For more information, CLICK HERE.
To access the interactive digital toolkit, CLICK HERE.
We are seeking qualified candidates for the following open positions based in Washington DC:
Behavioral Health Program Manager
Director of Congressional Relations
Congressional Relations Associate
Public Health Project Associate
On October 10, 2019, President Trump signed an Executive Order (EO), placing renewed emphasis on a 2005 Office of Management and Budget (OMB) policy, referred to as "Administrative-pay-as-you go". This policy is an effort to reach budget neutrality: if the agency's administrator puts forth an action proposal to increase the agency's mandatory spending, the administrator must then come up with a proposal to cut discretionary spending by the same amount.
The EO states that the director of OMB will issue instructions to agency leaders regarding implementation within 90 days. There are several ways in which this order can be waived, including if the agency's action delivers essential services to the public (for example, in the case of a natural disaster).
Earlier last week, the Congressional Budget Office (CBO) estimated the federal deficit for Fiscal Year (FY) 2019 reached $984 billion, the fourth year in a row that the deficit has increased.
To read the full EO, click here.
Negotiations around funding levels for federal agencies and departments are continuing in Congress. The House and Senate must agree on funding levels for the remainder of Fiscal Year (FY) 2020 by November 21. If that does not happen, Congress would have to enact another Continuing Resolution to fund the government at current levels or the government would shut down. It is crucial that Tribes engage with Congress to ensure adequate funding for Tribal health!
The Office of Representative Markwayne Mullin (R-OK) is collecting stories, anecdotes, and information on Tribal member's experiences with the Indian Health Service (IHS). The information will be used to inform congressional efforts on Tribal health priorities within Rep. Mullin's office. Congressman Mullin is a member of the House Energy and Commerce Committee and co-chair of the bipartisan IHS Task Force, which was created to examine legislative solutions towards improving the quality, accessibility, and comprehensiveness of health services within the Indian health system.
Tribal members and IHS users are welcome to submit stories on a variety of subjects related to the IHS experience including issues surrounding the IHS budget, workforce, health information technology (IT), and oversight of IHS.
For more information, or to submit a story, please contact Taylor Hittle, Legislative Director for Rep. Mullin, at [email protected].
On Friday, September 27, 2019, President Trump signed a short term funding bill--known as a Continuing Resolution (CR)--to keep the government operating while Congress continues appropriations work for Fiscal Year 2020. Included in this CR was a short term renewal for several public health programs, including the Special Diabetes Program for Indians (SDPI).
Congress now has until November 21, 2019 to enact long term renewal for SDPI. The National Indian Health Board is advocating for long term renewal of the program, and recently coordinated a postcard mailing campaign to Congress at our 2019 National Tribal Health Conference.
Currently, the Senate's proposed legislation renews SDPI for five years at $150 million, the same level of funding as every year since 2004. The House's proposed legislation renews the program at $150 million for four years.
For more information on the positive public health outcomes SDPI has supported since its creation in 1997, click here.
Last week, Senators Kevin Cramer (R-ND) and Kyrsten Sinema (D-AZ) introduced legislation to construct veteran nursing homes in Tribal communities.
S. 2558 would allow federal grants to pay for veteran nursing home construction on Tribal lands.
In its statement of support, the National Indian Health Board said, "The federal government has a dual responsibility to Native Veterans - one in recognition of their service to the country, and the other because of their political status as American Indians and Alaska Natives. The National Indian Health Board supports the Nursing Home Care for Native American Veterans Act, as it would significantly improve access to nursing homes for Native Veterans living on Tribal lands and reservations. In addition, it furthers the Trust responsibility by ensuring that Tribes are being reimbursed by the Veterans Administration for constructing these vital centers. NIHB is committed to working in a bipartisan fashion to advance this important bill."
The bill has been referred to the Senate Committee on Veterans Affairs.
Coalition of dentists joins partnership dedicated to elevating visibility and broad, multi-sectorial support for dental therapy
WASHINGTON, D.C. - Today, the National Indian Health Board celebrates the launch of The National Coalition of Dentists for Health Equity (DHE). The coalition is the third co-chair of the National Partnership for Dental Therapy. Together with DHE and Community Catalyst, the National Indian Health Board stands as a leader in the effort to expand dental therapy nationwide.
Dental therapists, focused providers who specialize in routine preventative and basic restorative care, have operated successfully in Alaska Native communities for 15 years. As more Tribes and states learn about dental therapy's strong record of success in Tribal communities in Alaska and the Pacific Northwest, support continues to grow...
Senate Appropriations Committee Passes FY 2020 Interior Bill, Funds Indian Health Service at $6.04 billion overall
On Thursday, September 26, 2019, the Senate Appropriations Committee unanimously passed the fiscal year (FY) 2020 Interior, Environment, and Related Agencies Appropriations bill by a vote of 31-0. The Interior bill, which funds the Indian Health Service (IHS) among other agencies, had easily passed out of subcommittee earlier in the week by a voice vote. The Interior package now heads to the Senate floor. In total, the Senate has now cleared ten out of twelve appropriations packages out of Committee. The two bills that have yet to be rescheduled for markups are the Labor-Health and Human Services bill and the Military Construction-Veterans Administration bill...
WASHINGTON, DC—September 26, 2019—At its annual National Tribal Health Conference in Temecula, California, the National Indian Health Board (NIHB) recognized a distinguished group of Tribal health leaders, providers and advocates during its annual Heroes in Health Awards Gala on September 18. At the gala, themed “Circles of Service,” NIHB recognized 17 individuals from across Indian Country in the categories of Area and Regional Impact, National Impact, Youth Leadership and the prestigious Lifetime Achievement Jake Whitecrow Award.
