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

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

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

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NCUIH Staff Member Visits Oklahoma City Indian Clinic

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

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

OKCIC’s Demonstration Kitchen

OKCIC’s Demonstration Kitchen

OKCIC’s Michelle Dennison and NCUIH’s Alexandra Payan

OKCIC’s Michelle Dennison and NCUIH’s Alexandra Payan

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

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

Background

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

AI/AN Historical Trauma

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

NCUIH’s Role

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

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

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

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

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

Medicaid Continuous Enrollment 

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

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

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

Read the letter

The Letter Identifies Drivers of Workforce Shortages:

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

The Letter Recommends:

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

Full Letter Text

Dear Chairman Sanders and Ranking Member Cassidy:

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

Drivers of Workforce Shortages

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

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

Recommendations

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

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

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

About the Partnership for Medicaid

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

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

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Dear Urban Indian Health Advocates,

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

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

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

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

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

Sincerely,

The National Council of Urban Indian Health (NCUIH)

STEPS TO CONTACT CONGRESS 

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

Email to Your Member of Congress

Dear Representative,

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

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

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

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

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

Sincerely,

[YOUR NAME]

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

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

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

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

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

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

Letter

Download Letter

Re: Native Behavioral Health Resources Program

Dear Director Young,

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

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

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

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

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

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

Background

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

NCUIH to Testify Before House Interior Appropriations

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NCUIH to Testify Before House Interior Appropriations

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

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

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Livestream

 

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

IHS Clarifies Additional $800,696 in Funding Allocated in the Consolidated Appropriations Act, 2022 Not Intended for UIO Infrastructure Study Activities

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On February 13, 2023, the Indian Health Service (IHS) sent a  Dear Urban Indian Organization Leader letter (DULL) clarifying use of funds requirements from the Fiscal Year (FY) 2022 Urban Indian Organization (UIO) Infrastructure Study as a follow-up to the virtual Urban Confer convened by the IHS on June 23, 2022. In the letter, IHS emphasized that “…the joint explanatory statement accompanying the Consolidated Appropriations Act, 2022 (CAA, 2022) does not mean Congress intends to allocate additional funding for UIO Infrastructure Activities. Instead, Congress intends to ensure that the additional funding provided remains in the Direct Operations accounts of IHS management use.” IHS notes that this aligns with UIO Confer recommendations to avoid using the funding for any additional UIO Infrastructure Study activities.

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 aims to better understand the most critical deficiencies facing UIOs. On March 15, 2022, Congress provided $800,666 in additional funding to IHS for the Infrastructure Study through the CAA, 2022. On June 16, 2022, IHS requested input from UIO leaders regarding the additional funding from the CAA, 2022 on 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 scheduled for release in January 2023. Results have not been released as of February 2023.

NCUIH’s Recommendations to IHS

On August 23, 2022, NCUIH submitted comments to IHS in response to the June 16, 2022 DULL regarding the use of funding available for the Urban Indian Infrastructure Study.  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 was an 8-month window in which UIOs and IHS will be able to review the Infrastructure Study results following their scheduled 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 Requests the Administration of Children and Families Host Urban Confer with UIOs Regarding the Tribal Maternal, Infant, and Early Childhood Home Visiting Program

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On January 27, 2023, the National Council of Urban Indian Health submitted comments to the Administration for Children and Families (ACF) in response to their December 20, 2022 request for comment on review of the Tribal Maternal, Infant, and Early Childhood Home Visiting Program (Tribal MIECHV) Guidance for Submitting Reports to the Secretary of the Office of Management and Budget (OMB). The Tribal MIECHV Program provides grants to tribal organizations and urban Indian organizations (UIOs) to develop, implement, and evaluate home visiting programs in American Indian and Alaska Native (AI/AN) communities.

Recommendations

NCUIH made the following recommendations to ACF in response to the request for comments:

  • NCUIH requested that ACF host an Urban Confer with UIO leaders to discuss the Tribal MIECHV program.
  • NCUIH recommended that ACF work with its colleagues at IHS to host and facilitate an Urban Confer on the annual reporting requirements for Tribal MIECHV grantees.
    • Given the substantial increase in the set-aside for the Tribal NCUIH further recommends that ACF consider broadening the scope of this Urban Confer to engage with UIOs on the Tribal MIECHV program generally.
    • This will provide ACF a forum in which to work with UIOs to ensure that they are participating in this program to the greatest extent possible and that urban Native communities are being served as Congress intended.

Background

Under the ACF, the MIECHV Program supports pregnant people and parents with young children who live in communities that face greater risks and barriers to achieving positive maternal and child health outcomes. The Tribal MIECHV program is funded by a six percent set-aside from the larger MIECHV program. The Tribal MIECHV program aims to support the development of happy, healthy, and successful AI/AN children and families through a coordinated home visiting strategy that addresses critical maternal and child health, development, early learning, family support, and child abuse and neglect prevention needs. It also implements high-quality, culturally relevant, evidence-based home visiting programs in AI/AN communities and expands the evidence base around home visiting interventions with Native populations.

Urban Native Maternal and Child Health Disparities

Native people have endured a tragic history of forced removal from their homelands throughout eras of colonization and US expansion. Formally dating back to the 1800s, forced removal included the loss of ancestral homelands,  children taken from their parents and placed into government boarding schools, and policy aimed at integrating Native people into US cities, each resulting in traditional and cultural deprivation. This migration into cities has resulted in urban Indians experiencing more unemployment and homelessness compared to the general population, lower levels of educational achievement, higher rates of morbidity and mortality and a loss of traditional and cultural connection. Urban Indian women have considerably lower rates of prenatal care and higher rates of infant mortality than their reservation counterparts within the same state. While UIOs provide critical health and social services, the safety net available to those living on reservations is often not matched in urban environments. Recognizing the health disparities experienced by urban Indians, MIECHV legislation allows Tribal MIECHV funds to be awarded to UIOs to further support the health and social needs of Native people living in urban areas.

NCUIH’s Role

NCUIH has engaged in extensive policy work, including attending Congressional meetings and joining sign-on letters with coalition partners, in support of reauthorizing the MIECHV program and doubling the Tribal set-aside. NCUIH was pleased that Congress reauthorized the Tribal MIECHV program and increased the funding level. The Tribal MIECHV program helps improve the lives of AI/AN children and families and NCUIH looks forward to more UIOs becoming grantees and working with ACF to support the development of happy, healthy, and successful Native children and families no matter where they live.