[Senate Hearing 112-656]
[From the U.S. Government Publishing Office]
S. Hrg. 112-656
PROGRAMS AND SERVICES FOR NATIVE VETERANS
=======================================================================
HEARING
before the
COMMITTEE ON INDIAN AFFAIRS
UNITED STATES SENATE
ONE HUNDRED TWELFTH CONGRESS
SECOND SESSION
__________
MAY 24, 2012
__________
Printed for the use of the Committee on Indian Affairs
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
_____
U.S. GOVERNMENT PRINTING OFFICE
76-708 PDF WASHINGTON : 2012
-----------------------------------------------------------------------
For sale by the Superintendent of Documents, U.S. Government Printing
Office Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800; DC
area (202) 512-1800 Fax: (202) 512-2104 Mail: Stop IDCC, Washington, DC
20402-0001
COMMITTEE ON INDIAN AFFAIRS
DANIEL K. AKAKA, Hawaii, Chairman
JOHN BARRASSO, Wyoming, Vice Chairman
DANIEL K. INOUYE, Hawaii JOHN McCAIN, Arizona
KENT CONRAD, North Dakota LISA MURKOWSKI, Alaska
TIM JOHNSON, South Dakota JOHN HOEVEN, North Dakota
MARIA CANTWELL, Washington MIKE CRAPO, Idaho
JON TESTER, Montana MIKE JOHANNS, Nebraska
TOM UDALL, New Mexico
AL FRANKEN, Minnesota
Loretta A. Tuell, Majority Staff Director and Chief Counsel
David A. Mullon Jr., Minority Staff Director and Chief Counsel
C O N T E N T S
----------
Page
Hearing held on May 24, 2012..................................... 1
Statement of Senator Akaka....................................... 1
Statement of Senator Barrasso.................................... 2
Statement of Senator Franken..................................... 3
Witnesses
Birdwell, Stephanie, Director, Office of Tribal Government
Relations, U.S. Department of Veterans Affairs................. 4
Prepared statement........................................... 6
Burke, Hon. Wayne, Chairman, Pyramid Lake Paiute Tribe........... 21
Prepared statement........................................... 23
Causley, Cheryl A., Chairwoman, National American Indian Housing
Council........................................................ 29
Prepared statement........................................... 31
Gover, Kevin, Director, National Museum of the American Indian... 15
Prepared statement........................................... 16
Grinnell, Randy, Deputy Director, Indian Health Service, U.S.
Department of Health and Human Services; accompanied by Dr.
Susan Karol, Chief Medical Officer............................. 9
Yvette Roubideaux, M.D., M.P.H., Director, Indian Health
Service, prepared statement................................ 11
Kalipi, D. Noelani, President, TiLeaf Group...................... 33
Prepared statement........................................... 34
McKaughan, Lt. Col. Kelly, Director, Veterans Advocacy, Choctaw
Nation; accompanied by Maj. Nathaniel Cox, Director, Choctaw
Global Staffing, Choctaw Nation................................ 26
Prepared statement........................................... 28
Appendix
Adame, Richard Allen, Sergeant First Class, Retired U.S. Army,
Prairie Band Potawatomi Nation Veteran, prepared statement..... 51
Keel, Jefferson, President, National Congress of American
Indians, prepared statement.................................... 42
Murkowski, Hon. Lisa, U.S. Senator from Alaska, prepared
statement...................................................... 41
Papa Ola Lokahi Native Hawaiian Health Board, prepared statement. 47
Response to Written Questions Submitted by Hon. Daniel K. Akaka
to:
Stephanie Birdwell........................................... 54
Cheryl A. Causley............................................ 57
Randy Grinnell............................................... 59
Response to Written Questions Submitted by Hon. John Barrasso to:
Stephanie Birdwell........................................... 55
Cheryl A. Causley............................................ 58
Randy Grinnell............................................... 59
PROGRAMS AND SERVICES FOR NATIVE VETERANS
----------
THURSDAY, MAY 24, 2012
U.S. Senate,
Committee on Indian Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 12:45 p.m. in
room 628, Dirksen Senate Office Building, Hon. Daniel K. Akaka,
Chairman of the Committee, presiding.
