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NCUIH Submits Comments to the Indian Health Service on the Creation of an Urban Indian Interagency Workgroup

On September 12, 2022, the National Council of Urban Indian Health (NCUIH) submitted comments and recommendations to the Indian Health Service (IHS) regarding the formation of an Urban Interagency Workgroup with other federal agencies. The agency held an Urban Confer on July 13, in response to a letter sent to President Biden and Vice President Harris from several Senators, requesting the formation of such a workgroup. NCUIH supports the development of an Interagency Workgroup and believes that this would be a key step to increasing support and resources to American Indians/Alaska Natives (AI/ANs) living in urban areas.

NCUIH Recommendations to IHS

NCUIH noted in the comments that Tribes have a unique government-to-government relationship with the federal government and it is essential that any group does not disrupt this. Furthermore, NCUIH supports the federal government in its attempts to better uphold the trust responsibility it has to AI/ANs living in urban areas, which requires more complete involvement of urban Indian organizations (UIOs). However, this does not mean that resources and funding should come at the expense of Tribes. Rather, the government should broaden and deepen the services it provides to all AI/ANs while additionally further meeting the trust responsibility to urban-dwelling AI/ANs.

NCUIH provided the following recommendations to IHS in response to the Urban Confer:

  • Respect Tribal Sovereignty and the government-to-government relationship in the formation of an Interagency Workgroup.
  • Create a committee within the White House Council on Native American Affairs (WHCNAA) focused on how federal agencies can better serve AI/ANs living in urban areas.
    • The White House Council on Native American Affairs (WHCNAA) was established to improve outcomes for AI/AN communities through a stronger relationship between the federal government and Native people.
    • Developing an Interagency Oversight Committee on Urban Indian Affairs within WHCNAA would allow cross-collaboration across all agencies and ensure that all other WHCNAA committees are accurately incorporating urban Indian communities into their work.
  • IHS should provide technical assistance to federal agencies to develop Urban Confer policies.
    • Urban Confer policies or UIO-specific consultations do not supplant or otherwise alter Tribal Consultations and the government-to-government relationship between Tribes and federal agencies. IHS should provide support and assistance to federal agencies as they begin the development of such policies.

Background

The formation of an Urban Indian Interagency Work Group to identify the needs and develop strategies to better serve urban AI/AN populations has been a priority for NCUIH. On February 3, 2022, Senator Van Hollen, along with Senators Alex Padilla (D-CA), Catherine Cortez Masto (D-NV), Tina Smith (D-MN), Dianne Feinstein (D-CA), Elizabeth Warren (D-MA), Ed Markey (D-MA), Mark Kelly (D-AZ), Amy Klobuchar (D-MN), Patty Murray (D-WA), Tammy Baldwin (D-WI), Jacky Rosen (D-NV), Jeff Merkley (D-OR), and Jon Tester (D-MT) sent a letter to the Biden Administration requesting the establishment of this workgroup. NCUIH worked closely with Senator Padilla on this letter and supports the effort to bring better representation for the needs of AI/ANs who do not reside on Tribal land.

The Senate Appropriations Subcommittee directed IHS to continue to explore the formation of this interagency working group in its Fiscal Year 2023 Interior Appropriations bill, noting that “in addition to the Indian Health Service, the working group should consist of the U.S. Department of Health and Human Services, U.S. Department of Housing and Urban Development, U.S. Department of Agriculture, U.S. Department of Justice, U.S. Department of Education, U.S. Department of Veteran Affairs, U.S. Department of Labor, the Small Business Administration, the Economic Development Agency, FEMA, the U.S. Conference of Mayors, and others as identified by UIOs.”

The Work Group would help identify federal funding strategies to better address the needs of urban AI/ANs, advance the development of a wellness-centered framework to inform health services, strengthen support for practice-based traditional healing approaches, improve Urban Confer policies at Health and Human Services and associated agencies, and ensure that Urban Indian Organizations can regularly meet with federal agencies to address relevant topics of concern.

NCUIH will continue to monitor for any further development on the formation of an Urban Interagency Workgroup. NCUIH will also continue to engage with IHS, the White House, and Congress on moving this proposal forward.

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.

