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Indian Health Service Launches Voter Registration Pilot Program at Indian Health System Sites

On March 5, 2023, President Biden announced agency actions to make the voting process more accessible in alignment with recommendations made by the Native American Rights Fund (NARF). This included a new initiative at the Indian Health Service (IHS) piloting “high-quality voter registration services across five different IHS facilities before the end of 2023”.

Urban Indian Organization, Native Health is First Announced Site

The first facility to be announced under this pilot program was Native Health, located in Phoenix, Arizona. Vice President Kamala Harris made the announcement on October 23, 2023, by stating:

Native Health has been active in voting rights and dedicated to increasing Native participation in the voting process. In 2022, they distributed Get Out the Vote information at various events, invited guests for voting related discussions on their podcast, Native Talk Arizona, and highlighted the importance of voter registration through social media. As part of this pilot program and being a NVRA designated site, they will continue this work by ensuring anyone who steps into their clinic is provided with an opportunity to register to vote. This includes staffing their table and voter registration kiosk, which can be found at their Central location.

Presidential Actions Related to Promoting Access to Voting for Native Communities

On March 7, 2021, President Biden signed an Executive Order on Promoting Access to Voting. Within the Executive Order, he included a specific section, Section 10, establishing a Native American Voting Rights Steering Group. This section sets out specific responsibilities and recommendations for that Steering Group, including:

  1. Engaging in meaningful and robust consultation with Tribal Nations and Native leaders
  2. Studying best practices for protecting Native American voting rights and produce a report outlining recommendations, including:
    1. Increasing voter outreach, education, registration, turnout, voting access, and mitigating internet accessibility issues in Native communities;
    2. Increasing language access and assistance;
    3. Mitigating barriers by providing guidance on how to use Tribal government ID cards as valid voter ID cards;
    4. Facilitating collaboration between local election officials, Native communities, and Tribal election offices; and
    5. Addressing other areas identified during the consultation process.

Voting as a Social Determinant of Health

These steps towards protecting voting rights are important outside of the political context because they can have a direct impact on health. Voting as a Social Determinant of Health has been acknowledged by the American Medical Association (AMA), and was included in their resolution from  2022, “Support for Safe and Equitable Access to Voting.” Social Determinants of Health are nonmedical factors that influence health outcomes, often the conditions or systems that shape conditions of daily life.

The AMA has identified that “more voting is associated with better health outcomes.” This is also reflected through research, where it’s noted that health disparities create gaps in voter participation, which influences biased health policy, and reinforces the same health disparities that prevent people from voting. Since voting is a tool to have voices heard about issues and preferred policies, without engagement from all constituents, those with important needs go unheard and are left out of the process. For health, this means the conditions impacting one’s health remain unchanged and continue to lack the political support needed to address them.

Native American Rights Fund Recommended Included Integration with IHS Facilities

Before this announcement, the NARF touched on the issue of obtaining National Voter Registration Act (NVRA) designation, as it has support throughout the Native community. Specifically, NARF noted that “by integrating voter registration services into their regular interactions with patients, IHS and 638-compacting facilities can leverage their significant reach and critical role in Indian country to move us closer to a democracy in which all communities are valued and thrive.”

NCUIH Staff Member Visits Oklahoma City Indian Clinic

NCUIH’s Federal Relations Manager, Alexandra Payan, recently visited the Oklahoma City Indian Clinic (OKCIC),  which has provided extensive health and social services to AI/ANs living in Oklahoma City for almost 50 years. Ms. Payan toured the facilities and met with OKCIC Executive Director, Robyn Sunday-Allen and Vice-President of Policy, Diabetes and Prevention, Michelle Dennison. Ms. Sunday-Allen also serves as Vice-President of NCUIH’s Board of Directors. Ms. Payan and OKCIC leadership discussed upcoming projects for the OKCIC, including breaking ground on the new women’s health and pediatric facility OKCIC purchased last year and continued expansion for the growing facility that serves over 22,000 patients from over 200 federally recognized Tribes each year. During the tour, Ms. Payan was also able to see the facility’s demonstration kitchen where they host classes for all ages through their healthy eating/nutrition program.

NCUIH is excited to see the great work OKCIC is doing for their community and looks forward to the many new projects ahead!

OKCIC’s Demonstration Kitchen

OKCIC’s Demonstration Kitchen

OKCIC’s Michelle Dennison and NCUIH’s Alexandra Payan

OKCIC’s Michelle Dennison and NCUIH’s Alexandra Payan

NCUIH Releases “2022 Annual Policy Assessment”

The Policy assessment informs urban Indian organization policy priorities in 2023, identifies traditional healing barriers, and addresses mental and behavioral health needs.

