Tag Archive for: Advance Appropriations

OMB Urges Passage of Appropriations Bills as a Priority for Indian Health

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On November 12, 2021, The Office of Management and Budget (OMB) released a fact sheet urging Congress to pass their appropriations bills for 2022. The fact sheet includes 17 top priorities around pandemic response and other public health initiatives, national security and American leadership, education, and core citizen services. Of the 17, inclusion of Indian Health Service (IHS) funding and addressing American Indians and Alaska Natives health disparities was in the top 3 priorities:

 

  • Address health disparities among American Indians and Alaska Natives. The President’s Budget and the House and Senate appropriations bills provide funding for thousands more inpatient admissions and millions more outpatient visits at Indian Health Service (IHS) facilities, compared to continuing 2021 funding levels, and would allow IHS to fill hundreds of open medical and other staff positions.

 

Appropriation Bills Status

 

The House fiscal year (FY) 2022 Interior, Environment, and Related Agencies bill (H.R. 4372), which includes $200.5 million for urban Indian health and $8.1 billion for IHS, was part of a seven-bill package the House passed on July 29.

 

The Senate Appropriations Committee released its FY 2022 Interior, Environment, and Related Agencies bill, which includes $92.7 million for urban Indian health, $7.61 billion for IHS, an additional $6.58 billion in advance appropriations to IHS for FY23, and a facilities fix to allow urban Indian organizations to use existing IHS funding for facilities improvement and renovations. However, the Senate has yet to pass their appropriations bill.

NCUIH Endorses Bills Providing Advance Appropriations for IHS

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On October 12, 2021, Representatives Betty McCollum (D-MN-04) and Don Young (R-AK-1) introduced a pair of bipartisan bills that would amend the Indian Health Care Improvement Act (IHCIA) to provide advance appropriations to the Indian Health Service (IHS).

 

The Indian Programs Advance Appropriations Act of 2021 (H.R. 5567), introduced by Rep. McCollum, authorizes advance appropriations authority for certain accounts of the Bureau of Indian Affairs, Bureau of Indian Education, and IHS. The Indian Health Service Advance Appropriations Act (H.R. 5549), introduced by Rep. Young, authorizes advance appropriations authority for IHS.

 

NCUIH has long advocated for advance appropriations for IHS to insulate Indian health care providers from shutdowns and allow for long-term planning. A companion Senate bill, Indian Programs Advance Appropriations Act of 2021 (S. 2985), was introduced by Senators Ben Ray Luján (D-NM) and Martin Heinrich (D-NM) on October 7.

 

NCUIH welcomes the Members of Congress’ legislation to provide budget stability for IHS and strengthen the federal government’s commitment to uphold its trust and treaty responsibilities to American Indians and Alaska Natives.

SENATE RELEASES FY22 FUNDING BILLS WITH HISTORIC INCREASE FOR URBAN INDIAN HEALTH, INDIAN HEALTH SERVICE, ADVANCE APPROPRIATIONS, MMIW AND UIO FACILITY FIX

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The Senate bill includes a $30 million increase above the FY21 enacted level for urban Indian health.

On October 11, 2021, the Senate Appropriations Committee released its fiscal year (FY) 2022 Interior, Environment, and Related Agencies bill, with $92.7 million for urban Indian health. The bill would authorize $7.61 billion for the Indian Health Service (IHS) for FY22, an increase of $1.38 billion above the FY21 enacted level and $593 million below the President’s request. Other key provisions include an additional $6.58 billion in advance appropriations to IHS for FY23 and a facilities fix to allow Urban Indian Organizations (UIOs) to use existing IHS funding for facilities improvement and renovations.

“After decades of being ignored and forgotten, we applaud the Senate Appropriations Committee for the robust legislation proposed to improve outcomes for Indian Country. We are especially encouraged to see the commitment to ensure equitable consideration for all Native communities. We are grateful for all Members of Congress who supported the request for full funding for Indian health, including urban Indian health, especially Senators Schatz, Feinstein, Murkowski, Tester, Moran, Merkley, Hoeven, Van Hollen, Heinrich, and Murray,” said NCUIH CEO Francys Crevier.  

