February Update

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Executive Summary
The year has started with major challenges for Urban Indian health, from funding threats to  policy changes that could impact care. CCUIH is actively engaged in advocacy, tracking key  legislation, and preparing for critical discussions at the February 24 budget hearing. Now is the  time for action—your voice and engagement are crucial to protecting Urban Indian health  services.

Indian Health Service (IHS) Updates 

• Potential Cuts to UIO Programs Under IHS: Recent federal budget discussions have  raised concerns over potential 50% cuts to UIO funding under the Indian Health  Service (IHS). Additionally, IHS is reviewing UIO contracts, which could impact financial  stability and service continuity. 
  • Potential Impact to UIOs: If enacted, these cuts could significantly reduce  resources for UIOs, affecting staffing, services, and overall capacity to meet  community needs. CCUIH is monitoring developments and coordinating  advocacy efforts with NCUIH. 
• New IHS Leadership Appointments: IHS has recently appointed key leadership  positions, including Dr. Beverly Cotton as Deputy Director for Field Operations and Dr. Christopher Poole as Bemidji Area Director. These changes may signal new  priorities and strategic direction within IHS. 
  • Potential Impact to UIOs: Leadership transitions may influence policy decisions  affecting UIO funding, collaborations, and program implementation. UIOs should  monitor any shifts in IHS priorities and engage with leadership as needed. 
• IHS Health Information Technology (HIT) Modernization Sessions: IHS is  conducting Tribal Consultation and Urban Confer sessions throughout 2025 on the HIT  Modernization Program. The next session, scheduled for May 9, 2025, will focus on  deployment and cohort planning. 
  • Potential Impact to UIOs: UIOs have an opportunity to provide input on the  modernization process to ensure the new HIT system meets urban Indian  healthcare needs, including data integration and billing processes. 
• Rescission of IHS Layoffs: Nearly 1,000 IHS layoffs were rescinded on February 14,  2025, after strong advocacy from Tribal and urban Indian health organizations. The  layoffs would have significantly impacted service delivery at IHS facilities nationwide. 
  • Potential Impact to UIOs: Avoiding staff reductions at IHS ensures continued  federal support for AI/AN health programs. However, concerns remain about  long-term funding stability, and UIOs should stay engaged in federal budget  advocacy.
• NCUIH Report on Federal Funding Disruptions: The National Council of Urban Indian  Health (NCUIH) released a report on February 11, 2025, warning that potential federal  funding disruptions pose serious risks to Urban Indian Organization (UIO) services and  financial stability. 
  • Potential Impact to UIOs: This report underscores the importance of securing  long-term, mandatory UIO funding. UIOs should use this data to inform local,  state, and federal advocacy efforts.
• Upcoming IHS Comment Opportunities: IHS will release additional Tribal Consultation  and Urban Confer opportunities in March and April 2025 regarding key issues such as  Medicaid reimbursement, workforce challenges, and public health funding allocations. 
  • Potential Impact to UIOs: Engaging in these discussions will be critical to  ensuring UIO priorities are included in federal funding and policy decisions.  CCUIH will track and share updates as they become available.

California State Updates 

• SPA Comments are due March 9, 2025 Public Provider Ground Emergency Medical Transportation (PP-GEMT) Intergovernmental Transfer (IGT) program for 2025,  providing increased Medi-Cal reimbursement for eligible GEMT providers. Tribally  owned and operated providers may opt in for the updated add-on rate. 
  • Key Dates:
    • Comments due: ~March 9, 2025 (30 days from notice).
    • Discussion: Next DHCS Medi-Cal Indian Health webinar (TBD).
  • Potential Impact to UIOs: Minimal direct impact expected. Tribal GEMT providers may benefit from  increased reimbursement but remain ineligible for the GEMT Quality Assurance  Fee (QAF) program.
• TH/NH BHIN Finalization: DHCS is finalizing the Traditional Health/Natural Helper  (TH/NH) Behavioral Health Information Notice (BHIN), which is expected to be released this week or next. This guidance will provide direct information on the implementation  details for integrating TH/NH services into Medi-Cal.
  • Potential Impact to UIOs: UIOs will soon have final guidance to incorporate  TH/NH services into their Medi-Cal behavioral health – SUD offerings, potentially  expanding culturally responsive care options. 

• Opt-In Package Availability: DHCS has developed an Opt-In Package for organizations  looking to participate in the TH/NH benefit. CCUIH has template materials, including all  required policies, to support organizations in this process. 
  • Potential Impact to UIOs: UIOs interested in opting in can leverage CCUIH’s  templates to streamline their application and implementation process, reducing  administrative burden. Please reach out to our policy team. 

• Governor’s Budget The 2025-26 budget invests in Medi-Cal and behavioral health but  does not list IHP as a standalone item, consistent with past budgets. Funding may still  be included within DHCS allocations, and we will continue to monitor this. 
  • State Indian Health Program (IHP) Funding Status: The 2025-26 budget does not  explicitly list IHP funding as a standalone item, but it may be included within  broader DHCS allocations.
    • Potential Impact to UIOs: Without clear designation, there is uncertainty  about continued direct funding for UIOs. Advocacy remains necessary to  ensure these funds are protected. 
  • Medi-Cal Funding and Enrollment: The budget increases Medi-Cal funding to  $188.1 billion ($42.1 billion General Fund), but enrollment is projected to decline  from 15 million to 14.5 million due to redeterminations.
    • Potential Impact to UIOs: While funding increases, the enrollment decline  may disrupt AI/AN coverage. UIOs should continue outreach to assist  with Medi-Cal renewals. 
  • Managed Care Organization (MCO) Tax Revenue Decline: Projected MCO tax  revenue is $7.9 billion in 2024-25, but decreases to $4.4 billion in 2025-26 and  $3.3 billion in 2026-27.
    • Potential Impact to UIOs: Reduced revenue may impact Medi-Cal  provider reimbursements, potentially affecting UIO funding stability. 
  • Behavioral Health Expansion – BH-CONNECT: The $8 billion BH-CONNECT  waiver expands behavioral health services, prioritizing children, justice-involved  individuals, and those experiencing homelessness.
    • Potential Impact to UIOs: UIOs may benefit from new behavioral health  funding opportunities and should engage in discussions on program implementation.
  • Medi-Cal Redetermination Updates: DHCS continues the Medi-Cal  redetermination process, reinstating eligibility checks post-COVID-19. Many  AI/AN beneficiaries face disenrollment risks due to administrative barriers and  lack of outreach. With most renewals now completed, data shows ongoing  coverage gaps, prompting state review of long-term impacts and potential policy  changes in the 2025 budget cycle to address procedural terminations and  improve retention efforts. For keytakeaways and data, see here. 
    • Potential Impact to UIOs: UIOs may see an increase in patients losing  Medi-Cal coverage, impacting access to care. Outreach and assistance  for patients navigating the renewal process remain critical.

Federal Updates 

The Trump administration has introduced significant policy changes affecting healthcare  access, federal funding, and agency operations. These shifts could have lasting impacts on  Urban Indian Organizations (UIOs) and the AI/AN communities served. 

