NCUIH, NIHB, and NCAI Celebrate Historic Inclusion of Advance Appropriations for the Indian Health Service

FOR IMMEDIATE RELEASE

Washington, DC | Friday, December 23, 2022 – Today, Congress enacted a Fiscal Year (FY) 2023 omnibus spending package, including a historic provision providing advance appropriations for the Indian Health Service (IHS). Prior to this change, IHS was the only federal healthcare provider without basic certainty of funding from one year to the next.

The Indian health system serves approximately 2.5 million patients at IHS, Tribal facilities, and urban Indian organizations, and was created to meet the U.S. trust responsibility to raise the physical, mental, social, and spiritual health of all Native people to the highest standard. Unfortunately, Indian healthcare remains chronically underfunded – a U.S. policy exacerbated by disruptions in the discretionary appropriations process.

With advance appropriations, American Indians and Alaska Natives will no longer be uniquely at risk of death or serious harm during delays in an FY 2024 funding agreement. Inclusion of IHS advance appropriations in the spending bill means that IHS services will be protected from the harmful effects of disruptions in federal funding for FY 2024 because Congress has agreed to an amount this year that becomes available immediately on October 1, 2023.

“We applaud Congress and the White House for listening to Native communities and doing what is right. For far too long, the federal government has allowed political disputes over budgets to jeopardize the lives of American Indian and Alaska Native people. Every single time there is a stopgap budget, the funding for urban Indian health clinics is deferred and reduced. This compromises the delivery of health care. We look forward to working with our leaders to help the United States make good on its responsibility to provide health care for the people who gave up the land we are on today.” 

  • Sonya Tetnowski (Makah), President of the National Council of Urban Indian Health  

Including advance appropriations for Indian health in the omnibus is a historic moment for Indian Country over a decade in the making. While Indian health remains chronically underfunded, this provision will help ensure that the Indian Health Service can provide stable, uninterrupted care to our people even when there is a government shutdown. We are confident that we can build on this win and continue our work toward full and mandatory funding for the Indian Health Service, fulfilling the promises this country made to our people over two centuries ago.” 

  • William Smith (Valdez Native Tribe), President of the National Indian Health Board  

“The National Congress of American Indians (NCAI) in partnership with our invaluable allies at the National Indian Health Board (NIHB) and the National Council of Urban Indian Health (NCUIH) have fought for years to get advanced appropriations for the Indian Health Service (IHS) and commends Congress for taking this critically important step for Indian Country. This historic decision comes not a moment too soon as Indian Country continues to be plagued by an ongoing health crisis that affects all of our communities. This week’s action represents a meaningful step taken by the United States towards fulfilling its trust and treaty responsibilities to Tribal Nations and we are grateful for it as we continue to call on the United States to make good on all of its promises made to our ancestors so that our communities may continue to thrive.” 

  • Fawn Sharp (Quinault Indian Nation), President of the National Congress of American Indians 

This success would not have been possible without all the advocacy from Tribes, Tribal organizations, and Urban Indian Organizations. As part of this effort, the National Indian Health Board, the National Congress of American Indians, and the National Council of Urban Indian Health have been part of a broad coalition of advocates and champions for IHS advance appropriations. Our organizations would like to thank the coalition for its dedication and leadership during this endeavor.

We would like to also provide special thanks to Leader Schumer, Speaker Pelosi, and the Biden-Harris administration for championing this historic change, as well as House and Senate appropriators, the Senate Committee on Indian Affairs, the House Committee on Natural Resources, the House Native American Caucus, and all of Indian Country’s champions throughout Congress. Finally, we would like to thank Office of Management and Budget Director Shalanda Young, Department of Health and Human Services (HHS) Secretary Becerra, IHS Director Roselyn Tso, and all the OMB and HHS staff who worked tirelessly to realize this moment.

Together, we made history.

###

About The National Council of Urban Indian Health (https://ncuih.org/)
The National Council of Urban Indian Health (NCUIH) is the national non-profit organization devoted to the support and development of quality, accessible, and culturally competent health and public health services for American Indians and Alaska Natives (AI/ANs) living in urban areas. NCUIH is the only national representative of the 41 Title V Urban Indian Organizations (UIOs) under the Indian Health Service (IHS) in the Indian Health Care Improvement Act (IHCIA). NCUIH strives to improve the health of the over 70% of the AI/AN population that lives in urban areas, supported by quality, accessible health care centers. 
Media Contact: Meredith Raimondi, Vice President of Public Policy, MRaimondi@ncuih.org 

About the National Indian Health Board (https://www.nihb.org/)
Established by the Tribes to advocate as the united voice of federally recognized American Indian and Alaska Native Tribes, NIHB seeks to reinforce Tribal sovereignty, strengthen Tribal health systems, secure resources, and build capacity to achieve the highest level of health and well-being for our People. 
Media Contact: Janee Andrews, Communications Manager, JAndrews@nihb.org

About the National Congress of American Indians (https://www.ncai.org/)
Founded in 1944, the National Congress of American Indians is the oldest, largest and most representative American Indian and Alaska Native organization in the country. NCAI advocates on behalf of tribal governments and communities, promoting strong tribal-federal government-to-government policies, and promoting a better understanding among the general public regarding American Indian and Alaska Native governments, people and rights. For more information, visit www.ncai.org.
Media Contact: Yawna Allen, yallen@ncai.org

Congressional Hearing Showcases Urgency of Stabilizing Indian Health Service Funding for Native Veterans

Congressional leaders emphasized the need for the VA to follow through on their promises to Native Veterans and responded to the calls for stable funding for IHS.

NCUIH Contact: Meredith Raimondi, Vice President of Public Policy, mraimondi@ncuih.org

On November 30, 2022, Sonya Tetnowski, President of the National Council of Urban Indian Health (NCUIH) and CEO of the Indian Health Center of Clara Valley, Army Veteran, and citizen of the Makah Tribe testified before the Senate Committee on Veterans’ Affairs at a hearing titled “Native American Veterans: Ensuring Access to VA Health Care and Benefits.”

(Note: Ms. Tetnowski also serves as the Chair of the Health Subcommittee within the first-ever Department of Veterans Affairs (VA) Advisory Committee on Tribal and Indian Affairs, but testified in her capacity as NCUIH President and CEO of the Indian Health Center of Santa Clara Valley.)

Hearing Highlights Urgent Need for Advance Appropriations

In addition to Ms. Tetnowski, the Committee heard from the Indian Health Service (IHS) Director Roselyn Tso (Navajo), IHS Deputy Director Benjamin Smith (Navajo), Veterans Health Administration (VHA) Deputy to the Deputy Under Secretary for Health Mark Upton, VA Office of Tribal Government Relations Director Stephanie Birdwell (Cherokee Nation in Oklahoma), John Bell from Veterans Benefits Administration, Nickolaus Lewis (Lummi Nation) from the National Indian Health Board, Larry Wright, Jr. (Ponca Tribe of Nebraska) from the National Congress of American Indians (NCAI), and Leo Pollock (Blackfeet Nation) from the Blackfeet Veterans Alliance.

As negotiations for the end of the year are well underway, witnesses were united in their impassioned advocacy on behalf of Native veterans who receive health care from IHS and asking for advance appropriations for IHS. While there are many key issues facing Native veteran access to health care, it was evident how urgent stable funding for IHS is, as over half use the IHS, Tribal organization, and UIO (I/T/U) system for their care.

Ms. Tetnowski emphasized how securing advance appropriations for IHS is critical to improving the health of Native veterans since more than 50% of Native veterans use the I/T/U system for their health needs. “Gaps in federal funding put lives at risk. In fact, 5 [UIO] patients died during the last shutdown. The risk is too big and the price is too high for us to continue without advance appropriations,” said Ms. Tetnowski in her testimony, “During the last government shutdown, my clinic supported another Urban Indian program so they could remain open, this should not be happening to our patients and specifically our veterans.”

