NCUIH President Walter Murillo testified on the critical work of urban Indian health. 

Washington, D.C. (April 14, 2021) – Today, the President of the National Council of Urban Indian Health (NCUIH) testified before the Senate Committee on Indian Affairs for an oversight hearing on “Examining the COVID-19 Response in Native Communities: Native Health Systems One Year Later.” Walter Murillo (Choctaw), CEO of Native Health in Phoenix, joined representatives from the Indian Health Service (IHS), National Indian Health Board, Papa Ola Lokahi, and Alaska Native Medical Center for the virtual hearing.

“Because the Indian health care system and UIOs have never been properly funded, we started from an extreme deficit when the pandemic hit,” Murillo said. He continued, “UIOs only receive $672 per patient for the year – this is unacceptable. The past 12 months have reminded us how resilient our people are and highlighted how critical our Indian health care system is to the lives of American Indians and Alaska Natives. Tragically, we have planned many funerals and lost far too many members of our communities.” 

Native health systems “started the rollout of some of the most successful vaccine campaigns in the country, and they continue to work every day to keep native communities safe. It really is remarkable how native health systems have overcome long odds, considering how under-resourced they were to begin,” said Chair Brian Schatz (D-HI) in his opening statement.

Senators from both sides of the aisle emphasized the importance of the federal government’s trust responsibility to provide health care for all Native people and key fixes needed to improve urban Indian health. Senator Tina Smith (D-MN) said, “We need to make sure that Congress is providing sufficient resources directly for the urban Indigenous.”  Senator Lankford (R-OK) who championed legislation to extend the Federal Tort Claims Act (FTCA) to UIOs applauded the IHS for swift implementation of that provision which passed as a standalone bill last year.

Hot Topic: 100% FMAP for UIOs

Senator Maria Cantwell (D-WA) pushed for the enactment of a permanent 100% Federal Medical Assistance Percentage (FMAP) for services provided by Urban Indian Organizations (UIOs). “There’s no reason to distinguish between an IHS, Tribal, or UIO facility. They all should get full 100% FMAP reimbursement. Urban Indian health is suffering, and there is no reason not to give them parity,” said Senator Cantwell. Mr. Murillo, who has been fighting for full FMAP for 20 years, explained how parity would help equalize serious funding shortages experienced by urban Indian organizations.

Hot Topic: Facilities

Infrastructure was another key topic of the hearing discussion with both Senator Smith and Senator Lankford inquiring about restrictions faced by UIOs with regards to facilities upgrades. In his written testimony, Mr. Murillo requested the Committee support $21 billion for Indian health infrastructure inclusive of UIOs and the support of removing restrictions on UIOs. Senators learned about how UIOs cannot access any infrastructure funds under the IHS facilities line item and the need for the American Jobs Plan to include avenues for improvements for urban Indian health facilities.

Next Steps

The Senate Committee on Indian Affairs will take the recommendations from today into consideration as they prepare their legislative priorities for this Congress related to responding to COVID-19.

More Information 

Read Written Testimony 

Watch Testimony

FEMA New Interim Policy: Public Assistance for Certain Private Nonprofits – Some UIOs Eligible

Safe Opening and Operation Work Eligible for Public Assistance (PA) Interim Policy

On April 5, 2021, FEMA Office of External Affairs released an interim policy to continue to maximize the framework that supports the safe opening and operation of work under the Public Assistance (PA) program. Eligibility is inclusive to certain private nonprofit (PNP) organizations for work performed when ensuring safe opening and operations associated with the COVID-19 emergency, from January 21, 2021 through September 30, 2021.

New Policy Inclusion of Qualified PNPs is Paramount to UIOs

Under the new interim policy, which includes Qualified PNPs, some Urban Indian Organizations (UIOs) will be eligible. UIOs are urged to review the requirements to determine eligibility.

Eligible Assistance

To have PNP designation in the FEMA PA Program, the facility must show a ruling letter from the Internal Revenue Service granting tax exemption under sections 501(c), (d), or (e) of the Internal Revenue Code of 1954; or documentation from the state substantiating that the non-revenue producing organization or entity is a nonprofit entity organized or doing business under state law.

The PNP must meet the program definition of an eligible facility and provide eligible service(s) that may be critical or noncritical, and were reasonably provided for safe opening and operation during the pandemic. Services may include education, utilities, emergency, medical, custodial care, and other essential social services.

