An April 27th Dear Urban Leader Letter gave notice of an upcoming Urban Confer with UIO leaders. The confer will be held Wednesday, June 9th, virtually at 2pm ET. The topic of this Confer will be on IHS Confer policies, as they are looking to improve upon them. Written comments are to be submitted no later than June 15th, by email.
On April 27, Sen. Tina Smith and Sen. Lisa Murkowski re-introduced NCUIH endorsed legislation to improve tribal health data surveillance. The bill intends to address challenges faced by tribes and tribal epidemiology centers when trying to access federal healthcare and public health surveillance data systems. NCUIH worked closely on the development of this bill to ensure urban Indians are adequately counted. If passed, the bill would require:
Encourage states to enter into data sharing agreements with tribes and tribal epidemiology centers.
On April 29, the Department of Health and Human Services (HHS) Secretary Xavier Becerra visited Seattle Indian Health Board (SIHB) where he witnessed the unique ways that Urban Indian Health Programs deliver services to American Indians and Alaska Natives (AI/ANs). Secretary Becerra met with SIHB leadership to listen to ideas on how HHS can better serve the large population of AI/ANs living in urban settings.
On February 11-13, 2021, the Tribal Budget Formulation Workgroup (TBFWG) convened to develop the National Tribal Budget Recommendation for fiscal year (FY) 2023. In May 2021, a summary of the TBFWG’s Budget Recommendation was released in a document entitled Building Health Equity with Tribal Nations. The FY 2023 National Tribal Budget Recommendation for the Indian Health Service (IHS) is $49.8 billion, representing a 291% increase above the FY 2022 National Tribal Budget Recommendation planning base. The increase for IHS is a need-based funding aggregate cost based on the FY 2018 estimate of 3.04 million eligible AI/ANs eligible to be served by IHS, Tribal and Urban health programs. The TBFWG stated, “Unfulfilled Trust and Treaty obligations results in American Indian and Alaskan Native people living sicker and dying younger than other Americans.”
The TBFWG recommended a $794.262 million increase for the urban Indian health line item, bringing the funding for Urban Indian Organizations (UIOs) to a total of approximately $950 million (a 373.8% increase above the FY 2022 planning base). In FY 2021, Urban Indian health received $62.7 million. For FY 2022, which has not been funded yet, the House approved $200.5 million for urban Indian health. While there is a long way to go to reaching the full level of need funding for urban Indian health, the increased level of commitment from Congress demonstrates progress for Indian health.
The IHS need-based funding aggregate cost estimate for FY 2023 is now approximately $49.8 billion, based on the FY 2018 estimate of 3.04 million eligible AI/ANs eligible to be served by IHS, Tribal and Urban health programs.
The TBFWG stated:
“As we inch closer to increased parity for urban Indians, it is imperative to highlight that up until the end of 2020 and beginning of 2021, UIOs have been deemed ineligible for cost-saving measures available to the other components of the IHS I/T/U system, including, among others, 100% Federal Medical Assistance Percentage (FMAP) for services provided at UIOs, reimbursement from the Department of Veterans Affairs (VA) for services provided to dually-eligible AI/AN Veterans, and liability coverage under the Federal Tort Claims Act (FTCA). Implementation of these hard-fought legislative victories at the agency level will require close attention to ensure that proper procedures and policies are put into place. Although these changes represent a step forward, associated issues remain. For example, UIOs will only remain eligible for 100% FMAP for two years and still are not receiving the IHS all-inclusive rate. Permanent policy fixes to address these issues are required.”
Other TBFWG priorities for Urban Indian Health were:
In addition, the TBFWG recommended that dedicated funding be provided to implement the new authorities and provisions of the Indian Health Care Improvement Act (IHCIA); President’s Budget request for FY23 must include substantial, separate investments for Health IT modernization; Tribes, Tribal Programs, and UIOs be permanently exempt from sequestration and recissions; mandate advance appropriations for IHS; the Special Diabetes Program for Indians (SDPI) be permanently reauthorized and increase funding to $250 million per year; and federal agencies provide recurring funding to support public health infrastructure to address current and future public health emergencies.