 Mr. Wright also mentioned the need for advance appropriations, stating that “Unlike the VA system, IHS continues to be subject to the harmful and disruptive effects of government shutdowns and short-term stopgap measures because it does not yet have advance appropriations. This is precisely why NCAI has long been in support of advance appropriation for IHS, and it is one step that can be taken immediately to help both Native veterans and Native communities more broadly.”

 Mr. Lewis echoed these sentiments, citing that, “In 2018, the Government Accountability Office reported how advanced appropriations have helped the VA. Our veterans are looking for that same help for IHS,” and urged the Committee to talk with the Appropriations Committee and those in leadership about including IHS advance appropriations in the final fiscal year 2023 spending bill.

 In his closing remarks, Ranking Member Jerry Moran highlighted a key takeaway that the “Indian Health Service has to be a consistent, constant provider open for business on an ongoing basis, based upon the reliance that Native Americans place in that service.”

The Indian health system is the only major federal provider of health care that is funded through annual appropriations. For example, the VHA receives most of its funding through advance appropriations, giving budget security for the agency and protecting the healthcare for veterans from government shutdowns and stopgap funding. Unfortunately, healthcare provided to Native people, including Native veterans, through IHS, Tribal facilities, or UIOs, is not similarly secure. Whenever there is a gap or disruption in IHS funding, either as a result of a shutdown or continuing resolution, Tribes and UIOs are often forced to reduce or sometimes even cease healthcare services entirely. For some Native veterans, a tribal or UIO facility is their only accessible provider of healthcare.

NCUIH thanks Chairman Tester, Ranking Member Moran, and the members of the Committee for the opportunity to testify and encourages Congress to continue to include urban Native veterans in the conversation of improving the quality of health care and services for Native veterans.

Additional Highlights

Native people have historically served in the U.S. military at a higher rate than any other population and in return for this service, the United States promises Native veterans, like all veterans, world-class benefits and services. However, Native veterans experience some of the worst health outcomes compared to other veterans and continue to experience significant barriers to accessing the benefits and services they earned through their military service.

NCUIH made the following recommendations during the hearing:

  • Improve access to care for Native veterans at their provider of choice within the Indian healthcare or veterans’ healthcare systems
  • Advance appropriations for the Indian Health Service
  • Increase outreach and technical assistance regarding the VA Reimbursement Program for UIOs
Native Veterans Utilize Indian Health Care Providers for Culturally Competent Care

Native veterans are entitled to receive healthcare through both the veterans’ healthcare system and the Indian healthcare system. Ms. Tetnowski stressed that “it is imperative that our physical, mental, and cultural needs are addressed in a culturally competent way […] we need the ability to go to a facility that understands, respects and recognizes our unique needs.” She noted that the majority of the Native veteran population lives in metropolitan areas, therefore it is important for the VHA to work with UIOs—a vital component of the I/T/U system—which provide these culturally competent services to Native veterans.

 Senator Moran raised that one challenge faced by AI/AN veterans is the distance to accessing healthcare, and sought input on what they can do to better utilize community care, telehealth, and other mechanisms to lessen that burden. Mr. Lewis responded that IHS facilities are the community care for Native veterans and “our veterans are saying they want to get their healthcare through our IHS facility instead of being forced to travel two hours to Seattle.” Ms. Tetnowski ensured that UIOs are considered in this conversation, noting that most of the urban clinics are placed in relocation sites and Native veterans in her community would rather be seen by her clinic as a Native provider. Mr. Wright agreed with her remarks and added that his Tribe, which was terminated in the 1960s and later reinstated without a reservation, has health clinics in the major cities in Nebraska and even when logistical barriers (scheduling, financial, travel, geography) are removed for Native veterans seeking care, “our veterans want to come to our [IHS] facility because of the cultural competency, care, and trust that they feel they have there.”

 Update on Native Copayment Implementation

In 2020, NCUIH worked with Chairman Tester and Ranking Member Moran on legislation meant to remove copayments for Native veterans receiving healthcare and extend this benefit to those who meet the statutory definition of the term ‘Indian’ or ‘Urban Indian’ set forth in the Indian Health Care Improvement Act. Unfortunately, the statute, which went into effect on January 5, 2022, is yet to be implemented. Senator Tester expressed his frustration to Mr. Upton that the VA hasn’t implemented the law to end copays for AI/AN healthcare at the VA, which “creates a disincentive for Native veterans to use the VA Healthcare facilities which is opposite of what should be occurring.” In September, VA Secretary Denis McDonough committed to putting this legislation into effect by the end of this year. Mr. Upton informed the Committee that the VA is looking into the ability to make the co-payment benefit retroactive, meaning that AI/AN veterans can be reimbursed for any co-pays they paid in 2022.

In a Federal Register notice concerning this issue, VA suggested that it is considering requiring Native veterans to show a Tribal identification card or a Certificate of Degree of Indian Blood (CDIB). Doing so would potentially exclude many eligible Native veterans and subvert Congress’ will to exempt all Native veterans meeting the definition of the term “Indian” or “Urban Indian” from VA copayments. For example, a Native veteran who is unhoused or low-income in an urban area may not have the ability to travel back to their Tribe to receive an identification card. That Native veteran might also have significant difficulty obtaining the required certified copy of a birth certificate needed to apply for a CDIB. In addition, in some cases, the Indian Health Care Improvement Act defines Indians and Urban Indians as descendants of Tribal citizens. Native veterans meeting that definition may not have the Tribal identification VA proposes to require. In her testimony, Ms. Tetnowski encouraged the VA to allow self-attestation in determining Native identity so that many Native veterans won’t be denied exemption from VA’s copayment rules.

Need for Increased Outreach and Technical Assistance for UIOs Regarding the VA Reimbursement Program

Thanks to NCUIH’s work with Congress on the passage of the Health Care Access for Urban Native Veterans Act of 2019 as part of the Consolidated Appropriations Act, 2021, UIOs are now eligible to enter the VA Reimbursement Agreements Program, which provides VA reimbursement to IHS, THP, and UIO health facilities for services provided to eligible AI/AN Veterans. Ms. Tetnowski called attention to the fact that, “many urban programs are experiencing difficulty enrolling, and only 1 of 41 completed the process” due to a lack of education and assistance for UIOs from the VA on this process. Ms. Tetnowski requested that the VA provide additional technical assistance and the ability to modify these agreements so that they work within the scope of services at their respective sites.

Need for an Urban Confer Policy with the VA

Urban Confer is an established mechanism for dialogue between federal agencies and UIOs. They are a response to decades of deliberate federal efforts (forced assimilation, termination, relocation) that have resulted in 70% of Native people living outside of Tribal jurisdictions. This has made Urban Confer integral to addressing the care needs of most Native people and is consistent with the federal government’s trust responsibility to AI/ANs. Failure to communicate about policies impacting urban Natives is not only inconsistent with the government’s trust responsibility, but it is contrary to sound public health policy. A VA Urban Confer Policy is especially important given that the majority of Native veterans live in urban areas. In her testimony, Ms. Tetnowski recalled when better communication was needed between the VA and UIOs during the rollout of COVID-19 vaccines, specifically with urban programs in Montana that didn’t receive as much of a supply, Some veterans who went to the VA to receive vaccines were told to go back to the ‘Indian clinic.’ This highlights the need for greater coordination among all entities serving our Native veterans.”

