The National Indian Health Board is a dedicated advocate to Congress on behalf of all Tribal Governments and American Indians/Alaska Natives. Each weekly issue contains a listing of current events on Capitol Hill, information on passed and upcoming legislation, Indian health policy analysis, and action items. To view all of our legislative resources, please visit www.nihb.org/legislative/washington_report.php. | |
|
Three Native American Women Assume Influential National Positions Within the Administration and Congress
Last week, there was an astounding historic commitment to Indian Country as three Native American women assumed influential national positions. As the first Native American female to be appointed, Chief Lynn Malerba was sworn in as the United States Treasurer. On the same day, the White House announced the inaugural, permanent position appointing Ms. Elizabeth Carr is to be the Tribal Advisor to the Director of the Office of Management and Budget. The next day, Representative-elect Mary Peltola (D-D-At-Large) was sworn in as the first Alaska Native woman to represent Alaska’s sole House congressional seat in a special election.
| |
|
U.S. Treasurer Chief Elizabeth ‘Lynn’ Malerba
On September 12, Chief Malerba was sworn in as the U.S Treasurer. A member of the Mohegan Tribe, President Biden first announce Chief Malerba’s appointment on June 21, 2022. She will not only be the first Native American female to serve as Treasurer of the United States and the signatory of U.S currency, but she will also lead the newly established Office of Tribal and Native Affairs within the U.S Treasury.
Chief Malerba is not the first Native American to become the U.S Treasurer. Houston Benge Teehee, a citizen of the Cherokee Nation, was the first Native American Treasurer under the Woodrow Wilson Administration. Thus, Chief Malerba is the first Native America woman to become the Treasurer.
Becoming the 18th Chief of the Mohegan Tribe in August of 2010, Malerba is the first female Chief in the Tribe’s modern history. The Mohegan Tribe is a sovereign, federally recognized Tribe on reservation land in Southeast Connecticut. The position is a lifetime appointment made by the Tribe’s Council of Elders.
Prior to becoming Chief, she served as Chairwoman of the Tribal Council and served in Tribal Government as Executive Director of Health and Human Services. Preceding her work for the Mohegan Tribe, she had a lengthy career as a registered nurse, ultimately as the Director of Cardiology and Pulmonary Services at Lawrence and Memorial Hospital. The Chief earned a Doctor of Nursing Practice at Yale University, and was named a Jonas Scholar. She was awarded an honorary Doctoral degree in Science from Eastern Connecticut State University and an honorary Doctoral Degree in Humane Letters from the University of St. Joseph in West Hartford, CT. She earned a master's degree in Public Administration from the University of Connecticut and a Bachelor of Science in Nursing from the College of St. Joseph.
Malebra is Chairwoman of the Tribal Self-Governance Advisory Committee of the Federal Indian Health Service (IHS), a member of the Justice Department’s Tribal Nations Leadership Council, a member of the Tribal Advisory Committee for the National Institute of Health, and a member of the Treasury Tribal Advisory Committee. She also serves as the Secretary of the United South and Eastern Tribes Board of Directors.
| |
|
Representative Mary Peltola (D-AK)
On September 13, Mary Peltola was sworn into the House of Representatives becoming the first Alaska Native woman elected to Congress. Representative Peltola is Yup’ik Alaska Native and is the first Democratic woman to represent Alaska. In the special election for late Representative Don Young’s congressional seat, Peltola beat former governor and vice-presidential candidate Sarah Palin in a tight 51.5 percent to 48.5 percent vote. She is the fifth representative representing Alaska since it gained statehood in 1959.
Representative Young was the longest-serving Member of the House of Representatives in this current Congress and was sworn into the 93rd Congress after winning a special election on March 6, 1973.
Peltola will serve as Alaska’s sole House Representative for the remainder of 117th Congress. NIHB looks forward to working with Peltola in advancing late Young’s Indian healthcare priorities.
Representative Young was the longest-serving Member of the House of Representatives in congressional history, having been the U.S. Representative for Alaska's at-large congressional district for 49 years after winning a special election on March 6, 1973. He was the sponsor of H.R. 5549, the Indian Health Service Advance Appropriations Act, which received a supportive, bipartisan hearing on July 28, 2022, in the House Natural Resources Subcommittee on Indigenous Peoples of the United States.
| |
|
Tribal Advisor Elizabeth Carr
"Liz Carr (Sault Tribe Citizen) is well qualified with over 10 years of senior advisory experience in federal administration. She has distinguished herself in outreach to Tribes and in preparing usable information for Tribal nations to under what resources are available."
