UIO Call to Action Toolkit: Health Care Access for Urban Native Veterans Act

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Call to Action: Ask Congress to Authorize the VA to Reimburse UIOs for Health Care

Representative Ro Khanna and Senator Tom Udall, vice chairman of the Senate Committee on Indian Affairs, introduced the Health Care Access for Urban Native Veterans Act, a bill to improve health care access for Native American Veterans by providing Department of Veterans Affairs (VA) coverage for care that Native American Veterans receive at urban Indian health centers.  This legislation would include “urban Indian organizations” in the statute requiring the VA to reimburse Indian Health Service (IHS) and Tribal health facilities for services they provide to native veterans. To ensure that the Health Care Access for Urban Native Veterans Act receives as much support as possible, we encourage you to contact your Member of Congress and request that they sign on as a cosponsor of this bill (if they have not already).

Write to Your House Member

Please use the following text below as a template to call or email to your Representatives. You should call and email your representative; you can find your representative here.

Dear Representative [ ],

On behalf of [program] and the communities we serve, we respectfully request you sign on as a cosponsor to the Health Care Access for Urban Native Veterans Act recently introduced by Representative Ro Khanna and Senator Udall.  This bill is a critical language fix that would include “urban Indian organizations” in the statute requiring the Department of Veterans Affairs (VA) to reimburse Indian Health Service (IHS) and Tribal health facilities for services they provide to native veterans.

Urban Indian Organizations (UIOs) are an integral part of the American Indian and Alaska Native (AI/AN) health care delivery system. However, due to an oversight in legislation UIOs are the only part of the IHS Indian/Tribal/Urban (I/T/U) system that do not receive reimbursement under the VA-IHS MOU reimbursement agreement. However, UIOs were created by Congress as a response to Tribes that wanted to ensure their members would receive quality health care off of reservations as part of the trust obligation.

The Department of Veterans Administration has stated that it cannot address the issue on its own, and that only Congress has the authority to correct this oversight. The Health Care Access for Urban Native Veterans Act of 2019 would ensure that all three branches of the I/T/U system receive reimbursement for health care services delivered to AI/AN veterans.   At [Your Program] we offer [services you provide]. With reimbursement under the VA-IHS MOU reimbursement agreement we could [expand services/hire additional staff/etc].  We hope you will become a cosponsor of the Health Care Access for Urban Native Veterans Act and show your support for the health of urban AI/AN Veterans.

For the sake of the health of American Indian and Alaska Native Veterans and the fulfillment of the U.S. trust obligation,  we request your support of this simple language fix. To sign on, please contact Mr. Will McKelvey (Will.Mckelvey@mail.house.gov ) 202-225-2631 from Congressman Ro Khanna’s office.

Sincerely, [Executive Director/CEO]

Write to Your Senator

Please use the following text below as a template to call or email to your Senators.  You can find your Senators here.

Dear Senator [ ],

On behalf of [program] and the communities we serve, we respectfully request you sign on as a cosponsor to the Health Care Access for Urban Native Veterans Act (S.2365) recently introduced by Senator Udall and Representative Ro Khanna.  This bill is a critical language fix that would include “urban Indian organizations” in the statute requiring the Department of Veterans Affairs (VA) to reimburse Indian Health Service (IHS) and Tribal health facilities for services they provide to native veterans.

Urban Indian Organizations (UIOs) are an integral part of the American Indian and Alaska Native (AI/AN) health care delivery system. However, due to an oversight in legislation UIOs are the only part of the IHS Indian/Tribal/Urban (I/T/U) system that do not receive reimbursement under the VA-IHS MOU reimbursement agreement. However, UIOs were created by Congress as a response to Tribes that wanted to ensure their members would receive quality health care off of reservations as part of the trust obligation.

The Department of Veterans Administration has stated that it cannot address the issue on its own, and that only Congress has the authority to correct this oversight. The Health Care Access for Urban Native Veterans Act of 2019 would ensure that all three branches of the I/T/U system receive reimbursement for health care services delivered to AI/AN veterans.

At [Your Program] we offer [services you provide]. With reimbursement under the VA-IHS MOU reimbursement agreement we could [expand services/hire additional staff/etc].  We hope you will become a cosponsor of the Health Care Access for Urban Native Veterans Act and show your support for the health of urban AI/AN Veterans.