In June, the Health Equity and Accountability Act was introduced with the first-ever legislative text establishing an urban confer policy with the VA. Ms. Tetnowski went on to urge the Committee to include that language in future packages related to Native health care.

Next Steps:

The testimony will be read and considered by the Committee as it makes recommendations to the VA.

2022-2023 National Urban Indian Youth Advisory Council Members Announced

FOR IMMEDIATE RELEASE

Media Contact:
National Council of Urban Indian Health
Carla Vigue, Director of Communications, Events, and Community Engagement
CVigue@ncuih.org
202-753-8310

Washington, D.C. (October 11, 2022) – The National Council of Urban Indian Health (NCUIH) proudly announces the 2022 cohort of National Urban Indian Youth and Young Adult Advisory Council Members (Youth Council). The 2022 – 2023 class of NCUIH Youth Council members are: Elinor Ascher (Muscogee Creek), Ella Weber (Three Affiliated Tribes), Gianni Lacey-Howard (Occaneechi Band of the Saponi Nation), Jada Allen (Lumbee Tribe of North Carolina), and Lauren Wendelle Yowelunh McLester-Davis (Oneida Nation of Wisconsin).

Meet the 2021-2022 Youth Council

Headshot of Elinor Ascher Headshot of Ella Weber Headshot of Gianni Lacey-Howard Headshot of Jada Allen Headshot of Lauren W. Yowelunh McLester-Davis
Elinor Ascher
Muscogee Creek
Sioux Falls, SD
Ella Weber 
Three Affiliated Tribes
Crookston, MN
Gianni Lacey-Howard
Occaneechi Band of the Saponi Nation
Billings, MT
 Jada Allen

Lumbee Tribe of North Carolina
Lumberton, NC

Lauren Wendelle Yowelunh McLester- Davis

Oneida Nation of Wisconsin
New Orleans, LA

About the Youth Council

The NCUIH Youth Council (Youth Council) was created to uplift our Native youth and young adults and make sure they have a seat at the table to advocate for better access to prevention and recovery services to address the challenges facing American Indian and Alaska Natives living in urban areas. The Youth Council consists of 5 young adults, between the ages of 18 to 24, who will be working over a 12-month period to advance prevention and awareness of youth suicide, substance misuse, and mental health challenges faced by urban American Indian and Alaska Native (AI/AN) youth and young adults. Since 2018, the NCUIH partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA) has created opportunities for Native young adults to share, learn, and advocate for initiatives to address suicide and substance misuse in AI/AN communities, while providing a leadership experience to assist and support their professional development.

Learn more about the Youth Council here or contact Molly Siegal, at msiegel@ncuih.org.

###

About NCUIH

The National Council of Urban Indian Health (NCUIH) is the national non-profit organization devoted to the support and development of quality, accessible, and culturally competent health and public health services for American Indians and Alaska Natives (AI/ANs) living in urban areas. NCUIH is the only national representative of the 41 Title V Urban Indian Organizations (UIOs) under the Indian Health Service (IHS) in the Indian Health Care Improvement Act (IHCIA). NCUIH strives to improve the health of the over 70% of the AI/AN population that lives in urban areas, supported by quality, accessible health care centers.

Tune in TODAY: Urban Indian Leader to Speak at White House Conference on Hunger, Nutrition, and Health

Walter Murillo (Choctaw), NCUIH President-Elect and CEO of NATIVE Health, will speak on addressing barriers to access for nutrition and health services for the urban Indian community.

FOR IMMEDIATE RELEASE

NCUIH Contact: Meredith Raimondi, Vice-President of Public Policy, mraimondi@ncuih.org, 202-417-7781

Headshot of Walter MurilloWASHINGTON, D.C. (September 28, 2022) – Today, the Biden-Harris Administration is hosting the White House Conference on Hunger, Nutrition, and Health. Walter Murillo (Choctaw), the National Council of Urban Indian Health (NCUIH) President-Elect and CEO of NATIVE Health in Phoenix will be speaking on the National Strategy Pillar Panel Session, Breaking Barriers: Bridging the gap between nutrition and health, at 12:10 p.m. EST. He will bring the voice of urban American Indians and Alaska Natives (AI/ANs) into the important conversation of food insecurity and nutritional barriers, which Native communities disproportionately experience.

Click here to watch the Conference live: https://www.youtube.com/watch?v=U1_iLHCOAeY

 

Background

It’s been more than 50 years since the first and only White House Conference on Food, Nutrition, and Health was held in 1969. At today’s Conference, the Administration will announce a National Strategy that identifies steps the government will take and catalyzes the public and private sectors to address the intersections between food, hunger, nutrition, and health. The Administration sought input on the development and implementation of this national strategy and initiated Tribal Consultation on June 28, 2022.  On July 15, 2022, NCUIH submitted comments to the Administration, the Department of Health and Human Services (HHS), and the US Department of Agriculture (USDA) and recommended that they support urban Indian organizations (UIOs) to promote food security, nutrition, and exercise; include urban AI/AN populations in future research efforts and government projects; and establish consistent Urban Confers regarding nutrition, hunger, and health.

AI/AN people face high levels of food insecurity and diseases related to lack of access to healthy foods, including diabetes and heart disease. Social determinants such as forced relocation, low socioeconomic status, and historical trauma have a significant impact on nutritional health among the population. Furthermore, AI/AN people who live in urban settings are especially likely to experience food insecurity. According to a 2017 report published in the Journal of Hunger & Environmental Nutrition, “[u]rban AI/ANs were more likely to experience food insecurity than rural AI/ANs.” The high rates of food insecurity in urban AI/AN communities are likely a result of “AI/ANs living on reservations… [having] access to tribally provided food and health care resource services that may not be accessible to AI/ANs living in urban areas.” This issue in AI/AN communities has only been exasperated by the COVID-19 pandemic, as isolation and economic hardship increased the barrier to nutritional food access.

UIOs provide different food programs and other nutrition services for urban AI/AN to address this ongoing challenge. NATIVE Health, a UIO in Phoenix, Arizona, provides a variety of food programs to address food insecurity. These programs include:

  • Free, daily food distribution to any needy individual.
  • Weekly backpacks of food for families with children.
  • Commodity Supplemental Food Program or Senior Food Box program.
  • Fresh meals for COVID-impacted families.
  • Kid’s Cafe meals for children under 18.
  • Ready to eat meals and fresh produce bags as available at NATIVE HEALTH Central and NATIVE HEALTH Mesa.
  • Weekly food bags for NATIVE HEALTH employees.
  • Traditional garden for community members.
  • Read it and Eat program that introduces families to healthy, affordable, easy cooking lessons. This program transitioned to an online model since the COVID-19 pandemic.

About NCUIH 
The National Council of Urban Indian Health (NCUIH) is the national non-profit organization devoted to the support and development of quality, accessible, and culturally competent health and public health services for American Indians and Alaska Natives (AI/ANs) living in urban areas. NCUIH is the only national representative of the 41 Title V Urban Indian Organizations (UIOs) under the Indian Health Service (IHS) in the Indian Health Care Improvement Act (IHCIA). NCUIH strives to improve the health of the over 70% of the AI/AN population that lives in urban areas, supported by quality, accessible health care centers.

###

OMB Creates a Tribal Policy Advisor Position After NCUIH and Tribal Leader Advocacy

NCUIH and Tribal leaders have advocated for a direct position between Indian Country and OMB to better coordinate communication of AI/AN needs.

