September 13, 2022

In This Week's Washington Report

Action Item: NIHB Passes Resolution to Support the Expansion of Self-Governance in the Department of Health and Human Services

Action Item: NIHB and NCAI Seek Tribal Testimony on Advance Appropriations, Tribes Share Initial Support

Action Item: Meet Your Member-Nebraska

Action Item: CDO Window Application Extended

Action Item: NIHB Joins Amicus Brief in Support of Upholding ICWA inSupreme Court Case Haaland v. Brackeen

Action Item: Register for the National Tribal Health Conference

News From Capitol Hill

NIHB Passes Resolution to Support the Expansion of Self-Governance in the Department of Health and Human Services

On September 12, the National Indian Health Board (NIHB) of Directors (BOD) passed Resolution no. 22-07 which supports the expansion of self-governance within the Department of Health and Human Services (HHS). Although this has been a top, longstanding priority for NIHB and Presidential Administrations, this is an inaugural, critical resolution.

The Tribal Self-Governance Amendments of 2000 directed HHS to conduct a study to determine whether a demonstration project extending Tribal self-governance to HHS agencies other than IHS was feasible. The HHS study, submitted to Congress in 2003, determine a demonstration project was feasible. In 2003, Senator Ben Nighthorse Campbell introduced S.1696, the HHS Tribal Self-Governance Amendments Act of 2004, to authorize these demonstration projects; however, Congress failed to pass the bill without Administration support.

A second study was completed in 2011 by the HHS Self-Governance Tribal Federal Workgroup that determined Congress must pass additional legislation for the expansion. A 2013 report of the same workgroup developed detailed recommendations to overcome legal and logistical barriers to self-governance expansion. Despite these findings supporting the expansion of Tribal self-determination and self-governance, Congress has yet to act.

The federal government should expand self-determination and self-governance authority to include all agencies and offices across HHS, providing greater flexibility for Tribes. Greater flexibility would allow Tribes to deliver critical services in collaboration with agencies such as the Administration on Aging, the Administration on Children and Families (ACF), the Centers for Disease Control and Prevention (CDC), the Substance Abuse and Mental Health Administration (SAMHSA), and the Health Resources and Services Administration (HRSA).

Read the resolution here.

Tribes Share Initial Support: NIHB and NCAI Seek Tribal Testimony on Advance Appropriations

“Government shutdowns represent the inability of government to work as a team. Politics should not be the rule of the day but cooperation and collaboration to run the country, including Sovereign Nations through treaties.”

Ensuring stable and predictable funding for the Indian Health Service (IHS), advance appropriations are a longstanding Tribal request and recommendation that the National Indian Health Board (NIHB) and the National Congress of American Indians (NCAI) have diligently advocated for years. Most recently, NIHB and NCAI have joined efforts to collect primary data through a survey from Tribes on the impacts of IHS from government shutdowns and continuing resolutions. 

An advance appropriation is funding that becomes available one year or more after the year of the appropriations act in which it is contained. For example, if advance appropriations were secured in the fiscal year (FY) 2023 spending bills there will be an appropriation for FY 2024 regardless of a government shutdown or continuing resolution occurrence. This means when the budget is being proposed for FY 2024IHS would already have an appropriation for that fiscal year because of the advance appropriation funded from the FY 2023 spending bills and therefore a more stable, predictable funding stream for IHS. 

Endorsing support for advance appropriations for IHS, the Biden Administration is aware of the adverse impacts of discretionary funding and has included advance appropriation in the FY 2023 President’s Budget. Passing their appropriation bills this July, the House did not include advance appropriations despite overwhelming Tribal advocacy. On the other hand, making a historic investment to the health of Indian Country, the Senate did include advance appropriations in their appropriation bills providing $5.577 billion for FY 2024. However, the securement of advance appropriations is not yet final. 

Tribes need advance appropriations for IHS funding now. Allies in Congress are asking for your stories to help get their colleagues on board. Members of Congress frequently ask, “Why do Tribes need Advance Appropriations?” and “How do funding disruptions harm Tribal nations and their people?”  

From initial survey responses, Tribal leaders and Tribal health directors have noted federal governmental shutdowns result in loss of patient contact hours, loss of third-party billing opportunity and revenue, and loss of hours of operations of health services. 

“There were cuts to Tribal Council and Director Salaries of 8.5  percent. Caused huge employee moral issues with people who are termed essential. Promoted racism within the organization. Cut hours and laid off some government staff.”

Overwhelmingly, multiple Tribes have experienced interruptions in providing mental health services, substance abuse treatment, and adverse impacts on recruiting and retaining professional medical staff. Fortunately, or unfortunately, some Tribes did not experience furloughing or layoffs because they were able to use the revenue to cover the wages. Others made the tough decision to furlough or layoff medical staff.

"Being critically underfunded affects the services we can provide especially in very remote areas, also not having advanced appropriations makes it hard to plan, and also having to supplement from our third-party funds takes away from the additional services we are able to provide to due people due to no access due because of our location." 

Testifying in support of advance appropriations, a Tribe noted, "People who actually visit villages, will better understand [their] living conditions, and see how remote [they] are. Transportation is mainly by aircraft; others, if the weather is allowable, travel by boats and during the winter by snowmobiles".  