For the sake of the health of American Indian and Alaska Native Veterans and the fulfillment of the U.S. trust obligation, we request your support of this simple language fix. To sign on, please contact Ms. Kim Moxley (Kim_Moxley@indian.senate.gov ) 202-224-2251 from Senator Udall’s office.

Sincerely, [Executive Director/CEO]

Press Release: Bipartisan, Bicameral Legislation Introduced to Improve Health Care Access for American Indian and Alaska Native Veterans in Urban Areas

Washington, DC (August 2, 2019) — Today, Senator Tom Udall (D-NM) and Representative Ro Khanna (D-Calif.) introduced the Health Care Access for Urban Native Veterans Act (S. 2365) which would improve health care access for American Indian and Alaska Native (AI/AN) veterans by providing Department of Veterans Affairs coverage for care that AI/AN vets receive from Title V Urban Indian Organizations (UIOs). The legislation allows AI/AN veterans better access to culturally-competent care and alleviates burdens on the VA system. In addition to Udall and Khanna, the bill is co-sponsored by U.S. Senators Jerry Moran (R-Kan.), Jon Tester (D-Mont.), ranking member of the Senate Committee on Veterans Affairs, Mike Rounds (R-S.D.), and Tina Smith (D-Minn.) and U.S. Representatives Paul Gosar (R-Ariz.), Ben Ray Luján (D-N.M.), Don Young (R-Alaska), Gwen Moore (D-Wis.), Paul Tonko (D-N.Y.), Greg Gianforte (R-Mont.), Don Bacon (R-Neb.), and Deb Haaland (D-N.M.).   

The National Congress of American Indians (NCAI) passed a resolution in July supporting this legislative fix to help UIOs have the resources to better serve AI/AN veterans. The bill is also supported by the Iraq and Afghanistan Veterans of America and VoteVets.

“The Health Care Access for Urban Native Veterans Act is important legislation to ensuring that our veterans in urban areas are no longer left behind. Now, the Department of Veterans Affairs will have the explicit authority to reimburse the 41 Title V Urban Indian Organizations who are already providing critical resources for American Indian and Alaska Native veterans who have served the United States,” said NCUIH Executive Director Francys Crevier.

“The National Council of Urban Indian Health has made it a priority to ensure that Urban Indian Organizations are included in the IHS-VA MOU to help provide health care to American Indian and Alaska Native veterans. As a Native veteran myself, I understand the importance of coming home and knowing I have a safe space to receive care. Thank you to my own Representative Ro Khanna,  and we are grateful for the leadership of the 116th Congress in introducing this landmark legislation,” said NCUIH Vice President Sonya Tetnowski.

“At First Nations Community HealthSource, we never turn anyone – veteran or not – away. Native veterans in Albuquerque consider our facility a safe, accessible space to receive health care. With critical underfunding, this legislation would allow all Urban Indian Organizations to finally be reimbursed for the necessary care we already provide to our Native veterans,” said Linda Son-Stone, NCUIH Secretary and Chief Executive Officer of First Nations Community HealthSource, an Urban Indian Organization and member of NCUIH.

The NCAI resolution states: “The National Congress of American Indians (NCAI) urges Congress to pass legislation that amends the Indian Health Care Improvement Act at 25 U.S.C. §1645(c) to insert UIOs after IHS and Tribal Organizations and require VA to reimburse for services provided to AI/AN veterans at all of the IHS, Tribal, and urban (I/T/U) system, in order to protect the health and welfare of AI/AN veterans living in urban centers, thereby honoring their sacrifices.”

Call to Action Toolkit: Health Care Access for Urban Native Veterans Act

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Call to Action: Ask Congress to Authorize the VA to Reimburse UIOs for Health Care

Representative Ro Khanna and Senator Tom Udall, vice chairman of the Senate Committee on Indian Affairs, introduced the Health Care Access for Urban Native Veterans Act, a bill to improve health care access for Native American Veterans by providing Department of Veterans Affairs (VA) coverage for care that Native American Veterans receive at urban Indian health centers.  This legislation would include “urban Indian organizations” in the statute requiring the VA to reimburse Indian Health Service (IHS) and Tribal health facilities for services they provide to native veterans. To ensure that the Health Care Access for Urban Native Veterans Act receives as much support as possible, we encourage you to contact your Member of Congress and request that they sign on as a cosponsor of this bill (if they have not already).

