🌾New NCUIH Resource: NCUIH Infographic on Traditional Food Programs at UIOs.

🏦 Report Update: NCUIH publishes a report on Medicaid Reimbursement at UIOs during the COVID-19 Pandemic.

📊 Appropriations Updates: FY25 bills advance with proposed increases to Indian Country programs; a Continuing Resolution might be needed post-September 30.

🇺🇸 NCUIH in Action: NCUIH represents UIOs at White House Voting Rights Convening.

📞 Advocacy: Advocating for the Urban Indian Health Parity Act and the Truth and Healing Commission bill.

✍🏽 Upcoming Comment Deadlines: September 6: IHS Health Information Technology (HIT) Modernization comments due; September 9: CMS Medicaid Four Walls Exemption feedback due; October 1: United States Department of Agriculture (USDA) Dietary Guidelines comments due.

📅 Important Dates: Mark your calendars for upcoming meetings, conferences, and events.

Next Week: Focus Groups to Shape 2025 Policy Priorities

2024 UIO Focus Groups

These sessions are an opportunity for UIO leaders and their staff to discuss your vital priorities that shape our advocacy efforts in 2025. We will host 5 individual sessions to allow UIO leaders and their staff from each UIO type to have unique discussions with NCUIH staff:

September 3 

  • 1:00-2:30 p.m. EST – Full Ambulatory
  • 3:00-4:30 p.m. EST – Outpatient and Residential

September 4   

  • 1:00-2:30 p.m. EST – Limited Ambulatory
  • 3:00-4:30 p.m. EST – Outreach and Referral

September 5   

  • 1:00-2:30 p.m. EST – Makeup Session

If you are unable to attend any of these dates, please email Policy@NCUIH.org to set up an individual session. We would love to hear from you!

NCUIH Resources: Report on Medicaid Reimbursement at UIOs during COVID-19 Pandemic and Infographic on Traditional Food Programs at UIOs

Traditional Foods Report

NCUIH’s Infographic “Analysis of Traditional Food Programs” complements NCUIH’s recently released report on Traditional Foods at UIOs and highlights:

  • Importance of traditional foods in Native communities.
  • Impact of colonization on traditional food practices.
  • Overview of common programs at UIOs that can incorporate traditional foods: Special Diabetes Program for Indians (SDPI), Nutritional Counseling, Food Prescriptions, and Community Gardens.
  • Access the Infographic here.

NCUIH’s report “Medicaid Reimbursement Rates at Urban Indian Organizations During the COVID-19 Pandemic” focuses on the impact of Medicaid reimbursement rates at UIOs during COVID-19. Despite UIOs providing additional services and growing programs to serve the urban Native community during COVID-19 pandemic, reimbursement rates did not significantly rise.

  • Access the report here.

Appropriations Updates: Senate Advances 2025 Funding Bill, Protects Key Indian Country Programs

Illustration of the U.S. Capitol

Senate Advances Labor-HHS Appropriations Bill: 

On August 1, 2024, the Senate Appropriations Committee advanced their FY 2025 Labor, Health, and Human Services (LHHS) appropriations bill which proposes increased or maintained funding for key Indian Country programs.

  • By the numbers: Includes $8 million for Improving Native American Cancer Outcomes, which would create an Initiative for Improving Native American Cancer Outcomes to be located at a National Cancer Institute-designated cancer center demonstrating strong partnerships with Tribes, Tribal Organizations, and UIOs;$24 million for the Good Health and Wellness in Indian Country program; and $23.67 million for Tribal Behavioral Health Grants.
  • What’s Ahead: FY 2024 funding is set to end on September 30, 2024. If Congress cannot come to a funding agreement by that deadline, a Continuing Resolution will be needed to maintain funding levels at FY24 levels until an agreement is reached.
  • Go deeper: Read NCUIH’s analysis of the bill.

Take Action to Support Mandatory Funding for IHS CSCs and 105(l) leases: 

NCUIH sent out an action alert urging advocates to contact Congress to support mandatory funding for IHS Contract Support Costs (CSCs) and 105(l) lease funding.

  • Ways to advocate: Call or email your Representative, and post on social media using the template language provided in the action alert. Contact Congress.

