Study Shows Native Children Disproportionately Experience Orphanhood Due to COVID-19

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On October 7, 2021, the American Academy of Pediatrics published a study on caregiver deaths by race and ethnicity. The study highlights stark COVID-19 disparities in American Indian/Alaska Native (AI/AN) communities.

According to the study, 1 of every 168 AI/AN children experienced orphanhood or death of caregivers due to the pandemic compared to 1 of every 310 Black children, 1 of every 412 Hispanic children, 1 of every 612 Asian children, and 1 of every 753 white children experienced orphanhood or death of caregivers. AI/AN children were 4.5 times more likely than white children to lose a parent or grandparent caregiver.

Native communities face some of the harshest disparities in health outcomes of any population in the U.S. and are disproportionately impacted by the COVID-19 pandemic.

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About the Study

The study was a collaboration between the Centers for Disease Control and Prevention (CDC), Imperial College London, Harvard University, Oxford University, and the University of Cape Town, South Africa. Published in the Oct. 7 issue of the journal Pediatrics, it was jointly led by CDC’s COVID Response and Imperial College London, and partly funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH), as well as Imperial College London.

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Padilla, 13 Other Senators Call on Biden Administration to Establish Advisory Group for Urban Indians

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On February 3, 2022, Senators Alex Padilla (D-CA), Catherine Cortez Masto (D-NV), Tina Smith (D-MN), Dianne Feinstein (D-CA), Elizabeth Warren (D-MA), Ed Markey (D-MA), Mark Kelly (D-AZ), Amy Klobuchar (D-MN), Patty Murray (D-WA), Tammy Baldwin (D-WI), Chris Van Hollen (D-MD), Jacky Rosen (D-NV), Jeff Merkley (D-OR), and Jon Tester (D-MT) sent a letter to the Biden Administration requesting the establishment of an Urban Indian Interagency Work Group to identify the needs and develop strategies to better serve urban American Indian/Alaska Native (AI/AN) populations. The National Council of Urban Indian Health (NCUIH) worked closely with Senator Padilla on this letter and supports the effort to bring better representation for the needs of American Indians and Alaska Natives who do not reside on Tribal land.

 

“In light of the goals you outlined in the Biden-Harris Plan for Tribal Nations, specifically to ensure that urban AI/ANs receive ‘quality health care, culturally relevant education, adequate and affordable housing, and other needed resources,’ we urge the administration to form an Urban Indian Interagency Work Group to identify the critical needs of urban AI/AN populations and develop strategies to implement real change that uplifts urban AI/ANs,” wrote the Senators.

 

The Work Group would help identify federal funding strategies to better address the needs of urban AI/ANs, advance the development of a wellness centered framework to inform health services, strengthen support for practice-based traditional healing approaches, improve Urban Confer policies at Health and Human Services and associated agencies, and ensure that Urban Indian Organizations can regularly meet with federal agencies to address relevant topics of concern.

 

Tribal Leaders Highlight Need for Increased Urban Indian Health Funding in Fiscal Year 2024 Area Reports

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On January 26-27, 2022, the Indian Health Service (IHS) held their Area Report Presentations Webinar for Fiscal Year (FY) 2024 where Tribal leaders from 12 IHS Areas and leaders from three Native organizations, including the National Council of Urban Indian Health (NCUIH), presented on their budget requests. Many Tribal leaders spoke about the need to increase urban Indian health funding and establish designated funding for urban Indian health facilities and infrastructure.  Many Areas also highlighted mental health and substance abuse needs, Health IT modernization, and permanent authorization of the Special Diabetes Program for Indians (SDPI). 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 HHS and the Director of the Office of Management and Budget. The recommendations are formed through the Tribal Budget Formulation Work Group 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 American Indians and Alaska Natives in fulfillment of the trust responsibility.

 

Tribal Leaders Highlight the Need for Increased Urban Indian Health Funding

Urban Indian health was a priority in the Area report presentations. IHS Oklahoma Area Representative and President of the Wichita and Affiliated Tribes, Terri Parton, advocated for $509.963 million in funding for urban Indian health, citing that “Although 78% of AI/ANs reside in urban areas, the IHS funding allocation for urban Indian health only reflects close to 1% of the total annual IHS budget,” and “There are inadequate levels of funding to address the rising urban Indian population.”

 

Several Areas featured the work of UIOs in their presentations and advocated for increased allocation of funding and resources for urban Indian health.