Principal Chief Chuck Hoskin, Jr. Cherokee Nation
On September 12, the White House announced the appointment of Elizabeth Carr as the Tribal Advisor within the Office of Management and Budget (OMB). Created under robust Tribal consultation and input, this position is unique as it is the first, permanent position of its kind. As the Tribal Advisor to the Director, Ms. Carr will work with the White House and the Administration to ensure coordination and implementation of Tribal priorities across OMB’s budget, management, and regulatory functions.
A member of the Sault St. Marie Tribe of Chippewa Indians of Michigan, Carr was a senior advisor to the director of the Indian Health Service (IHS), where she led strategy and implementation of health policy. She has more than 10 years of experience working with Tribes, Tribal colleges and universities, tribal organizations, and urban Indian organizations, including as a senior Native affairs advisor with the National Indigenous Women’s Resource Center, Inc.
“The James Town S’Klallam Tribe celebrates the establishment of a Senior Advisor on Native American Affairs. When Tribal Leaders hit the Hill or advocate with the Federal Administration, we are often treated like special interests. Tribe prepaid for health, education, and social welfare with over half a billion acres of Indian lands ceded to the United States. The establishment of this position is an excellent step forward to create systemic change for the Federal government to fully recognize the treaty and trust obligation.”
Tribal Chairman, Jamestown S'Klallam Tribe
With this historic commitment, the National Indian Health Board (NIHB) is looking forward to working with Carr and further strengthening the White House’s commitment to Indian healthcare. Most recently, NIHB held a Tribal caucus on Monday, September 12 to help Tribal Leaders prepare for the upcoming Office of Management and Budget (OMB) Tribal Consultation on the President’s Fiscal Year (FY) 2024 Budget which occurred later that day.
The President’s Budget indicates to Congress how it would like to organize and operate the Executive Branch to accomplish its governance missions. The President’s Budget also makes authorizing policy, revenue, and spending proposals to Congress that it views as consistent with its operational mission. Right now, federal agencies have submitted their proposed FY 2024 budgets to OMB as part of the “September Submission.” During this period, OMB is reviewing those agency budgets for consistency with the President’s budget and policy mission. In November, OMB will provide directives for any edits the President and OMB require to agency budgets to remain consistent with their instruction.
“Classifying Tribal funding as discretionary funding belittles the fidelity owed to Tribal nations for what tribes sacrificed during the building of the United States. . . fully recognizing this obligation and making systemic changes to truly commit to Tribes. Fully appreciating the treaty and trust obligation requires a senior Native Advisor in the OMB to be at the table to ensure spending caps and discretionary funding classifications do not abrogate the treaty and trust obligation. The appointment of Sault Tribe Citizen Liz Carr is significant as she has done an excellent job as Senior Advisor to the IHS Director position for the last two years.”
President Jonathan Nez, Navajo Nation
This consultation is a critical final moment to provide input to influence the President’s FY 2024 Budget. For FY24, NIHB and Tribal leaders outlined 13 key recommendations in the Tribal caucus that were presented at the OMB Tribal Consultation, including full, mandatory appropriations for IHS and, if necessary in the interim, advance appropriations. Tribal Leaders further urged OMB to involve the White House to negotiate advance appropriations in the final FY 2023 appropriations bill, as proposed by Senate Democrats.
As noted, for Indian healthcare, the OMB plays a critical role in shaping the fiscal year’s budget. With Carr as the Tribal Advisor to the Director of OMB, we hope to see equity improvement for Indian healthcare and look forward to working with Carr.
| |
|
Tribes Share Initial Support: NIHB and NCAI Seek Tribal Testimony on Advance Appropriations
“Government shutdowns represent the inability of government to work as a team. Politics should not be the rule of the day but cooperation and collaboration to run the country, including Sovereign Nations through treaties.”
Ensuring stable and predictable funding for the Indian Health Service (IHS), advance appropriations are a longstanding Tribal request and recommendation that the National Indian Health Board (NIHB) and the National Congress of American Indians (NCAI) have diligently advocated for years. Most recently, NIHB and NCAI have joined efforts to collect primary data through a survey from Tribes on the impacts of IHS from government shutdowns and continuing resolutions.
An advance appropriation is funding that becomes available one year or more after the year of the appropriations act in which it is contained. For example, if advance appropriations were secured in the fiscal year (FY) 2023 spending bills there will be an appropriation for FY 2024 regardless of a government shutdown or continuing resolution occurrence. This means when the budget is being proposed for FY 2024IHS would already have an appropriation for that fiscal year because of the advance appropriation funded from the FY 2023 spending bills and therefore a more stable, predictable funding stream for IHS.