"The National Indian Health Board honored many of our sisters and brothers who have demonstrated outstanding service in the quest to improve our people’s health. We hope their example inspires others in their own journey through the circle of service,” said NIHB CEO Stacy A. Bohlen. “NIHB is pleased to honor good work being done all around Indian Country – a true circle of service. Through tireless work, often in the most remote and challenging areas of Indian Country, and with limited resources – those who were recognized are among the best of us. Their work protects and improves health and has significant influence in reducing health disparities in all regions of Indian Country. We cannot thank you all enough for the work you are doing to improve the lives of our people."...
Chairwoman Kitcheyan Urges Congress to Support H.R. 1128 & H.R. 1135
Washington, DC.--On Wednesday September 25, 2019, National Indian Health Board (NIHB) Chairwoman Victoria Kitcheyan of the Winnebago Tribe of Nebraska testified before the House Natural Resources Subcommittee for Indigenous Peoples in support of advance appropriations for Indian programs. Securing advance appropriations has been a long-standing priority for Tribes and the National Indian Health Board to ensure better continuity and stability of health services for American Indians and Alaska Natives.
In her testimony, Chairwoman Kitcheyan reminded Congress of the federal government’s treaty and trust obligations to Tribes, which includes the provision of comprehensive health care services to American Indians and Alaska Natives. Chair Kitcheyan also highlighted the negative impacts of this year's 35-day government shutdown on the Indian health system. The Indian Health Service (IHS) was the only federal health care entity subject to the shutdown. By contrast, the Veterans Health Administration was able to continue its services uninterrupted during the shutdown because Congress enacted advance appropriations for that agency a decade ago...
On Thursday, September 19, 2019, the House of Representatives passed a short term funding bill, also known as a Continuing Resolution (CR). The CR would fund the government at current levels until November 21, buying additional time for congressional appropriators to finish their work on Fiscal Year 2020 appropriations. Included in the CR is short term renewal for the Special Diabetes Program for Indians (SDPI) and other public health extenders. This short term renewal would ensure funding for the programs remains available through November 21, 2019.
The Senate is expected to approve the CR, which has support from the White House, later this week. Congress would then have until November 21, 2019 to enact long term renewal for SDPI.
Currently, the Senate's proposed legislation renews SDPI for five years at $150 million, the same level of funding as every year since 2004. The House's proposed legislation renews the program at $150 million for four years.
For more information on the positive public health outcomes SDPI has supported since its creation in 1997, click here.
TEMECULA, Calif.—September 19, 2019—On Wednesday during the second plenary session of the National Indian Health Board's (NIHB) annual National Tribal Health Conference, attendees heard from the Centers of Medicare and Medicaid Services (CMS) about three main areas of the agency’s work with tribes – enrolling more American Indians and Alaska Natives (AI/AN) in Medicaid, educating tribal citizens about coverage benefits and increasing third-party revenue for the Indian health system through CMS reimbursements.
"Many of our tribal citizens are eligible to receive health care through the Medicaid system, and the tribes' partnership with CMS is critical as the agency contributes significantly to the delivery of health care to American Indians and Alaska Natives," said NIHB Board Chair and Great Plains Area Representative Victoria Kitcheyan.
TEMECULA, Calif.—September 18, 2019—Yesterday nearly 600 Tribal health providers, experts and advocates gathered for the opening session of the National Indian Health Board's (NIHB) annual National Tribal Health Conference to hear how Tribal leaders are strengthening sovereignty while partnering with federal agencies to ensure trust obligations are upheld.
A Tribal leader panel discussion focused on tribal sovereignty in relation to health equity. Panelists included NIHB Chair and Great Plains Area representative, Victoria Kitcheyan; National Congress of American Indians (NCAI) President and Chickasaw Nation Lt. Governor, Jefferson Keel; St. Regis Mohawk Nation Tribal Chief, Beverly Cook; and Lummi Nation Tribal Councilmember, Nick Lewis. NIHB Chair Kitcheyan said that sovereignty means "we are in charge of the destiny of our people, and we cannot let the federal government dictate what we do on our lands. I want to remind people that our Tribal nations existed before their role and will live on past their role. So, we must remind them of our sovereignty."
TEMCULA, Calif.—September 17, 2019—During Monday’s pre-conference day, the National Indian Health Board (NIHB) hosted four federal agency tribal consultation or listening sessions at its National Tribal Health Conference where tribal leaders and health advocates put the conference theme in motion – "Health = Sovereignty" – by reaffirming that the government is obligated to uphold its trust responsibility and that Tribes must be involved in every step of the policymaking process.
"Tribes are sovereign nations, and it is imperative that we continue to strengthen the government-to-government relationship with federal agencies to ensure that our Tribal voices are heard and realized through policies and regulations that makes sense and actually work for our Tribal communities," said NIHB Chairperson and Great Plains Area Representative Victoria Kitcheyan. "Tribes have a collective need for quality health care, but the access and delivery may be different. It's important for federal agencies to be reminded that not all Tribes are the same and there is not one cookie-cutter approach."
TEMECULA, Calif.—September 16, 2019—Yesterday, during a quarterly board meeting and in advance of the National Indian Health Board's (NIHB) National Tribal Health Conference, the NIHB Board of Directors met with the Indian Health Service (IHS) leadership to discuss funding for programs. The Board also voted on a new executive committee member and resolutions to support its work in Washington, DC and throughout Indian Country.
IHS Principal Deputy Director RADM Weahkee was joined by Deputy Director for Intergovernmental Affairs P. Ben Smith and Director of the Office of Management Services Athena Elliot. They spoke about efforts to work with NIHB to continue its current cooperative agreements that fund a portion of the organization’s advocacy and technical assistance work with tribes, like the Tribal Leaders Diabetes Committee and outreach and education on the Affordable Care Act.