FOR IMMEDIATE RELEASE

NCUIH Contact: Meredith Raimondi, Vice President of Public Policy, mraimondi@ncuih.org

WASHINGTON, D.C. (Sept. 12, 2022) – After recommendations from the National Council of Urban Indian Health (NCUIH) and Tribal leaders, the Office of Management and Budget (OMB) has created a permanent position of a Tribal Policy Advisor within their Office to communicate the needs of Indian Country and American Indians/Alaska Natives (AI/ANs). NCUIH and urban Indian leaders have a long-standing history of working with Elizabeth Carr, member of the Sault Ste. Marie Tribe of Chippewa Indians and Senior Advisor to the Director of the Indian Health Service (IHS), and we look forward to lifting up urban Indian voices through her work in this position.

“The President has shown a strong commitment to addressing the needs of Indian Country and urban Indians and we fully support OMB’s creation of a Tribal Liaison role within their Office. We applaud the Administration for this initiative and we look forward to creating equity and parity in American Indian and Alaska Native health. NCUIH looks forward to collaborating with OMB on longstanding issues impacting access to health care for urban Native communities including providing continuity of funding during continuing resolutions and shutdowns, which have needlessly cost Native lives,” – Francys Crevier (Algonquin), CEO of NCUIH.

Background

NCUIH and Tribal leaders have advocated for a permanent position within OMB dedicated to AI/AN health care, a liaison between Indian Country and OMB, and/or an Office of Tribal Affairs within OMB through Tribal consultation and written comments. NCUIH has stressed the importance of urban Indian organization (UIO) consultation and involvement in the establishment of any new position or office within the OMB that directly relates to AI/AN healthcare, and we hope that UIOs who have been negatively impacted by budgetary disputes and historically excluded from exception apportionment will be included in the conversation. With the devastating impact of the COVID-19 pandemic ongoing, it is imperative that OMB fully engage with Indian Country to finally honor federal trust obligations that have long been ignored.

About NCUIH

The National Council of Urban Indian Health (NCUIH) is the national non-profit organization devoted to the support and development of quality, accessible, and culturally competent health and public health services for American Indians and Alaska Natives (AI/ANs) living in urban areas. NCUIH is the only national representative of the 41 Title V Urban Indian Organizations (UIOs) under the Indian Health Service (IHS) in the Indian Health Care Improvement Act (IHCIA). NCUIH strives to improve the health of the over 70% of the AI/AN population that lives in urban areas, supported by quality, accessible health care centers.

###

Bipartisan Support for Urban Confer at Senate Hearing

FOR IMMEDIATE RELEASE
NCUIH Contact: Meredith Raimondi, Vice President of Public Policy, mraimondi@ncuih.org, 202-417-7781

The Administration and Congress emphasized the importance of urban confer legislation on issues such as COVID-19 vaccine distribution and Medicaid reimbursement in this week’s Senate hearing.

WASHINGTON, D.C. (July 25, 2022) – On July 20, 2022 the National Council of Urban Indian Health (NCUIH) testified before the Senate Committee on Indian Affairs (SCIA) in support of the Urban Indian Health Confer Act (H.R. 5221). Dr. Patrick Rock (Leech Lake Band of Ojibwe), Chief Executive Officer at the Indian Health Board of Minneapolis and NCUIH member, explained how this bipartisan, bicameral legislation would enable Urban Indian Organizations (UIOs) to engage in urban confer with all divisions within the Department of Health and Human Services (HHS) so that American Indians/Alaska Natives (AI/ANs) living in urban areas are made aware of major healthcare policies that affect them. Deputy Director of the Indian Health Service (IHS), Benjamin Smith, also testified on this critical legislation.

Testimony Highlights

Lack of Urban Confer Affects COVID-19 Vaccine Rollout and 100% FMAP Implementation for UIOs

In his testimony, Dr. Rock stressed how the lack of Urban Confer has enabled HHS and agencies outside of IHS to disregard the needs of urban Indians and neglect the federal obligation to provide healthcare to all AI/ANs, “Through the Indian Health Care Improvement Act, the Indian Health Service has a legal obligation to confer with UIOs, which is an essential tool used to ensure access to health services for Native people. Unfortunately, HHS has interpreted it to mean that only IHS has the requirement to confer with UIOs. It is crucial to patient care that HHS and ALL agencies it operates establish a formal confer process.”

To define the severity of this issue, he explained how communication issues between HHS and UIOs surrounding the initial COVID-19 vaccine rollout in December of 2020 created unnecessary hardships, resulting in many clinics experiencing serious delays in vaccine distribution. This had dire consequences, as the pandemic took the lives of AI/ANs at the highest rates of any population. Dr. Rock continued to explain how urban confer would also help with the implementation of the American Rescue Plan Act (ARPA) provision that provides 100% Federal Medical Assistance Percentage (FMAP) for services provided to Medicaid beneficiaries at UIOs for two years. Congress authorized this with the intent to increase financial resources for UIOs, however, UIOs are still not receiving any financial benefit from 100% FMAP and do not have a policy to confer with the Centers for Medicare and Medicaid Services (CMS) on this issue. In response to Senator Tina Smith’s (D-MN) concerns about this ARPA provision that Congress worked hard to get for UIOs and how urban confer may have alleviated this issue, Dr. Rock noted that, “Unfortunately, we have yet to see really any type of activity or actual reimbursement occur, utilizing the 100% FMAP through the federal system, which is extremely, extremely disappointing. We continue to seek out solutions moving forward. I think we’re going to need to help with our state partners as well as our federal partners including CMS. This would be an important point to have access to and conferring with CMS.” He highlighted that “an urban confer policy across HHS agencies, including CMS, would be instrumental in ensuring that obstacles relating to programs and benefits that directly affect UIOs are addressed quickly so UIOs are better equipped to provide healthcare to their patients.

Dr. Rock emphasized that H.R. 5221 remedies such problems and codifies a proper Urban Confer policy, thus ensuring that AI/AN lives are no longer jeopardized by the lack of adequate communication pathways between HHS agencies and UIOs. To conclude, Dr. Rock stated that H.R. 5221 is an essential parity issue for UIOs that ensures that AI/ANs residing in urban areas continue to have access to high quality, culturally competent health services. He urged SCIA to move forward with this necessary legislation to further improve healthcare delivered to urban Indian patients.

Administration Emphasizes the Importance of Urban Indian Inclusion in Federal Communication

The Administration highlighted that urban AI/AN communities are affected by the absence of an urban confer policy and that UIOs have been persistent in their advocacy to establish a confer process across all of HHS. During the hearing, IHS Deputy Director Benjamin Smith said, “IHS has consistently heard from UIOs through the confer process they would like the opportunity to confer with other HHS operating divisions and staff offices. They have also expressed that the need to confer with other HHS agencies is even more critical due to the pandemic and need for interagency collaboration.” In addition, he said that “the IHS confer process works to ensure that health care priorities for urban Indian populations are being heard and addressed at the local, area, and national levels.”

During questioning, Deputy Director Smith stressed the impact that IHS’ urban confer policy has on UIOs and urban Indians, such as COVID funding decisions, “Throughout the pandemic, Congress provided several supplemental packages that required funding decisions that had a huge impact on urban Indian organizations. We engaged in our policy in invoking our policy to confer with urban Indian organizations to solicit their input prior to making those funding decisions. And we believe that that did have an impact on the manner in which we made those decisions.”

Bipartisan Support from SCIA Members

H.R. 5221 has generated support from Members of Congress on both sides of the aisle. In Senator Smith’s opening remarks and introduction of Dr. Rock, she expressed support for this legislation, which was also introduced by her and Senator James Lankford (R-OK) in the Senate this past May, “This measure is an important step towards parity for urban Native communities and something that I think we should all be able to agree on. I look forward to working with the committee to get this bill across the finish line this year.” Later in her questioning about the urban confer bill, Senator Smith emphasized that “If there had been good consultation across all Department of Health and Human Services, that I think would have been easier to resolve on issues of data sharing, 100% FMAP, I would say also federally qualified health center issues, all of those would be easier to resolve if we had the kind of consultation that our bill would require.”

