Tag Archive for: Veterans

White House 2023 Progress Report for Tribal Nations Highlights Commitment to Supporting Urban Native Communities

The Biden-Harris Administration released the 2023 Progress Report for Tribal Nations (“Progress Report”) during the December 6-7, 2023, White House Tribal Nations Summit. The Progress Report touches on several areas of concern to urban Indian organizations (UIOs) as discussed in the National Council of Urban Indian Health’s (NCUIH) 2023 Policy Priorities. The Progress Report also highlights work done in partnership with UIOs, such as initiatives addressing Missing and Murdered Indigenous Peoples (MMIP), Native Veteran Health and Homelessness, Mental Health, Health Information Technology (HIT) Modernization, and Reproductive Health Care.

Successes with Urban Native Communities Highlighted MMIP

In January 2023, The Department of Health and Human Services (HHS) submitted the MMIP Prevention, Early Intervention, and Victim and Survivor Services Plan to the White House Domestic Policy Council and to the President. Developed in consultation with the Department of the Interior, Tribal Nations, research and community-based organizations and UIOs, it is a comprehensive plan to support prevention efforts that reduce risk factors for victimization of Native Americans and increase protective factors, including by enhancing the delivery of services for Native American victims and survivors as well as their families and advocates.

Native Veterans

In support of the Native American Veterans Homelessness Initiative, VA and other federal agencies engaged with UIOs to support and offer resources to AI/AN Veterans experiencing homelessness. The Initiative took the following actions in 2023:

  • VA and Indian Health Service (IHS) developed an informational brochure for Native American veterans experiencing homelessness and distributed these brochures to UIOs, IHS facilities, and external partners across the country.
  • VA and IHS developed and launched an interagency interactive map of UIOs and VA healthcare systems with points of contact information in June 2023.
  • VA developed and implemented training webinars for UIOs to raise awareness of VA homeless programs among Native American veterans and to build or increase effective, responsive, and collaborative relationships between UIOs and VA.
  • VA and various UIOs collaborated on Stand Down events in Seattle, Phoenix, Los Angeles, Albuquerque, and soon Alaska. These one-to-three-day events bring VA staff and volunteers together to provide food, clothing, and health screenings to homeless and at-risk veterans and receive referrals for healthcare, housing solutions, employment, substance use treatment, mental health counseling, and other essential services.

The Veterans Health Administration amended its medical regulations to implement a statute exempting eligible Indian and urban Indian veterans from copayment requirements. This change is based on a requirement within the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020. As of October 2023, 2,674 Native veterans have been approved for the copayment exemption, with copayment cancellations totaling just over $1.5 million.

Mental Health

HHS announced a new $35 million grant opportunity, enabled by the Bipartisan Safer Communities Act, to better support the 988 Suicide and Crisis Lifeline services in Tribal communities. One of the aims of the program is to facilitate collaborations between Tribal, state, and territory health providers, UIOs, law enforcement, and other first responders in a manner that respects Tribal sovereignty.

HIT Modernization

Throughout the process for selecting the new Electronic Health Record (EHR) vendor, IHS coordinated with Tribal and urban Indian organization partners through extensive Tribal engagement via Tribal consultations, listening sessions, urban confers, advisory committee meetings, an Industry Day, and the participation of hundreds of Tribal, urban Indian, and IHS system users in vendor product demonstrations. IHS ultimately awarded a 10-year contract to General Dynamics Information Technology to build, configure, and maintain a new enterprise EHR system utilizing Oracle Cerner technology.

Reproductive Health Care

In response to President Biden’s Executive Order on Strengthening Access to Affordable, High-Quality Contraception and Family Planning Services, IHS added new over-the-counter contraception options to the IHS National Core Formulary, which will expand access to high-quality contraception for patients. IHS encouraged Tribally or UIO operated IHS facilities to make the same options available to patients.

VA Responds to Advisory Committee on Tribal and Indian Affairs’ Recommendations to Improve Native Veteran Health

The Department of Veterans Affairs (VA) released its consolidated responses to VA’s Advisory Committee of Tribal and Indian Affairs’ (ACTIA) November 2022 recommendations to VA Secretary Dennis McDonough regarding improvements to VA’s programs and services to better serve Native American veterans. These recommendations were finalized during the November 8-11, 2022, ACTIA Meeting and included several recommendations to improve the delivery of health services to Native veterans living in urban areas. These included suggestions regarding interagency collaboration under the Veteran Health Administration-Indian Health Service (VHA-IHS) memorandum of understanding (MOU), development of a VA Urban Confer policy, use of traditional healing practice for American Indian and Alaska Native (AI/AN) veterans, data on urban veteran behavioral health, and urban veteran homelessness. VA’s responding is a crucial step toward achieving the goal of supporting AI/AN veterans as whole people and meeting their needs.

