May 2024 Legislative Brief Update

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May has been an eventful month, marked by numerous Federal and State responses. In our ever-evolving landscape, we aim to keep you informed with timely updates. CCUIH and its members actively engaged in advocacy efforts to protect the California Indian Health Program amid proposed budget cuts, participating in joint press releases, media campaigns, and multiple hearings. CCUIH is tracking 63 state bills relevant to UIOs and the AIAN community, with significant activity around the May Budget Revise. Federally, the NCUIH Annual Conference highlighted critical issues such as MMIP advocacy and 100% FMAP for urban Indian health. Upcoming FY 2025 appropriations and legislative updates, including the IHS Workforce Parity Act, underscore the continued push for enhanced resources and support for UIOs. Expect the comprehensive CCUIH legislative report in June.

STATE UPDATES:

• May Budget Revise Resources:
  • 2024-25 May Revision General Fund Solutions
    • Senate Budget and Fiscal Review (May 30, 2024)
    • Assembly Budget Committee Report (May 29, 2024)
  • Budget finalized June 15th 
    • CCUIH and Members’ Action on the Indian Health Program and other proposed cuts:
      • Joint Press Release with CCUIH and CRIHB
      • Media Campaign
      • Created Template Letters and shared broadly
        • submitted approximately 20 letters from UIOs, Tribal Governments, State and Federal supporting organizations
      • Attended multiple hearings and provided comments
      • Thank you to everyone that helped contact their local legislators and legislator friends to voice the need to protect the CA Indian Health Program
• State Bills: This has been a busy legislative session, with the May Revise Taking Center Stage. CCUIH is currently tracking 63 Bills that cover numerous topics that may impact our UIOs and AIAN Community. (Please let us know if you would like updates on any specific legislation, assistance with writing any position letters, or would like us to attend a hearing.)
  • May movement on select bills continuously changes, with multiple hearings a week. For updates on hearing dates or to see the staus of specific bills, you can contact us or see the link below:
    • State Bill Information: https://leginfo.legislature.ca.gov/faces/home.xhtml 
  • AB 1863 California Emergency Services Act: notification systems: Feather Alert
  • AB 1955: Pupil health: school-based health services and school-based mental health services
  • AB 1965: Public health. Office of Tribal Affairs
  • AB 2108: Foster care: missing children and nonminor dependents
  • AB 2138: Peace officers: tribal police pilot project
  • AB 2250 Social determinants of health: screening and outreach
  • AB 2711 Suspensions and expulsions: controlled substances: tobacco: alcohol: plans and protocols
  • AB 2795: CalWORKs Indian Health Clinic Program
  • SB 1067: Healing arts: expedited licensure process: medically underserved area or population
  • SB 1382: Community and rural health clinics: building standards

FEDERAL UPDATES

• National Council of Urban Indian Health (NCUIH) Annual Conference that included conferring with VA and a Day on the Hill! The top priorities and discussions included:
  • Asking for a Congressional Review of the Social Security Act (SSA) Definition to protect UIOs from federal exclusion terminology
  • Educating and asking for 100% FMAP, this meant a lot of eduating on the Urban Indian Health Care Delivery System 
  • Discussing actions legislators can take to further MMIP advocacy, protections, and support
  • Upcoming considerations regarding the UIO workforce
• HHS Urban Confer and Nation-to-Nation Tribal Consultation in Las Vegas
  • Continued Sharing with HHS from NCUIH Conference HHS Confer
  • Highlighted need for Syphilis focused outreach, intervention, and prevention efforts across Indian Country with Tribal and Urban Indian Health Programs
• OUIHP IHS Strategic Plan Confer: May 30, 2024 Live review and feedback
  • Written Comment Due Jun 28, 2024 IHS DRAFT
• CMS Traditional Healers Framework Update
  • From 3/20 NCUIH Policy Workgroup: March 27 – CMS Traditional Healing Framework
    • Comments Submitted
    • Potential Impact on UIOs: The impact is significant. All UIOs are encouraged to submit comment letters on this issue. Both NCUIH and CCUIH have template letters to facilitate these comments.
• Urban Confer 5/1 on VA-UIO Reimbursement Agreement Program (RAP)
  • DUIOLL for the revised Direct Care Services Reimbursement Agreement DRAFT
  • Comments Submitted
• FY 2025 Appropriations Updates:
  • On May 7-8, 2024, Todd Wilson, Executive Director of Helena Indian Alliance-Leo Pocha Clinic and NCUIH Board Member, will be NCUIH’s witness for the House Appropriations Committee’s AI/AN Witness Day.
  • NCUIH helped draft the House Dear Colleague Letter requesting the Tribal Budget Formulation Work Group (TBFWG) FY25 requests for the Urban Indian Health line item ($965.3M) and IHS ($53.85B).
  • Potential Impact on UIOs: This involvement highlights a significant advocacy effort poised to significantly boost the resources available to UIOs, enhancing their capacity to provide comprehensive healthcare services. UIOs are encouraged to contact your Members of Congress to support this vital funding initiative.
• Legislative Updates:
  • S.3022 – IHS Workforce Parity Act
    • On May 1, 2024, the NCUIH-endorsed legislation allowing part-time IHS providers to receive full scholarship benefits was ordered to be reported favorably during a Senate Committee on Indian Affairs markup.