Senator James Lankford (R-OK) highlighted two UIO leaders from his state on their work towards bettering AI/AN health, “Leaders like Robyn Sunday-Allen and Carmelita Skeeter in Tulsa and in Oklahoma City, they’re the reason that all this works so well. They work incredibly hard and they’re absolutely the gold standard for health care in clinic operations” and went on to express his support for urban confer, “I’m proud to be able to co-sponsor with Senator Smith, the Senate companion Urban Indian Health Confer Act. This simple legislation will ensure that UIOs are brought into important conversations and confer with HHS. We talk a lot about consultation with Tribes. But currently, HHS is not doing consultation with urban Indian clinics and that needs to start.”

Background

An Urban Confer is an established mechanism for dialogue between federal agencies and UIOs. Urban confer policies are a response to decades of deliberate federal efforts (i.e., forced assimilation, termination, relocation) that have resulted in 70% of AI/AN people living outside of Tribal jurisdictions, thus making Urban Confer integral to address the care needs of most AI/AN persons. NCUIH has long advocated for the importance of facilitating confer between numerous federal branches within HHS and UIO stakeholders without any resolve. Currently, only IHS has a legal obligation to confer with UIOs. It is important to note that urban confer policies do not supplant or otherwise impact Tribal consultation and the government-to-government relationship between Tribes and federal agencies.

The Urban Indian Health Confer Act (H.R. 5221/S.4323) will ensure the many branches and divisions within HHS and all agencies under its purview establish a formal confer process to dialogue with UIOs on policies that impact them and their AI/AN patients living in urban centers. This bill was first introduced on September 10, 2021, by Rep. Raúl Grijalva (D-AZ-3), Rep. Betty McCollum (D-MN), Rep. Tom Cole (R-OK), Rep. Karen Bass (D-CA), Rep. Eleanor Holmes Norton (D-DC), and the late Rep. Don Young (R-AK). On October 5, 2021, Walter Murillo (Choctaw Nation of Oklahoma), NCUIH President-elect and Chief Executive Officer of NATIVE HEALTH in Phoenix, Arizona, testified before the House Subcommittee for Indigenous Peoples of the United States in support of H.R. 5221 and on November 2, 2021, this legislation passed in the House by an overwhelming majority of 406 votes. An identical bipartisan bill was also introduced in the Senate on May 26, 2022, by Sen. Tina Smith (D-MN) and Sen. James Lankford (R-OK), S. 4323.

Next Steps

NCUIH will advocate for a swift markup in the Senate on this bill. In addition, NCUIH continues to advocate for an established confer policy between all HHS agencies and UIOs to improve the delivery of health services to all AI/ANs living in urban settings.

PRESS RELEASE:NCUIH Honors 2022 Urban Indian Health Champions

Yesterday, NCUIH celebrated 2022 honorees: Libby Washburn, Senators Padilla and Moran, along with Representatives Leger Fernandez and Joyce.

FOR IMMEDIATE RELEASE

WASHINGTON, D.C. (May 25, 2022) – On May 24, 2022, the National Council of Urban Indian Health (NCUIH) awarded four Congressional Urban Indian Health Champion Awards and one Award for Advocacy and Leadership in Urban Indian Health during its 2022 Annual Conference: No More Broken Promises: A Path to Health Equity in Indian Country. The Congressional Urban Indian Health Champion Awards were given to four members of Congress for their outstanding advocacy on behalf of urban Indian health: Senator Alex Padilla (D-CA), Senator Jerry Moran (R-KS), Representative Teresa Leger Fernandez (D-NM-03), and Representative David Joyce (R-OH-14). Libby Washburn (Chickasaw Nation of Oklahoma), the former Special Assistant to the President for Native Affairs, was awarded the Advocacy and Leadership in Urban Indian Health award. Last year, NCUIH recognized Senator James Lankford (R-OK), Senator Tina Smith (D-MN), the late Representative Don Young (R-AK-AL), and Representative Ruben Gallego (D-AZ-7) as the 2021 Urban Indian Health Congressional Champions.

NCUIH thanks the awardees for their dedication to upholding the federal trust and treaty obligation to provide the highest level of health to all American Indians/Alaska Natives.

“California is home to more urban Indian civic, service, and advocacy organizations than any other state in the nation serving more than 450,000 individuals, and I am proud to advocate for greater federal support of urban Indian health and autonomy […] The federal government must honor our country’s responsibility to Tribal Nations and urban Indians in all our policy decisions. Urban Indian organizations are a lifeline to Native Americans living in urban areas across California and across the nation and yet too many facilities are aging and underfunded,” said Senator Padilla.

“We know that there are more Native Americans living off our Tribal lands than on, and we know that the United States trust duty to provide quality healthcare does not stop when you move into a city or town. We also know that too often the urban Indian health centers are overlooked and underfunded,” said Representative Leger Fernandez in her remarks.

“I recognize that upholding the Tribal trust obligation is a responsibility shared by all members of Congress regardless of the congressional districts we represent. This trust obligation is not optional. The federal government’s push to relocate Native peoples off the reservations and into cities like Cleveland with the promise of job training and other services during the Termination Era had a profound impact on the lives of individuals, families, and Tribes. When those promises, like so many others, went unfulfilled, the right thing to do was, and still is, to provide culturally responsive healthcare access for urban Indians,” said Congressman Dave Joyce.

Award for Advocacy and Leadership in Urban Indian Health

Libby Washburn

During her time as the Special Assistant to the President on Native Affairs, Libby was a strong advocate for Indian Country including urban Indian communities. Her advocacy and leadership were responsible for the inclusion of urban Indian organizations in Executive Order 14053 which addresses the crisis of Missing or Murdered Indigenous People. Libby was also influential in including urban Native Americans in the Biden-Harris Plan for Tribal Nations and played a significant role in the development of the first-ever mandatory funding proposal for IHS that was released as part of the President’s FY 2023 budget.

Urban Indian Health Congressional Champions

Senator Alex Padilla

California is home to 10 urban Indian organizations (UIOs) with a service population of 450,000 AI/ANs. Sen. Padilla has made it a priority to ensure that these communities are provided with the resources and care needed. He introduced the bipartisan Urban Indian Health Providers Facilities Improvement Act to pave the way for increased investment in the renovation and construction of urban Indian health facilities. The Bipartisan Infrastructure Framework included the Padilla–Moran–Lankford Amendment to allow UIOs to make their facilities more COVID-19 compliant and safer by fixing a technicality that prevented clinics from using their federal funding to make renovations.

Sen. Padilla and 13 other senators sent a letter to the Biden Administration requesting the establishment of an Urban Indian Interagency Work Group to identify the needs and develop strategies to better serve urban AI/AN populations. He sent a letter to the Senate Committee on Finance urging for inclusion of permanent 100% Federal Medical Assistance Percentage (FMAP) reimbursement for UIOs and Native Hawaiian Health Care Systems in the reconciliation bill. Recently, he joined Senator Smith’s letter to the appropriations committee to request full funding for the urban Indian health line item in FY23. NCUIH is forever grateful for his commitment to helping us achieve crucial goals through his bipartisan leadership to ensure that UIOs are funded equitably and that urban AI/AN values are upheld.

Senator Jerry Moran

Senator Moran has advocated for the health of all AI/ANs and was an original cosponsor of the Urban Indian Health Facilities Provider Act. On April 9, 2021, Senator Moran arranged the first-ever visit of a U.S. Secretary of Veterans Affairs (VA), Denis McDonough, to a UIO at Hunter Health Clinic in Kansas as a part of a renewed partnership between the VA and UIOs and was instrumental in the enactment of the VA-IHS MOU legislative fix to allow UIOs to be reimbursed for services provided to veterans.

