Policy Blog Archives - Page 29 of 61

NCUIH Submits Comments to the Department of Veterans Affairs and IHS on VHA-IHS Memorandum of Understanding Operational Plan

January 10, 2023/0 Comments/in Policy Blog/by Colin Tompson

On November 30, 2022, NCUIH submitted comments to the U.S. Department of Veterans Affairs (VA) and the Indian Health Service (IHS) regarding the Veterans Health Administration (VHA) and IHS first-ever Draft Annual Operational Plan for fiscal year (FY) 2022 for the VHA-IHS Memorandum of Understanding (MOU). The MOU establishes a framework for coordination and partnership between VHA and IHS to leverage and share resources and investments in support of each organization’s mutual goals. NCUIH believes that the Draft Annual Operational Plan (Operational Plan) can be a significant step forward in implementing the IHS-VHA MOU and ensuring high quality health care for all American Indian/Alaska Native (AI/AN) veterans and continues to work closely with our colleagues at VA and IHS to ensure that Native veterans receive access to the care they earned through their military service, no matter where they live.

Background

AI/AN veterans have served in the United States military in every armed conflict in the Nation’s history and have traditionally served at a higher rate than any other population in the United States. In return for their service, the United States promised all veterans, including Native veterans, “exceptional health care that improves their health and well-being.” However, of the estimated 86.2 percent of AI/AN veterans that live in urban areas, they generally have higher unemployment, lower education attainment, lower income, higher VA-service connected disability, and generally live in poorer housing conditions than non-Native veterans also living in urban areas.

Recommendations

In its comments, NCUIH stressed the importance of the Operational Plan being a vehicle to articulate leadership priorities, provide direction for program management and distribution of resources, engage internal and external partners, and measure the overall progress toward meeting the MOU’s goals and objectives. NCUIH’s comments emphasized the importance of having OUIHP representation and leadership throughout the plan. As subject matter experts in the health needs of Natives living in urban areas, having representatives who are familiar with UIOs will ensure the needs of urban Native veterans are incorporated into the plan’s actions. Additionally, to improve the collaboration between the VA and IHS, and to ensure that care for AI/AN veterans is not disrupted, NCUIH recommended that the Operational Plan has a strategy in place to achieve seamless referrals between the VA and the I/T/U system. NCUIH further stressed the importance of regular consultation with Tribal Governments, Urban Confers with UIOs, and meetings with the HHS Secretary’s Tribal Advisory Committee on Tribal and Indian Affairs. Moreover, because VA data currently indicates that Native veterans use Veterans Benefits Administration benefits or services at lower percentages than other veterans, NCUIH recommended that the Operational Plan add an additional objective be added to increase AI/AN veteran use of VA benefits and services.

NCUIH’s work with the VA

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

For more information on NCUIH’s efforts please visit:

Maternal, Infant, and Early Childhood Home Visiting Program Reauthorization Included in Final Appropriations Package with Tribal Set-Aside Increase

January 9, 2023/0 Comments/in Policy Blog/by Jennifer Wendling

On December 29, 2022, the Jackie Walorski Maternal and Child Home Visiting Reauthorization Act of 2022 (H.R. 8876) was included in the final appropriations package, also known as the omnibus, for Fiscal Year (FY) 2023. Notably, the omnibus reauthorized the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) and increased funding through FY 2027. The program supports home visit programs, including the Tribal Home Visiting Program (THVP), for expectant and new parents who live in communities that are at risk for poor maternal and child health outcomes. To continue improving the infant and maternal health of American Indian/Alaska Native (AI/AN) communities, the bill provides a notable improvement to the THVP program by (from 3% to 6%) starting in FY 2023. The National Council of Urban Indian Health (NCUIH) has advocated for the reauthorization of MIECHV and increasing funding for the Tribal set-aside and continues to advocate on behalf of AI/AN mothers and infants.

In addition, the bill makes several to the MIECHV program overall, such as:

$500,000,000starting grant base in FY23, scheduled funding increases of $50,000,000 through FY 2027.
Dedicates a 2% set-aside for workforce support, retention, and case management.
Allows set-asides for research, evaluation, and administration (3%) and technical assistance (2%).
Creates an “outcomes dashboard” to help Congress and the public track MIECHV’s success in improving family outcomes.
Annual report to Congress to better oversee the program and make improvements in the future.

Background

The Tribal Home Visiting Program

Since 2010, a 3% set-aside has been allotted to the THVP, a program administered within MIECHV to specifically support and promote the health and well-being of AI/AN families.

From the MIECHV 2015 Congressional Report, THVP grantees, including urban Indian organizations (UIOs), served 870 families—5 times the number served in FY 2012. Nearly 20,000 home visits were provided to 3,197 adult participants and children between FY 2012 and FY 2014. After 3 years of implementation, 77% of grantees also demonstrated overall improvement in several benchmark areas. These include:

62% improvements in maternal and newborn health
85% increase in the prevention of child injuries, child abuse, neglect, or maltreatment, and reduction of emergency department visits
69% improvement in school readiness and achievement
77% reduction in crime or domestic violence
77% improvement in family economic self-sufficiency
69% improvements in the coordination and referrals for other community resources

Since its inception, the THVP has been an influential program to help improve the development of healthy AI/AN children and families through coordinated, culturally relevant, and evidence-based home-visiting strategies addressing critical maternal and child health needs.

NCUIH Advocacy

NCUIH has engaged in extensive advocacy on behalf of AI/AN mothers and infants for increased funding and support to the UIOs that provide maternal health, infant health, prenatal, and family planning services. On March 9, 2022, NCUIH signed on to a letter to Congress led by the National Home Visiting Coalition in support of reauthorizing the MIECHV program and doubling the Tribal set-aside, which includes UIOs.

NCUIH also submitted comments on March 10, 2022, to the Health Resources and Services Administration (HRSA) Advisory Committee on Infant and Maternal Mortality (ACIMM), which advises the Secretary of Health and Human Services (HHS) on department activities, partnerships, policies, and programs directed at reducing infant mortality, maternal mortality and severe maternal morbidity, and improving the health status of infants and women before, during, and after pregnancy. On August 31, 2022, NCUIH submitted comments to HRSA’s Maternal and Child Health Bureau (MCHB) regarding the Pediatric Mental Health Care Access Program. In those comments, NCUIH continued to stress the critical importance of including urban Natives populations in HRSA’s overall efforts of improving health outcomes for all AI/ANs living on and off reservations.

On September 14, 2022, NCUIH’s Vice President of Public Policy, Meredith Raimondi, presented before the HRSA ACIMM on urban Indian disparities and policy changes to address these disparities. Raimondi highlighted that “over half of urban Indian health centers provide care for maternal health, infant health, prenatal, and/or family planning. However, due to chronic underfunding, many of these health centers only have the capacity to carry out these services for the early stages of pregnancy.” She continued to say, “despite desiring to do so, many urban Indian health clinics cannot expand their services to provide complete care for mothers and infants from conception to birth due to underfunding.”

Thanks to this NCUIH advocacy, H.R. 8876 included language to double the Tribal set-aside from 3% to 6% in FY 2023, which was ultimately included in the final appropriations package for FY 2023.

AI/AN Maternal Health Disparities

American Indian and Alaska Native (AI/AN) communities throughout the country, including urban AI/AN communities, experience significant maternal and infant health disparities compared to the general population. A report by the National Center for Health Statistics noted that between 2005 and 2014, AI/ANs were the group that did not experience a decline in infant mortality.

Over half of UIOs provide care for maternal health, infant health, prenatal, and/or family planning. A study of Natives in UIO service areas found that while birth rates, in general, were lower in the urban Native population (12.8 and 16.5 per 1,000 population, respectively), premature birth rates for both urban and non-urban AI/AN were higher than those of all other races and ethnicities combined (12.3% of live births among AI/AI in urban areas and 10.9% among the general population in the same area).

Through expanded research efforts, many factors have been directly identified as reasons for AI/AN infant and maternal health disparities. These include:

41% of AI/AN women cite cost as a barrier to receiving the recommended number of prenatal visits.
AI/AN women are 3-4x more likely to begin prenatal care in the third trimester.
21% of AI/AN women ages 15-44 are uninsured, compared to 8% of white women.
23% of AI/ANs report they have faced discrimination in clinical settings due to being an AI/AN.
15% report avoiding medical care for themselves or family members due to fear of discrimination.
Access to culturally appropriate care can be difficult for AI/ANs living in urban areas, as most IHS clinics and hospitals, as well as Tribal healthcare facilities, are located on reservations.

Final FY2023 Omnibus Bill Includes Advance Appropriations for the Indian Health Service and Several Other Priorities

January 9, 2023/0 Comments/in Policy Blog/by NCUIH

The bill includes $6.96 billion for IHS and $90.42 million for urban Indian health.

On December 29, 2022, the Consolidated Appropriations Act, 2023 (H.R. 2617) for fiscal year (FY) 2023, also known as the ‘omnibus,’ was signed into law by President Biden. This follows a third continuing resolution for FY2023 through December 30. The bill passed in the Senate with a 68-29 vote followed by a House passage of a 221-205-1 vote. The 4,155-page omnibus bill authorizes $6.96 billion for the Indian Health Service (IHS) for FY 2023, a $360 million increase above the FY 2022 enacted level; advance appropriations for IHS totaling $5.13 billion for FY 2024; and $90.42 million for urban Indian health for FY 2023. In addition, the final package includes increased funding to expand behavioral health services and programs eligible to urban Indian organizations (UIOs).

The National Council of Urban Indian Health (NCUIH) has long advocated for larger investments in American Indian and Alaska Native (AI/AN) health care and has called on Congress to strengthen its commitment to Indian Country with increased funding in the FY 2023 appropriations. Unfortunately, despite robust NCUIH advocacy, the bill does not include an extension of 100% Federal Medical Assistance Percentage (FMAP) for UIOs or an Urban Confer policy with the Department of Health and Human Services (HHS). NCUIH will continue to advocate for these priorities in future legislation.

The Tribal Budget Formulation Workgroup (TBFWG), a national workgroup that identifies annual Tribal funding priorities, requested full funding for IHS at $49.9 billion and $949.9 million for urban Indian health. While the bill provides a key Indian Country request for advance appropriations for IHS, unfortunately, the final amount still falls short of fully funding IHS so that the agency can properly provide health care services for all AI/ANs.