OPENING STATEMENT OF HON. DANIEL K. AKAKA,
U.S. SENATOR FROM HAWAII
The Chairman. I call this hearing of the Committee on
Indian Affairs to order.
Aloha and thank you so much for being with us today.
Before we begin our oversight hearing on the Programs and
Services for Native Veterans, I would like to ask everyone to
please for the presentation of the colors and veterans song by
Dennis Zotigh, Cultural Specialist, at the National Museum of
Indians.
[Presentation.]
The Chairman. Thank you very much.
Carrying the colors today are members of the Lumbee
Warriors Association, commanded by Staff Sergeant Harold Hunt,
U.S. Army, Vietnam veteran; carrying the United States flag,
Specialist Fourth Class James Edward Thomas, U.S. Army,
Vietnam-era veteran; and carrying the Lumbee flag, Specialist
James Taft Smith, U.S. Army, Vietnam veteran.
Please present the colors.
[Colors are presented.]
The Chairman. Color guards, please proceed to the well and
Mr. Zotigh will sing the veterans song.
Mr. Zotigh. Thank you very much.
Preceding this, I would like to say that American Indians
have always been defenders of our lands, our lives, our
families and our way of life. We honor our warriors with our
songs. At this time, I would like to sing the veterans flag
song which is analogous to our national anthem.
[Presentation of flag song.]
The Chairman. Please retire the colors.
Please be seated.
Thank you very much, Dennis Sotigh and the Lumbee Warriors
Association for that wonderful opening.
It is fitting that we conduct this hearing before Memorial
Day in remembrance of the service of Native veterans to our
country. It is important that we as a Nation are meeting our
dual responsibility to them as veterans and as indigenous
people.
Native Americans, including American Indians, Alaskan
Natives and Native Hawaiians, have served in the United States
Armed Forces with honor for more than 200 years, fighting in
the Revolutionary War, the Civil War and the Spanish American
War long before they were acknowledged as American Citizens. It
is a well known fact in this committee that Native Americans
have the highest rate of service per capita of any group in the
Nation.
As a Native Hawaiian World War II veteran, I know the great
sacrifice of leaving your family, your community and your home
to fight for your country. As you look around this room, you
can see the faces of the service and the sacrifice and I am
humbled to be among them.
The work of the Code Talkers in Wars I and II may well have
meant the difference between victory and defeat and for many
years, their contributions went unacknowledged. Still, the
bravery and dedication of Native servicemen cannot go unnoticed
forever. Over two dozen American Indians, Alaskan Natives and
Native Hawaiians have received the Medal of Honor.
As Chairman of this Committee, it has been my goal to
conduct oversight in a way that ensures that the United States
is meeting its unique responsibilities to Native Americans. As
a former chairman and a current member of the Veterans Affairs
Committee, my commitment to the veterans is the same.
The Chairman. I am happy that my partner, friend and
brother here from Wyoming, Vice Chairman Barrasso and I are
able to work together on this Committee. Vice Chairman
Barrasso, would you like to make an opening statement?
STATEMENT OF HON. JOHN BARRASSO,
U.S. SENATOR FROM WYOMING
Senator Barrasso. I would, Mr. Chairman.
Good afternoon and thank you, Mr. Chairman, for holding
this hearing on Programs and Services for Native American
Veterans.
I especially want to thank you, Mr. Chairman, for your
service to this country as we head up to Memorial Day. Mr.
Chairman, you served in the U.S. Army from 1945 to 1947, and
you continue to serve this country honorably as one of only
three U.S. Senators today who are World War II veterans, you
along with your colleague from your home State, Senator Inouye,
as well as Senator Lautenberg. Thank you for your service.
Thank you for your leadership on veterans' issues.
Native Americans have long played a very important role in
protecting and preserving our freedoms. As many of you know and
the Chairman referenced, the Native American Code Talkers, I
believe, were instrumental. You said it could have been the
difference between victory and defeat. I believe they were
instrumental during both World Wars I and II in defeating the
enemy. Indian Code Talkers communicated messages across enemy
lines. They did it using secret codes derived from their Native
languages and these were never, never deciphered by enemy
forces.
