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

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

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

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

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.

Updated CDC Guidance for Pfizer-BioNTech COVID-19 vaccination

On Tuesday, January 4, the Centers for Disease Control and Prevention (CDC) issued two new recommendations on guidance on the administration of the COVID-19 vaccine technology from Pfizer-BioNTech. This guidance follows after the Food and Drug Administration (FDA) gave similar recommendations. The updated recommendations include the following: recommendations include the following:

  • Those who received the Pfizer-BioNTech COVID-19 vaccine as their primary series are not recommended to get a booster after 5 months.
  • Children 5-11-years-old who are moderately or severely immunocompromised should received an additional primary dose of the Pfizer-BioNTech vaccine 28 days after their second shot.

Additionally, following a recent Advisory Committee on Immunization Practices (ACIP) meeting, CDC is endorsing ACIP’s recommendation that people 12-17 years old should receive a booster shot 5-months after their initial Pfizer-BioNTech vaccination series. Currently, this vaccine is the only COVID-19 vaccine authorized for adolescents aged 12-17.

Customer Service Executive Order to Streamline Tribal Grant Application Process

On December 13, 2021, President Biden signed a new Executive Order (EO 14058) directing Government leaders to consider the public experience when seeking government services. This order, Transforming Federal Customer Experience and Service Deliver to Rebuild Trust in Government, includes 36 customer experience improvement commitments across 17 agencies which aim to improve service delivery and the lives of individuals.

Through this EO, agencies, especially those identified as High-Impact Service Providers, commit to centering their customers in all that they do; modernizing programs, reducing administrative burden and piloting new online tools and technologies. These customer service updates will impact the majority of Americans, especially those who are taxpayers, retirees, veterans, and many more. Included within the fact sheet is an update as to what this EO means for Tribal communities:

“Tribal communities will be able to expect more streamlined and integrated grants application processes, rather than having to provide information over and over again to the Federal Government and navigate across multiple agency websites.”

For the full text of the EO, visit the NCUIH regulation tracker at https://ncuih.org/policy/regulation-tracker/. Updated every other week, the regulation tracker collects all federal agency and Administration publications to the Federal Registrar. This tracker is an easily searchable resources for you to use on your own, or you can download a PDF copy to your own server.

NCUIH Submits Comments to DOI on Boarding School Initiative and the Lasting Impact on Urban Indian Health

On December 23, 2021, the National Council of Urban Indian Health (NCUIH) submitted comments to the Department of the Interior (DOI) regarding the agency’s Federal Boarding School Initiative (Initiative). NCUIH reiterated its ongoing support for the Administration’s efforts to address the legacy of boarding school programs, while urging the Administration to use the Initiative to address the public health impact of boarding schools on urban American Indian and Alaskan Natives (AI/ANs). NCUIH emphasized the importance of studying not only the impact of boarding school programs for survivors, but also the lasting impact of the intergenerational trauma caused by boarding schools within urban AI/AN communities.

Background

On June 22, 2021, DOI Secretary Haaland issued a memorandum directing DOI to prepare a report addressing the “intergenerational trauma, cycles of violence and abuse, disappearance, premature deaths, and other undocumented bodily and mental impacts.” This Initiative came weeks after the discovery of 215 Indigenous children’s remains were found at a boarding school site in Canada. Secretary Haaland noted that to “promote spiritual and emotional healing in [AI/AN] communities, we [DOI] must shed light on the unspoken traumas of the past…no matter how hard it will be.”

Boarding schools and residential schools are a tragic thread in history that the United States and Canada share: The United States Government Indian Boarding School Policy authorized the forced removal of hundreds of thousands of Native children, as young as 5 years old, relocating them from their homes in Tribal communities to one of the 367 Indian Boarding Schools across 30 States. Between 1869 and the 1960s, the United States federal government stole Native children from their families to destroy their indigenous identities, beliefs, and traditional languages to assimilate them into white American culture through federally funded Christian-run schools.

NCUIH’s Role

Following Secretary Haaland’s memorandum, NCUIH issued a statement commending Secretary Haaland for beginning the process of holding the United States to account for the effects of its boarding school policy.  NCUIH also reiterated its support of the Initiative’s ability to address Indian Country’s historical trauma. NCUIH recognizes the deeply sensitive and emotional impact that federal boarding schools have on the AI/AN community at large, including the continued impact on the many UIOs we serve and their constituents. NCUIH exists, in part, because of the historic oppression of the AI/AN population including federal boarding schools that resulted in the growing AI/AN populations in cities.

Additionally, NCUIH endorsed the Truth and Healing Commission on Indian Boarding School Policies in the United States Act. This bill would create a Truth and Healing Commission on Indian Boarding School Polices in the United States. The Commission will provide a space for AI/AN people to speak about their personal experiences in government-run boarding schools and allow them to provide recommendations to the government. NCUIH is in full support of this Commission and hopes to see DOI establish a similar commission in the Initiative that includes a UIO representative to represent AI/ANs who reside in urban settings.