• Federal Workforce Reductions: In February 2025, the administration announced major  layoffs across federal agencies, including HHS and IHS. Nearly 1,000 IHS layoffs were  rescinded after tribal organizations advocated for their reversal. 
  • Potential Impact to UIOs: Workforce reductions could affect IHS service capacity  and support for UIOs. While layoffs were rescinded, future cuts remain a  concern. Continued advocacy is essential. 
    • Resource: Native News Online 
• Medicaid Funding and Work Requirements: The administration and congressional  Republicans are considering Medicaid funding cuts and work requirements for eligibility.  AI/AN communities rely heavily on Medicaid, and tribal leaders are urging exemptions  for Native populations. 
  • Potential Impact to UIOs: If enacted, work requirements could increase barriers  to care for AI/AN populations. UIOs may face more administrative burdens  assisting patients in maintaining coverage. 
    • Resource: Associated Press
• Rescission of DEI Programs: Executive orders have eliminated Diversity, Equity, and  Inclusion (DEI) programs across federal agencies, affecting funding, contracts, and  health initiatives. 
  • Potential Impact to UIOs: DEI rollbacks could reduce funding and resources for  programs addressing AI/AN health disparities. UIOs may need alternative  strategies to sustain culturally specific services. 
  • Resource: Morrison & Foerster
• Communication Restrictions: A federal directive has paused public communications  from IHS and other health agencies, limiting access to information for tribal and urban  Indian health programs. 
  • Potential Impact to UIOs: Restricted communication could delay critical health  updates and policy guidance, making it harder for UIOs to stay informed and  advocate effectively. 
  • Resource: Native News Online 

These policy shifts highlight the need for continued advocacy to ensure that AI/AN healthcare  funding and services remain protected. CCUIH will monitor federal developments and provide  updates on key impacts to UIOs.

January Update – Brief Update 

Given this month’s rapid developments, we are providing this quick update instead of a full legislative report. This ensures timely information on policy changes and emerging issues. This email serves as a quick update on key legislative and policy developments that may be relevant to you. A link to further details is provided below.

Legislative Developments

• Multiple bills we are tracking in the California State Assembly have been accepted and are currently being assigned to committees. (Expect a list of bills we are tracking coming your way in February). If there are any bills you are particularly interested in, please let us know.

Policy Updates

• 1115 Waiver: The Department of Health Care Services (DHCS) guidance and opt-in guidance were submitted.

• Upcoming Meeting: DHCS Tribal Health/Native Health (TH/NH), Tribes, and Indian Health Program Representatives Meeting is scheduled for Monday, February 3rd, 1-3 PM.

December Update – 2024 A Year in Review

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In 2024, the California Consortium for Urban Indian Health (CCUIH) amplified the voice of Urban Indian Organizations (UIOs) with bold advocacy and strategic partnerships, achieving significant wins that will shape the future of AI/AN health services. This report provides a detailed look at the milestones, policy shifts, and challenges that defined the year—and how they impact our shared mission to advance health equity for urban Native communities.

Executive Summary

From tackling a $56 billion budget deficit to securing funding for critical health programs, 2024 was a transformative year for UIOs in California. Among the highlights:

• Securing Vital Funding: Against fiscal challenges, CCUIH, in collaboration with multiple UIOs, NCUIH, tribes, CRIHB, many allies outside of Indian Country, and with support from legislative partners, safeguarded $23 million in annual ongoing funding for the Indian Health Program and influenced state budget decisions to protect healthcare services for urban Native populations.
• Legislative Triumphs: Landmark legislation, including Traditional Healing Demonstrations in Medi-Cal, expanded the scope of culturally tailored healthcare services.
• Elevating Public Health Responses: CCUIH spearheaded initiatives to address critical health crises, including the syphilis outbreak, and advanced behavioral health reforms to ensure equitable care.

This year, CCUIH’s advocacy influenced over 60 state and federal bills, engaged with legislators on both sides of the aisle, and forged alliances that strengthened the policy landscape for UIOs. The collective effort of our organization and partners has set the stage for a more equitable healthcare system.

Advocacy for Funding and Resources CCUIH worked tirelessly to secure funding amidst California’s $56 billion budget deficit. Despite these challenges, the Indian Health Program’s funding was preserved, and advocacy efforts influenced critical budget decisions, including:

• Engagement in the May Revise Budget process to protect healthcare services.
• Monitoring of over 60 bills impacting UIOs and AI/AN communities.
• Joint press releases and hearings amplifying the need for Indian Health Program funding.

Legislative and Policy Wins Throughout 2024, CCUIH actively tracked and influenced state and federal legislation:

• Supported bills addressing healthcare access, workforce development, and public health.
• Successfully advocated for the inclusion of Traditional Healing Demonstrations in California’s Medicaid program, a landmark achievement benefiting UIOs.
• Engaged with federal policymakers to ensure bipartisan support for the Indian Health Service (IHS), resulting in significant appropriations for Urban Indian Health programs.

Health Equity and System Reforms Promoting health equity remained a cornerstone of CCUIH’s efforts:

• Supported State Plan Amendments for expanded roles of Community Health Workers and culturally competent care.
• Participated in syphilis outbreak consultations to strengthen public health responses.
• Advocated for federal reforms to stabilize IHS funding and protect the Indian Health Care Improvement Act (IHCIA).

Key Events and Engagements CCUIH’s leadership and collaboration were evident in events such as:

• In February, the MMIP Summit & Day of Action advocates for public health solutions to the MMIP epidemic.
• The California Native American Legislative Caucus meeting in August emphasized partnership development.
• A post-election webinar analyzing the implications of federal and state elections on UIOs and health equity.

Election Impacts and Future Outlook The 2024 elections brought opportunities and challenges for AI/AN communities:

• Key California ballot propositions passed, including Proposition 35, directing funds to Community Health Centers.
• Federal shifts, including a Republican-led Congress, highlighted the need for robust advocacy to protect health programs.

Looking Ahead As CCUIH reflects on 2024, we remain steadfast in our mission to advance health equity, foster collaboration, and build sustainable systems for Urban Indian communities. In alignment with our tactical planning, CCUIH will focus on the following priority areas:

• Workforce Recruitment and Retention: Implement training and technical assistance to support culturally and linguistically competent care, ensuring a resilient and well-equipped healthcare workforce.
• Expanding Partnerships: Strengthen relationships with stakeholders both within and outside Indian Country to amplify impact and foster collaborative solutions.
• Enhancing Advocacy Efforts: Advocate for policies and resources that address systemic barriers and promote equitable healthcare access for UIOs.
• Data-Driven Approaches: Leverage data to inform decision-making, track progress, and ensure accountability in addressing health disparities.
• Community Engagement: Deepen connections with AI/AN communities to co-create culturally informed solutions that are responsive to local needs.
• Strategic Positioning: Position CCUIH to build new relationships, foster a bipartisan approach to collaboration, and proactively mitigate anticipated changes in the federal policy landscape that may impact UIOs. This includes strengthening educational outreach and advocacy efforts to ensure the resilience of vital health programs and services.

CCUIH aims to address systemic challenges and create lasting change by leveraging partnerships, advocacy, and culturally informed practices.

For questions or more information, contact:

• Virginia Hedrick, Executive Director, virginia@ccuih.org
• Nanette Star, Director of Policy & Planning, nanette@ccuih.org

November Update

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As we transition into November, it’s essential to reflect on recent legislative developments and their implications for Urban Indian Organizations (UIOs) and the communities we serve. The November 5, 2024, general election brought several significant outcomes, particularly concerning the 10 ballot propositions that have the potential to impact American Indian and Alaska Native (AIAN) communities.