NCUIH in Action: Engaging at White House Event on Native American Voting Rights

FC at WH

NCUIH CEO, Francys Crevier (Algonquin) and Executive Director of White House Initiative for Native Americans and Tribal Colleges and Universities, Naomi Miguel (Tohono O’odham).

On July 31, NCUIH CEO Francys Crevier attended the White House Convening on Native American Voting Rights. Ensuring every Native vote is heard is essential to our democracy & the well-being of our people. UIOs are at the forefront of this mission, promoting civic engagement & health equity.

What else?: The election is coming up, and NCUIH has created special resources for UIOs. Download Posters and Flyers

Legislative Updates: Addressing Federal Indian Boarding Schools, Audio-Only Telehealth Services, and 100% FMAP for UIOs

S1723

Two potential pathways for the Truth and Healing Commission on Indian Boarding School Policies Act of 2023 (S. 1723/H.R. 7227) bill to be passed:

  • On July 8, 2024, the Senate bill was placed on the legislative calendar. The expectation is that the bill will pass the Senate.
  • Additionally, Senators Brian Schatz (Hawaii- Chair of the Senate Committee on Indian Affairs) and Lisa Murkowski (Alaska – Vice-Chair) filed a bipartisan amendment attaching the bill to the National Defense Authorization Act (NDAA), providing the bill with two potential pathways to be passed.
  • The Congressional Budget Office (CBO) score for the House bill was released with $90 million authorized over FY24-FY2034, funded from unobligated ARPA (American Rescue Plan Act) IHS funding.
  • The House bill is awaiting a committee report before being scheduled for a floor vote.
  • Why it matters: the bill would establish a formal commission to investigate, document, and acknowledge past injustices of the federal government’s Indian Boarding School Policies.

On August 2, Rep. Teresa Leger Fernandez (D-NM-3) introduced the NCUIH-endorsed IHS Audio-Only Telehealth Bill, which would make permanent a COVID-19 Public Health Emergency temporary provision allowing audio-only telehealth services for Medicare beneficiaries receiving care through Indian health programs or UIOs.

  • Why it matters: IHS, tribally operated facilities, and UIOs would benefit from continued reimbursement from Medicare for audio-only telehealth services as program budgets heavily depend upon third-party reimbursements.
  • Go Deeper: Read more on NCUIH’s blog.

Recent update on 100% Federal Medical Assistance Percentage (FMAP) for UIO Medicaid Services: 

NCUIH is working to advance legislation by the end of 2024 for 100% FMAP for UIO Medicaid services.

Next Steps: Congress is currently in recess until September 9 and will only have three weeks of work before the session ends on September 27. During this short session, the focus is expected to be on addressing the government funding that expires on September 30, making it unlikely that other legislation will advance before the election. However, the lame-duck session—the period between the November election and the start of the new Congress—will be crucial for passing key legislation. Reports suggest that Congress could move on an end-of-year package that includes health extenders. NCUIH will continue to advocate for the inclusion of 100% FMAP in any legislation Congress considers during this time.

What UIOs Can Do:

  • If UIOs would like to write a letter or meet with their Member of Congress to support this legislation, NCUIH is available to assist. Email policy@ncuih.org.
  • Reminder: UIOs can still work with their states to improve Medicaid reimbursement rates even without 100% FMAP.

NCUIH Advocates for Full Funding to Meet Indian Country Needs and UIO and Tribal Engagement in Recommendations to the White House

biden signing

On August 9, NCUIH submitted comments to the White House regarding Executive Order (EO) 14112 Section 4(a): Assessing Additional Funding to Better Live up to the Trust Responsibility.

 Go deeper: NCUIH recommended that forthcoming White House guidance to agencies working to calculate the unmet scope of the trust responsibility direct them to: capture the full level of federal funding need to meet the trust obligation for health to all of Indian Country and engage with UIOs through urban confer and continue to seek tribal feedback.