  • IHS Phoenix Area recommended a $18.86 billion funding increase for Health Care Facilities Construction with $2 billion for urban Indian health facility renovation. The Phoenix Area Representative also highlighted that the urban Indian health program increase of $92.6 million identified in the FY 2023 budget recommendations remains a top concern in FY 2024, and recommended increased funding for Tribal and Urban Community Health Representative services.
  • IHS Bemidji Area stressed that UIOs are underfunded and rely heavily on grants which can be unstable and recommended $477 million for urban Indian health in FY 2024.
  • IHS Portland Area recommended approximately $1.8 billion in funding for the FY 2024 urban Indian health line item.
  • IHS Tucson Area listed urban Indian facilities renovations in their top health priorities and Wavalene Saunders, Vice Chairwoman of the Tohono O’odham Nation, highlighted Tucson Indian Center’s collaboration with the Pascua Yaqui Tribe and Tohono O’odham Nation to address COVID-19 vaccine and testing efforts.
  • The IHS Billings Area Representatives highlighted two Billings UIO success stories. Lane Spotted Elk, Councilman of Northern Cheyenne Tribal Council, highlighted the Billings Urban Indian Health and Wellness Center’s student mental health and suicide prevention efforts though collaboration with schools. The Indian Family Health Clinic’s food pantry efforts was also highlighted for receiving 5000 pounds of donated food and providing food boxes to patients, primarily seniors, during the pandemic.

 

NCUIH supports the average of the 12 IHS Areas recommendation of $1 billion for urban Indian health funding for FY 2024.

 

Meredith Raimondi, NCUIH’s Interim Vice President of Public Policy, presented the following urban Indian organization (UIO) funding priorities for FY 2024 during the Area Report Webinar:

  1. Urban Indian health funding amount of approximately $1 billion, which reflects the average of the Area budget formulation recommendations.
  2. Availability of funds for UIOs to spend on facilities and infrastructure needs (these funds would be exclusive to UIOs and would not impact the IHS facilities accounts).
  3. Behavioral health funding for UIOs.
  4. SDPI reauthorization and increase to at least $200 million.
  5. Community Health Representatives fund of $3 million for UIOs.

In addition to budget priorities, Raimondi highlighted several “hot topics” for urban Indian health:

  1. Safeguard IHS funding through advance appropriations and exception apportionment across the entire IHS/ Tribal/UIO system.
  2. Permanent increase in Medicaid dollars for Indian health through the permanent extension of 100% Federal Medical Assistance Percentage (FMAP) to UIOs and increased reimbursement rates.
    1. The American Rescue Plan Act authorized a temporary two-year extension of 100% FMAP to UIOs beginning April 1, 2021, however, UIOs have not received a single dollar of increased funding.
  3. Urban confer: establish a mechanism for dialogue and input between the Department of Health and Human Services agencies overseeing UIO programs and UIOs.

 

Next Steps

IHS will hold their FY 2024 National Tribal Budget Formulation Work Group on February 10-11, 2022. NCUIH will continue to advocate for $1 billion in funding for urban Indian health and increased resources for UIOs.

VA Advisory Committee on Tribal and Indian Affairs Meet for the First Time

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Urban Indian Organization Representative Sonya Tetnowski named co-chair of the Veterans Health Administration Subcommittee

On January 25, 2022, the U.S. Department of Veterans Affairs (VA) Advisory Committee on Tribal and Indian Affairs (Committee) met for the first time and held a three-day long session to advise the VA on matters relating to Native American veterans.  The Committee is made up of 15 veterans, representing the 12 Indian Health Service (IHS) service areas, the Native Hawaiian veteran community, and Urban Indian Organizations (UIOs).  From January 25 – 27, the Committee provided advice and guidance to VA Secretary Dennis McDonough on matters related to Native Veteran healthcare services, COVID-19 efforts, homelessness and affordable housing initiatives, Indian Health Service (IHS) and urban Indian health, benefit access including memorial services, and the Vet Center program, among other items.  The National Council of Urban Indian Health (NCUIH) played a key role in the creation of the Committee and Sonya Tetnowski (Makah), NCUIH’s President-Elect and CEO of the Indian Health Center for Santa Clara Valley, currently serves as one of its members.