American Indians served in every one of our Nation's wars
since the Revolutionary War. Many fought for our country before
even being granted citizenship in 1924. They served in Vietnam,
in Iraq, in Afghanistan and have sacrificed much for the
freedoms of all Americans. Indian veterans deserve our
gratitude, our respect and full access to the services afforded
to all other veterans.
It appears there have been some longstanding challenges
with Native veterans accessing the benefits they are entitled
to. We are going to hear more about that today, particularly in
regard to health services for Native veterans. I would like to
hear what the Federal agencies are doing to overcome these
problems.
I want to thank all of our witnesses for being here today.
I appreciate your accommodating the schedule with a number of
Senate votes scheduled for later this afternoon and allowing us
to move up the hearing. I appreciate your providing the
Committee with thoughtful testimony.
Thank you again, Mr. Chairman, for your service to this
body and to our Nation.
The Chairman. Thank you very much, Vice Chairman Barrasso.
Senator Franken, do you have any opening remarks?
STATEMENT OF HON. AL FRANKEN,
U.S. SENATOR FROM MINNESOTA
Senator Franken. Yes. Thank you, Chairman Akaka, for
holding this very important hearing and for all the work you
have done over the years on behalf of Native veterans. You are
a true leader in this Congress' efforts to improve the lives of
Native veterans.
We owe so much to every veteran who has served our Nation.
When they return home, they should have at a minimum, a job, a
home and health care they need. That is equally true for Native
veterans who serve in our Armed Forces in greater numbers than
any other group of Americans and have served bravely as the
Vice Chairman said in every conflict since the Revolutionary
War.
The Native veterans not only share the challenges that
other veterans face in getting all they deserve, they also face
unique challenges. That is certainly true for the thousands of
Native veterans in Minnesota. Many of them, all of them live in
rural areas which makes access to VA's excellent health care a
real challenge.
I have a bill called the Rural Veterans Health Care
Improvement Act that I have introduced with Senator Boozman of
Arkansas to help VA improve access to health care for all rural
veterans, including, of course, Native veterans. The bill,
which calls on VA's Office of Rural Health to develop a
strategic plan so that it better uses the substantial resources
that Congress has appropriated for that office, would have the
strategic plan include a solution for better provision of care
for Native veterans.
I have also heard from Minnesotans that Indian veterans
suffer from a lack of trust in the VA because of a history of
poor treatment. I know VA, as well as our outstanding county
and Tribal veteran service officers in Minnesota making mighty
efforts to overcome that lack of trust, both through
consultation, outreach, and through practical improvement in
provision of services.
I am looking forward to the hearing today. I don't want to
get my first pow wow in Minnesota. The first thing Ms. Jibway,
an advisor on my staff, said the opening procession will be led
by veterans, by the warriors. I know the honored place that
warriors have in our Native communities. I honor you as well.
Thank you.
Thank you, Mr. Chairman.
The Chairman. Thank you very much, Senator Franken, for
your opening remarks.
As Chairman, it is my goal to ensure that we hear from all
who want to contribute to the discussion. Therefore, the
hearing record will be open for two weeks from today and I
encourage everyone to submit your comments and written
testimony.
I want to remind the witnesses to please limit your oral
testimony to five minutes.
Today, serving on our first panel is Ms. Stephanie
Birdwell, Director, Office of Tribal Government Relations, U.S.
Department of Veterans Affairs in Washington, D.C.; Mr. Randy
Grinnell, Deputy Director, Indian Health Service, U.S.
Department of Health and Human Services in Rockville, MD,
accompanied by Dr. Susan Karol, Chief Medical Officer, Indian
Health Service; and Mr. Kevin Gover, Director, National Museum
of the American Indian located in Washington, D.C. Welcome to
every one of you.
Ms. Birdwell, please proceed with your testimony.