Importance of Including Urban Indians in the Initiative

In its comments, NCUIH urged DOI and the Administration to address the ongoing effects of Indian boarding schools on AI/AN health.  Specifically, NCUIH requested that DOI incorporate the following items into the Initiative:

  • Partner with AI/AN organizations, including UIOs, to fully study and understand the impact of boarding school trauma and assist survivors in healing from this trauma.
  • Study the lasting impact of boarding school policies, including intergenerational trauma, on the social determinants of health of contemporary AI/AN communities, including those in urban areas
  • Include the UIOs representing the seventy percent (70%) of AI/ANs living in urban areas in DOI’s process through urban confer
    • NCUIH’s comments recognized the importance of Tribal sovereignty and the government-to-government relationship as vital to the Initiative, but noted failure to include UIOs in consultation will leave a significant portion of the AI/AN population without a voice
  • Ensure a comprehensive assimilation of data by making all AI/AN communities true partners in the Initiative.

The DOI report on the investigation is scheduled to be finished in April 2022. NCUIH will remain close to the investigation and monitor for updates. NUCIH will also continue to advocate for the inclusion of UIOs in the process and encourage DOI to incorporate a study of the impact of the boarding schools on urban AI/AN health into the Initiative.

Senator Cantwell Highlights Urban Indian Organizations in Senate Committee on Indian Affairs Oversight Hearing on VAWA

On December 8, 2021, the Senate Committee on Indian Affairs (SCIA) held an oversight hearing on “Restoring Justice: Addressing Violence in Native Communities through VAWA Title IX Special Jurisdiction.” Focusing on the successes and challenges of Title IX of the 2013 Violence Against Women Act (VAWA 2013), the hearing coincided with the committee’s release of the Reauthorization draft text.

When Congress passed VAWA 2013, it included a provision for Indian Tribal governments to exercise criminal jurisdiction over certain non-Indians who commit domestic violence against Indian victims on Tribal lands or violate qualifying protection orders. Although VAWA 2013 has been instrumental in these cases, there remain impactful jurisdictional gaps such as, being able to prosecute crimes against children, dating violence, sex trafficking, as well as co-occurring crimes such as assault on a law enforcement officer or DUI.

During the hearing, Senator Maria Cantwell (D-WA) brought to light the work of urban Indian organizations (UIOs) regarding Missing and Murdered Indigenous People (MMIP). Many UIOs conduct home visits and are at the front-line to identify domestic violence and other risk factors for MMIP. The National Council of Urban Indian Health (NCUIH) has been advocating for MMIP efforts and urban Indians to be included in the VAWA reauthorization to strengthen these critical services provided at UIOs for AI/ANs.

VAWA Hearing on Heels of Recent EO from Biden on MMIP

On November 15, 2021, President Biden signed Executive Order 14053 (E.O.) on Improving Public Safety and Criminal Justice for Native Americans and Addressing the Crisis of Missing and Murdered Indigenous People (MMIP) during the White House Tribal Nations Summit. NCUIH is pleased to see that the E.O. specifically mentions the Department of Health and Human Services (HHS) and the Secretary of the Interior conferring with UIOs on developing a comprehensive plan to support initiatives related to MMIP. We are also pleased to see that the E.O. highlights the need for improved data surrounding this crisis as it relates to urban Indian communities. NCUIH has voiced the importance of gathering more data on these communities, specifically on Missing and Murdered Indigenous Women.

CDC strengthens COVID-19 Booster Guidance

On November 29, CDC strengthened its recommendations on who should aim to complete a booster dose of the COVID-19 vaccine. This new recommendation urges that everyone ages 18 and older should receive a booster at least 6 months post completion of a 2-dose regimen, or 2 months post a single dose inoculation.

With the emergence of the Omicron variant, the importance of vaccination, and the use of boosters, as a prevention method is even more important. CDC Director, Dr. Rochelle Walensky also encouraged those who are unvaccinated to change that as soon as possible. Dr. Walensky also highlighted the importance of getting tested should you experience symptoms.

For more information, the Coronavirus Resources Center on the NCUIH website includes links to any recent guidance  or updates from federal agencies about COVID-19.

NCUIH Thanks Julia Dreyer for Her Service

NCUIH would like to thank Julia Dreyer, the Vice President of Public Policy, for her service to Indian Country as she moves on to her next endeavor! For the past four years, Julia has tirelessly advocated on behalf of American Indians and Alaska Natives living in urban settings. During Ms. Dreyer’s tenure, NCUIH has thrived and achieved significant wins for American Indian and Alaska Native health (AI/AN) care, such as more agency engagement on pressing issues, fighting against work requirements for AI/ANs, 100% FMAP for 8 quarters for services at Urban Indian Organizations (UIOs), UIO inclusion within every COVID-19 relief bill, and the amendment to the Indian Health Care Improvement Act to allow UIOs to use their line item funds for facilities related spending. Please join NCUIH in thanking Julia!

Julia Dreyer, NCUIH Vice President of Public Policy (Left) and Francys Crevier, NCUIH CEO (Right)