On February 27, 2023, Centers for Medicare & Medicaid Services (CMS) issued a new fact sheet regarding the ending of the federal Public Health Emergency for COVID-19 (PHE). The PHE was declared by the Department of Health and Human Services (HHS) under Section 319 of the Public Health Services Act and is scheduled to expire at the end of the day on May 11, 2023. The fact sheet is intended to provide clarity of the following services for receiving health care at the end of the PHE:
COVID-19 vaccines, testing, and treatments
Telehealth services
Health Care Access: Continuing flexibilities for health care professionals
Inpatient Hospital Care at Home: Expanded hospital capacity by providing inpatient care in a patient’s home.
What Won’t Be Affected
There are significant flexibilities and actions that will not be affected during the transition to the ending of the PHE. HHS is committed to ensuring that COVID-19 vaccines and treatments will be widely accessible to all who need them. There will also be continued access to pathways for emergency use authorizations (EUAs) for COVID-19 products through the Food and Drug Administration (FDA), and telehealth flexibilities will continue to exist for those participating in Medicare or Medicaid.
Medicaid Continuous Enrollment
The continuous enrollment condition for individuals enrolled in Medicaid is no longer linked to the end of the PHE. Under the Families First Coronavirus Response Act, states claiming a temporary 6.2 percentage point increase in the Federal Medical Assistance Percentage (FMAP) have been unable to terminate enrollment for most individuals enrolled in Medicaid as of March 18, 2020, as a condition of receiving the temporary FMAP increase. As part of the Consolidated Appropriations Act, 2023, the continuous enrollment condition will end on March 31, 2023. The temporary FMAP increase will be gradually reduced and phased down beginning April 1, 2023 and will end on December 31, 2023.
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On March 20, 2023, the National Council of Urban Indian Health (NCUIH) signed on to a Partnership for Medicaid letter to Chair Bernard Sanders and Ranking Member Bill Cassidy of the Senate Committee on Health, Education, Labor, and Pensions (HELP). This letter is in response to the Senate HELP request for information (RFI) following its February hearing on understanding the root causes of our current health care shortages and exploring potential legislative solutions.
The Letter Identifies Drivers of Workforce Shortages:
State provider payment rates are insufficient to achieve the goal of being able to recruit and retain enough providers to serve Medicaid beneficiaries.
Insufficient supply/Increased demand of providers for populations served by the Medicaid program.
The Letter Recommends:
Grants administered by relevant federal agencies such as the Department of Labor (DOL) and the Department of Health and Human Services (HHS) to strengthen the healthcare workforce, including the direct care workforce.
Expand loan repayment programs to include more health workers, especially those who come from disadvantaged backgrounds and/or racial or ethnic minorities.
Ensure broad eligibility for federal programs intended to increase providers in underserved areas.
Safety from Violence for Healthcare Employees (SAVE) Act (H.R. 7961), legislation that would protect caregivers from workplace violence.
Full Letter Text
Dear Chairman Sanders and Ranking Member Cassidy:
The following are part of a nonpartisan, nationwide coalition comprised of organizations representing clinicians, health care providers, safety net plans, and counties dedicated to preserving and improving the Medicaid program. The undersigned organizations appreciate the opportunity to provide comments in response to your request for input from stakeholders to best understand views on the drivers of health care workforce shortages and ideas on potential solutions. In our view, workforce shortages, especially those seen in providers and professionals struggling to care for the Medicaid population, stem from insufficient payment rates, insufficient supply of providers, and increased demand for particular services most acutely in urban and rural underserved areas. These challenges impact the ability of health care providers and plans to provide needed services to our nation’s most vulnerable: low-income children, pregnant individuals, parents, individuals with disabilities, seniors, and other adult Medicaid beneficiaries across the country. Below, we provide recommendations for specific policy solutions within your Committee’s jurisdiction that would start to address some of these issues. We hope to continue working with the HELP Committee as you begin to shape these policy solutions into actionable legislation.
Drivers of Workforce Shortages
State provider payment rates are insufficient to achieve the goal of being able to recruit and retain enough providers to serve Medicaid beneficiaries. While Federal law mandates that state Medicaid payments be “sufficient to enlist enough providers so that care and services are available under the [state] plan,”existing Federal regulations fail to adequately measure and enforce adequate payment rates. As such, Medicaid has notably low reimbursement rates, that are often much lower than Medicare payment rates, and at times lower than the actual cost of providing care to Medicaid patients. This makes it more difficult for the program to enlist a sufficient number of providers who can meet patient demand, and thus negatively impacts access to care for Medicaid beneficiaries, who are disproportionately people of color.
Insufficient supply of providers for populations served by the Medicaid program. Even before the pandemic, many types of providers and clinicians, including the longterm care community, behavioral health providers, and primary care providers as well as clinicians, increasingly experienced worsening workforce issues, and the COVID-19 pandemic only accelerated this decline. For a variety of reasons, including cost of education, not enough people are pursuing careers in these important fields.