On Friday, August 16, 2019, CMS rejected an element of Utah's 1115 Demonstration that would have imposed enrollment caps on Medicaid in the state. In its letter, CMS stated that it would "only approv[e] section 1115 demonstrations under which the section 1905(y)(1) match rate is provided if the demonstration covers the entire adult expansion group." This means that the agency will not provide enhanced FMAP to Utah because enrollment caps preclude the expansion of Medicaid. Earlier this year, Utah indicated that if CMS would not approve per capita caps by January 2020, then the state would implement a "fall-back" plan, expanding Medicaid up to 138 percent of the federal poverty level (FPL).
Other components to Utah's 1115 Demonstration are still under CMS review. This would include subjecting all Medicaid recipients to mandatory enrollment into managed care and instituting work requirements for Medicaid beneficiaries. However, there is an exemption from Medicaid work requirements for members of federally recognized Tribes.
NIHB is monitoring this issue closely and will provide updates as they are available.
In July, a group of Senators from both the Senate Committee on Indian Affairs and the Senate Special Committee on the Climate Crisis submitted a letter to American Indian, Alaska Native, and Native Hawaiian community leaders requesting information on the impacts of climate change on Tribal and Native Hawaiian communities. The Senate letter invited responses that outlined potential policy solutions around climate change mitigation and adaptation, including information about how climate change threatens Indigenous and traditional lifestyles and overall well-being.
In Victory for Tribes, Circuit Court Overturns Lower Court Ruling
TODAY, the United States Fifth Circuit Court of Appeals issued its decision in Brackeen v. Bernhard , where it upheld the constitutionality of the Indian Child Welfare Act (ICWA), reversing the decision of the Northern District of Texas. In its decision ( available here ), the Circuit Court found ICWA to be constitutional because it is based on a political classification that is rationally related to the fulfillment of Congress’ unique obligation toward Indians.
"The National Indian Health Board is very pleased that the Fifth Circuit Court ruled in favor of the Indian Child Welfare Act," said NIHB Chairperson Victoria Kitcheyan. "The Court's ruling affirms the federal government's unique political relationship with Tribes. We hope that this groundbreaking law will continue to help keep Indian families whole."
Earlier this year, NIHB, along with 325 Tribal nations and 57 Tribal organizations signed on to an amicus brief supporting ICWA. This followed passage of a resolution by the NIHB Board of Directors in strong support of ICWA in 2018.
The Indian Health Service (IHS) has extended its Opioid Grants Program Tribal Consultation and Urban Confer period until Tuesday, September 3, 2019. IHS is seeking Tribal guidance as it develops an Opioid Grant Program with $10 million dollar increase in funding in the Alcohol and Substance Abuse Program budget line to better combat the opioid epidemic. The IHS is specifically seeking your comments on the following questions about the new Special Behavioral Health Pilot Program...
On Thursday, August 1, 2019, by a final vote of 67-28 with five Senators not voting, the U.S. Senate passed a sweeping two-year budget deal that staves off the impending debt limit, increases both defense and non-defense spending caps for Fiscal Year (FY) 2020 and FY 2021, and permanently ends discretionary sequestration. The House of Representatives had passed the deal last Thursday, July 25, by a final vote of 284-149, before that chamber departed for August recess. On Friday August 2, 2019, President Trump signed the two-year budget deal into law.
To read NIHB's more detailed analysis of the Budget Deal, click here.
On July 17, 2019, the House Energy and Commerce Committee advanced legislation to renew the Special Diabetes Program for Indians (SDPI). SDPI is a vital program that gives Tribes the tools they need to combat diabetes in their communities, through both prevention and treatment. SDPI will expire on September 30, 2019 unless Congress renews it...
On July 10, 2019, the House Oversight and Reform Committee held a hearing to discuss the ongoing lawsuit in the Fifth Circuit Court of Appeals challenging the constitutionality of the Affordable Care Act (ACA). The hearing focused on the May, 2019 decision from the Trump Administration reversing its original position defending the ACA to instead concurring with the federal district court ruling that the entirety of the law is unconstitutional and should therefore be struck down.
The National Indian Health Board (NIHB), along with 483 Tribal Nations and Tribal organizations, filed an amicus brief before the Fifth Circuit conveying to all involved parties that the Indian Health Care Improvement Act (IHCIA) and Indian-specific provisions enacted in tandem with the ACA serve an entirely distinct purpose from the rest of the legislation, and exist to partially fulfill the federal government's constitutional obligations to provide health services to Tribal Nations and American Indian and Alaska Native Peoples.
NIHB reaffirmed this position in written testimony to the House Oversight and Reform Committee, highlighting the inherent severability of IHCIA and the Indian-specific provisions of the ACA. NIHB continues to be highly engaged in defending IHCIA and ensuring that the significant Indian-provisions are preserved.
To access NIHB’s testimony, click here
After weeks of negotiations, Congressional leaders and the Trump Administration agreed to a 2-year $1.37 trillion Budget Deal that raises spending caps, increases the debt limit, and permanently ends sequestration for discretionary programs, including for the Indian Health Service (IHS). The agreement was reached in principle with an announcement by the President on Monday, July 22, 2019, with House and Senate leaders now working to build broad support among their members to ensure passage of the deal on the floor...
NIHB is undertaking an exciting partnership with the Regenstrief Institute, a Department of Health and Human Services (HHS) contractor, to do an assessment of the Health Information Technology (IT) needs of the Indian Health Service (IHS). This work will result in a report that will make recommendations on IHS' Health IT Modernization efforts. NIHB's role is to help Regenstrief gain unique perspectives on the Indian health system from interviews with Tribal Leaders and with patients of IHS and Tribal Health Programs. Information shared through these interviews will result in tools like amalgamated persona narratives and journey maps that will help the Administration and Congress truly understand Health IT needs so that a realistic congressional appropriation can be given to fund it.
