BIDEN FY22 BUDGET REQUEST INCLUDES ADVANCE APPROPRIATIONS AND $2.2 BILLION INCREASE FOR IHS

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BIDEN FY22 BUDGET REQUEST INCLUDES ADVANCE APPROPRIATIONS AND $2.2 BILLION INCREASE FOR IHS

On April 12, 2021 President Biden released his discretionary budget request for Fiscal Year (FY) 2022, pending a more detailed version in the coming months, which will include the funding recommendations for urban Indian health. This request includes $131.7 billion for the Department of Health and Human Services (HHS), a 23.5% increase from the 2021 enacted level, and $8.5 billion in discretionary funding for the Indian Health Service (IHS), a $2.2 billion increase from FY21. The additional $2.2 billion requested for IHS will go towards promoting health equity for American Indians/Alaska Natives (AI/ANs) and include Urban Indian Organization (UIO) consultation to evaluate options, including mandatory funding, to provide adequate, stable, and predictable funding for IHS in the future. The proposal also includes an advance appropriation for IHS in FY23 to ensure a more predictable funding stream.

In a press release on the budget, IHS Acting Director Elizabeth Fowler stated, “The budget request for the IHS is developed in close partnership with tribes, tribal organizations, urban Indian organizations, and other key stakeholders to ensure it reflects the evolving health needs of American Indian and Alaska Native people and communities.”

Background and Next Steps

NCUIH has long advocated for advance appropriations for IHS to begin closing the funding disparities that have long hindered AI/AN communities. NCUIH has also requested inclusion of UIOs for urban confer with a philosophy of “no policies about us without us”.

The Appropriations Committees will review the President’s Budget for consideration as they craft their bills for FY23. NCUIH has requested $200.5 million forFY23 for urban Indian health with at least $12.759 billion for the Indian Health Service in accordance with the Tribal Budget Formulation Workgroup (TBFWG) recommendations. NCUIH will continue to work with the Biden Administration and Congress to push for full funding of urban Indian health in FY22.

Overview of Budget Request

The budget request includes the following for health:

Department of Health and Human Services

  • $131.7 billion for HHS, a $25 billion or 23.5% increase from the 2021 enacted level

Indian Health Service

Centers for Disease Control and Prevention

  • $8.7 billion in discretionary funding, an increase of $1.6 billion over the 2021 enacted level
    • Promotes Health Equity by Addressing Racial Disparities
      • $153 million for CDC’s Social Determinants of Health program, an increase of $150 million over the 2021 enacted level, to support all States and Territories in improving health equity and data collection for racial and ethnic populations.
    • Advances the Goal of Ending the Opioid Crisis
      • $10.7 billion, an increase of $3.9 billion over the 2021 enacted level, to support research, prevention, treatment, and recovery support services, with targeted investments to support populations with unique needs, including Native Americans, older Americans, and rural populations.
    • Commits to End the HIV/AIDS Epidemic
      • $670 million, an increase of $267 million over the 2021 enacted level, to support the critical effort to end the HIV/AIDS epidemic in the United States. Investments in CDC, the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), and NIH aim to reduce new HIV cases aggressively while increasing access to treatment, expanding use of pre-exposure prophylaxis (also known as PrEP), and ensuring equitable access to services and supports.
    • Provides Funding to Reduce the Maternal Mortality Rate and End Race-Based Disparities in Maternal Mortality
      • $200 million to reduce maternal mortality and morbidity rates for Black and American Indian/Alaska Native women nationwide, bolster Maternal Mortality Review Committees, expand the Rural Maternity and Obstetrics Management Strategies program, help cities place early childhood development experts in pediatrician offices with a high percentage of Medicaid and Children’s Health Insurance Program patients, implement implicit bias training for healthcare providers, and create State pregnancy medical home programs.
    • Addresses the Public Health Epidemic of Gun Violence in America
      • $100 million for CDC to start a new Community Based Violence Intervention initiative—in collaboration with Department of Justice—to implement evidence-based community violence interventions locally in communities of color, as Black men make up six percent of the population but over 50 percent of gun homicide victims, and American Indians/Alaska Natives and Latinos are also disproportionately impacted.

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IHS Pauses Johnson & Johnson COVID-19 Vaccine

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On Tuesday, April 14, the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) announced that they are recommending a pause on the Johnson & Johnson/Janssen (J&J) COVID-19 vaccine while they review data involving six reported U.S. cases of a rare and severe type of blood clot in individuals receiving the vaccine product. Per this recommendation, the Indian Health Service (IHS) has paused all J&J vaccine administration.