Background on the ACTIA

The Committee was established in accordance with section 7002 of Public Law 116- 315 (H.R.7105 – Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020). Pursuant to Public Law 116-315, the Committee provides advice and guidance to the Secretary of Veterans Affairs on all matters relating to Indian Tribes, tribal organizations, Native Hawaiian organizations, and Native American Veterans. The Committee serves in an advisory capacity and, at least once a year, the Committee must submit recommendations to the Secretary of Veterans Affairs and relevant Congressional committees concerning legislative or administrative action to improve programs and services of the Department to better serve Native American Veterans.

Alongside partners from throughout Indian Country, the National Council of Urban Indian Health (NCUIH) played a critical role in getting this legislation passed in 2020. In a December 4, 2020 letter NCUIH signed with other National Native organizations regarding the ACTIA, NCUIH emphasized the importance of establishing the ACTIA to improve programs and services for Native veterans.

NCUIH subsequently nominated NCUIH’s Board President, Ms. Sonya Tetnowski, to the ACTIA, where she serves as the Chair of the Health Subcommittee. Ms. Tetnowski is the CEO of the Indian Health Care Center of Santa Clara Valley and is an Army veteran.

Recommendations and Responses

The ACTIA submitted eleven recommendations to VA to improve the care of AI/AN veterans. NCUIH is highlighting VA’s response to five of those recommendations below. To read the full response, click here.

Recommendation 1C: Interagency Collaboration Under VHA-IHS MOU

VA Office of Tribal Government Relations (OTGR), Veterans Health Administration (VHA) Office of Tribal Health (OTH) and the Office of Rural Health concur in principle with the ACTIA recommendation to require annual partnership between Veterans Integrated Services Network Directors and at least one Indian Health Service (IHS), Tribal, Urban or Native Hawaiian Health program to meet a specific goal or objective as described in the current Veterans Health Administration (VHA) – IHS Memorandum of Understanding (VHA-IHS MOU). ACTIA recommended that this be implemented in FY 2023. OTGR, VHA OTH, and the Office of Rural Health recommend that Network Directors submit an annual report to the Executive Committee of the VHA/IHS MOU Interagency Workgroup documenting compliance with this recommendation. The VHA-IHS MOU Interagency Workgroup will then provide an annual summary report of these efforts to VA’s ACTIA.

Recommendation 1D: Urban Confer Policy

The ACTIA recommended that  VA develop an Urban Confer Policy in order to partner with UIOs more effectively in their provisions of health services of Native Veterans in urban areas.  The ACTIA stated that this recommendation should be implemented by December 2023.

VA will research the processes and authorities used by other federal agencies to create the urban confer policy that ACTIA recommended.

Recommendation 3A: Behavioral Health/Suicide Prevention

The ACTIA recommended that VA provide information on its efforts to collect data on:

(1) Veteran suicides that occur on tribal lands which can be included in the VA/IHS MOU operational plan; and

(2) AI/AN Veteran suicides that occur in urban areas.

The ACTIA stated that data concerning urban city in which Native Veteran suicides occur needs greater specificity to address issues such as how VA defines rural and urban. The ACTIA recommended VA begin collecting data by October 2023, publish its first report by October 2024, then annually publish the results at the beginning of each fiscal year thereafter in October of each calendar year.

VA stated that it supports the goals of this recommendation and requested the opportunity to discuss and coordinate regarding avenues for enhancing available data sources to broaden accurate and reliable reporting on suicides among AI/AN Veterans. VA stated that it is not aware of resources needed to identify whether Veteran suicide deaths occur on tribal lands and that Veteran suicide deaths are identified from joint VA/Department of Defense searches of the Centers for Disease Control and Prevention’s National Death Index (NDI). VA OTGR and VHA OTH will provide a plan of action by the end of the second quarter of FY 2024.

Recommendation 3B: Cultural Healers/Natural Helpers

As part of the ACTIA recommendations regarding cultural healers/natural helpers, the ACTIA recommended VA, incorporating input gathered in tribal consultation and urban confer, amend VA policy and relevant VHA Directives to champion and/or allow the use of traditional healing as a legitimate and evidence-based practice that promotes the wellbeing of American Indian, Alaska Native and Native Hawaiian Veterans. It stated that VA should complete this recommendation by October 2024.