NIHB needs your help in identifying patients and Tribal leaders who would be good to interview for this effort. We are looking for a variety of people from all age ranges, health statuses, and communities. Regenstrief is especially interested in interviewing people from the following Areas:
CLICK HERE to schedule an interview.
Please let NIHB's Director of Policy, Devin Delrow ([email protected]), know if you have any questions or would like more information. We only have until the end of July to complete these interviews so that Regenstrief can turn these into helpful tools by the time the report comes out in the fall.
NIHB, in partnership with the Centers for Medicare and Medicaid Services, created this administrative tool to assist Tribes in both in making informed staffing decisions and in achieving full reimbursement for Medicaid services delivered. The report examines state Medicaid programs across the country to determine what behavioral health, substance abuse and addiction services are reimbursable. It also identifies which practitioners have been authorized to bill for those services (and what their educational and licensing requirements are). Wherever possible links to web-based Tribal Billing guides or other state resources are included.
The report can be found here.
In 2016, the Indian Health Service (IHS) announced that it was expanding the Community Health Aide Program (CHAP) to Tribes outside of Alaska. The Indian Health Care Improvement Act gave the IHS the authority to expand the program, and based off the success in providing frontline medical, behavioral, and dental health service to Alaska Native communities, IHS elected to do so after Tribal consultation.
In 2018, IHS chartered the Community Health Aide Program Tribal Advisory Group (CHAP TAG) to develop an interim policy on CHAP expansion. That policy would establish the infrastructure for CHAP certification and academic review at the Area level and would be the program's guiding policy document while the agency worked with Tribes on a permanent policy. CHAP TAG has worked with the Indian Health Service for over a year to develop the agency's draft interim policy for national expansion of CHAP.
It is important to note that the draft interim policy for CHAP expansion does not impact the Community Health Representative program in any way. The two programs would remain distinct in the Fiscal Year 2020 House Interior Appropriations bill, which funds IHS. NIHB’s comment is now available here.
The National Indian Health Board (NIHB) is excited to announce that the Call for Proposals for the 2019 National Tribal Health Conference (NTHC) is now available! This year's conference, scheduled for September 16-20, 2019, will be held at the Pechanga Resort Casino in Temecula, California.
Tribal leaders, health directors, policy specialists, advocates, and allies are invited to submit abstracts. NIHB encourages presentations highlighting innovative and Tribally-driven approaches to improving the quality of health systems, strengthening the business of medicine, expanding pathways for successful advocacy efforts, enhancing government to government relationships, and evidenced based, wise, best or promising practices developed in and for Tribal communities.
This year's five conference tracks address a wide breadth of Tribal health priorities. Namely, they are:
Submissions are due by 11:59 pm ET on July 12, 2019.
To access the Call for Proposals page, click HERE.
H.R. 2680 Renews SDPI for 5 Years at $200 Million per Year This is the First Funding Increase for SDPI in 15 Years!
Call your member of Congress and urge them to support H.R. 2680 (Special Diabetes Program for Indians) and H.R. 2668 (Special Diabetes Program)
Representative Tom O'Halleran (D-AZ) has introduced legislation (H.R. 2680) to renew the Special Diabetes Program for Indians (SDPI) for 5 years at $200 million per year!
H.R. 2680 reflects two longstanding Tribal goals for the program that NIHB has worked to achieve: long term reauthorization and a funding increase...
On Wednesday May 22, 2019, on a 30-22 party-line vote, the House Appropriations Committee, chaired by Congresswoman Nita Lowey (D-NY), passed a $37.3 billion Interior-EPA spending package that included top-line and line item increases to the Indian Health Service (IHS) budget. The FY 2020 Interior-EPA bill boosts spending overall by 4%, and increases the IHS budget by $537 million overall, to a total of $6.3 billion...
Earlier this month, Senator Elizabeth Warren and Representative Elijah Cummings reintroduced the Comprehensive Addiction Resources Emergency (CARE) Act, which provides $100 billion in federal funding over a ten year period to combat the opioid epidemic, including over $800 million per year in direct funding to Tribal governments and organizations for substance and opioid use disorder prevention and treatment...
ALBUQUERQUE, NM—May 16, 2019—The National Indian Health Board (NIHB) continued a week of networking, learning and sharing with its American Indian and Alaska Native Behavioral Health Conference taking place May 16-17, 2019. Over 600 hundred tribal health leaders, behavioral health practitioners and community health workers heard from Dr. Evan Adams, Coast Salish actor and Chief Medical Officer of First Nations Health Authority , Canada, about seeing health and healing in two realities – indigenous and western...
ALBUQUERQUE, NM—May 16, 2019—A group of three Native youth volunteers acted as reporters and photographers on the ground this week at the National Indian Health Board’s (NIHB) 10th Annual National Tribal Public Health Summit . For two days they interviewed Summit presenters and attendees and learned about Tribal public health programs from across Indian Country...
ALBUQUERQUE, NM—May 14, 2019—During the 10th Annual National Tribal Public Health Summit opening reception, the National Indian Health Board (NIHB) presented two individuals – one from Alaska and the other from North Dakota – and one Tribal organization from California with the 2019 Native Public Health Innovation Awards for their effective approaches to and significant impact on American Indian and Alaska Native public health...
Messages from national leaders, public health experts to improve health outcomes for Indian Country.
ALBUQUERQUE, NM—May 13, 2019—The National Indian Health Board (NIHB) kicked off its 10th Annual National Tribal Public Health Summit with messages from national leaders committing to work jointly with tribes and discussions from experts on adverse childhood experiences, HIV and Alzheimer’s in Indian Country. This year’s two-day Summit also features dynamic national speakers, interactive workshops and roundtable discussions, the annual Special Diabetes Program for Indians (SDPI) poster session and presentation of the 2019 Native Public Health Innovation Awards...