STATE UPDATES

Department of Health Care Services (DHCS):

• State Plan Amendments (SPAs):

• Summary of Proposed Changes: This proposed State Plan Amendment (SPA 24-0032)  is to add Certified Wellness Coach (CWC) services as a covered Medi-Cal benefit starting January 1, 2025. This initiative, part of the Children and Youth Behavioral Health Initiative (CYBHI), aims to increase access to preventive behavioral health support for children and youth through non-clinical services like wellness promotion, care coordination, and crisis referrals. While this addition could enhance behavioral health support for Medi-Cal members, reimbursement limitations apply to Tribal Health Programs (THPs) and Federally Qualified Health Centers (FQHCs), which may impact their ability to fully utilize these services.Comments Due December 22 

ELECTIONS

As of November 21, 2024, the outcomes of California’s 10 ballot propositions from the November 5, 2024, general election are as follows:

• Proposition 1: Behavioral Health Services Program and Bond Measure
• Outcome: Passed.
• Details: This measure authorizes bonds to fund behavioral health services and housing for individuals experiencing homelessness.
• Proposition 2: Public Education Facilities Bond Measure
• Outcome: Passed.
• Details: Approves the issuance of bonds to construct and modernize public education facilities, including K-12 schools and community colleges.
• Proposition 3: Right to Marry and Repeal Proposition 8 Amendment
• Outcome: Passed.
• Details: Amends the state constitution to affirm the fundamental right to marry, regardless of sex or race, effectively repealing Proposition 8.
• Proposition 4: Parks, Environment, Energy, and Water Bond Measure
• Outcome: Passed.
• Details: Authorizes bonds to fund projects related to parks, environmental conservation, energy efficiency, and water infrastructure.
• Proposition 5: Lower Vote Threshold for Local Special Taxes and Bond Measures
• Outcome: Passed.
• Details: Reduces the voter approval requirement from two-thirds to 55% for local special taxes and bond measures aimed at funding housing projects.
• Proposition 6: Remove Involuntary Servitude as Punishment for Crime Amendment
• Outcome: Passed.
• Details: Eliminates language in the state constitution that permits involuntary servitude as a punishment for crime.
• Proposition 32: Minimum Wage Increase
• Outcome: Failed.
• Details: Proposed increasing the state minimum wage to $18 per hour by 2026. Voters rejected this measure.
  
• Proposition 33: Prohibit State Limitations on Local Rent Control
• Outcome: Failed.
• Details: Sought to repeal the Costa-Hawkins Rental Housing Act, allowing local governments to enact rent control on more properties. Voters rejected this proposition.
  
• Proposition 34: Taxpayer Approval Requirement for New Taxes
• Outcome: Failed.
• Details: Would have required any new state or local taxes to receive two-thirds voter approval. Voters did not pass this measure.
• Proposition 36: Increased Penalties for Certain Crimes
• Outcome: Passed.
• Details: Increases penalties for specific drug and theft crimes, including reclassifying certain offenses as felonies.
• California General Election: Unofficial Election Results
  
• State Representative Outcome California State Assembly: All 80 seats in the State Assembly were contested. The Democratic Party maintained its majority, though specific seat counts and notable shifts are still being finalized. California Election Results
• California State Senate: In the State Senate, half of the 40 seats were up for election. A significant development occurred in a purple district where Democratic State Senator Josh Newman conceded to former GOP Assemblymember Steven Choi. Newman’s loss was influenced by opposition from labor unions and the challenges posed by redistricting.
• U.S. House of Representatives: California’s 52 congressional districts were contested. Notably, Republican Ken Calvert secured reelection in the 41st Congressional District.

Overall, while Democrats continue to hold a majority of California’s seats in the U.S. House, there have been shifts in certain districts, reflecting evolving political dynamics within the state.

To delve deeper into these results and their implications for UIOs and urban AIAN communities, we will host a post-election webinar in early December. This session will provide a comprehensive analysis of the election outcomes and their anticipated impact on our advocacy efforts and policy priorities.

Stay tuned for the webinar details and registration link, which will be shared soon!

FEDERAL UPDATES

The 2024 United States elections, held on November 5, resulted in significant shifts at the federal level:

Presidential Election:

• Former President Donald Trump was re-elected, defeating Vice President Kamala Harris.

Congressional Elections:

• Senate: Republicans regained control by winning key races in Ohio, West Virginia, and Montana, and maintaining seats in Texas and Florida.

• House of Representatives: Republicans secured the necessary 218 seats for a majority, finalizing their control by November 13.

These outcomes grant the Republican Party control over the executive and legislative branches, enabling them to advance their policy agenda with minimal opposition. Key areas of focus include conservative judicial nominations, strict immigration policies, and the revival of energy projects.

The election also marked historic milestones, such as the election of two Black women to the Senate for the first time. Additionally, Republicans won eight out of eleven gubernatorial races, including a significant victory by Kelly Ayotte in New Hampshire.

These developments are expected to influence legislative priorities and policy directions in the upcoming congressional sessions.

IHS UPDATES

• CONFER AND LETTERS FOR COMMENT 

• Urban Confer: Proposed Reorganization of DDIGA Offices 

• Virtual Webinar Registration: Wednesday, November 13th 12-2pm PST
• Enclosure organization map

POLICY ENGAGEMENTS IN NOVEMBER

• Covered California Tribal Consultation
• CPEHN Board Meeting
• CPCA Biweekly Member
• CPCA Leg/Reg Committee
• CPCA Annual Conference
• RAC Monthly Directors
• NCUIH Policy Workgroup
• OUIHP Urban Program Executive Directors
• Children’s Partnership Conference
• CalAIM Indian Health – Transportation Committee
• CalAIM IHP Quarterly Meeting
• DHCS Behavioral Health Transformation – Quality & Equity Advisory Committee 
• County Behavioral Health Directors
• Racial Equity Commission 
• CPCA Peer Networking/Legislative and Regulatory
• California Racial Equity Coalition
• PATH Coalition
• Tribes and Indian Helath Program Representative
• Kaiser Permanente CAC
• CDPH Tribal Health Equity Advisory
• ITUP Policy Forum
• Dental Therapy Government Relations
• CalAIM IHP

Legislative Report prepared by CCUIH Director of Policy & Planning Nanette Star nanette@ccuih.org and CCUIH Executive Director Virginia Hedrick virginia@ccuih.org

October Update

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In October’s legislative update, we’re excited to lead with a monumental win—after more than a decade of advocacy, CMS has approved Traditional Healing Demonstrations in California. While this is a significant step forward for Urban Indian Organizations (UIOs), there is still critical work ahead to ensure that implementation aligns with the needs of UIOs and fully support the communities we serve. With the general election on November 5, 2024, it’s also crucial to understand how the 10 ballot propositions could further impact American Indian and Alaska Native communities. This update covers the Governor’s actions on key legislation, such as signed bills like AB 2435 on the California Health Benefit Exchange and vetoed bills like AB 2428 on Medi-Cal services. As we look ahead, be sure to mark your calendars for upcoming tribal consultations and UIO conferences. In November, two UIOs will also host their annual Galas, celebrating community achievements and support.

STATE UPDATES

• October State Legislative Calendar: Starting January 1, 2025, all bills enacted on or before October 2, 2024, will officially take effect. This means the legislative changes that have been passed into law this year will soon begin influencing policies, regulations, and everyday life across California. Keep an eye on these upcoming changes as they may affect various sectors, from healthcare to public safety, housing, and beyond! It’s a crucial time to stay informed and prepare for the impacts these new laws will bring in the new year.

• General Election November 5, 2024: Potential Impact on UIOs: There are 10 California ballot propositions, each with significant potential to impact American Indian and Alaska Native (AIAN) communities. Proposition 35 directly impacts UIOs as it would direct MCO tax dollars to Community Health Centers, including T/U programs. CCUIH is listed member of the Yes on 35 coalition.  These issues range from housing and healthcare to education, environmental protections, and public safety. CCUIH has released an “Understanding the Propositions” document to help guide some of these conversations. For a downloadable file, please share and check out here on our BE HEARD: Advancing Health and Empowering AIAN Voices at the Polls Program Page.

• The California State Legislature All bills needed to pass out of the Assembly and Senate by Saturday, August 31st. Any legislation that did not advance from the floor by this deadline is dead. Bills that successfully passed were sent to the Governor for review. The Governor has until September 30th to sign or veto these bills; here is what we know as of September 25. Below is the status of some select bills. You can also see the Governor’s Legislative Update with a more thorough listing of bills signed and vetoed here.

SIGNED

• AB 2435 (Maienschein) California Health Benefit Exchange.
• AB 2860 (Garcia) Licensed Physicians and Dentists from Mexico
• AB 2864 (Garcia) Licensed Physicians and Dentists from Mexico Pilot Program: extension of licenses 
• AB 2108: Foster care: missing children and nonminor dependents.
• AB 2711 ​​Suspensions and expulsions: voluntary disclosures.
• AB 2795: CalWORKs Indian Health Clinic Program.
• SB 1382: Community and rural health clinics: building standards.
• AB 1863 California Emergency Services Act: notification systems: Feather Alert.

