PRESS RELEASE:NCUIH Honors 2022 Urban Indian Health Champions

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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 Policy, mraimondi@ncuih.org

NCUIH President Elect Sonya Tetnowski Named to the Not Invisible Commission

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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
Read the DOJ Press Release Read the DOI Press Release

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

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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

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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.

NCUIH President-Elect Appointed To VA Advisory Committee

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FOR IMMEDIATE RELEASE 10.15.2021

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

NCUIH nominated Ms. Tetnowski to represent urban Native Veterans.

 

WASHINGTON, D.C. (October 15, 2021) – National Council of Urban Indian Health (NCUIH) President Elect and CEO of Indian Health Center of Santa Clara Valley, Sonya Tetnowski, a member of the Makah Tribe, was appointed to the Department of Veterans Affairs (VA) first-ever Advisory Committee on Tribal and Indian Affairs. The Committee will advise the Veterans Affairs Secretary based on personal experience on all matters relating to Indian Tribes, Tribal organizations, Urban Indian Organizations (UIOs), Native Hawaiian organizations, and Native American Veterans. NCUIH advocated for the bill that established the advisory committee and nominated Ms. Tetnowski for the role. In the past many advisory committees that relate to Indian health, including urban Indian health, have excluded urban Indian leaders from positions and conversations, which makes this appointment especially historic.

“NCUIH is proud of Sonya Tetnowski’s representation of urban Indian organizations on the Department of Veterans Affairs new Advisory Committee on Tribal and Indian Affairs. As a Veteran and urban Indian leader Sonya is uniquely qualified to serve on this committee. Sonya will be a strong voice for American Indian and Alaska Native Veterans who reside in urban areas,” said NCUIH President Walter Murillo (Choctaw Nation of Oklahoma).

Ms. Tetnowski was deployed multiple times during her service in the Army and has tirelessly advocated on behalf of health equity for American Indians, including Native Veterans, through Congressional testimony and leadership at NCUIH. In 2019, Ms. Tetnowski testified on bill H.R. 4153, the Health Care Access for Urban Native Veterans Act, which allows Urban Indian Organizations (UIOs) to be reimbursed for providing culturally competent care to American Indian and Alaska Native (AI/AN) Veterans residing in urban areas. Most recently, Ms. Tetnowski appeared before the House Committee on Natural Resources in July 2021. She submitted testimony on Native Veterans Suicide Prevention on behalf of NCUIH in September. Also in October, the Indian Health Center of Santa Clara Valley was recognized with the National Indian Health Board’s 2021 Outstanding Service Award.

“It is an honor to be a part of the first-ever VA Committee on Tribal and Indian Affairs. With approximately 160,000 Native Veterans around the country, it is vital to have a representative on the committee that can ensure that the healthcare needs for our Native Veterans is always a part of the broader discussion to ensure we are removing barriers to care while providing culturally competent care. I appreciate the VA’s foresight and vision to address these challenges” said Sonya Tetnowski (Makah), NCUIH President Elect and CEO of the Indian Health Center of Santa Clara Valley.

“Native Americans serve in the military at a higher rate than any other population, and over 70 percent of Native Americans live in urban areas. Urban Indian organizations, like the Indian Health Center of Santa Clara Valley (IHC) fill a crucial gap in the health care system for Native Americans that do not have access to more remote facilities run by the Indian Health Service. I congratulate Sonya Tetnowski (Makah), CEO of the IHC on her appointment to the inaugural Tribal Veterans Affairs Advisory Committee to represent our Native Veterans,” said Rep. Ro Khanna (D-CA-15).

“A wide range of VA activities impact urban Indian organizations and the communities they serve. Sonya‘s appointment as the Committee representative for urban Indians provides an added layer of accountability for VA to uphold its trust responsibility to Native Veterans living outside of reservation boundaries,” said Sunny Stevenson (Walker River Paiute Tribe), NCUIH Director of Federal Relations.

Resources 

Testimonies by Ms. Tetnowski 

 

Congressional Hearing Highlights How Lack of Urban Confer Delayed Vaccine Rollout for Urban Indians

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FOR IMMEDIATE RELEASE 10.15.2021

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

The Administration and bipartisan Members of Congress emphasized the need for urban confer legislation in yesterday’s House Natural Resources hearing.