Increased demand for provider types serving the Medicaid program. Due to COVID-19 and other factors, certain types of providers are experiencing ongoing surges in demand, likely to continue for the foreseeable future. For example, our aging population will continue to significantly increase demand for long-term care services, for which Medicaid is the primary payer.More than two-thirds of older adults will need some personal assistance in their daily lives, and nearly half will have a high enough level of need that they will be eligible for private long-term care insurance or Medicaid at some point in their lives. Further, the COVID-19 pandemic has exacerbated an already significant mental health crisis in this country, increasing demand for mental health services and further stretching the existing capacity of mental health providers serving the Medicaid population.
Recommendations
Grants administered by relevant federal agencies such as the Department of Labor (DOL) and the Department of Health and Human Services (HHS) to strengthen the healthcare workforce, including the direct care workforce.
The Committee should consider legislation that would authorize increased funding to relevant federal agencies within its jurisdiction to increase investments that support the recruitment, training, retention, and professional development of a diverse clinical and non-clinical workforce.
For example, the legislation can authorize funding to DOL to award grants to health care entities in health professional shortage areas to support the hiring, training, and retention of healthcare workers, including direct care workers.
The legislation could also authorize funding to HRSA to carry out grants for health care entities for pilot demonstrations to enhance the skills of healthcare workers including direct care workers mental health professionals and promote retention.
Last, the legislation could also increase funding for HRSA Title VII workforce development programs.
Expand loan repayment programs to include more health workers, especially those who come from disadvantaged backgrounds and/or racial or ethnic minorities.
The Committee should consider legislation that would expand loan repayment programs that provide for student loan repayment in exchange for service commitments for a range of different types of health care providers.
The Committee could look to S. 462 (The Mental Health Professionals Workforce Shortage Loan Repayment Act of 202313) as a guiding example. This bipartisan legislation would address the current lack of incentives for mental health providers working in the Substance Abuse treatment to serve in areas that struggle to recruit and retain physicians. It would also create new incentives to attract providers to serve in underserved areas. This legislation would repay up to $250,000 in eligible student loan repayment for mental health professionals who work in mental health professional shortage areas.
The Committee should consider these policy ideas and extend them to additional provider types experiencing severe shortage issues.
The Committee should also consider legislation that would incentivize current and former National Health Service Corps (NHSC) participants (physicians, nurses, and dentists) to enroll in demonstration programs to support entities, including long-term care facilities and hospitals at risk of losing obstetric services, experiencing severe staffing shortages.
The variety of settings experiencing severe staffing shortages also warrants consideration for expanding the NHSC to other qualified health specialties, including certain mental health professionals and direct care workers.
Ensure broad eligibility for federal programs intended to increase providers in underserved areas.
The Committee should consider utilizing expansive eligibility language in legislation intended to increase providers in underserved areas.
For example, Section 403 of the MISSION Act of 201814 directs the VA to expand its existing medical residency program to underserved non-VA facilities. The Act provides an expansive definition of “covered facility” for the purpose of the program by listing specific provider types and including “[s]uch other health care facility as the Secretary considers appropriate for purposes of this section” as a catch-all.
Safety from Violence for Healthcare Employees (SAVE) Act (H.R. 7961), legislation that would protect caregivers from workplace violence.
The bill, introduced by Reps. Madeleine Dean (D-Pa.) and Larry Bucshon, MD, (R-Ind.), would provide legal penalties, similar to federal protections that exist for flight crews, for individuals who knowingly and intentionally assault or intimidate hospital employees. Increasing threats and acts of violence against health care workers have further burdened a workforce already under immense strain from shortages, burnout, and trauma related to the COVID-19 pandemic. While Congress and the Department of Justice have addressed violence against airline workers, they have not done the same for the health care workforce.
The Coalition appreciates the opportunity to provide these comments and looks forward to working with the HELP Committee to identify bipartisan solutions to remedy our nation’s health care workforce shortages and develop these ideas into legislation. If you have questions or seek any additional information, please contact Elizabeth Cullen at the Jewish Federations of North America at Elizabeth.Cullen@jewishfederations.org.
Sincerely,
American Academy of Family Physicians
American Dental Association American Dental Education Association
American Health Care Association
America’s Essential Hospitals
ANCOR
Associations for Clinicians for the Underserved
National Association of Counties (NACO)
National Council of Urban Indian Health
National Health Care for the Homeless Council
The Jewish Federations of North America
About the Partnership for Medicaid
NCUIH is a member of the Partnership for Medicaid, which is a nonpartisan, nationwide coalition of organizations representing clinicians, health care providers, safety-net health plans, and counties. The goal of the coalition is to preserve and improve the Medicaid program. Members of this coalition include:
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We need your help contacting Congress to support increased healthcare resources for urban Native communities.
Representatives Ruben Gallego (D-AZ-3) and Raúl Grijalva (D-AZ-7) are again leading a letter to the Chair and Ranking Member of the Appropriations Subcommittee on Interior, Environment, and Related Agencies. This subcommittee appropriates funding for the Indian Health Service (IHS) and Urban Indian Organizations (UIOs).
The letter requests an increase for the urban Indian health line item to $973.59 million for Fiscal Year 2024 and retaining appropriations for IHS. Adequate funding for urban Indian health is necessary to fulfill the federal government’s trust responsibility to all American Indians and Alaska Natives. The proposed amount is determined by the Tribal Budget Formulation Workgroup (TBFWG) as part of the request for full funding for IHS at $51.4 billion.