To read NCUIH’s joint press release with the National Indian Health Board (NIHB) and the National Congress of American Indians (NCAI) on the inclusion of IHS advance appropriations in the omnibus, click here.

Bill Text:

Overview of IHS and Urban Indian Health Requests

Line Item	FY22 Enacted	FY23 TBFWG Request	FY23 President’s Budget	FY23 House Passed	FY23 Senate Proposed	FY23 Omnibus
Urban Indian Health	$73.43 million	$949.9 million	$112.5 million	$200 million	$80.4 million	$90.4 million
Indian Health Service	$6.6 billion	$49.8 billion	$9.3 billion – Mandatory funding*	$8.1 billion	$7.38 billion	$6.9 billion
Advanced Appropriations	——————-	———————-	—————	—————-	$5.6 billion	$5.1 billion
Hospitals and Clinics	$2.3 billion	$8.66 billion	$3.4 billion	$2.8 billion	$2.8 billion	$2.5 billion
TECs	$24.4 million	$24.4 million	$24.8 million	$34.4 million	$34.4 million	$34.4 million
EHRs	$145 million	$451 million	$284.5 million	$284.5 million	$217.5 million	$217.5 million
CHRs	$63.6 million	$1.4 billion	$68.8 million	$65.2 million	$67 million	$65.2 million
Direct Operations	$95 million	$98.4 million	$115.4 million	$135.4 million	$103.8 million	$103.8 million
Mental Health	$121.9 million	$3.9 billion	$199.1 million	$130 million	$127.1 million	$127.1 million
BIA MMIW	$24.9 million	——————–	—————	$25.1 million	$25.1 million	$25.1 million

Key Provisions for IHS, Tribal Organizations, and UIOs

$6.9 billion for IHS for FY 2023
$90.4 million for urban Indian health for FY 2023
$5.1 billion for Advance Appropriations for FY 202
$24 million for the Good Health and Wellness in Indian Country Program

$15.6 million to make payments under the National Health Service Corps Loan Repayment program
$80 million authorized to be appropriated through FY2023-FY2027 for Native Behavioral Health Access Grants
Reauthorizes and establishes scheduled funding increases for the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) and doubles the Tribal set-aside from 3% to 6% for the Tribal Home Visiting Program
Fully funds Contract Support Costs and Payments for Tribal Leases

Analysis

Urban Indian Health

$90,419,000 for urban Indian health for FY 2023

Indian Health Service

$5,129,458,000 in advance appropriations for IHS for FY 2024
$6,958,223,000 in agency funding for IHS in FY 2023
- Indian Health Services – $4,890,282,000
Hospitals and Health Clinics – $2,503,025,000
Tribal Epidemiology Centers (TECs) – $34,400,000
Electronic Health Records (EHRs) – $217, 564,000
Community Health Representative (CHRs) – $65,212,000
Mental health – $127,171,000
Direct Operations – $103,805,000
Indian Health Care Improvement Fund – $74,138,000
Indefinite appropriation to fully fund Contract Support Costs at $969,000,000 for FY 2023
Indefinite appropriation to fully fund payments for 105(l) leases at $111,000,000 for FY 2023
Funds Indian Health Facilities at $958,553,000

Health and Human Services (HHS)
Health Resources and Services Administration (HRSA)

Native Hawaiian Health Care
- $27,000,000
National Health Service Corps (NHSC)
- $15,600,000 to Indian Health Service facilities, Tribally Operated Health Programs, and Urban Indian Health Programs to make payments under the NHSC loan repayment program.
Center of Excellence for Eating Disorders – Screening and Referrals
- $1,000,000 through FY 2027
  - Funding for training and technical assistance to primary and behavioral health providers and non-clinical community support workers to identify treatment and provide ongoing support to individuals with eating disorders

Centers for Disease Control and Prevention (CDC)

Good Health and Wellness in Indian Country (GHWIC)
- $24,000,000
Minority HIV/AIDS Prevention and Treatment Program
$5,000,000 Tribal set-aside under the Minority HIV/AIDS Prevention and Treatment Program

Important Behavioral and Mental Health Provisions (Restoring Hope For Mental Health And Wellbeing)

Medication-Assisted Treatment for Prescription Drug and Opioid Addiction
- $14,500,000
Peer-Supported Mental Health Services
- $13,000,000 for each of fiscal years 2023 through 2027
  - A new grant program with direct UIO eligibility
Infant and Early Childhood Mental Health Promotion, Intervention and Treatment
- $50,000,000 for fiscal years 2023 through 2027
Behavioral Health and Substance Use Disorder Resources for Native Americans
- $80,000,000
- Ensures HHS consult with Indian Tribes and Tribal organizations, confer with UIOs, and engage with Native Hawaiian health organization regarding the administration of funding
Mental and Behavioral Health Education and Training Grants
- $31,700,000 for each fiscal year 2023-2027
  - The training demonstration has I/T/U eligible entities
State Opioid Response (SOR) Grants
- $55,000,000
- UIOs not eligible
Tribal Behavioral Health grant (formally known as Native Connections)
Reauthorized for fiscal years 2023 through 2027

Bureau of Indian Affairs (BIA)

Missing and Murdered Indigenous Women (MMIW)
- $24,898,000 for Law Enforcement Special Initiatives, of which an additional $5,000,000 is to continue addressing the MMIW effort
Mental Health and Suicide Prevention Outreach to Minority Veterans and American Indian and Alaska Native Veterans
- that each VA medical center has a full-time minority veteran coordinator who must receive training in the delivery of culturally appropriate mental health and suicide prevention services to AI/AN veterans

Tribal Home Visiting Program and Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV)
- Reauthorizes and establishes scheduled funding increases for the MIECHV and doubles the set-aside from 3% to 6% for the Tribal Home Visiting Program
- $500,000,000 starting grant base in FY23, scheduled funding increases of $50,000,000 through FY 2027
Native Boarding School Initiative
- $19,409,000 is for Assistant Secretary support, which maintains funding to implement the PROGRESS Act, the Diversity and Inclusion program for BIA and OST, and the Native boarding school initiative

Violence Against Women Act (VAWA) – $25,000,000
- $500,000 is for a national clearinghouse that provides training and technical assistance on issues relating to sexual assault of AI/AN women
- $11,000,000 is to assist tribal exercising special Tribal criminal jurisdiction
- $3,000,000 is for an initiative to support cross-designation of Tribal prosecutors as Tribal Special Assistant United States Attorneys