Background 

The National Council of Urban Indian Health (NCUIH) and the Tribal Budget Formulation Workgroup (TBFWG) requested $12.759 billion for the Indian Health Service (IHS) with an urban Indian health line item of $200.5 million for FY 2022. Additionally, 28 Congressional leaders requested $200.5 million for urban Indian health in FY 2022 from the House Appropriations Committee.  

House Appropriations Status 

The House bill (HR 4372) included $200.5 million for urban Indian health and was advanced by subcommittee June 28, and $8.1 billion for the Indian Health Service. The measure was part of a seven-bill package the House passed on July 29.  

Senate Bill Highlights 

Appropriations Chairman Patrick Leahy stated in the bill summary, “The bill makes an unprecedented investment to fulfill the federal government’s treaty and trust responsibilities to Native Americans by providing $18.1 billion for tribal programs and – for the first time – securing advanced appropriations for the Indian Health Service (IHS). The advance appropriation for IHS for fiscal year 2023 will enable IHS to continue to provide health services without interruption or uncertainty, improving the quality of care and providing peace of mind for patients and medical providers.”  

Indian Health Service 

  • $7,616,250,000 for IHS for fiscal year 2022, an increase of $1,379,971,000 to the enacted level and a decrease of $593,029,000 to the request 

Urban Indian Health 

  • $92,684,000 for the Urban Indian Health program, $30,000,000 above the enacted level and $7,316,000 below the budget request. 

Facilities Fix for Urban Indian Health 

  • “SEC. 435. The Secretary of Health and Human Services may authorize an urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603) that is awarded a grant or contract under title V of that Act (25 U.S.C. 1651 et seq.) to use funds provided in such grant or contract for minor renovations to facilities or construction or expansion of facilities, including leased facilities, to assist the urban Indian organization in meeting or maintaining standards issued by Federal or State governments or by accreditation organizations.” 

Advance Appropriations for IHS 

  • $6,586,250,000 in advance appropriations for fiscal year 2023, equal to the fiscal year 2022 Committee recommendation in accordance with the Concurrent Resolution on the Budget for Fiscal Year 2022
       
  • “The Committee recommendation also provides, for the first time, advanced appropriations for Indian Health Services and Indian Health Facilities. The bill includes $6,586,250,000 in advance appropriations for fiscal year 2023, equal to the fiscal year 2022 Committee recommendation in accordance with the Concurrent Resolution on the Budget for Fiscal Year 2022. The Committee recognizes that budget uncertainty due to temporary lapses of appropriations and continuing resolutions have an effect on the orderly operations of critical healthcare programs for Native American communities. Existing challenges related to recruitment and retention of healthcare providers, administrative burden and costs, and financial effects on Tribes were identified areas of concern in a Government Accountability Office [GAO] study (GAO–18–652).” 

Contract Support Costs and 105(l) Leases 

  • “The Committee strongly supports revising the budgetary classification for Contract Support Costs and Payments for Tribal Leases with the goal of including the language needed to codify such a change in the final appropriations Act for fiscal year 2022.” 


Bureau of Indian Affairs – Missing and Murdered Indigenous Women 

  • Missing and Murdered Indigenous Women: $24.9 million  
  • “The Committee is concerned about the crisis of missing, trafficked, and murdered indigenous women that has plagued Native communities. Native American women face high rates of violence and the lack of data on the number of women and girls who go missing or murdered further complicates the Nation’s ability to address this crisis. The Committee recommendation includes both funding and directives under the Bureau of Indian Affairs and the Indian Health Service in order to improve the Federal response to this epidemic.”
      
  • Note: It is unclear at this time if UIOs would be eligible for the funding resources provided to IHS under this provision. 

Bureau of Indian Education – Native Boarding School Initiative 

  • Native Boarding School Initiative: $7 million 

“In June 2021, the Department announced an investigation into the Federal government’s past oversight of Native boarding schools. The past policies of forcing children into these schools tore families apart and led to a loss of culture and identity for generations of Native American youth. The Committee applauds the efforts of the Department to reexamine this era and looks forward to the findings. The bill provides $7,000,000 for these efforts.” 