We encourage you to contact your Member of Congress and request that they sign the Gallego-Grijalva Urban Indian Health Letter by the deadline of March 17.
You can use the text below as a template to call and/or email to email your Member of Congress. You can find your representative here.
Sincerely,
The National Council of Urban Indian Health (NCUIH)
Step 3: Paste the email into the form and send. Please contact Lycia Maddocks (LMaddocks@ncuih.org) with questions.
Email to Your Member of Congress
Dear Representative,
As an urban Indian health advocate, I respectfully request you sign on to the Gallego-Grijalva letter to the Chair and Ranking Member of the Appropriations Subcommittee on Interior, Environment, and Related Agencies. The letter requests an increase for the urban Indian health line item to $973.59 million for Fiscal Year 2024 and retaining appropriations for IHS. Adequate funding for urban Indian health is necessary to fulfill the federal government’s trust responsibility to all American Indians and Alaska Natives. The proposed amount is determined by the Tribal Budget Formulation Workgroup (TBFWG) as part of the request for full funding for IHS at $51.4 billion.
It is the policy of the United States “to ensure the highest possible health status for Indians and urban Indians and to provide all resources necessary to effect that policy.” This requires that funding for Indian health must be significantly increased if the federal government is to finally fulfill its trust responsibility. At a minimum, funding must be maintained and protected as budget-cutting measures are being considered.
We respectfully ask that you join this year to help honor the federal trust obligation and support the overall health and well-being of American Indians and Alaska Natives.
To sign on to the letter, please contact Emma Reidy (Emma.Reidy@mail.house.gov) from Gallego’s office by this Friday, March 17.
Thank you for your leadership and commitment to upholding the United States’ trust and treaty responsibility.
Sincerely,
[YOUR NAME]
https://ncuih.org/wp-content/uploads/Website-Graphics-Logo-Package_NCUIH_D081_V1_Policy-Update.png11261501LMaddockshttps://ncuih.org/wp-content/uploads/NCUIH-2022-Logos_Full-Logo-3.pngLMaddocks2023-03-17 11:01:082023-03-17 11:06:22UPDATED: Contact Congress to Increase Funding for Urban Indian Health TODAY
Yesterday, President Biden released the annual budget proposal for Fiscal Year (FY) 2024. The Budget proposes $9.7 billion for the Indian Health Service (IHS), an increase of $2.5 billion or 36% above FY23 enacted levels.
NCUIH CEO Francys Crevier testified before Congress, and Committee leaders pledged to protect the Indian Health Service budget from cuts.
Read on to learn more.
Biden Budget Proposal Demonstrates Continued Commitment to Improving the Indian Health Service
On March 9, 2023, the President released the annual budget proposal for Fiscal Year (FY) 2024. The “HHS Budget in Brief” has been released but the Congressional Justification for the Indian Health Service has not been released.
The bottom line: Mandatory Funding for IHS Remains a Priority; Advance Funding Still Needed
What they’re saying: “The Administration is committed to upholding the United States’ trust responsibility to tribal nations by addressing the historical underfunding of IHS. The enactment of an advance appropriation for 2024 for IHS was a historic and welcome step toward the goal of securing adequate and stable funding to improve the overall health status of American Indians and Alaska Natives.”
The budget proposal includes the Administration’s commitment that by 2025, the IHS budget would shift from mostly discretionary to all mandatory funding.
The President also reaffirmed that “until [mandatory funding] is enacted, it is critical that Congress continue to prioritize advance appropriations for IHS through the discretionary appropriations process to ensure funding for healthcare services and critical facilities activities are not disrupted.”
The big picture: NCUIH will continue to advocate for the Tribal Budget Formulation Workgroup requests for urban Indian health and the Indian Health Service.
What’s next: Congress will hold hearings to review the President’s request. House Republicans are calling for reduced spending levels, while Senate appropriators are having bipartisan talks on top-line totals, with a goal of starting spending bill markups as soon as May.
By the numbers:
This chart shows how the enacted amounts compare to the Tribal request and President proposals.
Overall Budget for Department of Health and Human Services (HHS)
The Budget requests $144 billion in discretionary budget authority for FY24, a $14.8 billion or 11.5% increase from the FY23 enacted level.
Indian Health Service Budget Highlights
Indian Health Service Overall: $9.7 billion, an increase of $2.5 billion or 36% above FY23 enacted and $41.7 billion less than requested by TBFWG.
Urban Indian Health:$115 Million for an increase of $25 million or 27% above FY23 enacted and $858.6 million less than requested by the TBFWG.
Reauthorizes and Increases Funding for the Special Diabetes Program for Indians: The budget proposes to reauthorize the Special Diabetes Program for Indians and provide $250 million in FY24, $260 million in FY25, and $270 million in FY26 in new mandatory funding.
Proposes New Program to Increase Public Health Capacity and Infrastructure: The budget also proposes new funding of $150 million in FY25 to address public health capacity and infrastructure needs in Indian Country. This funding would support an innovative hub-and-spoke model to address local public health needs in partnership with tribes and urban Indian organizations.
Bipartisan Pledge from House Committee Leaders to Protect Indian Health Service Budget from Budget Cuts
NCUIH CEO, Francys Crevier (Algonquin), testifies at American Indian and Alaska Native Public Witness Day.