Topic	Section	Funding	Language
Urban Indian Health	Urban Indian Health	$90,419,000	Pg. 69 “The agreement includes $90,419,000 for the Urban Indian health program, which includes the reallocation of former NIAAA funds.”
Indian Health Service (IHS)	Advanced Appropriations	$5,129,458,000	Pg.67 ‘The agreement provides advance appropriations for the Indian Services and Indian Health Facilities accounts totaling $5,129,458,000 for fiscal year 2024.”
	IHS Funding	$6,958,233,000	Pg.67: “The bill provides a total of $6,958,223,000 for the Indian Health Service (IHS )”
	Indian Health Services	$4,890,282,000	Pg.67: “The bill provides a total of $6,958,223,000 for the Indian Health Service (IHS ), of which $4,890,282,000 is for the Services account”
	Hospitals and Clinics	$2,503,025,000	Pg.68 “The agreement provides $2,503,025,000 for Hospitals and Health Clinics, which includes an additional $10,000,000 for Tribal epidemiology centers, $2,000,000 for village built clinics, and an additional $1,000,000 to improve maternal health. This amount also includes requested reallocation of prior year staffing funds for the Phoenix Indian Medical Center, Cherokee Nation, and United Keetoowah Band. The agreement maintains funding at fiscal year 2022 enacted levels for the Alzheimer’s program and Produce Prescription Pilot program. The agreement also continues funding at the fiscal year 2022 enacted levels for the domestic violence prevention program, accreditation emergencies as discussed in the House report, health information technology, healthy lifestyles in youth project, and the National Indian Health Board cooperative agreement.”
	TECs	$34,433,361	Pg. 68 “The agreement provides $2,503,025,000 for Hospitals and Health Clinics, which includes an additional $10,000,000 for Tribal epidemiology centers, $2,000,000 for village built clinics, and an additional $1,000,000 to improve maternal health.”
	EHRs	$217,564,000	Pg. 69 “The agreement provides $217,564,000 for Electronic Health Records (EHR), which includes an increase for uses as requested.”
	CHRs	$65,212,000	Pg. 274: See Chart for Language
	Mental Health	$127,171,000	Pg. 69 “The bill provides $127,171,000 for Mental Health, which continues funding at fiscal year 2022 enacted levels for the behavioral health integration initiative, for suicide prevention, and for the Tele-behavioral Health Center of Excellence and includes the requested reallocation of staffing funds”
	Direct Operations	$103,805,000	Pg. 70 “The bill provides $103,805,000 for direct operations, which includes an increase of $5,000,000 for quality and oversight, for uses as requested, and an increase of $1,000,000 for management and operations.”
	Indian Health Care Improvement Fund	$74,138,000	Pg. 274: See Chart for Language
	Contract Support Costs	$969,000,000	Pg. 70: “The bill continues language from fiscal year 2022 providing an indefinite appropriation to fully fund contract support costs, which are estimated to be $969,000,000 in fiscal year 2023.”
	105(l) leases	$111,000,000	Pg. 74: “The bill continues language from fiscal year 2022 providing an indefinite appropriation to fully fund payments for Tribal leases, which are estimated to be $111,000,000 in fiscal year 2023.”
	Indian Health Facilities	$958,553,000	Pg. 70 “The bill provides $958,553,000 for Indian Health Facilities.
	Costs for accreditation emergencies and supplementing activities funded under the heading ‘‘Indian Health Facilities’’	$58,000,000	Pg.878: “That of the funds provided, $58,000,000 shall be for costs related to or resulting from accreditation emergencies, including supplementing activities funded under the heading ‘‘Indian Health Facilities,’’ of which up to $4,000,000 may be used to supplement amounts otherwise available for Purchased/ Referred Care”
Health and Human Services (HHS)	HRSA— Hawaiian Health Care Program	$27,000,000	Pg.10 The agreement includes no less than $27,000,000 for the Native Hawaiian Health Care Program, of which not less than $10,000,000 shall be provided to Papa Ola Lokahi for administrative purposes authorized under 42 U.S.C. 11706, including to expand research and surveillance related to the health status of Native Hawaiians and strengthen the capacity of the Native Hawaiian Health Care Systems.”
	HRSA— NHSC Loan Repayment Program	$15,600,000	Pg. 991: “That, within the amount made available in the previous provison, $15,600,000 shall remain available until expended for the purposes of making payments under the NHSC Loan Repayment Program under section 338B of the PHS Act to individuals participating in such program who provide primary health services in Indian Health Service facilities, Tribally-Operated 638 Health Programs, and Urban Indian Health Programs (as those terms are defined by the Secretary), notwithstanding the assignment priorities and limitations under section 333(b) of such Act”
	CDC— Good Health and Wellness in Indian Country	$24,000,000	Pg. 33: See Chart for Language
	CDC— Minority HIV/AIDS Prevention and Treatment Program	$5,000,000	Pg.130 Tribal Set-aside.-The agreement includes an increase of $2,000,000 for a Tribal set-aside within the Minority HIV/AIDS Prevention and Treatment program.
Important Behavioral and Mental Health Provisions (Restoring Hope For Mental Health And Wellbeing)	Medication-Assisted Treatment for Prescription Drug and Opioid Addiction	$14,500,000	Pg. 104 “The agreement directs SAMHSA to ensure that these grants include as an allowable use the support of medication-assisted treatment and other clinically appropriate services to achieve and maintain abstinence from all opioids, including programs that offer low-barrier or same day treatment options. Within the amount provided, the agreement includes $14,500,000 for grants to Indian Tribes and Tribal Organizations.”
	Peer-Supported Mental Health Services	$13,000,000 for FY23-FY27	Pg. 3067 “There is authorized to be appropriated to carry out this section $13,000,000 for each of fiscal years 2023 through 2027.’’
	Infant and Early Childhood Mental Health Promotion, Intervention and Treatment	$50,000,000 for FY23-FY27	Pg. 3177 “in subsection (g) (as redesignated by paragraph (1)), by striking ‘‘$20,000,000 for the period of fiscal years 2018 through 2022’’ and inserting ‘‘$50,000,000 for the period of fiscal years 2023 through 2027’’.
	Behavioral Health and Substance Use Disorder Resources for Native Americans	$80,000,000 for FY23-FY27	Pg. 3072 “There are authorized to be appropriated to carry out this section, $80,000,000 for each of fiscal years 2023 through 2027.’’
	Mental and Behavioral Health Education and Training Grants	$31,700,000 for FY23-FY27	Pg. 3171 ‘‘$10,000,000 for each of fiscal years 2018 through 2022’’ and $31,700,000 for each of fiscal years 2023 through 2027”
	State Opioid Response (SOR) Grants	$55,000,000	Pg. 1016: “That of such amount $55,000,000 shall be made available to Indian Tribes or tribal organizations”
	Tribal Behavioral Health grant (formally known as Native Connections)	Reauthorized	Pg. 3044: “PRIORITY MENTAL HEALTH NEEDS OF REGIONAL AND NATIONAL SIGNIFICANCE.—Section 520A of the Public Health Service Act (42 U.S.C. 290bb–32) is amended […](2) in subsection (f), by striking ‘‘$394,550,000 for each of fiscal years 2018 through 2022’’ and inserting ‘‘$599,036,000 for each of fiscal years 2023 through 2027’’.”
Bureau of Indian Affairs (BIA) and Bureau of Indian Education at the Department of the Interior (DOI)	for Law Enforcement Special Initiatives – MMIW Effort	$25,094,000	Pg.37 “The agreement includes $25,094,000 for Law Enforcement Special Initiatives, which continues funding at enacted levels for the MMIW Tribal Public Safety initiative, Tiwahe recidivism initiative, equipment to collect and preserve evidence at crime scenes, and victim witness specialists.”
	Native Boarding School Initiative	$19,409,000	Pg.37 “The bill includes $263,766,000 for Executive Direction and Administrative Services, of which: $19,409,000 is for Assistant Secretary support, which maintains funding to implement the PROGRESS Act, the Diversity and Inclusion program for BIA and OST, and the Native boarding school initiative.”
	Mental Health and Suicide Prevention Outreach to Minority Veterans and American Indian and Alaska Native Veterans	N/A	Pg.2652 “Not later than 180 days after the date of the enactment of this Act, the Secretary, in consultation December 19, 2022 with the Director of the Office of Mental Health and Suicide Prevention, shall ensure that the suicide prevention coordinator and minority veteran coordinator of each medical center of the Department have developed and disseminated to the director of the medical center a written plan for conducting mental health and suicide prevention outreach to all tribes and urban Indian health organizations within the catchment area of the medical center.”
	Tribal Home Visiting Program and Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV)	$500,000,000 starting grant base in FY23, scheduled funding increases of $50,000,000 through FY 2027. Doubles the set-aside from 3% to 6% for the Tribal Home Visiting Program	Page 3883: “(B) in subparagraph (A)— (i) by striking ‘‘3’’ and inserting ‘‘6’’; (ii) by inserting ‘‘and administering’’ before ‘‘grants’’;”
Violence Against Women Act (VAWA)	National clearinghouse that provides training and technical assistance on issues relating to sexual assault of AI/AN women	$500,000	Pg. 178 “$500,000 is for a national clearinghouse that provides training and technical assistance on issues relating to sexual assault of American Indian and Alaska Native women.”
	Assist tribal exercising special Tribal criminal jurisdiction	$11,000,0000	Pg. 178 ‘$11,000,000 is for programs to assist Tribal Governments in exercising special Tribal criminal jurisdiction, as authorized by section 204 of the Indian Civil Rights Act.”
	Initiative to support cross-designation of Tribal prosecutors as Tribal Special Assistant United States Attorneys	$3,000,0000	Pg. 179 ‘$3,000,000 is for an initiative to support cross-designation of tribal prosecutors as Tribal Special Assistant United States Attorneys.”

NCUIH Contact: Lycia Maddocks (Ft. Yuma Quechan), Director of Congressional Relations, lmaddocks@ncuih.org

Health Resources and Services Administration Seeking Nominations for Membership to Serve on the Advisory Committee on Infant and Maternal Mortality

January 5, 2023/0 Comments/in Policy Blog/by Alexandra Payan

On November 22, 2022, the Health and Resources and Services Administration (HRSA) issued a notice seeking nominations of qualified candidates for consideration to serve as members of the Advisory Committee on Infant and Maternal Mortality (ACIMM). ACIMM advises the Secretary of Health and Human Services (HHS) (Secretary) on department activities, partnerships, policies, and programs directed at reducing infant mortality, maternal mortality and severe maternal morbidity, and improving the health status of infants of women before, during, or after pregnancy. Written nominations for membership on the ACIMM must be received on or before January 23, 2022, and nomination packages must be submitted electronically as email attachments to Vanessa Lee, MPH, the ACIMM’s Designated Federal Official, at: SACIM@hrsa.gov. NCUIH strongly encourages UIO staff working in the areas of infant and maternal health to submit nomination materials.

Background

The ACIMM was established in 1991 and advises the Secretary on department activities, partnerships, policies, and programs directed at reducing infant mortality, maternal mortality and severe maternal morbidity, and improving the health status of infants and women before, during, and after pregnancy. The ACIMM provides advice on how to coordinate federal, state, local, tribal, and territorial governmental efforts designed to improve infant mortality, related adverse birth outcomes, and maternal health, as well as influence similar efforts in the private and voluntary sectors. The ACIMM provides guidance and recommendations on the policies, programs, and resources required to address the disparities and inequities in infant mortality, related adverse birth outcomes and maternal health outcomes, including maternal mortality and severe maternal morbidity. With its focus on underlying causes of the disparities and inequities seen in birth outcomes for women and infants, the ACIMM advises the Secretary on the health, social, economic, and environmental factors contributing to the inequities and proposes structural, policy, and/or systems level changes. The ACIMM meets approximately four times per year, or at the discretion of the Designated Federal Officer in consultation with the Chair.

Nomination Eligibility and Information

HRSA is requesting nominations for voting members to serve as Special Government Employees (SGEs) on the ACIMM to fill open positions. The Secretary appoints ACIMM members with the expertise needed to fulfill the duties of the Advisory Committee. Nominees sought are medical, technical, or scientific professionals with special expertise in the field of maternal and child health, in particular, infant and/or maternal mortality and related health disparities; members of the public having special expertise about or concern with infant and/or maternal mortality; and/or representatives from such public health constituencies, consumers, and medical professional societies. Interested applicants may self-nominate or be nominated by another individual or organization.

Individuals selected for appointment to the Committee will be invited to serve for up to 4 years. Members appointed as SGEs receive a stipend and reimbursement for per diem and travel expenses incurred for attending ACIMM meetings and/or conducting other business on behalf of the ACIMM, as authorized by 5 U.S.C. 5703 for persons employed intermittently in government service

Nomination Package Materials

The following information must be included in the package of materials submitted for each individual nominated for consideration:

A statement that includes the name and affiliation of the nominee and a clear statement regarding the basis for the nomination, including the area(s) of expertise and/or experience that may qualify a nominee for service on the ACIMM, as described above;
confirmation the nominee is willing to serve as a member of the ACIMM;
the nominee’s contact information (please include home address, work address, daytime telephone number, and an email address); and
A current copy of the nominee’s curriculum vitae or resume. Nomination packages may be submitted directly by the individual being nominated or by the person/organization recommending the candidate.

Individuals who are selected to be considered for appointment will be required to provide detailed information regarding their financial holdings, consultancies, and research grants or contracts. Disclosure of this information is required in order for HRSA ethics officials to determine whether there is a potential conflict of interest between the SGE’s public duties as a member of the ACIMM and their private interests, including an appearance of a loss of impartiality as defined by federal laws and regulations, and to identify any required remedial action needed to address the potential conflict.

AI/AN Infant and Maternal Health

AI/AN communities throughout the country, including urban AI/AN communities, experience significant maternal and infant health disparities compared to the general population. According to HHS’ Office of Minority Health (OMH), AI/AN infants have almost twice the infant mortality rate as non-Hispanic whites. Native infants are also almost three times more likely than non-Hispanic whites to die from accidental deaths before the age of one year. Contributing factors to these disparities include cost, discrimination, and lack of cultural competency during prenatal care. Additional ongoing and historical trauma due to colonization, genocide, forced migration, and cultural erasure also contribute to health inequities, including pregnancy-related deaths and other maternal health conditions. Approximately 41% of AI/AN women cite cost as a barrier to receiving the recommended number of prenatal visits and 23% of AI/ANs report they have faced discrimination in clinical settings due to being an AI/AN. Consequently, AI/AN people are more likely to have underlying chronic health conditions, and they face systemic barriers to care including higher rates of poverty and needing to travel long distances to receive quality health care services.