   

Next Steps 

Congress is likely to pass another continuing resolution before the current spending expires on December 3, 2021. If Democrats quickly begin “top-line” budget negotiations, it’s possible they could pass an omnibus funding package in the Senate.  

NCUIH FY22 IHS URBAN INDIAN HEALTH BUDGET ANALYSIS

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NCUIH FY22 IHS Urban Indian Health Budget Analysis

The President’s request includes nearly 60% increase for urban Indian health and endorses the NCUIH UIO facilities fix.

WASHINGTON, DC (June 16, 2021) – Recently, on May 28, 2021, President Biden released the detailed annual budget proposal for Fiscal Year (FY) 2022. The proposal includes a total of $131.7 billion for the Department of Health and Human Services (HHS), which represents a nearly 23.5% increase to current enacted budget for FY21. The request includes $8.5 billion for the Indian Health Service (IHS), a $2.2 billion increase from FY21 and $100 million for urban Indian health, a nearly 60% increase. The request also endorses NCUIH’s priority fix for allowing urban Indian organizations to use existing IHS funding for facilities improvement and renovations.

The Tribal Budget Formulation Workgroup (TBFWG) requested the Administration to fund IHS at $12.759 billion with an urban Indian health line item of $200.5 million for FY22. These suggested increases were formulated to counteract failed Indian healthcare policies and to fulfill the federal trust obligations to all AI/ANs in the administration of healthcare to American Indian/Alaska Native (AI/AN) populations.

The Budget includes the following legislative proposals:

  • Exempt the IHS from discretionary sequester
  • Authorize Urban Indian Organizations to use their resources for facilities activities
  • Provide the IHS full discretionary use of Title 38 hiring authorities

The additional $2.2 billion requested for IHS will go towards promoting health equity for American Indians/Alaska Natives (AI/ANs) and include Urban Indian Organization (UIO) confer to evaluate options, including mandatory funding, to provide adequate, stable, and predictable funding for IHS in the future. The proposal also includes an advanced appropriation for IHS in FY23 to ensure a more predictable funding stream. NCUIH has long advocated for advanced appropriations for IHS to begin closing the funding disparities that have long hindered Indian Health Care Providers.

NCUIH looks forward to working with the Administration and Congress to fully fund IHS and the urban Indian Health line item. Congress will consider the President’s request as it begins to draft appropriations bills for FY 2022. The House Appropriations Committee will markup its bill on June 28, 2021.

Please find below a summary of some of the proposed funding amounts that would impact urban Indian health.

URBAN INDIAN LINE ITEM

  • The spending proposal recommends a funding level for the urban Indian Health line item at $100 million. This is an approximately $38 million increase from the FY 2021 enacted amount of $62 million, but it is approximately $100.5 million below the TBFWG FY22 recommendation of $200.5 million.

IHS

The President’s Budget for fiscal year 2022 includes a total discretionary budget authority of $8.5 billion, which is $2.2 billion or 36 percent above the enacted FY 2021 funding level.

This includes four accounts:

  • Services: $5.7 billion
  • Facilities: $1.5 billion
  • Contract Support Costs: $1.1 billion .
    • Remains an indefinite discretionary appropriation for fully funding CSC
  • Payments for Tribal Leases: $150 million
    • Remains an indefinite discretionary appropriation for fully funding the cost of section 105(l) leases
  • Contract Support Costs and Payments for Tribal Leases are proposed to shift to mandatory funding in FY 2023.