WASHINGTON, D.C. (October 6, 2021) – On Tuesday, the National Council of Urban Indian Health (NCUIH) testified before the House Natural Resources Subcommittee for Indigenous Peoples of the United States (SCIP) in support of the Urban Indian Health Confer Act (H.R. 5221), sponsored by Chairman Raúl Grijalva (D-AZ-3). NCUIH President and Chief Executive Officer of NATIVE HEALTH, Walter Murillo (Choctaw Nation of Oklahoma), spoke in support of the NCUIH-endorsed legislation which 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).

In Chair Grijalva’s opening remarks, he noted that the Administration’s currently limited scope served as a barrier to UIOs and to other healthcare agencies and departments. “This was highlighted during the COVID-19 pandemic when it came to vaccine allocations. The current policy indicates that HHS was only obligated to initiate communications with Tribal governments and other agencies, not UIOs. As a result, UIOs were prevented from providing input and delayed vaccine distribution to many American Indians and Alaska Natives. H.R. 5221 will remedy this and codify a proper confer policy between HHS and urban Indian organizations.” 

The current public health crisis has only amplified the long-due need for urban confer among HHS agencies to adequately communicate the constantly changing healthcare policies with UIOs that directly impact their patients. However, only the Indian Health Service (IHS) has a legal obligation to confer with UIOs. President Murillo’s testimony spoke to the ongoing challenges that UIOs and urban AI/ANs continue to face absent an urban confer policy across all HHS agencies.

In his opening statement, Mr. Murillo explained, “Few are aware that urban confer policies are a response to decades of deliberate federal efforts, such as forced assimilation, termination, relocation, and boarding schools, that have resulted in 70% of American Indian and Alaska Native people living outside of Tribal jurisdictions…We must move past the notion that only IHS has a trust obligation to Native people, because the truth is the FEDERAL government has a responsibility to provide health care for all Native people.”  Finally, he noted how none of the $125 million appropriated in the CARES Act to the Centers for Disease Control and Prevention (CDC) by Congress for the Indian health system, including urban Indian health, was distributed to UIOs. Repeated attempts to contact CDC and further determine why UIOs have yet to receive funds remain unanswered and would be rectified by an urban confer policy with the Department.

 

Watch Full Hearing

NCUIH Testimony

IHS Testimony

 

Administration Emphasizes the Importance of Urban Indian Inclusion in Federal Communication

In response to a question regarding vaccine distribution, IHS Deputy Director for Intergovernmental Affairs, Benjamin Smith, said “Initially urban Indian organizations were not included in the discussion and request from the Department of Health and Human Services about whether urban Indian organizations would receive their vaccine allocation from the state or from the Indian Health Service. As a result, it was unclear to urban Indian organizations on whether they were expected to make a similar decision as tribes did. It was ultimately determined that the urban Indian organizations could select a state or Indian Health Service for their vaccine allocation. In some urban Indian organizations, however, there were delays in the initial vaccine rollout.” For example, the Baltimore UIO, Native American LifeLines, did not receive vaccines until just 5 days before the general public was eligible in a pandemic that took the lives of AI/ANs at the highest rates of any population. [Note: The majority of UIOs that received vaccines through IHS were expedient and efficient in their rollouts, which were touted as a success by the Administration in the high vaccination rates of AI/ANs.]

Deputy Director Smith, reflected on his personal connection as an urban Indian, “We acknowledge that there are many members of federally recognized Tribes that reside in urban areas. I’m an example of one. I’m a member and citizen of the Navajo Nation that resides here in the Washington D.C. area.” He went on to explain the importance of agency-wide urban confer with UIOs by saying, “It is extremely important to understand how members of American Indians/Alaska Natives that are residing in urban setting have access to healthcare services as outlined in this important piece of legislation.”

When asked about why it’s critical to boost urban Indian health coordination and resources, Darryl LaCounte, the Director of the Bureau of Indian Affairs, affirmed that “Approximately 70% of enrolled Native Americans live off reservation and in urban areas and think its vitally important that those people are served.” He continued to say, “I had a previous Assistant Secretary express his frustration to me one day that we were only serving 30% of the Indian population, I’d say we serve more than that but that’s the lay of the land.”