STATEMENT OF STEPHANIE BIRDWELL, DIRECTOR, OFFICE OF TRIBAL
GOVERNMENT RELATIONS, U.S. DEPARTMENT OF VETERANS AFFAIRS
Ms. Birdwell. Good afternoon, Chairman Akaka, Vice Chairman
Barrasso and members of the Committee.
Thank you for inviting me to discuss the Department of
Veterans Affairs programs and services for Native American
veterans.
On November 5, 2009, President Obama signed a memorandum on
Tribal consultation pronouncing Tribal consultation a critical
ingredient of a sound and productive Federal/Tribal
relationship. As part of the strategy to realize the
President's vision of regular and meaningful consultation and
collaboration with Tribal officials, VA created the Office of
Tribal Government Relations and I was appointed as the Director
of this new office last year.
Guided by the Tribal Consultation Policy signed by
Secretary Shinseki in February of 2011, our office has been
charged with developing partnerships with American Indian and
Alaskan Native Tribal governments for the purpose of enhancing
access to services and benefits for Native veterans.
Meaningful consultation is vital if we are to effectively
address the unique needs of Native American veterans. Trust is
the singlemost important aspect in our relationship with the
Tribes and Native American veterans. VA's goal is to earn the
trust of Tribal leaders and Native American veterans through
consistent outreach and an open door policy.
As an enrolled member of the Cherokee Nation of Oklahoma
with over 15 years of experience in Indian affairs, I know it
will take time but I believe it is a goal we can achieve.
Serving both Indian country and our Nation's heroes is both a
professional and deeply personal calling.
With an estimated 383,000 Native American veterans and 556
federally-recognized Tribal entities, there is much work to be
done. VA is embarking on a robust outreach and consultation
effort that will focus on listening, aiding and advocating.
Listening includes receiving communications through email,
phone and social media tools but we believe the best way to
create lasting bonds of trust is to meet with Tribal leaders in
their communities. VA has held listening sessions in Alaska,
Montana, North Dakota and New Mexico.
While we area in the communities, we are aiding and
training Native American veterans. For example, VA staff have
trained Tribal veteran representatives in Montana and Alaska
and provided technical assistance to Native Americans seeking
home loans during recent gatherings of northwest Tribal leaders
and veterans in Spokane, Washington; Washington, D.C.;
Minneapolis, Minnesota; and Albuquerque, New Mexico.
Outreach and consultation is a vital tool that provides
opportunities to increase Native American veteran enrollment in
VA's health care system, educate veterans about benefits for
which they may be eligible and connect them with online
resources such as eBenefits and MyHealtheVet.
We are working with the Veterans Health Administration to
enhance access to health care in several ways. First, we
facilitate technical assistance and assure best practices with
the Indian Health Service as part of our effort to implement
the Memorandum of Understanding between the VA and IHS. My
office's role is to ensure Tribal concerns are heard and
considered. To this end, we will hold annual listening sessions
in addition to formal consultation to obtain recommendations,
hear local priorities and advocate the Tribe's perspectives on
practices that will improve access to care.
Additionally, we have entered agreements with Tribal health
programs in Alaska under which VA will reimburse Alaska Tribal
health programs for direct services provided to eligible
veterans. These agreements will strength both the VA and Tribal
health program systems to increase access to care for Native
and non-Native veterans, particularly those in remote and rural
areas served by Alaska Tribal health programs. Special
recognition goes to our partners at IHS and Tribal leaders in
our ongoing work to establish a national agreement with IHS and
the efforts in Alaska.
The VA also offers a wide range of benefits for eligible
veterans such as compensation and pension, employment services
and the post-9/11 GI bill, to name a few. VA can and will do
more to increase access to and utilization of established
benefits that veterans have earned.
For example, recent changes to the post-9/11 GI bill
program illustrate the need for a direct link to Indian
country. We are using every avenue available to ensure that
veterans know how changes to this program will directly affect
them and my office will be a vital resource for Tribal leaders
and a conduit for feedback to VA.
I am hopeful that our efforts will increase utilization
rates for the Native American Direct Loan Program, a vital tool
in VA's efforts to provide housing options for Native American
veterans.