UIO Representation and Meeting Highlights

During the first meeting of the Committee, Ms. Tetnowski quickly established herself as a strong advocate for Native Veterans from all areas, including those living in urban areas. As an Army veteran, member of a rural tribe, and current executive of a UIO, Ms.Tetnowski highlighted many of the barriers AI/AN Veterans face in accessing health care and other benefits they earned from the United States.  She elevated urban Indian health priorities and issues throughout the conversations with the VA.  She reminded the VA that they have yet to fully implement the VA-IHS Memorandum of Understanding (MOU) for UIO reimbursements and that a VA Urban Confer Policy has yet to be executed.  Additionally, Ms. Tetnowski inquired about the rollout of the reimbursement agreement program (RAP) template for UIOs and how communications for that were to proceed.

Ms. Tetnowski also highlighted the importance of looking at the whole person and making sure that their needs are being met. She also brought forth potential subcommittees, including unhoused urban Veterans, Native Healer utilization and Behavioral Health and Substance Use.  At the end of the three-day meeting, Sonya volunteered to be, and was selected to be, Chair of the Veterans Health Administration (VHA) subcommittee within the TAC.

NCUIH is incredibly proud of Ms. Tetnowski and her extraordinary advocacy throughout this initial meeting of the Committee.  NCUIH will continue to support Ms. Tetnowski in her work on the Committee in addition to its ongoing advocacy work for UIOs before the VA.

Background

The advisory committee was created by Congress in 2020 and members were officially appointed to their roles in October 2021.  NCUIH played a critical role in getting this legislation passed in 2020 and in nominating an urban Indian Organization (UIO) representative to the Committee.  The purpose of the Committee is to advise the Secretary on all matters relating to Indian Tribes, tribal organizations, Native Hawaiian organizations, and Native American Veterans. This includes advising the Secretary on the administration of healthcare services and benefits to American Indians and Alaska Native Veterans; thereby assessing those needs and whether VA is meeting them.

 

On October 30, 2019, the House Committee on Veterans’ Affairs, Subcommittee on Health conducted an oversight hearing in which NCUIH’s then Board Vice President, Sonya Tetnowski, testified.  In her testimony, Ms. Tetnowski highlighted that “most AI/AN veterans live in urban areas and would benefit from the culturally competent care provided at UIOs.”

 

Additionally, NCUIH signed onto a December 4, 2020 letter with other National Native organizations regarding the VA Technical Advisory Committee bill.  In the letter, NCUIH emphasized the importance of UIOs in the healthcare delivery system, especially when addressing Native Veteran access to culturally competent care. Thanks to NCUIH’s advocacy, the legislation creating the Committee requires it to have a sitting member represent UIOs and be nominated by a national UIO.

NCUIH also provided testimony on Native Veterans Suicide Prevention to the House Committee on Veterans Affairs on September 21, 2022.  Again, Ms. Tetnowski testified on behalf of NCUIH and reiterated the importance of culturally competent health care provided to Native veterans.  She highlighted how UIOs offer several culturally centered mental health care services to Native Veterans, including operating residential substance use disorder (SUD) programs with inpatient treatment.

NCUIH nominated its President-Elect and CEO of Indian Health Center of Santa Clara Valley, Sonya Tetnowski to the Committee and she was selected as a member.   Ms. Tetnowski is a Makah Tribal Member and a Veteran of the U.S. military, having served in the Army as a Paratrooper.  She was deployed multiple times during her service in the Army and has tirelessly advocated on behalf of health equity for American Indians, including Native Veterans, through Congressional testimony and leadership at NCUIH.

About Native Veterans

According to a VA report, 140,507 Veterans identify themselves as American Indian or Alaska Native (AI/AN), and a higher percentage of AI/AN Veterans served in the Pre-9/11 period (17.7%) compared to Veterans of all other races (14.0%).  The report also showed that significant disparities between AI/AN veterans and other veterans including that:

  • AI/AN Veterans had lower personal incomes than Veterans of other races, ($29,847 v $38,792).
  • AI/AN Veterans were more likely to have some college compared to Veterans of other races (44.3% vs. 37.4%, respectively) but less likely to hold a bachelor’s degree (13.7% and 16.9%, respectively).
  • The percentage of AI/AN Veterans who were unemployed was higher than the percentage of Veterans of other races who were unemployed (5.5% vs. 3.4%, respectively).
  • AI/AN Veterans were more likely to lack health insurance than Veterans of other races (7.4% vs. 2.9%).
  • AI/AN Veterans were more likely to have a service-connected disability than Veterans of other races (30.0% vs. 23.0%, respectively).

AI/AN Veterans used Veterans Benefits Administration (VBA) benefits or services at a lower percentage than Veterans of other races (41.6% vs. 52.7%) in FY 2017.