Legislative Report prepared by CCUIH Health Policy Analyst Arianna Antone-Ramirez arianna@ccuih.org and CCUIH Director of Policy & Planning Nanette Star nanette@ccuih.org If you have questions or comments, please email the policy team.

APRIL 2024 LEGISLATIVE UPDATE 

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As we stepped into the Capitol this April, the CCUIH Policy Team didn’t just attend meetings; we  sparked crucial conversations about collaboration, particularly with notable figures like  Assembly Member Ramos, while continuing to closely watch 54 state bills that could  significantly affect our UIOs and the AIAN community. On the federal front, our fight continues  against the exclusion from the CMS Traditional Healers Framework, and we’re pushing for  substantial fiscal year 2025 funding—efforts underscored by NCUIH’s compelling testimony at  the House Appropriations Committee. Looking forward, the NCUIH Annual Conference and  CMS Health Equity Conference stand as upcoming platforms to deepen our engagement and  drive policy change that supports our community’s health and well-being. 

STATE UPDATES 

• California Primary Care Association Day at the Capitol, Tuesday, April 16th 
• Potential Impact on UIOs: CCUIH Policy Team met with: 
  • Assembly Member Liz Ortega 
  • Senator Angelique Ashby 
  • Assembly Member James Ramos 
  • All Meetings included CCUIH Packets with our updated fact sheet, Letter  of Intent, and Legislative Priorities. 
• Note: CCUIH will continue to work closely with AM Ramos on multiple Bills  moving forward and will continue to be a resource for all legislators regarding  ongoing and upcoming bills.

State Bills: This has been a busy legislative session with multiple bills presented. CCUIH is currently tracking 54 Bills that cover numerous topics that may impact our UIOs and AIAN Community. As of this calendar year, we have submitted 8 Position Letters and attended 2 Hearings. (Please let us know if you would like updates on any specific legislation, assistance with writing any position letters, or would like us to attend a hearing.)

• April movement on select bills: 
  • AB 1863 California Emergency Services Act: notification systems: Feather Alert.
    • Status: Referred to Committee on Appropriations.
  • AB 1955: Pupil health: school-based health services and school-based mental health services.
    • Status: To Consent Calendar, Do Pass. 
  • AB 1965: Public health. Office of Tribal Affairs.
    • Status: On 4/24/2024 From Committee. DO PASS 
  • AB 2108: Foster care: missing children and nonminor dependents.
    • Status: Referred to Suspense File.
  • AB 2138: Peace officers: tribal police pilot project. 
    • Status: Re-referred to Committee on Appropriations. 
  • AB 2250 Social determinants of health: screening and outreach 
    • Status: Re-referred to Committee on Appropriations. 
  • AB 2711 Suspensions and expulsions: controlled substances: tobacco: alcohol: plans and protocols
    • Status: Re-referred to Committee on Education 
  • AB 2795: CalWORKs Indian Health Clinic Program.
    • Status: Re-referred to Committee on Appropriations. 
  • SB 1067: Healing arts: expedited licensure process: medically underserved area or population
    • Status: Placed on Appropriations Suspense File. 
  • SB 1382: Community and rural health clinics: building standards.
    • Status: Re-referred to Committee on Appropriations. 

