Press Release Archives - Page 2 of 10

PRESS RELEASE: Report Finds States Again Shoulder the Cost of an Unmet Federal Trust Responsibility

September 15, 2023/in Policy Blog, Press Release/by NCUIH

Congress Must Reauthorize 100% FMAP for Urban Indian Health Care

FOR IMMEDIATE RELEASE

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

WASHINGTON, D.C. (September 15, 2023) – Today, the National Council of Urban Indian Health (NCUIH) announced the release of a policy report on the importance of setting the federal medical assistance percentage (FMAP) at 100% for services provided to Medicaid beneficiaries at urban Indian organizations (100% FMAP for UIOs). With Medicaid beneficiaries making up 46% of the UIO Native patient population, 100% FMAP for UIOs is critical to expanding community health programming and youth services, ultimately leading to improved long-term health outcomes.

“This report showcases what we already knew: when the federal government faithfully honors its Trust responsibility to Native people, health access in our communities improves,” said Francys Crevier, CEO of NCUIH. “This provision has broad support across Indian Country because it directly impacts our people. Congress must act now to permanently reauthorize 100% FMAP for UIOs.”

The report reflects the findings from case studies of two states, Washington and Montana, that successfully utilized the American Rescue Plan Act’s (ARPA) temporary authorization of 100% FMAP for UIOs to increase funding support for their UIOs. The reports’ findings demonstrate that 100% FMAP for UIOs results in:

Increased services at UIOs;
Significant cost savings for states; and,
Flexibility for states to support UIOs in their health care delivery.

The report also provides an extensive history of 100% FMAP in the Indian health care system. The Indian Health Service and Tribal facilities have been extended 100% FMAP for decades, and UIOs have advocated for parity through legislation since 1999. Parity for UIOs allows patients to seek care closer to their homes and access community-focused and culturally competent care.

The full report is available at this link.

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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.

NCUIH Applauds Supreme Court Decision to Uphold Indian Child Welfare Act

June 15, 2023/0 Comments/in Policy Blog, Press Release/by NCUIH

FOR IMMEDIATE RELEASE

WASHINGTON, D.C. (June 15, 2023) – The National Council of Urban Indian Health released the following statement on the Supreme Court’s decision to reject all challenges to the Indian Child Welfare Act (ICWA) in Haaland v. Brackeen.

“ICWA was enacted over 40 years ago to protect the best interests of Native children, by keeping them with their families and communities, and promote the stability and security of Tribes and Native families. ICWA requires state courts to respect Tribal sovereignty and to account for a child’s culture and community in child welfare proceedings. Today’s decision is a major win for all of Indian Country because it ensures that these protections remain in place. We applaud the tireless efforts of the Stand with ICWA campaign and the countless advocates who joined to fight for our children and for tribal sovereignty,” said NCUIH CEO Francys Crevier (Algonquin).

ICWA was created in 1978 by the federal government to re-establish Tribal authority over the adoption of Native American children. The Act aimed to strengthen and preserve Native American family structure and culture. Studies conducted in advance of ICWA’s drafting showed that between 25% and 35% of all Native children were being removed from their homes by state child welfare and private adoption agencies. Of those, 85% were placed with non-Native families, even when fit and willing relatives were available.

American Indian and Alaska Native children are overrepresented in state foster care systems. According to NICWA, AI/AN children are in foster care at a rate 2.7 times greater than their proportion in the general population. This means that while AI/AN children represent 0.9% of all children in the United States, they are 2.1% of all children placed in foster care. Because more than 70% of AI/AN people live in urban settings, this overrepresentation undoubtedly has an impact on urban AI/AN communities. Many health problems arise for AI/ANs living in urban settings because of mental and physical hardships due to the lack of family and the traditional cultural environments. Additionally, urban Indian youth are at a greater risk for serious mental health and substance abuse problems, suicide, increased gang activity, teen pregnancy, abuse, and neglect.

On August 19, 2022, NCUIH and five urban Indian organizations (UIOs) (Nebraska Urban Indian Health Coalition, Inc., Sacramento Native American Health Center, Fresno American Indian Health Project, All Nations Health Center, and Oklahoma City Indian Clinic) signed on to the National Indigenous Women’s Resource Center’s (NIWRC) amicus brief to the Supreme Court in support of the constitutionality of ICWA in the  Haaland v. Brackeen case. NCUIH worked directly with NIWRC to engage with UIOs to ensure that the submitted brief was inclusive of urban AI/ANs.