SERVICES AND FACILITIES

Funding Increases (Services & Facilities)

  • $207 million to fully fund Current Services
    • Offsets increasing costs due to pay, inflation, and population growth
  • $125 million for staffing and operating costs of newly-constructed healthcare facilities

Funding Increases (Hospitals and Health Clinics)

  • $190 million for a general program increase
  • $22 million for the Hepatitis C and HIV Initiative ($27 million total)
  • $20 million for the National Community Health Aide Program ($25 million total)
  • $27 million to offset the rising cost of HHS-wide assessments for information technology, human resources, financial management, and other activities

FACILITIES MAINTENANCE AND IMPROVEMENT

  • The President’s FY22 requested discretionary budget for Facilities Maintenance and Improvement is $222,924,000. This is a $53,952,0000 increase over the FY21 Enacted amount but remains $256,050,000 below the TBFWG requested of $478,974,000.Advanced Appropriations
  • Under advance appropriations, the IHS would request funding in two phases, comparable to the Veteran’s Health Administration. The first phase would address the amount necessary to maintain the current level of services and fully fund known costs, like staffing of new facilities. This amount that would be included for FY 2023 in the FY 2022 President’s Budget and appropriation.  In the second phase, the FY 2023 President’s Budget would address policy proposals that reflect input from Tribal and Urban Indian Organization leaders, as well as the Administration’s goals. While advance appropriations would provide the IHS funding for both FY 2022 and FY 2023, the funding for FY 2023 would not “score” against the discretionary funding caps until it became available in FY 2023.

SPECIAL DIABETES PROGRAM FOR INDIANS (SDPI)

  • Diabetes and its complications are major contributors to death and disability in nearly every Tribal community. AI/AN adults have the highest age-adjusted rate of diagnosed diabetes (14.7 percent) among all racial and ethnic groups in the United States, more than twice the rate of the non-Hispanic white population (7.5 percent).[1] In some AI/AN communities, more than half of adults 45 to 74 years of age have diagnosed diabetes, with prevalence rates reaching as high as 60 percent.[2]
  • The President’s budget also includes continued funding for the SDPI at $147 million. This is $3 million less than the enacted FY21 amount and $13 million less than FY22 TBFWG request. The Consolidated Appropriations Act, 2021 (P.L. 116-260) authorized SDPI until September 30, 2023. FY 2022 would be the 25th year of the SDPI.

105(I) LEASES

  • The FY 2022 budget adds $49 million for 105(l) leases for a total of $150 million. The TBFWG request of $337 million in FY 2022 for section 105(l) line item was to ensure that growing 105(l) lease costs are fully paid without impacting increases to other critical IHS line items. NCUIH opposes IHS action to unilaterally restrict ISDEAA authorities in the absence of Tribal consultation.

INDIAN HEALTH PROFESSIONS

  • The need for qualified mental health providers; in particular, the TBWFG voiced the difficulty in recruiting and retaining fulltime professionals to work and adapt to Native settings. Knowing of the need to grow Indian health professionals to fill this need, the TBWFG requested a nominal increase to $82,634,000. The President’s FY22 recommendation increases IHP to $92,853,000 million.  This is $25,539,000 above the FY21 enacted level and $10,219,000 million above the Tribal Budget Formulation Workgroup recommendation.

FACILITIES MAINTENANCE AND IMPROVEMENT

  • Current misinterpretations have halted the overall improvements and construction of  UIO facilities.  NCUIH continues to advocate for a substantial infrastructure investment within the UIO health system. Allowing the continued deterioration of critical health facilities goes against the mission of the Indian Health Service and Urban Indian Organizations to provide quality healthcare to all American Indians and Alaska Natives.We hope that once this facilities restriction is lifted that an amendment can be made to the Indian Health Improvement Act to add a line item for UIOs to use funding for facilities.
  • The President’s FY22 requested discretionary budget for Facilities Maintenance and Improvement is $222,924,000. This is a $53,952,0000 increase over the FY21 Enacted amount but remains $256,050,000 below the TBFWG requested of $478,974,000. “Facilities Renovation for Urban Indian Organizations to the extent Authorized for Other Government Contractors SEC. 433. The Secretary of Health and Human Services may authorize an urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)) Provides authority for IHS to make funds available to IHS-funded Urban Indian Organizations for minor renovations to facilities or construction or expansion of facilities, including leased facilities, to the extent authorized for other government contractor”.[3]

CENTERS FOR DISEASE CONTROL AND PREVENTION AND NATIONAL INSTITUTES OF HEALTH

  • The budget request would increase discretionary funding for the Centers for Disease Control and Prevention to $8.7 billion. This is a funding increase of $1.6 billion that would significantly affect the HHS core mission of preventing and controlling emerging public health issues.