FEDERAL UPDATES 

• CMS Traditional Healers Framework Update 
  • From 3/20 NCUIH Policy Workgroup: March 27 – CMS Traditional Healing  Framework 
    • Comment response period was announced on 3/6 at TTAG. 
    • CMS seeks feedback on a proposed Traditional Healing Framework for  section 1115 demonstrations. 
    • The presented Framework omitted UIOs as eligible facilities under the  proposed framework. 
    • CMS will have a second comment period with comments due May 3rd.
    • CCUIH staff met with DHCS State Medicaid Director Tyler Sadwith, DHCS Deputy Director Rene Mollow, and DHCS Office of Tribal Affairs Chief Andrea Zubiate. The DHCS State Medicaid director assured CCUIH  that the California plans remain intact, with UIOs included, until they are told otherwise.
  • Potential Impact on UIOs: The impact is significant. All UIOs are encouraged to  submit comment letters on this issue. Both NCUIH and CCUIH have template  letters to facilitate these comments. 

• Urban Confer 5/1 on VA-UIO Reimbursement Agreement Program (RAP)
  • DUIOLL for the revised Direct Care Services Reimbursement Agreement DRAFT
  • Written comments to tribalgovernmentconsultation@va.gov by May 10, 2024 
• Minority Veterans’ Roundtable 
  • On April 16, 2024, Sonya Tetnowski, CEO of IHCSCV and NCUIH Board  President, attended a roundtable on minority veterans hosted by the House  Committee on Veterans Affairs Democrats.
  • Roundtable discussed issues facing Native veterans, equity in access to  healthcare and benefits for minority veterans, and the state of cultural  competency at the VA and community care providers.

• Budget/Appropriations Updates 
  • FY 2024 Appropriations Updates – Labor, Health, and Human Services (LHHS)
    • On March 22, Congress passed the remaining 6 appropriations bills to  fund the government for FY24. The Labor-H appropriations bill is included  in this package.
    • Resource: FY 24 LHHS Bill Summary 
    • Some early highlights include:
      • UIOs were included in a $6M Initiative to Improve Native American  Cancer Outcomes. NCUIH worked with ACSCAN to add UIOs to the report language for this program.
      • Level funding for HIV funding, including maintaining $5M for the Tribal Set-aside for the Minority HIV/AIDS Prevention and Treatment program.
      • $600 earmark for NAL-Boston.
    • Potential Impact on UIOs: The recent passage of FY24 appropriations  bills, including the Labor-H appropriations bill, holds significant implications. Notably, UIOs are included in a new $6 million initiative to  improve Native American cancer outcomes, which promises to boost resources for culturally tailored cancer prevention and treatment programs. Additionally, the appropriations maintain level funding for HIV  programs, preserving $5 million for the Tribal Set-aside in the Minority  HIV/AIDS Prevention and Treatment program, which ensures ongoing  support for HIV services within tribal communities. While the $600,000  earmark for Native American Lifelines (NAL) in Boston doesn’t directly  impact California UIOs, it sets a precedent that California UIOs can leverage in advocating for earmarked funds to address specific health needs of urban Native American populations.
  • FY 2025 Appropriations Updates
    • On May 7-8, 2024, Todd Wilson, Executive Director of Helena Indian Alliance-Leo Pocha Clinic and NCUIH Board Member, will be NCUIH’s witness for the House Appropriations Committee’s AI/AN Witness Day.
    • NCUIH helped draft the House Dear Colleague Letter requesting the Tribal Budget Formulation Work Group (TBFWG) FY25 requests for the Urban Indian Health line item ($965.3M) and IHS ($53.85B).
    • Potential Impact on UIOs: This involvement highlights a significant advocacy effort poised to significantly boost the resources available to UIOs, enhancing their capacity to provide comprehensive healthcare services. UIOs are encouraged to contact your Members of Congress to support this vital funding initiative.

IHS UPDATES

• Sanitation Facilities and Construction Needs
  • The IHS Director announces FY 2024 allocation decisions for $700 million to address  sanitation facilities and construction needs in American Indian and Alaska Native  communities from the funding authorized in the Infrastructure Investment and Jobs Act,  or Bipartisan Infrastructure Legislation Posted April 23, 2024 
  • Potential Impact on UIOs: regional tribal health infrastructure could enhance  health outcomes for urban AIAN populations connected to these communities.  Additionally, focusing on funding economically infeasible projects may influence  future urban-specific health infrastructure funding, benefiting UIOs.