About the IHS Budget Process and the Tribal Budget Formulation Workgroup:
The annual budget request of the IHS is the result of the budget formulation and consultation process that involves IHS, Tribal, and urban Indian health program representatives and providers from the local to the national level.
The TBFWG consists of two Tribal representatives from each of the 12 IHS Areas. Additional representatives from Indian organizations, participate in the workgroup at the discretion of the Director of IHS. The workgroup provides input and guidance to the IHS Headquarters budget formulation team throughout the remainder of the budget formulation cycle for that fiscal year. The workgroup prepares the final set of tribal budget recommendations with an accompanying testimony on the results of the national budget work session and presents to the IHS Director as well as to the HHS senior officials at the annual HHS Tribal Consultation meeting.
On April 30, 28 Congressional leaders requested $200.5 million for urban Indian health in FY22 from the House Appropriations Committee.
Reps. Grijalva and Gallego requested $200.5 million for urban Indian health with $12 billion for IHS as recommended by the Tribal Budget Formulation Workgroup in a forward appropriations letter to Chairwoman Pingree and Ranking Member Joyce of the House Interior Appropriations Committee. The letter cited that this increase in funding would “make a huge difference to UIOs in providing care to urban Indians due to historically low funding levels for urban Indian health. Another letter by Reps. Adam Smith and Don Young included $200.5 million for urban Indian health and $24 million for Tribal Epidemiology Centers in FY22.
These appropriations letters come as a continued effort by NCUIH to address acute health disparities for AI/ANs living in urban areas, who suffer greater rates of chronic disease, infant mortality and suicide compared to all other populations that have only been exacerbated by COVID-19. Congress has acknowledged these the significant health care disparities in Indian Country, but continuously underfunds IHS at around $4,000 per patient, and UIOs at less than $700 per patient even though AI/ANs living in urban areas comprise over two-thirds of the total American Indian Alaska Native population.
These Appropriations letters send a powerful and straightforward message to Chairwoman Pingree and Ranking Member Joyce and members of Congress to fulfill the federal government’s trust responsibility to all AI/ANs to provide safe and quality healthcare, funding for urban Indian health must be significantly increased.
NCUIH is grateful for the support of the following Representatives:
On April 27, Sen. Tina Smith and Sen. Lisa Murkowski re-introduced NCUIH endorsed legislation to improve tribal health data surveillance. The bill intends to address challenges faced by tribes and tribal epidemiology centers when trying to access federal healthcare and public health surveillance data systems. NCUIH worked closely on the development of this bill to ensure urban Indians are adequately counted. If passed, the bill would require:
Encourage states to enter into data sharing agreements with tribes and tribal epidemiology centers.
On April 23, the Indian Health Service (IHS) released a Frequently Asked Questions (FAQ) document regarding Federal Tort Claims Act (FTCA) Coverage for Urban Indian Organizations (UIOs). This FAQ document follows Congress’ January 3, 2021 amendment to Title V of the Indian Health Care Improvement Act. The Amendment added Section 1660i “Deeming an Urban Indian organization and employees thereof to be a part of the public health service for the purposes of certain claims for personal injury”, and extends FTCA coverage to UIOs and their employees to the same extent and in the same manner as to Tribes and Tribal Organizations.
Why Does this Matter to UIOs?:
FTCA coverage for UIO allows for funding that would have been spent on the purchase of medical malpractice insurance to be used on programs and services that benefit their clients.
After months of tireless advocacy, the National Council of Urban Indian Health (NCUIH) has partnered with Native American Lifelines (NAL), the University of Maryland, Baltimore, and the Indian Health Service (IHS) to bring the COVID-19 vaccine to urban Indians in the Washington, DC, Maryland, and Virginia metropolitan area. Vaccine appointments are being held at the University of Maryland, Baltimore, can be scheduled online, and are open to DMV metropolitan Natives (ages 16+) as well as non-Native individuals who work in organizations serving the Native community.