VA responded by stating that VHA looks forward to supporting evidence-based traditional healing in alignment with VHA’s Whole Health System of Care. VA also stated that VHA suggested changes to language in this recommendation.

Recommendation 3C: Homelessness as a Health Disparity

The ACTIA recommended that VHA Homeless Programs Office (HPO) amend its Strategic Plan to target a 5% increase in Stand Downs located on tribal lands, rural communities, Native Hawaiian communities and in urban areas with a high population of AI/ANs.

It also recommended that VA should:

  • Create objectives in the operations plans of each region to ensure the target increase percentage in Stand Downs can be met.
  • Provide quarterly updates with information on progress made or a justification for why the goal was not reached.
  • Gather information on the number of American Indians, Alaska Natives and Native Hawaiians that attend each event, including their tribal affiliation.
  • Complete this recommendation by October 2025.

VA staff will ensure that messaging is provided to the Bureau of Indian Affairs when an event is planned, apply for VA specific purpose funding for local Stand Down events and work collaboratively with local providers to gather information on the number of American Indians, Alaska Natives and Native Hawaiians that attend each event, including their tribal affiliation.

VA stated that it is committed to increasing the number of Stand Downs in targeted areas with high populations of AI/AN. Starting in FY 2023, VA will begin sharing stand down data with the ACTIA.

VHA HUD-VA Supportive Housing agrees with the replacement of BIA with “IHS, Urban Indian Organizations and Tribal Health Programs.”

VHA Homeless Program Office (HPO) will:

  • encourage UIOs, IHS, and where appropriate, tribes to participate in existing stand down development and implementation.
  • collaborate with and support UIOs, IHS and tribes interested in developing Stand Downs.
  • provide an educational and outreach tool (VHA stand down presentation) it has developed to assist UIOs and IHS in developing tribal specific stand downs.

VHA HPO would recommend that Tribes who are interested in tribal specific Stand Downs request the assistance of VA OTGR.

For information on Stand Down events, please click here.

Next Steps

The National Council of Urban Indian Health (NCUIH) welcomes the VA’s response to the ACTIA’s recommendations. The ACTIA recommendations provide tangible programmatic changes that VA can make to better serve Native veterans. NCUIH looks forward to continuing to work with the ACTIA and VA to advance these changes and ensure that Native veterans have access to the benefits and services that the earned through their military services.

House Passes NCUIH-Endorsed Bipartisan Bill that Improves Home and Community-Based Services for Native Veterans, Includes Collaboration with Tribal Programs and Urban Indian Organizations

On December 5, 2023, the House passed the National Council of Urban Indian Health (NCUIH)-endorsed legislation, the Elizabeth Dole Home-and Community-Based Services for Veterans and Caregivers Act of 2023 (H.R. 542) with a vote of 414-5. The bill has now been received in the Senate. The original sponsor, Rep. Julia Brownley (D-CA-26) reintroduced this bipartisan legislation on January 26, 2023, which would direct the Department of Veterans Affairs (VA) to expand options for long-term home and community services. The bill also directs the VA to collaborate with the Director of the Indian Health Service (IHS) and representatives from tribal health programs and Urban Indian Organizations (UIOs) to ensure the availability of home-and community-based services for Native American veterans, including Native American veterans receiving health care and medical services under multiple health care systems. The bill currently has 63 Democrat and 13 Republican co-sponsors.

Specifically, the bill expands existing Home and Community Based Services (HCBS):

  1. The Veteran Directed Care Program, which provides veterans a flexible budget to hire friends, family, and neighbors to help with activities of daily living, such as bathing, or instrumental activities of daily living, such as making meals.
    1. The bill directs the VA Secretary to ensure the availability of the program for eligible veterans who are Native American veterans receiving care and services furnished by the Indian Health Service, a tribal health program, an Urban Indian organization, or (in the case of a Native Hawaiian veteran) a Native Hawaiian health care system, to the extent practicable.
  2. The Homemaker and Home Health Aide Program, which allows VA to contract with a community partner that employs home health aides to care for veterans in their homes, providing skilled services, case management, help with daily living, or to ease caregiver burnout.
  3. The Home-Based Primary Care Program, which allows for a VA physician to supervise a health care team that provides care in the veteran’s home for a veteran who has difficulty traveling or is isolated.
  4. The Skilled Home Health Care Program, which allows for VA to contract with a community health agency to provide in-home care for veterans who have higher levels of need like wound care, speech therapy, or skilled nursing.

