Budget Formulation Update: The National Tribal Budget Formulation Workgroup’s Recommendations Include Urban Indian Health Increase for the Indian Health Service Fiscal Year 2021 Budget

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May 6, 2019 Update

Last month Tribal sovereign leaders on the National Tribal Budget Formulation Workgroup (TBFWG) met to provide input regarding the Indian Health Service (IHS) budget request for FY 2021 (FY). After a thorough discussion of healthcare needs, their recommendations include $2.7 billion in program increases for the most critical health issues, including $50.9 Million for Urban Indian Health. The National Council of Urban Indian Health provided testimony concerning the status of the Urban Indian Health Programs (UIHPs). The TBFWG recommendations are an approximate 46% increase above the Fiscal Year 2019 funding, highlighting the crucial need for funding of the Indian healthcare system. Additionally, a recommendation was made to fund the Special Diabetes Program for Indians, increasing funding to $200 million per year, to include inflation. 105(l) leases were also a subject of importance, and while IHS does have an obligation towards fulfilling its 105(l) leases, adequate steps have been encouraged to protect other IHS programs for FY2021. The TBFWG understands that before significant steps are taken to address the healthcare concerns in Indian country, the fundamentals such as the I/T/U system, must have precedence.

April 30, 2019: The National Tribal Budget Formulation Workgroup’s Recommendations on the Indian Health Service Fiscal Year 2021 Budget

https://www.tribalselfgov.org/wp-content/uploads/2019/04/307871_NIHB-IHS-Budget-Book_WEB.pdf

March 14, 2019: NCUIH Recommendations for the FY 2021 Indian Health Service Budget

Hot Topics/Requests – National Budget Recommendations

  • Hot Topics/Requests 1: Increased funding for urban Indian line item to at least 2% of IHS or $116m
  • HotTopics/Requests 2: Respecting Tribal requests for direct funding but ensuring grants to continue for Title V UIOs only
  • Hot Topics/Requests 3: Implementation of unfunded IHCIA provisions
  • Hot Topics/Requests 4: Ensuring UIHPs are held harmless from unrelated budget shortfalls, including creating a new line item for §105(l) leases
  • Hot Topics/Requests 5: Funding initiatives should include funds for Title V UIHPs
    • Opioid funding
    • Behavioral health funding
  • Hot Topics/Requests 6: 100% FMAP for UIHPs
  • Hot Topics/Requests 7: Funds for UIHPs to modernize Health IT
  • Hot Topics/Requests 8: Suicide and substance use disorder among youth
    • -One urban youth residential treatment center

Priorities

  • Priority 1: Advanced appropriations
  • Priority 2: SDPI
  • Priority 3: Substance use and mental health
  • Priority 4: Opioids funding

Preliminary Report: Impact of Government Shutdown on Urban Indian Organizations

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Overview

The federal government shutdown of 2018–2019 occurred from midnight EST on December 22, 2018 until January 25, 2019. This shutdown became the longest federal government shutdown in US history, lasting 35 days and causing severe and detrimental impact on the Indian healthcare delivery system. The interruption in funding precipitated by the shutdown had dire consequences for UIOs and consequently on American Indian/Alaska Natives (AI/ANs) across the country. This brief summarizes the results of a survey NCUIH circulated during the shutdown to capture important metrics and narratives regarding the impacts of the shutdown. The 2018/2019 Government Shutdown: Impacts on your Program survey was fielded January 2 to January 15, 2019 by the National Council of Urban Indian Health.

Key Findings

  • UIOs operate on very low margins.
    • UIOs operate on margins so low that even the most minor changes to their funding structure leads to devastating impacts on the services they provide to AI/ANs as well as their ability to keep their facilities operational.
  • All aspects of the urban healthcare delivery system were impacted by the shutdown, but UIO workforce were the first to experience its disastrous effects.
    • The survey results pointed to a pattern which suggests that among the difficult decisions UIOs were forced to make during the 2013 and the 2018/2019 shutdown, delaying hiring, reducing hours, and laying off of staff was usually the first choice.
  • Services were also greatly impacted.
    • Another pattern highlighted by the survey was that UIOs were forced to cut back on services that were not as consequential as others – services such as dental services, transportation, case management, and community outreach services. However, some UIOs were forced to cut even the essential services like substance abuse services, and purchase requests for insulin and blood pressure medications.
  • UIOs were forced to use savings designated for other purposes to shield staff and patients from impact of the last two shutdowns.
    • Yet another pattern illustrated in the survey results suggests that UIO leaders make an effort to protect their staff and current services by using savings earmarked for growing their program.
  • More research is needed.
    • Impacts of the shutdown are ongoing. This study was limited to only 13 days in the field so with further funding support, additional information on the long-term shutdown impacts can be determined. As the nationwide organization representing all Urban Indian Health Programs, NCUIH can assist with coordination of further research. To provide funding resources or inquire further, contact Alejandro Bermudez at abermudez@ncuih.org.