IHS has three vaccine safety monitoring systems in place. To date, there have been no reported cases of the rare and severe type of blood clot seen in some individuals who have received this vaccine. The J&J vaccine makes up approximately 1.5% percent of IHS’s recorded shots in arms to, and IHS does not expect this pause to affect the agency’s goal of fully vaccinating 44% of its active adult patients by the end of April.

IHS employees have been advised to offer Pfizer and Moderna vaccines when available to patients that are scheduled to receive the J&J vaccine and will work to ensure that all vaccination sites have adequate stock of these vaccine products.

For more information, you may also visit the FDA YouTube site to hear the FDA and CDC press conference held this morning to answer questions about this pause in Johnson & Johnson/Janssen vaccine administration.

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Sixth Amendment to HHS Declaration on COVID-19 Vaccine Efforts Adds Flexibility

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On February 16, the HHS issued its latest amendment to its Declaration that provides immunity from liability for COVID-19 vaccine administration and other countermeasures during this Public Health Emergency (PHE). Since the pandemic emergency started back in late January 2020, HHS has issued the declaration and six amendments to it.

The Public Emergency and Emergency Preparedness Act (PREP Act) authorizes HHS Secretary to issue such a declaration to insulate from liability, except for willful misconduct. The flexibility inherent in the PREP Act and in the HHS agency actions, has afforded expanded protections for UIOs, as well as increase the number of interventions and categories of people able to administer vaccines.

On April 10, 2020, the former Secretary Alex M. Azar II, amended the Declaration under the PREP Act to extend liability immunity to countermeasures authorized under the CARES Act (85 FR 21012, Apr. 15, 2020). On June 4, the former Secretary further amended the Declaration to clarify that covered countermeasures under the Declaration include qualified countermeasures that limit the harm “COVID–19 might otherwise cause” securing further liability from tort claims. (85 FR 35100, June 8, 2020). On August 19, the next amendment approved additional categories of Qualified Persons authorized to prescribe and dispense the covered countermeasures.

The last amendment posted February 10, 2021, authorizes any health care provider authorized or licensed in any state to administer vaccines in any other state or territory (physician, registered nurse, practical nurse whose license expired in last 5 years and was in good standing to administer in any state or territory). The health care provider is required to complete CDC vaccine training.

In another turn of great advocacy by NCUIH staff in Congressional Relations, all the difficulties experienced by IOUs wanting to test for COVID-19, and interaction with the various federal agencies during the course of the COVID-19 emergency, served to lay the ground work and arguments for introducing the Congressional bill that for the first time extended protections in the Federal Torts Claim Act to urban Indian health providers, becoming Public Law 116-313 on January 5, 2021! See our FTCA bill, H.R. 6535, 116th Congress (2019-2020), deeming an urban Indian organization and its employees to be part of the Public Health Service for purposes of certain claims of personal injury.

Biden Administration Resumes White House Council on Native American Affairs

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The first White House Council on Native American Affairs (WHCNAA) meeting of the Biden-Harris administration will be held by Secretary of the Interior Deb Haaland and Domestic Policy Advisor Susan Rice on April 23, 2021. Secretary Haaland will serve as the Council’s Chair.

In a press release from the U.S. Department of Interior, Secretary Haaland stated, “Addressing the systemic inequities that impact Indigenous peoples is the responsibility of every federal agency that will require an all-of-government approach across the Administration.”

President Obama signed an executive order on June 26, 2013, establishing the WHCNAA to bring together federal leaders and Indian Country. The convening of the WCHNAA comes as the Biden-Harris administration has prioritized getting resources out to Tribal communities to address the impacts of climate change, racial equity, economic recovery, and COVID-19 response.

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NATIONAL NATIVE ORGANIZATIONS CALL FOR BOLD ACTION, INCLUSION OF URBAN INDIANS IN INFRASTRUCTURE PACKAGE

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On April 13, 2021, the National Council of Urban Indian Health (NCUIH) and several other American Indian and Alaska Native (AI/AN) organizations signed a joint letter urging Congress to address Indian Country’s infrastructure priorities in the upcoming legislative package. The letter includes several requests for infrastructure investments into Urban Indian Organizations (UIOs).

There are 41 UIOs operating in 77 health facilities across 22 states that provide high-quality, culturally competent care to urban Indian populations. Tribal leaders advocated to Congress for the creation of UIOs after the Relocation Era in recognition that the trust obligation for healthcare follows Indians off reservations. Unfortunately, there are significant parity issues experienced by UIOs as compared to other federally funded healthcare systems, which greatly impact their services and operations. For example, the IHCIA prohibits UIOs from making even minor renovations to their facilities using their annual appropriations. This provision was intended to help UIOs maintain or attain accreditation with grants, but instead has hamstrung UIOs from using their already limited funding for any infrastructure needs.

