Letter to IHS in re: FY2017 Urban Indian Health Budget Funds Distribution Confer

August 4, 2017

Rear Admiral Michael D. Weahkee
Acting Director
Indian Health Service
5600 Fishers Lane
Mail Stop: 08E86
Rockville, MD 20857

In re: FY2017 Urban Indian Health Budget Funds Distribution Confer

Dear Rear Admiral Weahkee:

On behalf of the National Council of Urban Indian Health (NCUIH), which represents 44 urban Indian health programs (UIHPs) across the nation, I provide our recommendations on the distribution of remaining FY17 urban Indian health budget funds.

UIHPs, an integral part of the Indian Health Service’s (IHS) I/T/U (IHS/Tribal facilities/Urban Indian Health Programs) system, are public-private partnerships which employ their own staffs. UIHPs receive slightly more than 1% of IHS’ budget, but still manage to provide high-quality culturally- competent health care to urban Indians, i.e., those American Indian/Alaska Native (AI/AN) people who live off of reservations, because of the federal government’s forced relocation policy or they seek greater economic and educational opportunities. Urban Indians experience health conditions and outcomes that are comparable to those of AI/AN people who live on reservations and markedly worse than non-AI/AN people who also live in urban environments.

At the outset, we are disappointed that IHS did not begin the confer process until so late in fiscal year 2017, despite repeated attempts over the previous ten months by NCUIH members to raise this important matter earlier. The short interval between the July 28 confer meeting and the deadline for submission of comments precludes NCUIH from advancing a defined and comprehensive recommendation.

Let us please use this unfortunate lapse as a compelling rationale to commit to four key objectives:

1. The prompt distribution by IHS of remaining FY17 urban Indian health funds before the end of the fiscal year;

Obviously, UIHPs would be able to serve their patients even better with additional financial resources—and the sooner the better. More expeditious distribution allows UIHPs to make more informed planning decisions, which benefits patients. One program “would like to add pharmacy and dental services, but without knowing the amount of money I’m getting every year, I cannot adequately plan.” Moreover, some lawmakers may understandably take a dim view of IHS not using in timely fashion the funding appropriated by Congress for urban Indian health, and they might even reduce that appropriation in FY18, which would be a disastrous result.

2. Beginning the confer process on funds distribution much earlier in fiscal year 2018;

NCUIH recognizes that part of the delay relates to the transition to a new Administration and approval of the Office of Urban Indian Health Programs’ (OUIHP) strategic plan. Ideally, OUIHP would schedule a confer meeting almost immediately after a FY18 budget is enacted for IHS if these questions are pertinent next year.

3. The development of a distribution formula, in collaboration with NCUIH and UIHPs, which can be employed, as appropriate, in future years; and

4. Dramatically improved transparency with respect to both past and future funding.

Funds, both base and increases, should be identified with budget accounting information that is made available to NCUIH and all UIHPs in the FY18 budget process.

Some programs have heard that $1.8 million has been taken out of the FY17 increase in order to operate OUIHP. Some programs are also unclear as to the amounts of the recurring increases in urban Indian health funding in FY15, FY16, and FY17 and whether IHS determined these increases in the context of its decision to fund the National Institute of Alcohol Abuse and Alcoholism programs through the already financially-constrained urban Indian health line item. The chart below suggests there should be more funding for UIHPs.


We request that IHS respond in writing to these concerns in an effort to be transparent, particularly with respect to how funding has been distributed (not just to programs, but the entire budget for urban Indian health for fiscal years 2016, 2016, and 2017.

In the absence of a defined and comprehensive recommendation, I would like to convey the views of several NCUIH members:

• We have received one recommendation to use the “30/70 split method wherein all of the urban sites receive a base of 30% even split of the total increase and the remaining 70% be distributed based on user population.”

• We received two responses that recommend, because of time constraints, to distribute funds in the most expeditious manner possible, which they believe is an even split to all programs. One program also recommended that in the future, “the funds (base and increases) should be identified with budget accounting information and all programs should have this information. The formula should be set at a time early in FY18.”

Thank you for your consideration. Please contact Francys Crevier (fcrevier@ncuih.org), NCUIH’s Executive Director, if you have any questions.


Ashley Tuomi National