Preliminary Report

View here.

Additional Information

Please contact Julia Dreyer, Director of Federal Relations at jdreyer@ncuih.org.

Thank You for Making our NCUIH 2017 Washington Summit a Success!

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To Our Summit Attendees,

Thank you so much for making our NCUIH Washington Summit an absolute success! We truly appreciate everyone’s support and participation and hope that you were able to take something away from the Summit. A few friendly reminders:

1. Summit Survey: Please fill out the Summit survey if you haven’t already. This can help provide NCUIH with valuable information on how we can better serve you moving forward. Please find the survey here: http://www.ncuih.org/2017_nls

2. Presentations! The NCUIH Washington Summit Presentations have been posted. Please click here: http://www.ncuih.org/2017_nls

3. Keep in touch! Let us know how you put the lessons you learned in the sessions to work! The end of the Summit just means our real work has begun. Be on the lookout for our new testimony on SDPI, which reflects the issues and concerns of several NCUIH members. We’re working on a similar statement on our infrastructure needs, which would benefit enormously from your input. And we’re going to be sending out materials and holding webinars in the near future on how NCUIH members can move our agenda forward. If your program didn’t have time to participate in the Summit, don’t worry because there’s plenty of ways you can help NCUIH.

Have any other feedback or questions? Feel free to email me at FCrevier@NCUIH.org. Thanks again!

Sincerely,

Francys Crevier
Director of Governmental Affairs

National Council of Urban Indian Health Supports the Affordable Care Act in Light of the 2016 Presidential Elections

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FOR IMMEDIATE RELEASE

November 16, 2016

Contact: Francys Crevier

NCUIH Policy Analyst and Congressional Relations Liaison
FCrevier@NCUIH.org

 

Washington, D.C.  – The 2016 Presidential election results have created panic among those in the healthcare industry, as the new administration states they will repeal all or much of the Patient Protection and Affordable Care Act (ACA). The National Council of Urban Indian Health (NCUIH) reaffirms its mission to fight for quality and access to healthcare for American Indians and Alaska Natives (AI/AN).

The National Council of Urban Indian Health was founded 18 years ago to represent the interests of Urban Indian Health Programs (UIHPs) before Congress and Federal agencies, and to influence policies impacting the health conditions experienced by urban American Indians and Alaska Natives (AI/AN).The National Council of Urban Indian Health is a 501(c)(3), membership-based organization devoted to support the development of quality, accessible, and culturally sensitive health care programs for AI/AN living in urban communities.  NCUIH fulfills its mission by serving as a resource center providing advocacy, education, training, and leadership for urban Indian health care providers.  NCUIH strives for healthy American Indians and Alaska Natives living in urban settings, which comprise over 70% of the AI/AN population, supported by quality, accessible health care centers and governed by leaders in the Indian community.

The National Council of Urban Indian Health stands firm in representing the health and welfare of American Indians and Alaska Natives (AI/AN) and recognizes the Indian Healthcare Improvement Act is at risk under the new administration, as well as the Affordable Care Act. NCUIH is working with our partners to ensure the protection of these laws that have not only permanently reauthorized the Indian Health Care Improvement Act, but also the AI/AN provisions that are included in them that aid in facilitating the trust responsibility.

NCUIH will be working side by side with our Tribal partners to protect the healthcare trust responsibility that AI/AN were promised. We are stronger together.  For questions, comments or concerns, feel free to contact NCUIH Policy Analyst and Congressional Relations Liaison Francys Crevier at FCrevier@NCUIH.org.

The U.S. Department of Veterans Affairs (VA) hosts Tribal Consultation at the National Museum of the American Indian

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On September 28, 2016 the U.S. Department of Veterans Affairs (VA) held an in-person Tribal consultation session at the National Museum of the American Indian in Washington, DC to discuss amending the current VA Memorandum of Understanding (MOU) status to consolidate multiple community care programs, previously known as non-VA care, into one standard program with standard rates. The meeting was announced on September 12, 2016 through a Dear Tribal Leader Letter. NCUIH Board member Kerry Lessard and NCUIH Policy Analyst and Congressional Relations Liaison Francys Crevier emphasized the need to work with the VA to allow Urban Indian Health Programs the ability to have MOUs to better serve Native veterans. These MOUs would reimburse UIHPs for services provided to Native veterans who often prefer going to a UIHP for service rather than the VA because of shorter wait times and culturally competent care.

