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National Indian Health Board:Washington Report: Issue 18-45

December 11, 2018

GAO releases report on IHS funding levels compared to other federal health programs

On December 10, 2018, the Government Accountability Office (GAO), which acts as the “audit, evaluation, and investigative arm of Congress”, published a report considering spending levels for the Indian Health Service (IHS), compared to three other federal health care providers. The report comes at the request of Congressional leaders on the Interior appropriations subcommittee of the House of Representatives.


In the report GAO compared the funding levels of IHS, the Veterans Health Administration (VHA), Medicare, and Medicaid. It looks at funding levels from 2013 through 2017 and analyzed budget and program documents from the four programs to determine total annual spending levels and spending on a per capita basis. The report found that IHS’s per capita spending was $4,078, compared to $8,109 for Medicaid, $10,692 for VHA, and $13,185 for Medicare. The report highlights that IHS has a different by design form the other federal healthcare providers, in that it has smaller facilities that are more rural, and often offer mostly primary and emergency care services. In addition, the IHS and VHA depend on funding levels that are subject to the annual appropriations process, meaning that per capita spending could drop, with more people being served.



The GAO also analyzed the IHS Purchase/Referred Care (PRC) program, which helps pay for services that are not available from providers at a federal or Tribal facility. They note that not all request that are made through the PRC program get approved, and denials for Fiscal Year 2017 were nearly 35,000. There has been longstanding concerns regarding whether IHS has sufficient funding to provide the 1.6 million American Indian and Alaska Native people, they serve. The National Indian Health Board continues to work with Tribes and Federal Agencies to advocate for this need daily.


Read the full report here.


If you have any questions regarding NIHB’s work with IHS funding or appropriations, please contact Caitrin Shuy, Director of Congressional Relations, at cshuy@nihb.org

In This Issue:



GAO releases report on IHS funding levels compared to other federal health programs



Please join us in creating the National Indian Health Board’s 2019 Legislative and Policy Agenda!

Tell Your Special Diabetes Program for Indians Story

NIHB Joins Combined Federal Campaign



SCIA to hold hearing on Missing and Murdered Indigenous Women; Senate passes Savannas Act

Wisconsin Legislature Attempts to Block Incoming Governor Action on Medicaid and ACA

President signs a two week budget extension

Key Senators Introduce Legislation to Authorize HHS to Fine Drug Companies for Mislabeling Drugs Covered under Medicaid



HHS Tribal Consultation Policy Deadline Extended by 90 days

Virginia Files an Extension of its 1115 Demonstration

Marketplace Open Enrollment ends December 15



December 12-13: CMS I/T/U training in Rapid City

December 18: TSGAC Webinar on Tribal Best Practices in Third-Party Revenue Generation

December 20: U.S. Commission on Civil Rights Report Release & Conference call

January 10: Tribal Dental Therapy Advocates Call

Upcoming Area Budget Formulation Meetings



NEW* SAMHSA Announces New Funding Opportunities for Tribes

CDC Funding Opportunities

Funding Opportunity: CMS Announces MOM Model Funding to Improve Health for Mothers and Children with Opioid Use Disorder
HRSA Funding Opportunity: 2019 Health Center Controlled Networks

OMH Funding Opportunity: AI/AN Public Health Workforce

Resources Available to Tribes on Health Issues

Please join us in Creating the National Indian Health Board’s 2019 Legislative and Policy Agenda!

Every year, the National Indian Health Board (NIHB) engages with Tribes and Tribal leaders to examine the political landscape to set forth an agenda that focuses on key priorities and topical areas that will require targeted efforts and concerted energy to advance throughout the year. This Legislative and Policy Agenda lays the path for NIHB’s work each year.

During meetings with Congress and the Administration, NIHB uses this agenda to advocate, with a unified voice, for the top priorities of the Tribes when it comes to health. The document allows NIHB to not only elevate the most important issues of the Tribes, but also track progress for Indian Health policy.


Some of the major successes from the 2018 Legislative and Policy Agenda include:

  • $50 million Tribal Set-aside for opioid grants in both FYs 2018 and 2019
  • 5% Tribal set-aside for opioid funding in the SUPPORT for Patients and Communities Act (P.L. 115-271)
  • Continued increased funding for the Indian Health Service
  • $5 million increase for the Good Health and Wellness in Indian Country program in FY 2019
  • $10 million increase for Tribal Behavioral Health Grants in FY 2019
  • 2 year renewal of the Special Diabetes Program for Indians

Click here to view the full 2018 Legislative and Policy Agenda.


In the first quarter of next year, NIHB’s Board of Directors will develop the 2019 Legislative and Policy Agenda based on feedback from Indian Country. We urge you to submit your policy priorities for the Board’s consideration either to your regional board member or Member Organization or NIHB staff.


If you would like to submit recommendations directly to NIHB staff, please send your recommendations to Caitrin McCarron Shuy, NIHB Director of Congressional Relations at cshuy@nihb.org by January 4, 2019.

Tell Your Special Diabetes Program for Indians Story

To raise awareness of diabetes in Indian Country, the National Indian Health Board (NIHB) is collecting local impact stories from diabetes care providers and Special Diabetes Program for Indians (SDPI) program participants. These stories will be featured on NIHB’s website, and may be used in future projects to educate on and support SDPI, including sharing stories with Members of Congress. With SDPI up for renewal by Congress in 2019, it is critical that we are able to collect as much information as possible about the success of this program. 


If you have participated in an SDPI program, and want to share your experience, click HERE to share your story.


If you are a diabetes care provider, and you want to share information about your SDPI program, including data, successes, challenges, and innovative ideas, click HERE to share your story.


View all local impact stories HERE.


For more information on SDPI and diabetes in Indian Country, click HERE.

Please contact Sarah Price, sprice@nihb.org with any questions.

NIHB Joins Combined Federal Campaign

The National Indian Health Board (NIHB) is an eligible recipient through the Combined Federal Campaign (CFC) which allows federal employees to make charitable contributions through payroll deduction to designated non-profit organizations.  NIHB is the premier, national, health advocacy organization focused solely on issues confronting federally recognized American Indian and Alaska Native Tribes. If you are a federal employee, talk to your payroll administrator about donating to NIHB using CFC number 84221 Click here for more information on NIHB’s CFC campaign, and here for more information on the CFC as a federal effort.


If you are not able to participate in the CFC, please  Click here to donate to NIHB.


Last modified: June 28, 2021