Recognizing the infant and maternal health disparities that AI/AN people and communities experience, the HHS Secretary Xavier Becerra attended the White House Tribal Nations Summit on December 1, 2022, where he discussed the Department’s commitment to addressing mental and maternal health in AI/AN communities. As part of HHS’ commitment, the Centers for Disease Control and Prevention (CDC) and the Office of Minority Health (OMH) launched a new Hear Her campaign segment that works to improve AI/AN maternal health outcomes by raising awareness of life-threatening warning signs during and after pregnancy and improving communication between health care providers and their patients. Given HHS’ current focus on addressing Native infant and maternal health, it is highly recommended that UIO staff submit applications to the ACIMM to ensure that the voice of urban Native communities continues to be heard in this work.

UIO and NCUIH work in AI/AN Infant and Maternal Mortality

UIOs provide a range of services such as primary care, behavioral health, and traditional, and social services— including those for infants, children, and mothers. Several UIOs provide care for maternal health, infant health, prenatal, and/or family planning. They also provide pediatric services and participate in maternal-child care programs such as WIC and the Health Resources and Services Administration (HRSA) Maternal, Infant, and Early Childhood Home Visiting program (MIECHV).

NCUIH has engaged in extensive policy work on behalf of AI/AN mothers and infants and for increased funding and support to the UIOs which provide maternal health, infant health, prenatal, and family planning services to AI/AN mothers and infants. On March 9, 2022, NCUIH signed on to a letter to Congress led by the National Home Visiting Coalition in support of reauthorizing HRSA’s MIECHV and doubling the Tribal set-aside— which includes UIOs.

Also, in March, NCUIH submitted comments to the ACIMM, and on September 14, 2022, NCUIH’s Vice President of Public Policy, Meredith Raimondi, testified before the ACIMM on urban Indian disparities and policy changes to address these disparities. Raimondi highlighted that “over half of urban Indian health centers provide care for maternal health, infant health, prenatal, and/or family planning. However, due to chronic underfunding, many of these health centers only have the capacity to carry out these services for the early stages of pregnancy.” She continued to say, “despite desiring to do so, many urban Indian health clinics cannot expand their services to provide complete care for mothers and infants from conception to birth due to underfunding.” Raimondi provided the following recommendations to the Advisory Committee:

Reauthorize MIECHV at a higher amount and double the Tribal set-aside from 3% to 6%.
ACIMM and other stakeholders should collaborate with UIOs to gather critical and accurate information on urban AI/AN populations.
Advise the HHS Secretary to lead the establishment of an urban confer policy across all HHS agencies.
Include a Tribal and UIO health provider representative on the ACIMM and create an ACIMM subcommittee dedicated to addressing AI/AN infant and maternal health disparities.

In August, NCUIH submitted comments to HRSA’s Maternal and Child Health Bureau (MCHB) regarding the Pediatric Mental Health Care Access Program. In our comments, we have continued to stress the critical importance of including urban Natives populations in HRSA’s overall efforts of improving health outcomes for all AI/ANs living on and off reservations.

Furthermore, NCUIH recently released an infographic showcasing data on infant and maternal health disparities in American Indian/Alaska Native (AI/AN) communities.

What’s Happening: Advance Appropriations for the Indian Health Service

December 19, 2022/0 Comments/in Policy Blog/by Meredith Raimondi

Advance Appropriations for the Indian Health Service is the most impactful policy that Congress can do for Native communities this year.
We can’t let our momentum fade during this critical time.
Now is the time to keep the pressure on Congress.

1 Big Thing: Congress has reached a deal on the omnibus

The Latest: Congressional leaders agreed to a government funding framework for a year-end omnibus spending package. (Top appropriators clinch deal on government funding framework)

What’s next: This week, Congress is finalizing the details of the framework, and it’s important that Congress hear from you about why stable funding for the Indian Health Service (IHS) should be on the must-have list.

Last week: The Native American Caucus sent a bipartisan letter from nearly 30 Members of Congress to leadership to request advance appropriations for IHS in the end-of-year package.

This week: The National Indian Health Board sent an updated letter with nearly 140 groups, including Tribes, Urban Indian Organizations, and other supporters to Congress and the White House reiterating the need for stable funding for IHS this year:

“Each day without full funding, with only temporary or no funding from the Continuing Resolutions or government shutdowns, is a step backward for Indian health care systems. Health care service delivery, administrative functions, and other operations are significantly impeded, delayed, or disrupted during periods of Continuing Resolutions or government shutdowns to the detriment of the American Indian and Alaska Native patients.”

What can you do?

It’s time to take action: We urge you to contact your Member of Congress and request that they support including advance appropriations for IHS in the FY 2023 final spending package. You can use the text below as a template to call and/or email your Members of Congress.

Step 1: Find your Representative here and your Senators here.
Step 2: Use the call script and copy the email below.
Step 3: Call and email. Use the call script to call your Members of Congress. Next, copy and paste the email into the form on their contact page and send.

Call Script

“(Introduce yourself). It is time that the federal government protect healthcare funding for Native Americans as it does for other health programs. Please let leadership know that advance appropriations for the Indian Health Service must be in the final spending package. Not another Native life should be lost due to budget uncertainty. Can I count on your support?”

Email to Your Representative and Senators

Dear [Member of Congress],

As an Indian health advocate, I respectfully request you ensure the inclusion of advance appropriations for the Indian Health Service (IHS) in the upcoming Fiscal Year (FY) 2023 final spending package.

The Indian health system, including IHS, Tribal facilities, and urban Indian organizations (UIOs), is the only major federal health care provider funded through annual appropriations. If IHS were to receive advance appropriations, it would not be subject to government shutdowns, automatic sequestration cuts, and continuing resolutions as its funding for the next year would already be in place. We need this to protect Native lives!

Please do what’s right for American Indians and Alaska Natives by ensuring that advance appropriations for IHS can finally be made a reality this year.

Thank you for your leadership.

Sincerely,
[contact information]

Do more! Visit our social media toolkit and

Thank you for your advocacy. Your outreach on this is invaluable to providing greater access to health care for all American Indians and Alaska Natives.

Why does the Indian Health Service need advance appropriations?

The Indian health system, including IHS, Tribal facilities, and urban Indian organizations (UIOs), is the only major federal healthcare provider funded through annual appropriations.

Short-term budgets cause delayed funding to Indian Health Care Providers that can impact service delivery for patients and families. This is unacceptable.
If IHS were to receive advance appropriations, it would ensure continuity of care for American Indians and Alaska Natives.

Over 50% of Native Veterans use the Indian health system for care. VA health funding is protected, but Congress doesn’t protect Native health care. This is unacceptable for our heroes.

Native communities have experienced deaths due to government shutdowns in the past. Five deaths during the last government shutdown is too many.

By the numbers: According to a recent CDC study, Native Americans experienced the biggest drop in life expectancy of any population in the past two years— decreasing by 6.6 years between 2019-2021!

The bottom line: The lives of Native people should not be subject to politics. We need this to protect Native people and preserve access to health care.

Resources

Native Lives Can’t Wait

During the White House Tribal Nations Summit, Native leaders gathered to call on Congress to take action now:

Congressional leaders support stabilizing health care delivery for the Indian Health Service.

The White House supports advance appropriations. Secretary Becerra said:

It’s an imperative to be able to provide health care regardless of what the political climate is in Washington, DC. So our job is to continue to push the President’s agenda of having mandatory funding for Indian country. And if we can’t get Congress to go all the way to mandatory funding, at least give us advanced appropriations. So that this way Indian country has a way to foresee what’s coming for the next year.

Let’s keep going and make advance appropriations for the Indian Health Service a reality this year.

Bipartisan Group of over Two Dozen Congressional Leaders Request Stable Funding for the Indian Health Service

December 15, 2022/0 Comments/in Policy Blog/by Jeremy Grabiner

On December 6, 2022, the House Native American Caucus sent a letter with 29 signatures from Members of Congress to the House Committee on Appropriations Chair Rosa DeLauro and Ranking Member Kay Granger on including advanced appropriations for IHS in the final Fiscal Year (FY) 2023 Appropriations bill. With the ultimate goal of mandatory funding, the letter urges the Biden Administration, the Indian Health Service (IHS), authorizing committees, and tribal nations to collaborate and work towards authorizing the shift away from discretionary funding.

The letter emphasizes that “all other federal government healthcare providers—Medicare, Medicaid, Children’s Health Insurance Program, TRICARE, and Veterans Health Administration—are all either under mandatory funding or receive advanced appropriations. IHS is the only major federal healthcare program that does not receive either and is up for annual appropriations,” and “[a]dvanced appropriations for FY24 will enable IHS to continue to provide health services without potential interruption, guaranteeing access to the necessary care for 2.6 million Native Americans and Alaska Natives.”

The outlined priorities include advance appropriations for FY24 to address the disruptions and chronic underfunding of IHS. Appropriate funding can help to avoid the current challenges including staffing shortages, limited equipment availability, and extended wait times. In addition, each Continuing Resolution (CR) requires hundreds of tribal and urban Indian organization (UIO) contracts to adjust for funding, affecting financial stability. Advanced appropriations give Indian health programs the ability to manage budgets, coordinate care, and improve health quality outcomes.

This letter sends a powerful and straightforward message to Chair DeLauro and Ranking Member Granger that in order to fulfill the federal government’s trust responsibility to all AI/ANs to provide safe and quality healthcare, funding for Indian health must be secure.

