Senate Committee on Indian Affairs Holds Hearing on Access to Water in Native Communities

Posted on October 10, 2023 by Erisel Cruz

On September 27th, The Senate Indian Affairs Committee held a hearing entitled “Water as a Trust Resource: Examining Access in Native Communities.”. The witnesses were Bryan Newland, Assistant Interior Secretary for Indian Affairs; Benjamin Smith, Deputy Director of IHS; Crystalyne Curley, Navajo Nation Council Speaker; Valerie Nurr’araaluk Davidson, Alaska Native Tribal Health Consortium (ANTHC) President; Kali Watson, Department of Hawaiian Homelands Chairman; and Heather Tanana, Universal Access to Clean Water for Tribal Communities project Initiative Lead.

Committee Chairman, Brian Schatz, called the oversight hearing to order, stating in his opening statement that “native households are 19 times more likely than non-Native households to lack indoor plumbing.” The Senate Indian Affairs Committee, Energy and Natural Resources Committee, and Environment and Public Works Committee coordinated hearing efforts to address the ongoing challenges communities everywhere are facing when it comes to clean water access.

During COVID-19, the consistent health and safety inadequacies that American Indians and Alaskan Natives (AI/ANs) experience were brought to light. Congress addressed water insecurity in Native communities through the Bipartisan Infrastructure Law and the Inflation Reduction Act. $3.5 billion went to IHS for critical water and sanitation infrastructure while $2.5 billion was used to fund existing water rights settlements and drought mitigation in AI/AN communities. Vice Chair Murkowski acknowledged in her remarks the vast amount of existing grants across several agencies that could be used for AI/AN communities but are not currently. Additionally, the Senator discussed the importance of including every committee related to this broad issue, including but not limited to the Agriculture Committee.

Ms. Davidson was asked specifically about the data currently available regarding operation and management needs for the Alaska region, and whether AI/AN communities could wait until IHS completes its own study and disburse their findings, which is unlikely to occur until FY 2027. Davidson responded by discussing the extensive data and feedback that ANTHC has already provided IHS but has not seen the light of day. Stating further that “from our perspective, we can either spend our limited time and resources to perfect another study and make that study perfect, or we can invest in what we already know works. And the data that ANTHC has previously provided is not an estimate. These are from real systems that exist in Alaska today. And so, we believe that the best investment would be to use those dollars to be able to fund a pilot project that would be able to extend and provide real information that the IHS could then build upon. And so, really, we have a choice to make. We can either fund another study or we can make an investment…”

To view a video of the hearing and read witness testimony, visit Senate Committee on Indian Affairs website. The National Indian Health Board is launching a Technical Assistance Center in conjunction with the Environmental Protection Agency’s Thriving Communities Network to connect Tribes with existing resources and opportunities around environmental justice issues, including water sanitation. The Technical Assistance Center will launch at the end of 2023.

NIHB Hosts Tribal Health Equity Data Symposium

Posted on October 9, 2023 by Erisel Cruz

On September 25 and 26, the National Indian Health Board (NIHB) hosted the Tribal Health Equity Data Symposium in Washington, DC. Over the two-day event, speakers, panels, and facilitated sessions covered a range of topics, including measuring health equity with an Indigenous lens, culturally relevant data collection methods, promising practices in improving the collection of race and ethnicity data, and challenges and opportunities in Tribal access to data held by federal and state agencies. These discussions concluded that future directions for health equity work should honor the importance of good stewardship of American Indian/Alaska Native (AI/AN) data, Tribal access to datasets held by federal and state agencies, and furthering Indigenous perspectives in health equity and health research.

NIHB Chairperson and Alaska Area Representative, Chief William Smith (Valdez Native Tribe), delivered the opening remarks, noting, “Data is a critical component of the path to health equity.” Keynote speakers Abigail Echo-Hawk (Pawnee) and Dr. Myra Parker (Mandan-Hidatsa-Cree) began the discussion on what a culturally driven approach to measuring health equity can look like with their presentations on “Decolonizing Data: Restoring Culture, Building Beauty,” and “Indigenizing Data: Mapping a Path Toward Health Equity,” respectively. Dr. Donald Warne (Oglala Lakota) continued the conversation on day two with his keynote titled, “Measuring Health Equity with a Tribal Lens: Leaning on Strengths, Sovereignty, and Indigenous Identity.”

Professionals from across the spectrum of health data joined the symposium as guest speakers. Centers of Disease Control and Prevention (CDC) Senior Health Scientist, Delight Satter (Confederated Tribes of Grand Ronde), and Indian Health Service (IHS) Officer and Director of the Office of Information Technology, Mitchell Thornbrugh (Muscogee Creek Nation), and Meagan Khau, Director, Data Analytics & Research Group within the Centers for Medicare and Medicaid Services’ Office of Minority Health represented federal partners in Tribal data work. Sujata Joshi of the Northwest Portland Area Indian Health Board, and Rachael DeMarce (Little Shell Tribe of Chippewa Indians and Blackfeet Nation) and Ben Han of Alaska Native Tribal Health Consortium represented regional Tribal organizations and their ideas for future work with health equity and data. Other guest speakers included Native researchers and NIHB subject matter experts.

Concluding sentiments from the symposium conveyed the importance of using data in advocacy efforts. The final presentation of the event, “Putting it into Practice: Story as Data and Data as Story,” ended with a call to widely share stories of Tribal data and its impact on health equity work.