VETOED

• AB 2428 (Calderon) Medi-Cal: Community-Based Adult Services.
  • The governor stated that codifying the requirement for them to receive an FFS rate is unnecessary because the budget included $16 million in annual payment increases to CBAS providers.  
• AB 2428 Veto Message

• AB 2250 Social determinants of health: screening and outreach
• The Governor cited the bill’s overlap with existing state and federal efforts, such as CalAIM and new federal billing codes. He highlighted concerns about the bill’s lack of clarity on “adequate access” to community health workers, making implementing it challenging.
• AB 2138: Peace officers: tribal police pilot project.
• The response letter is hyperlinked above and this is part of the Governors response, “Unfortunately, while well-intentioned, this bill creates a significant legal disparity between California peace officers and tribal police officers. There are a range of important obligations, as well as powers, that accompany peace officer status. These obligations must be maintained should the powers of peace officer status be shared with tribal police officers.” 
• SB 1067: Healing arts: expedited licensure process: medically underserved area or population
• The response letter is hyperlinked above and this is part of the Governors response, “… I am concerned about the aggregate effect of legislation that seeks to expedite licensure…”

Held Under Submission:

• AB 1965: Public health. Office of Tribal Affairs.

Joint Rule 62 (a) Suspended:

• AB 1799: Child abuse: Reporting

FEDERAL UPDATES

• Congress is out until November 12th

IHS UPDATES

• CMS Approves Traditional Healing 1115 Demonstrations for Arizona, New Mexico, California, and Oregon

• Register for the All Tribes Webinar (and Urban Indian Organizations ) Traditional Health Demonstrations on October 31st 11am

• Urban Confer: Proposed Reorganization of DDIGA Offices 

• Virtual Webinar Registration: Wednesday, November 13th 12-2pm PST
• Enclosure organization map

POLICY ENGAGEMENTS IN OCTOBER

• Covered California Tribal Consultation
• CPEHN Board Meeting
• CPCA Biweekly Member
• CPCA Leg/Reg Committee
• CPCA Annual Conference
• RAC Monthly Directors
• NCUIH Policy Workgroup
• OUIHP Urban Program Executive Directors
• Children’s Partnership Conference
• CalAIM Indian Health – Transportation Committee
• CalAIM IHP Quarterly Meeting
• DHCS Behavioral Health Transformation – Quality & Equity Advisory Committee 
• County Behavioral Health Directors
• Racial Equity Commission 
• CPCA Peer Networking/Legislative and Regulatory
• California Racial Equity Coalition
• PATH Coalition
• Tribes and Indian Helath Program Representative
• Kaiser Permanente CAC
• CDPH Tribal Health Equity Advisory
• ITUP Policy Forum
• Dental Therapy Government Relations
• CalAIM IHP

Legislative Report prepared by CCUIH Director of Policy & Planning Nanette Star nanette@ccuih.org and CCUIH Executive Director Virginia Hedrick virginia@ccuih.org

September Update

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This month’s legislative landscape brings several critical updates impacting Urban Indian Organizations (UIOs) and healthcare services for AI/AN communities. At the state level, DHCS is advancing key State Plan Amendments, including changes to reimbursement models and expanded roles for Community Health Workers, signaling shifts in Medi-Cal services that could affect care delivery. On the federal front, Congress is working to pass a short-term Continuing Resolution to prevent a government shutdown, temporarily securing funding but leaving long-term budget stability uncertain. This highlights the importance of continued advocacy to protect UIO funding and ensure culturally appropriate services remain a priority. With election season approaching, CCUIH is preparing resources to help navigate key 2024 propositions, providing valuable insights on their potential impact. As leaders, staying engaged and proactive in these evolving discussions is essential to maintaining the support and growth of our community-focused initiatives.

STATE UPDATES

Department of Health Care Services (DHCS)

• State Plan Amendments (SPAs):
• Summary of Proposed Changes: DHCS is seeking approval for SPA 24-0039 from the Centers for Medicare and Medicaid Services (CMS) to eliminate the APM reimbursement for COVID-19 vaccine-only administration visits for FQHCs, RHCs, and THPs, effective October 1, 2024. Comments Due September 13– CCUIH SUBMITTED COMMENT
• Summary of Proposed Changes: This SPA proposes adding Enhanced Community Health Worker (CHW, or Community Health Representative, CHR) Services as a preventive service for Medi-Cal members with significant behavioral health needs. Comments Due September 22 – CCUIH SUBMITTED COMMENT
• Summary of Proposed Changes: DHCS seeks to expand the list of providers supervising CHW/Rs to include pharmacies. Currently, the State Plan lists CBOs, LHJs, licensed providers, hospitals, and clinics as defined in Title 42 of the Code of Federal Regulations section 440.90 to

supervise CHW/Rs. The expanded list of providers who can supervise CHW/Rs would include providers in both the fee-for-service (FFS) and managed care delivery systems. The proposed effective date for State Plan Amendment (SPA) 24-0037 is October 1, 2024. Comments Due September 22 – CCUIH SUBMITTED COMMENT

The California State Legislature All bills needed to pass out of the Assembly and Senate by Saturday, August 31st. Any legislation that did not advance from the floor by this deadline is dead. Bills that successfully passed were sent to the Governor for review. The Governor has until September 30th to sign or veto these bills; here is what we know as of September 25. Below is the status of some select bills. You can also see the Governor’s Legislative Update with a more thorough listing of bills signed and vetoed here.

The Governor signed:

• AB 2435 (Maienschein) California Health Benefit Exchange.
• AB 2860 (Garcia) Licensed Physicians and Dentists from Mexico
• AB 2864 (Garcia) Licensed Physicians and Dentists from Mexico Pilot Program: extension of licenses 

The Governor vetoed:

• AB 2428 (Calderon) Medi-Cal: Community-Based Adult Services.

• The governor stated that codifying the requirement for them to receive an FFS rate is unnecessary because the budget included $16 million in annual payment increases to CBAS providers.  
• AB 2428 Veto Message

• AB 2250 Social determinants of health: screening and outreach
• The Governor cited the bill’s overlap with existing state and federal efforts, such as CalAIM and new federal billing codes. He highlighted concerns about the bill’s lack of clarity on “adequate access” to community health workers, making implementing it challenging.

Held Under Submission:

• AB 1965: Public health. Office of Tribal Affairs.

Joint Rule 62 (a) Suspended:

• AB 1799: Child abuse: Reporting

Enrolled and Presented to the Governor:

• AB 2108: Foster care: missing children and nonminor dependents.
• AB 2138: Peace officers: tribal police pilot project.
• AB 2711 ​​Suspensions and expulsions: voluntary disclosures.
• 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.
• AB 1863 California Emergency Services Act: notification systems: Feather Alert.

Voting on Propositions: A Sneak Peek at What’s on the 2024 Ballot, CCUIH’s take.

As election season approaches, California voters will decide on several propositions—proposed laws and amendments that can impact our communities. This preview highlights key 2024 propositions and their potential effects on American Indian and Alaska Native (AI/AN) communities. Stay tuned for CCUIH’s upcoming blog, featuring an easy-to-navigate version with images and graphics to help make these propositions clearer and more engaging.

FEDERAL UPDATES

*This is the last week Congress will meet until November 12th.

Appropriations Status and Impact on UIOs

• Congress is currently working to pass a short-term Continuing Resolution (CR) to avoid a government shutdown as the fiscal year ends on September 30, 2024. This CR would temporarily fund the government through December 20, 2024, providing additional time to negotiate full-year appropriations bills for FY2025.