Chairman Chester Antone Stepping Down After Long Career Fighting for Tribal Health
Phoenix, AZ--Today, the Department of Health and Human Services (HHS) Secretary's Tribal Advisory Committee (STAC) met for its annual meeting in Indian Country. STAC is an invaluable resource for both HHS and the Tribes, as the Committee works to ensure the Tribal voice is heard at all levels of HHS. The STAC routinely meets with agency officials from across the operational divisions of HHS to exchange views, share information, and provide advice and recommendations to HHS and its divisions. For the past three years, Chester Antone, Councilman from Tohono O'odham Nation, has served in the critical role of Chair of the STAC. Chairman Antone has used this role to fight tirelessly for Indian Country's health and for the federal government to uphold the trust responsibility...
Mr. Joseph advocated for full funding for IHS, Advance Appropriations, and the protection of the Community Health Representatives Program
Washington, DC.--Today, National Indian Health Board’s Member at Large and Portland Area Representative, Andy Joseph Jr. testified before the Senate Committee on Indian Affairs regarding the President's Fiscal Year (FY) 2020 Budget Request for Indian programs. He testified alongside leadership of the Department of Interior, the Indian Health Service (IHS), and the National Congress of American Indians. You can watch a recording of the hearing here...
On Friday May 3, 2019, President Trump signed a new proclamation declaring May 5 as a national day of awareness for murdered and missing American Indians and Alaska Natives. The White House proclamation coincided with a similar resolution passed by the United States Senate that declared May 5 as National Day of Awareness for Missing and Murdered Native Women and Girls. That resolution, S.Res.144, was introduced by Senator Steve Daines (R-MT) and agreed to under unanimous consent on Thursday May 2...
On April 23-24, Tribal Leaders from across the country met with top officials from the U.S. Department of Health and Human Services (HHS), as the department hosted its annual Tribal Budget Consultation. This consultation provided a forum for Tribes to engage with HHS officials on national Tribal health funding for the Department's Fiscal Year (FY) 2021 budget request.
The two day consultation included discussions with the Department's leadership, including Deputy Secretary Eric Hargan. Tribal leaders expressed their concerns with the President's FY 2020 budget request, which would cut the HHS budget by 12 percent and cut programs critical to improving health outcomes for American Indians and Alaska Natives (AI/AN). They also noted the need for Tribal consultation before decisions impacting AI/ANs are made by agencies within the Department...
On Monday, April 29, 2019, the House Appropriations Labor, Health and Human Services, Education, and Related Agencies Subcommittee (commonly referred to as Labor-HHS) released its draft legislation appropriating funds for Fiscal Year (FY) 2020. The bill funds several key health care and public health agencies working in Indian Country, and its annual release is followed closely by NIHB and the Tribes. It is important to note that the Indian Health Service (IHS) is funded through the Interior Appropriations Subcommittee, not Labor-HHS.
The bill, which still must be marked up by the Subcommittee and the full Appropriations Committee, pass the House and Senate, and be signed into law, contains several key provisions for Tribal health. Overall, the spending level is $189.8 billion for FY 2020 ($11.7 billion above FY 2019 level and $47.8 billion above the FY 2020 President's Budget Request). Of particular interest to Tribes, the bill...
Congress is currently crafting appropriations legislation for Fiscal Year (FY 2020), which begins on October 1, 2019. The Appropriations Committee has 12 subcommittees, each responsible for developing the legislation that will ultimately fund the agencies under its purview. Each committee accepts Outside Witness Testimony so that the public can comment on proposed appropriations levels.
Two of these twelve subcommittees are relevant to Indian health. The Interior Appropriations Subcommittee funds the Indian Health Service (IHS) and many other programs working in Indian Country. Interior Appropriations is accepting Outside Witness Testimony until Friday, May 17. Click here for instructions on how to submit testimony.
The Government Accountability Office (GAO) released a report with updated information on the Department of Veterans Affairs' (VA) and the Indian Health Service's (IHS) efforts to implement their Memorandum of Understanding (MOU) to improve the health status of American Indian and Alaska Native (AI/AN) veterans through coordination and resource sharing among VA, IHS, and Tribes.
The GAO report focuses on implementation of the MOU since June 2014, the last time that GAO released a report on the topic. The GAO found that while the MOU had identified goals, there were not any sufficient measures for assessing progress. In some cases, a performance measure was established but lacked a target to measure performance. Overall, the GAO made three recommendations to strengthen the oversight and coordination of healthcare for AI/AN Veterans:
Both agencies have concurred with the reporting and have said they are currently in process of revising the MOU and updating their performance measures.
Click here to read the full GAO Report.
The House and Senate have failed to pass a budget resolution by the April 15 deadline, meaning that future spending negotiations will lack an agreed upon outline.
Congress is currently in recess, so members are working in their home states. When Congress returns to Washington on April 29, Speaker Pelosi and Senate Majority Leader McConnell plan to begin negotiations on a budget agreement for Fiscal Year 2020. These talks will be crucial to developing a spending agreement as Congress works to avoid sequestration.
Congress has successfully averted sequestration, the across the board spending cuts that are automatically triggered if Congress does not appropriate money within its established spending caps, every year since 2013. In 2011, Congress passed the Budget Control Act in an effort to control spending by applying sequestration across every federal department and agency on every fiscal year until 2021 unless Congress agrees to impose spending caps on itself.
In a failure to uphold the trust responsibility, the 2013 sequestration impacted the Indian Health Service and Indian Country. For more information on NIHB's work to protect the Indian health system from sequestration, click here.