On March 9, 2023, the National Council of Urban Indian Health CEO Francys Crevier (Algonquin), testified before the House Interior Appropriations Subcommittee as part of American Indian and Alaska Native (AI/AN) Public Witness Days regarding FY24 funding for the Indian Health Service. NCUIH was invited to testify on the critical health needs of American Indians and Alaska Natives living in urban areas.
Did you know?: It was the first hearing of this Subcommittee with the return of Chairman Mike Simpson.
NCUIH’s testimony called attention to the staggering health disparities that Native communities face and requested full funding for the Indian Health Service.
“Native people deserve full, healthy lives. We cannot continue to rely on short-term solutions that only address the symptoms of the problem. We ask for full funding for IHS and the urban Indian health line item. Make advance appropriations and 100% FMAP for UIOs permanent. Protect us from sequestration now.”
– Francys Crevier (Algonquin), NCUIH CEO
Following Ms. Crevier’s testimony, Chairman Simpson pledged to prioritize protecting the Indian health budget from the expected budget cuts.
“We are going to have to make sure that we prioritize Indian healthcare in these budgets…There are some areas we’re going to have to protect and Indian health is going to have to be one of them.”
-Chairman Mike Simpson (R-ID)
Ranking Member Chellie Pingree also attended and reaffirmed her continued commitment to prioritizing Native health care.
“Protecting Indian health is critically important, as is housing and education and so many other things, but meeting our treaty and trust obligations is just so critical… The idea that the budget is six, seven billion but should be 51, we just have to take a big leap at getting closer because you and the centers you represent know how to distribute and spend that money and know how to make sure we get access to it and that you can use it in the ways that its most important for [Tribes and Urban Indian Organizations].”
– Ranking Member Chellie Pingree (D-ME)
Our thought bubble: NCUIH applauds the bipartisan leadership of Chair and Ranking Member of the Appropriations Committee.
On February 17, 2023, the National Council of Urban Indian Health (NCUIH), the National Indian Health Board (NIHB), Self-Governance Communication and Education Tribal Consortium, and the United South and Eastern Tribes Sovereignty Protection Fund sent a letter to request that the President include funding for the Native Behavioral Health Program authorized in the omnibus. Specifically, the organizations asked for the full authorized level of $80 million for the Native Behavioral Health Resources Program included in the Restoring Hope for Mental Health and Well-Being Act be funded in the President’s Fiscal Year (FY) 2024 Budget Request.
NCUIH particularly applauds Senator Tina Smith for her sponsorship and the co-sponsorship of Senator Cramer, Senator Tester, Senator Lujan, Senator Warren, and Senator Cortez Masto of the Native Behavioral Health Access Improvement Act of 2021, which was the foundation for the behavioral health provisions included in the Restoring Hope for Mental Health and Well-being Act. NCUIH also thanks Ranking Member Frank Pallone and Representative Raul Ruiz for championing this proposal to ensure that American Indians/Alaska Natives (AI/ANs) have greater access to resources necessary to address critical behavioral health needs and bring the federal government closer to fulfilling its trust obligations to AI/AN populations.
In particular, the letter outlines that the Restoring Hope for Mental Health and Well-Being Act includes a Native behavioral health provision that contains:
A funding authorization of no less than $125 million annually over a minimum of four fiscal years.
A mandate to deliver funding on a non-competitive basis.
The opportunity to receive funding through Indian Self-Determination Act contracts or compacts.
A requirement that any funding formulas be developed in consultation with Tribal Nations and conference with Urban Indian Health Organizations.
A requirement that reporting requirements be developed through a negotiated rulemaking process between the federal government, Tribal Nations, and Urban Indian Health Organizations.
This is in response to the high rates of behavioral health issues caused by centuries of generational trauma resulting from colonization and hostile acts of the United States Government. In fact, as outlined in the letter, Native people experience serious mental illnesses at a rate 1.58 times higher than the national average, and high rates of alcohol and substance abuse. In fact, between 1999 and 2015, the drug overdose death rates for Native populations increased by more than 500%. Native youth also experience the highest rates of suicide and depression, with the Native youth suicide rate being 2.5 times that of the national average.
On behalf of the undersigned Tribal partner organizations, we write to urge the inclusion of the full authorized level of $80 million in the President’s Fiscal Year (FY) 2024 Budget Request to fund the Native Behavioral Health Resources Program as included in the Restoring Hope for Mental Health and Well-Being Act. Tribal Nations and our citizens continue to face high rates of behavioral health issues, caused by myriad factors, including centuries of generational trauma resulting from colonization and hostile acts of the United States government. Yet, in violation of federal trust and treaty obligations to provide comprehensive health care to Tribal Nations, we continue to lack substantial and sustained funding to address these challenges for current and future generations. As the collective trauma of living through the COVID-19 public health crisis only exacerbates and intensifies these issues, it is critical that Tribal Nations and the Indian Health System are equipped with the resources necessary to bring healing and recovery to our communities.