Write to Your House Member

Please use the following text below as a template to call or email to your Representatives. You should call and email your representative; you can find your representative here.

Dear Representative [ ],

As your constituent, I respectfully request you sign on as a cosponsor to the Health Care Access for Urban Native Veterans Act recently introduced by Representative Ro Khanna and Senator Udall.  This bill is a critical language fix that would include “urban Indian organizations” in the statute requiring the Department of Veterans Affairs (VA) to reimburse Indian Health Service (IHS) and Tribal health facilities for services they provide to native veterans.

Urban Indian Organizations (UIOs) are an integral part of the American Indian and Alaska Native (AI/AN) health care delivery system. However, due to an oversight in legislation UIOs are the only part of the IHS Indian/Tribal/Urban (I/T/U) system that do not receive reimbursement under the VA-IHS MOU reimbursement agreement. However, UIOs were created by Congress as a response to Tribes that wanted to ensure their members would receive quality health care off of reservations as part of the trust obligation.

The Department of Veterans Administration has stated that it cannot address the issue on its own, and that only Congress has the authority to correct this oversight. The Health Care Access for Urban Native Veterans Act of 2019 would ensure that all three branches of the I/T/U system receive reimbursement for health care services delivered to AI/AN veterans.  We hope you will become a cosponsor of the Health Care Access for Urban Native Veterans Act and show your support for the health of urban AI/AN Veterans.

For the sake of the health of American Indian and Alaska Native Veterans and the fulfillment of the U.S. trust obligation,  we request your support of this simple language fix. To sign on, please contact Mr. Will McKelvey (Will.Mckelvey@mail.house.gov ) 202-225-2631 from Congressman Ro Khanna’s office.

Sincerely, [Your Name and Address]

Write to Your Senator

Please use the following text below as a template to call or email to your Senators.  You can find your Senators here.

Dear Senator [ ],

As your constituent, I respectfully request you sign on as a cosponsor to the Health Care Access for Urban Native Veterans Act (S.2365) recently introduced by Senator Udall and Representative Ro Khanna.  This bill is a critical language fix that would include “urban Indian organizations” in the statute requiring the Department of Veterans Affairs (VA) to reimburse Indian Health Service (IHS) and Tribal health facilities for services they provide to native veterans.

Urban Indian Organizations (UIOs) are an integral part of the American Indian and Alaska Native (AI/AN) health care delivery system. However, due to an oversight in legislation UIOs are the only part of the IHS Indian/Tribal/Urban (I/T/U) system that do not receive reimbursement under the VA-IHS MOU reimbursement agreement. However, UIOs were created by Congress as a response to Tribes that wanted to ensure their members would receive quality health care off of reservations as part of the trust obligation.

The Department of Veterans Administration has stated that it cannot address the issue on its own, and that only Congress has the authority to correct this oversight. The Health Care Access for Urban Native Veterans Act of 2019 would ensure that all three branches of the I/T/U system receive reimbursement for health care services delivered to AI/AN veterans.

We hope you will become a cosponsor of the Health Care Access for Urban Native Veterans Act and show your support for the health of urban AI/AN Veterans.

For the sake of the health of American Indian and Alaska Native Veterans and the fulfillment of the U.S. trust obligation, we request your support of this simple language fix. To sign on, please contact Ms. Kim Moxley (Kim_Moxley@indian.senate.gov ) 202-224-2251 from Senator Udall’s office.