A full archive of our coverage on ICWA is available at: https://ncuih.org/policy-resource-center/#icwa.

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

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PRESS RELEASE: NCUIH Honors 2023 Indian Health Care Warriors and Native Veteran Health Allies

June 8, 2023/0 Comments/in Press Release/by NCUIH

Congressional Awards | Indian Health Care Warrior Awards | Native Veterans Health Ally Awards

NCUIH recognized Tribal partners, Members of Congress, and federal partners for their work in securing advance appropriations for Indian Health Service and in advancing the health of Native veterans.

Robyn Sunday-Allen (NCUIH VP), Francys Crevier (NCUIH CEO), Darren Benjamin (Relation Strategy LLC), Representative Betty McCollum (D-MN), Senator Jeff Merkley (D-OR), Representative Sharice Davids (D-KS), Stacy Bohlen (NIHB CEO), Larry Wright (NCAI ED), Meredith Raimondi (NCUIH VP of Policy and Communications), Walter Murillo (NCUIH Board President).

Washington, D.C.- On May 17, 2023, the National Council of Urban Indian Health (NCUIH) presented fifteen Indian Health Care Warrior Awards for Advance Appropriations for the Indian Health Service (IHS) to Tribal partners, Congressional advocates, federal advocates, as well as three Native Veterans Health Ally Awards during its 2023 Annual Conference: Honoring Our Ancestors & Preparing for the Next Seven Generations: NCUIH Celebrates 25 Years of Health Leadership. 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 (AI/ANs), regardless of where they reside.

Indian Health Care Warrior Award for Advance Appropriations

Tribal Partners: National Indian Health Board and the National Congress of American Indians

Larry Wright (NCAI ED), Stacy Bohlen (NIHB CEO), Walter Murillo (NCUIH Board President).

NCUIH’s president-elect, Walter Murillo (Choctaw), presented the Indian Health Care Warrior Award for Advance Appropriations to Stacy Bohlen (Sault Ste. Marie Tribe of Chippewa Indians), CEO of the National Indian Health Board, and Larry Wright Jr. (Ponca Tribe of Nebraska), Executive Director of the National Congress of American Indians, for their tireless efforts in fighting for advance appropriations for the Indian Health Service. In their acceptance speech, Bohlen succinctly captured the spirit of unity and triumph in her statement, “[w]hen we stand together, we win.” Her powerful quote embodies the essence of collective action and highlights the importance of solidarity in achieving positive outcomes for Native communities.

Indian Health Care Warrior Award for Advance Appropriations: Members of Congress

The Congressional Awards were given to Members of Congress for their work in achieving advance appropriations.

Representative Betty McCollum

Representative Betty McCollum (D-MN).

Representative Betty McCollum delivered a powerful address emphasizing the urgent need for comprehensive legislation to support the Indian Health Service. She remarked, “Until we pass this legislation to permanently authorize advance appropriations for the Indian Health Service and until we provide mandatory funding to IHS, this will always be a fight. It will be a fight to make sure that the US government honors its sacred treaty obligations – we must continue this fight and make sure it is included.”

Representative McCollum’s impassioned words resonated deeply with the audience, highlighting the critical importance of addressing healthcare disparities and ensuring equitable access to quality care for Native communities. Her unwavering commitment to championing the cause of the IHS and advancing the rights of Native communities has been a driving force behind numerous initiatives aimed at securing the necessary support and funding to uphold the sacred treaty obligations of the United States government.

Representative Sharice Davids

Robyn Robyn Sunday-Allen (NCUIH VP), Representative Sharice Davids (D-KS), Francys Crevier (NCUIH CEO).

Representative Sharice Davids, a trailblazing voice in Congress and an influential member of the Native American caucus attended the conference in person and emphasized the importance of education in her address, stating, “One of the main priorities for the Native American caucus has been to educate. We need to educate not just our colleagues, but also ensure that our staff and everyone on the Hill has an understanding of how complex and diverse the issues that exist in Indian Country are.” Davids’s voice serves as a powerful catalyst for change, shedding light on the multifaceted challenges faced by Native communities across the country, and actively works to bridge gaps and promote meaningful dialogue in pursuit of equitable solutions.