 

 

Government Accountability Office Calls on Agencies to Improve Information on Federal Funds for Native Communities and the Budget Formulation Process

On May 19, 2022, the Government Accountability Office (GAO) published a new report calling for immediate action to improve transparency for federal funding that benefits American Indians and Alaska Natives (AI/ANs), including AI/ANs living in urban areas. GAO found divergent interpretations of the Office of Management and Budget’s (OMB) guidance for identifying and providing information on federal funding related to the Native American crosscut. GAO also found that three of the agencies whose budgets are captured in the crosscut do not have formal processes for incorporating Tribal input into their budget proposals and do not develop budgets that reflects the needs of Tribes.  The report recommends seven key agency actions to improve budget formulation and reporting processes for programs that serve AI/AN communities, including urban Indian organizations (UIOs) and the 70 percent of AI/ANs living in urban areas.

The Native American Crosscut and The Beginning of GAO’s Investigation

GAO is an independent, nonpartisan federal agency tasked by Congress with examining how taxpayer dollars are spent and provides both Congress and federal agencies fact-based recommendations to help the government save money and work more efficiently. GAO reviews federal programs across a broad range of topics and concerns, including health care, education, economic development, environmental protection, justice, and infrastructure. Agency oversight supports federal efforts to uphold the trust responsibility.

The U.S. Commission on Civil Rights published a 2018 report detailing broken promises to AI/ANs, which recommended regular assessment of unmet needs for both urban and rural AI/AN communities. Shortly thereafter, GAO launched an investigation of agency failures to keep accurate, consistent, and comprehensive records of federal programs benefiting AI/ANs, and transparency mechanisms to facilitate monitoring of such funding. This included a review of consultation, data collection, and reporting practices at OMB. OMB serves as a clearinghouse for budget formulation and reporting across federal agencies and publishes the most comprehensive annual report of federal funding that benefits Native peoples across federal agencies, known as the Native American crosscut. GAO also investigated the extent to which pertinent agencies have formal processes for incorporating Tribal input when developing their budget proposals and the extent to which their budget proposals reflects Tribal needs

GAO’s Recommendations Regarding the Native American Crosscut and Budget Formulation

GAO published seven recommendations to improve federal practices related to budget formulation, data sharing, transparency, and oversight:

  1. The Director of OMB should issue clear guidance as part of the annual budget data request for the Native American Crosscut that directs agencies to provide detailed information about how they collected data to report and selected programs to include; and
  2. The Director of OMB should publish in the Native American Crosscut a statement of its purpose and detailed information that it receives from agencies in response to its budget data request; and
  3. The Director of OMB should establish a formal process to regularly solicit and assess feedback about the Native American Crosscut from tribal stakeholders and relevant federal agencies, and to incorporate such feedback into guidance; and
  4. The Secretary of Transportation should ensure that the Deputy Assistant Secretary for Intergovernmental Affairs develops a formal process to ensure meaningful and timely input from tribal officials when formulating budget requests and program reauthorization proposals for programs serving tribes and their members; and
  5. The Secretary of Education should ensure that the department develops a formal process to ensure meaningful and timely input from tribal officials when formulating budget requests for programs serving tribes and their members; and
  6. The Secretary of Agriculture should ensure that the Office of Tribal Relations and the Office of Budget and Program Analysis develop a formal process to ensure meaningful and timely input from tribal officials when formulating budget requests and program reauthorization proposals for programs serving tribes and their members; and
  7. The Director of OMB should update OMB’s annual budget guidance to direct federal agencies to assess, in consultation with tribes, tribal needs for federal programs serving tribes and their members, and submit this information as part of their publicly available budget documents.

Though the report did not provide explicit recommendations for the Department of Health and Human Services (HHS) or the Department of the Interior (DOI), GAO noted the failure to provide public notice in Indian Health Service budget formulation sessions and concerns that inclusion of urban Indian organizations in such processes remains discretionary.

In response to the published recommendations, OMB expressed overall agreement, shared general plans to better capture and report on funding that benefits Native peoples, and is currently considering new consultation recommendations. The Department of Transportation and the Department of Education agreed with the relevant recommendations, while the Department of Agriculture neither agreed nor disagreed.  DOI provided no comments.

NCUIH will continue to monitor ongoing efforts to improve the budget formulation process, and to provide updates to budget formulation and reporting practices across federal agencies.