Sincerely, [Your Name and Address]

Social Media

Twitter

    • From your Twitter account, tweet to your Senators and Members of Congress.
      • Find your Senators’ handles here.
        • Example tweet: “Dear [@ Senator’s handle], please sign on to Health Care Access for Urban Native Veterans Act to support Native Veterans! #urbanIndianhealth @ncuih_official”
      • Find your Members of Congress here.
        • Example tweet: “Dear [@ Member’s handle], please sign on to Health Care Access for Urban Native Veterans Act to support Native Veterans! #urbanIndianhealth @ncuih_official”
    • Retweet

Facebook

Press Release: Bipartisan, Bicameral Legislation Introduced to Improve Health Care Access for American Indian and Alaska Native Veterans in Urban Areas

Washington, DC (August 2, 2019) — Today, Senator Tom Udall (D-NM) and Representative Ro Khanna (D-Calif.) introduced the Health Care Access for Urban Native Veterans Act (S. 2365) which would improve health care access for American Indian and Alaska Native (AI/AN) veterans by providing Department of Veterans Affairs coverage for care that AI/AN vets receive from Title V Urban Indian Organizations (UIOs). The legislation allows AI/AN veterans better access to culturally-competent care and alleviates burdens on the VA system. In addition to Udall and Khanna, the bill is co-sponsored by U.S. Senators Jerry Moran (R-Kan.), Jon Tester (D-Mont.), ranking member of the Senate Committee on Veterans Affairs, Mike Rounds (R-S.D.), and Tina Smith (D-Minn.) and U.S. Representatives Paul Gosar (R-Ariz.), Ben Ray Luján (D-N.M.), Don Young (R-Alaska), Gwen Moore (D-Wis.), Paul Tonko (D-N.Y.), Greg Gianforte (R-Mont.), Don Bacon (R-Neb.), and Deb Haaland (D-N.M.).   

The National Congress of American Indians (NCAI) passed a resolution in July supporting this legislative fix to help UIOs have the resources to better serve AI/AN veterans. The bill is also supported by the Iraq and Afghanistan Veterans of America and VoteVets.

“The Health Care Access for Urban Native Veterans Act is important legislation to ensuring that our veterans in urban areas are no longer left behind. Now, the Department of Veterans Affairs will have the explicit authority to reimburse the 41 Title V Urban Indian Organizations who are already providing critical resources for American Indian and Alaska Native veterans who have served the United States,” said NCUIH Executive Director Francys Crevier.

“The National Council of Urban Indian Health has made it a priority to ensure that Urban Indian Organizations are included in the IHS-VA MOU to help provide health care to American Indian and Alaska Native veterans. As a Native veteran myself, I understand the importance of coming home and knowing I have a safe space to receive care. Thank you to my own Representative Ro Khanna,  and we are grateful for the leadership of the 116th Congress in introducing this landmark legislation,” said NCUIH Vice President Sonya Tetnowski.

“At First Nations Community HealthSource, we never turn anyone – veteran or not – away. Native veterans in Albuquerque consider our facility a safe, accessible space to receive health care. With critical underfunding, this legislation would allow all Urban Indian Organizations to finally be reimbursed for the necessary care we already provide to our Native veterans,” said Linda Son-Stone, Chief Executive Officer of First Nations Community HealthSource, an Urban Indian Organization and member of NCUIH.

The NCAI resolution states: “The National Congress of American Indians (NCAI) urges Congress to pass legislation that amends the Indian Health Care Improvement Act at 25 U.S.C. §1645(c) to insert UIOs after IHS and Tribal Organizations and require VA to reimburse for services provided to AI/AN veterans at all of the IHS, Tribal, and urban (I/T/U) system, in order to protect the health and welfare of AI/AN veterans living in urban centers, thereby honoring their sacrifices.”

Call to Action Toolkit: Senate Appropriations Bill

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The National Council of Urban Indian Health is calling for the Senate to match the House mark of $81 million for the urban Indian health line item.

We ask that members of our community do the same by sending letters or calling their Senators to advocate for this important increase. Presently, the Indian Health Service (IHS) budget for urban Indian programs is less than 1% creating serious budget constraints for us to still provide culturally-competent and quality healthcare. An increase would provide 41 Urban Indian Organizations with critical funding that is long overdue.

Currently, the House bill that is moving to the floor for a vote has the $81 million line item for urban Indian health. The Senate has not published any of their funding bills for FY2020.

We have put together several ways you can advocate for this important funding.

NCUIH Outreach

  • Read our press release.
  • Read our letter to the Senate Appropriations Committee requesting to match the funding for the urban Indian health line item in the House Appropriations bill that recently passed out of the full Appropriations Committee.