NCUIH Submits Comments to IHS on Newly Allocated American Rescue Plan Act Funding and Proposed Build Back Better Act Funding

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On January 21, 2022, the National Council of Urban Indian Health (NCUIH) submitted comments to the Indian Health Service (IHS) regarding funding opportunities in the American Rescue Plan Act (ARPA) and the Build Back Better Act (BBBA).  The comments were submitted in response to a November 22, 2021 (updated on December 20), IHS Dear Urban Indian Organization Leader letter (DULL) that outlined an additional $210 million allocated for Public Health Workforce Activities from the ARPA.  The DULL also outlined $2.35 billion in proposed funding in the BBBA.

ARPA and BBBA’s IHS Program Impact

In response to the COVID-19 pandemic, President Biden signed the ARPA into law in March 2021.  This COVID-19 relief bill included $84 million for urban Indian health and two years of 100% Federal Medical Assistance Coverage for urban Indian Organizations (UIOs). In November 2021, the Administration announced additional directed funding to support COVID-19 response and recovery efforts in the hardest-hit and high-risk communities and populations, including additional funding of $210 million allocated to the IHS.  The newly allocated funding includes $92 million to provide nurses in Bureau of Indian Educations schools; $67 million to enhance public health capacity for IHS and Tribal Nations; $45 million for additional IHS loan repayment awards; and $6 million for core surveillance and epidemiology work for American Indian and Alaska Native populations.

The BBBA proposes $1.75 trillion in government spending with an emphasis on social and climate goals. While the BBBA is currently stalled in Congress, the proposed funding includes $2.35 billion in additional resources for several IHS programs. The $2.35 billion includes $1 billion to address the 1993 Health Care Facilities Construction Priority List; $945 million for Maintenance and Improvement projects; $124 million for behavioral health services, including necessary facilities improvements; $113 million for Facilities and Environmental Health Support activities; $100 million for Urban Indian Organization construction; $40 million for the Small Ambulatory Program; and $25 million for Tribal Epidemiology Centers.

NCUIH’s Role

On December 15, 2021, NCUIH held a prep call with UIOs to discuss the additional ARPA and BBBA funding. This call allowed UIOs to share concerns, recommendations, and specific requests for the upcoming Urban Confer with IHS.  NCUIH and UIOs then attended the IHS Urban Confer to voice support for and stress the importance of the additional funding.

In its submitted comments, NCUIH applauded the allocation of a further $210 million to support pandemic recovery in AI/AN communities.  The additional ARPA funding will be used to protect children in BIE schools, recruit and retain highly skilled health care professionals, enhance public health capacity, and support epidemiology work for AI/AN populations.  NCUIH noted that at both the December 9, 2021 All Tribal and Urban Indian Organization Leaders meeting and the subsequent December 15, 2021 Urban Confer that the IHS committing to making $47 million of the $67 million allocated to enhance public health capacity and build emergency preparedness available to Tribes, Tribal organizations, and UIOs.  NCUIH reiterated to IHS that it must follow through on this plan and make this funding available to UIOs in addition to Tribes and Tribal organizations, as the funding is crucial to ensuring that all AI/AN communities can continue to battle the on-going COVID-19 pandemic and also build capacity to prepare for future emergencies.

NCUIH also requested that in addition to allocating the additional ARPA funds, IHS promptly disburse previously allocated ARPA funds which many UIOs have still not received.  To date, many UIOs have yet to receive all previously allocated ARPA assistance funds — funds critical to addressing adequate COVID-19 response and recovery.  As new funds are prepared for distribution, IHS must not lose sight of already allocated ARPA funds that are delayed and have yet to be received by all UIOs.

NCUIH also supported and applauded the historic levels of funding for AI/AN health in the BBBA.  However, it urged IHS to take notice of the fact that the level of funding for Indian Country currently proposed in the BBBA is significantly below the $20.5 billion announced in the original reconciliation instruction and the fact that the $2.35 billion in additional funding for several IHS programs does not come close to the $48 billion needed to fully fund IHS.

NCUIH noted with concern that UIOs continue to be excluded from the vast majority of federal funding allocated for AI/AN health.  Of the $2.35 billion in proposed funding, UIOs are ineligible for almost $2.1 billion. Full and inclusive funding of IHS is imperative to ensure Tribes and UIOs have the resources required to serve our communities.