Senator Jeff Merkle

Robyn Sunday-Allen (NCUIH VP), Senator Jeff Merkley (D-OR), Francys Crevier (NCUIH CEO).

During his acceptance speech, Senator Merkley delivered a compelling message regarding the critical need for advance appropriations for the Indian Health Service. He stated, “The Indian Health Service, which 2.5 million people rely on for their wellbeing, should have never been dependent on the whims of a budget cycle. The rhythm of healthcare means that when you need that care, it is there – not a week later or after Congress figures it out. This provision must be reinstated and reaffirmed forever more.”

Senator Merkley’s words underscored the urgent necessity of ensuring consistent and reliable funding for the IHS, which plays a vital role in providing healthcare services to millions of Native Americans. His unwavering commitment to reinstating the provision for advance appropriations reflects his recognition that healthcare should not be subject to uncertainties and delays caused by the budgetary process.

Majority Leader Chuck Schumer

In his virtual address, Majority Leader Chuck Schumer expressed his gratitude for being awarded the Indian Healthcare Warrior Award for Advance Appropriations. He acknowledged the federal government’s historical neglect of its obligations to support Native communities, particularly in helping them access quality, affordable, and culturally competent healthcare services. However, he expressed pride in the Senate’s historic provision of advance appropriations for the Indian Health Service in the 2023 Omnibus spending package, stating that “IHS was the only federal health care provider that lacked guaranteed funding from year to year- so for the first time in history, we bring Indian Health Services into parity with other health providers.” He promised to continue fighting for Indian Country and hopes to work together to bring more success.

Watch Majority Leader, Chuck Schumer’s Remarks Here

Speaker Emerita Nancy Pelosi

During her virtual acceptance speech, Speaker Emerita Nancy Pelosi highlighted recent policy accomplishments, stating, “Powered by Native voices and your powerful advocacy, we achieved a landmark victory last Congress by securing critical funding for the Indian Health Service.” She added, “Your voices continue to be essential for promoting health and economic justice for tribal communities.”

Watch Speaker Emerita, Nancy Pelosi’s Remarks Here

Senator Lisa Murkowski

Senator Lisa Murkowski expressed gratitude for receiving the Indian Healthcare Warrior award during her virtual acceptance speech but credited the accomplishment to the collective efforts of her fellow advocates. She highlighted her 2013 introduction of legislation to provide Advance Appropriations for IHS and praised the tireless work of tribal organizations in realizing this goal. Senator Murkowski ended by emphasizing that “no matter where Native people live, whether on tribal lands or in urban areas, you deserve quality health care and the federal government has a duty to uphold its trust responsibility.”

Watch Senator Lisa Murkowski’s Remarks Here

Representative Mike Simpson

In his virtual address, Rep. Simpson, the Chairman of the Interior Subcommittee, highlighted the crucial responsibility of his subcommittee to ensure the protection of Native Americans who receive Health Care through IHS funding, particularly from budget uncertainties. He further emphasized that providing funding for Indian Health Care is “not just a trust responsibility, but also a moral one.”

Watch Representative Mike Simpson’s Remarks Here

Representative Tom Col

As Representative Tom Cole was unable to attend the NCUIH conference in person, Robyn Sunday-Allen (Cherokee), Chief Executive Officer of the Oklahoma City Indian Clinic and NCUIH Vice President, was able to meet with Representative Cole to recognize his exceptional dedication to Indian healthcare. As a token of appreciation, Sunday-Allen presented Representative Cole with a specially designed blanket created by NCUIH. This award served to acknowledge Representative Cole’s tireless advocacy for Advance Appropriations in Indian healthcare, demonstrating his unwavering commitment to ensuring consistent and sufficient funding for Native communities. The meeting was an opportunity to honor Representative Cole as an Indian healthcare warrior and express gratitude for his outstanding contributions to improving the lives of Native people.

Indian Health Care Warrior Award for Advance Appropriations: federal partners

Three Indian Health Care Warrior Awards for Advance Appropriations were presented to federal partners for their work in achieving advance appropriations: 

Tracy Goodluck, Senior Advisor to the Assistant Secretary for Indian Affairs, U.S. Department of the Interior;
Daron Carriero, Former Senior Policy Advisor for Native Affairs for the White House Domestic Policy Council
The Office of Management and Budget (OMB): Shalanda Young, Director; Liz Carr, Tribal Advisor to Director; and Topher Spiro, Associate Director of Health.

