National Council of Urban Indian Health
On April 25, 2022, the Indian Health Service (IHS) published their Fiscal Year (FY) 2023 Congressional Justification with the full details of the President’s Budget, which includes $112.5 million for Urban Indian Health — a 53.2% increase above the FY 2022 enacted amount of $73.4 million. According to the Indian Health Service Congressional Justification, “This funding increase could support an estimated 1,072,935 health care, outreach, and referral services to Urban Indian users in FY 2023.” The President’s proposal included a total of $127.3 billion in discretionary funding for the Department of Health and Human Services (HHS) and, for the first time ever, $9.3 billion in mandatory funding for Indian Health Service for the first year, which includes $9.1 billion in proposed law funding and $147 million in current law funding for the Special Diabetes Program for Indians (SDPI). The budget proposes increased funding for Indian Health Service each year over ten years, building to $36.7 billion in FY 2032, to keep pace with population growth, inflation, and healthcare costs.
[Note: The President's budget proposal is reviewed by Congress and used throughout the Appropriations process to determine budgets. Since it is an election year, it is unlikely that Congress will pass a full Appropriations package and unfortunately, it is being reported by Punchbowl News that Congress will likely do a Continuing Resolution, which would mean that amounts would remain at the FY22 enacted levels.]
“The Indian Health System and urban Indian health have long been severely underfunded: only 1% of the Indian health budget goes to urban Indian health despite more than 70% of American Indians and Alaska Natives residing in urban areas. We are grateful for the President’s inclusion of $113 million for urban Indian health in FY 2023. President Biden has shown a strong commitment to urban Indian communities, and we recognize this Administration’s dedication to improving outcomes for all of Indian Country. As the final amount still falls well short of fully funding the Indian Health Service to properly provide health care services for all Natives in the United States to meet the trust responsibility, we will continue to push Congress to provide all the resources necessary to protect the lives of the entire Native population, regardless of where they live,”
– Francys Crevier (Algonquin), CEO, National Council of Urban Indian Health.
|Line Item||FY21 Enacted||FY22 Enacted||FY23 TBFWG Request||FY23 President’s Budget|
Urban Indian Health
Indian Health Service
The National Council of Urban Indian Health requested full funding for urban Indian health for FY 2023 at $949.9 million and at least $49.8 billion for Indian Health Service in accordance with the Tribal Budget Formulation Workgroup (TBFWG) recommendations. The marked increase for FY23 is a result of Tribal leaders, over several decades, providing budget recommendations to phase in funding increases over 10-12 years to address growing health disparities that have largely been ignored. The Congressional Justification states, “Indian Health Service recognizes that we must continue to work in consultation with Tribes and confer with Urban Indian Organizations, and with our partners in Congress, to ensure the budget is structured and implemented correctly with the resources identified over the next 10 years.”
Background and Advocacy
On March 28, 2022, President Biden released his budget request for Fiscal Year FY 2023, pending the more detailed Indian Health Service budget request released April 25, which includes specifics on the Indian Health Service budget request, including the funding recommendations for urban Indian health.
- Indian Health Service FY 2023 Congressional Justification
- President’s FY 2023 Budget
- National Council of Urban Indian Health Analysis of President’s FY 2023 Budget
On April 5, 2022, National Council of Urban Indian Health President-Elect and CEO of the Indian Health Center of Santa Clara Valley, Sonya Tetnowski (Makah Tribe), testified before and submitted public witness written testimony to the House Appropriations Subcommittee on Interior, Environment, and Related Agencies regarding FY 2023 funding for Urban Indian Organizations (UIOs). National Council of Urban Indian Health requested $49.8 billion for the Indian Health Service and $949.9 million for Urban Indian Health for FY 2023 as requested by the Tribal Budget Formulation Workgroup, Advance appropriations for Indian Health Service, and support of mandatory funding for Indian Health Service including Urban Indian Organizations.
- National Council of Urban Indian Health Appropriations Testimony
- Watch Ms. Tetnowski's Opening Remarks
- Watch Full Appropriations Hearing
- National Council of Urban Indian Health Press Release on FY 2023 Appropriations Hearing
National Council of Urban Indian Health recently worked closely with Representatives Gallego and Grijalva on leading a Congressional letter to the House Committee on Appropriations in support of increasing the urban Indian health line item for FY 2023. The letter has bipartisan support and calls for the highest possible funding for Urban Indian Health up to the Tribal Budget Formulation Workgroup’s recommendation of $949.9 million and advanced appropriations for Indian Health Service until such time that authorizers move Indian Health Service to mandatory spending.
- Rep. Gallego and Rep. Grijalva’s Letter
- National Council of Urban Indian Health Toolkit: Contact Congress to Increase Funding for Urban Indian Health TODAY
The Appropriations Committees will review the President’s Budget for consideration as they craft their bills for FY 2023. National Council of Urban Indian Health will continue to work with the Biden Administration and Congress to push for full funding of urban Indian health in FY 2023.