NIHB Chairman William Smith testified on July 18 about the importance of culture in healing for Indigenous People at the 16th Session of the Expert Mechanism on the Rights of Indigenous Peoples.

“NIHB’s sole commitment and focus is to the health care and public health for all American Indian and Alaska Native Peoples. That includes the work of healing our Peoples and our Nations,” said Chairman Smith, a citizen of the EYAK Tribe in the Alaska Village of Valdez. “That work cannot succeed without restoration of language and culture, and healing from colonization.  Our very concepts of what it is to be healthy are rooted in our cultures, languages and in in our shared and individual histories. Without standing in the full knowledge and understanding of the impact colonization has defined in all indigenous experience, we will not know health. We will not heal.”

In April, NIHB supported the United Nations Permanent Forum on Indigenous Issues’ adoption of the Indigenous Determinants of Health (IDH), an international paper with 17 Indigenous authors including NIHB, designed as a tool to help UN Member States understand the social determinants of health as they relate to Indigenous Peoples. In May, at the 76th World Health Assembly, NIHB supported the World Health Organization’s adoption of the IDH.

Now, NIHB is focused on ensuring these organizations continue to listen to Indigenous Peoples to create further recommendations on health.

From July 25 to July 27, the MMPC and TTAG held their first Face-to-Face meetings in over three years. These meetings brought together Tribal health policy advocates, Tribal leaders, and leadership from the Centers for Medicare and Medicaid Services (CMS) to discuss recent developments and current priorities for the Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) programs. The MMPC is a committee within NIHB that serves as a forum for Tribes, Tribal organizations, and those that work in Tribal health policy to share information on emerging issues and to identify agenda and action items for the TTAG meeting which follows the next day. The TTAG meeting began on July 26 at the National Museum of the American Indian and was attended by committee members from IHS service areas, as well as representatives from NIHB, the National Council on Urban Indian Health, National Congress of American Indians, and Tribal Self Governance Advisory Committee. Both meeting agendas featured a variety of presentations and discussion points, and three issues resounded throughout.

During this period of “Unwinding,” Medicaid has resumed checking eligibility and disenrolling as a result of the end of the public health emergency. At present, CMS has not publicly released disenrollment data by state. During a discussion with Daniel Tsai, Deputy Administrator and Director of the Center for Medicaid and CHIP Services, Mr. Tsai announced that general statistics on Medicaid disenrollment will be shared imminently. However, demographic data including racial and ethnic background will likely not be available for several more months. Tribal representatives also shared that there have been difficulties with certain states sharing their disenrollment data with Tribes, which has impeded efforts to combat disenrollments due to procedural missteps rather than ineligibility.

The TTAG also touched base with Mr. Tsai on the recent Four Walls grace period extension through February 2025, which permits IHS and Tribal facilities to receive Medicaid reimbursements for services provided outside of the “four walls” of their facilities. Mr. Tsai shared that this extension was intended to signal CMS’s intention to resolve the Four Walls limitation and to create time to work through the complex regulatory impact of such a change and the statutory barriers that exist.

It was also shared that CMS is considering Arizona’s 1115(a) Demonstration Waiver application to reimburse for traditional healing with the support of Medicaid and expects to have a decision before the end of the 2023 calendar year. There are three other pending waiver applications with traditional healing components: California, New Mexico, and Oregon. Arizona was the first state to submit an application to CMS back in 2016. Should it be approved, the Arizona waiver would lay the foundation for the remaining waivers.

The next MMPC Face-to-Face Meeting is tentatively scheduled for October 17, 2023, ahead of the TTAG Face-to-Face Meeting on October 18-19, 2023.

Councilman Lee Spoonhunter, NIHB Board Member representing the Billings Area, testified to the House Committee on Natural Resources Subcommittee on Indian and Insular Affairs Thursday, July 27, 2023. The legislative hearing discussed the draft legislation: Restoring Accountability in the Indian Health Service (IHS) Act of 2023.

According to the Committee, this hearing was held, in part, to address the Indian Health Service’s history of “substandard medical care, high staff vacancy rates, aging facilities and equipment, and unqualified or predatory healthcare staff.”

“There is no amount of red tape that can patch an underfunded system,” said Spoonhunter. “Imagine having only one day’s worth of food for a week: for generations. The funding of IHS at 1/7th the estimate of the Tribal Budget Formulation Workgroup sets us up for failure.”

Spoonhunter testified that NIHB is supportive of the intent of this bill to address policy concerns at the IHS. However, more work is needed before any amendments are made to the Indian Health Care Improvement Act. The draft bill has many well-intended provisions that seek to address past misconduct and a lack of accountability at the IHS, but these good intentions could have the potential to impact Tribally operated health facilities.

To view the hearing and view additional information on the draft legislation, click here.

Last week, Congress adjourned for their 5-week August recess, without resolving many of the key legislative deadlines set to expire on September 30, 2023 – including but not limited to the FY 2024 Discretionary appropriations and the renewal of the Special Diabetes Program for Indians (SDPI).

SDPI: SDPI expires on September 30, 2023. Committees in both the House and Senate have passed legislation (H.R. 3561 and S. 1855, respectively) to renew SDPI for 2 years at a funding level of $170 million per year.  SDPI has been funded at $150 million since FY 2004, so this funding increase is an important step towards getting more money for this lifesaving program.   On Thursday, July 27, Navajo Nation President, and NIHB Board Member Buu Nygren testified before the Joint Economic Committee discussing the economic impacts of diabetes. NIHB provided support for his testimony through our Tribal Assistance Program – you can view his written testimony here.  President Nygren urged the Committee members to support SDPI renewal.

FY 2024 Appropriations: Last week, the Senate Appropriations Committee released and passed its FY 2024 Interior, Environment and Related Agencies Appropriations bill. This bill would fund the Indian Health Service (IHS) at about $7.2 billion, which is a small increase of $218.6 million over FY 2023. However, the Senate’s bill also included a “rescission” of $350 million from IHS from American Rescue Plan Act funds, sending IHS funds back to Treasury.  Earlier this summer, the House Appropriations Committee released a bill that would fund IHS at roughly $7.1 billion.  The Senate and House Bills both continue IHS advance appropriations.   Unfortunately, neither the House nor Senate bill included reclassification of Contract Support Costs and 105(l) leases as mandatory spending, which is a long-time request of Tribal nations. NIHB will be sharing more information about FY 2024 appropriations later this week and what we can expect going into final negotiations and newly established spending caps set by Congress. Stay tuned to your inboxes!

Farm Bill: The Farm Bill is also up for renewal by September 30, 2023, which contains many critical nutrition programs important to Tribal communities.  The Senate Committee on Indian Affairs held a hearing on Native priorities for the 2023 Farm Bill Reauthorization. Witness testimony included support for the expansion of Tribal Self-governance in nutrition programs and pilot programs to improve healthy foods in Native communities. NIHB supports the work of the Native Farm Bill Coalition to improve these programs. You can read more about their legislative asks here. The full video of the hearing is available here.

August is a great time to reach out to your Congressional delegation! If you need assistance with talking points or issue briefs for Congress please reach out to Taylor Barrett, NIHB’s Congressional Relations Coordinator at [email protected].