Tracy Goodluck

Robyn Robyn Sunday-Allen (NCUIH VP), Francys Crevier (NCUIH CEO), Tracy Goodluck, Lauren W. Yowelunh McLester-Davis.

Tracy Goodluck’s role as Senior Advisor to the Assistant Secretary for Indian Affairs at the US Department of the Interior is of immense importance in advancing the cause of urban Native issues. With her expertise and dedication, she plays a pivotal role in bringing these often overlooked concerns to the forefront of policy decision-making. Tracy’s deep understanding of the complex challenges faced by urban Native communities enables her to effectively advocate for their unique needs and amplify their voices within the government. Her ability to bridge the gap between policy development and the lived experiences of urban Native populations helps ensure that their perspectives are heard and integrated into meaningful policy reforms.

Daron Carriero

Daron Carriero, a dedicated advocate for Native healthcare, was recognized for his exceptional efforts and awarded for his significant contributions. As a Choctaw Nation citizen and former Senior Policy Advisor for Native Affairs for the White House Domestic Policy Council under President Biden, Mr. Carriero played a crucial role in securing Advance Appropriations for the Indian Health Service. Through his work at the Department of Justice and later at the White House, he actively supported Tribes across the nation by advocating for increased funding and facilitating crucial conversations between key stakeholders. Although unable to attend the ceremony, Mr. Carriero’s unwavering commitment and substantial achievements in advancing Indian healthcare were acknowledged and celebrated.

The Office of Management and Budget: Shalanda Young, Topher Spiro, and Liz Carr

The Office of Management and Budget (OMB), represented by Director Shalanda Young, Associate Director Topher Spiro, and Ms. Liz Carr, Tribal Advisor to Director, were honored for their instrumental contributions to advancing Indian healthcare. Despite being unable to attend the Award Ceremony, their unwavering dedication and tireless efforts played a pivotal role in achieving this momentous milestone. As essential figures in this achievement, their leadership and commitment were crucial in navigating the complex landscape of healthcare funding and policy. The OMB’s invaluable support and partnership have laid the groundwork for future collaborations.

Darren Benjamin

Robyn Sunday-Allen (NCUIH VP), Darren Benjamin, Francys Crevier (NCUIH CEO).

NCUIH also awarded our Ally in Indian Country, Darren Benjamin, for his work within Tribal organizations and in Congress to advance the healthcare of all Native people. While accepting his award, Benjamin noted the crucial role of bipartisan policymaking in saving Native lives. Effective solutions require the support and cooperation of lawmakers from both sides of the aisle, and transcending partisan divides is essential for securing the necessary resources and funding to address pressing issues impacting Native communities, ultimately ensuring their well-being and promoting positive health outcomes.

Native Veterans Health Ally Award

The Native Veterans Health Ally Awards were given to individuals for their commitment to advocating on behalf of Native American veterans:

Councilman Nick Lewis (Lummi Nation)
Chief William Smith (Valdez Native Tribe)
The Honorable Denis McDonough, Secretary of Veterans Affairs

Robyn Sunday-Allen (NCUIH VP), Francys Crevier (NCUIH CEO), Honorable Denis McDonough, Roslyn Tso (IHS Director), Councilman Nicklaus Lewis.

NCUIH board member Robyn Sunday-Allen (Cherokee) presented the Native Veterans Health Ally Award to Chief William Smith (Valdez Native Tribe), Councilman Nicklaus Lewis (Lummi Nation), and the Honorable Denis McDonough, in recognition of their work to advance the health and well-being of American Indian and Alaska Native veterans. Chief Smith and Councilman Lewis serve on the Department of Veterans Affairs Advisory Committee on Tribal and Indian Affairs with NCUIH’s Board President Sonya Tetnowski, where they are fierce advocates for Native veterans and secure funding and support for tribal veteran services. Chief William Smith has worked tirelessly to address the disproportionate health challenges faced by Native veterans, particularly those related to mental health. Although unable to attend the ceremony, Chief Smith’s achievements were acknowledged and celebrated. The Honorable Denis McDonough, Secretary of Veterans Affairs, has been instrumental in securing resources for Native veterans, pushing for increased funding for Native health care, and advocating for policies that support Native veteran access to care. In his acceptance speech, Secretary McDonough stated that “If you fight for us, we’ll fight for you. If you take care of us, we’ll take care of you. If you have our backs, we’ll have your backs when you leave the service. Native Veterans have kept their part of that promise. Now, it’s time for us—as a country and at VA—to uphold our end of the bargain. We will not rest until every Veteran gets access to equitable, world-class care and benefits.” Together, these three individuals have made significant contributions to improving the lives of Native veterans and their families.