We are committed to building a relationship with Tribal
leaders built on a culture of trust and respect to increase to
care and utilization of benefits. We see a bright future but
there is still much to be done.
I look forward to answering any questions you may have.
[The prepared statement of Ms. Birdwell follows:]
Prepared Statement of Stephanie Birdwell, Director, Office of Tribal
Government Relations, U.S. Department of Veterans Affairs
Introduction
Good afternoon, Chairman Akaka and members of the committee, I
appreciate the opportunity to discuss the Department of Veterans
Affairs' (VA) programs and services for Native Veterans.
On November 5, 2009, President Obama signed a Presidential
Memorandum directing all U.S. Government agencies to develop detailed
plans to fully implement the Executive Order 13175, ``Consultation and
Coordination With Indian Tribal Governments.'' The President described
tribal consultation as ``a critical ingredient of a sound and
productive Federal-Tribal relationship.''
In signing the Presidential Memorandum, the President set a
standard of action to which he expects his Administration to be held,
and we are being challenged to meet that standard. As such, VA created
the Office of Tribal Government Relations (OTGR) and I was hired as the
Director of the Office last year. In August 2011, VA hired four Tribal
Government Relations Specialists to manage a portfolio of relationships
with tribal governments within specific regions across the country.
These specialists serve as a resource to tribal governments seeking to
engage in productive relationships with VA.
Guided by the VA's Tribal Consultation Policy, signed by Secretary
Shinseki in February 2011, OTGR has been charged to develop
partnerships with American Indian and Alaska Native Tribal governments
to enhance access to services and benefits for Native Veterans. VA must
build and maintain lasting bonds with Tribal leaders and Native
American Veterans. Toward this end, meaningful consultation is
absolutely vital if we are to effectively address the unique needs of
Native American Veterans.
Trust is the single most important aspect in our relationship with
the Tribes and Native American Veterans. VA is working to earn the
trust of Tribal leaders and Native American Veterans through consistent
outreach and an open door policy. As an enrolled member of the Cherokee
Nation of Oklahoma with over 15 years experience in Indian Affairs, I
know it will take time, but I believe it is a goal VA will achieve.
Serving both Indian Country and our Nation's heroes is both a
professional and deeply personal calling.
Outreach and Consultation
Within VA, OTGR serves as an entry point for American Indian and
Alaskan Native Tribal Government concerns. With an estimated 383,000
Native American Veterans and 566 federally-recognized tribal
governments, there is much work to be done. VA is embarking on a robust
outreach and consultation effort that consists of three pillars:
listening, aiding, and advocating.
While listening includes receiving communications from Tribal
leaders through e-mail, phone, and social media tools, we believe the
best way to create lasting bonds of trust is to meet with Tribal
leaders and Native American Veterans in their communities. VA held
listening sessions in Bethel, Alaska; Billings, Montana; Bismarck,
North Dakota; and Albuquerque, New Mexico. OTGR has participated in
conferences in Arizona, Montana, Idaho, Texas, Wisconsin, Oklahoma, and
Washington. During April 2012, OTGR held four regional meetings
throughout Indian Country with Tribes in an effort to facilitate
discussions about increasing access to healthcare and benefits through
informative presentations and interactive discussions about VA's
efforts to reach Veterans in Indian Country. VA has also conducted site
visits to key locations that deliver services to Native American
Veterans, including the Consolidated Mail Outpatient Pharmacy in
Leavenworth, Kansas, and Tribal courts in Navajo Nation, Hopi and
Laguna Pueblo Tribes, and Tribal communities in South Dakota. OTGR is
very grateful for the vast cooperation each of these Tribes has
provided. Without this support, it would be difficult for OTGR to
understand the challenges Native American Veterans are facing.
Maintaining an aggressive outreach schedule to increase the number of
American Indian and Alaska Native Tribal governments with which we are
building relationships remains paramount.