He also introduced the now-enacted Native American Veterans PACT Act to exempt Native veterans from copayments and co-sponsored the Improving Trauma Systems and Emergency Care Act – which included UIOs as eligible entities.

Senator Moran has taken many actions throughout his career on behalf of AI/AN people and we are grateful for his service.

Representative Teresa Leger Fernandez

From the time that Representative Leger Fernandez entered congress, she has been a fierce advocate for our AI/AN communities. As the Chair of the Subcommittee for Indigenous Peoples of the United States, she has been an influential voice on legislation impacting Indian Country. She was also a co-sponsor of the Urban Indian Health Confer Act and the NCUIH-endorsed Truth and Healing Commission on Indian Boarding School Policies Act and was a signee of the Gallego Grijalva letter to the appropriations committee to request full funding for the urban Indian health line item. Representative Leger Fernandez forties leadership that cares and expresses the values of human dignity.

Representative David Joyce

Representative Joyce has been a strong advocate in upholding the federal treaty and trust obligations to Indian Country. His commitment to urban Indians is most prevalent in his legislation as co-sponsor of the Urban Indian Health Confer Act, co-sponsor of the Stronger Engagement for Indian Health Needs Act which elevates the IHS director to an assistant secretary, and his leadership as the Ranking Member of the House Appropriations Committee’s Subcommittee on Interior, Environment, and Related Agencies which passed the Tribal Budget Formulation Workgroup recommendation of $200.5 million of urban Indian health for the FY22 bill. We are humbled by his generosity of spirit and compassion for his fellow human beings.

Honoring Congressman Don Young

NCUIH also honored the late Representative Don Young, who previously received NCUIH’s 2021 Urban Indian Health Congressional Champion Award. As the longest-serving member of Congress, Rep. Young was a long-time ally of all Native people and tirelessly worked on critical issues affecting Indian Country throughout his incumbency. His leadership on the Subcommittee for Indigenous People was unwavering when it came to upholding the federal treaty and trust obligations and its extension to urban Indians. He championed programs such as the Special Diabetes Program for Indians (SDPI) and led efforts to amend the Violence Against Women Act (VAWA) to criminally prosecute offenders on Native lands, among countless other efforts for the betterment of Indian Country. His fierce leadership, voice, and dedication to upholding the trust responsibility to all Native people will truly be missed and remembered.

NCUIH Contact: Meredith Raimondi, Vice President of Public Policymraimondi@ncuih.org

NCUIH President Elect Sonya Tetnowski Named to the Not Invisible Commission

The Administration has demonstrated a strong commitment to including urban Native communities in efforts to end the crisis of Missing and Murdered Indigenous Persons.

FOR IMMEDIATE RELEASE

NCUIH Contact: Carla Vigue, Director of Communications, Events, and Community Engagement, cvigue@ncuih.org

WASHINGTON, D.C. (May 5, 2022) – Today, May 5, National Missing and Murdered Indigenous Persons (MMIP) Awareness Day, Secretary of the Interior Deb Haaland and Deputy Attorney General Lisa Monaco hosted an event to announce the U.S. Department of the Interior (DOI)’s Not Invisible Act Commission (Commission). The Commission is led by the Departments of the Interior and Justice and is aimed at reducing violent crime against American Indians and Alaska Natives. Members of the Commission include Sonya Tetnowski (Makah), the National Council of Urban Indian Health’s President-Elect and the Chief Executive Officer of the Indian Health Center of Santa Clara Valley. NCUIH supported the nomination of Ms. Tetnonwski who also serves on the U.S. Department of Veterans Affairs (VA) Advisory Committee on Tribal and Indian Affairs.

“I am honored and proud to be appointed to the Not Invisible Act Commission. In this role, I will work hard to shed light on the devastating impact of violence against American Indians and Alaska Natives (AI/ANs) living in urban areas. Thank you to Secretary Haaland and Deputy Attorney General Lisa Monaco for this tremendous opportunity to represent American Indians and Alaska Natives who reside in urban areas,” said Commission Member Sonya Tetnowski.

“On behalf of all the brothers and sisters we have lost to the horrible epidemic of violence, I am encouraged by this Administration’s commitment to ensuring that urban Native people are no longer left out of efforts to find solutions to end this crisis. From the President’s Executive Order on MMIP to Secretary Haaland’s work on this Commission, we are grateful that our leaders are listening and focusing on Indigenous-led conversations that include urban Native voices like Ms. Tetnowski. We look forward to the day when we no longer fear for the safety of our relatives,” said Francys Crevier (Algonquin), CEO, NCUIH.

About the Not Invisible Act and the Administration’s Work to Include Urban Natives on MMIP Efforts

NCUIH worked closely with Congress on the Not Invisible Act, which was enacted in October 2020. The Act calls for the Interior Department to coordinate prevention efforts, grants, and programs related to missing and murdered Indigenous peoples. Secretary Haaland was the lead sponsor of the Not Invisible Act when she served in Congress. The bill was passed unanimously by voice vote in both chambers of Congress. The Act also established the Commission. Earlier this week, DOJ announced the creation of a Missing or Murdered Indigenous Persons Webpage (https://www.justice.gov/tribal/mmip).

On November 15, 2021, President Biden signed Executive Order 14053 (E.O.) on Improving Public Safety and Criminal Justice for Native Americans and Addressing the Crisis of Missing and Murdered Indigenous People (MMIP) during the White House Tribal Nations Summit. The E.O. states, “Given that approximately 70 percent of American Indian and Alaska Natives live in urban areas and part of this epidemic of violence is against Native American people in urban areas, we must continue that work on Tribal lands but also build on existing strategies to identify solutions directed toward the particular needs of urban Native Americans.”

About Commission Member Tetnowski

The following was included in a nomination letter prepared by NCUIH in support of Ms. Tetnowski:

Ms. Tetnowski will bring a deep understanding of the impact of violence on the health of American Indians and Alaska Natives (AI/ANs) living in urban areas to the Commission. As a board member of both NCUIH and CCUIH, Ms. Tetnowski is a leader in the provision of health and wellness services to AI/ANs living in urban areas. Violence is a key public health issue and is considered a social determinant of health (SDOH) and both NCUIH and CCUIH are committed to the reduction of violence of AI/ANs. Furthermore, as Chief Executive Officer of the Indian Health Center of Santa Clara Valley, Ms. Tetnowski has first-hand experience with the provision of health and wellness services to crime victims.

Ms. Tetnowski’s commitment to serving victims of violent crime is evidenced by her work supporting the Red Women Rising Project. The Red Women Rising Project works to uplift the voices of urban AI/AN survivors of domestic violence and sexual assault. It does so through increasing awareness around urban AI/AN women’s domestic violence issues and enhancing survivors’ access to domestic violence services. The Red Women Rising Project was formed as a direct result of the gap in resources and culturally relevant services dedicated to serving the needs of the majority of American Indian women created by the Tribal Law and Order Act of 2010 and the of the Violence Against Women Act’s lack of focus and resources for AI/AN women living in urban areas. As a member of the Commission, Ms. Tetnowski will bring key knowledge and experience about the impact of violent crime against AI/ANs living in urban areas.