Legislative Report prepared by CCUIH Health Policy Analyst Arianna Antone-Ramirez  arianna@ccuih.org and CCUIH Director of Policy & Planning Nanette Star nanette@ccuih.org If  you have questions or comments, please email the policy team. 

MARCH 2024 LEGISLATIVE UPDATE 

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March kicked off with the highly successful Annual IHSTribal Leaders Meeting (CA Area Urban Confer) in Burlingame, CA, and we’re grateful to everyone who played a part in its success. We promptly shared updates and feedback with Director Tso. In our upcoming March blog, we’ll be exploring the important theme of “Unlocking Healthcare: The Journey for American Indians and Alaska Natives.” As we approach the legislative spring recess starting on March 21st, our focus remains on legislative updates and key developments affecting Urban Indian Organizations. We’re closely monitoring policy agendas, webinars, and noteworthy bills like AB 2132 and AB 2711. Additionally, the recent release of the President’s Fiscal Year 2025 Budget reflects significant increases in funding for the Indian Health Service, aligning closely with tribal and urban organization priorities. 

STATE UPDATES 

• CHW/P/R POLICY AGENDA: The Community Health Workers/ Promotoras/ Representatives (CHW/P/R Policy Coalition) has released their policy agenda. Policy recommendations outlined in the Policy Agenda fall into 4 key areas: workforce development, economic equity, effective integration of CHW/P/Rs into care teams, & equitable access to CHW/P/R services for Medi-Cal enrollees.
  •  Request for your input: CCUIH serves on the steering committee for this Coalition and we are always seeking feedback from CHWs at UIOs. If you have any CHWs at your UIO who could help inform CCUIH’s advocacy efforts in this area, please let the CCUIH policy team know. 

• DHCS WEBINAR FOR TRIBES & INDIAN HEALTH PROGRAM REPRESENTATIVES: On March 11, DHCS hosted a webinar for Tribes & Indian Health Program Representatives. 
  • Resource: Powerpoint will be posted here. If you would like a copy sooner, please reach out to CCUIH policy team.
  • Potential Impact to UIOs:
    • Medi-Cal Enrollment Data:
      • Enrollment peaked in May 2023, reaching almost 15.6 million members.
      • Ethnicity/race data shows 55,302 Alaskan Native/American Indian (AI/AN) enrollees, accounting for 0.4% of total Medi-Cal enrollees in July 2023.
    • Funding and Budget Updates:
      • Future funding releases totaling $20,926,000 were announced, with ongoing funding for the Indian Health Program (IHP) until June 30, 2025.
      • The Governor’s proposed budget for fiscal year 2024-25 includes significant investments in health and human services programs, including Medi-Cal.
    • Behavioral Health Update:
      • Efforts are underway to secure approval for covering Traditional Healer and Natural Helper services under the Drug Medi-Cal Organized Delivery System (DMC-ODS).
      • CMS aims to approve requests in 2024 and engage with Tribal partners for guidance on implementation. (Third request from DHCS to CMS)

• AB 2132 (LOW) TUBERCULOSIS SCREENING: AB 2132 would require health facilities and clinics that provide outpatient primary care services in California to offer voluntary screening for tuberculosis (TB). The bill would require primary care providers to offer a TB risk assessment and TB screening, if TB risk factors are identified, to patients. The bill would also require the provider to offer the patient follow-up health care or refer the patient to a provider who can provide follow-up health care. Early detection and treatment of latent tuberculosis infection (LTBI) can substantially reduce the risk that the infection progresses to active TB disease, preventing unnecessary hospitalizations and death. CCUIH submitted a letter of support for AB 2132 on March 12.
  • Resource: Asm. Low AB 2132 
  • Potential Impact to UIOs: AB 2132’s passage is crucial for UIOs, given the heightened TB risk among AI/AN communities. By enhancing early detection and treatment of latent TB infection, the bill can reduce TB incidence and prevent transmission, particularly vital considering AI/AN individuals’ increased risk. Supporting this bill is essential for advancing public health equity and addressing the disproportionate burden of TB on underserved populations. 