NCUIH expressed its strong support for the $100 million proposed in the BBBA for UIO facilities. This funding will assist UIOs in addressing critical needs that they face in their mission to improve health outcomes for AI/ANs. NCUIH estimates that ninety percent (90%) of UIOs need facility upgrades to improve health care services. Current estimates place the total cost of these needed upgrades at $200 million.  This includes $172 million in shovel ready projects at UIOs.  The allocation of $100 million for UIO facilities in BBBA is historic and long overdue to uphold the trust and treaty responsibilities of the federal government to all AI/ANs.  NCUIH requested that if the BBBA is passed, IHS identify out of the $100 million what it intends to use for administrative functions, so that NCUIH and UIOs can fully assess the total amount of funding available.

Finally, NCUIH backed the allocation of $124 million to behavioral health services and necessary facilities in the BBBA.  NCUIH noted that pursuant to the reported text of the BBBA, UIOs are fully eligible to receive funds from this allocation, as there are no restrictions on entities to whom the IHS may disburse this money.  NCUIH urged IHS to maintain this broad eligibility in any implementing regulations if the BBBA is passed.  NCUIH has long advocated before Congress to fund and preserve behavioral health initiatives for UIOs under the Indian health care system, as AI/AN populations are at a much higher risk for behavioral health issues than the general population.  NCUIH is especially encouraged by the ability to use this funding for facility renovation, construction, or expansion. This funding will enhance opportunities for UIO residential programs who have had to reduce the number of patients they admit due to COVID-19 guidelines, in a pandemic that has exacerbated behavioral health needs.

NCUIH will continue to closely monitor the status of the additional allocated ARPA funds.  NCUIH also continues to track the progress of the BBBA and advocate against any further cuts to Indian Country’s allocation in the bill.

NCUIH Submits Comments to IHS on the OUIHP 5-Year Strategic Plan

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On January 28, 2022, the National Council of Urban Indian Health (NCUIH) submitted comments to the Office of Urban Indian Health Program (OUIHP) and the Indian Health Service (IHS) regarding the upcoming 5-Year Strategic Plan (Plan). These comments were submitted in response to a December 3, 2021, Dear Urban Leader letter seeking input for recommendations and in consultation with UIOs to address needs and areas for improvement in the new Plan.

Background

In 2017, the IHS developed an OUIHP Strategic Plan 2017-2021, pursuant to the Consolidated Appropriations Act, which described what the Agency hoped to achieve over the next 5 years.  The 2017-2021 Plan was based on the participation and feedback received from UIO Leaders, IHS staff, and other stakeholders. In fiscal year (FY) 2022, IHS expects to evaluate the existing OUIHP Strategic Plan and to develop a new Plan. According to the OUIHP, the new Plan will include goals, objectives, strategies, and performance measures, based on input from UIO Leaders, partners, and external stakeholders.

NCUIH’s Role

NCUIH provided several comments and recommendations for the Plan. These comments were based on NCUIH’s consultations with UIOs, the IHS Urban Confer held on December 16, 2021, and NCUIH’s subject matter expertise.

In its comments, NCUIH applauded OUIHP for its efforts to meet the goals and objectives of the 2017-2021 Plan, including Objective 2.2 which it successfully accomplished.  However, NCUIH noted that there remains significant unmet goals and objectives from the 2017-2021 Plan which need continued attention and action in the upcoming Plan.  NCUIH supports keeping the 2017-2021 Plan’s goals and objectives in the Plan, except for Objective 2.2. which was completed.  Those goals and objectives are listed below. NCUIH also urged OUIHP to continue to build on and update the 2017-2021 Plan’s goals and objectives in the Plan to further meet the Plan’s stated mission and vision.

  • Goal 1: Support Currently IHS-Funded UIOs’ Efforts to Address the Key Challenges they Identified for Improving and Expanding Access to Care for Urban Indians.
    • Objective 1.1: Support UIOs’ efforts to diversify funding and increase third-party reimbursements to ensure UIO sustainability
    • Objective 1.2: Support UIOs’ efforts to attract and retain skilled, culturally competent health service providers
    • Objective 1.3: Increase awareness and actively seek support for health care needs of Urban Indians
    • Objective 1.4: Strengthen the capacity of UIOs to work as a community to improve knowledge sharing
  • Goal 2: Increase OUIHP’s Administrative Capacity
    • Objective 2.1: Build capacity for OUIHP to transfer administration of the former NIAAA awards
    • Objective 2.2: Lay the groundwork for performance-based oversight, both within the IHS and for the IHS-funded UIOs
    • Objective 2.3: Leverage OUIHP staff capacity by maximizing partnerships and resources. Ensure the IHS has available staff to perform the roles of OUIHP and support the IHS mission regarding Urban Indian health