During the consultation, Tribal Leaders emphasized that the VA to fully implement the VA-IHS Memorandum of Understanding (MOU) that was implemented in 2012.  Many Tribal leaders expressed their disappointment of the MOU process taking over four years for approval, and others were concerned that VA’s consolidation plan would end  the current IHS/Tribal – VA MOU structure and would result a lengthier process and would most importantly infringe on the government-to-government relationship with the federal government.

At the National Indian Health Board’s conference in Scottsdale last month, the VA hosted a workshop on the MOU process. When the Ms. Crevier requested that the VA work with UIHPs as an integral part of the Indian Health system, the VA responded there was no need to work with UIHPs because there are VA offices in urban areas. NCUIH vehemently disagrees and strongly suggested that because of shorter wait times and cultural competency as well as the vital support UIHPs can bring to the VA, MOUs are necessary. A recent report from the Office of Inspector General showed that 215 VA patients died waiting for specialty care at the Phoenix VA, while Native Health, the Phoenix UIHP, resides in the same neighborhood and is willing to help alleviate that burden. Working together is the only way to make sure veterans do not fall through the cracks.

Tribal Consultation on the VA’s plan for consolidation is open until November 5, 2016. Click here to view the Federal Register Notice and submit comments.

100% FMAP State Health Official Announcement

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On Friday, February 26, 2016 the Centers for Medicare & Medicaid Services (CMS) released the Dear State Health Official letter regarding 100% FMAP to inform state agencies and health officials about the update in payment policy affecting federal funding for services received by Medicaid-eligible individuals who are AI/ANs through facilities of the Indian Health Service (IHS), whether operated by IHS or Tribes. Through this letter, CMS is re-interpreting its payment policy with respect to services “received through” an IHS/Tribal facility, and is expanding the scope and nature of services that qualify for the matching rate.

This update to the national policy has Tribal implications for IHS and Tribal facilities as well as on Urban Indian Health Programs (UIHPs) that provide services to AI/AN Medicaid beneficiaries. CMS held several Tribal Consultations, participated in an Urban Conferring session between IHS and NCUIH, and solicited comments on the parameters of a reinterpretation of section 1905(b) of the Social Security Act as specified in CMS’ October 2015 Medicaid Services ‘Received Through’ and Indian Health Service/Tribal Facility: A Request for Comment.” They received comments from Tribes, Tribal organizations, urban Indian organizations, States, and other stakeholders in support of the proposed policy change.

The new policy is intended to help states, IHS, Tribes, and UIHPs improve the delivery of health to AI/AN Medicaid beneficiaries by increasing access to care and strengthening continuity of care. The letter outlining the new policy is attached and will be available online on Medicaid.gov here. CMS will be holding an All Tribes’ Call to walk through the policy and provide time for questions and answers.  They will send out a Save the Date notice for the All Tribes’ Call, and information about the All Tribes’ Call will be posted here. We will make sure that notice gets sent out to UIHP Directors.

NCUIH believes that the new policy marks progress for UIHPs at the regulatory level. The CMS announcement coupled with the 100% FMAP for All Indian Health Programs inclusion in the President’s FY2017 budget demonstrates a desire by the government to achieve parity for Urbans within the Indian healthcare system for Medicaid beneficiaries. There are still determinations to be made regarding technical eligibility issues and operationalizing the updated CMS regulation. Consultations with State Medicaid programs and conferring sessions between IHS and NCUIH’s FMAP Work Group will be sought to clarify outstanding issues and to figure out the best way advance the interests of UIHPs within the context of the new FMAP regulation. NCUIH still seeks the help of all UIHPs in reaching out to Members of Congress to request support for the 100% FMAP provision within the President’s budget. Lastly, NCUIH would like to express gratitude to the FMAP Work Group (Donna Keeler – South Dakota, Aren Spark – Seattle, Walter Murillo – Phoenix, and Ashley Tuomi – Detroit) as well as all of the UIHP Directors that have contributed time and effort over recent days, weeks, months, and years towards achieving 100% FMAP inclusion for Urbans. Should you have any questions regarding this announcement, please contact Rudy Soto, NCUIH Policy Analyst, at rsoto@ncuih.org.