2022 Policy Assessment thumbnailThe National Council of Urban Indian Health (NCUIH) is pleased to announce the release of its 2022 Annual Policy Assessment. NCUIH hosted five focus groups to identify Urban Indian Organization (UIO) policy priorities for 2023, as they relate to the Indian Health Service (IHS) designated facility types (full ambulatory, limited ambulatory, outreach and referral, and outpatient and residential). The focus groups were held on October 18, 21, and 24, 2022. Additional information was also collected from the UIOs via a questionnaire sent out on November 15, 2022.

Together these tools allow NCUIH to work with UIOs to identify policy priorities in 2023 and identify barriers that impact delivery of care to Native patients and their communities.  Of 41 UIOs, 26 attended the focus groups and/or participated in the questionnaire. This is the third year that NCUIH has conducted the assessment via focus groups and follow up questionnaire. This is also the highest response from UIOs NCUIH has seen since following this process.

Overview of Policy Assessment

2022 Policy Assessment chartAfter the height of the COVID-19 pandemic, newfound priorities were identified for 2023, including workforce development and retention, increased funding for traditional healing, and expanded access to care and telehealth services. Existing priorities also remain a key focus across UIOs, especially increasing funding amounts for the urban Indian health line item and IHS, maintaining advance appropriations for IHS, establishing permanent 100% Federal Medical Assistance Percentage (FMAP) for UIOs, reauthorizing the Special Diabetes Program for Indians (SDPI), and increasing behavioral health funding.

 

Key findings from the discussions are as follows:

  • Funding Flexibility is Key to Expanding Services
  • Need for Funding Security Remains a Priority
  • Advance Appropriations Mitigates Funding Insecurities Generated by Government Shutdowns and Continuing Resolutions
  • Facility Funding Directly Impacting UIOs
  • Permanent 100% FMAP Increases Available Financial Resources to UIOs
  • Workforce Concerns Amidst Inflation and Market Changes
  • Traditional Healing Crucial to Advance Comprehensive Native Healthcare
  • Addressing Access and Quality of Native Veteran Care
  • Health Information Technology and Electronic Health Record Modernization
  • New Barriers Limit UIO Distribution of Vaccines
  • HIV, Behavioral Health, and Substance Abuse Report
  • Reauthorizing the Special Diabetes Program for Indians
  • UIOs Find Current NCUIH Services Beneficial

Next Steps

NCUIH will release a comprehensive document of the 2023 Policy Priorities in the coming weeks.

Past Resources:

NCUIH Bill Helps Urban Indian Organization Purchase New Building for Women’s Health and Pediatric Services

In October 2022, the Oklahoma City Indian Clinic (OKCIC), one of the 41 Urban Indian Organizations (UIOs) serving the more than 70% of American Indian and Alaska Native (AI/AN) individuals living in urban areas, announced their purchase of a new clinic building in Oklahoma City, Oklahoma. “This building is larger than our other locations” says Oklahoma City Indian Clinic’s Chief Operating Officer Lysa Ross. “The extra space will give us more opportunities to expand services and continue providing excellent health care to American Indians.” In 2021, The National Council of Urban Indian Health (NCUIH) worked tirelessly to include the Padilla-Moran-Lankford Urban Indian Health amendment to the bipartisan infrastructure package which allows UIOs to use existing Indian Health Service (IHS) funding for facilities improvement and renovations.

The clinic plans to renovate the nearly 65,000 square foot structure, with six-stories, to hold primarily women’s health and pediatric services. Their pediatric department offers several specialty clinics, including an asthma and a foster care clinic. Well-child visits, same-day visits, physical examinations, immunizations, and vision and hearing checks will also be procedures provided in the new building. The women’s health department at Oklahoma City Indian Clinic offers birth control, preventative health and wellness services and prenatal care, including delivery options.

The new building is still undergoing renovations, but OKCIC plans to see patients at this new location in 2023.

Background

NCUIH has worked on a bipartisan basis for legislation that that would expand 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 UIOs. In August 2021, NCUIH successfully advocated for the Padilla-Moran-Lankford Urban Indian Health Amendment to be included in the bipartisan infrastructure package, which allows UIOs to use existing IHS funding for infrastructure projects.

Prior to the passage of the bipartisan infrastructure package with this amendment, IHS did not have funding allocated specifically for use toward UIO facilities, maintenance, sanitation or medical equipment, nor could UIOs use their contract funds to make such purchases or payments. At the height of the pandemic, while the whole IHS system transitioned to telehealth, negative pressurizing rooms and other facility renovations that were needed to safely continue to see patients, restrictions within the relevant statutory text would not allow UIOs to spend their funds to make similar such transition. Section 509 of the Indian Health Care Improvement Act (IHCIA), where the technical fix this amendment provided exists, only allowed IHS to provide UIOs with funding for minor renovations and to assist UIOs in meeting or maintaining compliance with The Joint Commission (TJC) accreditation standards.