Contact Your Senators with this Example E-mail/Letter

  • Find your senators here.
  • Write to your Senators using this sample letter.
  • Dear Senators [Senators from your state]:Last month the House Appropriations Committee approved the FY 2020 Interior, Environment, and Related Agencies appropriations bill that included an approximately $30 million increase – bringing funding to $81 million for Urban Indian programs. This needed increase would allow the 41 Urban Indian Organizations (UIOs) to hire more staff, expand vital services from behavioral health to substance misuse programs, and improve health outcomes for the growing demand of health care for urban Indians.Sincerely,
  • [First and Last Name, Address, City, State, Zip]
  • I hope you will urge the Senate Appropriations Committee to include the line item of $81 million for Urban Indian programs and show your support for the health of urban American Indian/Alaska Native (AI/AN) people.
  • As a constituent of [State] and a supporter of the National Council of Urban Indian Health, I humbly request that you honor the United States’ trust responsibility to urban Indians and support funding in the amount of $81 million for the urban Indian health line item.

Graphic

  • Download the graphic for your Facebook post or tweet.

Tweet

  • Write to your Senators on Twitter.
  • Find your Senators’ handles here.
  • Example tweet: “As a constituent, I urge [@ Senator’s handle] to please support the $81 million line item for urban Indian health in the Senate Appropriations Bill. #urbanIndianhealth @ncuih_official”

Facebook Post

  • Post your support on your Facebook.
  • Example post: “I just wrote to my Senators to include $81 million for urban Indian health. Show your support for this important increase by joining me! Find out how here: https://www.ncuih.org/policy_blog?article_id=259”

UIO Call to Action Toolkit: Urban Indian Health Funding

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This is a big deal! The inclusion of $81 million for the urban Indian health line item in the House budget is a huge step for our programs.

Next week, the House of Representatives will vote on the bill that includes the $81 million line item for urban Indian health. NCUIH supports the bill in its current form with the inclusion of this large increase and recommends Members of Congress vote YES.

We need your help to urge the Senate to do the same. If this nearly $30 million increase is in both bills and signed into law, all 41 Urban Indian Organizations (UIOs) would see a major increase in funding.

If the budget includes this $30 million increase for the urban Indian health line item, all 41 programs will see impacts. The inclusion of $81 million for the urban Indian health line item by the House is a huge step for our programs. We need your help to urge the Senate to do the same. If it is included in both bills and signed into law, the 41 Urban Indian Organizations (UIOs) would see a major increase in funding.

Currently, the House bill that is moving to the floor for a vote has the $81 million line item for urban Indian health. The Senate has not published any of their funding bills for FY2020.

NCUIH Outreach

  • Read our press release.
  • Read our letter to the Senate Appropriations Committee requesting to match the funding for the urban Indian health line item in the House Appropriations bill that recently passed out of the full Appropriations Committee.

Advocacy Toolkit

Here are several ways you can advocate for this important funding in an easy-to-use toolkit. Please share with your networks the opportunity to advocate for this funding increase, whether through a newsletter, blog post, social media, letters from your community, and/or a press release.

Please contact Meredith Raimondi (mraimondi@ncuih.org) with any questions.

Graphic

  • Download our graphic for inclusion in your newsletter/blog, Facebook post, tweet, etc.

Newsletter/Blog Entry

  • Below is a sample newsletter entry to include in your next newsletter or blog post.
  • Example Text:[Program Name] joins the National Council of Urban Indian Health in calling for the Senate to match the House budget of $81 million for the urban Indian health line item. We need members of our community also communicate this important message. Please send emails, letters or call Senators to advocate for this important increase. Presently, the Indian Health Service (IHS) budget for urban Indian programs, like ours, is less than 1%. This creates serious budget constraints to still provide culturally-competent and quality healthcare. An increase would provide [Program Name] with critical funding that is long overdue. Currently, the House bill is moving to the floor for a vote this week. The Senate has not published any of their funding bills for FY2020. Our Senators are [Senators for your state] and they can be reached here. Email your Senators using this sample letter.

Ask Your Community to Send E-mails and Letters to Your Senators and Members of Congress

Here is information that you can share with your community members for sending emails.

Letters to Senators

  • Find your Senators here.
  • Write to your Senators using this sample letter.