Read the Full Analysis

[1] Centers for Disease Control and Prevention (CDC). National Diabetes Statistics Report 2020: Estimates of Diabetes and Its Burden in the United States. Atlanta, GA: U.S. Department of Health and Human Services; 2020. Available at: https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

[2] Lee ET, Howard BV, Savage PJ, et al. Diabetes and impaired glucose tolerance in three American Indian populations aged 45-74 years: the Strong Heart Study. Diabetes Care. 1995;18:599-610

President’s Budget Request Includes Nearly 60% Increase for Urban Indian Health

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President’s Budget Request Includes Nearly 60% Increase for Urban Indian Health
The FY 22 budget request includes $8.5 billion for IHS and $100 million for urban Indian health, a nearly 60% increase over the FY 21 enacted amount. WASHINGTON, DC (May 28, 2021)Today, May 28, the Biden Administration released the detailed annual budget proposal for Fiscal Year (FY) 2022. The proposal includes a total of $131.7 billion for the Department of Health and Human Services (HHS), which represents a nearly 23.5% increase to current enacted budget for FY21. The request includes $8.5 billion for the Indian Health Service (IHS) and $100 million for urban Indian health.

The National Council of Urban Indian Health (NCUIH) and the Tribal Budget Formulation Workgroup (TBFWG) requested the Administration to fund IHS at $12.759 billion with an urban Indian health line item of $200.5 million for FY 2022. These suggested increases were formulated to counteract failed Indian healthcare policies and to fulfill the federal trust obligations to Tribal Nations in the administration of healthcare to American Indian/Alaska Native (AI/AN) populations.

“For decades, urban Indian health has been severely underfunded even though more than 70% of American Indians and Alaska Natives reside in urban areas.  We are pleased to see the President’s inclusion of $100 million for urban Indian health in FY22, which represents an important step towards achieving full funding.  As the federal trust responsibility for health care follows all Natives off of reservations into the cities where many of us reside today, it is encouraging to see the Administration and Congress finally prioritizing the Indian health system with a significant increase in resources for next year,” said Francys Crevier.

On April 14, 2021, NCUIH submitted public witness written testimony to the House Appropriations Subcommittee on Interior, Environment, and Related Agencies regarding Fiscal Year (FY) 2022 funding for Urban Indian Organizations (UIOs).

On April 12, 2021, President Biden released his discretionary budget request for Fiscal Year FY 22, pending the more detailed IHS budget request released today, which includes specifics on the IHS budget request, including the funding recommendations for urban Indian health. The request includes $8.5 billion in discretionary funding for IHS, a $2.2 billion increase from FY21. The $2.2 billion increase for IHS will go towards promoting health equity for AI/ANs. The proposal also includes an advance appropriation for IHS in FY23 to ensure a more predictable funding stream.

Next Steps

Congress will consider President Biden’s request as it begins to draft appropriations bills for FY 2022.  A more in-depth analysis of the White House’s FY 2022 Budget is forthcoming.

Learn More

NCUIH Submits Written Testimony to Senate Interior Appropriations with FY22 Budget Requests for UIOs

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NCUIH Submits Written Testimony to Senate Interior Appropriations with FY22 Budget Requests for UIOs

The National Council of Urban Indian Health (NCUIH) CEO, Francys Crevier, submitted public witness written testimony to the Senate Appropriations Subcommittee on Interior, Environment, and Related Agencies regarding Fiscal Year (FY) 2022 funding for Urban Indian Organizations (UIOs) in response to the Subcommittee Hearing, Addressing Health Disparities in Indian Country: Review of the Indian Health Service’s COVID Response and Future Needs, held on April 28.

UIOs provide culturally competent health care to some of the 70% of American Indians and Alaska Natives (AI/AN) living in cities and are primarily funded by a single line item in the annual Indian health budget, which constitutes approximately 1% of the total Indian Health Service (IHS) annual budget. The devastating impact of the COVID-19 pandemic on Indian Country proved the dire need for increased funding and resources for UIOs, who have continuously provided services in the hardest hit urban areas during the entire pandemic.

