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WASHINGTON — President Biden revealed on Friday his administration’s first discretionary spending proposal, a preview to the full budget he will release later in the spring. The spending proposal shows an administration committed to invest in government programs aimed at boosting education, health care, housing and confronting climate change.

The National Indian Health Board (NIHB) compiled the Indian Health provisions included across several agencies within the President’s proposed budget request. 

Provisions Related to Indian Health

$8.5 billion in discretionary funding for the Indian Health Service (IHS) in 2022, an increase of $2.2 billion.

  • For the first time, the President’s proposed budget includes an advance appropriation for IHS in 2023 to support Administration and Tribal priorities – an issue that has been at the forefront of NIHB’s work for over a decade.
  • The budget also outlines a commitment to a robust Tribal consultation.

Budget Requests Impacting American Indian and Alaska Native Health Outside IHS

CDC: $8.7 billion. The CDC has the largest budget request increase in nearly two decades with the intention to “restore capacity at the world’s preeminent public health agency.” The CDC funding is meant to support core public health capacity improvements in states and territories, modernize public health data collection nationwide, train new epidemiologists and other public health experts, and build international capacity to detect, prepare for, and respond to emerging global threats.

Reduce maternal mortality and morbidity rates: $200 million. The 2022 budget request includes $200 million for Centers for Disease Control and Prevention (CDC) to bolster Maternal Mortality Review Committees, expand the Rural Maternity and Obstetrics Management Strategies program, help cities place early childhood development experts in pediatrician offices with a high percentage of Medicaid and Children’s Health Insurance Program patients, implement implicit bias training for healthcare providers, and create State pregnancy medical home programs. Tribes are not specifically mentioned as eligible for funding despite the fact that maternal mortality rates among American Indian and Alaska Native women are unacceptably high.

  • HIV Prevention and Treatment: $670 million. The request is an increase of $267 million over the 2021 enacted level for Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA), IHS, and National Institutes of Health (NIH) to support critical efforts to end the HIV/AIDS epidemic in the United States.
  • Social Determinants of Health Program: $153 million. This is an increase of $150 million over the 2021 enacted level for the CDC to support all states and territories in improving health equity and data collection for racial and ethnic populations.  Tribes are not specifically mentioned as eligible for funding and NIHB continues to advocate for the explicit inclusion of Tribes for the detailed budget and plans to work with Congress, if necessary.

Opioid Crisis: $10.7 billion. The request is an increase of $3.9 billion over the 2021 enacted level for the CDCHRSA, and NIH to help end the opioid crisis, including funding for states and Tribes, medication-assisted treatment (MAT), research, and expanding the behavioral health provider workforce. It is unclear if IHS is receiving any funding from this program.

Community Mental Health Services Block Grant: $1.6 billion. This increase more than doubles the FY 2021 enacted level for the program through the Substance Abuse and Mental Health Services Administration (SAMHSA). The program provides crucial funding for partnerships between mental health providers and law enforcement, expands mental health services, and bolsters suicide prevention activities. However, Tribes are not eligible for this vital funding, even though AI/ANs experience some of the worst mental health disparities.

Lead and Home Health Hazard Reduction: $400 million. This is an increase of $40 million from FY 2021 enacted levels for Department of Housing and Urban Development (HUD) to be slated for state and local governments and nonprofits to reduce lead-based paint and other health hazards in the homes of low-income families with young children. Tribes are not specifically mentioned as eligible for funding and NIHB continues to advocate for the explicit inclusion of Tribes for the detailed budget and plans to work with Congress, if necessary.

Accelerating Environmental and Economic Justice: $936 million. This new initiative in the Environmental Protection Agency (EPA) is intended to help create jobs, clean up pollution, implement Justice40 and advance racial equity, and provide assistance for communities that have been neglected by the environmental justice movement. , including rural and Tribal communities.

Air Quality: $100 million of this funding is for states and Tribes to reduce greenhouse gas emissions.

Rural Water and Wastewater Grants and Loans: $717 million.  This funding for the Department of Agriculture (USDA) includes $25 million for grants targeted to Native Americans, and Alaska Native Villages and $75 million for grants targeted to rural, poor communities. This is an increase of $100 million over the 2021 enacted level.

IHS Advanced Appropriations Request is a Victory for Indian Country 

Advanced appropriations for the Indian Health Service has been a long-standing priority for Tribes. For over a decade, NIHB has advocated to Congress and current and past Administrations to provide advanced appropriations for IHS and NIHB is pleased to see this priority included in the President Biden's budget request.

The request to increase the IHS budget by $2 billion is welcomed by Tribes; however, the National IHS Tribal Budget Formulation Workgroup recommendations for the President’s FY 2022 budget was $12.759 billion as a first step of a 12-year phase in achieving full funding. NIHB plans to continue its work with Congress to enact full funding for IHS, further strengthen the government-to-government relationship, and hold the federal government accountable for the Trust and Treaty obligations owed to Tribal Nations as the budget moves through the FY 2022 appropriations process.

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