If you would like to share your stories highlighting the direct adverse impacts of unstable IHS funding, please submit them through this survey. Answers can remain anonymous in which there is an option on the survey to keep your Tribe’s name anonymous. In addition, you will be routed to a separate link to enter to win a Pendleton.

For questions, please contact NIHB Director of Government Relations Aaron Payment, EdD, at apayment@nihb.org. 

Meet Your Member

Nebraska

Other News and Events

CDO Application Window Extended

The certified designated organization (CDO) application window typically runs from June 1 to August 31, annually. To support organizations in FFM states during the Unwinding period, the Marketplace will extend the current CDO application window to November 1, 2022, and will open another CDO application window once the Medicaid Unwinding begins.

These application window extensions will enable eligible organizations in FFM states to apply to become a CDO, which will provide access to FFM and Medicaid Unwinding technical guidance, training materials, and consumer support resources such as the Complex Case Help Center (CCHC).

CMS invites new applicant organizations who want to become a CDO for Plan Year 2023 to apply during CMS’ Open Season, which has been extended to November 1, 2022.

Any organization operating in an FFM state seeking to provide certified application counselor (CAC) enrollment assistance to consumers for Plan Year 2023 must apply to become a CDO and enter into an agreement with CMS, if they are not a current CDO.

CDOs are a vital component of the assister community. In the FFM, CDOs oversee CACs, who are annually trained and able to help consumers seeking health coverage options through the Marketplace. For an overview of the CDO Program and resources that walk users through the CDO application, please visit:

• CDO Program Information – information about who can become a CDO and CDO role responsibilities.
• CDO Application Information – information about who should apply and how to apply during CMS’ Open Season.
• Submit a CDO Application – link to CDO application web form.
• CDO Application Demonstration Video (Transcript) (Slides) - video demonstration of CDO application completion.
• CDO Application FAQs – frequently asked questions (FAQs) about application submission, post-application submission, and troubleshooting guidance.
• CDO Application User Guide - systematic, detailed guide to completing your organization’s CDO application.

Only organizations that complete the two steps below by November 1, 2022, and receive a CDO ID from CMS can certify staff or volunteers as federally certified application counselors (CACs) to provide enrollment assistance services.

To apply to become CDO:

1. Access and complete the CDO application at: https://mats.secure.force.com/CDOApplication/. CMS will review your application and send a determination email with your application status. Please allow up to 10 business days for this review.
2. If CMS approves your application, you must access the CDO Organizational Maintenance Web Form (link provided in approval email) and submit a signed CMS-CDO agreement. CMS will then review your signed agreement and send a determination email. If CMS approves your agreement, you will receive a Welcome Packet email with a unique CDO ID. Please allow up to five business days for this review.

For questions or updates, you can email CACQuestions@cms.hhs.gov. Please include your organization’s name and address in the body of your email.

NIHB Joins Amicus Brief In Support of Upholding ICWA In Supreme Court Case Haaland v. Brackeen

On August 19, 2022, the National Indian Health Board (NIHB) joined 497 Tribes and 62 Tribal and Tribal organizations to submit an amicus brief in support of upholding the Indian Child Welfare Act (ICWA) in the Supreme Court case Haaland v. Brackeen. This highlights Indian Country’s unity in protecting and defending Native children, their families, and Tribal sovereignty. NIHB is proud to join this brief in support of preserving and strengthening ICWA’s ability to protect our children.

This case has huge implications for our children and their families and can potentially impact the future of Tribal nations. If the protections of ICWA are dismantled, opponents could set legal precedent that has serious consequences for other issues like Tribal economic development and land rights. Oral argument for this case has been scheduled for Wednesday, November 9, 2022, and we are hopeful this strong showing by Tribes and Tribal organizations will result in a positive outcome for Indian Country and our children.

Congress enacted ICWA in 1978 as an exercise of its well-established federal trust responsibility for Tribes and their members. Congress enacted ICWA to address a nationwide crisis: the wholesale removal of Indian children from their families by state and private child welfare agencies—often without due process—at rates far higher than those of non-Indian families. Removing children from their culture and communities can adversely impact health and mental health outcomes. 

Supporting ICWA means supporting Native children, youth, and families. ICWA ensures that children’s and families’ best interests are considered in making decisions over child placement, placing children with their extended families or community, when possible—which is regarded as the gold standard in child welfare practice. ICWA is not only constitutional but also upholds and respects Tribal sovereignty.

Click here to find a copy of the Tribal Amicus Brief. 

Learn more about Brackeen v. Haaland here. 

For questions, please contact NIHB Federal Relations Director, A.C. Locklear, J.D., at alocklear@nihb.org. 

National Tribal Health Conference and 50th Anniversary Celebration

THE POWER OF IDENTITY: A PATH TO TRIBAL HEALTH EQUITY

Join the National Indian Health Board (NIHB) as we take a look back at the history of NIHB and build our plans for the next 50 years. Together we will explore the topics of health equity, health policy, Tribal advances in health, and many more. The National Tribal Health Conference (NTHC) The event will be held in Washington, DC at the Hyatt Regency Capitol Hill from September 25-28, 2022. Learn more and register here.