NCUIH is grateful for the support of the following Representatives:

Rep. Tom Cole, Co-chair, Congressional Native American Caucus
Rep. Sharice Davids, Co-chair, Congressional Native American Caucus
Rep. Markwayne Mullin, Vice Chair, Congressional Native American Caucus
Rep. Doug LaMalfa, Vice Chair, Congressional Native American Caucus
Rep. Raúl M. Grijalva, Vice Chair, Congressional Native American Caucus
Rep. Frank Pallone Jr., Vice Chair, Congressional Native American Caucus
Rep. Betty McCollum, Vice Chair, Congressional Native American Caucus
Rep. Mary Peltola
Rep. Earl Blumenauer
Rep. Darren Soto
Rep. Adam Smith
Rep. Tom O’Halleran
Rep. Joe Neguse
Rep. Daniel T. Kildee
Rep. Dusty Johnson
Rep. Jared Huffman
Rep. Kurt Schrader
Rep. Gwen Moore
Rep. Doris Matsui
Rep. Peter DeFazio
Rep. Raul Ruiz
Rep. Zoe Lofgren
Del. Eleanor Holmes Norton
Rep. Melanie Stansbury
Rep. Shontel Brown
Rep. Teresa Leger Fernández
Rep. Tony Cárdenas
Rep. Ruben Gallego
Rep. Liz Cheney

Full Letter Text

Dear Chairwoman DeLauro and Ranking Member Granger,

In the Fiscal Year 2023 (FY23) President’s Budget, the President requested that the funding for the Indian Health Service (IHS) be shifted from discretionary to mandatory funding. This will ensure funding is secured for IHS and the millions of Native Americans and Alaska Natives it serves, regardless of a government shutdown and delayed appropriations. All other federal government healthcare providers—Medicare, Medicaid, Children’s Health Insurance Program, TRICARE, and Veterans Health Administration—are all either under mandatory funding or receive advanced appropriations. IHS is the only major federal healthcare program that does not receive either and is up for annual appropriations.

As members of the Congressional Native American Caucus, we encourage the Biden Administration, IHS, authorizing committees, and tribal nations to collaborate and work towards authorizing this shift to mandatory funding. While this process is underway, advanced appropriations for IHS should be included in the final FY23 Appropriations bill. The advanced appropriations for FY24 will enable IHS to continue to provide health services without potential interruption, guaranteeing access to the necessary care for 2.6 million Native Americans and Alaska Natives.

IHS has been chronically underfunded since its creation in 1955. According to a Government Accountability Office (GAO) Report, in 2017 per capita spending for IHS was $4,078 compared to $13,185 for Medicare. Due to these insufficient funds, IHS regularly experiences staffing shortages, limited equipment availability, extended wait times, and several other problems. Every time Congress passes a Continuing Resolution (CR), IHS must modify hundreds of tribal contracts to adjust for the available funding. This also takes an extensive toll on a tribe’s financial stability as higher interest on loans can occur when there is uncertainty of federal funding, leading to a downgrade in credit rating.

Advanced appropriations would allow Indian health programs to manage budgets, coordinate care, and improve health quality outcomes for Native Americans and Alaska Natives effectively and efficiently. This population suffers disproportionately from a variety of health afflictions including diabetes, heart disease, tuberculosis, and cancer. This change in the appropriations schedule will help the federal government meet its trust obligation to tribal governments and bring parity to federal health care systems. Health care services in particular require consistent and reliable funding to be effective.

Background on Mandatory Funding and Advance Appropriations for the Indian Health Service

The Indian health system, including IHS, Tribal facilities, and UIOs, is the only major federal provider of health care that is funded through annual appropriations. If IHS were to receive mandatory funding or, at the least, advance appropriations, it would not be subject to the harmful effects of government shutdowns and CRs as its funding for the next year would already be in place. This is needed as lapses in federal funding put lives at risk. Without funding certainty during government shutdowns can cause UIOs to reduce services, close their doors, or force them to leave their patients without adequate care. During the last government shutdown, UIOs reported at least 5 patient deaths and significant disruptions in patient services. Securing stable funding for IHS has been a major priority for Indian Country and NCUIH has taken part in extensive advocacy to ensure the continuation and delivery of health services to all Native people regardless of where they live.

There has also been strong long-standing support from Congress on this issue and legislation on this effort has been introduced in 11 bills since 2013. Currently, 107 current Members of Congress have expressed support for advance appropriations for the Indian Health Service since the first bill was introduced by the late Representative Don Young (R-AK-At Large; H.R. 3229) and Senator Lisa Murkowski (R-AK; S. 1570). Congress has sent letters in the past advocating on this issue:

January 12, 2022 – Native American Caucus sent letters to the House Appropriations Committee Chair DeLauro and Ranking Member Granger requesting that advance appropriations for IHS for FY 2023 be included in the final FY 2022 appropriations bill on January 12, 2022.
April 25, 2022 – Bipartisan group of 28 Representatives requestedup to $949.9 million for urban Indian health in FY 2023 and advance appropriations for IHS until such time that authorizers move IHS to mandatory spending, and 12 Senators sent a letter with the same requests.
June 3, 2022 – Native American Caucus sent another letterencouraging the Committee to work towards shifting IHS from discretionary to mandatory funding and requesting that, while this shift is underway, the Committee include advanced appropriations for IHS in the final FY 2023 Appropriations bill.

Resources on Advance Appropriations for IHS:

Next Steps

Congress has until December 16, 2022, to pass a longer-term spending package for FY 2023. In the meantime, NCUIH will continue to advocate for advance appropriations in the final FY 2023 omnibus.

NCUIH Joins NIHB and over 130 Tribal Nations and Other Organizations in Urgent Push for Stable Funding for the Indian Health Service

December 12, 2022/0 Comments/in Policy Blog/by Jennifer Wendling

As Native American Heritage Month ended, advocates for Native communities joined together during the Tribal Nations Summit in Washington, DC to call for Congress and the White House to enact Advance Appropriations for Indian health now.

On December 12, 2022, the National Council of Urban Indian Health (NCUIH) joined the National Indian Health Board (NIHB) and over 130 groups, including Urban Indian Organizations (UIOs), Tribal Nations, and friends of Indian health in sending letters to the President and Congressional leadership while negotiations on Fiscal Year (FY) 2023 spending are currently underway. The letters request support for the House-passed funding of $8.121 billion for the Indian Health Service (IHS) for FY 2023 and advance appropriations for IHS for FY 2024. The urgency is being felt among advocates as the government is currently funded under a Continuing Resolution through December 16. During the last government shutdown, UIOs reported at least 5 patient deaths and significant disruptions in patient services. Securing stable funding for IHS in the final FY 2023 omnibus has been a major priority for Indian Country to ensure the continuation and delivery of health services to all Native people regardless of where they live. There is bipartisan support for ensuring advance appropriations and ending budget delays for the Indian Health Service.

This week, allies joined in support of a Day of Action on November 30, 2022 on the last day of Native American Heritage Month and the first day of the White House Tribal Nations Summit.

Native Leaders Call on Congress to Act Now on Advance Appropriations

A Bipartisan Tradition: Supporting Stability for the Indian Health Service Unites a Divided Congress

Currently, 107 current Members of Congress have expressed support for advance appropriations for the Indian Health Service since the first bill was introduced by the late Representative Don Young (R-AK-At Large; H.R. 3229) and Senator Lisa Murkowski (R-AK; S. 1570) in 2013. Closing today, House Native American Caucus Co-Chairs Sharice Davids (D-KS-03) and Tom Cole (R-OK-04) are leading the third bipartisan letter of the year to the House Appropriations Committee calling for advanced appropriations for IHS to be included in the final FY23 Appropriations bill. Members of Congress also joined the Day of Action conversation by expressing their direct support for protecting IHS funding. For example:

Longstanding sponsor of the Indian Health Service advance appropriations, Rep. Betty McCollum (D-MN-04) called on her colleagues to vote in support of advance appropriations and stated that “Vital health care services should NOT be interrupted if there’s a government shutdown.”
Former Chair of the Senate Committee on Indian Affairs and current Committee Member, Senator John Tester (D-MT) stated, “Our Native communities deserve a stable health care system—yet the Indian Health Service is the only major federal provider without stable funding. I stand with advocates across Indian Country today in pushing for advance appropriations for the IHS.”
Champion of the Honoring Promises to Native Nations proposal, Senator Elizabeth Warren (D-MA) said, “IHS is the only major federal provider of health care that faces budget uncertainty. It’s time for Congress to guarantee predictable funding and end this inequity.”
Melanie Stansbury (D-NM-01), member of the House Natural Resources Committee, stated that “When budget negotiations falter, Indigenous lives are at stake… I stand with Indigenous communities in support of advance appropriations for the Indian Health Service.”.
Staunch advocate for IHS on the Energy and Commerce Committee, Rep. Raul Ruiz (D-CA-36) stated that “Lack of funding shouldn’t be an impediment for our Tribes to receive the lifesaving services they need and deserve.”

Full List of Letter Supporters

The full list of supporting Tribal Nations and organizations is as follows:

Tribal Nations:

Absentee Shawnee Tribe of Oklahoma
Caddo Nation
Chickasaw Nation
Citizen Potawatomi Nation
Cloverdale Rancheria of Pomo Indians of California
Confederated Tribes of the Colville Reservation
Cowlitz Tribe
Fond du Lac Band of Lake Superior Chippewa
Jamestown S’Klallam Tribe
Jamul Indian Village of California
Keweenaw Bay Indian Community
La Posta Band of Mission Indians
Lummi Indian Business Council
Manchester Point Arena Band of Pomo Indians
Match-E-Be-Nash-She-Wish Band of Pottawatomi Indians (Gun Lake Tribe)
Mississippi Band of Choctaw Indians
Nez Perce Tribe
Oneida Nation
Pechanga Band of Indians
Peoria Tribe of Indians of Oklahoma
Poarch Creek Indians
Pueblo of Tesuque
Pyramid Lake Paiute Tribe
Rappahannock Tribe
Resighini Rancheria
Saint Regis Mohawk Tribe
San Carlos Apache Tribe
Sault Ste. Marie Tribe of Chippewa Indians
Skokomish Tribe
Sokaogon Chippewa Community
Standing Rock Sioux Tribe
Swinomish Indian Tribal Community
Tohono O’odham Nation
Tsalagiyi Nvdagi Tribe
Tunica-Biloxi Tribe of Louisiana
Upper Mattaponi Indian Tribe
Walker River Paiute Tribe
Wampanoag Tribe of Gay Head (Aquinnah)
Ysleta del Sur Pueblo

Organizations:

ACA Consumer Advocacy
AI/AN Health Partners
Alaska Native Health Board
Alaska Native Tribal Health Consortium
Albuquerque Area Indian Health Board, Inc.
American Academy of Dermatology Association
American Academy of Pediatrics
American Indian Health & Services
American Indian Health Commission for Washington State
American Indian Health Service of Chicago
Association on American Indian Affairs
Bakersfield American Indian Health Project, Inc.
Bristol Bay Area Health Corporation
California Consortium for Urban Indian Health
California Rural Indian Health Board
Canoncito Band of Navajos Health Center
Caring Ambassadors Program
Choctaw Health Center
Coalition of Large Tribes
Colorado Consumer Health Initiative
Consolidated Tribal Health Project, Inc.
Cook Inlet Tribal Council, Inc.
Copper River Native Association
Council of Athabascan Tribal Governments
Every Texan
Fallon Tribal Health Center
Families USA
Family Voices
First Focus on Children
Fresno American Indian Health Project
Great Lakes Area Tribal Health Board
Great Plains Tribal Leaders’ Health Board
Health Care Voices
Hepatitis C Mentor & Support Group, Inc.
Hunter Health
Indian Health Care Resource Center of Tulsa
Indian Health Center of Santa Clara Valley
Indigenous Pact
Inter Tribal Association of Arizona
International Association for Indigenous Aging
International Association of Forensic Nurses
Justice in Aging
Kansas City Indian Center
Kids Forward
Maniilaq Association
Metro New York Health Care for All
Michigan League for Public Policy
National Association of Pediatric Nurse Practitioners
National Council of Urban Indian Health
National Indian Health Board
National Indigenous Women’s Resource Center
National League for Nursing
National Native American Boarding School Healing Coalition
National Partnership for Women & Families
Native American Connections
Native American LifeLines, Inc.
Native American Rehabilitation Association of the Northwest, Inc.
Native Americans for Community Action, Inc.
NATIVE Project – Urban Indian Health Program – Spokane, WA
Nevada Coalition to End Domestic and Sexual Violence
Nisqually Tribal Health & Wellness Center
Northwest Harvest
Northwest Portland Area Indian Health Board
Oklahoma City Indian Clinic
Oklahoma Policy Institute
Partners In Health
R2H Action [Right to Health]
Riverside-San Bernardino County Indian Health, Inc.
Rocky Mountain Tribal Leaders Council
San Francisco AIDS Foundation
Sault Tribe Health Division
Seattle Indian Health Board
Self-Governance Communication & Education Tribal Consortium
SF Hep B Free – Bay Area
South Dakota Urban Indian Health
Southcentral Foundation
Southeast Alaska Regional Health Consortium
Southern Indian Health Council, Inc.
Southern Plains Tribal Health Board
Texas Native Health
Treatment Action Group
Tuba City Regional Health Care Corporation
United American Indian Involvement, Inc.
United South and Eastern Tribes Sovereignty Protection Fund
Universal Health Care Foundation of Connecticut
University of California San Francisco School of Medicine HEAL Initiative
Urban Inter-Tribal Center of Texas – Urban Indian Health Program – Dallas, TX
USAging
Wiconi Wakan Health and Healing Center
Work for Consolidated Tribal Health Project

Friends of Indian Health:

Angela Alvary
Ken Artis (Ho-Chunk Nation), Artis Law Office
Lana Fox
Miranda Carman, LCSW
Patricia Powers
Yana Blaise

Next Steps

NCUIH continues to advocate for the inclusion of advance appropriations for IHS in the final FY 2023 appropriations package. NCUIH will also provide updates on the status of advance appropriations in Congress during final negotiations.

President Announces Interagency Initiative to Address Homelessness for Urban Native Veterans

December 9, 2022/0 Comments/in Policy Blog/by Colin Tompson

VA, HHS, HUD, through the White House Committee on Native American Affairs, to increase access to care and services for Native veterans experiencing or at risk of homelessness in urban areas.

Last week, President Biden convened the White House Tribal Nations Summit where he released the Tribal Nations Summit Progress Report, which outlined a new initiative aimed to assist Native veterans experiencing or at risk of homelessness. During the White House Tribal Nations Summit on December 1, 2022, the Department of Veterans Affairs (VA) Secretary McDonough announced that the VA, in partnership with the Departments of Health and Human Services (HHS), Housing and Urban Development (HUD), and the White House Committee on Native American Affairs are launching an interagency initiative to increase access to care and services for American Indian and Alaska Native (AI/AN) veterans experiencing or at risk of homeless in urban areas. According to Secretary McDonough, “the initiative will involve enhanced partnerships with 41 urban Indian organizations and will focus on intake and referral services to ensure that Native veterans are aware of and have access to resources already set aside for them.”

“I am encouraged by the VA’s commitment to improving the health and well-being of Native veterans, including those of us living in urban areas. Natives serve in the military at a higher rate than any other population in the U.S., but we experience some of the largest health disparities when we complete our service. As we all know, housing is a key social determinant of health, and homelessness in our community is a contributing factor to the health inequities Native veterans face. I look forward to being involved in the partnership between urban Indian organizations and the VA, HHS, HUD, and White House Council on Native American Affairs to bring housing resources to urban Native veterans.”– Sonya Tetnowski (Makah), CEO, Indian Health Center of Santa Clara Valley and NCUIH President.

Background

Native Veteran Disparities

Native veterans have served in the United States military in every armed conflict in the Nation’s history and have traditionally served at a higher rate than any other population in the United States. Unfortunately, Native veterans suffer significant disparities when they transition to civilian life. For example, Native veterans are more likely to be uninsured and have a service-connected disability than other veterans. Native veterans suffer these disparities no matter where they live. Native veterans living in urban areas experience the same poor physical and mental health outcomes as Native veterans in rural areas. In addition, urban Native veterans generally have lower incomes, higher unemployment, lower education attainment, higher VA-service connected disability, and generally live in poorer housing conditions than non-Native urban veterans.

This initiative is critical given that the National Council of Urban Indian Health (NCUIH) estimates that there are about 8 Native veterans experiencing homelessness per 1000 veterans, compared to about 1.5 white veterans per 1000 veterans. Urban Native veterans are greatly impacted by this, as NCUIH estimates that 86.2% of the veteran population identifying as Native lives in urban areas. Homelessness is a key Social Determinant of Health (SDOH) and a lack of stable housing can lead to an increased risk of premature death, preterm delivery, exposure to disease vectors like vermin, and other negative health impacts. Without consistent access to stable housing for all of our Native veterans, who have answered the call to make the ultimate sacrifice on behalf of this Nation, they will remain at risk of the health disparities associated with unstable housing.

Urban Indian Organizations Provide Critical Housing Support

UIOs are essential partners in serving AI/AN veterans and are vital to this initiative to improve care and access to services for AI/AN veterans because of their deep ties to the AI/AN community in urban areas. UIOs currently serve seven of the ten urban areas with the largest AI/AN veteran populations, including the following areas: Phoenix, Arizona; Los Angeles, California; Seattle, Washington; Dallas, Texas; Oklahoma City, Oklahoma; New York City, New York; and Chicago, Illinois. Due to the cultural competency of the health care available at UIOs, many Native veterans prefer to receive their health care from a UIO provider, as well as at IHS and Tribal facilities, over a VHA facility.

UIOs are uniquely positioned to assist agencies, such as the VA, HHS, and HUD, in improving housing access for AI/AN people. Some UIOs already provide housing services and all UIOs provide numerous other social and community services to AI/ANs living in urban areas. As such, the partnership with UIOs announced in this initiative has the potential to improve the quality of care and well-being to Native veterans in urban areas, but it is also consistent with the United States’ trust responsibility to provide services and resources to improve the health of all AI/ANs.

Sonya Tetnowski, Chair of Veterans Health Administration Subcommittee within the VA Advisory Committee on Tribal and Indian Affairs Committee, Army veteran, NCUIH President, and CEO of the Indian Health Center for Santa Clara Valley, highlighted the importance of looking at the whole person and making sure that their needs are being met during a Committee meeting in January. She also brought forth potential subcommittees, including unhoused urban Veterans, Native Healer utilization, and Behavioral Health and Substance Use. On August 17, 2022, the Committee held a meeting where Ms. Tetnowski presented five priority areas, including homelessness and housing as a priority.

NCUIH and the VA

NCUIH continues to advocate on behalf of AI/AN veterans living in urban areas and to strengthen its partnership with VA. Thanks to NCUIH’s work with the VA, UIOs are now eligible to enter the VA IHS/THP/UIO Reimbursement Agreements Program, which provides VA reimbursement to IHS, THP, and UIO health facilities for services provided to eligible AI/AN Veterans. NCUIH also played a critical role in getting the legislation that established the VA Advisory Committee on Tribal and Indian Affairs passed in 2020 and nominated Ms. Tetnowski to be a representative on the Committee.

NCUIH has highlighted in several written comments to the VA and in meetings with agency representatives, the need for the VA to address and provide services to Native veterans living in urban areas. VA data currently indicates that Native veterans use VA benefits or services at a lower percentage than other veterans. To address these disparities, NCUIH has provided the VA with several recommendations and administrative guidance on how to improve Native veteran health through collaboration with the VA. In the last year alone, NCUIH has raised various issues such as the lack of VA services provided to Native veterans who reside in urban areas as well as the lack of culturally competent VA health care providers in these areas. In July, NCUIH wrote to comments to the VA urging the agency to improve the medical workforce at UIOs through the Pilot Program on Graduate Medical Education and Residency (PPGMER). Moreover, NCUIH recently provided comments and recommendations for the VHA and IHS in collaboration to improve their outreach and services to urban Native veterans.

In addition to working with the VA, NCUIH submitted comments to HUD, encouraging the agency to incorporate urban Natives in its FY22-26 Strategic Plan and focus areas. HUD provides housing resources and funding for Tribes, but these resources are very limited when it comes to urban AI/ANs, or not applicable at all. These efforts have emphasized the critical importance of working with UIOs to reach and serve the significant portion of Native veterans living in urban areas.

Senator Warren and Representative Kilmer Introduce NCUIH-Endorsed Bill to Honor Promises to Native People with Key Provisions for Urban Indian Health

December 7, 2022/0 Comments/in Policy Blog/by Carrie Kowalyk

On December 5, 2022, Senator Elizabeth Warren (D-MA) and Representative Derek Kilmer (D-WA-6) introduced the Honoring Promises to Native Nations Act, which will address the underfunding and barriers to sovereignty in Indian Country acknowledged in the 2018 U.S. Commission on Civil Rights report, Broken Promises: Continuing Federal Funding Shortfall for Native Americans. The legislation reaffirms the federal government’s trust obligation to all American Indians and Alaska Natives (AI/ANs) to strengthen federal programs and support Native Communities. This legislation guarantees mandatory, full, and inflation-adjusted funding that can support healthcare, education, housing, and economic development and is cosponsored by national Indian organizations such as the National Council of Urban Indian Health (NCUIH), the National Congress of American Indians, and the National Indian Health Board.