Finally, Ms. Tetnowski’s unique background will contribute to the Commission’s diversity of experience, background, and geography. Ms. Tetnowski is a member of the Makah Tribe and grew up on the Tribe’s land on the tip of the Olympic Peninsula. As a Soldier in the United States Army, Ms. Tetnowski was stationed at both Ft. Lewis, Washington and Ft. Bragg, North Carolina and deployed in support of Operations Desert Shield and Desert Storm and Operation Uphold Democracy. She has served AI/ANs in numerous capacities including as the CEO of the Lower Elwha Klallam Tribe in Port Angeles, Washington, as the Executive Director of the Affiliated Tribes of Northwest Indians, Economic Development Corporation in Portland, Oregon, and as the Economic Development Director for the Makah Tribe in Neah Bay, Washington. Currently, Ms. Tetnowski works as the CEO of the Indian Health Center of Santa Clara Valley, in San Jose, California.

About the Commission

Among its mission, the Commission will:

  • Identify, report and respond to instances of missing and murdered Indigenous peoples (MMIP) cases and human trafficking,
  • Develop legislative and administrative changes necessary to use federal programs, properties, and resources to combat the crisis,
  • Track and report data on MMIP and human trafficking cases,
  • Consider issues related to the hiring and retention of law enforcement offices,
  • Coordinate Tribal-state-federal resources to combat MMIP and human trafficking offices on Indian lands, and
  • Increase information sharing with Tribal governments on violent crimes investigations and other prosecutions on Indian lands.

The Commission has the authority to hold hearings, gather testimony, and receive additional evidence and feedback from its members to develop recommendations to the Secretary and Attorney General.

Members of the Commission:

  • Bazil-Lu Adams, Officer, Yakima County Sherriff’s Office
  • Natasha Anderson, Nez Perce Tribe, Assistant Prosecutor for Nez Perce
  • Deidra Angulo, Sonder Mind Mental Health Services
  • Eric Broderick, retired physician
  • Ruth Buffalo, Legislator, 27th House District of North Dakota
  • Grace Bulltail, survivor or family member of missing or murdered person
  • Francisco Burrola, Special Agent in Charge for Immigration and Customs Enforcement at Homeland Security Investigations, U.S. Department of Homeland Security
  • Elizabeth Carr, Senior Advisor to the Director, Indian Health Services – U.S. Department of Health and Human Services
  • Kerri Colfer, National Indigenous Women’s Resource Center
  • Christine Crossland, Senior Social Science Analyst, National Institute of Justice – U.S. Department of Justice
  • Amber Crotty, Navajo National Councilmember
  • Jordan Dresser, Northern Arapaho, Tribal Business Councilmember
  • Michelle Demmert, Judge, Tlingit & Haida Indian Tribes of Alaska
  • Dale Fine, Jr, Special Agent, Oklahoma State Bureau of Investigation
  • Leanne Guy, survivor or family member of missing or murdered person
  • Jolene Hardesty, Michigan State Police, Missing Children’s Clearing House Analyst
  • Carmen Harvie, survivor or family member of missing or murdered person
  • Karen ‘Kari’ Hearod, Director, Office of Tribal Affairs and Policy; Substance Abuse & Mental Health Services Admin – U.S. Department of Health and Human Services
  • Don Hedrick, Chief of Police, Rapid City Police Department
  • Tamra Truet Jerue, Alaska Native Women’s Resource Center
  • Vivian Korthuis, CEO of the Associated Village of Presidents, Native Village of Emmonak
  • Hope MacDonald LoneTree, Deputy Commissioner, Administration for Native Americans – U.S. Department of Health and Human Services
  • Annita Lucchesi, survivor or family member of missing or murdered person
  • Jason O’Neal, Director, Office of Justice Services, Bureau of Indian Affairs, Department of the Interior
  • Gregg Peterman, Supervisory Assistant U.S. Attorney for District of South Dakota; US Attorney’s Office—U.S. Department of Justice
  • Kim Poyer, Section Chief, Victim Services Division, Federal Bureau of Investigation – U.S. Department of Justice
  • Allison Randall, Acting Director, Office of Violence Against Women— U.S. Department of Justice
  • Shawnna Roach, Investigator, Cherokee Nation Marshal Service
  • Delight Satter, Senior Health Scientist/Advisor to the Director for Center for State, Tribal, Local and Territorial Support – Centers for Disease Control and Prevention
  • Katherine Drake Schmitt, Deputy Director, Office of Victims of Crime – U.S. Department of Justice
  • Heston Silbert, Colonel, Arizona Department of Public Safety
  • Sonya Tetnowski, National Council of Urban Indian Health
  • Karonienhawi Thomas, Sergeant, Saint Regis Mohawk Tribal Police Department
  • Kristen Welch, Walking Women Healing Institute
  • Patricia Whitefoot, survivor or family member of missing or murdered person
  • Cord Wood, Captain, Oregon State Police
  • Daniel Yonkin, Detective, Montana Lake County Sheriff’s Office

PRESS RELEASE: NCUIH Testifies at Two Congressional Hearings Regarding Critical Funding for Urban Indian Health

Congressional leaders emphasized the need to increase resources for urban Indian health and provide opioid funding for urban Indian communities.

FOR IMMEDIATE RELEASE

NCUIH Contact: Meredith Raimondi, Vice President of Public Policy, mraimondi@ncuih.org, 202-417-7781

WASHINGTON, D.C. (April 5, 2022) – The National Council of Urban Indian Health (NCUIH) President-Elect and CEO of the Indian Health Center of Santa Clara Valley, Sonya Tetnowski (Makah Tribe), testified before the House Interior Appropriations Subcommittee as part of American Indian and Alaska Native (AI/AN) Public Witness Day hearing regarding Fiscal Year (FY) 2023 funding for Urban Indian Organizations (UIOs). Maureen Rosette (Chippewa Cree Nation), NCUIH board member and Chief Operating Officer of NATIVE Project, testified before the House Natural Resources Oversight & Investigations Subcommittee for a hearing entitled, “The Opioid Crisis in Tribal Communities.” In their testimonies, NCUIH leaders highlighted the critical health needs of urban Indians and the needs of the Indian health system.

NCUIH thanks the members of the subcommittees for the opportunity to testify on the needs of urban Indians and encourages Congress to continue to prioritize urban Indian health in FY 2023 and years to come.

House Appropriators Demonstrate Strong Commitment to Indian Health

NCUIH President-Elect Tetnowski testified before the House Appropriations Subcommittee along with Ms. Fawn Sharp for the National Congress of American Indians, Mr. Jason Dropik for the National Indian Education Association, and Mr. William Smith for the National Indian Health Board. The House Appropriations Committee uses testimony provided to inform the FY 2023 Appropriations decisions.

NCUIH requested the following:

  • $49.8 billion for the Indian Health Service (FY22 Enacted: $6.6 billion) and $949.9 million for Urban Indian Health (FY22 Enacted: $73.4 million) for FY 2023 as requested by the Tribal Budget Formulation Workgroup
  • Advance appropriations for the Indian Health Service (IHS)
  • Support of mandatory funding for IHS including UIOs

Full Funding for the Indian Health System a Priority for Congress

Many Members of Congress on both sides of the aisle noted the need to increase resources for Indian health in order to meet the trust responsibility. The federal trust obligation to provide health care to Natives is not optional and must be provided no matter where they reside,” said Ms. Tetnowski in her testimony, “Funding for Indian health must be significantly increased if the federal government is, to finally, and faithfully, fulfill its trust responsibility.”

Ranking Member David Joyce (R-OH-14) agreed with Ms. Tetnowski, “There is still much to do to fulfill the trust responsibility.” Representative Mike Simpson (R-ID-02), also emphasized that more must be done so “there’s not disparity between Indian Health Services and other health services delivered by the federal government.”