Between 1999 and 2015, the drug overdose death rates for American Indian and Alaska Native (AI/AN) populations increased by more than 500%. Addressing the challenges presented by the opioid crisis in Indian Country is further complicated by high rates of alcohol and substance abuse, suicide, and other serious mental health conditions. AI/AN populations experience serious mental illnesses at a rate 1.58 times higher than the national average, and Native youth experience the highest rates of youth suicide and depression in the country. Yet far too many facilities across the Indian Health System are unable to access the quality health care and services necessary to address these behavioral health issues. A survey conducted by the Indian Health Service (IHS) found that Tribal Nations rated the expansion of inpatient and outpatient mental health and substance abuse facilities as our number one priority. Currently, only 39% of IHS facilities provide 24-hour mental health crisis intervention services, and 10% of IHS facilities do not provide any crisis intervention services at all.
To combat the opioid epidemic and the broader behavioral health crisis in Indian Country, Tribal Nations and facilities across the Indian Health System require flexible and substantial funding to create behavioral health programs that are responsive to the unique circumstances facing our communities. Toward that end, along with Congressional partners, we urged at the end of the 117th Congress that the Restoring Hope for Mental Health and Well-Being Act include a Native behavioral health provision that contained the following:
A funding authorization of no less than $125 million annually over a minimum of four fiscal years;
A mandate to deliver funding on a non-competitive basis;
The opportunity to receive funding through Indian Self-Determination Act contracts or compacts;
A requirement that any funding formulas be developed in consultation with Tribal Nations and conference with Urban Indian Health Organizations; and
A requirement that reporting requirements be developed through a negotiated rulemaking process between the federal government, Tribal Nations, and Urban Indian Health Organizations.
Although only some of our priorities were adopted in the final bill and while centuries of underinvestment in mental and behavioral health across Indian Country will require sustained funding and thoughtful effort on the part of Congress and the Administration to properly address, funding the Native Behavioral Health Resources Program would represent a significant step toward this goal. We urge the Biden Administration to prioritize its trust and treaty obligations to Tribal Nations by supporting Tribal Nation access to federal mental health and substance use disorder programs, including the Native Behavioral Health Resources Program. We thank you for your attention to this matter and look forward to continued collaboration on improve health care throughout Indian Country.
Sincerely,
National Council of Urban Indian Health
National Indian Health Board
Self-Governance Communication and Education Tribal Consortium
United South and Eastern Tribes Sovereignty Protection Fund
Background
In response to these chronic health disparities and the dire need for behavioral health resources for Indian health care providers, the House Energy and Commerce Committee drafted bipartisan legislation creating the Native Behavioral Health Resources Program. This legislation was included in the House-passed Restoring Hope for Mental Health and Well-Being Act (H.R.7666), and ultimately included in the Consolidated Appropriations Act, 2023. This provision authorized to be appropriated $80 million for the Native Behavioral Health Resources Program.
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On Thursday, March 9, 2023 at 9:00 AM, the National Council of Urban Indian Health (NCUIH) Chief Executive Officer, Francys Crevier, JD (Algonquin) will testify in person before the House Interior Appropriations Subcommittee hearing as part of American Indian and Alaska Native Public Witness Days (March 8 and 9, 2023).
In the testimony, NCUIH will advocate for full funding for the Indian Health Service and Urban Indian Health as requested by the Tribal Budget Formulation Workgroup (TBFWG) for Fiscal Year (FY) 2024. Other requests include: maintaining advance appropriations for IHS until mandatory funding is enacted and appropriating at least $80 million for the Native Behavioral Health Resources Program.
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On February 13, 2023, the Indian Health Service (IHS) sent a Dear Urban Indian Organization Leader letter (DULL) clarifying use of funds requirements from the Fiscal Year (FY) 2022 Urban Indian Organization (UIO) Infrastructure Study as a follow-up to the virtual Urban Confer convened by the IHS on June 23, 2022. In the letter, IHS emphasized that “…the joint explanatory statement accompanying the Consolidated Appropriations Act, 2022 (CAA, 2022) does not mean Congress intends to allocate additional funding for UIO Infrastructure Activities. Instead, Congress intends to ensure that the additional funding provided remains in the Direct Operations accounts of IHS management use.” IHS notes that this aligns with UIO Confer recommendations to avoid using the funding for any additional UIO Infrastructure Study activities.
Background
In 2021, Congress allocated $1 million in funds for IHS to conduct an Urban Indian Infrastructure study through the Consolidated Appropriations Act, 2021. The purpose of the Infrastructure Study aims to better understand the most critical deficiencies facing UIOs. On March 15, 2022, Congress provided $800,666 in additional funding to IHS for the Infrastructure Study through the CAA, 2022. On June 16, 2022, IHS requested input from UIO leaders regarding the additional funding from the CAA, 2022 on how these funds can be utilized by IHS. On June 23, 2022, UIO Leaders and NCUIH attended an Urban Confer where IHS explained that the Infrastructure Study will be completed by December 31, 2022, with results scheduled for release in January 2023. Results have not been released as of February 2023.
NCUIH’s Recommendations to IHS
On August 23, 2022, NCUIH submitted comments to IHS in response to the June 16, 2022 DULL regarding the use of funding available for the Urban Indian Infrastructure Study. NCUIH made the following recommendations regarding the Infrastructure Study:
Provide UIOs with the findings from the first Infrastructure Study prior to making any decisions regarding use of the additional funds
It is crucial that UIOs are aware of the scope, results, and usefulness of the Infrastructure Study before they make any recommendations regarding the use of the further funding.
