Omnibus package includes $6.6 billion for Indian Health Service

Biden administration wanted $8.5 billion, tribal advocates pressed for $12.8 billion; no advanced appropriations included.

Mar 10, 2022

WASHINGTON – Whenever the new Indian Health Service (IHS) director takes the reins – which should have happened a long time ago, according to Native advocates – they will have a budget of $6.6 billion to oversee if the current omnibus spending bill passes both chambers of the U.S. Congress and is signed into law by President Joe Biden.

The omnibus is widely expected to clear the Senate by March 15 after House Speaker Nancy Pelosi (D-Calif.) agreed on Wednesday to remove COVID-19 supplemental funding from the $1.5 trillion package. The Democratic House passed the bill Wednesday evening, with some some GOP support.

The Biden administration had requested $8.5 billion for IHS for fiscal year 2022, and a group of Native advocates known as the Tribal Budget Formulation Workgroup had made the case for $12.8 billion.

Before the omnibus negotiation occurred between the House and Senate, the House had already passed an unprecedented $8.1 billion for IHS.

Still, $6.6 billion would be a 6.3 percent increase above the fiscal year 2021 enacted level for the agency, which oversees Indian healthcare and delivery services as part of the U.S. Department of Health and Human Services’ trust responsibility to tribes and Native Americans.

And it’s a vast improvement from the low IHS funding levels earlier in the 2000s, including during the Obama administration when sequestration was a constant worry for tribal health advocates.

Several Native advocates, including those with the National Council of Urban Indian Health (NCUIH), are framing it as a good deal, despite some shortcomings.

“[T]he amount enacted would be the highest increase of any account for the Department of Interior and Related Agencies, which demonstrates a strong bipartisan commitment from Congress to improving health outcomes for American Indians and Alaska Natives,” the NCUIH said in a policy alert issued Wednesday.

“Unfortunately, the final amount still falls well short of fully funding the Indian Health Service to properly provide health care services for all American Indians and Alaska Natives in the United States to meet the [federal] trust responsibility,” the organization continued.

The NCUIH, as well as the National Indian Health Board (NIHB), noted that the omnibus bill does not include advanced appropriations for IHS, despite robust advocacy from many tribes and Native organizations.

“We will continue to advocate. I think it will happen in the next year or so,” Meredith Raimondi, vice president of public policy with NCUIH, told Indigenous Wire. “I think it’s logistics, but I’m honestly not sure the hold up, and I don’t think I’ve heard a real answer.”

Stacy Bohlen, chief executive officer of the NIHB, had made a strong case for advanced IHS appropriations during the February meeting of the National Congress of American Indians. She explained that government shutdowns and budget continuing resolutions have continually put IHS funding in jeopardy, making healthcare for Indians perennially uncertain.

“Congress can end this practice by passing advanced appropriations that will provide two years of funding,” Bohlen said last month, as Indigenous Wire previously reported. “We have a unique opportunity to get advanced appropriations enacted this year.”

The Biden administration and Senate leadership were supportive, Bohlen said at the time, but “pushback” was coming from some portions of Capitol Hill “on some esoteric issues that really should not be a stopping point for us.”

Bohlen said that some Hill folks believe Indian Country only wanted advanced appropriations because the Veterans Health Administration has it.

“That is an affront to sovereignty,” Bohlen added. “Advanced appropriations supports the government’s trust obligation to provide healthcare service to our people.”

Tribal health advocates are expected to continue to make the case for advanced appropriations in coming months.

In terms of urban Indian health, $73.4 million is included in the omnibus for fiscal year 2022, a 17.13 percent increase above the fiscal year 2021 enacted level and the highest increase in this area in the past 10 years, according to the NCUIH.

The organization provided the following additional background, noting that the package includes the following priorities for urban Indian health:

Summary
$73.4 million for urban Indian health for FY 2022
Inclusion of UIOs in the 2022 VAWA reauthorization
$30 million annually from FY23-FY27 for grants for Creating Hope Through Outreach, Options, Services, and Education for Children and Youth (CHOOSE Children & Youth) grants to enhance the safety of youth and children who are victims of, or exposed to, domestic violence, dating violence, sexual assault, stalking, or sex trafficking and prevent future violence.
UIOs added as eligible entities.
$10 million annually for a new 3-year program (FY23-FY27) to award grants for the clinical training of sexual assault forensic examiners to administer medical forensic examinations and treatments to survivors of sexual assault. Of the $10 million, there is a set aside of 15 percent for purposes of making grants to entities that are affiliated with Indian Tribes or Tribal organizations or Urban Indian organizations.
UIOs included as eligible entities.
$5 million for a new 5-year demonstration grants (FY23-FY27) established for comprehensive clinical training of health care providers to provide generalist forensic services and trauma-informed care to survivors of interpersonal violence of all ages. Of the $5 million, there is a set-aside of 10 percent for purposes of making grants to support training and curricula that addresses the unique needs of Indian Tribes, Tribal organizations, Urban Indian organizations, and Native Hawaiian organizations.
UIOs included as eligible entities.
Title VIII “Safety for Indian Women” includes the following purposes:
to empower Tribal governments and Native American communities, including urban Indian communities and Native Hawaiian communities, with the resources and information necessary to effectively respond to cases of domestic violence, dating violence, stalking, sex trafficking, sexual violence, and missing and murdered Native Americans; and
to increase the collection of data related to missing and murdered Native Americans and the sharing of information among Federal, State, Tribal, and local officials responsible for responding to and investigating crimes impacting Indian Tribes and Native American communities, including urban Indian communities and Native Hawaiian communities, especially crimes relating to cases of missing and murdered Native Americans.
In summary, the bill provides the following for IHS, tribal organizations, and Urban Indian Organizations (UIOs):
$6.6 billion for the Indian Health Service for fiscal year 2022
$4.7 billion for the IHS health services account
Fully funds Contract Support Costs and Payments for Tribal Leases
$940 million for health facilities construction
$12 million from Substance Abuse and Mental Health Services Administration (SAMHSA) to Indian Tribes, Tribal Organizations, or consortia for Medication-Assisted Treatment for Prescription Drug and Opioid Addiction
Increase to SAMHSA State Opioid Response (SOR) Grants for tribes and tribal organizations
UIO are not included
$22.5 million for the Good Health and Wellness in Indian Country program
$15.6 million to make payments under the National Health Service Corps loan repayment program

As we reported yesterday, enhanced tribal Violence Against Women Act provisions are included in the omnibus as well.