Bipartisan Support from the House Natural Resources Committee Members

Members of Congress from both sides of the aisle demonstrated strong support for urban Indian health and confer policies with UIOs. Subcommittee Chair Leger Fernandez expressed support for the bill and UIOs, emphasizing that “UIOs are a pillar of the Indian Health System.”  Representative Matt Rosendale (R-MT-AL) emphasized Murillo’s statement regarding urban Indian parity: no policies about us, without us. “If none of us take anything from this hearing today, that should be the one statement that everybody should take home and make sure that they remember,” said Rep. Rosendale. ​Rep. Darren Soto (D-FL-9) said, “It’s time to modernize and improve health access for our Native Americans. This requires us to have greater urban access through the Indian Health Service and the U.S. Department of Health and Human Services, which is why we applaud Chair Grijalva for this great bill.”

“Even before the pandemic, we’ve known that resources within the Indian Health System were stretched thin. Urban Indian health centers in particular play a critical role in providing healthcare to Indigenous communities and remain on the frontlines during the pandemic, all of which they do while dealing with longstanding parity issues within the Indian Health System— supply shortages, closures, and financial hardships,” said Rep. Jesus “Chuy” Garcia (D-IL-4). “We cannot afford to leave urban Natives without access to adequate care during this public health crisis especially.”

Representative Melanie Stansbury (D-NM-1) expressed direct support of the Urban Indian Health Confer Act and provided comments on the impact of UIOs on healthcare in New Mexico. “Urban Indian Organizations are vital to serving the healthcare needs of our Tribal communities across the country, and especially here in my home state of New Mexico. The First Nations Community HealthSource in my district is a member of the National Council of Urban Indian Health and is the sole urban Indian health center in the state of New Mexico. […] I want to take a moment to shout out and lift up their incredible work,” said the Congresswoman.

NCUIH thanks SCIP for scheduling a hearing for testimony on this crucial urban confer bill and furthering parity for UIOs and the urban AI/AN patients whom they serve with the rest of the Indian Health System.

NEXT STEPS

NCUIH will request a full Committee markup and expeditious floor consideration. NCUIH urges advocates of Indian health to request their Members of Congress cosponsor H.R. 5221.

BACKGROUND

An urban confer is an established mechanism for dialogue between federal agencies and UIOs. NCUIH has long advocated for the importance of facilitating confer between numerous federal branches within HHS and UIO-stakeholders without any resolve. 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 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 areas. The bill was introduced on September 10, 2021, by Chair Grijalva, Rep. Betty McCollum (D-MN), Rep. Tom Cole (R-OK), Rep. Don Young (R-AK), Rep. Karen Bass (D-CA), and Del. Eleanor Holmes Norton (D-DC). It currently has 10 cosponsors.

RESOURCES

PRESS RELEASE: Bipartisan Padilla-Moran-Lankford NCUIH Amendment for Urban Indian Health Passes Senate

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The technical fix will be critical to improving health infrastructure for off-reservation American Indians and Alaska Natives.

FOR IMMEDIATE RELEASE – 8.2.21

Media Contact: National Council of Urban Indian HealthMeredith Raimondi, Director of Congressional Relations MRaimondi@ncuih.org 202-417-7781

Washington, D.C. (August 2, 2021) – On Monday, the Senate voted on amendments to the bipartisan infrastructure package including the Padilla-Moran-Lankford Urban Indian Health Amendment, which passed 90-7. The National Council of Urban Indian Health (NCUIH) has worked closely on a bipartisan basis for the past year on this technical legislative fix to support health care for tribal members who reside off of reservations. This amendment would allow existing resources to be used to fund infrastructure projects within the Indian health system.

“We applaud Senators Padilla, Moran, Lankford, Rounds, Smith, Feinstein, Schatz, and Schumer for their steadfast and tireless leadership on behalf of Indian Country. This technical fix will be critical to expanding health care infrastructure for Native communities who have been devastated by the COVID-19 pandemic. We also thank the National Congress of American Indians for their partnership in advocating for improved outcomes for all of Indian Country,” said Francys Crevier (Algonquin), CEO of NCUIH.

Next Steps

The Senate will continue to debate amendments to the bipartisan infrastructure plan. In the meantime, NCUIH will continue to advocate for $21 billion for Indian health infrastructure in the budget reconciliation package from the a joint letter led by the National Congress of American Indians (NCAI) on April 13, 2021.