Further, unlike other parts of the Indian health system, UIOs do not receive any funding for facilities infrastructure, which has made repairs, renovations, and remediation extremely difficult. The pandemic has made it even harder for UIOs as they now must make updates for no-contact services, socially distanced waiting rooms, and increased security to adhere to COVID-19 safety guidelines. The time is long overdue for investment into UIO infrastructure for this vital prong of the Indian health system.

The letter includes the following priorities for UIO infrastructure:

Infrastructure for UIOs

  • Amend the IHCIA to remove restrictions on using UIO funds for making facility renovations.
  • At least $100 million for Urban Indian Health IT (25 U.S.C. § 1660h).
  • At least $749.3 million for Urban Indian Health.
  • At least $3 million for Urban Indian Health Community Health Representatives (25 U.S.C. § 1660f).
  • Extend Full (100 percent) Federal Medical Assistance Percentage (FMAP) to services provided at UIOs permanently.
  • Establish an Urban Confer Policy for HHS.

Health Care Facilities Construction

  • At least $21 billion for Healthcare Facilities Construction, including but not be limited to, support for new and current planned projects, the Small Ambulatory Health Center Program, UIOs, the Joint Venture Construction Program, and innovative approaches to addressing unmet construction needs for health facilities as described in 25 U.S.C. §1631(f).

Public Health Infrastructure

  • Allow I/T/U providers to be reimbursed for services provided outside of the four walls of their clinic, just as they would if they were provided in the clinic.
  • Establish a Native Behavioral Health Program for I/T/U and fund through FY26 at $200 million annually with annual increases for medical inflation, and funding available through contracts/compacts for Title I and Title V Tribes.

Tribal Health Workforce Development

  • Fully fund the Community Health Aide Program for implementation in all states and for UIOs.

READ THE LETTER

NCUIH Submits Written Testimony to House Interior Appropriations with FY22 Budget Requests for UIOs

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On April 14, the National Council of Urban Indian Health (NCUIH) CEO, Francys Crevier, submitted public witness written testimony to the House Appropriations Subcommittee on Interior, Environment, and Related Agencies regarding Fiscal Year (FY) 2022 funding for Urban Indian Organizations (UIOs).

UIOs provide culturally competent health care to some of the 70% of American Indians and Alaska Natives (AI/AN) living in cities and are primarily funded by a single line item in the annual Indian health budget, which constitutes less than 1% of the total Indian Health Service (IHS) annual budget. The devastating impact of the COVID-19 pandemic on Indian Country proved the dire need for increased funding and resources for UIOs, who have continuously provided services in the hardest hit urban areas during the entire pandemic.

In the testimony, NCUIH requested the following:

  • $200.5 million for Urban Indian Health for FY22
  • Include report language to allow use of facilities funding to UIOs
  • Advance appropriations for IHS
  • UIOs be insulated from unrelated budgetary disputes through a spend faster anomaly so that critical funding is not halted

These requests are essential to ensure that urban Indians are properly cared for and moves us closer to fulfilling the federal government’s trust responsibility to AI/ANs.

NEXT STEPS:

The testimony will be read and considered by the subcommittee as the appropriations process goes forward for Fiscal Year 2022.

Read the Full Testimony

NCUIH Testifying Before Senate Committee on Indian Affairs on COVID-19 (4/14)

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NCUIH President and CEO of Native Health in Phoenix, AZ, Walter Murillo (Choctaw) has been invited to testify before the Senate Committee on Indian Affairs on the COVID-19 impacts in Indian Country. The Senate Committee on Indian Affairs, led by Chair Brian Schatz (D-HI) and Vice-Chair Lisa Murkowski (R-AK), will also hear from the National Indian Health Board and Papa Ola Lokahi.

Watch the Hearing

Senate Hearing Highlights Importance of Urban Indian Health as COVID-19 Rages On

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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

NCUIH Testifying Before Senate Committee on Indian Affairs on COVID-19

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NCUIH President and CEO of Native Health in Phoenix, AZ, Walter Murillo (Choctaw) has been invited to testify before the Senate Committee on Indian Affairs on the COVID-19 impacts in Indian Country. The Senate Committee on Indian Affairs, led by Chair Brian Schatz (D-HI) and Vice-Chair Lisa Murkowski (R-AK), will also hear from the National Indian Health Board and Papa Ola Lokahi.

Watch the Hearing

FEMA’s Coronavirus (COVID-19) Pandemic: Safe Opening and Operation Work Eligible for Public Assistance (PA) Interim Policy

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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