• AB 2711 (RAMOS) SERVING YOUTH AND REDUCING SUBSTANCE USE: Assembly Bill 2711 would revise school suspension and expulsion policies for drug- related infractions by requiring local education agencies to create policies using a public health approach, in lieu of suspensions and expulsions. By requiring school districts to create a public health framework for assisting students with substance possession and use infractions, the administrators will have more resources and ability to make referral-based decisions for students. CCUIH is currently drafting our support letter.
  • Resource: Asm. Ramos AB 2711 Fact Sheet
  • Potential Impact to UIOs: By emphasizing screening, education, and referrals for youth with substance use needs, the bill could lead to more comprehensive support systems for students, potentially reducing the reliance on suspensions and expulsions. This could ultimately contribute to improved outcomes for Urban Indian youth by addressing underlying health needs and reducing the risk of future substance abuse and addiction. 

• AB 1965 (RUBIO) PUBLIC HEALTH. OFFICE OF TRIBAL AFFAIRS: AB 1965, sponsored by Blanca Rubio, establishes the Office of Tribal Affairs within the State Department of Public Health to address public health disparities in Tribal communities. It mandates the appointment of a Tribal Health Liaison by the State Public Health Officer, emphasizing regular consultation and input from the Liaison. CCUIH submitted a letter of support and consideration for AB 1965 on March 18.
  • Potential Impact to UIOs: The establishment of the Office of Tribal Affairs within the State Department of Public Health, led by a Tribal Health Liaison, could have significant impacts for UIOs. This includes a requirement for the State Public Health Officer to regularly consult with and consider input from the Tribal Health Liaison suggests a heightened awareness of Tribal health needs. UIOs may benefit from increased collaboration and support from this office, potentially leading to improved access to resources, funding, and tailored public health programs for Urban AIANs. 

FEDERAL UPDATES 

• PRESIDENT’S FY 2025 BUDGET RELEASED: On March 11, IHS notified UIOs of the release of the President’s Fiscal Year 2025 Budget. [The budget] builds on the…implementation of advance appropriations and includes a total of $8.2B for the Indian Health Service in FY 2025, which is an increase of $1.1B or 16% above FY 2023. The FY 2025 budget is reflective of tribal and urban Indian organization leader priorities, as it includes significant funding increases beginning in FY 2025 towards the top tribal budget recommendations. In FY 2025, the budget includes a total of $8B in discretionary funding, as well as $260M in proposed mandatory funding for the Special Diabetes Program for Indians. In FY 2026, the budget makes all funding for IHS mandatory, culminating in a total funding level of approximately $42B FY 2034. This mandatory budget proposal builds towards the tribal recommendation of full funding. This budget continues the administration’s support for full mandatory funding for the IHS and provides a net increase of $208 billion over the discretionary baseline. Over a five-year period, the budget provides an increase of more than $17B to expand direct health care services and close the Indian Health Care Improvement Fund Level of Need gap. It also includes an additional $6.5B to finalize modernization of the IHS electronic health record system. The budget would also fully fund the remaining projects on the 1993 Health Care Facilities Construction Priority List and start funding other construction needs in 2031.” 
  • Potential Impact to UIOs: The FY 2025 President’s Budget proposes a substantial increase in funding for the Indian Health Service (IHS), including discretionary and mandatory allocations, aiming to address persistent health disparities and historic underinvestment in AIAN communities. This increase in funding offers potential benefits for UIOs by bolstering resources for direct healthcare services, enhancing operational capacity, and supporting critical infrastructure needs. Additionally, the proposed legislative initiatives seek to address workforce challenges, including recruitment and retention of healthcare professionals, which could positively impact UIOs’ ability to deliver essential healthcare services to Urban AIAN populations. 

IHS UPDATES 

• SUPPLEMENTAL REQUEST FOR FENTANYL & OPIOID ABUSE FUNDING: On March 4, CCUIH submitted written comments on the Supplemental Request for Fentanyl & Opioid Funding following the urban confer session held on February 2. CCUIH highlighted the need for equitable distribution and increased outreach/collaboration for any potential funding.
  • Resources: DUIOLL 
  • Summary of Recommendations: The recommendations aim to ensure equitable funding distribution for Urban Indian populations by considering factors like substance abuse prevalence and healthcare accessibility, with input from Tribal Consultation & Urban Confer sessions. Additionally, there’s a call to allocate funds for culturally sensitive outreach programs and education campaigns, leveraging partnerships and noncompetitive funding models. Collaboration among UIO clinics, tribal health programs, and stakeholders is emphasized to enhance opioid abuse interventions, including joint planning and engagement with SAMHSA for comprehensive treatment approaches. Finally, there’s advocacy for full funding for mental health, alcohol and substance abuse, and urban health initiatives within the I/T/U system. 