Background

“Urban Indian Organizations (UIOs) are a lifeline to Native Americans living in urban areas across California,” said Senator Alex Padilla (D-CA). “Yet, UIOs are prohibited from using Indian Health Service funding for facilities, maintenance, equipment, and other necessary construction upgrades. During the pandemic, many UIOs couldn’t get approval for ventilation upgrades, heaters, generators, and weatherization equipment. Removing this unjust burden on UIOs is a commonsense fix and would allow them to improve the quality of the culturally competent care that they provide.”

“Oklahoma has the second-largest Urban Indian patient population and is proudly served in both Tulsa and Oklahoma City clinics. We should continue to improve health care access for our Urban Indian population and broaden the flexibility for Urban Indian Organizations’ use of facilities renovation dollars, in addition to those for accreditation, to meet patient needs,” said Senator James Lankford (R-OK).

“The impacts of COVID-19 will be with our Native communities for a long time to come. It is critical that the Indian Health Care Center of Santa Clara Valley and other UIOs be able to provide a safe environment for the families and patients we serve. We are extremely grateful for Senator Padilla’s leadership in rectifying a longstanding barrier preventing us from using existing funding to make urgent upgrades,” said Sonya Tetnowski (Makah), CEO of Indian Health Care Center of Santa Clara Valley, President of California Consortium for Urban Indian Health (CCUIH), and President-elect of NCUIH.

“It is time to live out this Country’s commitment to each other to live with respect for one another and in community. With this legislation, Friendship House in San Francisco will build a home village site for our urban Native Americans, so that our people may contribute to saving and enriching our homeland, which we must now all share and care for or lose. We greatly appreciate Senator Padilla’s leadership on this issue,” said Abby Abinanti (Yurok), President of the Friendship House Association of American Indians Board of Directors.

UIOs lack access to facilities funding under the general IHS budgetary scheme, meaning there is no specifically allocated funding for UIO facilities, maintenance, sanitation, or medical equipment, among other imperative facility needs. While the whole IHS system has made the transition to telehealth, negative pressurizing rooms, and other facility renovations to safely serve patients during the pandemic, restrictions in the relevant statutory text did not allow UIOs to make those transitions. Section 509 currently permits the IHS to provide UIOs with funding for minor renovations and only in order to assist UIOs in meeting or maintaining compliance with the accreditation standards set forth by The Joint Commission (TJC).

These restrictions on facilities funding under Section 509 have ultimately prevented UIO facilities from obtaining the funds necessary to improve the safety and quality of care provided to American Indian/Alaska Native (AI/AN) persons in urban settings. Without such facilities funding, UIOs are forced to draw from limited funding pools, from which they must also derive their limited funding for AI/AN patient services. This lack of facility funding for UIOs is a breach of the federal trust obligation to AI/AN health care beneficiaries, necessitating congressional action to include UIOs in future legislative measures for IHS facility funding.

In May, Congressman Ruben Gallego (D-AZ) and Congressman Don Bacon (R-NE) introduced the Urban Indian Health Facilities Provider Act (H.R. 3496) in the House of Representatives which expands the use of existing IHS resources under Section 509 of the Indian Health Care Improvement Act (IHCIA) (25 U.S.C. § 1659) to increase the funding authority for renovating, constructing, and expanding Urban Indian Organizations (UIO). Senators Alex Padilla (D-CA), James Lankford (R-OK) along with co-sponsors Moran (R-KS), Feinstein (D-CA), and Smith (D-MN) on the Senate Indian Affairs Committee introduced the identical Senate bill (S. 1797).

Last month, NCUIH testified before the House Natural Resources Subcommittee for Indigenous Peoples of the United States (SCIP) and the Senate Committee on Indian Affairs (SCIA) in support of the Urban Indian Health Facilities Provider Act (H.R. 3496 / S. 1797). Sonya Tetnowski (Makah Tribe), NCUIH President-Elect and Chief Executive Officer of the Indian Health Center of Santa Clara Valley, testified before SCIP and Robyn Sunday-Allen (Cherokee), NCUIH Vice President and CEO of the Oklahoma City Indian Clinic, testified before SCIA.

This fix is broadly supported in Indian Country and the National Congress of American Indians passed a resolution in June to “Call for Congress to Amend Section 509 of the Indian Health Care Improvement Act (IHCIA) to Remove Facility Funding Barriers for Urban Indian Organizations”.