In her testimony, NCUIH requested the following:

  • $200.5 million for Urban Indian Health for FY22
  • Include report language to allow use of facilities funding to UIOs
  • Advance appropriations for IHS
  • UIOs be insulated from unrelated budgetary disputes through a spend faster anomaly so that critical funding is not halted

These requests are essential to ensure that urban Indians are properly cared for and moves us closer to fulfilling the federal government’s trust responsibility to AI/ANs.

NEXT STEPS:

The testimony will be read and considered by the subcommittee as the appropriations process goes forward for Fiscal Year 2022. NCUIH previously submitted testimony to the House Appropriations Subcommittee on Interior regarding UIO funding for FY22.

On April 12, 2021 President Biden released his discretionary budget request for Fiscal Year (FY) 2022, pending a more detailed version in the coming months, which will include the funding recommendations for urban Indian health. This request includes $131.7 billion for the Department of Health and Human Services (HHS), a 23.5% increase from the 2021 enacted level, and $8.5 billion in discretionary funding for the Indian Health Service (IHS), a $2.2 billion increase from FY21. The Biden Administration is expected to release his comprehensive budget on May 27.

NCUIH Submits Written Testimony to House Interior Appropriations with FY22 Budget Requests for UIOs

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On April 14, the National Council of Urban Indian Health (NCUIH) CEO, Francys Crevier, submitted public witness written testimony to the House Appropriations Subcommittee on Interior, Environment, and Related Agencies regarding Fiscal Year (FY) 2022 funding for Urban Indian Organizations (UIOs).

UIOs provide culturally competent health care to some of the 70% of American Indians and Alaska Natives (AI/AN) living in cities and are primarily funded by a single line item in the annual Indian health budget, which constitutes less than 1% of the total Indian Health Service (IHS) annual budget. The devastating impact of the COVID-19 pandemic on Indian Country proved the dire need for increased funding and resources for UIOs, who have continuously provided services in the hardest hit urban areas during the entire pandemic.

In the testimony, NCUIH requested the following:

  • $200.5 million for Urban Indian Health for FY22
  • Include report language to allow use of facilities funding to UIOs
  • Advance appropriations for IHS
  • UIOs be insulated from unrelated budgetary disputes through a spend faster anomaly so that critical funding is not halted

These requests are essential to ensure that urban Indians are properly cared for and moves us closer to fulfilling the federal government’s trust responsibility to AI/ANs.

NEXT STEPS:

The testimony will be read and considered by the subcommittee as the appropriations process goes forward for Fiscal Year 2022.

Read the Full Testimony

Tribal Budget Formulation Workgroup Recommends $950 Million for Urban Indian Health in FY23

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Other priorities include funds for construction or expansion of urban facilities and UIOs inclusion in the nationalization of the Community Health Aide Program

On February 11-13, 2021, the Tribal Budget Formulation Workgroup (TBFWG) convened to develop the National Tribal Budget Recommendation for fiscal year (FY) 2023. In May 2021, a summary of the TBFWG’s Budget Recommendation was released in a document entitled Building Health Equity with Tribal Nations. The FY 2023 National Tribal Budget Recommendation for the Indian Health Service (IHS) is $49.8 billion, representing a 291% increase above the FY 2022 National Tribal Budget Recommendation planning base. The increase for IHS is a need-based funding aggregate cost based on the FY 2018 estimate of 3.04 million eligible AI/ANs eligible to be served by IHS, Tribal and Urban health programs.  The TBFWG stated, “Unfulfilled Trust and Treaty obligations results in American Indian and Alaskan Native people living sicker and dying younger than other Americans.”

The TBFWG recommended a $794.262 million increase for the urban Indian health line item, bringing the funding for Urban Indian Organizations (UIOs) to a total of approximately $950 million (a 373.8% increase above the FY 2022 planning base). In FY 2021, Urban Indian health received $62.7 million. For FY 2022, which has not been funded yet, the House approved $200.5 million for urban Indian health. While there is a long way to go to reaching the full level of need funding for urban Indian health, the increased level of commitment from Congress demonstrates progress for Indian health.