• None of the 12 full-year appropriations bills have been enacted, which raises concerns about the stability of funding for programs impacting Urban Indian Organizations (UIOs) and healthcare services for American Indian and Alaska Native communities.
• The CR maintains existing funding levels but does not address new funding needs, limiting program growth and responsiveness to increasing demands. This could impact healthcare delivery, particularly in underserved urban areas where UIOs play a critical role.
  • Funding Stability: UIOs must closely monitor federal budget negotiations to ensure continued funding and advocate for equitable allocations in the final appropriations.
  • Advocacy Needs: It remains critical to engage with federal representatives to highlight the importance of sustained and enhanced funding for UIOs, ensuring culturally appropriate healthcare services for AI/AN populations remain a priority.
• Key Considerations for UIOs
  • Funding Stability: UIOs must closely monitor federal budget negotiations to ensure continued funding and advocate for equitable allocations in the final appropriations.
  • Advocacy Needs: It remains critical to engage with federal representatives to highlight the importance of sustained and enhanced funding for UIOs, ensuring culturally appropriate healthcare services for AI/AN populations remain a priority.

SAMHSA Unified Client-Level Performance Reporting Tool (SUPRT) – Tribal Consultation Opportunity
A Dear Tribal Leader Letter was released regarding the proposed SUPRT tool (OMB No. 0930-NEW), with a 60-day Federal Register Notice (FRN) now open for comments. The FRN invites stakeholders to provide input on the SUPRT and its associated burden estimates. Comments are due by October 15, 2024, and can be sent to the SAMHSA Reports Clearance Officer at the address or email provided in the letter. This is an opportunity to engage with SAMHSA’s efforts to improve Tribal behavioral health through enhanced data reporting. 

AI/AN Healthcare Workforce Development Summit – Salt Lake City: Key Takeaways and Opportunities

• The AI/AN Healthcare Workforce Development Summit in Salt Lake City brought together healthcare leaders, educators, and policymakers to address workforce challenges and develop strategies for strengthening healthcare services for American Indian and Alaska Native communities. IHEART has announced the selection of Regional Hub Champions who will lead initiatives and foster collaboration across five regions, providing critical support and guidance. Additionally, IHEART is offering Seed Project Funding of up to $20,000 per region to catalyze innovative, scalable interventions, including mentorship programs, strategic planning, and regional needs assessments.
• Focus Areas:
  • Policy Advocacy: Engage state assembly members to support AI/AN healthcare workforce growth.
  • Workforce Development: Promote educational opportunities, advance CRIHB’s initiatives, and foster new healthcare career pathways.
  • Next Steps: Utilize Seed funding, participate in upcoming events like the NIEA Conference, and deepen regional collaborations.

POLICY ENGAGEMENTS IN SEPTEMBER

• CalWellness Board Meeting
• American Indian Physicians Association Conference
• CCUIH Annual Conference
• CA Surgeon General
• CPEHN Board Meeting
• CPCA Biweekly Member
• RAC Monthly Directors
• NCUIH Policy Workgroup
• OUIHP Urban Program Executive Directors
• Health Career Connection Intern and Workforce 
• iHEART Regional Meeting
• AI/AN Healthcare Workforce Development Summit – Utah
• County Behavioral Health Directors
• Indian Health Cal-AIM Collaborative
• Racial Equity Commission 
• CPCA Peer Networking/Legislative and Regulatory
• California Racial Equity Coalition
• DHCS: Tribes and Indian Health Program Representative Meeting
• HCC Regional Health Workforce Advisory
• CNVP Board
• Workforce Steering Committee International Medical Corps
• CDSS Annual Tribal Consultation Summit 

Legislative Report prepared by CCUIH Director of Policy & Planning Nanette Star nanette@ccuih.org and CCUIH Executive Director Virginia Hedrick virginia@ccuih.org

August Update

click here for downloadable pdf

 August 2024 has been a lively and impactful month for Urban American Indian and Alaska Native (AIAN) advocacy. It began with an important HHS Tribal consultation on August 5, focusing on the syphilis outbreak among AIAN populations. On August 6, the California State Native American Legislative Caucus combined meaningful discussions with a celebratory awards ceremony recognizing key contributors. The momentum continued on August 20, when the IHS California Area Tribal Advisory Committee (CATAC) tackled budget shifts, Regional Specialty Centers, and critical policy updates. On August 23, the DHCS Tribes and Indian Health Program Representative Meeting brought hot topics to the table, including Traditional Healers, the status of Unwinding, and strategies to best reach our community. With the California Legislature racing toward its August 31 deadline, there’s a strong push to pass bills shaping the future for Urban AIAN communities. Looking ahead, the upcoming CCUIH Conference and November elections are set to keep the energy high and the focus sharp.

STATE UPDATES

• IHS California Area Tribal Advisory Committee (CATAC) August 20
  • Budget and Funding Updates
    • Transition to Mandatory Authority: Discuss moving budget allocations from discretionary to mandatory based on FY25 budget approppriations 
    • Senate Bill: Includes $3 million for urban health, with funding levels determined by actual need.
  • Regional Specialty Centers:
    • Progress noted, with Sacramento and San Diego already providing letters of support.
  • Policy and Program Updates
    • “4 Walls” Policy:
      • Proposed tribal exemption discussed.
      • Urban centers would be limited to Behavioral Health services.
      • Comments on this proposal are due by September 9.
  • PRC (Purchased/Referred Care) Program:
    • Inaccurate Data Concerns: The impact of inaccurate data on funding allocations was discussed.
    • PRC Reimbursement Program: Issues related to obligated balances and carryover were reviewed.
    • PRCDA (Purchased/Referred Care Delivery Area): Emphasize the importance of accurate data to ensure appropriate resource allocation.
  • Health and Emergency Response
    • Syphilis Outbreak:
      • Emphasized the need for collaboration with local health agencies to combat the outbreak
    • Emergency Response:
      • Coordination efforts were highlighted, with Carolyn Garcia as the point of contact for emergency response initiatives
• CA Native American Legislative Caucus & CA Indian Cultural Awareness Event August
  • In addition to legislative discussions, the California State Native American Legislative Caucus meeting on August 6, 2024, featured a reception and networking opportunities for attendees. The event also included an awards ceremony recognizing individuals and organizations’ contributions to advancing Native American issues in the state. This combination of legislative work and community-building activities helped strengthen relationships among lawmakers, advocates, and community members, furthering collaborative efforts to address key concerns facing Native American communities in California.
• Department of Health Care Services (DCHS)
  • August 26, 2024 Tribes and Indian Health Program Representatives Meeting 930-4pm
  • DHCS Update:
    • The rate increase is delayed until the 2025 or 2026 fiscal year, with BCHIP funding being eliminated and BRIDGE funding delayed until July 1, 2025.
    • Members requested that the titles of State Plan Amendments (SPAs) be included in the email subject lines for clarity.
    • Community Health Workers (CHWs) will see an increased reimbursement rate to 100% of Medicare. Guidance is needed to improve billing encounters and utilize the all-inclusive rate. Additionally, work is ongoing to categorize Traditional Healers and Natural Helpers’ duties into a billable platform, with DHCS planning to contact them for more
      information.
    • DHCS is expanding the Transforming Maternal Health Model as a pilot project in specific regions, including Kern County and the Bakersfield Indian Health Project.
    • The “Unwinding” process ended on May 31, 2024, with 90% renewals, primarily hindered by unreturned renewal packets. A summary of redetermination statistics for AI/AN Medi-Cal members was presented, and slides will be made available later.
    • A new Interactive Map of Medi-Cal Enrolled Indian Health Care Providers (IHCPs) will be released soon.
  • State Plan Amendments (SPAs):
    • Summary of Proposed Changes: DHCS is seeking approval for SPA 24-0039 from the Centers for Medicare and Medicaid Services (CMS) to eliminate the APM reimbursement for COVID-19 vaccine-only administration visits for FQHCs, RHCs, and THPs, effective October 1, 2024. Comments Due September 13
    • Summary of Proposed Changes: This SPA proposes adding Enhanced Community Health Worker (CHW, or Community Health Representative, CHR) Services as a preventive service for Medi-Cal members with significant behavioral health needs. Comments Due September 22
    • Summary of Proposed Changes: DHCS is seeking to expand the list of providers supervising CHW/Rs to include pharmacies. Currently, the State Plan lists CBOs, LHJs, licensed providers, hospitals, and clinics as defined in Title 42 of the Code of Federal Regulations section 440.90 to supervise CHW/Rs. The expanded list of providers who can supervise CHW/Rs would include providers in both the fee-for-service (FFS) and managed care delivery systems. The proposed effective date for State Plan Amendment (SPA) 24-0037 is October 1, 2024. Comments Due September 22

• The California State Legislature is in its final month of the regular legislative session, scheduled to adjourn on August 31, 2024. During this period, the Assembly and the Senate are actively finalizing and passing bills before the session concludes. The focus is on reviewing and voting on bills that have made it through the committee stages and addressing any last-minute legislative priorities.

