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IHS Advance Appropriations Initiative -

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Tribal Self-Governance Annual Consultation ConferenceLegislative UpdatesApril 1, 2019
Geoffrey D.Strommer
IHS Advance AppropriationsInitiative
For many years tribes have sought advance appropriations for IHS funding to address negative impacts of CRs and government shutdownsAdvance appropriations has applied to VA medical accounts for many yearsLegislation was previously introduced on House that would implement this initiative and House directed GAO to conduct a study on feasibilityGAO issued study last year making it clear concepts can workRecent35-day governmentshutdown increasedinterest in advance appropriations and led to introduction ofnew legislation
IHS Advance AppropriationsInitiative (cont.)
There are 3pendingbillsHR 1135 by Rep. DonYoung (R-AK). It wouldauthorizeadvance appropriationsfor IHS Services and FacilitiesAccounts. There are 10 co-sponsors frombothparties.HR 1128 by Rep. Betty McCollum (D-MN) who isChairof theHouse AppropriationsSubcommittee on Interior. It would authorizeadvanceappropriationsfor IHS Services and Contract Support and some BIA/BIEprograms.There are 10 co-sponsors frombothparties.S. 229 by Sen. Tom Udall (D-NM) who isRanking Memberon theSenate InteriorAppropriations Subcommittee. Thereare 7 co-sponsors, all Democrats.Itis the same as HR 1128 and it was Referredto the SenateBudget Committee.
IHS Advance Appropriations Initiative (cont.)
Numerous national and regional tribal organizations, as well as many tribes support this initiativeThe ABA is about to enact resolution in support of advance appropriationsThe Trump Administration is still not clearly on record as supportingNot clear when hearings will happen or when bills will moveIncluding ask for extension of advance appropriations to BIA in addition to IHS complicates the landscape
SDPI Reauthorizationand Funding
Authorization for SDPI expires on 9/30/2019SDPI has been level funded at $150 million per year since fiscal year2004NCAI and NIHB are advocating that Congress increase the annual appropriation for SDPI to $200 million for fiscal year 2020 to begin to address this unmet need
SDPI Reauthorizationand Funding (cont.)
Senator Alexander introduceda healthcare extendersbill (S. 192)that would reauthorize SDPI for an additional five years from2019–2024The bill was referred to the Senate Health, Education, Labor, and Pensions (HELP) Committee, where it remains underconsiderationCongressman O’Halleranis expected to introduce a similar bill in the House inApril
SDPI Reauthorizationand Funding (cont.)
Hearingson SDPI reauthorization are expected to take place in either late spring or earlysummerTheHouse Diabetes Caucus is circulating a sign-on letter of support in theHouse; aSenate companion letter is expected to be releasedsoonNIHB is coordinating tribaloutreachtoMembersofCongress
Section 105(l) Leasing: Background
Chronic underfunding of tribal facilities used to provide servicesM&I funds inadequate to fully fund these needsSection 105(l)of ISDEAA:Tribally owned/leasedUsed for the purpose of providing PFSAs in FAMandatory
Section105(l) (Con’t)
ManiilaqI: Lease may be part of funding agreement; lease proposal subject to final offer process; IHS failed to respond within 45 daysManiilaqII: Section 105(l) and the regulations require that IHS fully fund reasonable, non-duplicative lease costs
Section 105(l) (Con’t)
Supplemental tribal clinics appropriation: Funds both VBC program increase and 105(l) lease compensation105(l) leasing has spread throughout Indian CountryIn FY 2018, Congress appropriated $11 million to tribal clinics, but IHS had to reprogram $25 million moreIn FY 2019, Congress increased the tribal clinics appropriation by $25 million, to $36 millionRecently IHS opened consultation on how to address a projected $45 million need in 2019
Section 105(l)(cont.)
Section 105(l) leasing will continue to increaseIHS needs to administer Section 105(l) leasesinamanner that allows the agency to better anticipate and budget for this expansionIHS should drop its efforts to seek a legislative “fix” similar to the one proposed in the Administration’s last two budget proposals—that nullifies 105(l)The ideal solution: a separate, indefinite appropriation for 105(l) like that for contract support costs
Questions?For more information, please contact:Geoff [email protected]





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IHS Advance Appropriations Initiative -