House Interior Appropriations Bill Advances with Historic Inclusion of $200.5 Million for Urban Indian Health

The National Council of Urban Indian Health (NCUIH) and the Tribal Budget Formulation Workgroup (TBFWG) requested the Administration to fund IHS at $12.759 billion with an urban Indian health line item of $200.5 million for FY 2022. Additionally, on April 30, 28 Congressional leaders requested $200.5 million for urban Indian health in FY 2022 from the House Appropriations Committee. Reps. Grijalva and Gallego requested $200.5 million for urban Indian health with $12 billion for IHS as recommended by the Tribal Budget Formulation Workgroup in a forward appropriations letter to Chairwoman Pingree and Ranking Member Joyce of the House Interior Appropriations Committee. Another letter by Reps. Adam Smith and Don Young included $200.5 million for urban Indian health and $24 million for Tribal Epidemiology Centers in FY 2022.

“This bill supports Native American families by investing in a strong and resilient Indian Country, including through education and health care programs,” said Chair Pingree in her opening remarks during Monday’s hearing.

UIOs serve a fundamental role in aiding Congress in fulfilling its trust obligation to approximately 70% of federally enrolled Indians who do not live on tribal lands. The increased funding and facilities fix for the 41 UIOs across the country are imperative to bringing the Federal government closer to fulfilling that obligation.

1.2. Bill Highlights

1.2.1. Urban Indian Health

• Bill Report: “The recommendation includes $200,500,000 for Urban Indian Health, $100,500,000 above the budget request and $137,816,000 above the enacted level.”

• The following report language, "the Committee expects the Service to continue including current services estimates for Urban Indian health in annual budget requests," reflects the House Committee's commitment to ensuring high-quality health care reaches all Native populations.

1.2.2. Facilities Fix for Urban Indian Health

• Bill Report: “Section 434 allows the Secretary of Health and Human Services to allow Urban Indian Organizations to use grant or contract funds for minor renovations to facilities, or construction or expansion of facilities, to meet certain standards.”

• This is NCUIH’s facility fix that was also recently endorsed by President Biden in the FY 2022 IHS Budget.

• The COVID-19 pandemic has exacerbated the need for UIOs to make updates to their facilities for no-contact services, socially distanced waiting rooms, and increased security to adhere to COVID-19 safety guidelines— all of which UIOs do not receive any funding for under the general IHS budgetary scheme. Chair Pingree’s bill addresses the critical unmet needs of urban Indians by increasing the urban Indian health line item and incorporating an authorization for UIOs to use funds for “minor renovations to facilities or construction or expansion of facilities, including leased facilities, to assist the urban Indian organization in meeting or maintaining standards issued by Federal or State governments or by accreditation organizations.”

1.2.3. Community Health Representatives

• Bill Report: “Community Health Representatives (CHR) played an important role in pandemic response. As individuals quarantined themselves, CHRs made home visits to prevent avoidable hospital readmissions and emergency department visits for patients with chronic health conditions. The recommendation includes $65,557,000 for CHR, as requested, and $2,665,000 above the enacted level. The Committee encourages IHS to examine whether UIOs should be eligible for these funds and to confer with UIOs to determine the amount necessary.”

1.2.4. UIO Infrastructure Study

• The FY 2021 funding for IHS included $1 million for a UIO infrastructure study that is in progress. For FY 2022, from the report, “The Committee does not continue the $1,000,000 for a UIO infrastructure study but continues to direct IHS to conduct urban confer and prepare the study and report on UIO infrastructure needs with the funds provided in fiscal year 2021. Within 30 days of completion of the study and report, the Committee expects IHS to submit the report to the Committee.”

1.2.5. Advance Appropriations

• Bill Report: “The Committee notes the budget requests advance appropriations beginning in fiscal year 2023. A proposal of this magnitude often takes years to fully evaluate and obtain appropriate authority. Yet as of budget submission, IHS has not commenced dialogue with the authorizing committees about this proposal. Further, to advance appropriate funds, IHS needs to be included in the list of accounts for which advance appropriations can be made. IHS is not on this list. Therefore, the Committee is unable to act on this request. In addition, to effectively evaluate an advance appropriation request, the Committee requires more details on the proposal. For the last two years, the Committee directed IHS to report on its policies and procedures that may need to be changed in the event of advance appropriations. IHS has not submitted this report nor has IHS evaluated each line of its budget to explain which lines may be essential for advance appropriation and the reason why. The Committee again directs IHS to submit this information within 120 days of enactment of this Act.”

1.2.6. Alzheimer’s Disease

• Bill Report: “The recommendation includes an additional $500,000 for a total of $5,500,000 to continue Alzheimer’s and related dementia activities. These funds will further efforts on Alzheimer’s awareness campaigns tailored for the AI/AN perspective to increase recognition of early signs of Alzheimer’s and other dementias; quarterly, competency-based training curriculum, either in-person or virtually, for primary care practitioners to ensure a core competency on assessing, diagnosing, and managing individuals with Alzheimer’s and other dementias; pilot programs to increase early detection and accurate diagnosis, including evidence based caregiver services within Indian Country, inclusive of UIOs; and an annual report to the Committee with data elements including the prevalence of Alzheimer’s incidence in the preceding year, and access to services within 90 days of the end of each fiscal year. The Committee continues to be concerned that IHS-funded facilities are not adequately prepared for the expected increase in Native patients with Alzheimer’s. Therefore, the Committee continues to direct IHS, in consultation with Indian Tribes and UIOs, to develop a plan to assist those with Alzheimer’s, the additional services required, and the costs associated with increasing Alzheimer’s patients and submit this information to Congress within 270 days of enactment of this Act.”

1.2.7. Ending Hepatitis C, HIV/AIDS and STDs

• Bill Report: “The recommendation includes an additional $22,000,000, as requested, for a total of $27,000,000 to identify, treat, prevent, and eliminate Hepatitis C, HIV/AIDS, and sexually transmitted diseases. The Committee encourages IHS to confer with UIOs to determine how they may participate in this initiative.”

1.2.8. Produce Prescription Pilot Program

• Bill Report: “The Committee is concerned with food insecurity among Native populations and recognizes the important role access to healthy food plays in preventing and managing chronic disease and reducing health care utilization. Produce prescription programs across the country allow medical providers to ‘‘prescribe’’ fresh fruits and vegetables to individuals or households who are at-risk due to health status or income, often pairing these prescriptions with financial incentives and nutrition education resources. The Committee provides $3,000,000 for IHS to create, in coordination with Tribes and UIOs, a pilot program to implement this model to increase access to produce and other traditional foods among its service population. Within 60 days of enactment of this Act, the Committee expects IHS to explain how the funds are to be distributed and the metrics to be used to measure success of the pilot, which shall include engagement metrics, and may include appropriate health outcomes metrics, if feasible.”

1.2.9. Pandemic Challenges Study

• Bill Report: “The Committee expects IHS to submit a report within 180 days of enactment of this Act, detailing the challenges it, as well as Tribes and UIOs, faced over the course of the pandemic and how they were resolved. The term ‘‘challenges’’ in this context includes, but is not limited to, distribution of funds, supply chain issues; vaccine availability and distribution policies amongst tribes; outdated health record systems; and overall COVID–19 case numbers.”