NCUIH worked closely with Senator Warren’s office on this landmark policy platform, which includes permanent 100% Federal Medical Assistance Percentage (FMAP) for urban Indian organizations (UIOs) and modifying an existing policy to allow the Secretary of the Department of Health and Human Services (HHS) to better communicate on issues affecting urban Indian health. Additionally, the legislation includes mandatory-adjusted funding for the Indian Health Service (IHS), advance appropriations for IHS, increased long-term funding for Special Diabetes Programs for Indians (SDPI) to $300 million through fiscal year (FY) 2032 (currently expiring in FY 2023 and only funded at $150 million annually), and exempting Indian programs from sequestration.

“For generations, the U.S. government has clearly failed to fulfill its commitments to Tribal Nations. This bill is sweeping in ambition to make good on those commitments and empower Native communities, and it provides a much-needed legislative blueprint to deliver significant, long-term funding for the advancement of Native Americans. I won’t stop fighting to ensure the U.S. government honors its promises,” said Senator Warren.

“Congress and the federal government have a moral and a legal obligation to fulfill the promises made to Indian Country. That’s why I’m proud to introduce this legislation with Senator Warren to help reverse the decades-long pattern of systemic funding shortfalls to Native communities and to strengthen federal programs that support Indian Country. Congress should move swiftly to get this legislation enacted. It is long overdue.” said Representative Kilmer. “

“The health of our people has suffered due to the failure of the government to uphold the trust responsibility of providing health care to all American Indians and Alaska Natives. It is time that we address the needs of Indian Country and enact the recommendations included in the 2018 Broken Promises report, including improving health care for all Native people. The National Council of Urban Indian Health is grateful for the inclusion of Urban Indians in this legislation, especially regarding permanent 100% FMAP for urban Indian organizations and Urban Confer within HHS, both of which have been top priorities for NCUIH. We fully support this bill and believe that this Act is fundamental in honoring the federal government’s trust responsibility to American Indian and Alaska Natives,” – Francys Crevier (Algonquin), CEO, NCUIH.

“On behalf of the nearly 1/4 UIOs in California, CCUIH endorses the Honoring Promises to Native Nations Act because it will increase health access for American Indians no matter where they live.  California is home to the largest population of American Indians, with more than 90% living in an urban area.  Full, mandatory, inflation-adjusted funding for the Indian Health Service; funding for the Special Diabetes Programs for Native Americans; permanent FMAP for Urban Indian Health Programs; and Medicaid coverage of any services provided by Indian health care providers will offer critical funding necessary to address the continued disparities in health experienced by American Indians,” – Virginia Hedrick (Yurok), Executive Director, California Consortium for Urban Indian Health, Inc.

“The American Indian Health Service of Chicago, Inc. is pleased to endorse the Honoring Promises to Native Nations Act, as it will enable the 70% of American Indians and Alaska Natives who live in Urban Areas to continue to receive the same level of care that is received by other federally funded health programs, while slowly moving toward true health equity with the rest of the United States. With hope that Urban Programs will be able to receive an increase in the funding to be able to offer additional services (such as dental, podiatry, imaging, and women’s wellness) to the American Indian and Alaska Native Chicago based population. AIHSC also appreciates the efforts to increase the Special Diabetes Program for Indians, as our percentages of AI/AN who are diagnosed with diabetes increase,” – RoxAnne M LaVallie-Unabia (Turtle Mountain Band of Chippewa Indians), Executive Director, American Indian Health Service of Chicago.

“South Dakota Urban Indian Health enthusiastically supports the Honoring Promises to Native Nations Act. This bill secures funding for essential health services and through the inclusion of Medicaid reimbursements for substance use disorder facilities, recognizes the urgency of addiction for our relatives. For generations, Native Americans have persevered through forced assimilation, forced removal from our ancestral lands, and broken promises from the United States government. Despite these challenges, we remain a thriving group of sovereign nations and peoples across the geographic United States. This bill is a stride toward health equity for the more than 70% of Native Americans who live in urban areas of the United States.” – Michaela Seiber (Sisseton-Wahpeton Dakota), CEO, South Dakota Urban Indian Health.

“Native Health endorses the Honoring Promises to Native Nations Act because it will provide resources to fulfill the Federal Government’s obligation to provide health care to AI/ANs. The bill supports urban Indian organizations through 100% FMAP and SDPI reauthorization. These measures are especially needed by the underserved AI/AN urban community. In the current environment, UIOs are overwhelmed by the rising demand and the rising costs of providing health care,” – Walter Murillo (Choctaw Nation of Oklahoma), CEO, Native Health.

“The Honoring Promises to Native Nations Act is a major step forward in recognizing the trust and treaty obligations to Tribes and American Indian and Alaska Native peoples,” – Jacqueline Mercer, CEO, Native American Rehabilitation Association of the Northwest (NARA).

“Hunter Health endorses the Honoring Promises to Native Nations Act because it will increase access to quality healthcare services and allows Urban Indian Organizations to work with their state to expand services for Native American people living in their community,” – Rachel Mayberry, Chief Advancement Officer, Hunter Health.

“The Indian Health Center of Santa Clara Valley is pleased to endorse Senator Warren’s Honoring Broken Promises Act. This bill addresses priorities for urban Indian organizations such as mandatory funding, 100% FMAP, increased SDPI funding, and urban confer. This bill contributes to health equity for American Indians and Alaska Natives and moves forward with the federal government’s trust and treaty responsibility by improving AI/AN health services,” – Sonya Tetnowski (Makah), CEO, Indian Health Center of Santa Clara Valley.

“Denver Indian Health and Family Services endorses the Honoring Promises to Native Nations Act because it will allow all Urban Indian Organizations (UIOs) to leverage their services and sustain their funding despite many healthcare challenges. (i.e., the pandemic, the opioid crisis, suicide prevention, etc.). It is time the federal government met its trust and treaty obligations to Native peoples, particularly regarding federal spending. Failing to fund Indian Health Service (IHS) fully and UIOs fails to fulfill the federal government’s trust responsibilities. As recipients of less than 1% of the Indian Health Service budget, inadequate funding requires UIOs to depend on every dollar of federal funding and find creative ways to stretch limited resources. The Act will cover a wide range of issues that impact Indian Country; specifically, urban confer for HHS and the VA; 100% FMAP for UIOs; and Special Diabetes for Indians, reauthorized at $300 million for ten years,” – Adrianne Maddux (Hopi Tribe), Executive Director, Denver Indian Health and Family Services.

“The Oklahoma City Indian Clinic (OKCIC) endorses the Honoring Promises to Native Nations Act because it will provide promised and necessary funding for Indian Health Care services. The OKCIC is the largest Urban Indian Health Care Center in the United States, serving 22,000 patients from over 200 Tribes. Many of our patients are chronically ill and require high levels of expensive medical care. To provide that care it is very important that Title II of the Honoring Promises to Native Nations Act, specifically a full, mandatory and inflation-adjusted funding for the Indian Health Service and permanent adequate funding for the Special Diabetes Program for Indians is not only necessary but vital to maintaining the good health of our people,” – Robyn Sunday-Allen (Cherokee), CEO, Oklahoma City Indian Clinic.

Bill Highlights for Urban Indian Organizations

Mandatory Funding and Advance Appropriations for the Indian Health Service

The Indian health system, including IHS, Tribal facilities, and UIOs, is the only major federal provider of health care that is funded through annual appropriations. If IHS were to receive mandatory funding or, at the least, advance appropriations, it would not be subject to the harmful effects of government shutdowns and continuing resolutions (CRs) as its funding for the next year would already be in place. This is needed as lapses in federal funding put lives at risk. Without funding certainty during government shutdowns can cause UIOs to reduce services, close their doors, or force them to leave their patients without adequate care. During the last government shutdown, UIOs reported at least 5 patient deaths and significant disruptions in patient services. Securing stable funding for IHS has been a major priority for Indian Country and NCUIH has taken part in extensive advocacy to ensure the continuation and delivery of health services to all Native people regardless of where they live.

This bill authorizes $50,138,679,000 in mandatory appropriations for FY 2023, $51,416,373,000 for FY 2024, and for FY 2025 and each fiscal year thereafter, “an amount equal to the sum of the amount appropriated for the previous fiscal year, as adjusted annually to reflect the change in the medical care component of the consumer price index for all urban consumers (U.S. city average); and, as applicable, 1.8 percent of the amount appropriated for the previous fiscal year.” The bill also provides advance appropriations for IHS.

Special Diabetes Programs for Indians

The SDPI Demonstration Project includes research-based interventions for diabetes prevention and cardiovascular disease (CVD) risk reduction into AI/AN community-based programs and health care settings. The program has demonstrated success with a 50% reduction in diabetic eye disease rates, drops in diabetic kidney failure, and a 50% decline in End Stage Renal Disease. Many UIOs receive SDPI funding and the program has directly enabled UIOs to provide critical services to their AI/AN patients, in turn significantly reducing the incidence of diabetes and diabetes-related illnesses among urban Indian communities. These successes are impactful, as AI/ANs have the highest diabetes prevalence rates of all racial and ethnic groups in the United States, with AI/AN adults almost three times more likely than non-Hispanic white adults to be diagnosed with diabetes. According to the Centers for Disease Control and Prevention, 13.7% of adults in urban Native communities are diagnosed with diabetes. SDPI is a critical program to address the high rates of diabetes among AI/ANs and requires secure funding to continue its success. NCUIH has long advocated for SPDI to be fully funded. On May 16, 2022, NCUIH submitted comments and recommendations to IHS emphasizing the importance of SDPI in reducing health disparities related to diabetes for AI/AN populations. These comments included increasing SDPI funding with built-in automatic annual medical inflationary increases and that IHS ensures the SDPI remains inclusive of UIOs.

This legislation will reauthorize SDPI at $300,000,000 for each fiscal year beginning in 2023 through 2032.

Permanent 100% Federal Medical Assistance Percentage (FMAP)

FMAP refers to the percentage of Medicaid costs covered by the federal government, which will be reimbursed to the states. Permanent 100% FMAP for UIOs will further the government’s trust responsibility to AI/ANs by increasing available financial resources to UIOs and support them in addressing critical health needs of AI/AN patients. In March of 2021, Congress enacted the American Rescue Plan Act of 2021 (ARPA) which authorized eight fiscal quarters of 100% FMAP coverage for UIOs. Unfortunately, with only 3 months until the provision expires, most UIOs have not received any increase in financial support because many states have not increased their Medicaid reimbursement rates to UIOs, citing short-term authorization concerns.

