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National Indian Health Board Releases Budget Request for Fiscal Year 2022
Key recommendation is to increase the Indian Health Service budget to $12.7 billion. 
WASHINGTON, DC—May 5, 2020—The National Indian Health Board (NIHB) continues to advocate for increases in the Indian Health Service (IHS) budget as Tribes across the country fight the novel coronavirus with limited funding and resources. On May 3, NIHB submitted testimony to the U.S. Department of Health and Human Services (HHS) detailing the Tribal health budget priorities for fiscal year (FY) 2022. The testimony urges the Administration to follow the National Tribal Budget Formulation Workgroup (TBFWG) recommendations that includes funding the IHS at $12.7 billion, strengthening Tribal access to Medicare and Medicaid programs, and expanding grants for Tribal behavioral health.

“Every year, Tribal Leaders put forward a national budget request that proposes to phase in funding increases and bring the federal government closer to fulfilling the treaty and trust obligations for health services," said NIHB Chairperson Victoria Kitcheyan. "This year, with many of our Tribal communities suffering from coronavirus, Tribes urge the Administration to fulfill the historic agreements by putting forth a budget that will finally eradicate the persistent health disparities that have impacted Tribal communities for generations, and are now exacerbated by COVID-19.”
The Tribal Budget Formulation Workgroup and NIHB proposed to increase the President’s Budget Request to a total of $12.759 billion for the IHS in FY 2022 by adding at a minimum :
  • +$337 million for full funding of current services
  • +474.5 million for binding fiscal obligations
  • +$2.7 billion for program increases for the most critical health issues (~30% above FY 2021 enacted)

Access the full FY 2022 Tribal Budget Formulation Workgroup Recommendations for the IHS budget on the NIHB website at .
Earlier this year, the Administration released the President’s Budget Request for FY 2021 , and though it has increases to the IHS budget for needed areas like Electronic Health Records, the budget request also proposes significant cuts to 13 IHS line items with the largest cut to the Health Care Facilities Construction at roughly $134 million below the fiscal year 2020 amount. Overall, the President’s FY 2021 Budget Request for IHS fell short of the Tribal Budget Formulation Workgroup Recommendations across every IHS line item except for Direct Operations. NIHB is unequivocally opposed all proposed IHS cuts.

“Tribal Nations continue to call on the Administration to prioritize department resources to make American Indian and Alaska Native health equal with the rest of the country. Tribal citizens experience tremendous health disparities, and this can be directly linked to the persistent, chronic underfunding of the Indian Health Service and other Tribal health programs across the agency,” said Chairperson Kitcheyan. “We are seeing the devastating impacts of that underfunding as our Tribal people suffer from COVID-19 in old hospitals with limited supplies and outdated equipment. America is seeing it too, and Tribes are looking to the Administration to make it right with a budget that gives our people a chance to be healthier and live longer.”

NIHB also included budget recommendations for other HHS agencies that have Tribal-specific programs, like Centers for Medicare and Medicaid Services (CMS); Centers for Disease Control and Prevention (CDC); Substance Abuse and Mental Health Services Administration (SAMHSA); National Institutes of Health (NIH); Health Resources and Services Administration (HRSA); and the Office of Minority Health (OMH).

The President’s Budget Request for FY 2021 encourages substantive changes to Medicaid that could greatly harm access to healthcare for American Indians and Alaska Natives and deplete third-party billing revenue collected by IHS, Tribes and urban Indian health centers (ITU). In response, NIHB urged CMS to protect these vital funds and strengthen them in Tribal communities by ensuring that all eligible users can enroll in CMS programs. NIHB also reiterated the request to provide exemption to Tribes and American Indian and Alaska Native people from block grants and mandatory work requirements, and to protect Medicaid expansion for all IHS beneficiaries.

“CMS programs, like Medicaid, Medicare and the Children’s Health Insurance Program, play a critical role in the Indian health care delivery system as its third-party revenue brings in crucial supplemental funding for Tribal health programs and it also supports the federal government’s trust responsibility,” Chairperson Kitcheyan said.

To the CDC, NIHB stressed the continued lack of public health infrastructure in Tribal communities and the need for CDC to provide meaningful, direct, recurring and non-competitive funding to Tribal governments to bolster public health. NIHB urged CDC to restore and increase funding to $32 million for the highly successful Good Health and Wellness program , which currently funds 35 Tribes and Tribal organizations to implement community-driven, culturally adapted strategies to improve public health in their communities such as limiting tobacco use, improving nutrition and physical activity, and increasing health literacy. For the third year in a row, CDC has proposed to eliminate Good Health and Wellness.

A continued priority area for Tribes is direct funding to help address mental and behavioral health issues including substance use disorders, overdose, mental illness, historical and intergenerational trauma and suicide. NIHB requested that the SAMHSA double its funding for the Tribal Behavioral Health Grants to $80 million and allow Tribes the flexibility to implement projects that are uniquely tailored to meet their community needs.

“Tribes look to the Administration to propose a FY 2022 budget that addresses the critical health needs of American Indians and Alaska Natives, especially today as we tackle COVID-19 at every front. NIHB asks that the Administration utilize the recommendations of the National Tribal Budget Formulation Workgroup to inform all budgetary decision-making, as their recommendations reflect the collective national voice of all 574 sovereign Tribal Nations,” Chairperson Kitchen added.

Learn more about the National Tribal Budget Formulation Workgroup FY 2022 Budget Request at:

National Indian Health Board Mission Statement

Established by the Tribes to advocate as the united voice of federally recognized American Indian and Alaska Native Tribes, NIHB seeks to reinforce Tribal sovereignty, strengthen Tribal health systems, secure resources, and build capacity to achieve the highest level of health and well-being for our People.