Prior to the passage of the Padilla-Moran-Lankford amendment, in May, Congressmen Ruben Gallego (D-AZ) and Don Bacon (R-NE) introduced the Urban Indian health Facilities Provider Act (H.R. 3496) in the House of Representative, expanding the use of existing IHS resources under Section 509 to increase the funding authority for renovating, constructing, and expanding UIOs. An identical bill was introduced at the same time in the Senate (S. 1797) by Senators Alex Padilla (D-CA) and James Lankford (R-OK), with initial co-sponsors including Senators Moran (R-KS), Feinstein (D-CA) and Smith (D-MN) who is on the Senate Committee on Indian Affairs.

NCUIH also testified in support of the Urban Indian health Facilities Provider Act before both the House Natural Resources Subcommittee for Indigenous Peoples of the United States (SCIP) and the Senate Committee on Indian Affairs (SCIA) in May of 2021. Sonya Tetnowski (Makah Tribe), Chief Executive Officer of the Indian Health Center of Santa Clara Valley and the NCUIH President-Elect at the time of the hearing, testified before SCIP, and Robyn Sunday-Allen (Cherokee), Chief Executive Officer of the Oklahoma City Indian Clinic and NCUIH Vice President, testified before SCIA.

NCUIH Comments on the IHS Urban Indian Infrastructure Study

On August 23, 2022, the National Council of Urban Indian Health (NCUIH) submitted comments regarding additional funding for the Urban Indian Infrastructure Study (Infrastructure Study) provided by the Consolidated Appropriations Act, 2022. The additional fiscal year (FY22) funding for the Infrastructure Study is approximately $800,696. NCUIH supports the appropriation of the additional funding and it recommended that IHS disseminate the findings of the FY21 Infrastructure Study, already in progress, to UIOs prior to making any decisions regarding the use of the additional funding. NCUIH also requested that the Office of Urban Indian Health Programs (OUIHP) create a timeline of when the Infrastructure Study will be released to UIOs, the contracting process necessary to use additional funding, and the deadline for obligation of the additional funding. Lastly, NCUIH requested that IHS host an additional Urban Confer after the release of updates about the scope and results of the FY21 Infrastructure Study.

Background

In 2021, Congress allocated $1 million in funds for IHS to conduct an Urban Indian Infrastructure study through the Consolidated Appropriations Act, 2021. The purpose of the Infrastructure Study is to further understand the most critical deficiencies facing UIOs. IHS contracted with The Innova Group, a healthcare consultancy entity, to conduct the Infrastructure Study.

On March 15, 2022, Congress provided $800,969 in additional funding to IHS for the Infrastructure Study through the Consolidated Appropriations Act, 2022. As of September 2022, the results from the Infrastructure Study have not been released by IHS and The Innova Group. On June 16, 2022, IHS requested input regarding the additional funding from 2022 and how these funds can be utilized by IHS. On June 23, 2022, UIO Leaders and NCUIH attended an Urban Confer where IHS explained that the Infrastructure Study will be completed by December 31, 2022, with results to be released in January 2023.

NCUIH’s Recommendations to IHS

NCUIH made the following recommendations regarding the Infrastructure Study:

  • Provide UIOs with the findings from the first Infrastructure Study prior to making any decisions regarding use of the additional funds
    • It is crucial that UIOs are aware of the scope, results, and usefulness of the Infrastructure Study before they make any recommendations regarding the use of the further funding.
    • Given the timeline presented during the Urban Confer, there should be an 8-month window in which UIOs and IHS will be able to review the Infrastructure Study results following their release in January 2023 and decide as to the best use of the additional funding
  • OUIHP should provide a timeline of the Planning Process to UIOs
    • NCUIH requested a timeline be released to UIOs delineating when the initial Infrastructure Study will be released, the contracting process necessary to use the additional funding, and the deadline for the obligation of the additional funding.
    • The requested timeline will provide clarity to UIOs. With a clearer picture in mind, the planning process and use of the additional FY22 funds for the Infrastructure Study becomes more cooperative between UIOs and IHS.
  • IHS should host an additional Urban Confer after releasing the results of the Infrastructure Study.
    • NCUIH notes that informed feedback from UIOs creates a scenario where the additional funding can be best used to support the needs of UIOs.

NCUIH continues to advocate for transparency in the process of the Infrastructure Study and greater support to address the critical infrastructure needs at UIOs. NCUIH will continue to keep UIOs informed as more information is made available from IHS.