TITLE: Call to Congress to Enact Legislation Ensuring Medicaid Advances the Federal Trust Responsibility to American Indians/Alaska Natives
WHEREAS, we, the members of the National Congress of American Indians of the United States, invoking the divine blessing of the Creator upon our efforts and purposes, in order to preserve for ourselves and our descendants the inherent sovereign rights of our Indian nations, rights secured under Indian treaties and agreements with the United States, and all other rights and benefits to which we are entitled under the laws and Constitution of the United States and the United Nations Declaration on the Rights of Indigenous Peoples, to enlighten the public toward a better understanding of the Indian people, to preserve Indian cultural values, and otherwise promote the health, safety and welfare of the Indian people, do hereby establish and submit the following resolution; and
WHEREAS, the National Congress of American Indians (NCAI) was established in 1944 and is the oldest and largest national organization of American Indian and Alaska Native tribal governments; and
WHEREAS, tribal nations are political, sovereign entities whose status stems from the inherent sovereignty they possess as self-governing people predating the founding of the United States, and since its founding the United States has recognized them as such and entered into treaties with them on that basis; and
WHEREAS, tribal nations have a unique government-to-government relationship with the federal government, and it is required that the federal government consult with tribal nations on any policy or action that will significantly impact tribal governments and American Indians and Alaska Natives (AI/ANs); and
WHEREAS, in 24 U.S.C. § 1602(a)(1), Congress declared that “it is the policy of this Nation, in fulfillment of its special trust responsibilities and legal obligations to Indians…to ensure the highest possible health status for Indians and urban Indians and to provide all resources necessary to effect that policy;” and
WHEREAS, in 1955, Congress created the Indian Health Service (IHS) in order to help fulfill its trust responsibility for health care to tribal nations; and
WHEREAS, the unmet health needs of AI/ANs are severe and the health status of AI/ANs is far below that of the general population of the United States, resulting in an average life expectancy for AI/ANs 4.5 years less than that for the U.S. all races population; and
WHEREAS, in 1976, Congress noted that Medicaid payments were a “needed supplement to a health care program which has for too long been insufficient to provide quality health care to the American Indian” (H.R. Rep. No. 94-1026-Part III); and
WHEREAS, in 1976, Congress established the authority for the IHS, tribal nations, and tribal health organizations, to seek reimbursement under the federal Medicaid program in order to help fulfill its trust responsibility for health care to the Tribes; and
WHEREAS, in FY 2017, the congressional appropriations for IHS was only $3,026 per person, as compared to average per capita spending nationally for personal health care services of $9,207; and
WHEREAS, the IHS continues to be funded by Congress at less than half of expected need—even when considering available government health insurance resources—leading to rationed care and worse health outcomes for AI/ANs; and
WHEREAS, the federal Medicaid program generates significant resources that are critical to the ability of tribal nations to meet the health care needs of tribal citizens, but there are significant gaps in access to quality health care services under the federal Medicaid program for low- and moderate-income AI/ANs, depending upon state of residence; and
WHEREAS, AI/ANs across the United States have substantially different eligibility and access to services under the federal Medicaid program based on their state of residence; and
WHEREAS, state governments are not reimbursed for the costs of care provided by urban Indian health care providers to AI/ANs to the same degree that state governments are reimbursed for care to AI/ANs provided by IHS and tribal health care providers; and
WHEREAS, the federal Medicaid program provides insufficient flexibility to tribal nations to design and implement health service delivery approaches that meet the often times unique circumstances in Indian country; and
WHEREAS, tribal nations have developed a legislative proposal to address these gaps in access to quality health care services which will create authority for states to extend Medicaid eligibility to all AI/ANs with household income up to 138% of the federal poverty level; authorize Indian Health Care Providers in all states to receive Medicaid reimbursement for health care services authorized under the Indian Health Care Improvement Act and delivered to AI/ANs; extend full federal funding (through 100% FMAP) to states for Medicaid services furnished by urban Indian providers to AI/ANs, in addition to services furnished by IHS/tribal providers to AI/ANs; clarify that state Medicaid programs are authorized to implement Indian-specific policies and are not permitted to override Indian-specific Medicaid provisions in federal law through state waivers; and removes the limitation on billing by Indian health care providers for services provided outside the four walls of a clinic facility.
NOW THEREFORE BE IT RESOLVED, that the National Congress of American Indians (NCAI) calls on Congress to enact legislation ensuring Medicaid advances the federal trust responsibility to American Indians and Alaska Natives; and
BE IT FURTHER RESOLVED, that this resolution shall be the policy of NCAI until it is withdrawn or modified by subsequent resolution.
The foregoing resolution was adopted by the General Assembly at the 2018 Annual Session of the National Congress of American Indians, held at the Hyatt Regency in Denver, Colorado October 21-26, 2018, with a quorum present.
Jefferson Keel, President
Juana Majel Dixon, Recording Secretary