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Posted: April 10, 2020


NIHB, Native Organizations Request Over $8 billion for the Indian Health System Ahead of Fourth Congressional COVID-19 Funding Package
Request includes funding for hospitals, equipment and specialty care.
WASHINGTON, DC—April 10, 2020—In active nationally coordinated effort to ensure Tribes are meaningfully included in COVID-19 relief funding, the National Indian Health Board (NIHB) along with a coalition of 10 national and regional Tribal organizations sent a letter outlining Tribal health care and public health priorities to House Speaker Nancy Pelosi, Senate Majority Leader Mitch McConnell, Senate Minority Leader Chuck Schumer, and House Minority Leader Kevin McCarthy late Wednesday night. The letter includes a robust and comprehensive list of Tribal priorities, including over $8 billion in funding for the Indian health system, in addition to multiple legislative priorities such as maximizing third-party health care revenue streams and ensuring Indian Country has direct access to the Strategic National Stockpile. 
“Tribal leaders and Tribal health directors were instrumental in identifying Tribal and public health priorities and we urge Congress to include them in phase four funding that will address critical, Tribal needs around COVID-19,” said NIHB Chairperson Victoria Kitcheyan. “Indian Country had significant wins in the CARES Act, but our systems operate on such limited resources, that the Indian health system needs more support to effectively respond to COVID-19.”
The Tribal and public health priorities are broken into four sections: funding, technical Medicaid and Medicare fixes, technical amendments, and legislative fixes and reauthorizations. Notable priorities include:
  • $1.215 billion for hospitals and health clinics
  • Establish a $1.7 billion Emergency Third-Party Reimbursement Relief fund for IHS, Tribes, Tribal organizations and urban Indian organizations
  • $85 million for equipment purchases and replacements
  • Maximize third party-reimbursements by making technical fixes to Medicare and Medicaid
  • Expand telehealth capacity and access in Indian Country by permanently extending waivers under Medicare
  • Provide direct IHS, Tribal and urban Indian organization access to the Strategic National Stockpile
  • Permanently reauthorize the Special Diabetes Program for Indians 

The organizations’ ask for $1 billion for Purchased/Referred Care (PRC) will ensure Indian Health Service (IHS) and Tribal facilities have the resources needed to pay for outside specialty care related to COVID-19. PRC, also known as contract health, is a program that allows IHS and Tribally operated facilities to contract out essential health care services that are not available within the Indian health care delivery system. Because of Coronavirus, IHS and Tribal facilities are having to refer patients to outside providers for high cost emergency and specialty care which is quickly depleting Purchased/Referred Care resources.
“With more and more positive COVID-19 cases increasing in our Tribal communities, the need for specialty care increases too. Purchase and referred care dollars are already scarce even without a pandemic,” Kitcheyan said. “A lack of sufficient funding for PRC forces IHS and Tribal facilities to ration health care at a time when our people’s lives are at stake. We should never have to pick and choose who gets health care.”
In addition to advocacy efforts, NIHB continues to work with federal agencies that are administering the funding from the first three COVID-19 funding packages to Tribes by hosting listening sessions and consultations for Tribal leaders to engage in dialogue on how the funding should get to the Tribes.
“Tribal consultation is imperative right now and it’s incredibly important for federal agencies to follow their own Tribal consultation policies. Tribes know best on how to take care of their people and where best to allocate these funds. The federal agencies need to trust the Tribes to lead and protect their own people,” said Kitcheyan.
Visit the NIHB COVID-19 Tribal Resource Center:
National Indian Health Board Mission Statement
Established by the Tribes to advocate as the united voice of federally recognized American Indian and Alaska Native Tribes, NIHB seeks to reinforce Tribal sovereignty, strengthen Tribal health systems, secure resources, and build capacity to achieve the highest level of health and well-being for our People.
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