  • Dear Senators [Senators from your state]:

    As a constituent of [State] and a community member of [Your Program], I humbly request that you honor the United States’ trust responsibility to urban Indians and support funding in the amount of $81 million for the urban Indian health line item.

    Last month the House Appropriations Committee approved the FY 2020 Interior, Environment, and Related Agencies appropriations bill that included an approximately $30 million increase – bringing funding to $81 million for Urban Indian programs. This needed increase would allow the 41 Urban Indian Organizations (UIOs), including ours, to hire more staff, expand vital services from behavioral health to substance misuse programs, and improve health outcomes for the growing demand of health care for urban Indians.

    I hope you will urge the Senate Appropriations Committee to include the line item of $81 million for Urban Indian programs and show your support for the health of urban American Indian/Alaska Native (AI/AN) people.

    Sincerely,
    [First and Last Name, Address, City, State, Zip]

Letters to the House of Representatives

  • Find your Member of Congress here.
  • Write to your Members of Congress using this sample letter.

  • Dear [Member of Congress],

    As your constituent and a community member of [Your Program], I humbly request that you honor the United States’ trust responsibility to urban Indians and support funding in the amount of $81 million for the urban Indian health line item by voting YES on H.R. 3055.
    This needed increase would allow the 41 Urban Indian Organizations (UIOs), including ours, to hire more staff, expand vital services from behavioral health to substance misuse programs, and improve health outcomes for the growing demand of health care for urban Indians.

    I hope you will vote yes on H.R. 3055 to support the health of urban American Indian/Alaska Native (AI/AN) people with an increased budget of $81 million for urban Indian programs.  Thank you for your time and for your leadership.

    Sincerely,
    [First and Last Name, Address, City, State, Zip]

Twitter

  • From your program’s Twitter account, tweet to your Senators and Members of Congress.
    • Find your Senators’ handles here.
      • Example tweet: “We urge [@ Senator’s handle] to please support the $81 million line item for urban Indian health to help our program in [YOUR STATE] in the Senate Appropriations Bill. #urbanIndianhealth @ncuih_official”
    • Find your Members of Congress here.
      • Example tweet: “Please support #urbanIndianhealth by voting YES on H.R. 3055 [@ Member’s handle], which includes $81 million for urban Indian health to help our program. @ncuih_official”

Facebook

  • Post your support on your Facebook.
  • Example post: “We need you to help advocate Congress for an increase of nearly $30 million for urban Indian health. Show your support for this important increase that would help our funding! Find out how here: https://www.ncuih.org/policy_blog?article_id=259”

Press Release

  • Send a press release to your local media to let them know about your advocacy.
  • This is a big deal! If the budget includes this $30 million increase for the urban Indian health line item, all 41 programs will see impacts. Your local media should care about how this would improve your program’s ability to serve your community.
  • Example press release.

House Appropriations Approves Bill with Nearly $30 Million Increase for Urban Indian Health

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House Appropriations Full Committee Markup of Interior Bill Held on Wednesday, May 22, 2019

NCUIH supports the bill in its present form. 

Last week the House Appropriations full Committee passed their FY2020 Interior, Environment,and Related Agencies Appropriations bill – This bill includes $81 million for Urban Indian Health Programs, which is $29 million above FY 2019 enacted levels, and $32 million above the President’s budget request. This increase would assist urban Indian health programs in their continued efforts to provide high-quality, culturally-competent care.

The committee also released its report on the FY2020 spending package.  The 221-page report provides details on the bill the Subcommittee had previously passed earlier this month.

Please let your Member of Congress know that you support the bill’s inclusion of the $81 million line item for Urban Indian Health.

Read the Report

“NCUIH applauds the leadership of Chair Betty McCollum and her longstanding commitment to fulfilling the trust and treaty responsibilities of the US government with American Indians and Alaska Natives by investing in the Indian Health Service and urban Indian health programs. After years of stagnation and chronic underfunding to urban Indian health and the Indian Health Service (IHS) budget, NCUIH is hopeful that Chair McCollum’s bill requesting $6.3 billion for IHS, which is higher than the proposed budget by the President of $5.9 billion, and $81 million for urban Indian health will continue to move forward for consideration by the full House,” said NCUIH Executive Director Francys Crevier.

Please read full Press Release here.