• URBAN EMERGENCY FUND: On March 5, Director Tso sent a DUIOLL on the Urban Emergency Fund, which is $200,000 allocated by OUIHP each year. This funding is available to address some of the costs incurred during one-time, non-recurring emergencies and disaster relief efforts involving UIOs. “To make a UEF request, a UIO must submit a written request to the applicable IHS Area Director, with copies to the Area Chief Contracting Officer and the UIO’s Contracting Officer Representative, as soon as reasonably practicable after the emergency situation.” 
  • Resources: DUIOLL
  • Potential Impact to UIOs: The potential impact is significant. The UEF provides a limited discretionary allocation to address costs incurred during one-time emergencies and disaster relief efforts involving UIOs, with funding up to $200,000 annually, subject to availability. Several CA UIOs have received UEF funds. UIOs must have a contract with the IHS to be eligible for UEF access, and emergency situations requiring funding must be clearly defined and documented, with a written request outlining the emergency, requested amount, rationale, and impact. The UEF offers crucial financial assistance during emergencies, enabling UIOs to address immediate health and safety concerns within their communities, but its availability is contingent on appropriations and specific eligibility criteria. 

• 2024 CA AREA URBAN CONFER SESSION: On March 6, the CA Area Office hosted the 2024 CA Urban Confer during the CA Tribal Leaders Meeting. UIO Leaders shared the importance of 100% FMAP for UIOs, PRCDA Expansion, accurate UIO data, and MMIP.
• FY 2025 IHS BUDGET ROLLOUT: On March 13, IHS held a webinar to share an overview of the agency’s FY 2025 Budget. The budget includes $8.2B for the IHS and $260M for SDPI. 
  • Resources: 03.13.24 IHS Budget Rollout Slides
  • Potential Impact to UIOs: The budget outlines a mandatory funding formula starting in FY 2026, exempting the IHS from sequestration, and includes legislative proposals to address various healthcare challenges. However, adjustments in funding allocations, such as the decrease in funding for the Community Health Aide Program (CHAP), may impact UIOs’ abilities to address specific health needs within Urban Indian communities. 

Legislative Report prepared by Arianna Antone-Ramirez, CCUIH Health Policy Analyst and
Nanette Star, CCUIH Director of Policy. If you have questions or comments please email us
arianna@ccuih.org, nanette@ccuih.org

FEBRUARY 2024 LEGISLATIVE UPDATE 

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In February, various updates emerged across state, federal, and Indian Health Service (IHS)  sectors impacting Urban Indian Organizations (UIOs). CCUIH attended the Missing & Murdered  Indigenous People (MMIP) Summit & Day of Action on February 12-13, 2024, advocating  solutions to the MMIP epidemic, reinforcing the need for public health-centered approaches. The  projected $73 billion budget deficit in California for 2024-25 may challenge UIOs’ financial stability,  while new workplace violence prevention requirements and the H.R. 7307 Workforce Innovation  Act could prompt resource allocation and partnership opportunities. Federally, IHS’s $250M  supplemental request to address the Fentanyl & Opioid Crisis offers potential funding for UIOs to  expand services, contingent on IHS’s commitment to inclusive feedback incorporation. Moreover,  IHS’s Health IT Modernization Project and the 2024 Agency Work Plan may eventually affect  UIOs’ electronic health records reporting systems and operational priorities. February 16th marked the deadline for bill introduction at the state level, and next month kicks off with the Indian  Health Service (IHS)/California Area Office (CAO) Annual Tribal Consultation & Listening Session  from March 5 to 7, 2024, and the Spring Legislative Recess begins March 24th. 

IN THE NEWS 

• MMIP SUMMIT & DAY OF ACTION: CCUIH attended the MMIP Summit & Day of  Action on February 12-13, 2024, in Sacramento, CA. This event was hosted by the  Yurok Tribe in partnership with Wilton Rancheria. CCUIH Board President Sonya  Tetnowski and CCUIH Executive Director Virginia Hedrick spoke on a panel focused on  highlighting solutions to the MMIP epidemic that go beyond the scope of law  enforcement and are centered in the realm of health. 

