September 27 2019
Senate Appropriations Committee Passes FY 2020 Interior Bill, Includes Funding Increases for Indian Health Service

September 27, 2019

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.

While the funding levels passed by the Senate Appropriations Committee come in lower than those passed by the House for FY 2020, nearly every IHS line item receives an increase compared to FY 2019 enacted levels. Below is a breakdown of funding levels for a few critical line items within the IHS budget.

To compare how Senate funding levels compare with those passed by the House, see NIHB's previous report on the FY 2020 House Interior package.

IHS Services

  • Hospitals & Clinics: $2.339 billion (+ $192.3 million above FY 19)
  • Mental Health: $108.5 million (+ $3.2 million above FY 19)
  • Alcohol/Substance Abuse: $247.8 million (+ $2.2 million above FY 19)
  • Purchased/Referred Care: $967.3 million (+ $2.5 million above FY 19)
  • Community Health Representatives: $62.8 million (equal to FY 19)
  • Urban Indian Health: $53 million (+ $1.8 million over FY 19)
  • Indian Health Professions: $57.7 million (+ $433K over FY 19)

The Senate bill maintains $10 million for a special behavioral health program, and instructs the IHS to work with the Substance Abuse and Mental Health Services Administration (SAMHSA) to leverage technical assistance and evaluation resources.

The package also maintains $72.2 million for the Indian Health Care Improvement Fund, and $2.1 million for immunization efforts in Alaska.

Unfortunately, none of the newly proposed line items in the FY 2020 President's Budget were included. However, the Senate bill does include $5 million for Community Health Aide Program (CHAP) expansion, and $3 million to assist with modernization of electronic health records (EHRs). However, these funding levels come in lower than the $25 million and $20 million proposed for CHAP and EHR modernization, respectively, in the President's Budget.

105(l) Leases
The Senate Interior bill includes $97 million to help pay for a backlog of existing agency expenses associated with 105(l) lease contracts. The report accompanying the bill outlines the continued concern of Senate appropriators in meeting the full funding needs associated with 105(l) leases. Further, it includes language directing IHS to work with the Office of Management and Budget (OMB) and the Department of Interior (DOI) to formulate budget and legislative strategies and report back to Congress on whether obligations for 105(l) lease contracts should be treated as an appropriated entitlement, similar to Contract Support Costs. The report also directs IHS to report back to Congress within 90 days of bill enactment on the specific challenges that prevent the agency from formulating an accurate assessment of need around 105(l) lease costs.

Contract Support Costs (CSCs)
The Senate bill maintains the rightful full funding of CSCs as an indefinite appropriation, currently at $820 million for FY 2020.

IHS Facilities
  • Maintenance/Improvement: $168.9 million (+ $1.4 million above FY 19)
  • Sanitation Facilities: $193.5 million (+ $1.5 million above FY 19)
  • Health Care Facilities: $249.2 million (+ $5.7 million above FY 19)
  • Facilities/Environmental Health: $261.9 million (+ $9.9 million above FY 19)
  • Equipment: $29 million (+ $5.3 million above FY 19)

Next Steps
Although the Senate Appropriations Committee has now cleared ten out of twelve funding bills, it has yet to reconcile differences with the House or pass the bills on the Senate floor. Because differences in opinion still exist between House and Senate appropriators for FY 2020 spending bills, the Senate cleared a short-term continuing resolution (CR) yesterday, September 26, that was sent to the President's desk. The House had cleared that same package on Thursday of last week.

The short-term CR, titled H.R. 4378 - Continuing Appropriations Act, 2020, and Health Extenders Act of 2019 - funds the federal government through November 21 of this year. As NIHB reported previously, the CR also extends the vital Special Diabetes Program for Indians (SDPI) through November 21. This ensures that the program does not expire at the end of the fiscal year on September 30, and provides additional time to secure long-term renewal.

To access the FY 2020 Senate Interior Bill, click here
To access the FY 2020 Senate Interior Report, click here

For any questions on FY 2020 appropriations, please contact NIHB Deputy Director of Congressional Relations, Shervin Aazami, at


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