The IHS need-based funding aggregate cost estimate for FY 2023 is now approximately $49.8 billion, based on the FY 2018 estimate of 3.04 million eligible AI/ANs eligible to be served by IHS, Tribal and Urban health programs.

The TBFWG stated:

“As we inch closer to increased parity for urban Indians, it is imperative to highlight that up until the end of 2020 and beginning of 2021, UIOs have been deemed ineligible for cost-saving measures available to the other components of the IHS I/T/U system, including, among others, 100% Federal Medical Assistance Percentage (FMAP) for services provided at UIOs, reimbursement from the Department of Veterans Affairs (VA) for services provided to dually-eligible AI/AN Veterans, and liability coverage under the Federal Tort Claims Act (FTCA). Implementation of these hard-fought legislative victories at the agency level will require close attention to ensure that proper procedures and policies are put into place. Although these changes represent a step forward, associated issues remain. For example, UIOs will only remain eligible for 100% FMAP for two years and still are not receiving the IHS all-inclusive rate. Permanent policy fixes to address these issues are required.”

Other TBFWG priorities for Urban Indian Health were:

  • Funds for construction or expansion of urban facilities
  • UIOs inclusion in the nationalization of the Community Health Aide Program (CHAP)
  • No funding from Urban Indian Health line item withheld or reprogrammed from UIOs
  • Retain eligibility for IHS UIOs to participate in grant programs

In addition, the TBFWG recommended that dedicated funding be provided to implement the new authorities and provisions of the Indian Health Care Improvement Act (IHCIA); President’s Budget request for FY23 must include substantial, separate investments for Health IT modernization; Tribes, Tribal Programs, and UIOs be permanently exempt from sequestration and recissions; mandate advance appropriations for IHS; the Special Diabetes Program for Indians (SDPI) be permanently reauthorized and increase funding to $250 million per year; and federal agencies provide recurring funding to support public health infrastructure to address current and future public health emergencies.

About the IHS Budget Process and the Tribal Budget Formulation Workgroup:

The annual budget request of the IHS is the result of the budget formulation and consultation process that involves IHS, Tribal, and urban Indian health program representatives and providers from the local to the national level.

The TBFWG consists of two Tribal representatives from each of the 12 IHS Areas. Additional representatives from Indian organizations, participate in the workgroup at the discretion of the Director of IHS. The workgroup provides input and guidance to the IHS Headquarters budget formulation team throughout the remainder of the budget formulation cycle for that fiscal year. The workgroup prepares the final set of tribal budget recommendations with an accompanying testimony on the results of the national budget work session and presents to the IHS Director as well as to the HHS senior officials at the annual HHS Tribal Consultation meeting.

BIDEN FY22 BUDGET REQUEST INCLUDES ADVANCE APPROPRIATIONS AND $2.2 BILLION INCREASE FOR IHS

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BIDEN FY22 BUDGET REQUEST INCLUDES ADVANCE APPROPRIATIONS AND $2.2 BILLION INCREASE FOR IHS

On April 12, 2021 President Biden released his discretionary budget request for Fiscal Year (FY) 2022, pending a more detailed version in the coming months, which will include the funding recommendations for urban Indian health. This request includes $131.7 billion for the Department of Health and Human Services (HHS), a 23.5% increase from the 2021 enacted level, and $8.5 billion in discretionary funding for the Indian Health Service (IHS), a $2.2 billion increase from FY21. The additional $2.2 billion requested for IHS will go towards promoting health equity for American Indians/Alaska Natives (AI/ANs) and include Urban Indian Organization (UIO) consultation to evaluate options, including mandatory funding, to provide adequate, stable, and predictable funding for IHS in the future. The proposal also includes an advance appropriation for IHS in FY23 to ensure a more predictable funding stream.

In a press release on the budget, IHS Acting Director Elizabeth Fowler stated, “The budget request for the IHS is developed in close partnership with tribes, tribal organizations, urban Indian organizations, and other key stakeholders to ensure it reflects the evolving health needs of American Indian and Alaska Native people and communities.”