Additionally, NCUIH recommended the following items be incorporated into the goals and objectives of the Plan:

  • Improved data accuracy
  • Modernizing Health information Technology
  • Establishment of specific metrics by which to measure OUIHP’s progress towards fulfilling the Plan
  • Improved Area Office consistency
  • Increased support for behavioral health services, including for health providers
  • Support for Community Health Representatives (CHRs) at UIOs as authorized in the Indian Health Care Improvement Act
  • Establishment of goals and objectives to support efforts to extend the Community Health Aide Program to UIOs
  • Inclusion of traditional healing practices as an allowable billing expense
  • Development of a fair and equitable UIO All-Inclusive Rate or extension of the existing IHS All-Inclusive Rate to UIOs
  • Incorporation of Title V Contract improvement suggestions from UIOs
  • Improved budget planning with respect to UIOs
  • Modified targets and adaptive planning for unforeseen events such as the COVID-19 pandemic

NCUIH further recommended that the OUIHP and IHS schedule an annual performance plan report.  NCUIH advised OUIHP to incorporate meaningful metrics into the Plan which will permit it to report useful quantitative analysis of its progress towards accomplishing the goals and objectives included in the Plan.  NCUIH believes that any performance plan report should be made publicly available.

NCUIH also expressed its appreciation to OUIHP for initiating a new Plan proactively by using savings from salaries and for fulfilling its trust responsibility and statutory mandate to confer with UIOs by proactively seeking to collaborate with UIOs on the development of the Plan.  NCUIH stressed that input from UIOs is vital for the IHS and its operating divisions to effectively gather comprehensive feedback, share critical information, and build mutual trust, in addition to being required by the Indian Health Care Improvement Act (IHCIA).

NCUIH strongly believes that the Plan is an important vehicle to articulate leadership priorities, provide direction for program management functions, engage external partners and entities, and measure OUIHP’s progress towards meeting the goals and objectives contained in the Plan.  NCUIH will continue to participate in the development of the Plan and inform UIOs of upcoming opportunities to provide comments and participate in Urban Confers.  NCUIH encourages UIOs submit any comments at future opportunities which they believe will be helpful in the development of the Plan.

NCUIH Submits Comments to HUD on Strategic Plan Focus Areas Urging Support for All Native Communities

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NCUIH urges incorporation of urban AI/ANs and UIOs into focus areas and eventually the FY22-26 Strategic Plan

 

On January 28, 2022, the National Council of Urban Indian Health (NCUIH) submitted written comments to the Department of Housing and Urban Development (HUD) in response to its invitation for feedback on its draft FY22-26 Strategic Plan focus areas.  NCUIH stated its strong support for the proposed focus areas: support underserved communities, ensure access to and increase the production of affordable housing, promote homeownership, and advance sustainable communities. NCUIH also affirmed that is heartened by HUD’s attention to the housing needs of American Indian and Alaska Native (AI/AN) communities through the inclusion of Tribal governments in the “support for underserved communities” focus area.  However, NCUIH also urged HUD to more completely fulfill its trust responsibility to improve the housing conditions and socioeconomic status of tribal members by also incorporating urban AI/ANs and UIOs into its focus areas and, eventually, the FY22-26 Strategic Plan.

 

The United States has a general trust responsibility to support AI/AN governments and AI/AN people.  This includes a specific responsibility to “work[] with tribes and their members to improve their housing conditions and socioeconomic status.”  There is no exception to this trust responsibility for tribal members who no longer live on a reservation or reside in an urban area.  Among the efforts the United States will take to make available affordable homes in safe and healthy environments in AI/AN communities is the provision of housing assistance.  In its comments, NCUIH noted that despite its trust responsibility the United States does little to provide AI/AN-specific housing services to urban AI/ANs.

 

NCUIH noted that AI/ANs living in urban areas are disproportionately disadvantaged economically and face numerous barriers to accessing services and achieving a measure of housing security and stability.  NCUIH also observed that urban AI/AN households have higher rates of cost burden, are more likely to live in housing lacking complete plumbing and kitchen facilities, and are more likely to live in overcrowded housing.  Further, the AI/AN population is disproportionately represented in the homeless population nationwide and experience poverty at a higher rate than the overall population.

