Resolution Calling on Congress to Establish an Indefinite Discretionary Appropriation for the Indian Health Service to Fund Section 105(l) Lease Obligations under the Indian Self-Determination and Education Assistance Act (ISDEAA)

WHEREAS, the National Indian Health Board (NIHB), established in 1972, serving all Federally recognized American Indian/Alaska Native (AI/AN) Tribal governments by advocating for the improvement of health care delivery to AI/ANs, as well as upholding the Federal government’s trust responsibility to AI/AN Tribal governments, does hereby establish and submit the following resolution; and

WHEREAS, Section 105(l) of the ISDEAA requires the Indian Health Service (IHS), upon Tribal request, to enter into a lease for a facility owned or leased by the Tribal Nation or organization and used to carry out its ISDEAA agreement; and

WHEREAS, as established in Maniilaq Association v. Burwell (2016), IHS must compensate the Tribal Nation or organization fully for its reasonable facility expenses under Section 105(l); and

WHEREAS, on July 10, 2018, IHS sent a Dear Tribal Leader Letter (DTLL) proposing to fund a $13 million FY 2018 shortfall of Section 105(l) ISDEAA lease costs by reprogramming funding from IHS unallocated inflation increases; and

WHEREAS, on September 14, 2018, IHS sent a follow-up DTLL informing Tribal Nations that it had decided that in order to meet FY 2018 105(l) lease funding requirements it had reprogrammed $25 million from the $70.4 million increase identified for inflation; and

WHEREAS, on March 2, 2019, IHS issued an additional DTLL stating that:

• IHS has received 100 105(l) lease proposals from Tribal Nations and Tribal organizations, totaling approximately $39 million for FY 2019; and

• In addition to an initial $5 million that IHS identified in the base services appropriation, Congress provided IHS an increase of $25 million for Tribal clinic operational costs in FY 2019; and

• Base IHS appropriation increases IHS’s capacity to address the anticipated FY 2019 funding need, but full FY 2019 need remains unknown; and

• FY 2018 reprogramming was done on a one-time basis in the hopes that other options might become available in FY 2019; andPage 2 of 2

• Due to the continued need for resources beyond those identified for Tribal clinic operational costs in FY 2019, IHS is legally required to use a portion of the funds included in the IHS appropriation to fund 105(l) leases; and