Every veteran should have the right to a peaceful and dignified life after their service to our country, and every veteran should have the right to stay in their home and receive the care they need, the care they have earned, and the care they deserve.” – Congresswoman Julia Brownley (D-CA)

Background on Native Veterans

Native Veteran Disparities 

Native veterans have served in the United States military in every armed conflict in the Nation’s history and have traditionally served at a higher rate than any other population in the United States. Unfortunately, Native veterans suffer significant disparities when they transition to civilian life. For example, Native veterans are more likely to be uninsured and have a service-connected disability than other veterans. Native veterans suffer these disparities no matter where they live. Native veterans living in urban areas experience the same poor physical and mental health outcomes as Native veterans in rural areas. In addition, urban Native veterans generally have lower incomes, higher unemployment, lower education attainment, higher VA-service connected disability, and generally live in poorer housing conditions than non-Native urban veterans.

Urban Indian Organizations Provide Culturally Competent Care for Native Veterans

UIOs are essential partners in serving Native veterans and are vital to improve care and access to services for Native veterans because of their deep ties to the Native community in urban areas. UIOs currently serve seven of the ten urban areas with the largest Native veteran populations, including the following areas: Phoenix, Arizona; Los Angeles, California; Seattle, Washington; Dallas, Texas; Oklahoma City, Oklahoma; New York City, New York; and Chicago, Illinois.

UIOs are uniquely positioned to assist the VA in improving culturally competent healthcare access for Native people. As such, this partnership has the potential to improve the quality of care and well-being to Native veterans in urban areas, but it is also consistent with the United States’ trust responsibility to provide services and resources to improve the health of all Native people.

Next Steps

This bill has been received in the Senate. NCUIH will continue to monitor the bill’s progress.

Department of Veterans Affairs Seeks Nominations for Membership on the Advisory Committee on Tribal and Indian Affairs for California and Nashville Areas

The Department of Veterans Affairs (VA) Office of Tribal Government Relations (OTGR) is seeking nominations of qualified candidates to be considered for appointment as a member of the Advisory Committee on Tribal and Indian Affairs (“the Committee”) to represent the following Indian Health Service (IHS) Areas: California; Nashville. Nominations for membership on the Committee must be received no later than 5:00 PM Eastern on October 20, 2023, and should be mailed to OTGR at 810 Vermont Ave. NW, Suite 915H (075) or emailed to tribalgovernmentconsultation@va.gov. UIOs are encouraged to work with local Tribes and Tribal organizations to identify local American Indian and Alaska Native veterans for nomination. The Committee is an important opportunity to uplift the voices of American Indian and Alaska Native veterans no matter where they reside.

Please see NCUIH’s previous blog for more information on the Committee and nomination requirements.

For further information, contact Peter Vicaire (Peter.Vicaire@va.gov), Office of Tribal Government Relations, 810 Vermont Ave. NW, Ste. 915H (075), Washington, DC 20420. A copy of the Committee charter can be obtained by contacting Peter Vicaire at 612–558–7744 or accessing the website managed by OTGR at: https://www.va.gov/​TRIBALGOVERNMENT/​index.asp.

Department of Veterans Affairs Seeks Nominations for Membership on the Advisory Committee on Tribal and Indian Affairs

The Department of Veterans Affairs (VA) Office of Tribal Government Relations (OTGR), is seeking nominations of qualified candidates to be considered for appointment as a member of the Advisory Committee on Tribal and Indian Affairs (“the Committee”) to represent the following Indian Health Service (IHS) Areas: Bemidji; California; Great Plains; Nashville; Navajo; Tucson. Nominations for membership on the Committee must be received no later than 5 p.m. EST on August 21, 2023, and should be mailed to OTGR at 810 Vermont Ave. NW, Suite 915H (075) or emailed to tribalgovernmentconsultation@va.gov. Individuals interested in participating in this Committee and who are located in the open IHS areas should work with local tribes and tribal organizations to be nominated.

Requirements for Nomination Submission:

Nominations should be typewritten (one nomination per nominator). The nomination package should include:

(1) a letter of nomination that clearly states the name and affiliation of the nominee, the basis for the nomination (i.e., specific attributes which qualify the nominee for service in this capacity), and a statement from the nominee indicating a willingness to serve as a member of the Committee;

(2) the nominee’s contact information, including name, mailing address, telephone number(s), and email address;

(3) the nominee’s curriculum vitae or resume, not to exceed five pages; and

(4) a summary of the nominee’s experience and qualification relative to the professional qualifications criteria outlined by the VA (diversity in professional and personal qualifications; experience in military service and military deployments; current work with Veterans; committee subject matter expertise; and experience working in large and complex organizations).