• Purchase and distribution of face masks and PPE, items such as N95, surgical masks, gloves, protective eyewear, face shields, & protective clothing.
• Cleaning and disinfection, in accordance with CDC guidelines, including the purchase of necessary supplies and equipment.
• COVID-19 diagnostic testing
• Screening and temperature scanning, including the purchase and distribution of hand-held devices.
• Acquisition and installation of temporary physical barriers.
• Signage to support social distancing.
• Purchase and storage of PPE or other supplies based on projected needs.

FAQs

• FEMA will not duplicate assistance already provided by the Department of Health and Human Services (HHS). This is inclusive to the Centers for Disease Control (CDC) & other federal agencies.
• Eligible costs will be provided at a 100% Federal funding
• PA reimbursement requires the execution of a FEMA-State/Tribal/Territory Agreement, as appropriate, and execution of an applicable emergency plan.

Eligibility Process

During the application process, applicants will need to provide general information to support eligibility determination.

• Organizational information: physical location and point of contact
• Work performed
• Cost expenditures

Those interested in applying for a PA Grant should visit the FEMA Grants Portal or the Grants Line at (866) 337-8448. FEMA is currently allocating program delivery managers to support those interested in PA.

Next Steps

NCUIH will continue to monitor the changes in the FEMA PA policy. Issues raised during the consultation process are being considered for permanent updates in the FEMA Public Assistance Program and Policy Guide.

Read the Policy

Read the Dear Tribal Letter

Learn More and Apply

Yesterday, the Indian Health Service (IHS) released a March 26, 2021 Dear Urban Indian Organization (UIO) Leader Letter (DULL)  announcing an updated allocation of $95 million in telehealth funding from the Coronavirus Aid, Relief, and Economic Security Act. Since IHS’ announcement of these funds in an April 23, 2020 DULL, NCUIH has regularly been asking IHS officials about updates regarding funding allocation.

Of the $95 million in telehealth funding, only $4 million will be allocated to UIOs through existing IHCIA contracts by providing a one-time, base amount for each UIO, and an additional amount based on each UIO’s Urban Indian users. $67 million will be allocated to the IHS and Tribal Health Programs (THPs) and the remaining $24 million will be used by IHS to support nationwide outreach, education, training, technical assistance, contract management, coordination and program/policy development activities, as well as the acquisition of a clinical video telehealth solution.

UIOs deliver quality and culturally competent healthcare to the >70% of American Indian/Alaska Natives (AI/ANs) living in urban areas. Despite this large number of the AI/AN population served, UIOs receive a disproportionately low amount allocated funds to serve their patients, especially during a global pandemic.

Read the Letter

NCUIH recently submitted testimony to the Senate Committee on Indian Affairs for the Oversight Hearing “A call to action: Native communities’ priorities in focus for the 117th Congress.” In the testimony, NCUIH outlined how decades of underfunding of the IHS system coupled with the recent COVID-19 pandemic have highlighted the urgency of rectifying the long-standing inequities UIOs face. UIOs do not have parity with IHS and Tribal Health Providers in many cost-saving programs. UIOs already operate on thin financial margins and receive funding from a single line item, which is less than 1% of the total IHS budget.

This chronic underfunding is exacerbated by UIOs inability to participate in essential cost-saving measures. NCUIH has worked closely with Representative Raul Ruiz (D-CA) and key Congressional leaders to push for the inclusion of 100% FMAP for services provided at UIOs. Last week, Representative Ruiz introduced H.R.1373 the Urban Indian Health Parity Act, bipartisan legislation, with 12 original cosponsors to extend the 100% FMAP provision permanently to expand resources for American Indians and Alaska Natives living in urban areas especially as COVID-19 pandemic continues to ravage Native communities.

Why Does this Matter to UIOs?:

There is a pressing need for the health care services provided by UIOs. Urban AI/ANs experience disproportionate rates of chronic diseases and are therefore more likely to need access to health care. Urban AI/ANs are 3 times more likely to have diabetes, more than 1.5 times more likely to have been hospitalized for respiratory infections in the past, and more than 1.5 times more likely to have coronary heart disease than non-Hispanic whites.

Policy Contact: Meredith Raimondi, mraimondi@NCUIH.org

Read the Testimony