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

PRESS RELEASE: NCUIH Leads Over 200 Organizations in Urging the Administration to Protect Healthcare Access for Families During Medicaid Unwinding

April 24, 2023/0 Comments/in Policy Blog, Press Release/by NCUIH

The loss of coverage may exacerbate the significant healthcare disparities faced by Native communities.

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

WASHINGTON, D.C. (April 24, 2023) – Today, the National Council of Urban Indian Health (NCUIH), in collaboration with the Asian & Pacific Islander American Health Forum, the Coalition on Human Needs, The Leadership Conference on Civil and Human Rights, the National Association for the Advancement of Colored People, National Urban League, Protect Our Care, UnidosUS and 220 other organizations sent a letter to the Department of Health and Human Services (HHS) Secretary Xavier Becerra. Since Medicaid unwinding may disproportionately harm vulnerable communities, the Consolidated Appropriations Act of 2023 included authorities to protect beneficiaries from losing Medicaid coverage for administrative reasons. For example, according to the Assistant Secretary for Planning and Evaluation, three-fourths of children losing Medicaid will remain eligible but be terminated because of state administrative requirements. The letter calls on the Administration to use the full extent of these authorities to safeguard Medicaid coverage and outlines specific steps the Administration can take to avoid wrongful terminations.

“The unwinding currently taking place will have devastating and disproportionate impacts on Native people. It is estimated that 12% of all Native American children and 6% of all Native adults will lose their Medicaid or CHIP coverage as state Medicaid programs unwind. There is no reason that our people should lose access to necessary healthcare services because of administrative barriers. The federal government must do everything in its power to honor the trust responsibility to Native people and ensure we are not left without coverage,” – Francys Crevier (Algonquin), NCUIH CEO.

Impact on Native Health

In 2019, Medicaid covered 1.3 million urban American Indians and Alaska Natives (AI/ANs), including 30% of urban AI/AN adults under age 65.1 Comparatively, Medicaid covered 19.8% of all urban U.S. adults under age 65.2 Native people may be at an increased risk of disenrollment in Medicaid and CHIP programs during the Medicaid unwinding period. In fact, Medicaid coverage losses are estimated to take twice the toll on AI/AN communities than they will take among non-Hispanic white families. It is estimated that 12% of all AI/AN children and 6% of all AI/AN adults nationwide will lose CHIP or Medicaid coverage as state Medicaid programs return to normal operations. AI/ANs may be at an increased risk of losing Medicaid and CHIP coverage due to administrative barriers during the unwinding. AI/AN beneficiaries face several challenges in enrolling or retaining coverage such as geographical remoteness, limited access to internet or phone service, and language barriers. Inadequate health insurance coverage is a significant barrier to healthcare access, and the loss of coverage may exacerbate the significant healthcare disparities faced by AI/AN communities.

The federal government has a trust responsibility to provide federal health services to maintain and improve the health of AI/AN people. Medicaid and CHIP are critical to fulfilling the United States’ trust responsibility to maintain and improve AI/AN health. Patients at Urban Indian Organizations (UIOs) may lose their Medicaid coverage as a result of the unwinding, and inadequate health insurance coverage or gaps in coverage may cause UIO patients to delay or avoid medical care altogether.

Requests to the Administration in the Letter

The letter requests the Administration take four key steps to protect families:

CMS mitigation plans should prevent states from wrongfully terminating beneficiaries for purely procedural reasons. 
CMS should hold state and local Medicaid agencies accountable for compliance with civil rights laws.
CMS should promote transparency and accountability by publishing state unwinding and performance indicator data as soon as possible.
CMS should hold states accountable for renewing coverage based on data matches “to the maximum extent practicable,” as required by Affordable Care Act.