The nominee must also appear to have no conflict of interest that would preclude membership. An ethics review is conducted for each selected nominee.

The individual selected for appointment to the Committee shall be invited to serve a two-year term. All members will receive travel expenses and a per diem allowance in accordance with the Federal Travel Regulations for any travel made in connection with their duties as members of the Committee. For more information, contact Ms. Stephanie Birdwell and/or Mr. Peter Vicaire, Office of Tribal Government Relations, 810 Vermont Ave., NW, Ste 915H (075), Washington, DC 20420. A copy of the Committee charter can be obtained by contacting Peter.Vicaire@va.gov (612-558-7744) or by accessing the Web site managed by OTGR at: https://www.va.gov/TRIBALGOVERNMENT/index.asp.

Background

The Committee was established in accordance with section 7002 of Public Law 116- 315 (H.R.7105 – Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020). In accordance with Public Law 116-315, the Committee provides advice and guidance to the Secretary of Veterans Affairs on all matters relating to Indian Tribes, tribal organizations, Native Hawaiian organizations, and Native American Veterans. The Committee serves in an advisory capacity and makes recommendations to the Secretary on ways the Department can improve the programs and services of the Department to better serve Native American Veterans.

In carrying out its duties, the Committee’s responsibilities include, but are not limited to:

(1) Identifying for the Department’s evolving issues of relevance to Indian Tribes, tribal organizations and Native American Veterans relating to programs and services of the Department;

(2) Proposing clarifications, recommendations and solutions to address issues raised at tribal, regional and national levels, especially regarding any tribal consultation reports;

(3) Providing a forum for Indian Tribes, tribal organizations, urban Indian organizations, Native Hawaiian organizations and the Department to discuss issues and proposals for changes to Department regulations, policies and procedures;

(4) Identifying priorities and provide advice on appropriate strategies for tribal consultation and urban Indian organizations conferring on issues at the tribal, regional, or national levels;

(5) Ensuring that pertinent issues are brought to the attention of Indian tribes, tribal organizations, urban Indian organizations and Native Hawaiian organizations in a timely manner, so that feedback can be obtained;

(6) Encouraging the Secretary to work with other Federal agencies and Congress so that Native American Veterans are not denied the full benefit of their status as both Native Americans and Veterans;

(7) Highlighting contributions of Native American Veterans in the Armed Forces;

(8) Making recommendations on the consultation policy of the Department on tribal matters;

(9) Supporting a process to develop an urban Indian organization confer policy to ensure the Secretary confers, to the maximum extent practicable, with urban Indian organizations; and

(10) With the Secretary’s written approval, conducting other duties as recommended by the Committee.

AI/AN Veterans

There is an urgent need to ensure that all AI/AN Veterans have access to the benefits they earned through their service.  According to a 2020 VA Report, AI/AN Veterans served in the Pre-9/11 period at a higher percentage than other Veteran populations.  Despite a distinguished record of service, VA’s statistics also show that AI/AN Veterans were more likely to be unemployed, were more likely to lack health insurance, and were more likely to have a service-connected disability when compared to Veterans of other races.  In addition, in Fiscal Year 2017, AI/AN Veterans used Veterans Benefits Administration benefits or services at a lower percentage than veterans of other races.

NCUIH and the VA

The National Council of Urban Indian Health (NCUIH) has continued to advocate on behalf of AI/AN veterans living in urban areas and to strengthen its partnership with VA. In October 2021, Sonya Tetnowski (Makah), Army veteran, NCUIH President, and CEO of the Indian Health Center for Santa Clara Valley, was appointed to the VA’s first-ever Advisory Committee on Tribal and Indian Affairs to represent the voice of urban Indians. She currently serves as a member of the Committee and the Chair of the Veterans Health Administration Subcommittee and has highlighted the importance of looking at the whole person and making sure that their needs are being met. She has also brought forth potential subcommittees, including unhoused urban Veterans, Native Healer utilization, and Behavioral Health and Substance Use.

Thanks to NCUIH’s work with VA, UIOs are now eligible to enter the VA Indian Health Service/Tribal Health Program (THP)/UIO Reimbursement Agreements Program, which provides VA reimbursement to IHS, THP, and UIO health facilities for services provided to eligible AI/AN Veterans. NCUIH is also working to address homelessness among urban Native veterans and works closely with the VA, Department of Health and Human Services (HHS), Housing and Urban Development (HUD), and the White House Committee on Native American Affairs on the implementation of the interagency Native American Veteran Homelessness Initiative.  These efforts have emphasized the critical importance of working with UIOs to reach and serve the significant portion of Native veterans living in urban areas.