  • Both houses of the legislature are currently on a brief recess, with the Assembly adjourned until August 26, 2024. Many bills are still under consideration, including thirteen privacy and AI-related bills that have previously crossed chambers. The final days of August will be critical as lawmakers work to pass the remaining legislation before the session ends.
  • Below are current results of selected bills by category of status (definitions of the legislative process)
    • Held Under Submission
      • AB 1965: Public health. Office of Tribal Affairs.
    • Ordered to Third Reading
      • AB 1799: Child abuse: Reporting
      • AB 2108: Foster care: missing children and nonminor dependents.
      • AB 2138: Peace officers: tribal police pilot project.
      • AB 2711 Suspensions and expulsions: voluntary disclosures.
      • 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.
    • Read Third Time and Amended. Ordered to second reading
      • AB 2250 Social determinants of health: screening and outreach
    • Ordered to Engrossing & Enrolling
      • AB 1863 California Emergency Services Act: notification systems: Feather Alert.
    • Chaptered
      • AB 1955: Support Academic Futures and Educators for Today’s Youth Act. Chapter 95, Statutes of 2024.
      • ACR-166: The Indian Citizenship Act of 1924. Chapter 151, Statutes of 2024.

FEDERAL UPDATES

• Tribal Consultation and Urban Confer Health IT Modernization Program: Multi- Tenant Domain Considerations These sessions aim to gather feedback on various aspects of the modernization program, including system configuration, deployment planning, and site readiness. The first session is on February 8, with subsequent sessions in May, August, and November. Participants can register online, and written comments are encouraged within 30 days of each session.

• IHS Dear Tribaland Urban Leader Letters (DTLL/DULL)
  • August 12, 2024 Climate Change Resources
• White House Council on native American Affairs (WHCNAA) Homeless Veterans Initiative Workgroup
  • A charter for WHCNAA is being drafted.
  • Emphasis on inviting UIOs for more in-depth collaboration
• National Consortium for Urban Indian Health Monthly Policy Workgroup
  • FMAP Updates
    • Urban Indian Health Parity Act was included in the House Energy Commerce Minority’s priorities for a hearing.
    • Working to secure a Republican Senator to co-lead the Senate version of the Urban Indian Health Parity Act (H.R. 6533)
    • CCUIH submitted a joint letter request with NCUIH
      • If you would like to write a letter, NCUIH or CCUIH are happy to
        help. Please contact policy@ncuih.org or nanette@ccuih.org
  • S. 1723/H.R. 7227 Truth and Healing Commission on Indian Boarding School Policies Act of 2023
    • Expected to pass the Senate.
    • Senators of HI and AK filed a bipartisan amendment attaching the bill to
      the National Defense Authorization Act (NDAA)
  • Telehealth for Tribal Communities
    • Introduced by Rep Leger Fernandez (D-NM)
    • This bill would make permanent a COVID-19 Public Health Emergency temporary provision allowing audio-only telehealth services for Medicare beneficiaries receiving care through Indian health programs or urban Indian Organizations (UIOs)

• Syphilis and Congenital Syphilis Outbreak Tribal Consultation August 5, 2024, The U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Health (OASH) will hold a Tribal consultation to address syphilis and congenital syphilis outbreak among Tribal citizens. HHS has established the National Syphilis and Congenital Syphilis Syndemic Federal Task Force, involving multiple federal agencies, to optimize screening, expand access to testing and treatment, and increase awareness. The consultation aims to gather input from Tribal leaders to inform Task Force initiatives and identify priorities and successful models for addressing the epidemic. Written comments are accepted until September 5, 2024 – CCUIH is gathering information and submitting it to NCUIH.

POLICY ENGAGEMENTS IN AUGUST

• CMS Leadership National Call Update

• Covered CA Tribal Advisory Workgroup

• OASH Tribal Consultation for Syphilis and Congenital Syphilis

• CPEHN Board Meeting

• CPCA Biweekly Member

• RAC Monthly Directors

• NCUIH Policy Workgroup

• OUIHP Urban Program Executive Directors

• Health Career Connection Intern and Workforce

• ITUP Policy Group: LA and Orange County

• Pathfinder Council Meeting

• Behavioral Health Equity Collaboration

• Indian Health Cal-AIM Collaborative

• Racial Equity Commission

• CPCA Legislative and Regulatory

• California Racial Equity Coalition:
  Department and Agency
  Accountability/ Advocacy

• AB 2795 Asm. Arambula

• CA Dental Therapy

• CATAC

• DHCS: Tribes and Indian Health Program Representative Meeting

Legislative Report prepared by CCUIH Director of Policy & Planning Nanette Star nanette@ccuih.org and CCUIH Executive Director Virginia Hedrick virginia@ccuih.org

July Update

click here for downloadable pdf

The California Budget for 2024-25 includes significant cuts in affordable housing and healthcare workforce programs, impacting Urban AIAN populations. Despite reductions, funding for the State Indian Health Program continues. New employment laws require policy revisions for employee rights and accommodations. Key legislative actions involve bills on child abuse reporting, emergency notifications, and public health. The Supreme Court’s decision on San Carlos Apache v. Becerra affects IHS financial planning. Federal updates highlight increased funding for Urban Indian Health, syphilis outbreak consultations, and behavioral health initiatives. The state legislature reconvenes on August 5, 2024.

STATE UPDATES

• CALIFORNIA BUDGET 2024-2025 The California State Budget for 2024-25 addresses financial challenges while striving to maintain essential services, significantly impacting Urban AIAN populations. Major reductions include $1.1 billion in affordable housing and $746.1 million in healthcare workforce programs, affecting housing stability and healthcare access for AIAN communities. Despite these cuts, key programs like the State Indian Health Program remain funded. Advocacy and partnerships are crucial to ensure AIAN voices are heard. Continued funding for CalWORKs and SSI/SSP offers critical support, though education and housing program cuts present ongoing challenges.
  