PRESS RELEASE – NCUIH Testifies at House and Senate Hearings Highlighting Need for Urban Indian Health Infrastructure Fix

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Washington, D.C. (July 22, 2021) – This week, the National Council of Urban Indian Health (NCUIH) testified before the House Natural Resources Subcommittee for Indigenous Peoples of the United States (SCIP) and the Senate Committee on Indian Affairs (SCIA) in support of the Urban Indian Health Facilities Provider Act (H.R. 3496 / S. 1797). On Tuesday, Sonya Tetnowski (Makah Tribe), NCUIH President-Elect and Chief Executive Officer of the Indian Health Center of Santa Clara Valley, testified before SCIP. On Wednesday, Robyn Sunday-Allen (Cherokee), NCUIH Vice President and CEO of the Oklahoma City Indian Clinic, testified before SCIA. Tetnowski and Sunday-Allen spoke in support of the NCUIH-endorsed Urban Indian Health Providers Facilities Improvement Act, which will pave the way for increased investment in the renovation and construction of Urban Indian Organization (UIO) facilities. It will amend Section 509 of The Indian Health Care Improvement Act (IHCIA) (25 U.S.C. § 1659) to permit UIOs to access existing avenues for Indian Health Services (IHS) facilities renovation funding. This bipartisan amendment of prior legislation will not otherwise affect federal facilities funding for IHS or Tribally operated programs through existing Indian Health Service appropriations for improvements and renovations.

Read Full NCUIH SCIP Testimony              Watch Full SCIP Hearing

Read NCUIH’s Full SCIA Testimony               Watch Full SCIA Hearing

 

Leaders from the House Natural Resources Committee Expressed Support for the Bill

Subcommittee Chair Leger Fernandez supported the bill and Chair Grijalva said “Mr. Gallego’s bill is particularly important as a follow-up to the COVID pandemic and to the follow-up on the disparity with regard to the healthcare that Indigenous people receive. It’s a really good piece of legislation, very timely given all of the other discussions that are going on right now in terms of reconciliation, etc.” Ranking Member Young also expressed support for H.R. 3496 and suggested it be moved forward. ​

“Making sure UIOs can use their limited resources on the projects they know will most benefit patients is how we ensure that these vulnerable populations receive the best care possible. That’s why my bipartisan bill simply removes this obsolete provision of law and allows UIOs to spend their money where it will be most effective for patients,” said Rep. Ruben Gallego (D-AZ-07).

Several Members of Congress from both sides of the aisle demonstrated a strong interest in expanding resources in urban Indian health and followed up with Ms. Tetnowski about the implications of the legislation. For example, Chair Leger Fernandez asked about the impacts of any changes on accreditation processes for the 41 UIOs, and Ms. Tetnowski explained the legislation will have no effect on accreditation statuses for UIOs.
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In a hearing last month, IHS also reiterated the law is archaic and there is no reason to retain this provision that ultimately impedes health care for urban AI/ANs.

Senate Hearing Highlights Urgency for Parity for Urban Indian Health

Senator James Lankford (R-OK) introduced Robyn Sunday-Allen and the bill of which he is the primary sponsor, “I strongly believe that more must be done to achieve parity for the UIOs within the Indian Health System umbrella.” In addition to support from Chair Schatz and Vice Chair Murkowski, IHS Deputy Director for Management Operations, Randy Grinnell testified that providing UIOs with broader authority “to improve their health care facilities will assist in providing the high quality, safe, and culturally relevant health care for the urban Indian population.”

Several other parity issues for urban Indian health were raised by the Senators, including Native Behavioral Health and the need for 100% FMAP for UIOs. Senator Cantwell asked IHS, “How long will it take for us to get full FMAP for Urban Indian Health?” IHS said they would have to follow up with a response and was unable to provide any timeline for when resources would reach urban Indian organizations. To date, UIOs have not received any benefits from the 100% FMAP for UIOs included in the American Rescue Plan Act passed in March of this year.

The Senate hearing also covered the Native American Child Protection Act. The bill includes the following updates for UIOs that were advocated for by NCUIH and noted by Heidi Todacheene:

  • Includes the establishment of a 12-member Advisory Board appointed by the Secretary of the Interior that will consist of representatives from Indian tribes, Tribal organizations, and urban Indian organizations with expertise in child abuse and child neglect.
  • Includes development of training and technical assistance materials on the prevention, identification, investigation, and treatment of incidents of family violence, child abuse, and child neglect for distribution to Indian tribes, Tribal organizations, and urban Indian organizations.