New IHS/VA Map Tool Connects Native Veterans to Healthcare and Support Services Nationwide, Including at Urban Indian Organizations

The Department of Veterans Affairs (VA) and the Indian Health Service (IHS) launched an interagency map tool, called Find Health Care & Resources for Native Veterans, to make healthcare more accessible for American Indian and Alaska Native (AI/AN) veterans. This map hosts location data from 41 urban Indian organizations (UIOs) with 82 locations and 1,500 VA healthcare facilities and is an easy way for AI/AN veterans to find health and support services ranging from dental care centers to substance abuse help. The tool also identifies resources to address homelessness and was developed as a part of the Native American Veteran Homelessness Initiative whose goal, in partnership with UIOs, is to provide education on resources from the VA and IHS and to encourage Native veterans to access those services. Ending veteran homelessness was labeled as a top priority of the Biden administration. In accordance with this, the tool labels as many Veterans Health Administration (VHA) sites as possible, usable by all Native and non-Native veterans. The map helps Native veterans from around the country get connected to services they need and deserve.

Background

Native Veteran Disparities

Native Americans have served for the United States military at higher rates than any other group in almost every armed conflict in the nation’s history. However, Native veterans face significantly higher disparities once transitioned back to civilian life. For example, Native veterans are more likely to be uninsured and have a service-connected disability than other veterans. Urban Native veterans generally have lower incomes, higher unemployment, lower education attainment, higher VA-service connected disability, and generally live in poorer housing conditions than non-Native urban veterans.  The National Council of Urban Indian Health (NCUIH) estimates that there are about 8 Native veterans experiencing homelessness per 1000 veterans, compared to about 1.5 white veterans per 1000 veterans. Urban Native veterans are greatly impacted by this, as NCUIH estimates that 86.2% of the veteran population identifying as Native lives in urban areas.  Homelessness is a key Social Determinant of Health and a lack of stable housing can lead to an increased risk of premature death, preterm delivery, exposure to disease vectors like vermin, and other negative health impacts.

NCUIH and the VA

NCUIH has highlighted in several written comments to the VA and in meetings with agency representatives, the need for the VA to address and provide services to Native veterans living in urban areas. VA data currently indicates that Native veterans use VA benefits or services at a lower percentage than other veterans. To address these disparities, NCUIH has provided the VA with several recommendations and administrative guidance on how to improve Native veteran health through collaboration with the VA. This map tool will also help eligible AI/AN veterans access VA health care, where they are no longer required to make copayments for health care and urgent care. For years, NCUIH has worked to remove copayment barriers for AI/AN veterans at the VA and recently provided comments to the VA’s Proposed Rule on the Copayment Exemption for AI/AN Veterans and was successful in getting the agency to remove a proposed cap on the amount of urgent care visits which qualify for the exemption. Current eligibility for the copay exemption is available to AI/AN Veterans who met the definition of “Indian” or “urban Indian” under the Indian Health Care Improvement Act.

NCUIH is also working to address homelessness among urban Native veterans and works closely with the VA, Department of Health and Human Services (HHS), Housing and Urban Development (HUD), and the White House Committee on Native American Affairs on the implementation of the interagency Native American Veteran Homelessness Initiative. Sonya Tetnowski (Makah), Chair of Veterans Health Administration Subcommittee within the VA Advisory Committee on Tribal and Indian Affairs Committee, Army veteran, NCUIH President, and CEO of the Indian Health Center for Santa Clara Valley, highlighted the importance of looking at the whole person and making sure that their needs are being met during a Committee meeting in January. She also brought forth potential subcommittees, including unhoused urban Veterans, Native Healer utilization, and Behavioral Health and Substance Use. On August 17, 2022, the Committee held a meeting where Ms. Tetnowski presented five priority areas, including homelessness and housing as a priority. In addition, NCUIH submitted comments to HUD, encouraging the agency to incorporate urban Natives in its FY22-26 Strategic Plan and focus areas. HUD provides housing resources and funding for Tribes, but these resources are very limited when it comes to urban AI/ANs, or not applicable at all. These efforts have emphasized the critical importance of working with UIOs to reach and serve the significant portion of Native veterans living in urban areas.