VA also provides training and assistance to Native American
Veterans. For example, VA provided technical assistance to Native
American Veterans seeking home loans during the recent meeting held in
April. Our outreach provides a unique opportunity to deliver technical
information to Native American Veterans. OTGR has sponsored outreach
booths at the National Congress of American Indians annual convention,
Gathering of Nations Pow-Wow, and Indian Health Service Self-Governance
Conference, and will host a booth at the upcoming National Indian
Health Board annual consumer conference. Officials can leverage these
opportunities to increase Native American Veteran enrollment in VA's
health care system, educate Veterans about benefits for which they may
be eligible, and connect them with online resources such as eBenefits
and My HealtheVet. Every encounter with Tribal leaders and Veterans in
Indian Country is an opportunity to make a difference in a Veteran's
life.
OTGR is also advocating for Tribal governments. The Secretary of VA
is committed to conducting meaningful consultation with Tribes; this
means transforming words into action. VA conducted its first Tribal
consultation in April 2012 in Washington, DC. Three more Tribal
consultation sessions are scheduled in fiscal year (FY) 2012 for
Alaska, Nebraska and Colorado. Tribal leaders will have an opportunity
to voice their concerns on issues that affect the well being of
Veterans and their families. With a direct link to the Tribes through
OTGR, we will be able to address their concerns before new policies and
procedures are implemented. OTGR is already serving as a vital
intergovernmental link for VA's health, benefits, and memorial
programs.
Sustainable Economic Opportunities
The VA mission to ``care for him who shall have borne the battle,
and for his widow, and his orphan'' extends to all Veterans, but VA
officials understand that Veterans in Indian Country face unique
challenges. My office works closely with the Veterans Benefits
Administration (VBA) to address systemic economic issues within Tribal
communities. VA can and will do more to increase access to and
utilization of established benefits such as compensation and pension,
vocational rehabilitation and employment services, and Post-9/11 GI
Bill and other education benefits. Recent changes to the Post-9/11 GI
Bill program illustrate the need for a direct link to Indian Country.
We are using every avenue available to us to ensure that Veterans know
how changes to that program will directly affect them, and OTGR will be
a vital resource for Tribal leaders and a conduit for feedback.
One area that VA believes deserves special attention is the Native
American Direct Loan Program (NADL), a vital tool in VA's efforts to
provide housing options for Native American Veterans. NADL is available
for Native American Veterans, and for qualified non-Native American
Veterans who are married to Native American spouses, to purchase,
construct or improve a home on trust land or to refinance an existing
NADL at a lower interest rate. OTGR is working with VBA to increase
VA's efforts in Indian Country and Alaska to educate eligible Veterans
about this important program. Our goal is to make sure every eligible
Veteran understands the value of the NADL benefit as a long-term
housing solution.
OTGR will also work with Tribal leaders to address burial and
memorial issues. On August 15, 2011, the Secretary approved the VA's
first grant to establish a Veterans cemetery on Tribal trust land, as
authorized in Public Law No. 109-461 (Dec. 22, 206). In FY 2011, VA
made the first three Tribal Veterans cemetery grants. The Rosebud Sioux
Tribe was awarded $6.9 million and the Yurok Tribe was awarded $3.3
million to establish new Tribal Veterans' cemeteries, and the Pascua
Yaqui Tribe was awarded $323 thousand to complete renovations to an
existing cemetery.
VA must measure our progress and hold ourselves to a high standard
of achievement if we are to accomplish our goals. This starts with
compiling recommendations from Tribal leaders and tracking these action
items to completion. VA does not promise that every recommendation
received will be adopted, but we do commit to ensuring Tribal leaders'
and Veterans' voices are heard and considered. A stronger relationship
between the Tribes and VA will lead to better results and outcomes for
Native American Veterans.
Collaboration with Indian Health Service (IHS)
On October 1, 2010, VA and IHS signed an updated Memorandum of
Understanding (MOU). The Memorandum's principal goals are for VA and
IHS to promote patient-centered collaborations in consultation with
Tribes. Although national in scope, the MOU provides the necessary
flexibility to tailor programs through local implementation. VA
leadership believes that by bringing together the strengths and
resources of each organization, we will improve the health status of
American Indian and Alaska Native Veterans.
VA and IHS staff have been working together to develop specific
recommendations and action items related to the MOU. This work has been
focused on areas such as services and benefits, coordination of care,
health information technology, implementation of new technologies,
payment and reimbursement, sharing of services, cultural competency and
awareness, training and recruitment, and others. VA and IHS have made
progress in many of these areas, and will continue to monitor progress
through periodic meetings and quarterly updates to VA and IHS
leadership.
Most recently, VA and IHS produced a proposed draft agreement that
sets forth the underlying terms and conditions for reimbursement by VA
to IHS and Tribal health facilities for direct care services provided
by IHS and tribal health facilities to eligible American Indian and
Alaska Native Veterans. The proposed draft agreement, which was
released for tribal consultation in April 2012, calls for demonstration
sites; defines the eligible service populations and reimbursable
services; discusses quality, payment methodologies, and claims
submission; and includes appeals processes, confidentiality of health
information, and information security. After tribal consultation, VA
and IHS will make any needed revisions to the proposed draft agreement
and design an implementation plan that will allow all parties to move
forward expeditiously while having an opportunity to work through
issues that may arise.
Collaboration with American Indian and Alaska Native Tribes
On a separate but parallel track, and consistent with the
Administration's goal to increase access to care for Veterans, the
Alaska VA Healthcare System negotiated and entered into agreements with
Tribal Health Programs in Alaska under which Alaska VA will reimburse
Alaska Tribal Health Programs (ATHP) for direct care services provided
to eligible Veterans. These agreements will strengthen both the VA and
Alaska Tribal Health Program systems to increase access to care for
Native and non-Native Veterans particularly those in remote and rural
areas served by Alaska Tribal Health Programs.
The effort to establish this agreement began one year ago following
Secretary Shinseki's visit to Alaska. Since that time, the Alaska VA
and the Alaska Tribal Health Program organizations have met on a
regular basis to craft the agreement. We are now scheduling briefings
to Tribal Leaders about VA health care eligibility and enrollment
requirements. Additionally, the Alaska VA is coordinating training
sessions for Alaska Tribal Health Program staff on VA benefits and
eligibility and enrollment processes to encourage and facilitate
enrollment of eligible Veterans into VA's system. Special recognition
goes out to our partners at IHS and Tribal Leaders as our ongoing work
to establish a national underlying agreement with IHS informed the
efforts in Alaska.
To address substance abuse and mental health issues among Veterans,
VA has worked with Veterans Treatment Courts across the country. These
Courts identify treatment options for many of our Veterans with
substance use disorders or mental health conditions. OTGR is working
with VHA to create a Veterans Treatment Court ``How To'' guide to help
identify and link Native American Veterans involved with the criminal
justice system with VA resources and other providers as an alternative
to incarceration. The anticipated release of this guide is scheduled
for September 2012. Our goal is to provide Tribal governments the
resources they need to incorporate, at their discretion, elements of
the Veterans Treatment Court model that may promote healing in their
communities. This model may not work for every Tribal justice system,
but these practices generally are consistent with the holistic approach
to criminal justice practiced by many tribal justice systems and may be
a valuable tool at their disposal. Local circumstances will help define
our ability to implement many of these best practices, but we must
learn from our experiences and leverage our successes.
Conclusion
Secretary Shinseki's leadership has enabled VA to move forward with
developing partnerships with Tribal Governments to enhance access to
services and benefits for American Indian and Alaska Natives. VA
provides high quality care and services to Native American Veterans and
our partnerships with both IHS and Tribes will enhance our ability to
provide care closer to home. We can and will do more to increase access
to and utilization of benefits such as compensation and pension,
vocational rehabilitation and employment services, and Post-9/11 GI
Bill and other education benefits that they have earned. Additionally,
we are pleased to have been able to move forward with the first grants
for tribal cemeteries in 2011 and look forward to increase outreach for
this program.