Upcoming Federal Comment Opportunities: Syphilis Outbreak, HIT Modernization, Medicaid Four Walls Exemption, and Dietary Guidelines

Illustration of a virus surrounded by caution tape

September 5: HHS Office of the Assistant Secretary for Health (OASH) – Syphilis and Congenital Syphilis Outbreak 

OASH seeks information from Indian Country about possible HHS actions that may support efforts to reduce the number of syphilis and congenital syphilis cases among American Indians and Alaska Natives. Specifically, they seek comments on the following questions:

  • What are your top three priorities for addressing the syphilis and congenital syphilis epidemic in Indian country?
  • What are the top three changes that HHS could implement to reduce the cases of syphilis and congenital syphilis in your communities?
  • What successful models or innovations have you implemented that could be adapted and scaled by other communities?

What’s next: The deadline for written comments is September 5, 2024, and can be submitted to STI@hhs.gov, using the following subject line: “Tribal Consultation.”

September 6: IHS – Health IT Modernization Multi-Tenant Domain Considerations. 

IHS seeks to better understand how to enhance the benefits and address challenges with the new Electronic Health Record (EHR) system, now called PATH (Patients at the Heart). IHS specifically seeks comments on the following questions:

  • What can IHS do to increase the value proposition for urban partners to participate in PATH EHR (Electronic Health Record)?
  • What challenges and risks might your facilities face when transitioning to PATH EHR?
  • What should IHS consider when preparing end users to operate within a shared EHR environment with a single patient record?

What’s Next: The deadline for written comments is September 6, 2024, and can be submitted to consultation@ihs.gov or urbanconfer@ihs.gov, using the following subject line: ” Health IT Modernization.”

There will also be a joint IHS Tribal Consultation/Urban Confer session on November 7, 2024, 1:30-3 PM ET, on HIT Modernization Site Readiness and Training. This will be a hybrid event at IHS Headquarters in Rockville, MD. Register here.

September 9: CMS – Outpatient Prospective Payment System (OPPS) Proposed Rule

  • CMS hosted an All Tribes Consultation Webinar on August 8, 2024.
  • CMS is requesting information related to a Tribal Technical Advisory Group (TTAG) request to apply the IHS Medicare encounter rate to all outpatient Tribal clinics for Medicare services.
  • CMS also proposes to establish a permanent exception to the Medicaid clinic services benefit four walls requirement for IHS and Tribal clinics, and, at state option, for behavioral health clinics and clinics located in rural areas.

What’s Next: The deadline for written comments is September 9, 2024, and can be submitted electronically at https://www.regulations.gov (follow the “Submit a comment” instructions), or by mail to the following address: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1809-P, P.O. Box 8010, Baltimore, MD 21244-8010.

October 1 – United States Department of Agriculture (USDA) Dietary Guidelines for America   

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

What’s next: Written comments are due October 1, 2024, and can be submitted online (preferred method) at the Federal eRulemaking Portal, or by mail to Janet M. de Jesus, MS, RD, HHS/OASH Office of Disease Prevention and Health Promotion (ODPHP), 1101 Wootton Parkway, Suite 420, Rockville, MD 20852. All submissions received must include the agency name and Docket OASH-2022-0021.

Upcoming Events and Important Dates

Calendar with events on it

Sept. 5: Association of American Indian Physicians (AAIP) Conference in Salt Lake City, UT. NCUIH will be presenting its reports on Traditional Healing. Register here.

Sept. 10-12: IHS Direct Service Tribes Advisory Committee (DSTAC) 4th Quarter Meeting. Location TBD. Visit IHS website for more information.

Sept. 10-12: HHS Secretary’s Tribal Advisory Committee (STAC) – Northwest Portland Area

Sept. 10: Medicare, Medicaid and Health Reform Policy Committee (MMPC) Monthly Meeting

Sept, 17-18: Tribal Leaders Diabetes Committee (TLDC) Quarterly Meeting in Washington, D.C (hybrid). Link to join meeting on September 17. Link to join meeting on September 18.

ICYMI: Recent IHS Tribal and Urban Leader Letters, IHS Strategic Plan Recommendations, and Budget Insights

Illustration of a neon sign in the shape of a health plus with an information "i" in the center.

Recent Dear Tribal and Urban Leader Letters (DTLL/DULL) 

August 12: IHS writes to Tribal and UIO leaders to share tools to address climate change, associated health risks, and strategies to address environmental justice (EJ).