Please find below a brief overview of some of the key programs included affecting AI/AN communities.

Topic/Program Amount Proposed Excerpt – Key Text to Be Aware of or Watch
Urban Indian Health $81,000,000 $1,429,000 for current services

$26,887,000 for direct patient care services/program adjustments

*Includes the proposed transfer of $1,369,000 from former NIAAAs from Alcohol and Substance Abuse line item to this line item

* “The Committee recognizes nonprofit organizations such as the Siouxland Human Investment Partnership that help American Indians in urban areas outside of the Urban Indian Health Program, and encourages the Service to offer technical assistance to such organizations whenever possible and within Service authority.”
Advance Appropriations N/A The Committee directs IHS to examine its existing processes and determine what changes are needed to develop and manage an advance appropriation and report to the Committee within 180 days of enactment of this Act on the processes needed and whether additional Congressional authority is required in order to develop the processes.
Domestic Violence Prevention Program $12,967,000 The recommendation includes $12,967,000, as requested, for Domestic Violence Prevention, $4,000,000 above the enacted level.
IHS-VA MOU N/A “The Committee is aware of the recent Government Accountability Office (GAO) report on the Memorandum of Understanding (MOU) between the VA and IHS. The Committee urges IHS to ensure performance measures related to the MOU are consistent with the key attributes of successful performance measures, including having measurable targets, as recommended by GAO.”

*Does not reference implementation for UIOs.
Alcohol and Substance Use $ 280,051,000

 

 $34,485,000 above the enacted level and $34,017,000 above the budget request.
Unfunded IHCIA Provisions N/A “The Committee requests that the Service provide, no later than 90 days after enactment, a detailed plan with specific dollars identified to fully fund and implement the IHCIA.”
Hepatitis C & HIV/AIDS Initiative $25,000,000 “for the Administration’s new Ending the HIV Epidemic: A Plan for America and Eliminating Hepatitis C in Indian Country initiative.”

*”The Committee encourages IHS to confer with Urban Indian Organizations (UIOs) to determine how UIOs may participate in this Initiative.”
Maternal and Child Health N/A “The Committee encourages IHS to establish a pilot program to determine the most effective ways to: (1) educate IHS health care providers on how to evaluate risk factors that could interfere with successfully meeting breastfeeding goals; (2) provide necessary support to AI/AN mothers to prevent or address delayed initiation of milk production during the critical period immediately following birth; and (3) provide support to AI/ AN mothers to help them understand the benefits of long-term breastfeeding and improve clinically recommended rates, particularly when they return to work. The Committee also directs IHS, where possible and within scope of agency authority, to encourage breastfeeding support recommendations within the workplace which encourage job retention.”
Electronic Health Records $25,000,000 To improve the current IT infrastructure system.

“The bill includes language prohibiting IHS from obligating or expending funds to select or implement a new IT infrastructure system unless IHS notifies the Committee at least 90 days before such funds are obligated or expended.” (also outlines requirements to include in the notification and requires IHS to look at the VA system to, among other things, determine if it is feasible for IHS and tribal facilities).

Legislation to Renew Special Diabetes Program for Indians (SDPI) Introduced in the House

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NCUIH urges support for H.R. 2680 and H.R. 2668. 

Representatives Tom O’Halleran (D-AZ) and Diana DeGette (D-CO) have introduced legislation requesting the renewal and increased funding of the Special Diabetes Program (SDP) and the Special Diabetes Program for Indians (SDPI).

  • Rep. DeGette’s bill, H.R. 2668 calls for the renewal of the SDP, including the research of Type-1 diabetes treatment.
  • Rep. O’Halleran’s bill, H.R. 2680 requests a long overdue funding increase for SDPI, authorizing a 5 year renewal at $200 million per year.  Increasing the funding from $150 million every year to $200 million every year, will ensure the continued work and success of the SDPI in the prevention and treatment of diabetes across Indian Country.

NCUIH has worked hard to make certain these bills had support in Congress and will continue support and work to ensure these bills pass – 376 out the 435 members of the House of Representatives signed a bipartisan letter of support. See the letter here.

For questions, comments or concerns, feel free to contact NCUIH Director of Congressional Relations Carla Lott, cmlott@ncuih.org.

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

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