 

VA Approves Copay Exemption for American Indian and Alaska Native Veterans

On April 3, 2023 the Department of Veterans Affairs (VA) announced that American Indian and Alaska Native (AI/AN) veterans are exempt from copay requirements for urgent care or healthcare provided by VA. Under this new policy, the VA will reimburse copays paid on or after January 5, 2022, and it will waive future copays for AI/AN veterans. VA Secretary Denis McDonough stated “American Indian and Alaska Native Veterans deserve access to world-class health care for their courageous service to our nation. By eliminating copays, we are making VA health care more affordable and accessible — which will lead to better health outcomes for these heroes.” For years, the National Council of Urban Indian Health (NCUIH) has worked to remove copayment barriers for AI/AN veterans at the VA and recently provided comments to the VA’s Proposed Rule on the Copayment Exemption for AI/AN Veterans and was successful in getting the agency to remove a proposed cap on the amount of urgent care visits which qualify for the exemption. This is a significant victory that will directly impact the level of access to health care for AI/AN veterans. Current eligibility for the copay exemption is available to AI/AN Veterans who met the definition of “Indian” or “urban Indian” under the Indian Health Care Improvement Act.

Background

The copay exemption is a significant step to upholding the federal government’s trust responsibility to “maintain and improve the health of the Indians.” AI/ANs serve in the military at one of the highest rates of any group in the United States and many Native veterans receive healthcare from the Veterans Health Administration, an agency within VA, in addition to utilizing IHS, Tribal, and UIO facilities. Unfortunately, AI/AN veterans generally have a higher prevalence of mental health disorders compared with White veterans, and among all veterans, the prevalence of suicidal ideation is highest for those reporting a diagnosis of depression, anxiety, or post-traumatic stress disorder. Further, an estimated 86.2 percent of AI/AN veterans that live in urban areas generally have higher unemployment, lower education attainment, lower income, higher VA-service connected disability, and generally live in poorer housing conditions than non-Native veterans also living in urban areas.

NCUIH’s Role

NCUIH continuously advocates for Native veterans living in urban areas to ensure that they have access to the high-quality, culturally competent care the country owes to them for their military service and as a result of federal trust responsibility. In February 2023 NCUIH submitted comments to the VA regarding the copay exemption proposed rule and expressed VA copayments have historically represented a significant barrier to AI/AN veterans’ ability to access the healthcare this Nation owes them through VA facilities. NCUIH further recommended VA utilize self-attestation in determining eligibility for copay exemptions, VA cover all urgent care visits needed by Indian or urban Indian veterans, VA make clear that the copay exemption exists because of the trust responsibility, and VA host an Urban Confer and Tribal Consultation on the copay exemption. NCUIH appreciates the VA’s commitment to ensuring quality health care is more accessible for Indian and urban Indian veterans.

NCUIH Participates in SAMHSA’s Native Veterans Expert Panel Discussion

Expert Panel veterans

On February 15-16, 2023, the National Council of Urban Indian Health (NUCIH) Federal Relations Manager, Alexandra Payan, represented NCUIH at the Substance Abuse and Mental Health Services Administration’s (SAMHSA) American Indian and Alaska Native (AI/AN) Veterans Expert Panel Discussion. The purpose of this two-day meeting was to have a collaborative conversation around the development of a virtual training tool related to AI/AN military and veteran suicide prevention. The proposed tool will be available for states, territories, and communities to use as they work to implement their efforts. NCUIH was invited to participate in the Expert Panel Discussion to provide insight on the unique needs of AI/AN veterans who reside in urban areas.

Expert Panel’s Work to Support the Governor’s Challenge

Expert Panel with CAPT HearodThe Expert Panel Discussion was an opportunity to ensure broad representation of AI/AN veterans in the Governor’s Challenge to Prevent Suicide Among Service Members, Veterans, and their Families (Governor’s Challenge). Through collaboration with the VA, SAMHSA and SAMHSA’s SMVF Technical Assistance Center, the Governor’s Challenge seeks to provide a forum for teams to consider how existing policies, practices, infrastructure, and resources influence the effectiveness of the systems that support SMVF. Teams develop state and territory-wide plans based on a comprehensive public health approach and the National Strategy for Preventing Veteran Suicide (National Strategy).  During the Expert Panel Discussion, the team engaged in initial steps to develop a virtual toolkit aimed at addressing suicide in AI/AN veteran communities to supplement the Governor’s Challenge. Once created, the virtual toolkit will serve as instruments of change, providing a best-practice public health model that demonstrates meaningful results in suicide prevention for AI/AN veterans.

