Letter to Senator Tom Udall in re Budget Resolution

The Honorable Tom Udall
Ranking Member, Senate Indian Affairs Committee
531 Hart Senate Office Building
Washington, DC 20510

Dear Ranking Member Udall:

On behalf of the National Council on Urban Indian Health (NCUIH), I offer our strong support for your amendment to the Senate budget resolution to make it more difficult to eliminate or reduce reimbursement from Medicaid to an Indian health program or an urban Indian organization.

Putting aside the controversy surrounding the Affordable Care Act, American Indians experience greater disparities in health status and general well-being than any racial group, despite the federal government’s longstanding treaty obligations to provide adequate health care. Your important amendment would deter efforts that could further undermine the quality and availability of health care made possible through Medicaid for less advantaged Native Americans.

I would be remiss if I failed to point out the discriminatory effect experienced by American Indians and Alaska Natives who live in urban settings, who make up over almost 70% of the United States’ Native American population, because of Medicaid’s inadequate reimbursements. Services provided by the Indian Health Service (IHS) and tribal organizations to Medicaid patients are reimbursed by the federal government at 100% of costs, with no contributions from the states required. This is only fair because the obligation to provide health care to Indian Country resides with the federal government, not the states. However, the federal government offsets only part of the cost of Medicaid patients of urban Indian health care providers—at the same time states are cutting back on Medicaid coverage and funding. It makes no sense that the federal government would compensate 100% of costs for a Medicaid AI/AN patient when she is being treated at an IHS or tribal facility but much less when that same patient is being treated at an urban facility.

NCUIH looks forward to working with you, Ranking Member Udall, to correct this inequity.

Thanks again for your leadership on protecting Medicaid spending for Native Americans from false and costly economies.


Ashley Tuomi President
National Council of Urban Indian Health