In­dian Health Ser­vice’s ur­ban pro­grams in fund­ing squeeze

Modern Healthcare - - News - By Su­san­nah Luthi

AS THE PAR­TIAL GOVERN­MENT SHUT­DOWN drags into its fourth week, Na­tive Amer­i­can health­care ad­vo­cates are warn­ing law­mak­ers that fund­ing for the In­dian Health Ser­vice is al­ready dry­ing up for some key pro­grams.

The Na­tional Coun­cil of Ur­ban In­dian Health last week warned law­mak­ers that one of its Ur­ban In­dian Health Pro­gram fa­cil­i­ties was slated to close Jan. 12. That facility took care of three pa­tients who over­dosed on opi­oids the week the shut­down started. Two of those pa­tients died.

Three more clin­ics may have to close be­fore the end of the month if Congress and the White House can’t find a res­o­lu­tion, the coun­cil warned, and an­other will need to cut back on op­er­a­tions two weeks after that. Thou­sands of pa­tients would get short­changed on treat­ment, ac­cord­ing to the coun­cil’s es­ti­mate. One-third of the 13 fa­cil­i­ties sur­veyed have started to pre­pare for clo­sure.

The Ur­ban In­dian Health Pro­gram has 41 dif­fer­ent pro­grams across the coun­try and is funded by grants to cover ad­dic­tion and be­hav­ioral health treat­ment, pri­mary care, den­tal care, im­mu­niza­tions, HIV treat­ment and more. Nearly 80% of Amer­i­can In­di­ans and Alaska Na- tives live in ur­ban ar­eas, but fund­ing for those pa­tients is less than 1% of the IHS budget so these pro­grams serve as a sup­ple­ment to other fund­ing sources.

For broader tribal health­care op­er­a­tions, in­di­vid­ual tribes have to de­cide how to main­tain and man­age their pro­grams through the shut­down, ac­cord- ing to the Na­tional In­dian Health Board, an ad­vo­cacy group. De­spite the fund­ing losses, IHS will keep up its di­rect clin­i­cal treat­ments “be­cause they in­volve the safety of hu­man life,” the board said in a state­ment. But other pro­grams “not di­rectly re­lated to the safety of the hu­man life” won’t nec­es­sar­ily con­tinue.

Not all tribes have the fund­ing to op­er­ate fully now, even with the prom­ise of re­im­burse­ment from IHS when the shut­down ends. And in a separate is­sue, if a tribal hospi­tal or clinic needs to re­fer pa­tients to a hospi­tal, they need ready money to pay for the care.

As con­gres­sional spend­ing talks fell apart be­fore Christ­mas, Rep. Mark­wayne Mullin (R-Okla.), GOP co-chair of the House In­dian Health Ser­vice Task Force, in­tro­duced a bill to fund the agency through Septem­ber, or the end of the cur­rent fis­cal year. He had to rein­tro­duce the mea­sure at the start of the new Congress, but it isn’t likely to go any­where.

Mullin ar­gued that the agency, which is peren­ni­ally plagued with fund­ing short­ages but whose budget doesn’t count as manda­tory spend­ing from Congress, needs a fi­nan­cial buf­fer from the pol­i­tics of the cur­rent spend­ing fight.

“Na­tive Amer­i­cans de­serve qual­ity, re­li­able health­care ser­vices as promised in treaties with the fed­eral govern­ment,” Mullin said. “My bill, which would pro­vide a sta­ble source of fund­ing for IHS through fis­cal year 2019, is a good start.”

Mullin’s Demo­cratic co-chair on the task force, Rep. Raul Ruiz of Cal­i­for­nia, said he sup­ports “any legislation that rec­og­nizes this unique re­la­tion­ship and the need to fund the IHS dur­ing gov­ern

 ment shut­downs.”

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