Urban Indian Organizations and Native Veteran Support

Sadly, AI/AN veterans have a higher prevalence of mental health disorders compared with White veterans and among all veterans the prevalence of suicidal ideation is highest for those reporting a diagnosis of depression, anxiety, or post-traumatic stress disorder. While there is limited data and research on suicide among AI/AN veterans, the 2020 National Veteran Suicide Prevention Annual Report documents growing AI/AN veteran suicide rates from 2005-2018.

UIOs are essential partners in serving AI/AN veterans and reducing AI/AN veteran suicides. UIOs are critical in improving care and access to services for AI/AN veterans because of their deep ties to the AI/AN community in urban areas. UIOs currently serve seven of the ten urban areas with the largest AI/AN veteran populations, including Phoenix, Arizona; Los Angeles, California; Seattle, Washington; Dallas, Texas; Oklahoma City, Oklahoma; New York City, New York; and Chicago, Illinois. Many AI/AN veterans prefer to receive care at IHS facilities, or may only have access to an IHS, Tribal, or UIO facility.

UIOs are uniquely positioned to assist agencies, such as the VA, SAMHSA, and HHS, in improving health care access for AI/AN people. Several UIOs already provide mental health and substance abuse disorder services and all UIOs provide numerous other social and community services to AI/ANs living in urban areas. NCUIH looks forward to continuing to work with SAMHSA, VA, and other agencies to improve the quality of care available to Native veterans in urban areas.

NCUIH’s work with the VA and Native Veterans in Urban Areas

NCUIH continues to work on behalf of Native veterans living in urban areas to ensure that they have access to the high-quality, culturally competent care the country owes to them for their military service and as a result of the trust responsibility.

For more information on NCUIH’s efforts please visit:

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 Submits Comments to the Department of Veterans Affairs and IHS on VHA-IHS Memorandum of Understanding Operational Plan

On November 30, 2022, NCUIH submitted comments to the U.S. Department of Veterans Affairs (VA) and the Indian Health Service (IHS) regarding the Veterans Health Administration (VHA) and IHS first-ever Draft Annual Operational Plan for fiscal year (FY) 2022 for the VHA-IHS Memorandum of Understanding (MOU). The MOU establishes a framework for coordination and partnership between VHA and IHS to leverage and share resources and investments in support of each organization’s mutual goals. NCUIH believes that the Draft Annual Operational Plan (Operational Plan) can be a significant step forward in implementing the IHS-VHA MOU and ensuring high quality health care for all American Indian/Alaska Native (AI/AN) veterans and continues to work closely with our colleagues at VA and IHS to ensure that Native veterans receive access to the care they earned through their military service, no matter where they live.

Background

AI/AN veterans have served in the United States military in every armed conflict in the Nation’s history and have traditionally served at a higher rate than any other population in the United States. In return for their service, the United States promised all veterans, including Native veterans, “exceptional health care that improves their health and well-being.” However, of the estimated 86.2 percent of AI/AN veterans that live in urban areas, they generally have higher unemployment, lower education attainment, lower income, higher VA-service connected disability, and generally live in poorer housing conditions than non-Native veterans also living in urban areas.

Recommendations

In its comments, NCUIH stressed the importance of the Operational Plan being a vehicle to articulate leadership priorities, provide direction for program management and distribution of resources, engage internal and external partners, and measure the overall progress toward meeting the MOU’s goals and objectives. NCUIH’s comments emphasized the importance of having OUIHP representation and leadership throughout the plan. As subject matter experts in the health needs of Natives living in urban areas, having representatives who are familiar with UIOs will ensure the needs of urban Native veterans are incorporated into the plan’s actions. Additionally, to improve the collaboration between the VA and IHS, and to ensure that care for AI/AN veterans is not disrupted, NCUIH recommended that the Operational Plan has a strategy in place to achieve seamless referrals between the VA and the I/T/U system. NCUIH further stressed the importance of regular consultation with Tribal Governments, Urban Confers with UIOs, and meetings with the HHS Secretary’s Tribal Advisory Committee on Tribal and Indian Affairs.  Moreover, because VA data currently indicates that Native veterans use Veterans Benefits Administration benefits or services at lower percentages than other veterans, NCUIH recommended that the Operational Plan add an additional objective be added to increase AI/AN veteran use of VA benefits and services.

NCUIH’s work with the VA

NCUIH continues to work on behalf of Native veterans living in urban areas to ensure that they have access to the high-quality, culturally competent care the country owes to them for their military service and as a result of the trust responsibility.

For more information on NCUIH’s efforts please visit: