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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

October 5, 2022

In This Week's Washington Report

Action Item: Congress Passes Temporary Government Funding Measure

Action Item: NIHB Board of Directors Advocate for Advance Appropriations in Congress 

Action Item: CDO Window Application Extended

News From Capitol Hill

Congress Passes Temporary Government Funding Measure

Congress passed a funding package that was signed into law on Friday, September 30 - one day before the start of federal fiscal year (FY) 2023, averting a government shutdown and keeping the government operating through December 16, 2022. Often referred to as a Continuing Resolution or CR, the measure passed the Senate with a strong bipartisan vote (72-25), while the House vote of 230-201 was mostly along party lines and hinted of funding battles ahead after the midterm elections and in the next Congress.

The Indian Health Service (IHS) is level-funded for the duration of the CR, except for an increase provided for costs of staffing and operating facilities that were opened, renovated, or expanded in FY 2022 and 2023. IHS is expected to continue its policy from FY 2020 of providing the full prior-year base Secretarial amount to Tribal health programs with performance periods starting within the CR period. Tribes and Tribal Organizations with ISDEAA agreements should connect with IHS directly on timing and complete any FY 2023 funding agreements so that funds can be made available. 

Formula-based program funding will likely not be distributed until Congress enacts a final FY 2023 appropriation and the IHS completes distribution decisions. Programs operated by the IHS, including contracts to Urban Indian Organizations, are expected to receive level-funding prorated for the duration of the CR. 

In addition to these funding inequities within the IHS budget, there exist inequities in relation to other federal healthcare programs. Hardships imposed on these programs by CR and government shutdowns are well documented by the Government Accountability Office, as are the benefits of advance appropriations. Advance appropriations help reduce these hardships by committing, at least one year in advance, to appropriating a full annual budget, available at the start of the fiscal year, regardless of any CR or government shutdown.  

According to the Congressional Research Service, IHS is the only major federal provider of health care that is solely funded through regular appropriations on an annual basis. In 27 years, IHS has only once (in FY 2006) received full-year appropriations by the start of the fiscal year. Other federal health care providers, such as the Veterans Health Administration, receive the majority of their funding through advance appropriations, and a number of health programs, including Medicare and Medicaid, receive mandatory funding, which is controlled outside of appropriations acts. 

In essence, Congress protects healthcare for seniors through mandatory funding and protects veterans through advance appropriations, yet continues to tolerate leaving Tribes vulnerable to stopgap funding and government shutdowns. This inequity is discriminatory and it needs to stop. A simple proposal for FY 2024 is right in front of Congress and it doesn’t cost one extra dime

What comes next, and what you can do 

Although Members of Congress have gone home until after the midterm elections, the House and Senate Appropriations Committees are busy preparing for inevitable negotiations on final FY 2023 appropriations bills. House Majority and bipartisan Senate leadership have signaled a desire to complete negotiations and enact a final omnibus appropriations bill before the current CR expires on December 16. It’s unclear yet whether House Minority leadership will agree to that timeline or prefer to extend the CR into the new year if midterm elections flip party control of the House. 

When the negotiations begin, advance appropriations for IHS will be on the table. This past July, Senators Leahy (D-VT) and Merkley (D-OR) released the FY 2023 Interior, Environment, and Related Agencies appropriations bill containing FY 2024 advance appropriations for the IHS. The bill guarantees a full-year appropriation at the start of FY 2024 that is at least equal to the amounts appropriated for FY 2023 with the exception of funding provided for Electronic Health Records, Sanitation Facilities Construction, and Health Care Facilities Construction. 

The Leahy-Merkley proposal for IHS advance appropriations isn’t perfect but it is consistent with NIHB Resolution 14-03 and the 2022 NIHB Legislative and Policy Agenda and is an incremental step towards full mandatory funding for IHS. 

If enacted, the Leahy-Merkley proposal provides a level-funding floor for the FY 2024 IHS budget but is not the last word on the matter. Just as with advance appropriations for veterans, Congress can add funding to the IHS budget during the regular FY 2024 appropriations process as more accurate estimates of FY 2024 needs are developed. 

Strong and sustained pressure from Tribal leaders to their Members of Congress is still needed. Here are two things you can do: 

  1. In June, NIHB and the National Congress of American Indians (NCAI) issued a Call to Action, providing templates and talking points for letters and phone calls to Members of Congress. Consider taking these actions if you have not already done so, and, even if you have, consider reminding those Members that this issue remains a top priority. 
  2. In August, the NIHB and the NCAI issued a Call to Action seeking Tribal testimony on the impacts of government shutdowns on the delivery of IHS programs. 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?” Sharing stories with NIHB and NCAI through this survey will help NIHB and NCAI to effectively better advocate for advance appropriations in Congress. Consider filling out the survey if you have not already done so. Or, if you would prefer, you can email your stories directly to Ciara Johnson, NIHB Congressional Relations Associate, at 

Other News and Events

NIHB Board of Directors Advocate for Advance Appropriations in Congress

Finishing strong on the last day of the National Tribal Health Conference, the National Indian Health Board (NIHB) went to Congress advocating for Tribal healthcare funding. 

As pictured, NIHB Chairman Chief William Smith and NIHB Billings Area Representative Timothy Davis met with Representative Mary Peltola (D-AK-At-Large). Chairman Smith and Representative Peltola spent time connecting over Alaska’s isolating factors to Indian Health Service (IHS)facilities. Thereafter, Chairman Smith and Councilman Davis discussed three NIHB legislative priorities concerning advance appropriations in the government funding bill for IHS, reauthorization of the Special Diabetes Program for Indians (SDPI), and full mandatory funding for IHS. 

Advocating for these three NIHB legislative priorities, Chairman Smith and Councilman Davis met with the staff of Senators Dan Sullivan (R-AK) and Senate Committee on Indian Affairs Ranking Member Lisa Murkowski (R-AK). Councilman Davis later met with the staff of Senators John Thune (R-SD), and John Barrasso (R-WY). 

On the House side, NIHB Board alternates Melissa Gower, Senior Advisor, Policy Analyst of the Chickasaw Nation Executive Department of Health Policy, and Lesley Hunt, Vice Chair of the Board of the K’ima:w Medical Center, along with Buck Ellingson, Health Policy Analyst for the California Rural Indian Health Board, advocated on for NIHB legislative priorities. They met with the staff of Representative Betty McCollum (D-MN) and Representative Ken Calvert (R-CA). 

Additional NIHB Board members and alternates made trips to Capitol Hill throughout the week with coordinated messages on advance appropriations. NIHB staff will continue to up with Members of Congress regularly, in pursuit of legislative victories for Tribes in the remainder of this Congress. 

On behalf of NIHB, we want to thank Representative Mary Peltola and the staff of the Congressional offices who met with NIHB and listened to Tribal concerns and priorities. We look forward to advancing those Tribal priorities and working with the Congressional offices. 

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 guidancetraining 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:

  1. Access and complete the CDO application at: CMS will review your application and send a determination email with your application status. Please allow up to 10 business days for this review.
  2. 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 Please include your organization’s name and address in the body of your email.

National Indian Health Board | | 202-507-4070
Congressional Relations Associate Ciara Johnson at
Visit the NIHB COVID-19 Tribal Resource Center at
Media inquiries, contact Janee Andrews at
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