Given the timeline presented during the Urban Confer, there was an 8-month window in which UIOs and IHS will be able to review the Infrastructure Study results following their scheduled release in January 2023 and decide as to the best use of the additional funding
OUIHP should provide a timeline of the Planning Process to UIOs
NCUIH requested a timeline be released to UIOs delineating when the initial Infrastructure Study will be released, the contracting process necessary to use the additional funding, and the deadline for the obligation of the additional funding.
The requested timeline will provide clarity to UIOs. With a clearer picture in mind, the planning process and use of the additional FY22 funds for the Infrastructure Study becomes more cooperative between UIOs and IHS.
IHS should host an additional Urban Confer after releasing the results of the Infrastructure Study.
NCUIH notes that informed feedback from UIOs creates a scenario where the additional funding can be best used to support the needs of UIOs.
NCUIH continues to advocate for transparency in the process of the Infrastructure Study and greater support to address the critical infrastructure needs at UIOs. NCUIH will continue to keep UIOs informed as more information is made available from IHS.
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On January 27, 2023, the National Council of Urban Indian Health submitted comments to the Administration for Children and Families (ACF) in response to their December 20, 2022 request for comment on review of the Tribal Maternal, Infant, and Early Childhood Home Visiting Program (Tribal MIECHV) Guidance for Submitting Reports to the Secretary of the Office of Management and Budget (OMB). The Tribal MIECHV Program provides grants to tribal organizations and urban Indian organizations (UIOs) to develop, implement, and evaluate home visiting programs in American Indian and Alaska Native (AI/AN) communities.
Recommendations
NCUIH made the following recommendations to ACF in response to the request for comments:
NCUIH requested that ACF host an Urban Confer with UIO leaders to discuss the Tribal MIECHV program.
NCUIH recommended that ACF work with its colleagues at IHS to host and facilitate an Urban Confer on the annual reporting requirements for Tribal MIECHV grantees.
Given the substantial increase in the set-aside for the Tribal NCUIH further recommends that ACF consider broadening the scope of this Urban Confer to engage with UIOs on the Tribal MIECHV program generally.
This will provide ACF a forum in which to work with UIOs to ensure that they are participating in this program to the greatest extent possible and that urban Native communities are being served as Congress intended.
Background
Under the ACF, the MIECHV Program supports pregnant people and parents with young children who live in communities that face greater risks and barriers to achieving positive maternal and child health outcomes. The Tribal MIECHV program is funded by a six percent set-aside from the larger MIECHV program. The Tribal MIECHV program aims to support the development of happy, healthy, and successful AI/AN children and families through a coordinated home visiting strategy that addresses critical maternal and child health, development, early learning, family support, and child abuse and neglect prevention needs. It also implements high-quality, culturally relevant, evidence-based home visiting programs in AI/AN communities and expands the evidence base around home visiting interventions with Native populations.
Urban Native Maternal and Child Health Disparities
Native people have endured a tragic history of forced removal from their homelands throughout eras of colonization and US expansion. Formally dating back to the 1800s, forced removal included the loss of ancestral homelands, children taken from their parents and placed into government boarding schools, and policy aimed at integrating Native people into US cities, each resulting in traditional and cultural deprivation. This migration into cities has resulted in urban Indians experiencing more unemployment and homelessness compared to the general population, lower levels of educational achievement, higher rates of morbidity and mortality and a loss of traditional and cultural connection. Urban Indian women have considerably lower rates of prenatal care and higher rates of infant mortality than their reservation counterparts within the same state. While UIOs provide critical health and social services, the safety net available to those living on reservations is often not matched in urban environments. Recognizing the health disparities experienced by urban Indians, MIECHV legislation allows Tribal MIECHV funds to be awarded to UIOs to further support the health and social needs of Native people living in urban areas.
NCUIH’s Role
NCUIH has engaged in extensive policy work, including attending Congressional meetings and joining sign-on letters with coalition partners, in support of reauthorizing the MIECHV program and doubling the Tribal set-aside. NCUIH was pleased that Congress reauthorized the Tribal MIECHV program and increased the funding level. The Tribal MIECHV program helps improve the lives of AI/AN children and families and NCUIH looks forward to more UIOs becoming grantees and working with ACF to support the development of happy, healthy, and successful Native children and families no matter where they live.
https://ncuih.org/wp-content/uploads/Website-Graphics-Logo-Package_NCUIH_D081_V1_Policy-Update.png11261501Colin Tompsonhttps://ncuih.org/wp-content/uploads/NCUIH-2022-Logos_Full-Logo-3.pngColin Tompson2023-03-07 09:58:162023-04-14 13:20:46NCUIH Requests the Administration of Children and Families Host Urban Confer with UIOs Regarding the Tribal Maternal, Infant, and Early Childhood Home Visiting Program
The Policy assessment informs urban Indian organization policy priorities in 2023, identifies traditional healing barriers, and addresses mental and behavioral health needs.
The National Council of Urban Indian Health (NCUIH) is pleased to announce the release of its 2022 Annual Policy Assessment. NCUIH hosted five focus groups to identify Urban Indian Organization (UIO) policy priorities for 2023, as they relate to the Indian Health Service (IHS) designated facility types (full ambulatory, limited ambulatory, outreach and referral, and outpatient and residential). The focus groups were held on October 18, 21, and 24, 2022. Additional information was also collected from the UIOs via a questionnaire sent out on November 15, 2022.