  • Potential Impact on UIOs Summary document HERE
• Employment Law Updates: New employment laws affecting workplace policies have taken effect. Employers are now required to review and potentially revise their policies related to employee rights under the National Labor Relations Act, as well as ensuring compliance with the Pregnant Workers Fairness Act, which mandates reasonable accommodations for pregnant employees.
• Department of Health Care Services:
  • July 17th, Traditional Healers and Natural Helpers (TH/NH) Letter Submitted
  • July 22nd, Tribes and Indian Health Program Representatives TH/NH meeting
• The California State Legislature is currently on its summer recess. The Assembly and Senate adjourned for this recess on July 3, 2024, and will reconvene on August 5, 2024. During this time, no committee hearings or floor sessions are scheduled. If there are bills you would like updates on please contact the policy team. Below are current results of selected bills:
  • AB 1799: Child abuse: reporting
    • Status: Do pass and re-refer to Com. on APPR. (Ayes 4. Noes 0.) (July 2). Re-referred to Committee on Appropriations.
  • AB 1863 California Emergency Services Act: notification systems: Feather Alert.
    • Status: Referred to Committee on Appropriations. Hearing August 5th, 10am
  • AB 1955: Support Academic Futures and Educators for Today’s Youth Act.
    • Status: Chaptered by Secretary of State – Chapter 95, Statuates of 2024
  • AB 1965: Public health. Office of Tribal Affairs.
    • Status: Referred to suspense file.
  • AB 2108: Foster care: missing children and nonminor dependents.
    • Status: Re-referred to Committee on Appropriations. To Consent Calendar. Hearing August 5th, 10am
  • AB 2138: Peace officers: tribal police pilot project.
    • Status: Re-referred to Committee on Appropriations Hearing August 5th, 10am
  • AB 2250 Social determinants of health: screening and outreach
    • Status: Referred to suspense file.
  • AB 2711 Suspensions and expulsions: voluntary disclosures.
    • Status: Read second time adn amended. Re-referred to Committee on Appropriations.
  • AB 2795: CalWORKs Indian Health Clinic Program.
    • Status: Re-referred to Committee on Appropriations. Hearing August 5th, 10am
  • ACR-166: The Indian Citizenship Act of 1924
    • Status: Senate amendments concurred in. To Engrossing and Enrolling. These steps are part of the legislative process that ensures the resolution is finalized and ready for official enactment or recognition. This process confirms that ACR 166, commemorating the 100th anniversary of the Indian Citizenship Act of 1924, is set to be formally recognized and recorded.
  • SB 1067: Healing arts: expedited licensure process: medically underserved area or population
    • Status: Do pass (July 2). Ordered to consent calendar.
  • SB 1382: Community and rural health clinics: building standards.
    • Status: Re-referred to Committee on Appropriations.

FEDERAL UPDATES

• San Carlos Apache v. Beerra Supreme Court Decision The Supreme Court’s decision in San Carlos Apache v. Becerra ruled that under the Indian Self-Determination Act (ISDA), the Indian Health Service (IHS) must reimburse Tribes for contract support costs (CSCs) incurred when collecting and spending program income from third-party payers like Medicare and Medicaid. This ruling implies increased financial responsibilities for IHS and potential adjustments in its budget to accommodate these costs, impacting fiscal planning for FY2025 and beyond.
  • Potential Impact to UIOs: The impact of increased contract support costs (CSCs) on UIOs remains uncertain. If UIOs are affected, their funding could be reduced to accommodate the additional CSCs, as UIO funds are discretionary and the IHS budget has limited allocations. Since CSCs are paid first from the IHS budget, other areas, including UIO funding, might see decreases. However, given that UIO funding historically represents a small portion of the IHS budget, it might remain unaffected, with adjustments made elsewhere. The National Council of Urban Indian Health (NCUIH) will monitor the situation and provide updates, with potential impacts expected to begin in FY2025.
• FY 2025 House Interior Appropriations Update On July 9, 2024, the House Appropriations Full Committee passed the FY 2025 appropriations bill for Interior, Environment, and Related Agencies, including $8.56 billion for the Indian Health Service (IHS) and $99.99 million for Urban Indian Health. This bill represents an increase from FY24 levels and exceeds the President’s budget request. It also includes provisions for advance appropriations for IHS, funding for generators, a produce prescription pilot program, and increased support for Tribal Epidemiology Centers. The bill emphasizes the federal trust responsibility to Native people, including those in urban areas, and has received bipartisan support. The House is scheduled to vote on this bill the week of July 22, with negotiations expected with the Senate to finalize the legislation.
  • Potential Impact to UIOs: This boost in funding may enhance healthcare services and program expansion for UIOs in California, improve nutrition through the Produce Prescription Pilot Program, and may further improve infrastructure resilience with funding for generators.
• H.R. 6533 Urban Indian Health Parity Act This bill applies a Federal Medical Assistance Percentage (i.e., the federal matching rate under Medicaid) of 100% with respect to amounts expended as medical assistance for services received through an Urban Indian organization under a grant or contract with the Indian Health Service.
  • Potential Impacts to UIOs: This change would ensure full federal funding for Medicaid services received by Urban AIAN populations, significantly increasing the financial support for UIOs. This would enhance healthcare delivery, reduce financial burdens on UIOs, and potentially expand the range of services offered to urban Indian communities.
• Syphilis and Congenital Syphilis Outbreak Tribal Consultation August 5, 2024 The
  U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Health (OASH) will hold a Tribal consultation, to address the syphilis and congenital syphilis outbreak among Tribal citizens. HHS has established the National Syphilis and Congenital Syphilis Syndemic Federal Task Force, involving multiple federal agencies, to optimize screening, expand access to testing and treatment, and increase awareness. The consultation aims to gather input from Tribal leaders to inform Task Force initiatives and identify priorities and successful models for addressing the epidemic. Written comments are accepted until September 5, 2024.
• Tribal Consultation and Urban Confer Health IT Modernization Program: Multi-Tenant Domain Considerations August 8, 2024 These sessions aim to gather feedback on various aspects of the modernization program, including system configuration, deployment planning, and site readiness. The first session is on February 8, with subsequent sessions in May, August, and November. Participants can register online, and written comments are encouraged within 30 days of each session.
• IHS Behavioral Health Initiative Funding IHS is seeking guidance from Tribal and Urban Indian Organization Leaders on funding methodologies for seven behavioral health initiatives, currently distributed through grants, in line with President Biden’s Executive Order 14112. This order aims to reform federal funding to be more accessible and equitable. In fiscal year 2024, IHS administers over $59 million for programs including Substance Abuse and Suicide Prevention, Domestic Violence Prevention, Behavioral Health Integration, Zero Suicide Initiative, and Youth Regional Treatment Centers Aftercare.
  • Comments were submitted by July 22, 2024 by CCUIH.
  • Potential Impact on UIOs: The proposed changes to the funding methodologies for behavioral health initiatives could positively impact UIOs by increasing flexibility and accessibility of funds, making the allocation more equitable, and enhancing program support. These reforms aim to reduce administrative burdens, streamline application processes, and ensure UIOs receive adequate funding proportional to their needs.

POLICY ENGAGEMENTS IN JULY

• Traditonal Indian Health Advisory Committee
•  Tribal Fentanyl Summit Chat
• DHCS Harm Reduction Summit
• CPEHN Board Meeting
• CPCA Biweekly Member
• RAC Monthly Directors
• NCUIH Policy Workgroup
• OUIHP Urban Program Executive Directors
• ITUP Policy Group
• Behavioral Health Equity Collaboration
• Indian Health Cal-AIM Collaborative
• Racial Equity Commission
• CPCA Legislative and Regulatory
• DHCS Traditional Healers and Helpers
• Training MCO Ballot Initiative
• California Racial Equity Coalition: Department and Agency Accountability
• AB 2795 Asm. Arambu

Legislative Report prepared by CCUIH Director of Policy & Planning Nanette Star
nanette@ccuih.org and CCUIH Executive Director Virginia Hedrick virginia@ccuih.org

June Update

click here for downloadable pdf

Hello everyone! We’ve had a busy year with significant developments at both the federal and state levels. While there has yet to be movement on our key supported federal bills, we’re keeping a close watch and will share updates as they happen. Governor Newsom and Legislators are finalizing California’s budget to address a $56 billion deficit, which could impact UIO funding for essential services. The DHCS webinar on June 24th will discuss authorizing traditional healer services under Medi-Cal, enhancing UIO healthcare offerings. A Supreme Court ruling now requires IHS to cover contract support costs for tribal health programs funded by third-party revenue, potentially increasing UIO funding. We also advocate for an inclusive interpretation of the SSA’s IHS definition. IHS seeks input on funding methodologies for behavioral health initiatives to make funds more accessible and equitable for UIOs. Thank you for your continued support and dedication to our communities. Let’s keep pushing forward together!