STATE UPDATES 

• STATE BUDGET DEFICIT: According to the Legislative Analyst’s Office, the 2024-25  deficit, which was estimated at about $58 billion in January, is now projected to be about  $73 billion. This recalculation will have significant impacts on Governor Newsom’s  proposed state budget. CCUIH will continue to track these crucial budget developments.
  • Resource: 2/20 CalMatters Article
    • Potential Impact on UIOs: The projected $73 billion budget deficit in California  for the 2024-25 fiscal year poses significant challenges for UIOs. Facing potential  funding reductions and increased competition for limited resources, UIOs may  experience financial strain, service disruptions, and difficulties in maintaining vital  programming for urban Indian populations. Strategic advocacy and resource  allocation will be essential for UIOs to mitigate the impact of budget cuts and  safeguard access to essential healthcare services for Urban Indian communities  in California. 

• CALIFORNIA’S WORKPLACE VIOLENCE PREVENTION REQUIREMENTS: Our  partners at CPCA have shared that “Senate Bill 553, signed into law by Governor  Newsom, requires California employers to establish, implement, and maintain an  effective workplace violence prevention plan. Community health centers are not exempt  from these requirements and will need to comply by the July 1, 2024, deadline. Read more here.
  • Potential Impact on UIOs: UIOs, operating as community health centers, will  need to allocate resources and develop comprehensive prevention plans to  ensure compliance with the new law. This may involve additional training for  staff, investment in security measures, and revisions to existing workplace  policies and procedures. Failure to comply could result in penalties and legal  consequences. 

FEDERAL UPDATES 

• H.R. 7307 WORKFORCE INNOVATION ACT: From CPCA “[NACHC] endorsed a new  bill that will support health center workforce needs. Rep. Marc Molinaro (R-NY) and Rep.  Angie Craig (D-MN) introduced the bipartisan Health Care Workforce Innovation Act  (H.R. 7307) earlier this month. The bill would authorize a new grant program to scale up  health center-led workforce development programs, such as partnerships with schools,  more preceptorships, and innovative career laddering programs. Click here for a link to  Rep. Molinaro’s press release.” 
  • Resources: H.R. 7307 Bill Text; Rep. Molinaro Press Release on H.R. 7307
  • Potential Impact on UIOs: This legislation would support programs fostering  partnerships with educational institutions, expanding mentorship programs, and  offering career advancement opportunities. Ultimately, it aims to address  healthcare workforce shortages and improve access to culturally competent  care. 

IHS UPDATES 

• $250M SUPPLEMENTAL REQUEST TO ADDRESS THE FENTANYL & OPIOID  CRISIS: During this urban confer session held on February 2, 2024, IHS shared details  regarding the Biden Administration’s supplemental funding request of $250M to address  the Fentanyl & Opioid Crisis. IHS expressed their commitment to using the feedback  received through Tribal Consultation & Urban Confer to create the funding distribution  methodology. The deadline to submit written comments following this confer session is  March 4, 2024. 
  • Resources: DUIOLL; 2/2 Urban Confer Session Slide Deck 
  • Potential Impact on UIOs: With this funding, organizations can expand access  to treatment, prevention, and harm reduction services tailored to the unique  needs of urban Native populations. Furthermore, the commitment by the IHS to  incorporate feedback from Tribal Consultation & Urban Confer sessions ensures  that the distribution methodology reflects the diverse perspectives and priorities  of affected communities. This funding initiative has the potential to catalyze  collaborative efforts among stakeholders and continues to support UIOs to  implement comprehensive strategies to address the opioid crisis effectively. 

• HEALTH IT MODERNIZATION ENTERPRISE COLLABORATION GROUP: During this  joint tribal consultation/ urban confer session, IHS shared their updates on the Health IT  Modernization Project, including an invitation to join focus groups. The initial 3 focus  groups are: Health IT Implementation, Interoperability, and Data Management &  Analytics. 
  • Resource: DUIOLL 
  • Potential Impact on UIOs: The selection of pilot sites for the Health IT Modernization Project may impact  electronic health records (EHR) reporting systems in several ways. First, the  implementation of new IT systems may require updates or modifications to  existing EHR systems to ensure compatibility and interoperability. Second, the  transition to a new system may temporarily disrupt EHR reporting processes as staff members undergo training and familiarization with the new technology.  Third, if the new system offers enhanced features or functionalities, it could  potentially improve EHR reporting accuracy and efficiency over time.