 

NCUIH urged HUD to consider the needs of AI/ANs living in urban areas in its Strategic Plan focus areas and ultimately in the Strategic Plan. By failing to extend its AI/AN-specific services to urban AI/ANs, HUD fails to fulfill its trust responsibility to the seventy (70) percent of AI/ANs who live in urban areas.  UIOs are uniquely positioned to assist HUD in supporting underserved communities, ensuring access to and increasing the production of affordable housing, promoting homeownership, and advancing sustainable communities among AI/AN people.  UIOs provide numerous other social and community services to urban AI/ANs.  Providing housing services aligns with UIOs’ mission to provide quality, accessible, and culturally competent health and public health services for AI/ANs living in urban settings because housing is a key social determinant of health. HUD has also previously acknowledged the need to coordinate health, housing, and social welfare services.  UIOs have the cultural competency and community connections necessary to further support HUD’s mission and assist HUD in fulfilling it trust responsibility to urban AI/ANs.

 

NCUIH will continue to monitor the development of HUD’s FY22-26 Strategic Plan.  NCUIH will advocate for HUD to incorporating urban AI/ANs and UIOs in the Strategic Plan itself throughout the development process and in future comment opportunities.

NCUIH-Endorses Bill to Elevate the Health Care Needs of Native Americans Within the Federal Government

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On January 13, 2022, Representative Greg Stanton (D-AZ) and Representative David Joyce (R-OH) introduced the Stronger Engagement for Indian Health Needs Act (H.R. 6406). This bill would elevate the Indian Health Service Director to Assistant Secretary for Indian Health within the Department of Health and Human Services (HHS), increasing their authority within the federal government on the health care needs of the American Indian and Alaska Native (AI/AN) population. The National Council of Urban Indian Health (NCUIH) worked closely with Representatives Stanton and Joyce on this legislation and supports their effort to bring better representation for the health needs of AI/ANs.

“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. The pandemic, which continues to devastate Indian Country, has made it clear that it’s time for the Administration to recognize the importance of Indian health by elevating the position of the Director of the IHS to Assistant Secretary,” said Walter Murillo (Choctaw), President of NCUIH and Chief Executive Officer of Native Health, which is based in Phoenix, Arizona. “We applaud Representatives Greg Stanton and David Joyce for their longstanding leadership to improve health outcomes for Native people and hope this change will usher in a new era where Indian health is a priority and not an afterthought.”

The bill has been endorsed by leading Native American advocacy groups—including the National Congress of American Indians, National Indian Health Board, and NCUIH. The bill was referred to the Committee on Natural Resources and the Committee on Energy and Commerce. It currently awaits consideration.

 

NCUIH-Endorsed Comprehensive Addiction Resources Emergency (CARE) Act Includes Funding for Urban Indian Organizations

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On December 16, 2021, Senator Warren (D-MA) and Representative Maloney (D-NY) reintroduced the Comprehensive Addiction Resources Emergency (CARE) Act (S. 3418/H.R. 6311). The CARE Act addresses the substance use epidemic by providing state and local governments with $125 billion in federal funding over ten years, Of the nearly $1 billion, the CARE Act sets aside $150 million a year in funding to Native non-profits and clinics, including to urban Indian organizations, Native Hawaiian organizations, and projects designed to test innovative service delivery and culturally informed care models to tackle addiction.

NCUIH worked closely with Congressional leaders to ensure the inclusion of urban Indians in this important legislative response to the Nation’s substance use epidemic and is pleased to endorse this bill. The bill was originally introduced in 2018 and is currently endorsed by over 175 national, local, and tribal organizations. In the Senate it was referred to the Committee on Health, Education, Labor, and Pensions. In the House it was referred to the Committee on Energy and Commerce, in addition to the Committees on Natural Resources, the Judiciary, and Oversight and Reform. It currently awaits further consideration.

“Many times, critical funding, even when appropriated in equitable amounts, does not reach across AI/AN urban communities, largely in part because when urban Indians are not specifically mentioned in legislative language they are most often excluded or forced to prove their eligibility under the intent of the laws created. NCUIH appreciates that the CARE Act has detailed specific language that ensures urban Indian organizations are listed as an eligible entity in this important legislative act,” wrote Francys Crevier (Algonquin), CEO of the National Council of Urban Indian Health (NCUIH).

 

Additional Information about the CARE Act

Additional funds from the $1 billion include $790 million per year for grants to Tribal governments to help fight this crisis and invest in substance use prevention and treatment; $7.5 million in additional funding for Tribal nations and regional tribal epidemiology centers to improve data collection on overdoses; and 50 million a year to Tribal Colleges and Universities, Indian Health Service-funded organizations, and medical training programs that partner with Tribal nations and Tribal organizations to train Native health professionals to improve substance use disorder treatment services. This Act also provides $1 billion per year to expand access to the overdose reversal drug, Naloxone, to states to distribute to Tribal nations, first responders, public health departments, and the public.