Background on Medicaid Unwinding

In response to the COVID-19 pandemic, Congress passed a “continuous coverage” requirement which required states to keep beneficiaries continuously enrolled in Medicaid through the end of the COVID-19 public health emergency in return for enhanced federal funding. The Consolidated Appropriations Act of 2023 set an end date for the requirement on March 31, 2023, meaning that states may resume reviewing all Medicaid enrollees’ eligibility for coverage, a process referred to as “unwinding,” on April 1, 2023. As states begin these redeterminations, millions of eligible families, including AI/ANs, could lose coverage due to administrative barriers even though they are still eligible for Medicaid coverage. According to HHS, 15 million people could lose their current Medicaid or CHIP coverage.

Full Letter Text

The Honorable Xavier Becerra
Secretary, Department of Health and Human Services
200 Independence Ave., SW
Washington, D.C. 20201

Dear Secretary Becerra:

In just two years, the Biden-Harris Administration has made incredible progress promoting health equity and bringing millions of people the financial security and health care access that result from high-quality, affordable health coverage. We are grateful for your team’s extraordinary work, led by Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure and Deputy Administrators Daniel Tsai and Ellen Montz, to preserve struggling families’ health care as Medicaid continuous coverage requirements unwind.

In light of these accomplishments, we remain concerned that unwinding could cause the largest Medicaid losses in history, with disproportionate harm experienced by communities of color, mothers, and children. To prevent a civil rights and health equity disaster, we urge you to make the strongest possible use of the powers recently granted by Congress for holding states accountable to preserve eligible families’ health care.

Without vigorous federal intervention, state Medicaid programs are likely to operate as they did in the past. If that happens during the unwinding, the Assistant Secretary of Planning and Evaluation (ASPE) projects that 15 million people will be terminated. Such losses would greatly exceed the largest previous annual drop in Medicaid coverage, when the number enrolled fell by 2 million in 2018 and again in 2019.

Unprecedented Medicaid terminations, focused on historically disadvantaged communities, would deepen already severe health inequities. More than half of those whom ASPE expects to lose Medicaid are people of color, including nearly 5 million Latinos, more than 2 million African Americans, and almost 1 million Asian Americans and Pacific Islanders. Other research suggests that nearly 7 million children are at risk of losing coverage, and that children of color are particularly vulnerable. Among all Black children in America, 13% will lose Medicaid if the program operates as it did in the past, as will 12% of all Native American children, 12% of all Latino children, 10% of all children who are Native Hawaiians or Pacific Islanders, and 6% of all Asian American children in the United States.

Needless red tape and bureaucracy threaten to take a terrible toll. More than half of all people of color and three- fourths of all children losing Medicaid will remain eligible but be terminated because of state administrative requirements, according to ASPE. These projections fit recent history, when states like Tennessee, Texas, and Utah redetermined numerous families and saw huge coverage losses. In each state, more than 80% of all terminated families were dropped only because the state did not receive a response to its requests for information. This happened when forms were mailed to the wrong address or never delivered, the family did not understand the forms, the family could not reach a Medicaid call center to provide requested information, renewal procedures were not accessible to people with limited English proficiency or people with disabilities, or for other reasons.

The Consolidated Appropriations Act, 2023, (CAA) gave you unprecedented authority to prevent such patterns from recurring on a vastly larger scale during the unwinding. If a state does not fulfill “all Federal requirements applicable to Medicaid redeterminations,” CMS can require a corrective action plan, reduce the state’s federal matching rates, impose civil monetary penalties, or place procedural terminations on “hold” pending corrective action.

While many important strategies can limit coverage loss, such as measures to facilitate a smooth transition from Medicaid to CHIP, the Marketplace, or employer-based coverage, we urge you to take four key steps to prevent a tidal wave of paperwork terminations from ending health care for millions of eligible families:

First, CMS mitigation plans should prevent states from wrongfully terminating beneficiaries for purely procedural reasons. CMS is working with states to remedy longstanding violations of federal legal requirements. If a state is implementing a “mitigation plan” to fix those violations, CMS will not use its CAA authority to cut federal matching rates. For a state to benefit from sanction suspension, we believe it should be barred from ending families’ coverage due to legal violations that have not yet been fixed. Accordingly, when a state’s violations threaten to cause procedural terminations of eligible people, its mitigation plan should forbid procedural terminations until the violations end.

