National Council of Urban Indian Health (NCUIH) –

Source: National Council of Urban Indian Health (NCUIH)
On March 28, 2022, President Biden released his Fiscal Year (FY) 2023 Budget. The budget includes $9.1 billion in mandatory funding for the Indian Health Service (IHS) for the first year, an increase of $2.9 billion above FY 2021, and $40.7 billion less than requested by the Tribal Budget Formulation Workgroup (TBFWG). The budget proposes increased funding for IHS each year over ten years, building to $36.7 billion in FY 2032, to keep pace with population growth, inflation, and healthcare costs. Funding for Contract Support Costs and 105(l) leases also shifted from discretionary to mandatory funding in the FY 2023 budget. The President’s budget does not include advance appropriations for IHS, which was requested in the FY 2022 budget. Note: The urban Indian health amount has not yet been released and detailed agency requests are expected to be available in the coming days.
A notable change in this year’s budget is that all funding for IHS will be mandatory funding beginning in FY23. Biden stated, “This historic step is in response to the longstanding recommendations of Tribal leaders shared in consultation with HHS.” The Budget Brief stated, “The Administration is committed to implementing long-term solutions to address chronic under-funding of IHS and finally delivering on the nation’s promises to Indian Country.” Further, it states, “Implementing this change to the IHS budget will make meaningful progress toward redressing health inequities and ensuring that the disproportionate impacts of the COVID-19 pandemic on AI/AN communities are never repeated.” About the budget for IHS, President Biden stated it, “makes high-impact investments that will expand access to healthcare services, modernize aging facilities and information technology infrastructure, and address urgent health issues, including HIV and Hepatitis C, maternal mortality, and opioid use. It also includes funding to improve healthcare quality, enhance operational capacity, fully fund operational costs for Tribal health programs to support tribal self-determination, and recruit and retain healthcare providers.”
Advancing health equity by providing high quality care in Indian country is a priority for Biden. The budget book states, “Historical trauma and chronic underinvestment significantly contributed to the perpetuation of health disparities in Indian Country. These stark inequities illustrate the urgent need for investments to improve the health status and quality of life of AI/ANs. In FY 2023, the budget includes $6.3 billion in the Services account, an increase of $1.6 billion above FY 2022 enacted. These increases will expand access to programs that provide essential health services and community-based disease prevention and promotion in tribal communities. This funding will support additional direct patient care services across the IHS system, including inpatient, outpatient, ambulatory care, dental care, and medical support services, such as laboratory, pharmacy, nutrition, behavioral health services, and physical therapy.”
Chart from the Budget Book with Projected Funding for IHS
From President Biden’s Strengthening America’s Public Health Infrastructure section in the Budget, it states the following, “Guarantees Adequate and Stable Funding for the Indian Health Service (IHS). The Budget significantly increases IHS’s funding over time, and shifts it from discretionary to mandatory funding. For the first year of the proposal, the Budget includes $9.1 billion in mandatory funding, an increase of $2.9 billion above 2021. After that, IHS funding would automatically grow to keep pace with healthcare costs and population growth and gradually close longstanding service and facility shortfalls. Providing IHS stable and predictable funding would improve access to high quality healthcare, rectify historical underfunding of the Indian Health system, eliminate existing facilities backlogs, address health inequities, and modernize IHS’ electronic health record system. This proposal has been informed by consultations with tribal nations on the issue of IHS funding and will be refined based on ongoing consultation.”
According to the Budget, Tribal Consultation and Reconvening the White House Council on Native American Affairs was also included as priority. In his first days in office, the President issued a memorandum making it a priority of his Administration to make respect for Tribal sovereignty and self-governance, commitment to fulfilling Federal trust and treaty responsibilities to Tribal Nations, and regular, meaningful, and robust consultation with Tribal Nations cornerstones of Federal Indian policy. Since then, the Administration has been regularly meeting with Tribal Nations on a range of Administration priorities, from implementing the Bipartisan Infrastructure Law to drafting the President’s Budget.
The Appropriations Committees will review the President’s Budget for consideration as they craft their bills for FY23. NCUIH has requested $949.9 million for FY23 for urban Indian health with at least $49.8 billion for the Indian Health Service in accordance with the Tribal Budget Formulation Workgroup (TBFWG) recommendations. NCUIH will continue to work with the Biden Administration and Congress to push for full funding of urban Indian health in FY 2023.
The budget request includes the following for American Indians/Alaska Natives:
Department of Health and Human Services (HHS)
Indian Health Service
Maternal Health and Health Equity
Department of the Interior (DOI)
increase from the 2021 enacted level.
Bureau of Indian Affairs (BIA)
Bureau of Indian Education (BIE)
Arts & Entertainment
Federal Recognition
Federal Register
Indian Gaming
Indian Trust
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