 

Background

to the Indian Health Service, the opioid crisis and COVID-19 pandemic are intersecting with each other and presenting unprecedented challenges for American Indian and Alaskan Native (AI/AN) families and communities. Because of the pandemic, substance and opioid use and fatalities have significantly increased in low-income communities.

AI/ANs continue to be deeply impacted by the opioid crisis and continue to see an overwhelming increase of deaths, addiction, and overdoses above the National average. AI/ANs had the second-highest rate of opioid overdose out of all U.S. racial and ethnic groups in 2017, and the second and third highest overdose death rates from heroin and synthetic opioids, respectively, according to the Centers for Disease Control and Prevention.

Since 1974, AI/AN adolescents have consistently had the highest substance abuse rates than any other racial or ethnic group in the U.S. Staggering statistics such as these do not happen overnight, they are the direct result of intergenerational trauma caused by adverse childhood experiences such as alcoholism, drug abuse and domestic violence in a family, emotional neglect, incarceration of a family member, and physical or sexual abuse— which are known to lead to a higher risk of addiction and other behavioral and mental health problems later in life.

Unfortunately, the majority of the nation’s AI/ANs living on and off reservations have limited access to substance abuse services due to transportation issues, lack of health insurance, poverty, inadequate healthcare facilities and a shortage of appropriate treatment options in their communities. Some of the disparities in treatment that occur within the AI/AN population can be resolved through increased availability of culturally sensitive treatment programs. Studies have shown that cultural identity and spirituality are important issues for AI/ANs seeking help for substance abuse, and these individuals may experience better outcomes when traditional healing approaches (such as powwows, drum circles, and sweat lodges) are incorporated into treatment programs.

NCUIH-Endorsed Bill Reintroduced to Improve Access to Critical Medical Supplies for American Indians and Alaska Natives

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On January 4, 2022, Senator Elizabeth Warren (D-MA) and Representatives Ruben Gallego (D-AZ) and Tom Cole (R-OK) reintroduced the Tribal Medical Supplies Stockpile Access Act (S. 3444/H.R. 6372). This bipartisan, bicameral legislation would guarantee that the Indian Health Service (IHS), tribal health authorities, and urban Indian organizations (UIOs) have access to the Strategic National Stockpile, a federal repository of drugs and medical supplies that can be tapped if a public health emergency could exhaust local supplies. The National Council of Urban Indian Health (NCUIH) welcomes the reintroduction of this important legislation to provide critical resources to UIOs amid the current pandemic and future public health emergencies.

 

“We are encouraged by the leadership of Senator Warren, Representative Gallego, and Representative Cole to increase health care access for American Indians and Alaska Natives through the Strategic National Stockpile. As the coronavirus continues to have greater impacts, Congress must do everything possible to uphold its trust responsibility to Indian Country by providing appropriate resources. The stockpile is designed for those who need it most in times of emergency and Indian Country should not be left behind,” said Francys Crevier (Algonquin), Chief Executive Officer, NCUIH.

 

NCUIH supported the original legislation that was introduced in March 2020 by Senator Warren and remains unchanged in the reintroduction. Other organizations that support the bill include the National Indian Health Board, the National Congress of American Indians, United South and Eastern Tribes Sovereignty Protection Fund, Seattle Indian Health Board, and the Friends Committee on National Legislation. This bill was referred to the Senate Committee on Health, Education, Labor, and Pensions and currently awaits further consideration.

 

Background

 

Currently, Indian Country’s access to the Strategic National Stockpile is limited and is not guaranteed in the statute. NCUIH has advocated for UIOs to have access to the National Strategic Stockpile in light of the COVID-19 pandemic. In April 2020, NCUIH and other National Native organizations sent a letter to Members of both chambers of Congress outlining a joint COVID-19 recovery legislative proposal which included a request to include Tribal and UIO access to the Strategic National Stockpile.

 

On June 18, 2020 the Center for American Progress, a Washington DC based think tank, released a report on the COVID-19 response in Indian Country and included recommended policy solutions for better funding and supporting IHS, such as providing all Indian Health Service/Tribal Health Program/UIO facilities access to the Strategic National Stockpile and Public Health Emergency Fund.