Background and Next Steps

NCUIH has long advocated for advance appropriations for IHS to begin closing the funding disparities that have long hindered AI/AN communities. NCUIH has also requested inclusion of UIOs for urban confer with a philosophy of “no policies about us without us”.

The Appropriations Committees will review the President’s Budget for consideration as they craft their bills for FY23. NCUIH has requested $200.5 million forFY23 for urban Indian health with at least $12.759 billion for the Indian Health Service in accordance with the Tribal Budget Formulation Workgroup (TBFWG) recommendations. NCUIH will continue to work with the Biden Administration and Congress to push for full funding of urban Indian health in FY22.

Overview of Budget Request

The budget request includes the following for health:

Department of Health and Human Services

  • $131.7 billion for HHS, a $25 billion or 23.5% increase from the 2021 enacted level

Indian Health Service

Centers for Disease Control and Prevention

  • $8.7 billion in discretionary funding, an increase of $1.6 billion over the 2021 enacted level
    • Promotes Health Equity by Addressing Racial Disparities
      • $153 million for CDC’s Social Determinants of Health program, an increase of $150 million over the 2021 enacted level, to support all States and Territories in improving health equity and data collection for racial and ethnic populations.
    • Advances the Goal of Ending the Opioid Crisis
      • $10.7 billion, an increase of $3.9 billion over the 2021 enacted level, to support research, prevention, treatment, and recovery support services, with targeted investments to support populations with unique needs, including Native Americans, older Americans, and rural populations.
    • Commits to End the HIV/AIDS Epidemic
      • $670 million, an increase of $267 million over the 2021 enacted level, to support the critical effort to end the HIV/AIDS epidemic in the United States. Investments in CDC, the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), and NIH aim to reduce new HIV cases aggressively while increasing access to treatment, expanding use of pre-exposure prophylaxis (also known as PrEP), and ensuring equitable access to services and supports.
    • Provides Funding to Reduce the Maternal Mortality Rate and End Race-Based Disparities in Maternal Mortality
      • $200 million to reduce maternal mortality and morbidity rates for Black and American Indian/Alaska Native women nationwide, bolster Maternal Mortality Review Committees, expand the Rural Maternity and Obstetrics Management Strategies program, help cities place early childhood development experts in pediatrician offices with a high percentage of Medicaid and Children’s Health Insurance Program patients, implement implicit bias training for healthcare providers, and create State pregnancy medical home programs.
    • Addresses the Public Health Epidemic of Gun Violence in America
      • $100 million for CDC to start a new Community Based Violence Intervention initiative—in collaboration with Department of Justice—to implement evidence-based community violence interventions locally in communities of color, as Black men make up six percent of the population but over 50 percent of gun homicide victims, and American Indians/Alaska Natives and Latinos are also disproportionately impacted.

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NCUIH Submits Written Testimony to House Interior Appropriations with FY22 Budget Requests for UIOs

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On April 14, the National Council of Urban Indian Health (NCUIH) CEO, Francys Crevier, submitted public witness written testimony to the House Appropriations Subcommittee on Interior, Environment, and Related Agencies regarding Fiscal Year (FY) 2022 funding for Urban Indian Organizations (UIOs).

UIOs provide culturally competent health care to some of the 70% of American Indians and Alaska Natives (AI/AN) living in cities and are primarily funded by a single line item in the annual Indian health budget, which constitutes less than 1% of the total Indian Health Service (IHS) annual budget. The devastating impact of the COVID-19 pandemic on Indian Country proved the dire need for increased funding and resources for UIOs, who have continuously provided services in the hardest hit urban areas during the entire pandemic.

In the testimony, NCUIH requested the following:

  • $200.5 million for Urban Indian Health for FY22
  • Include report language to allow use of facilities funding to UIOs
  • Advance appropriations for IHS
  • UIOs be insulated from unrelated budgetary disputes through a spend faster anomaly so that critical funding is not halted

These requests are essential to ensure that urban Indians are properly cared for and moves us closer to fulfilling the federal government’s trust responsibility to AI/ANs.

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The testimony will be read and considered by the subcommittee as the appropriations process goes forward for Fiscal Year 2022.

Read the Full Testimony