National Council of Urban Indian Health
On April 13, 2021, the National Council of Urban Indian Health (NCUIH) and several other American Indian and Alaska Native (AI/AN) organizations signed a joint letter urging Congress to address Indian Country’s infrastructure priorities in the upcoming legislative package. The letter includes several requests from National Council of Urban Indian Health for investments into Urban Indian Organizations (UIOs).
Background from Letter
There are 41 Urban Indian Organizations operating in 77 health facilities across 22 states that provide high-quality, culturally competent care to urban Indian populations. Tribal leaders advocated to Congress for the creation of Urban Indian Organizations after the Relocation Era in recognition that the trust obligation for healthcare follows Indians off reservations. Unfortunately, there are significant parity issues experienced by Urban Indian Organizations as compared to other federally funded healthcare systems, which greatly impact their services and operations. For example, the IHCIA prohibits Urban Indian Organizations from making even minor renovations to their facilities using their annual appropriations. This provision was intended to help Urban Indian Organizations maintain or attain accreditation with grants, but instead has hamstrung Urban Indian Organizations from using their already limited funding for any infrastructure needs.
Further, unlike other parts of the Indian health system, Urban Indian Organizations do not receive any funding for facilities infrastructure, which has made repairs, renovations, and remediation extremely difficult. The pandemic has made it even harder for Urban Indian Organizations as they now must make updates for no-contact services, socially distanced waiting rooms, and increased security to adhere to COVID-19 safety guidelines. The time is long overdue for investment into Urban Indian Organization infrastructure for this vital prong of the Indian health system.
Urban Indian Organization Priorities in Letter
Infrastructure for Urban Indian Organizations
- Amend the IHCIA to remove restrictions on using Urban Indian Organization funds for making facility renovations.
- At least $100 million for Urban Indian Health IT (25 U.S.C. § 1660h).
- At least $749.3 million for Urban Indian Health.
- At least $3 million for Urban Indian Health Community Health Representatives (25 U.S.C. § 1660f).
- Extend Full (100 percent) Federal Medical Assistance Percentage (FMAP) to services provided at Urban Indian Organizations permanently.
- Establish an Urban Confer Policy for HHS.
Health Care Facilities Construction
- At least $21 billion for Healthcare Facilities Construction, including but not be limited to, support for new and current planned projects, the Small Ambulatory Health Center Program, Urban Indian Organizations, the Joint Venture Construction Program, and innovative approaches to addressing unmet construction needs for health facilities as described in 25 U.S.C. §1631(f).
Public Health Infrastructure
- Allow I/T/U providers to be reimbursed for services provided outside of the four walls of their clinic, just as they would if they were provided in the clinic.
- Establish a Native Behavioral Health Program for I/T/U and fund through FY26 at $200 million annually with annual increases for medical inflation, and funding available through contracts/compacts for Title I and Title V Tribes.
Tribal Health Workforce Development
- Fully fund the Community Health Aide Program for implementation in all states and for Urban Indian Organizations.