Read more about this new development from local news outlets:
University of Maryland, Baltimore opens COVID vaccine clinic for Indigenous peoples
UMB opens first regional COVID-19 clinic exclusively for Native Americans
COVID-19 Vaccine Available for Native Americans at UMB
UMB News: COVID-19 Vaccine Available for Native Americans at UMB
Vaccine clinic for Native Americans opens in Baltimore
Local clinic aims to get vaccinations to Native American community
On April 8, 2021, Rep. David Trone introduced a bill titled “State Opioid Response Grant Authorization Act of 2021” to amend the 21st Century Cures Act to reauthorize and expand a grant program for State response to the opioid use disorders crisis, and for other purposes. This bill authorizes funding at $1.75 billion for each of fiscal years 2022 through 2027, to remain available until expended.
This bill includes a 5% set aside of the funds made available for each fiscal year for Indian Tribes, Tribal organizations, and Urban Indian Organizations (UIOs) to address substance abuse disorders through public health-related activities such as implementing prevention activities, establishing or improving prescription drug monitoring programs, training for health care practitioners, supporting access to health care services, recovery support services, and other activities related to addressing substance use disorders.
NCUIH has long advocated for UIOs to be added to the SOR grants given the extent of the impact of the opioid epidemic on urban Indians. NCUIH supports Rep. Trone’s legislation to reauthorize the 21st Century Cures Act grant program for State response to the opioid crisis and its inclusion of UIOs.
Dear Urban Indian Health Advocates,
We need your help contacting Congress to support Urban Indian Organizations!
Representative Ruben Gallego (D-AZ) and Raúl Grijalva (D-AZ) are leading a letter to the Chair and Ranking Member of the Appropriations Subcommittee on Interior, Environment, and Related Agencies. This subcommittee appropriates funding for the Indian Health Service and for Urban Indian Organizations.
The letter calls for an increase in funding of a minimum of $200.5 million for urban Indian health. This funding increase is necessary to address the chronic underfunding UIOs have experienced, particularly during a global pandemic that is killing Natives at the highest rates worldwide. This amount also reflects the recommendation made by the Tribal Budget Formulation Working Group (TBFWG). To ensure that the urban Indian health line item receives as much support as possible, we encourage you to contact your Member of Congress and request that they sign on to the Gallego-Grijalva Urban Indian Health letter by the deadline of April 23.
You can use the text below as a template to call and/or email to your Member of Congress. If you can please, call and email your representative. You can find your representative here.
Thank you for your leadership. Your outreach on this is invaluable to providing greater access to health care for American Indians and Alaska Natives in urban areas.
Sincerely,
NCUIH
Email to Your Member of Congress
Dear Representative,
As an urban Indian health advocate, I respectfully request you sign on to the Gallego-Grijalva letter to the House Committee on Appropriations in support of increasing the urban Indian health line item to $200.5 million for FY22.
As of the 2010 Census, it was reported that over 70% of American Indians and Alaska Natives (AI/ANs) reside in cities. There are 41 Urban Indian Organizations (UIOs) that provide health care through the Indian Health Care Improvement Act to reach this population as part of the government’s trust responsibility to all AI/AN people.
As an integral part of the AI/AN health care delivery system, UIOs rely on funding from IHS to provide care to urban AI/AN people. UIOs depend on scarce federal resources to provide services to our AI/AN patients at the rate of only $672 per patient compared with the national average of over $11,000 per patient. The primary source of funding for UIOs is the urban Indian health line item. The letter requests increasing funding to at least $200.5 million, which reflects the recommendation made by the Tribal Budget Formulation Working Group (TBFWG) for FY 2022. Because of the pandemic, UIOs are serving record patients through vaccination and testing clinics along with all regular operations.
To sign, on please contact Ms. Mariel Jorgensen (Mariel.Jorgensen@mail.house.gov) from Rep. Gallego’s office by April 23.
Thank you for your leadership and your commitment to upholding the United States trust responsibility.
Sincerely,
YOUR NAME
SOCIAL MEDIA
Post your support on your Facebook.
From your Twitter account, tweet to your Member of Congress.
Dear [@ Member’s handle], please sign on to Gallego Grijalva letter for $200.5 million for #urbanIndianhealth in FY22 @ncuih_official.
National Council of Urban Indian Health
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Phone: 202.544.0344