IHS wrote to share tools to address climate change, associated health risks, and strategies to address environmental justice:

Important Events:

July 22-23: IHS Tribal Self-Governance Advisory Committee (TSGAC) Meeting

  • IHS representatives reported that reclassifying CSC and 105 (l) leases to mandatory funding would protect the entire IHS budget.

TSGAC’s recommendations for improving the IHS strategic plan:

  • Develop a public strategic plan scorecard
  • Develop evaluation or monitoring mechanism
  • Tribal consultation requirements in the plan’s objectives/activities

July 25: IHS FY 2026-2027 Tribal Budget Formulation Planning and Evaluation Meeting

  • The FY25 President’s Budget provides an additional $1 billion annually in FY26 and FY27 to fully address the 2023 estimated backlog of essential maintenance, alteration, and repair (BMAR) for IHS and tribal facilities, and to account for anticipated growth in the BMAR through FY 2026.
  • IHS staff stated that the FY 2025 House Bill includes a $115 million decrease to the Electronic Health Record (EHR) Modernization Project. This decrease is likely due to the Fiscal Responsibility Act (FRA).

One last thing, check out this upcoming funding opportunity:

Health Resources and Services Administration (HRSA) New Access Points (NAPs)

  • HRSA announces that applications to establish NAPs are now open to expand access to affordable, high-quality primary health care, including mental health and substance use disorder services, for underserved communities and populations. HRSA will only be able to make awards for this Notice of Funding Opportunity if Congress appropriates additional funds for the Health Center Program in FY 2025. HRSA-funded health centers operate more than 15,000 service sites nationwide. If Congress appropriates additional funding in FY 2025, these NAPs will expand the number of health centers in the HRSA Health Center Program and help HRSA-funded health centers open new locations. NAP applicants may be currently funded health centers, look-alikes, or new organizations (those not yet part of the Health Center Program).
  • Applications are due in Grants.gov on August 30, 2024, and in HRSA’s Electronic Handbooks on September 30, 2024 (Apply).

NCUIH Recommends Noncompetitive Funding Model and Support for Whole Family Substance Abuse Treatment in IHS Behavioral Health Initiatives

/in /by

On July 22, 2024, the National Council of Urban Indian Health (NCUIH) submitted comments to the Indian Health Service (IHS) Director, Roselyn Tso, in response to a May 21, 2024, Dear Tribal Leader and Dear Urban Indian Organization Leader letter (DTLL/DULL) and June 20, 2024, Urban Confer on IHS Behavioral Health Initiative Funding. In its comments, NCUIH recommended that IHS consider developing a funding methodology similar to the Special Diabetes Program for Indians (SDPI) National Funding Formula, which was developed to avoid competition for funds and to reduce barriers to access in an effort to ensure equitable distribution of funds for behavioral health grant funding.

Background

President Biden’s December 6, 2023, Executive Order (EO) 14112, “Reforming Federal Funding and Support for Tribal Nations To Better Embrace Our Trust Responsibilities and Promote the Next Era of Tribal Self-Determination,” directs Federal agencies to implement reforms to federal funding and support programs to make them more accessible, flexible, and equitable. In accordance with EO 14112, the IHS Division of Behavioral Health (DBH) is evaluating Agency-wide processes for distributing appropriated funding for behavioral health initiatives. In fiscal year 2024, the IHS administers more than $59 million in behavioral health initiatives funding, including the seven grant programs that address substance abuse, domestic violence, suicide, and youth regional treatment centers aftercare.

Almost every UIO provides behavioral health, mental health, or substance use disorder care, in addition to primary care services, Traditional Healing and Medicine, and social and community services. Further, seven UIOs have intensive inpatient/residential services as part of their behavioral health services. To fund this important work, 18 UIOs utilize the seven behavioral health grant programs that IHS is seeking feedback on to support and save lives, but the need for these programs is felt at all 41 UIOs.