The HHS Annual Tribal Budget Consultation will be hosted by HHS next week on April 23 - 24, 2019 in Washington, DC. Click here for the Dear Tribal Leader Letter (DTLL) announcing the session and here for the final agenda.
A planning call for any final questions will be held Wednesday, April 17 at 3:00 PM ET. Call details can be found in the attached DTLL.
If you plan to attend the consultation, please RSVP to [email protected] with your name, title, and Tribe. If you plan on sending a designee, they should also RSVP.
*Please note, per the HHS Tribal Consultation Policy, non-elected Tribal designees must present a letter of designation on Tribal letter head to IEA before participating in the consultation.
The case holds tremendous potential for impact to Indian Country. The ACA incorporated the Indian Health Care Improvement Act (IHCIA) through reference and was permanently reauthorized when Congress passed the ACA. In addition to the IHCIA, the ACA included other important Indian-specific provisions integral to the Indian health system. A court ruling that invalidates the ACA also jeopardizes the IHCIA and Indian specific provisions of the ACA.
The National Indian Health Board (NIHB), along with 483 Tribes and Tribal organizations, worked with the law firm of Hobbs Straus Dean & Walker, LLP to file an amicus brief that argues that the IHCIA and Indian-specific provisions are “severable” from the ACA and should be protected no matter what the 5th Circuit decides with respect to the rest of the ACA. That brief was filed on April 1.
On April 4, 2019, NIHB Director of Policy Devin Delrow took part in an interview with Montana Public Radio regarding protecting the Indian Health Care Improvement Act (IHCIA). Listen to the interview here: https://www.mtpr.org/post/native-health-advocates-weigh-obamacare-repeal-case
The webinar will provide information about the national update of automatically designated Health Professional Shortage Areas (HPSA) for summer 2019. The webinar will also provide dedicated time for Tribes and Urban Indian organization leaders to provide input on the project.
You can view the full announcement here.
The opioid epidemic is one of the most pressing public health crises facing Indian Country. As of 2017, American Indians and Alaska Natives (AI/ANs) experience the second highest opioid overdose mortality rate nationwide at 15.7 deaths per 100,000. Drug overdose death rates increased 519% among AI/ANs from 1999-2015 – the sharpest such increase of any group nationwide. Tribal communities face significant challenges in turning this tide. Some of these obstacles include industry opioid dumping in Indian Country, overuse of opioids as a place-holder for unfunded medical treatments, critical shortages of medical and public health practitioners, poverty and chronic underfunding of the Indian health system. On March 27, 2019 NIHB’s Chief Executive Officer, Stacy A. Bohlen, joined DEMOCRACY NOW! to discuss the state of the opioid crisis in Indian Country and shared insight on the challenges and successes towards achieving healing and recovery for all American Indians and Alaska Natives. You can view this Democracy Now! Show here: https://www.democracynow.org/2019/3/27/an_invisible_crisis_native_american_tribes
On Monday, March 25, 2019, the Indian Health Service (IHS) released its Congressional Justification (CJ) which provides additional details in support of President Trump's Budget proposal priorities to enhance the health and well-being, strengthen direct medical services and expand efforts to improve medical quality at IHS facilities.
You can view the full CJ here.
Major Cuts to Domestic Spending
Today the President released his fiscal year (FY) 2020 Budget Request to Congress. This document contains funding recommendations to Congress as it begins to draft next year's appropriations bills.
Additional details on the FY 2020 request will be available in the coming weeks, but you can read the overall budget request here and the HHS Budget in Brief here (Indian Health Service (IHS) starts on page 36). You can also view the recommendations of the Tribal Budget Formulation Workgroup for FY 2020 here...
On March 6, 2019, NIHB Chairwoman Victoria Kitcheyan of the Winnebago Tribe of Nebraska, testified before the House Appropriations Subcommittee on Interior, Environment, and Related Agencies. This was part of a two day public witness hearing that is focused on Tribal programs. The Subcommittee holds public witness hearings annually and provides an opportunity for testimony regarding the Indian Health Service, Bureau of Indian Affairs, and other critical Tribal programs...
On February 26, 2019, during the National Indian Health Board's 2019 quarterly Board of Directors Meeting, members of the Board held elections for the positions of Chairperson, Vice-Chair, Member-at-Large, and Secretary...
The Co-Chairs of the Congressional Native American Caucus are circulating a Congressional sign on letter to the Chairman and Ranking Member of the House Budget Committee to support advance appropriations for the Indian Health Service (IHS) and the Bureau of Indian Affairs (BIA).
As noted above, advance appropriations would mean that the IHS budget would be enacted one year in advance of the fiscal year. This would mean IHS and BIA would not be subject to government shutdowns and continuing resolutions if Congress cannot get the budget passed by the start of the fiscal year. The recent 35-day partial government shutdown demonstrated the urgency to enact Advance Appropriations for programs serving Indian Country.
We are requesting that you contact your Representatives and encourage them to sign onto the letter. The deadline to sign onto the letter is Friday, March 8...
The Co-Chairs of the House Diabetes Caucus are circulating a Congressional sign on letter to House leadership supporting the Special Diabetes Program, which funds type-1 research, and the Special Diabetes Program for Indians (SDPI), which supports Tribal programs focused on diabetes prevention and treatment.
Congressional authorization for SDPI will expire on September 30, 2019 unless Congress renews the program. Currently, legislation in the Senate would renew SDPI for five years at the current funding level of $150 million per year. House legislation will be introduced in the near future. The letter from the Diabetes Caucus will be a useful tool for advocates of SDPI, so NIHB is working to ensure as many congressional offices as possible sign onto the letter...
