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Top Takeaways
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“There is no amount of red tape that can patch an underfunded system”: Read about Councilman Lee Spoonhunter’s testimony to the House Committee.
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IHS Tribal Consultation on August 9, 2023: Learn how to provide input on IHS Tribal Consultation Policy and participate in NIHB's Tribal Caucus.
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Meetings for the Medicare, Medicaid, and Health Reform Policy Committee (MMPC) and the Tribal Technical Advisory Group (TTAG): Catch up on the first Face-to-Face meeting in three years.
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In this Letter:
📰 News
📝 Dear Tribal Leader Letters
📣Announcements
📒Upcoming Tribal Advisory Committees & Tribal Consultations
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Congress Adjourns for August Recess – FY 2024 Funding, SDPI reauthorization, and Other Items still on the “to-do” list
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.
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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].
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Councilman Spoonhunter Testimony | |
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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.
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Data on Medicaid Disenrollment – July 25, 2023 Update
The Kaiser Family Foundation has created a tracker for the most recent data on the unwinding of Medicaid. The data is not specific to American Indians/Alaska Natives.
Rates of disenrollment differ widely across states, ranging from 10% in Michigan to 82% in Texas. On average, 73% of Medicaid participants had their coverage terminated for procedural reasons, rather than being determined ineligible. In states where the data is available publicly, Medicaid procedural disenrollment rates range from 30% in Iowa to 96% in New Mexico. Procedural disenrollments can happen when a state has outdated contact information or when enrollees are unaware of timelines for renewal, for example. American Indians and Alaska Natives are at higher risk of procedural disenrollments.
Note: Since March 2020, the Medicaid continuous enrollment provision placed a hold on all Medicaid disenrollments through the duration of the COVID-19 Public Health Emergency. As of March 31, 2023, the provision is no longer in effect and states have begun to redetermine eligibility of their Medicaid enrollees.
NIHB has created a website with background information and materials about the unwinding process.
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NIHB Calls on United Nations and Member States to Implement Indigenous Determinants of Health as Part of the 16th Session of the Expert Mechanism on the Rights of Indigenous Peoples
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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.
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Dear Tribal Leader Letters
View all of IHS' Tribal Leader Letters Here
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July 27 Letter: The IHS Director writes to invite you to attend the Agency's Health Information Technology (IT) Modernization Summit
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July 26 Letter: The IHS Director writes to Tribal Leaders to initiate Tribal Consultation on updates to the Indian Health Service Tribal Consultation Policy
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July 19 Letter: The IHS Director writes to provide information regarding the syphilis epidemic affecting American Indian and Alaska Native communities
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July 19 Letter: IHS Director writes to provide an update on the status of implementing the FY 2024 advance appropriations for the IHS
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Submit Nominations to the Centers for Disease Control and Prevention /Agency for Toxic Substances and Disease Registry (CDC/ATSDR) Tribal Advisory Committee
The CDC/ATSDR Tribal Advisory Committee currently has vacancies in the Alaska, Bemidji, Billings, California, Nashville, Oklahoma, Portland, and Tucson Areas, along with four Tribes-at-Large positions open. Nominations for these vacancies will be open through August 22, 2023. Contact the Office of Tribal Affairs and Strategic Alliances at [email protected] for more information on the nomination process.
Participate in NIHB and Centers for Disease Control and Prevention (CDC) Regional Tribal Environmental Health Summits
CDC and the Agency for Toxic Substances and Disease Registry (ATSDR) in partnership with the National Indian Health Board are hosting a series of Regional Tribal Environmental Health Summits this summer. Each summit will include discussions on climate change, emergency preparedness, water safety, land revitalizations, and polyfluoroalkyl substances (PFAS), as well as the new CDC Tribal Public Health Data tool. The summits will take place in Phoenix, Arizona, on August 8-9; Billings, Montana, on August 17-18; and Green Bay, Wisconsin on August 22-23.
Department of Interior Self-Governance Advisory Committee and IHS Tribal Self-Governance Advisory Committee Meeting Information Available
The Department of Interior Self-Governance Advisory Committee (SGAC) and IHS Tribal Self-Governance Advisory Committee (TSGAC) will meet in August 2023. The Department of Interior SGAC will meet on August 29 all day and the first half of August 30, while the IHS TSGAC will meet on the second half of August 30 and August 31 all day. NIHB will provide registration information as it becomes available.
SAMHSA Office of Tribal Affairs and Policy (OTAP) and Office of Recovery’s (OR) Tribal Recovery Summit is Upcoming
SAMHSA's OTAP and Office of Recovery OR will convene a Tribal Recovery Summit on August 15 - 16, 2023, at the Radiance Plaza located at 1301 Young Street in Dallas, TX. The purpose of the summit is to share best practices and experiences related to expanding recovery-related programs and opportunities within AI/AN communities. More information about the event is available here. You can register to attend the event virtually here.
Submit Written Comments on the Administration for Children and Families Child Care and Development Fund (CCDF) Program
ACF's Office of Child Care is consulting with Tribes on how the CCDF Program impacts Tribal communities, as well as broader engagement around how Federal-Tribal partners can work together to promote the early learning and development of Native children and family stability. Comments can be submitted to [email protected] through August 18, 2023.
Register for the Upcoming Tribal Health Equity Data Symposium on September 25 and 26
National Indian Health Board will host the Tribal Health Equity Data Symposium on Monday, September 25 and Tuesday, September 26, 2023 in Washington, D.C. at American University. Note the new dates. The symposium will explore how we can reimagine the ways in which we use data to advance health equity for American Indians and Alaska Natives. We will hear diverse perspectives and participate in robust discussions about what it can look like to have a Tribally-driven, culturally-grounded approach to data collection, analysis, governance, and communications. Sessions will include a focus on both theory-based insights and practical applications.
Some of the topics on the agenda include:
- Measuring health equity" Considering Tribal sovereignty, strengths, and Indigenous identities
- Promising practices in improving how we collect data about race & ethnicity
- Challenges and opportunities in Tribal access to data held by federal and state agencies
Registration is now open. This is a no-cost session, and registration is limited. Due to space constraints, we kindly ask that you only register if you intend to attend the symposium. For more information on the symposium and NIHB’s health equity work, please see nihb.org/health-equity. Questions and concerns can be directed to Jeannie Le at [email protected] or Rochelle Ruffer at [email protected].
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Upcoming Tribal Advisory Committees & Tribal Consultations
Consultations
The Department of Health and Human Services (HHS) Annual Regional Tribal Consultations Summer 2023: Each of the 10 HHS regions will again be hosting consultations with regional Tribes to discuss programmatic issues and Tribal priorities. Each session will include one-on-one opportunities with regional leadership. The remaining consultation dates are:
August 1-2 | Region 8 | Denver, CO
August 10-11 | Region 10 | Anchorage, AK
August 22-24 | Region 6 | Dallas, TX
August 30-31 | Region 4 | Choctaw, MS
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ACF Tribal Consultation on Implementation of the Indian Child Welfare Act (ICWA)
Date: August 7, 2023
Time: 3:00 PM ET
Registration Link
Written Comment Deadline: September 15, 2023
Written Comment Submission: [email protected]
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NIHB Tribal Caucus on IHS Tribal Consultation Policy
NIHB will host a Tribal Caucus to help Tribal leaders, delegates, and Technical Advisors prepare for the IHS Tribal Consultation on Consultation Policy. After registering, you will receive a confirmation email containing information about joining the meeting. NIHB will follow up with a calendar invite for your convenience.
Date: Monday, August 7, 2023
Time: 2:00 PM ET
Registration Link
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IHS Tribal Consultation on IHS Tribal Consultation Policy Toward Consulting with Alaska Native Corporations
Date: August 9, 2023
Time: 12:00 – 2:00 PM ET
Written Comment Deadline: September 11, 2023
Written Comment Submission: [email protected], subject line “IHS TRIBAL CONSULTATION POLICY”
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Substance Abuse and Mental Health Services Administration (SAMHSA) Tribal Consultation
This consultation will provide an opportunity for SAMHSA to engage with Tribal leaders and ensure meaningful and timely input from Tribes on the development of the Behavioral Health and Substance Use Disorder Resource for Native Americans program.
Date: August 29, 2023
Time: 4:00 PM ET
Registration Link
Tribal Consultation and Urban Confer: Health Information Technology Modernization Leaders Engaging in Governance
Date: August 2, 2023
Time: 1:30 – 3:30 PM ET
Registration Link
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Substance Abuse and Mental Health Services Administration (SAMHSA) Tribal Technical Advisory Committee (TTAC)
Date: August 29, 2023
Time: 1:00 – 4:00 PM ET
Meeting Registration Link
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IHS’ Tribal Self-Governance (Self-Gov) Tribal Advisory Committee
Date: August 30, 2023 – August 31, 2023
Time: August 30 (afternoon) - August 31 (All Day)
Meeting Registration Link
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FY 2025-2026 Tribal Budget Formulation Planning and Evaluation Meeting
The primary objectives of the annual Budget Formulation Evaluation meeting are:
- To have an open discussion of what worked and what didn’t work in the entire budget formulation process for FY 2025 and,
- To (a) recommend improvements, (b) set due dates for deliverables, (c) review/revise the technical instruction and accompanying templates, (d) set funding levels, and (e) set date for FY 2026 National Budget Work Session.
Date: August 16, 2023
Time: TBD
Meeting Link
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Listening Session
Substance Abuse and Mental Health Services Administration (SAMHSA) Tribal Listening Session
Date: August 8, 2023
Time: 3:00 PM ET
SAMHSA's Tribal Listening Session and virtual Tribal Consultation on Behavioral Health and Substance Use Disorder Resources for Native Americans. This is a new program, authorized but not appropriated, under the 2023 Omnibus Funding bill. The listening session will provide an opportunity for SAMHSA to share information about the statute and engage with Tribal Leaders prior to the consultation.
Listening Session Registration Link
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