We at NCUIH would like to thank SCIP and SCIA for scheduling hearings for testimony from stakeholders in Indian health regarding infrastructure expansion in Indian Country. These hearings are an important first step for bringing UIOs and the urban AI/AN patients whom they serve into parity with beneficiaries served at IHS or Tribal health facilities.

SCIP and SCIA will take the requests from Tetnowski’s and Sunday-Allen’s testimonies this week into consideration as its members prepare their legislative priorities in deciding which bills may be included in the upcoming bipartisan infrastructure framework proposal. NCUIH will request markups by both Committees.

Background

UIOs lack access to facilities funding under the general IHS budgetary scheme, meaning there is no specifically allocated funding for UIO facilities, maintenance, sanitation, or medical equipment, among other imperative facility needs. While the whole IHS system has made the transition to telehealth, negative pressurizing rooms, and other facility renovations to safely serve patients during the pandemic, restrictions in the relevant statutory text did not allow UIOs to make those transitions. Section 509 currently permits the IHS to provide UIOs with funding for minor renovations and only in order to assist UIOs in meeting or maintaining compliance with the accreditation standards set forth by The Joint Commission (TJC).

These restrictions on facilities funding under Section 509 have ultimately prevented UIO facilities from obtaining the funds necessary to improve the safety and quality of care provided to American Indian/Alaska Native (AI/AN) persons in urban settings. Without such facilities funding, UIOs are forced to draw from limited funding pools, from which they must also derive their limited funding for AI/AN patient services. This lack of facility funding for UIOs is a breach of the federal trust obligation to AI/AN health care beneficiaries, necessitating congressional action to include UIOs in future legislative measures for IHS facility funding.

RESOURCES

PRESS RELEASE: NCAI PASSES RESOLUTION URGING CONGRESS TO REMOVE FEDERAL FACILITIES FUNDING BARRIERS FOR URBAN INDIAN ORGANIZATIONS

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The fix called for in the resolution will better ensure that UIOs can meet the changing health care delivery needs for tribal citizens residing in urban areas.

Washington, D.C. (June 28, 2021) – After extensive advocacy from NCUIH and our partners for Urban Indian health, the National Congress of American Indians (NCAI) passed resolution AK-21-020: Call for Congress to Amend Section 509 of the Indian Health Care Improvement Act to Remove Facility Funding Barriers for Urban Indian Organizations (UIOs) on June 24, 2021, during NCAI’s Mid-Year Conference. The resolution urges Congress to enact legislation to amend the Indian Health Care Improvement Act (IHCIA) to remove the language restricting UIO facilities’ funding availability only to minor renovations to meet or maintain accreditation standards.

“Facility-related use of federal funds remains the most requested priority for our UIOs,” said NCUIH CEO Francys Crevier (Algonquin). “The current limitations found in the Indian Health Care Improvement Act force UIOs to use their limited third-party reimbursement funds for necessary minor facility improvements to meet or maintain accreditation by Joint Commission for Accreditation of Health Care Organizations. NCUIH leadership advocated for the adoption of this important resolution, and we applaud NCAI for passing it.”

NCAI resolutions are one of the policy mechanisms used to express the organizational positions on tribal, federal, state, and/or local legislation, litigation, and policy matters that affect tribal governments or communities. NCAI members establish the organization’s positions on issues that affect tribal nations and Native people through a resolution process. Resolutions to be considered at the Mid-Year Convention are only accepted if they are determined to be emergency in nature and national in scope. The resolution, submitted by NCUIH Director of Federal Relations, Sunny Stevenson (Walker River Paiute), calls on Congress to continue to honor the obligations made to tribal members by the federal government.