The Tribal Health Equity Data Symposium contributes to NIHB’s ongoing advocacy for improved data practices to protect Tribal sovereignty and advance health equity, in laws, policies, and private industry standards. NIHB advances Tribal data priorities by providing technical assistance and policy analysis for Tribal leaders as they participate in Tribal consultations and Tribal Advisory Committee meetings with government agencies like the Office of Management and Budget, CDC, National Institutes of Health, IHS, and others. In addition, NIHB is leading several data projects to make improvements in specific areas, like Maternal Mortality Review Committees and Electronic Case Reporting.

Videos, slides, poster presentations, and other resources from the symposium will be posted on NIHB’s website here. The full report on the event is expected to be published in January 2024. If you would like to learn more about NIHB’s work, you can read NIHB’s Health Equity in Indian Country Report here.

CMS Takes Action to Make Care for Older Adults & People with Disabilities More Affordable and More Accessible

Posted on October 9, 2023 by Erisel Cruz

Last week, the Centers for Medicare and Medicaid Services (CMS) issued its final rule updating Medicaid regulations that aim to make it easier for low-income older adults and people with disabilities to get help with their Medicare costs. The new final rule on “Streamlining Medicare Savings Program Eligibility Determination and Enrollment” simplifies the burdensome processes for applying to, and verifying income and assets for, the Medicare Savings Programs (MSPs) across states.

The agency notes that only about half of the people eligible for MSPs are currently enrolled, so reducing the paperwork burden and streamlining the enrollment rules will help many older adults get the financial help that MSPs offer. The changes are designed to help the millions of people who currently have MSPs retain coverage during redeterminations and renewals, especially our Elders who we have seen dropped from coverage.

Under the final rule, many recipients of supplemental security income (SSI) will now be enrolled automatically into the most comprehensive form of MSP coverage: the Qualified Medicare Beneficiary (QMB) eligibility group, which covers Medicare premiums and cost sharing. According to CMS, this should ease the burden on MSP applicants and enrollees to provide documentation of income and assets and should ensure QMB enrollment for people with Part A premiums is effective when Medicare entitlement begins.

Learn more about the new rule in CMS’s press release.

Centers for Disease Control and Prevention (CDC) Tribal Advisory Committee Meets and Visits Local Tribal Health Center

Posted on October 4, 2023 by Erisel Cruz

Centers for Disease Control and Prevention (CDC) Tribal Advisory Committee Meets and Visits Local Tribal Health Center

The Centers for Disease Control and Prevention (CDC) Tribal Advisory Committee (TAC) meeting was hosted by the Oneida Nation in Green Bay, Wisconsin on September 6-7. The CDC Tribal Advisory Committee advises the CDC and the CDC Director on policy and programmatic efforts that affect American Indian and Alaska Native (AI/AN) health. The TAC works with CDC leadership to exchange information about public health issues, provide guidance, and ensure that AI/ANs and Tribes are included in all public health efforts. National Indian Health Board staff attended the CDC TAC Meeting and provided technical assistance to Tribal leaders.

Topics covered during the meeting included CDC budget, Indigenous knowledge, improving Tribal access to public health data with electronic case reporting, evaluation, and maternal mortality prevention, among others. Tribal leaders serving on the TAC emphasized the importance of equitable funding for public health in Indian Country. TAC members also requested that the CDC provide more transparency about which non-Tribal entities have access to Tribal public health data and for which purposes. Another issue raised was the absence of CDC Director Mandy Cohen from the TAC meeting, observing that President Biden has stated that it should be a priority of federal agencies to proactively engage with Tribal leaders and Tribal advisory committees, and that requires participation from top agency leadership. Other discussions included the vital role of Indigenous knowledge and culture in health. As explained by the TAC Chair and Deputy Principal Chief Bryan Warner of the Cherokee Nation, “What we’re finding is that there’s healing in our language.”

CDC officials provided updates to the TAC from different divisions. CDC Behavioral Scientist and Evaluator Stacey Ann Willocks shared that their Indigenous Evaluation Toolkit is in the process of being adapted for use across all types of public health programs. CDC Chief Evaluation Officer of the Office of Policy, Performance, and Evaluation, Daniel Kidder, also shared that the CDC is working on a refresh of the CDC framework for evaluation that includes cultural competency considerations and health equity.

The TAC meeting included a site visit to the Oneida Community Health Center. Oneida Community Health Center is part of the Oneida Nation’s Comprehensive Health Division and strives to provide “the highest level of quality, culturally sensitive, holistic, and preventive health care” to Oneida citizens. Hosts of the health center visit shared the importance of patient-centered, culturally-informed design, noting that the health center building incorporates elements of traditional longhouse design and many Oneida design motifs.

The CDC TAC noted the many open seats on the committee and the need for more Tribal representatives and alternates. The CDC TAC consists of 17 representatives: 1 delegate (and 1 alternate) from a federally recognized Tribe from each of the 12 Indian Health Service Areas, and 1 delegate (and 1 alternate) from 5 National At-Large Tribal Member (NALM) positions. If you are interested in joining the TAC and helping to ensure the federal government upholds its trust responsibility and honors the government-to-government relationship, NIHB can offer support. If you have questions on the process or want assistance in the nomination process, please contact Garrett Lankford, NIHB Federal Relations Analyst, at glankford@nihb.org or 202-996-4302. 