• 2024 IHS AGENCY WORK PLAN: On February 22, 2024, IHS announced their new  2024 IHS Agency Work Plan meant to replace the 2023 Agency Work Plan as it is  closed out. Priority areas in the 2024 Agency Work Plan include: Patient Safety, Human  Capital, Operational, Financial, Compliance/Regulatory, and Strategic. 
  • Resource: Fact Sheet – IHS 2024 Agency Work Plan 
  • Potential Impact on UIOs: UIOs could benefit from this plan, potentially  receiving increased support and resources as IHS focuses on bolstering services  for Urban Indian populations. Adapting to these changes will be crucial for UIOs  to optimize their healthcare delivery and enhance their impact within their  communities. 

• DEFINITION OF INDIAN TRIBE: CCUIH submitted written comments following the  January 11 tribal consultation session on the Definition of Indian Tribe. 
  • Resource: DTLL, 2/23 CCUIH Written Comments 

JANUARY 2024 LEGISLATIVE UPDATE 

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Back to session! As of January 3rd, California state legislators reconvened, and quickly following, the state budget was submitted by the governor. January 19th was the last day to submit bill requests to the Office of Legislative Counsel. Furthermore, we are closely monitoring 28 State Bills and will continue to provide monthly updates with any changes. CCUIH will submit the CA Area Office – Urban Confer Session Agenda (taking place in March) after being reviewed with CCUIH Members in early February. In January, CCUIH submitted one comment letter to the Department of Interior on E.O. 14112. CCUIH’s policy team is planning for the new year with events such as Day at the Capitol in Sacramento and Washington D.C. We have also started our new policy blog that will be published in the middle of each month; the January blog is A Policy Story in 6 Steps. Check the new section below on Policy Engagements, for other policy meetings attended. 

STATE UPDATES 

• Governor Proposed State Budget FY 2024-2025 Proposed Budget Summary ○ Despite budget reductions, the BH-Connect program remains level funded. ○ Behavioral Health Continuum Infrastructure Program—A delay of $140.4 

million General Fund from 2024-25 to 2025-26, for a total of $380.7 million for the final round of grants in 2025-26. The Budget maintains $300 million 

General Fund in 2023-24 and $239.6 million General Fund in 2024-25. 

• Proposed State Budget Analysis 

○ CPEHN State Budget Update 

○ CPCA has released its analysis of the FY 2024-2025 Proposed Budget focusing on CHC Impact. CPCA FY 2024-2025 Proposed Budget Summary with CHC Impact 

○ California Budget & Policy Center First Look: Understanding the Governor’s 2024-25 State Budget Proposal 

FEDERAL UPDATES 

• E.O. 14112: On 1/22, CCUIH staff attended a webinar on implementing E.O. 14112 “Reforming Federal Funding and Support for Tribal Nations to Better Embrace Our Trust Responsibilities and Promote the Next Era of Tribal Self-Determination”. CCUIH submitted written comments. 

○ Resource: Executive Order 14112 

○ Potential Impact on UIOs: May affect some UIO funding and make it easier for UIOs to access some federal program funding. We submitted a comment letter asking to ensure UIOs are not excluded from federal program 

opportunities with the proposed E.O.

• NCUIH Legislative & Regulation Trackers NCUIH tracks and monitors the development of relevant regulations and legislation, and proposed agency actions that impact Urban Indian Organizations or directly affect their operational growth, financial structure and service expansionFor detailed information, please refer to the legislation tracker on federal updates: 

○ NCUIH Leg Tracker 

○ NCUIH Regulation Tracker 

IHS UPDATES 

• PRCDA Expansion: On 1/11, there was a special meeting of CATAC to discuss the PRCDA Expansion; this topic for discussion will also be brought to the March CA Area IHS Urban Confer session. 

○ Resource: Purchased/Referred Care Delivery Areas (PRCDA) Counties in the United States 

○ Potential Impact on UIOs: CCUIH underscored the importance of accurate data that reflects those being served and how inaccurate numbers negatively affect UIO funding and services. 

• FY 2023 Budget to Support UIOs: On 1/22, IHS shared the. See the DUIOLL for more information. 

○ Resource: DUIOLL Budget Report Support UIOs 

○ Potential Impact on UIOs: Details the funds distribution by OUIHP and IHS Area Offices. Provides transparency of the funds that have been allocated for program administration, contract, and grant awards, health information 

technology, and Urban INdian Health initiatives.