NCAI has been a longtime partner of NCUIH, having collaborated on previous resolutions adopted in favor of Urban Indian health, including the extension of the Federal Tort Claims Act (FTCA) to be inclusive of UIOs, temporary 100% FMAP for UIOs under the American Rescue Plan Act, and federal reimbursement for AI/AN Veterans served at UIO facilities. Each of these NCAI resolutions has been instrumental in compelling Congressional action to pass these critical means of addressing contemporary issues that urban AI/AN persons encounter in seeking care under the federal trust responsibility. NCAI’s resolution follows the introduction of the Urban Indian Health Providers Facilities Improvement Act under identical House and Senate bills (H.R. 3496 / S. 1797). The bipartisan, bicameral bills will pave the way for increased investment in the renovation and construction of UIO facilities. The passage of the Urban Indian Health Providers Facilities Act would amend Section 509 of the Indian Health Care Improvement Act (25 U.S.C. § 1659), the provision of IHCIA that pertains to UIO facility funding. The amendment will not otherwise affect federal facilities funding for IHS or tribally-operated programs through existing Indian Health Service appropriations for improvements and renovations.

 

RESOURCES

 

Full Resolution Text

List of NCAI Mid-Year Resolutions 

NCUIH Statement on Indigenous Residential and Boarding Schools

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Washington, D.C. (June 25, 2021) – In Canada this past May, the discovery of 215 unmarked graves at Kamloops Indian Residential School brought past Indigenous traumas into the international spotlight. Yesterday, over 700 more unmarked graves were found on the grounds of the former Marieval Indian Residential School in Canada.

Boarding schools and residential schools are a tragic thread in history that the United States and Canada share: The United States Government Indian Boarding School Policy authorized the forced removal of hundreds of thousands of Native children, as young as 5 years old, relocating them from their homes in Tribal communities to one of the 367 Indian Boarding Schools across 30 States. Between 1869 and the 1960s, the United States federal government stole Native children from their families to destroy their indigenous identities, beliefs, and traditional languages to assimilate them into White American culture through federally funded Christian-run schools.

Today, National Council of Urban Indian Health Chief Executive Officer Francys Crevier (Algonquin) released the following statement in response to these recent discoveries:

“I am devastated to hear the discovery of mass graves of our children, but tragically, I am not surprised. The National Council of Urban Indian Health (NCUIH) exists because of the historic oppression like this that forced relocation of our people by the United States (and Canadian) governments, which included ripping our children from their families and placing them in federally funded boarding schools in their attempt to “kill the Indian, save the man.” Indian Country’s social determinants of health demonstrate the connection to the historical trauma inflicted by these governments that caused tremendous health consequences for our people – most recently with the COVID-19 pandemic taking the lives of many of our relatives. At NCUIH, we are charged with holding the US government to its trust and treaty responsibility of providing health care for all Native people.

The atrocities Native children experienced during the boarding school era are marked by years of pain as Indigenous communities were forced to suffer in silence. These long-standing intergenerational trauma cycles are, unfortunately, nothing new to Native people.  Federal policies in the United States and Canada attempted to destroy Native identity, culture, and language and continue to be a cause of suffering in our communities. For centuries of historic trauma, this process has been a long and challenging journey for our relatives.

With that, we applaud Secretary Deb Haaland, the first Native American cabinet holder, for beginning the conversation to hold the United States government that created these boarding schools accountable through the Federal Indian Boarding School Initiative. The Department of the Interior will identify boarding school sites, locations of known and possible student burial sites located at or near school facilities and identify the children and their tribal affiliations to bring them home to their families.

As the effort continues to bring these children home, we are reminded of the resilience of Native people and ask our relatives to lean on each other as more information from the boarding school era is revealed to the public. While Natives have been well aware of the government’s violation of basic human rights and genocide of our people, it is important for the United States and Canada to finally take responsibility for these horrific actions.

At NCUIH, we are charged with holding the US government to its trust and treaty responsibility of providing health care for all Native people. Our work will continue as we fight to make up for centuries of oppression and needless deaths of our people – including our own children. The United States government can begin to rectify their actions by finally honoring its trust and treaty responsibilities to our people.”

For more information on the history of Native American Boarding Schools, please visit The National Native American Boarding School Healing Coalition website.

Recommended Readings: 

Pipestone My Life in an Indian Boarding School

Boarding School Seasons American Indian Families, 1900-1940

The Middle Five: Indian Schoolboys of the Omaha Tribe

Stringing Rosaries: The History, the Unforgivable, and the Healing of Northern Plains American Indian Boarding School Survivors

They Called Me Uncivilized: The Memoir of an Everyday Lakota Man from Wounded Knee

A Voice in Her Tribe: A Navajo Woman’s Own Story

Boarding School Blues: Revisiting American Indian Educational Experiences

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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.