Endorsing support for advance appropriations for IHS, the Biden Administration is aware of the adverse impacts of discretionary funding and has included advance appropriation in the FY 2023 President’s Budget. Passing their appropriation bills this July, the House did not include advance appropriations despite overwhelming Tribal advocacy. On the other hand, making a historic investment to the health of Indian Country, the Senate did include advance appropriations in their appropriation bills providing $5.577 billion for FY 2024. However, the securement of advance appropriations is not yet final.
Tribes need advance appropriations for IHS funding now. Allies in Congress are asking for your stories to help get their colleagues on board. Members of Congress frequently ask, “Why do Tribes need Advance Appropriations?” and “How do funding disruptions harm Tribal nations and their people?”
From initial survey responses, Tribal leaders and Tribal health directors have noted federal governmental shutdowns result in loss of patient contact hours, loss of third-party billing opportunity and revenue, and loss of hours of operations of health services.
“There were cuts to Tribal Council and Director Salaries of 8.5 percent. Caused huge employee moral issues with people who are termed essential. Promoted racism within the organization. Cut hours and laid off some government staff.”
Overwhelmingly, multiple Tribes have experienced interruptions in providing mental health services, substance abuse treatment, and adverse impacts on recruiting and retaining professional medical staff. Fortunately, or unfortunately, some Tribes did not experience furloughing or layoffs because they were able to use the revenue to cover the wages. Others made the tough decision to furlough or layoff medical staff.
"Being critically underfunded affects the services we can provide especially in very remote areas, also not having advanced appropriations makes it hard to plan, and also having to supplement from our third-party funds takes away from the additional services we are able to provide to due people due to no access due because of our location."
Testifying in support of advance appropriations, a Tribe noted, "People who actually visit villages, will better understand [their] living conditions, and see how remote [they] are. Transportation is mainly by aircraft; others, if the weather is allowable, travel by boats and during the winter by snowmobiles".
If you would like to share your stories highlighting the direct adverse impacts of unstable IHS funding, please submit them through this survey. Answers can remain anonymous in which there is an option on the survey to keep your Tribe’s name anonymous. In addition, you will be routed to a separate link to enter to win a Pendleton.
For questions, please contact NIHB Director of Government Relations Aaron Payment, EdD, at apayment@nihb.org.
| |
CDO Application Window Extended
The certified designated organization (CDO) application window typically runs from June 1 to August 31, annually. To support organizations in FFM states during the Unwinding period, the Marketplace will extend the current CDO application window to November 1, 2022, and will open another CDO application window once the Medicaid Unwinding begins.
These application window extensions will enable eligible organizations in FFM states to apply to become a CDO, which will provide access to FFM and Medicaid Unwinding technical guidance, training materials, and consumer support resources such as the Complex Case Help Center (CCHC).
CMS invites new applicant organizations who want to become a CDO for Plan Year 2023 to apply during CMS’ Open Season, which has been extended to November 1, 2022.
Any organization operating in an FFM state seeking to provide certified application counselor (CAC) enrollment assistance to consumers for Plan Year 2023 must apply to become a CDO and enter into an agreement with CMS if they are not a current CDO.
CDOs are a vital component of the assister community. In the FFM, CDOs oversee CACs, who are annually trained and able to help consumers seeking health coverage options through the Marketplace. For an overview of the CDO Program and resources that walk users through the CDO application, please visit:
Only organizations that complete the two steps below by November 1, 2022, and receive a CDO ID from CMS can certify staff or volunteers as federally certified application counselors (CACs) to provide enrollment assistance services.
To apply to become CDO:
-
Access and complete the CDO application at: https://mats.secure.force.com/CDOApplication/. CMS will review your application and send a determination email with your application status. Please allow up to 10 business days for this review.
- If CMS approves your application, you must access the CDO Organizational Maintenance Web Form (link provided in approval email) and submit a signed CMS-CDO agreement. CMS will then review your signed agreement and send a determination email. If CMS approves your agreement, you will receive a Welcome Packet email with a unique CDO ID. Please allow up to five business days for this review.
For questions or updates, you can email CACQuestions@cms.hhs.gov. Please include your organization’s name and address in the body of your email.
| |
|
National Tribal Health Conference and 50th Anniversary Celebration
THE POWER OF IDENTITY: A PATH TO TRIBAL HEALTH EQUITY
The National Indian Health Board (NIHB) will see you next week as we take a look back at the history of NIHB and build our plans for the next 50 years. Together we will explore the topics of health equity, health policy, Tribal advances in health, and many more. The National Tribal Health Conference (NTHC) The event will be held in Washington, DC at the Hyatt Regency Capitol Hill from September 25-28, 2022. Learn more and register here.
| | | | | |