Together these tools allow NCUIH to work with UIOs to identify policy priorities in 2023 and identify barriers that impact delivery of care to Native patients and their communities. Of 41 UIOs, 26 attended the focus groups and/or participated in the questionnaire. This is the third year that NCUIH has conducted the assessment via focus groups and follow up questionnaire. This is also the highest response from UIOs NCUIH has seen since following this process.
After the height of the COVID-19 pandemic, newfound priorities were identified for 2023, including workforce development and retention, increased funding for traditional healing, and expanded access to care and telehealth services. Existing priorities also remain a key focus across UIOs, especially increasing funding amounts for the urban Indian health line item and IHS, maintaining advance appropriations for IHS, establishing permanent 100% Federal Medical Assistance Percentage (FMAP) for UIOs, reauthorizing the Special Diabetes Program for Indians (SDPI), and increasing behavioral health funding.
Key findings from the discussions are as follows:
Funding Flexibility is Key to Expanding Services
Need for Funding Security Remains a Priority
Advance Appropriations Mitigates Funding Insecurities Generated by Government Shutdowns and Continuing Resolutions
Facility Funding Directly Impacting UIOs
Permanent 100% FMAP Increases Available Financial Resources to UIOs
Workforce Concerns Amidst Inflation and Market Changes
Traditional Healing Crucial to Advance Comprehensive Native Healthcare
Addressing Access and Quality of Native Veteran Care
Health Information Technology and Electronic Health Record Modernization
New Barriers Limit UIO Distribution of Vaccines
HIV, Behavioral Health, and Substance Abuse Report
Reauthorizing the Special Diabetes Program for Indians
UIOs Find Current NCUIH Services Beneficial
Next Steps
NCUIH will release a comprehensive document of the 2023 Policy Priorities in the coming weeks.
February is almost over. Here’s what you missed, and a look ahead!
1 Big Thing: The National Congress of American Indians Honors Partnership with NCUIH
The National Congress of American Indians (NCAI) President Fawn Sharp and Executive Director Larry Wright honor NCUIH President Sonya Tetnowski and CEO Francys Crevier at their Executive Council Winter Session (ECWS) 2023.
Last week, NCAI hosted a Special Recognition Ceremony for Indian Health Care Warriors where NCUIH was honored alongside the National Indian Health Board for our joint effort in securing advance appropriations for the Indian Health Service.
NCUIH was also invited to present at the NCAI’s Executive Council Winter Session before the general assembly. President Tetnowski highlighted NCUIH’s work for improving veterans’ health and celebrated our longtime partnership with NCAI.
President Tetnowski presents at ECWS.
Why it matters: Inter-organizational efforts are critical for addressing complex issues that require collaboration across multiple sectors and stakeholders. When organizations work together, we can pool resources, expertise, and knowledge to achieve a more significant impact than any one organization could achieve alone. By leveraging the strengths and capabilities of different organizations, inter-organizational efforts can drive innovation and create more sustainable solutions and outcomes for American Indians and Alaska Natives (AI/ANs).
NCUIH team at NCAI Executive Council Winter Session.
NCUIH team at the 2023 State of Indian Nations.
Urban Indian Leaders and NCUIH Attend Budget Formulation
NCUIH at 2023 National Tribal Budget Formulation Workgroup Session.
The Indian Health Service held the National Tribal Budget Formulation Workgroup Session on February 13 and 14 in Washington, DC.
Did you know?: As part of the trust responsibility to provide health care to all American Indians and Alaska Natives, Tribal leaders present their funding needs each year to the Secretary of the Department of Health and Human Services (HHS) and the Director of the Office of Management and Budget.
Why it matters: The recommendations are formed through the Tribal Budget Formulation Work Group (TBFWG) and serve as a framework for the Administration in setting budget amounts for their annual requests to Congress. This process ensures the federal government has the resources to provide health care to all AI/ANs in fulfillment of the trust responsibility.
Save the Date – HHS Annual Tribal Budget Consultation Coming on April 18-19, 2023: The Annual Tribal Budget Consultation provides a forum for Tribes to collectively share their views and priorities with HHS officials on national health and human services funding priorities and make recommendations on HHS’s FY 2025 budget request. This year’s consultation will occur in-person at the Hubert H. Humphrey Building in Washington, D.C. Please see this Dear Tribal Leader Letter for more.
Tribal Leaders Highlight Need for Increased Urban Indian Health Funding in Fiscal Year 2025 IHS Budget Requests
On January 25-26, IHS held its annual Area Report Presentations Webinar for FY 2025 where Tribal leaders from all 12 IHS Areas and leaders from Native organizations, including the NCUIH, presented on their budget requests.
What they’re saying: Many Tribal leaders emphasized the need to increase funding and resources for urban Indian health in the FY2025 budget. Navajo Nation President Buu Nygren stated: “The [Navajo] nation is also supporting the push to support urban Indian healthcare facilities and many Navajos live off the reservation should still be able to receive equitable healthcare through the IHS network system.”