The federal government is seeking direct input from stakeholders on two key strategic documents that guide federal programmatic and policy decisions - the National HIV/AIDS Strategy (NHAS) and the National Viral Hepatitis Action Plan (NVHAP). NIHB is collecting comments, input, stories, and information on HIV and viral hepatitis prevention, care and treatment in response to this request for information. NIHB will bring together the comments from across Indian Country to submit to the U.S. Department of Health and Human Services, Office of HIV/AIDS and Infectious Disease Policy to inform the creation of the next iterations of the National HIV/AIDS Strategy and the National Viral Hepatitis Action Plan...
The law firm Hobbs, Straus, Dean & Walker is leading efforts to file an amicus brief on behalf of Tribal Nations and Tribal organizations in response to the December 2018 decision by a district court in Texas that ruled the entire Patient Protection and Affordable Care Act (ACA) to be unconstitutional. The Court's ruling was based on the premise that, because the individual mandate is an essential component of the ACA, that Congress' elimination of the tax penalty associated with the mandate in the Tax Cuts and Jobs Act of 2017 rendered the entire legislation unconstitutional. The ruling has faced heavy criticism from both ends of the political aisle and is currently on appeal in the United States Court of Appeals for the Fifth Circuit...
Last Friday, February 15, 2019, President Trump signed legislation funding federal agencies through the end of Fiscal Year (FY) 2019 and ending the risk of a second 2019 government shutdown. With this legislation now signed into law, all federal agencies are funded through the end of the fiscal year.
Overall, the Indian Health Service (IHS) will receive $5.8 billion in FY 2019, an increase over FY 2018's $5.5 billion. This continues a historic trend of bipartisan budget increases for the agency, although the Tribal Budget Formulation Workgroup recommended $6.4 billion for IHS in 2019.
After 15 years of practice in the United States, dental therapists are expanding access to oral health care in a number of states where they practice as part of dental teams. Despite the documented success, the majority of people in Indian Country and in the U.S. as a whole cannot get care from these dental professionals.
Community Catalyst and the National Indian Health Board are launching the National Partnership for Dental Therapy to accelerate the authorization of dental therapists nationwide so that people can get care where and when they need it, in their own communities.
The Special Diabetes Program for Indians (SDPI) is one of the most successful public health programs in Indian Country. During the lifetime of the program, the rate of End Stage Renal Disease among the American Indian/Alaska Native population has plummeted by 54%!
Without renewal from Congress, the program will expire on September 30, 2019. The House Diabetes Caucus, led by Reps. Diana DeGette (D-CO) and Tom Reed (R-NY) have issued a letter to House leadership asking for their support for SDPI and the Special Diabetes Program (SDP), which funds research into Type 1 Diabetes. A letter for Senators will be available in the near future. The last time a letter for SDP and SDPI was circulated, over 75% of Congress signed on!
Congressional leaders have submitted legislation that would end the funding impasse over border security by providing $1.375 billion for physical barriers on the U.S.-Mexico Border. The 1,100-page legislation also contains funding for 9 other federal departments and dozens federal agencies - including the Indian Health Service (IHS) - through September 30, 2019...
On Friday, February 8, Congresswoman Betty McCollum (D-MN) and Congressman Don Young (R-AK) introduced two bipartisan bills to authorize advanced appropriations for essential Tribal services that are funded by the federal government. Congresswoman McCollum's bill, H.R. 1128, the Indian Programs Advanced Appropriations Act (IPAAA), would provide advanced appropriations to the Bureau of Indian Affairs, the Bureau of Indian Education, and the Indian Health Service. Congressman Young's, H.R. 1135, the Indian Health Service Advance Appropriations Act of 2019 provides advance appropriations authority for the Indian Health Service. Advance appropriations make funding available one year or more after the year of the appropriations act in which it is contained. Both bills are cosponsored by the Co-Chairs of the Native American Caucus, Congressman Tom Cole (R-OK) and Congresswoman Deb Haaland (D-NM)...
HHS Releases Request for Information on Updating the National HIV/AIDS Strategy and National Viral Hepatitis Action Plan
During his 2019 State of the Union Address, President Trump announced that his Administration will be putting forth a national strategy for ending new HIV infections in the United States by the year 2030. In addition to the President's announcement, on Friday February 8, the U.S. Department of Health and Human Services (HHS) posted a request for information (RFI) on the Federal Register soliciting public comment on the next iteration of the National HIV/AIDS Strategy (NHAS) and the National Viral Hepatitis Action Plan (NVHAP) - both of which currently expire next year.
The Office of National Drug Control Policy (ONDCP) has released its annual report outlining the Administration's priorities and blueprint for addressing drug addiction and trafficking nationwide. Located in the Executive Office of the President, the ONDCP is the principal office that coordinates drug control and response efforts across all federal agencies involved in prevention, treatment and interdiction including the Substance Abuse and Mental Health Services Administration, Drug Enforcement Agency, and Food and Drug Administration...
On Monday, President Trump announced that David Bernhardt would be the next Secretary of the Interior. Bernhardt has served as Acting Secretary since former Secretary Ryan Zinke announced his departure from the agency in January. Bernhardt's background is in energy and natural resources policy.
Because the Department of the Interior oversees the Bureau of Indian Affairs and the Bureau of Indian Education, as well as other agencies working in Indian Country, the Secretary often works closely with Tribes. The position is subject to confirmation by the Senate.
The Vice Chairman of the Senate Committee on Indian Affairs, Senator Tom Udall (D-NM), introduced legislation to protect the Indian Health Service (IHS), the Bureau of Indian Affairs, and the Bureau of Indian Education from future shutdowns. The legislation, the Indian Programs Advance Appropriations Act, would fulfill a longstanding Tribal health priority by providing advance appropriations to IHS, which means Congress would enact funding for the agency a year ahead of time. The shutdown, in which Tribes had to curtail health services or cut other services to keep health facilities open in the absence of funding from IHS, highlighted the need for a long term budget solution for Tribal programs...
