Policy Alert: 12 Senators Send Letter Requesting Long-Term Medicaid Fix for Urban Indian Organizations

Full permanent FMAP for UIOs would rectify a longstanding parity issue.  

On September 16, 2021, Senators Maria Cantwell (D-WA), Catherine Cortez Masto (D-NV), Richard Durbin (D-IL), Dianne Feinstein (D-CA), Mazie Hirono (D-HI), Amy Klobuchar (D-MN), Ben Ray Lujan (D-NM), Jeffrey Merkley (D-OR), Alex Padilla (D-CA), Brian Schatz (D-HI), Tina Smith (D-MN), and Elizabeth Warren (D-MA) sent a letter to the Senate Committee on Finance urging for inclusion of permanent 100% Federal Medical Assistance Percentage (FMAP) reimbursement for Urban Indian Organizations (UIOs) and Native Hawaiian Health Care Systems in the upcoming reconciliation bill. 

 

The American Rescue Plan Act (ARPA) temporarily extended 100% FMAP to UIOs for two years, however, UIOs are yet to receive any benefits from this ARPA provision passed in March of this year. It is part of the federal government’s trust responsibility to provide health care to all American Indians/Alaska Natives (AI/ANs), and implementation of this permanent equitable resource would allow Congress to fulfill that obligation. 

 

The National Council of Urban Indian Health (NCUIH) thanks the Senators for their advocacy on this important issue and for ensuring parity for Urban Indian Health.  

 

Full text of the letter: 

September 16, 2021 

The Honorable Ron Wyden 

Chair 

Senate Committee on Finance 

219 Dirksen Senate Office Building 

Washington, DC 20510 

 

Dear Chair Wyden: 

 

We write to urge you to include a permanent 100% Federal medical assistance percentage (FMAP) reimbursement for Urban Indian Organizations and Native Hawaiian Health Care Systems in the upcoming reconciliation bill. 

 

The United States has a trust responsibility to provide health care to all American Indians, Alaska Natives, and Native Hawaiians. Congress established the Indian Health Service, the Native Hawaiian Health Care Systems, and a number of other particular programs and benefits to honor this obligation. However, over the course of designing these programs unintended inequities arose, most notably the exclusion of Urban Indian Organizations and Native Hawaiian Health Care Systems from the 100% FMAP reimbursement rate offered to federally and Tribally-run Indian Health Service facilities. 

 

Urban Indian Organizations and Native Hawaiian Health Care Systems provide a variety of health care services, including operating health care clinics, outpatient facilities, substance abuse and mental health programs, and a variety of other services that benefit American Indians, Alaska Natives and Native Hawaiians. These health care providers are on the front lines providing critical health care services to American Indians, Alaska Natives, and Native Hawaiians through 46 programs across the country, serving some of the most at-risk populations. Cases of COVID-19 are three times greater among American Indians and Alaska Natives, who are four times as likely to die from the disease compared to the white non-Hispanic population. And in Hawaii, Native Hawaiians are experiencing increasingly disproportionate rates of COVID-19 cases and hospitalizations. It is therefore critical that these organizations are provided equitable resources in furtherance of the federal government’s trust responsibilities. 

 

While Congress was able to provide Urban Indian Health Organizations and Native Hawaiian Health Care Systems a two year, temporary 100% FMAP reimbursement in the American RescuePlan Act, it is critical that we make this reimbursement permanent. It is the Federal government’s trust responsibility to provide health care to American Indians, Alaska Natives, and Native Hawaiians equally. However, Urban Indian Health Organizations and Native Hawaiian Health Care Systems will not receive an equitable FMAP reimbursement after this temporary fix expires. In addition, at a time when our states are strapped for resources, this fix would allow more federal resources to flow back into our states. 

 

Now is the time to permanently provide Urban Indian Organizations and Native Hawaiian Health Care Systems parity. We urge you to include a permanent 100% FMAP reimbursement for Urban Indian Organizations and Native Hawaiian Health Care Systems in the upcoming reconciliation. 

 

Thank you for your consideration. 

 

 

Sincerely, 

 

Maria Cantwell                                             Brian Schatz 

United States Senator                                United States Senator 

 

Elizabeth Warren                                         Tina Smith 

United States Senator                                United States Senator 

 

Alex Padilla                                                   Dianne Feinstein 

United States Senator                                 United States Senator 

 

Catherine Cortez Masto                             Amy Klobuchar 

United States Senator                                United States Senator 

 

Jeffrey A. Merkley                                       Richard J. Durbin 

United States Senator                                United States Senator 

 

Mazie K. Hirono                                          Ben Ray Luján 

United States Senator                               United States Senator 

 

 

Next Steps 

NCUIH will continue to advocate to include permanent 100% FMAP reimbursement for UIOs in the budget reconciliation bill. 

 

Background and Advocacy 

UIOs are a critical component of the IHS/Tribal Health Program/UIO system, yet still face significant parity issues within the Indian Health System. NCUIH and UIOs have long advocated for this necessary parity fix by working closely with Congressional leaders and making 100% FMAP for urban Indian health a priority. 

By NCUIH, posted on Thursday September 23, 2021
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