NCUIH Board of Directors Meets with IHS Director Roselyn Tso
IHS Director Roselyn Tso and NCUIH Board President, Sonya Tetnowski
This month, Director Roselyn Tso joined the quarterly NCUIH Board Meeting where she spent time providing updates on key issues at the Indian Health Service and discussing the new IHS 2023 Workplan.
NCUIH to Testify before Congress at Tribal Public Witness Day Next Week
NCUIH’s CEO Francys Crevier will testify before the House Interior Appropriations Subcommittee for American Indian and Alaska Native Public Witness Day.
On March 8 and 9, the Committee on Appropriations, Subcommittee on Interior, Environment, and Related Agencies of the House of Representatives will host American Indian and Alaska Native Public Witness Days.
NCUIH’s CEO Francys Crevier will testify on March 9 at 9:30 AM.
The bottom line: Congress hosts American Indian and Alaska Native Public Witness Days to hear from stakeholders in Indian Country about budget needs. NCUIH will discuss the need for resources to support access to health care for urban Native communities in its testimony.
More information to follow next week.
Bipartisan Urban Indian Health Confer Act Reintroduced
On February 15, 2023, Senators Tina Smith (D-MN) and Markwayne Mullin (R-OK) re-introduced the Urban Indian Health Confer Act (S.460)
This is part of an ongoing effort to rectify longstanding parity issues within the Indian health system.
Why it matters: The legislation would require agencies and offices within the U.S. Department of Health and Human Services (HHS) to confer with UIOs on policies and initiatives related to healthcare for urban Native communities.
Go deeper: NCUIH worked closely with the Senators on this bill which was originally introduced in May 2022 as S. 4323 by Sen. Smith, as well as with Representative Raúl Grijalva (D-AZ-7) on the House companion bill (H.R. 630), which was recently re-introduced on January, 30, 2023.
Centers for Medicare and Medicaid Services (CMS), issued guidance that creates an easier path to specialty care for Medicaid and CHIP beneficiaries..
CMS Director Publishes State Health Official Letter #23-002 Issuing Guidance to States on Medicaid Continuous Enrollment Condition Changes
NCUIH Monitoring Supreme Court Case: Lac du Flambeau Band of Lake Superior Chippewa Indians v. Coughlin
The Lac du Flambeau Band of Lake Superior Chippewa Indians v. Coughlin case before the Supreme Court centers on the question of tribal sovereign immunity and its applicability to state regulatory actions. The tribe contends that they are immune from state regulatory action because of their sovereign status, while the state maintains that it has a legitimate interest in regulating tribal activities that affect public health and safety. The Supreme Court’s decision, in this case, could have significant implications for the balance of power between states and tribes and the scope of tribal sovereignty in the United States.
The Issue at Hand: Whether the Bankruptcy code “unequivocally” abrogates Tribal sovereign immunity by stating the Code applies to “other domestic and international governments” without specifically listing Tribes.
How would this apply to UIOs?
How the Court decides this case has the potential to weaken the statutory language necessary to abrogate Tribal sovereignty. This case is more attenuated to UIOs specifically but will have ramifications throughout the federal Indian law space.
Native American Rights Fund has an amicus workgroup for this case, and NCUIH is attending.
What’s next: Appeal from the 1st Circuit, Cert. Granted Jan. 13, 2023, Oral Argument scheduled for April 24th, 2023- expected at 1 pm.
Upcoming Events and Important Dates
March 3 – Comment Deadline for Office of the Assistant Secretary for Health Strengthening Primary Health Care
March 8 – House Appropriations Committee American Indian and Alaska Native Public Witness Days
March 9 – NCUIH Testifying at House Appropriations Committee American Indian and Alaska Native Public Witness Day
March 8-9 - IHS Tribal Self-Governance Advisory Committee Meeting (TSGAC)
March 15 – NCUIH Monthly Policy Workgroup
One last thing: NCUIH Early Bird Registration Ends March 15
Early Bird Registration is now open for our 2023 Annual Conference!
Our conference will be held May 15-18, 2023 with the option of joining us in person in Washington, D.C., or virtually. This year’s theme is Honoring Our Ancestors & Preparing for the Next Seven Generations: NCUIH Celebrates 25 Years of Health Leadership. (Register Here)
Note: Early Bird Registration ends March 15.
Thank you for all your hard work and advocacy!
https://ncuih.org/wp-content/uploads/2023-Web-Assets_NCUIH_D356-V2-SM_Policy-Update.png23443125NCUIHhttps://ncuih.org/wp-content/uploads/NCUIH-2022-Logos_Full-Logo-3.pngNCUIH2023-02-28 13:17:022025-06-10 14:34:13Urban Indian Health Policy Updates
The National Council of Urban Indian Health (NCUIH) is pleased to announce the release of its 
After the height of the COVID-19 pandemic, newfound priorities were identified for 2023, including workforce development and retention, increased funding for traditional healing, and expanded access to care and telehealth services. Existing priorities also remain a key focus across UIOs, especially increasing funding amounts for the urban Indian health line item and IHS, maintaining advance appropriations for IHS, establishing permanent 100% Federal Medical Assistance Percentage (FMAP) for UIOs, reauthorizing the Special Diabetes Program for Indians (SDPI), and increasing behavioral health funding.