There has been strong support for the expansion of 100% FMAP to UIOs across Indian Country and NCUIH has tirelessly advocated to permanently fix this parity issue. The National Congress of American Indians and the National Indian Health Board passed resolutions along with NCUIH in support of extending 100% FMAP to UIOs. Additionally, there has been longstanding bipartisan congressional support, with over 17 pieces of legislation having been introduced since 1999 on this issue. NCUIH recently sent a letter to the House Committee on Energy and Commerce leadership requesting a markup on the Improving Access to Indian Health Services Act (H.R. 1888), which would establish permanent 100% FMAP for services provided to AI/ANs Medicaid beneficiaries at UIOs.

This bill amends the Social Security Act by including UIOs as eligible entities to receive permanent 100% FMAP.

Urban Confer with HHS and UIOs

An Urban Confer is an established mechanism for dialogue between federal agencies and UIOs. Urban confer policies are a response to decades of deliberate federal efforts (i.e., forced assimilation, termination, relocation) that have resulted in 70% of AI/AN people living outside of Tribal jurisdictions, thus making Urban Confer integral to addressing the care needs of a majority of AI/ANs. An urban confer policy that includes all HHS agencies, including the Centers for Medicare & Medicaid Services (CMS), ensures that obstacles relating to programs and benefits that directly affect UIOs are addressed quickly so UIOs are better equipped to provide healthcare to their patients. NCUIH has long advocated for facilitating confer between numerous federal branches within HHS and UIO stakeholders. Currently, only IHS has a legal obligation to confer with UIOs. It is important to note that urban confer policies do not supplant or otherwise impact Tribal consultation and the government-to-government relationship between Tribes and federal agencies.

This bill would require the Secretary of HHS, to the maximum extent practicable, to confer with UIOs in carrying out the health services of the Department.

Office of Management and Budget Office of Native Nations

The bill establishes an Office of Native Nations within the Office of Management (OMB), which coordinates with the rest of OMB and the Executive branch on matters of funding for federal programs and policy affecting AI/ANs and Native Hawaiians. The Administrator, a career position, of the office is responsible for matters such as compiling data on all federal funding for federal programs affecting AI/ANs and Native Hawaiians; ensuring that the budget requests of IHS and the Bureau of Indian Affairs indicate how much funding is needed for programs affecting AI/ANs and Native Hawaiians to be fully funded and how far the federal government is from achieving that full funding; and preparing a crosscutting document each fiscal year containing detailed information, based on data from all federal agencies, on the amount of federal funding that is reaching Indian Tribes, tribal organizations, Native Hawaiian organizations, and UIOs. The bill directs the Administrator to consult with Indian Tribes, collaborate with Native Hawaiian organizations, and confer with UIOs annually to ascertain how the crosscutting document can be modified to make it more useful to Indian Tribes, Native Hawaiian organizations, and UIOs.

On September 12, 2022, after recommendations from NCUIH and Tribal leaders, the Biden administration created a position of a Tribal Policy Advisor within OMB to communicate the needs of Indian Country and AI/ANs. This position was an important first step in ensuring that Native voices are heard during the budget process, and we are grateful that this bill works to further consider the needs of Native programs in federal funding.

Next Steps

Senator Warren and Congressman Kilmer invite comments and feedback on how to refine and improve the legislation in the next Congress. Written input can be submitted at HonoringPromises@warren.senate.gov.

Background

Broken Promises

On December 20, 2018, the Broken Promises report was released and addressed areas where the federal government has failed to fulfill its trust responsibility, including criminal justice and public safety, health care, education, housing, and economic development. Specifically, the report requests advance appropriations for the IHS and funding to implement the Indian Health Care Improvement Act, including job training programs to address chronic shortages of health professionals in Indian Country and a mental health technician training program to address the suicide crisis in Indian Country. The report also recommends direct, long-term funding to Tribes, analogous to the mandatory funding Congress provides to support Medicare, Social Security, and Medicaid, avoiding pass-through of funds via states.

The proposal for this bill was first introduced in August 2019 by Congresswoman Deb Haaland (D- N.M.) and Senator Warren. Lawmakers then took feedback from tribal governments and citizens, tribal organizations, UIOs, experts, and other stakeholders which informed the development of this current legislation.

Partnership for Medicaid Advocates for Key Urban Indian Health Priority in Omnibus Request

December 7, 2022/0 Comments/in Policy Blog/by Mary Jomia

On October 28, 2022, the Partnership for Medicaid (Partnership) sent a letter to House and Senate leadership urging that several Medicaid policy proposals be prioritized as Congress considers an end-of-year health care package. In the letter, they requested that Congress seek to include legislation that would extend 100% Federal Medical Assistance Percentage (FMAP) for urban Indian organizations (UIOs) and Native Hawaiian Health Systems for another two years. After advocacy from the National Council for Urban Indian Health (NCUIH), the American Rescue Plan Act (ARPA) authorized 8 fiscal quarters of 100% FMAP to UIOs, which is set to expire in just 3 months.

Partnership for Medicaid Letter to Congress on Medicaid Priorities in an End of Year Legislative Package

Full Letter Text

Dear Leader Schumer, Speaker Pelosi, Minority Leader McConnell, and Minority Leader McCarthy:

On behalf of the Partnership for Medicaid (Partnership), thank you for your continued commitment to the Medicaid program. Our member organizations are eager to collaborate with you to build upon efforts to sustain and strengthen Medicaid.

The Partnership – a nonpartisan, nationwide coalition made up of organizations representing clinicians, health care providers, safety net plans, and counties –appreciates initiatives from Congress throughout the COVID-19 pandemic to bolster the Medicaid program and support the health care safety net. Your continued attention has not only allowed the program to meet the needs of millions of Americans during a public health crisis but has also reinforced the importance of investing in Medicaid now to protect and sustain its promise for the future.

As the Congress considers an end-of-year health care package, the Partnership urges lawmakers to prioritize policy proposals to strengthen Medicaid and ensure its stability for underrepresented populations who rely on this critical program. Congress should seek to include legislation that would:

building on provisions included in the FY 2022 Continuing Resolution, create a permanent and sustainable Medicaid financing solution for Puerto Rico and other territories;
permanently ensure that all pregnant individuals on Medicaid and the Children’s Health Insurance Program (CHIP) keep their health coverage during the critical first year postpartum;
provide one year of continuous eligibility for children covered by Medicaid and CHIP;
appropriately fund the Medicaid program in a manner that supports states to set competitive rates necessary for garnering equitable access for Medicaid, as undervaluing Medicaid payments—and consequently, the patients Medicaid serves—perpetuates systemic barriers to health and health care and worsens health disparities;
invest in and improve access to Medicaid home-and community-based services (HCBS) and mental health services, including for children, while strengthening the direct care workforce;
provide Medicaid coverage to eligible, justice-involved individuals 30 days prior to release;
extend the 100 percent federal medical assistance percentage (FMAP) for Urban Indian Organizations and Native Hawaiian Health Systems for another two years;
make permanent Medicaid’s Money Follows the Person program and the Protection Against Spousal Impoverishment.
permanently fund CHIP; and
close the Medicaid coverage gap for Americans living in states that have yet to expand Medicaid and still lack access to health insurance

Taken together, these proposed improvements to Medicaid and CHIP represent an opportunity to stabilize and expand access to health care and long-term services and supports for millions of low-income Americans, from older adults, people with disabilities, children, pregnant and postpartum individuals, and their families, and more.

Furthermore, for Medicaid issues legislatively tied to the public health emergency, we urge Congress to proceed with caution when applying imminent, static sunsets to policies stakeholders rely upon to help mitigate COVID-19’s ongoing impact. For example, Congress should create a predictable, evidence-informed wind down of the enhanced FMAP and continuous coverage provisions included in the Families First Coronavirus Response Act that provides sufficient guardrails to protect beneficiaries while also reflecting the trajectory of the COVID-19 pandemic.

We remain grateful for your leadership and commitment to the Medicaid program and the populations it serves. If you have questions or seek any additional information, please contact Jonathan Westin at the Jewish Federations of North America, First Co-Chair of the Partnership for Medicaid at Jonathan.Westin@jewishfederations.org.

Sincerely,

America’s Essential Hospitals
American College of Obstetricians and Gynecologists
American Dental Education
Association American Network of Community Options and Resources (ANCOR)
Associations of Clinicians for the Underserved
Catholic Health Association of the United States
Children’s Hospital Association
Easterseals
Jewish Federations of North America
National Association of Counties
National Association of Pediatric Nurse Practitioners
National Association of Rural Health Clinics (NARHC)
National Council for Mental Wellbeing
National Council of Urban Indian Health
National Health Care for the Homeless Council
National Rural Health Association

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:

Background and NCUIH Advocacy on Medicaid

100% FMAP for UIOs

FMAP refers to the percentage of Medicaid costs covered by the federal government, which will be reimbursed to the states. Permanent authorization or an extension of the 100% FMAP for UIOs provision will further the government’s trust responsibility to American Indians/Alaska Natives (AI/ANs) by increasing available financial resources to UIOs and support them in addressing critical health needs of AI/AN patients. In March of 2021, Congress enacted ARPA which authorized eight fiscal quarters of 100% FMAP coverage for UIOs. Congress did this in part to increase the financial resources available to UIOs and support the provision of critically needed health services to urban AI/ANs during the COVID-19 pandemic. Unfortunately, with only 3 months until the provision expires, most UIOs have not received any increase in financial support because many states have not increased their Medicaid reimbursement rates to UIOs, citing short-term authorization concerns.

NCUIH and Partnership for Medicaid Priority: Medicaid Unwinding

After the COVID-19 Public Health Emergency (PHE), states will resume normal operations, which includes processing eligibility renewals and ending coverage for individuals no longer eligible for Medicaid and Children’s Health Insurance Program (CHIP) in a process known as “unwinding.” The Partnership for Medicaid advocates for protections against the potential loss of coverage for millions of Medicaid beneficiaries at the end of the PHE. NCUIH recently released a Medicaid unwinding toolkit for UIOs as they prepare for changes in Medicaid coverage. This document outlines the impact of Medicaid unwinding on AI/ANs and the steps UIOs can take to assist their patients with their coverage, such as working with their state, Tribes, federal agencies, and their community.

NCUIH COVID-19 Public Health Emergency Medicaid Unwinding Toolkit