Last Friday, President Trump signed a Continuing Resolution (CR) reopening the agencies that were subject to the federal government shutdown. Under the CR, these agencies, including the Indian Health Service, will receive funding through February 15, 2019.
Employees who had to work without pay during the shutdown or who were furloughed will receive back pay under the terms of the CR. These 800,000 employees had missed two pay checks during the shutdown. Additionally, the end of the shutdown means that the Indian Health Service can resume its payments to Tribes operating their own health systems, something the agency's leadership said it planned to do as soon as possible.
On January 17, 2019, NIHB submitted comments to the U.S. Department of Health and Human Services (HHS) on their proposed objectives for Healthy People 2030. Every ten years, the Healthy People initiative establishes core objectives and health topic areas to guide HHS in its efforts to improve the health of all Americans. The Healthy People framework acts as a blueprint that helps inform the major health goals and priorities of the department and its agencies including the Indian Health Service, Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, and other agencies. The Healthy People initiative is managed by the Office of Disease Prevention and Health Promotion at HHS.
To access NIHB’s comments, click HERE. You can access all of NIHB’s Comments HERE.
To learn more about the Healthy People initiative, click HERE
This afternoon, President Trump announced an agreement between himself and Congressional leaders to end the partial government shutdown, currently in its 35th day.
While this agreement will not supply funding for a border wall, the central issue of disagreement leading to the shutdown, the President said that Congress would study the issue.
Under the terms of the agreement, Congress will fund the closed agencies until February 15, 2019, at which point another deal will have to be reached. The 800,000 affected federal employees will return to work for that time period and also receive back pay for the past 35 days. This includes the employees of the Indian Health Service (IHS)...
Yesterday, the Centers for Medicare and Medicaid Services (CMS) approved Arizona's request for an amendment to add work and community engagement requirement to its Medicaid Program. As part of the approval by CMS, members of Federally Recognized Tribes will be exempted from work and community engagement requirements...
On January 10, 2019, eight national Tribal organizations, including the National Indian Health Board (NIHB), submitted a letter to the president and bi-partisan congressional leadership urging immediate action to end the partial government shutdown that is disproportionately impacting American Indian and Alaska Native Tribal Nations. The letter highlighted the shutdown’s impact on Tribal economies, access to healthcare, Tribal self-governance, and Indian housing, education, nutrition, and child welfare.
To read the letter, click HERE (PDF)
To read the accompanying statement, click HERE (DOC)
WASHINGTON, D.C. | On the 20th day of the government shutdown, eight national Native organizations are jointly urging the President and Congress to immediately end the partial government shutdown, which breaks the treaty and trust obligations the federal government owes to tribal nations. The organizations jointly sent a letter to Congress and the President outlining the wide-ranging impacts of the shutdown on Indian Country.
America’s longstanding, legally-mandated obligations to tribal nations should be honored no matter the political quarrels of the moment. “During this shutdown, Congress and the President are putting the well-being of our tribal nations and our citizens in jeopardy. As governmental leaders, we know that it is simply not an option to stop serving our citizens. On behalf of Indian Country, we urge the President and Congress to do their jobs and reopen the government immediately,” said National Congress of American Indians (NCAI) President Jefferson Keel...
As the government shutdown reaches its 20th day, leaders across a spectrum of health, public health and civil rights organizations call on Congress and the President to immediately reopen the government.
The ongoing shutdown is having a negative impact on the public’s health, both directly and by impacting other factors that influence health such as nutrition support programs at the Department of Agriculture and rental assistance programs at the Department of Housing and Urban Development. That impact will only grow and become more detrimental if the shutdown continues...
Today is the 13th day of the partial government shutdown, and the federal agencies impacted are beginning to see their services effected as carry over funds diminish.
This shutdown is unlike others due to its limited impact: it only affects those agencies which have not been funded by Congress for the entirety of Fiscal Year (FY) 2019. Unfortunately, this includes the Department of Interior as well as the Indian Health Service. Other public health programs operating in Indian Country within HHS are funded and will continue without disruption...
Today, January 3, 2019, marks the 13th day of the partial government shutdown. The Indian Health Service (IHS) is one of the agencies affected by the lapse in funding, and both Direct Service and Self Governance Tribes have been impacted.
Even as IHS facilities remain open to provide medical care, Tribes are still feeling the impact of the shutdown. Due to the IHS's inability to provide funding to Tribes and many federal employees during the shutdown, many health programs and critical health services are unable to continue providing care...
The federal government may be undergoing a partial shutdown if Congress fails to pass a Continuing Resolution (CR) by the end of the day today, December 21, 2018. At the time of this writing, it is unclear if the Congress and the President will reach an agreement to keep the government open by tonight. President Trump has indicated that he will not sign legislation that does not fund the border wall. Senate Democrats have said that they will not accept that option.
Today the 116th Congress took the oath of office and began its two-year term. With Democrats in Control of the House and Republicans in the majority in the Senate, Congress is divided for the first time since 2014.
As NIHB detailed in a webinar analyzing the results of the 2018 midterm elections on Indian health, the new Congress includes four members of federally-recognized Tribes, the most ever in the history of Congress. Committee assignments for the two newly elected Tribal women, as well as the 88 other Congressmembers elected for the first time, will be known in the very near future.
As expected, former Speaker Nancy Pelosi (D-CA) reclaimed her place as the top member of the House, a post which she held from 2007-2011. While there had been some doubt as to whether the House Democrats would continue to support Pelosi, who has led the caucus since 2004, she won a crucial caucus vote following the 2018 elections. Pelosi has demonstrated familiarity with the federal government's trust responsibility to provide health to Tribes and has been a supporter of many of Indian Country's health priorities.