President Sharp stated, “This subcommittee’s jurisdiction includes some of the most critical funding for Indian Country. As detailed in the 2018 Broken Promises Report, chronically underfunded and inefficiently structured federal programs have left some of the most basic obligations of the United States to tribal nations unmet for centuries. We call on this subcommittee in Congress to get behind the vision of tribal leaders for right these wrongs by providing the full and adequate funding for Indian country.”

The Case for Mandatory and Advance Appropriations for IHS

The Indian health system, including IHS, Tribal facilities and UIOs, is the only major federal provider of health care that is funded through annual appropriations. For example, the Veterans Health Administration at the Department of Veterans Affairs receives most of its funding through advance appropriations. If IHS were to receive advance appropriations, it would not be subject to government shutdowns, automatic sequestration cuts, and continuing resolutions (CRs) as its funding for the next year would already be in place. According to the Congressional Research Service, since FY 1997, IHS has once (in FY 2006) received full-year appropriations by the start of the fiscal year.

“During the most recent 35-day government shutdown at the start of FY 2019, the Indian health system was the only federal healthcare entity that shut down. UIOs are so chronically underfunded that several UIOs had to reduce services, lose staff, or close their doors entirely, forcing them to leave their patients without adequate care. Advance appropriations is imperative to provide certainty to the IHS system and ensure unrelated budget disagreements do not put lives at stake,” said Ms. Tetnowski.

Many Members of Congress were interested in hearing more about the differences between mandatory and advance appropriations. In her opening remarks, Chair Pingree pointed out that the mandatory funding proposal, if implemented, would remove the jurisdiction from the Appropriations Committee to the authorizing committees. Both NCAI President Sharp and NIHB Chair Smith also expressed support for the mandatory funding proposal from President Biden. Mr. Smith testified the President’s proposal is “a bold vision to end chronic underfunding and building a comprehensive Indian health care system. We urge Congress to support the request and work together with administrations and the tribes to see that as passed into law.”

Rep. Simpson sought to clarify whether both Advance Appropriations and Mandatory Appropriations remain priorities for Indian Country. President Sharp explained that “both [advance and mandatory funding] are critically important” in fulfillment of the trust responsibility while noting that basic health should be a mandatory expenditure of the United States government. President-Elect Tetnowski also stated that, “Advance appropriations would ensure that we weren’t shut down during any type of government closure. IHS is currently the only health care [provider] in the Federal government that does not have advanced appropriations.”

Resources

Congressional Leaders Express Support for Expanding Opioid Funding to Urban Indians

“Opioid overdose deaths during the pandemic increased more in Native American communities than in communities for any other racial or ethnic group,” said Representative Katie Porter (D-CA-45), “to address this crisis, we need to provide more resources for tribal governments and urban Indian health organizations to treat the opioid epidemic.” 

Urban Indians Left out of Opioid Grant Funding

Funding to assist AI/AN communities to address the opioid crisis have repeatedly left out urban Indians. UIOs were not eligible for the funding designated to help Native communities in the State Opioid Response (SOR) Grant reauthorization included in the recently passed FY 2022 Omnibus (H.R. 2471) despite inclusion of UIOs in the SOR bill (H.R. 2379) that passed the House on October 20, 2021. The final language in the omnibus (H.R. 2471) did not explicitly include “Urban Indian Organizations” as eligible and did not use the language from H.R. 2379. While this was likely a result of legislative text being copied from previous legislation, this prohibits urban Indian health providers from being able to access the critical funding needed to combat the opioid crisis.

“During the last government shutdown, one UIO suffered 12 opioid overdoses, 10 of which were fatal. This represents 10 relatives who are no longer part of our community,” Ms. Rosette emphasized, “These are mothers, fathers, uncles, and aunties no longer present in the lives of their families. These are tribal relatives unable to pass along the cultural traditions that make us, as Native people, who we are.”

Responding to a question from Rep. Stansbury (D-NM-01) on what the committee can do to help support UIO’s work on the ground to address the opioid crisis in Native communities, Ms. Rosette reiterated, “Funding is always an obstacle for us. Grants, like the state opioid response grant, would allow us to provide culturally appropriate treatment to our community, but we were not included. You have to specifically say “urban” along with “tribal” otherwise we are not allowed to get the funding.”

Opioid Epidemic in AI/AN Communities

Since 1974, AI/AN adolescents have consistently had the highest substance abuse rates than any other racial or ethnic group in the U.S. Urban AI/AN populations are also at a much higher risk for behavioral health issues than the general population. For instance, 15.1% of urban AI/AN persons report frequent mental distress compared to 9.9% of the general public.

Additionally, the opioid crisis and COVID-19 pandemic are intersecting with each other and presenting unprecedented challenges for AI/AN families and communities. On October 7, 2021, the American Academy of Pediatrics published a study on caregiver deaths by race and ethnicity. According to the study, 1 of every 168 AI/AN children experienced orphanhood or death of caregivers due to the pandemic and AI/AN children were 4.5 times more likely than white children to lose a parent or grandparent caregiver. Unfortunately, this has exacerbated mental health and substance use issues among our youth. In the age group of 15-24, AI/AN youth have a suicide rate that is 172% higher than the general population in that age group.

Resources

Next Steps

NCUIH will continue to advocate for full funding of Indian Health Service and urban Indian health at the amounts requested by Tribal leaders as well as for additional resources for the opioid response for Native communities.

House Passes NCUIH Urban Indian Health Confer Bill

FOR IMMEDIATE RELEASE 11.3.2021

Media Contact:
National Council of Urban Indian Health
Meredith Raimondi, Director of Congressional Relations
MRaimondi@ncuih.org
651-470-1857

WASHINGTON, D.C. (November 3, 2021) – On November 2, 2021, the House passed the Urban Indian Health Confer Act (H.R. 5221) with a 406-17 recorded vote. This bipartisan bill introduced by Rep. Raúl Grijalva (D-AZ-3), Rep. Betty McCollum (D-MN), Rep. Tom Cole (R-OK), Rep. Don Young (R-AK), Rep. Karen Bass (D-CA), and Rep. Eleanor Holmes Norton (D-DC) would require agencies within the Department of Health and Human Services (HHS) to confer with urban Indian organizations (UIOs) on policies related to healthcare for urban American Indian/Alaska Natives (AI/ANs).

“We are thankful for the passage of the Urban Indian Health Confer Act in the House today and particularly for the leadership of Congressman Raul Grijalva, Don Young, Betty McCollum and Tom Cole. Establishing proper urban confer policies across all HHS agencies has been long overdue and exacerbated amid the current public health crisis ravaging Indian Country. We welcome the federal government’s effort to further fulfill their trust and treaty obligation for all American Indians and Alaska Natives, including those residing in urban areas,” said Walter Murillo (Choctaw Nation of Oklahoma), Chief Executive Officer of NATIVE HEALTH and President of NCUIH.

“As an original cosponsor of this legislation, I believe this bipartisan bill will benefit Native peoples, particularly those who live and seek health care outside of tribal jurisdictions. This legislation will establish direct lines of communication for UIOs across all of HHS and ensure that urban Indian communities are aware of health care policy changes,” said Representative Young (R-AK).

“HHS’ failure to communicate with UIOs about healthcare policies that impact urban Indian communities is inconsistent with the federal trust responsibility and contrary to sound public health policy. The Urban Indian Health Confer Act will establish direct communication for UIOs across the entire department and ensure that urban Indian communities are aware of healthcare policy changes,” said Chairman Raúl M. Grijalva (D-AZ).

Background

The National Council of Urban Indian Health (NCUIH) has long advocated for the establishment of formal dialogue between HHS agencies and UIOs and has tirelessly worked with Congressional leaders to put forth a legislation to address this parity issue.

Next Steps

The bill now awaits action in the Senate.