NCUIH’s Recommendations and Requests

In response to the May 21 DTLL/DULL and June 20 Urban Confer, NCUIH made the following recommendations and requests to IHS regarding Behavioral Health Initiative Funding:

  • Ensure noncompetitive program awards across the I/T/U system
  • Support whole family treatment
  • Support for youth residential treatment centers at UIOs
  • Ensure funding reform for these programs does not create additional reporting requirements
  • Continue to engage with UIOs

NCUIH will continue to monitor as IHS conducts the grant funding evaluation process.

House Committee Report Reveals Persistent Voting Barriers for Native Communities and Calls for Legislative Action

/in /by

In July 2024, House Committee on Administration Ranking Member Joseph D. Morelle (D-N.Y.), released a critical report titled Voting for Native Peoples: Barriers and Policy Solutions. This report underscores the ongoing struggles faced by Native communities in exercising their right to vote—a fundamental right that has been undermined for decades.

The Report provides a detailed history of the oppression and discrimination against Native peoples by the United States federal government, highlighting physical, identification, language, and systematic barriers that continue to hinder full participation in the electoral process. It also highlights the efforts of state and local governments to dilute Native votes and engage in racial gerrymandering, stating that “lawmakers further dilute Tribal citizens’ voting strength by packing supermajorities of Native voters into single electoral districts, even where the community is large enough to constitute a majority and elect candidates of choice in more than one district.”

The report also calls for actionable solutions to the problems outlined. It advocates for the passage of key legislation, including the Native American Voting Rights Act, the Freedom to Vote Act (H.R. 11), and the John R. Lewis Voting Rights Advancement Act (H.R. 14), which aim to dismantle the barriers to voting and restore essential protections for Native voters. NCUIH endorsed the Native American Voting Rights Act in the 117th Congress and supports the reintroduction of this legislation in a future Congress.

Key Findings and Policy Proposals:

Barriers to Voting for Native Peoples:

  • Physical Barriers: The report highlights “Native Americans face substantial barriers to accessing in person voting and voter services, including voter registration and ballot drop boxes, due to extreme physical distances”.
  • Language Barriers: “Few states and localities offer robust assistance in Indigenous languages, sometimes in violation of federal law.”
  • Identification Barriers: “Several states have enacted, implemented, or enforced voter identification laws, including documentation requirements to register to vote and to cast a ballot in person or by mail, that abridge the right of Native peoples to participate fully and equally in the nontribal political process.”
  • Systematic Barriers: “[The]federal government’s removal, reservation, assimilation, and termination policies of the nineteenth and twentieth centuries created systemic obstacles that compound the barriers Tribal citizens face to full and equal participation in the nontribal political process.”
  • Residential Address Barriers: “Tribal members commonly use descriptive addresses, specifying where they live using highway or Bureau of Indian Affairs route numbers, mile markers, and other landmarks. Tribal members who rely primarily on descriptive addresses often face substantial obstacles when attempting to register to vote and cast a ballot. Most troublingly, in some instances, Tribal members have been completely barred from the political process or certain methods of voter registration when they attempt to use a descriptive address”.

Proposed Policy Solutions:

  • The Frank Harrison, Elizabeth Peratrovich, and Miguel Trujillo Native American Voting Rights Act (NAVRA): this legislation would address many of the barriers to voting faced by Native peoples by establishing baseline, consistent standards for voting throughout Indian Country, ensuring that Native Americans no longer bear the burden of lengthy, costly litigation to defend and enforce their right to vote. NCUIH has endorsed this legislation.
  • John R. Lewis Voting Rights Advancement Act (VRAA): this bill would restore important provisions of the Voting Rights Act that have been severely curtailed by the U.S. Supreme Court and other federal courts over the past two decades. The VRAA also strengthens Section 2 of the Voting Rights Act—a key pillar that allows plaintiffs, including Tribal nations and individual voters, to bring claims for vote denial and vote dilution.

For more details, read the full report here.

NCUIH Advocacy on Native Voting

NCUIH has taken several steps to address some of the barriers discussed in the report. In February 2024, NCUIH signed a letter of support for the John R. Lewis Voting Rights Advancement Act and endorsed the legislation. Additionally, NCUIH has worked closely with the National Urban Indian Family Coalition to Get Out The Vote and improve voter registration abilities at Urban Indian Organizations.