Second, CMS should hold state and local Medicaid agencies accountable for compliance with civil rights laws. In 5131(a)(4) and (b), the CAA authorizes CMS to use all enforcement tools if a state violates any “Federal requirement applicable to eligibility redeterminations.” Such requirements include regulations under Title VI of the Civil Rights Act of 1964 and Section 1557 of the Affordable Care Act barring practices that have discriminatory effects, based on race or national origin, unless those practices are necessary to accomplish a substantial legitimate objective. The Administration has already made clear that a failure to make redetermination processes accessible to people with limited English proficiency and to people with disabilities violates federal civil rights laws. Those laws can also be violated by other renewal practices that threaten to trigger significant procedural terminations with discriminatory effects, such as:

Underfunding of call centers that causes prolonged delays and effectively prevents telephonic renewal. Families of color disproportionately need fully accessible call centers, as such families face systemic barriers to receiving and providing information on-line and in-person. Compared to others, people of color are less likely to have broadband access, digital fluency, and jobs that provide paid time off to meet with Medicaid staff.
Using complex language on essential forms and notices that is incomprehensible to people with low literacy skills, who disproportionately include people of color and immigrants.
Refusing to let Medicaid plans and providers help their members and patients renew coverage, including through completing forms telephonically. Without one-on-one assistance completing renewal forms that could be at least 8 pages long—longer than the long-form federal income tax return—families of color will suffer disproportionate terminations. As the White House Office of Management and Budget observed, administrative burdens like form completion “do not fall equally on all entities and individuals, leading to disproportionate underutilization of critical services…, often by the people and communities who need them the most. Burdens that seem minor … can have substantial negative effects for individuals already facing scarcity.”

Third, CMS should promote transparency and accountability by publishing state unwinding and performance indicator data as soon as possible. Without rapid publication, stakeholders may be unable to intervene in time to prevent significant coverage losses. The consequences of delayed publication could be particularly serious in many of the states where most Medicaid beneficiaries are people of color. To prevent rapid, inequitable losses, CMS cannot let the risk of data errors deter the prompt release of preliminary numbers. Instead, CMS should publish state reports as soon as possible, noting that the numbers are preliminary and subject to later correction. America has long used this approach for employment statistics, releasing each month’s preliminary numbers during the first week of the following month.

Fourth, CMS should hold states accountable for renewing coverage based on data matches “to the maximum extent practicable,” as required by Affordable Care Act (ACA) §1413(c)(3). This requirement, which applies to all beneficiaries, including older adults and people with disabilities, eliminates the need for eligible people to complete paperwork. Any state with data-based renewal rates far below its peers is, by definition, failing to achieve such rates at “maximum practicable” levels. We believe longstanding problems with a state’s eligibility system should not affect CMS’s determination of the maximum practicable level of data-based renewals. A state’s past refusals to modernize its systems should not be rewarded by lessening the state’s duties to protect its residents. Eligible people must not be terminated because they did not complete paperwork telling the state what it should have been able to learn on its own.

The steps we urge would protect the Biden-Harris Administration’s extraordinary legacy of bringing quality, affordable health coverage to more people than ever before in our country’s history. Please know that the undersigned organizations stand ready to support your efforts to protect the more than 90 million people in America who now rely on Medicaid and CHIP for their health care. For further information, please feel free to contact Joyce Liu at the Asian & Pacific Islander American Health Forum (jliu@apiahf.org), Deborah Weinstein at the Coalition on Human Needs (dweinstein@chn.org), Peggy Ramin at the Leadership Conference on Civil and Human Rights (ramin@civilrights.org), Lisa Malone at NAACP (lmalone@naacpnet.org), Chandos Culleen at the National Council of Urban Indian Health (cculleen@ncuih.org), Morgan Polk at the National Urban League (mpolk@nul.org), Andrea Harris at Protect Our Care (aharris@protectourcare.org), or Stan Dorn at UnidosUS (sdorn@unidosus.org).

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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. 

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

January 9, 2023/0 Comments/in Press Release/by NCUIH

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.

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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

December 7, 2022/0 Comments/in Press Release/by Meredith Raimondi

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

October 11, 2022/0 Comments/in Press Release/by NCUIH

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

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.

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About NCUIH

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

September 28, 2022/0 Comments/in Press Release/by Meredith Raimondi

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

WASHINGTON, 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.

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

September 12, 2022/0 Comments/in Press Release/by Meredith Raimondi

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

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Bipartisan Support for Urban Confer at Senate Hearing

July 27, 2022/0 Comments/in Press Release/by Meredith Raimondi

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.