STATE UPDATES

• CALIFORNIA BUDGET PENDING FINALIZATION Governor Gavin Newsom and top Democrats are negotiating California’s state budget behind closed doors following the Legislature’s passage of a placeholder budget to meet a mandatory deadline. Key issues include addressing a projected $56 billion deficit over the next two years, with proposals involving dipping into reserves, deferring school funding, and cutting government jobs. The Legislature’s counterproposal seeks deeper cuts to prison funding to protect other programs. Ongoing negotiations must finalize the budget by July 1, 2024.
  • Potential Impact to UIOs: UIOs could face funding reductions for critical health and social services they provide to their populations. Potential cuts to public health programs, subsidized childcare slots, and housing development could disproportionately affect these communities, which rely heavily on such support. Additionally, changes in funding allocation and prioritization may limit the capacity of UIOs to deliver essential services, thereby exacerbating existing health disparities and challenges faced by urban Indian populations. We all must remain engaged in advocating for the preservation of funds and programs vital to their communities’ well-being.
  • Note: A special CCUIH Impact Report on the New Budget will be sent out the first week of July!
    • Contact your legislators
    • Write letters: Contact us for Templates to the Governor
    • Use Social Media: See our Press Release here
    • Share with your Patients for more involvement
• Tribes and Designees of Indian Health Programs Meeting on Traditional Healers and Natural Helpers Webinar 6/24/2024 The Department of Health Care Services (DHCS) is hosting a Medi-Cal Tribal and Designee Webinar to discuss California’s Section 1115 demonstration request, which aims to authorize traditional healer and natural helper services. California submitted this request to the Centers for Medicare & Medicaid Services (CMS) in June 2021, and CMS is now considering the proposal. The webinar will provide information about the proposed approach and seek feedback from participants, with time allotted at the end for questions and comments.
  • Potential Impact to UIOs: Enhancing healthcare’s cultural relevance and effectiveness for urban Indian populations. This initiative would allow UIOs to offer a broader range of holistic services, integrating traditional practices with conventional medical care, thus improving health outcomes. Additionally, including these services under Medi-Cal could provide UIOs with increased funding opportunities, supporting the sustainability and expansion of their programs. The proposal could foster greater community trust and engagement by officially recognizing and supporting culturally familiar practices.

FEDERAL UPDATES

• Request for Inclusive Interpretation of Indian Health Service Definition A formal letter was sent to Dr. Reynosa, Director of HHS Region 9, requesting assistance in advocating for an inclusive interpretation of the Social Security Act’s (SSAs) definition of the Indian Health Service (IHS) to encompass UIOs as defined in Title V of the Indian Health Care Improvement Act (IHCIA).
  • Response: Dr. Reynosa responded that HHS will work internally with colleagues on this issue and get back to CCUIH.
• FY 2025 Appropriations Update Watch
  • The appropriations process for FY 2025, initiated in both the House and Senate, follows the Fiscal Responsibility Act, which caps base discretionary spending at $1.606 trillion, including $895 billion for defense and $711 billion for nondefense. The House has advanced various appropriations bills, with notable progress on defense and other key areas, setting interim 302(b) allocations for subcommittees. This process is crucial for UIOs and health funding, as it will determine the allocation of federal resources impacting health programs and services. Lawmakers are urged to avoid budget gimmicks and consider the long-term trajectory of discretionary spending to ensure sustained support for essential health services.
    • Note: At the Senate Interior Appropriations Committee, Sen. Van Hollen asked NCUIH what can be done to address underfunding of UIOs. NCUIH drafted a letter and also provided testimony. More here.

IHS UPDATES

• Supreme Court Ruling on Contract Support Costs On June 7, 2024, Indian Health Service (IHS) Director Roselyn Tso stated the U.S. Supreme Court’s decision requiring IHS to pay contract support costs on portions of tribal health programs funded by third-party revenue like Medicare and Medicaid. IHS has been preparing for this transition to minimize service disruption and urges Congress to shift the IHS budget from discretionary to mandatory funding to ensure stable future funding. The IHS remains committed to supporting tribal self-determination and looks forward to continued partnership with tribal nations. For more information, visit the U.S. Department of Health and Human Services website.
  • Potential Impact on UIOs: This decision could significantly benefit UIOs by providing increased funding for administrative and operational costs, improving service quality, and enhancing financial stability. If Congress shifts IHS funding from discretionary to mandatory, UIOs will gain more predictable funding, aiding in long-term planning and sustainability. However, UIOs may need to adapt to new administrative systems. This decision emphasizes the importance of continued advocacy and collaboration between UIOs, tribal organizations, and federal agencies.
• IHS Behavioral Health Initiative Funding The Indian Health Service (IHS) is seeking guidance from Tribal and Urban Indian Organization Leaders on funding methodologies for seven behavioral health initiatives, currently distributed through grants, in line with President Biden’s Executive Order 14112. This order aims to reform federal funding to be more accessible and equitable. In fiscal year 2024, IHS administers over $59 million for programs including Substance Abuse and Suicide Prevention, Domestic Violence Prevention, Behavioral Health Integration, Zero Suicide Initiative, and Youth Regional Treatment Centers Aftercar.
  • Virtual consultation sessions are scheduled for June 18 and June 20, 2024, with a comment submission deadline of July 22, 2024. For questions, contact Dr. Glorinda Segay at glorinda.segay@ihs.gov.
  • Potential Impact on UIOs: The proposed changes to the funding methodologies for behavioral health initiatives could positively impact UIOs by increasing flexibility and accessibility of funds, making the allocation more equitable, and enhancing program support. These reforms aim to reduce administrative burdens, streamline application processes, and ensure UIOs receive adequate funding proportional to their needs.
• Alzheimer’s Grant Program to Address Dementia in Tribal and Urban Indian Communities for fiscal years 2024 and 2025 DUIOLL
  • IHS has announced funding decisions for the Alzheimer’s Grant Program toAddress Dementia in Tribal and Urban Indian Communities for FY 2024 and 2025. This aligns with President Biden’s Executive Order 14112, promoting Tribal Self-Determination in healthcare. Following consultations with Tribal and Urban Indian Organization leaders, IHS has allocated over 50% of the program’s budget to grants, small program awards, and pilot development. A new three-year funding opportunity will support up to six new Alzheimer’s program awards, focusing on expansion and sustainability, with a total of $1.2 million annually. Additionally, IHS will continue funding eight existing awardees and has enhanced technical assistance to improve collaboration and best practices among programs.
  • Potential Impact to UIOs: This funding has the potential to provide essential financial support for addressing dementia. The allocation includes over 50% of the program’s budget for grants, small program awards, and pilot development, focusing on sustainability and expansion planning. This funding will enable UIOs to develop and refine culturally informed care models, improve collaboration with other IHS, Tribal, and Urban Indian programs, and explore new billing opportunities through CMS. These measures may enhance UIOs’ capacity to deliver effective dementia care and support long-term program viability.

POLICY ENGAGEMENTS IN JUNE:

• CalWellness
• CPG
• CDSS Tribal Advisory Committee
• CDPH Tribal Data Workgroup
• CPEHN Board Meeting
• Testify on SB 1065. Healing Arts Expedited Licensing
• CPCA Biweekly Member
• RAC Monthly Directors
• Pathway to Healing – The California Endowment
• Native Health Data UCSF
• CPCA CEO Peer Network
• NCUIH Policy Workgroup
• UIO Site Visit NAIC
• IHS Urban Confer Behavioral Health
• OUIHP Urban Programs
• CDPH Tribal Advisory
• Health Career Connect Regional Health
• CPCA Legislative and Regulatory
• IHS, NCUIH, CCUIH All Inclusive Rate
• DHCS Traditional Healers and Helpers
• Training MCO Ballot Initiative
• Dental Therapy Allies
• California Racial Equity Coalition: Department and Agency Accountability

Legislative Report prepared by CCUIH Director of Policy & Planning Nanette Star nanette@ccuih.org and CCUIH Executive Director Virginia Hedrick virginia@ccuih.org

May 2024 Legislative Brief Update

click here for downloadable pdf version

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 

click here for downloadable pdf version

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 

click here for downloadable pdf version

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.