We see a future where American Indian and Alaska Native Tribal
governments view VA as an organization of integrity that advocates on
behalf of Native American Veterans for their needs. We see a future
where VA demonstrates its commitment to Native American Veterans by
being culturally competent, respecting the unique sovereign status of
Tribes, and reaching out to Veterans in their communities. We are
committed to building relationships with Tribal leaders built on a
culture of trust and respect. We see a bright future, but there is
still much to be done.
Thank you again for the opportunity to discuss VA's programs and
services for American Indians and Alaska Natives. I look forward to
answering any questions you may have.
The Chairman. Mr. Grinnell, please proceed with your
testimony.
STATEMENT OF RANDY GRINNELL, DEPUTY DIRECTOR,
INDIAN HEALTH SERVICE, U.S. DEPARTMENT OF HEALTH
AND HUMAN SERVICES; ACCOMPANIED BY DR. SUSAN KAROL, CHIEF
MEDICAL OFFICER
Mr. Grinnell. Thank you, Mr. Chairman and members of the
Committee.
Good afternoon, I am Randy Grinnell, Deputy Director,
Indian Health Service. I am accompanied by Dr. Susan Karol our
Chief Medical Officer.
Dr. Roubideaux has laryngitis today and she is very sorry
that she is unable to attend. I am here to testify on behalf of
IHS and programs and services for Native American veterans.
American Indian and Alaska Native veterans may be eligible
for health care services from both the IHS and the Department
of Veterans Affairs. The IHS patient registration system
documents approximately 45,000 veterans have received care in
our system of IHS, Tribal and urban Indian health programs.
American Indian and Alaska Native veterans have told us
they want better coordination of services between VA and IHS.
IHS is primarily a rural health system. Therefore, in some
locations our facilities may be some distance from VA
facilities. In addition, the eligibility rules for IHS and VA
health care services differ which may cause confusion about
coverage for services.
For some American Indian and Alaska Native veterans
navigating the two health care systems may prevent optimal use
of health services for which they are eligible. VA and IHS will
continue to work together to address the input we receive from
Tribes and to improve services. We are making progress.
The Department of Health & Human Services, IHS and VA have
made progress in developing a draft agreement to facilitate VA
reimbursement for direct care services for eligible American
Indian and Alaska Native veterans by IHS and participating
Tribal programs.
IHS and VA initiated consultation on March 5 of this year
to request input from Tribes on the main points of this
agreement. IHS and VA also held a consultation session at the
IHS Tribal Consultation Summit on March 13 here in Washington,
D.C. On April 5, IHS and VA sent a letter to Tribes with the
draft reimbursement agreement and requested input.
The draft agreement focused on reimbursement for direct
care services provided to veterans at IHS and participating
Tribal facilities. IHS and VA proposed that implementation of
these agreements begin with a demonstration project to be
followed by national implementation. Tribes were asked to
provide written comments on the draft agreement and
recommendations for the demonstration project. The deadline has
been extended to May 25 of this week.
The national draft agreement also informed the recently
signed agreements between VA and the Alaska Tribal Health
Programs.
IHS has a unique government-to-government relationship with
Tribal governments and is committed to regular and meaningful
consultation and collaboration. Comments from Tribes include
requests to include specific types of services in the
agreement, questions about timelines and process, and comments
about reimbursements and copays.
IHS and VA are reviewing Tribal input and plan to proceed
soon on the demonstration and national implementation of the
reimbursement agreement.
In 2010, MOU between IHS and VA was renewed and signed to
establish coordination, collaboration and resource-sharing
between the two departments. It builds upon decades of
successful collaboration. The MOU provides a framework for a
broad range of IHS and VA collaboration at the local level by
IHS area offices and Tribal health programs with the Veterans
Health Administration.
The MOU recognizes the importance of a coordinated and
cohesive effort of national scope while acknowledging local
adaptation to meet the needs of individual Tribes and
communities. IHS and VA have consulted with Tribes on
priorities for implementation of this MOU.
The MOU sets five mutual goals for serving veterans:
increasing access to and improving the quality of care;
promoting patient-centered collaboration and facilitating
communication; establishing consultation with Tribes, effective
partnerships and sharing agreements; and ensuring appropriate
resources are identified and improving health promotion and
disease prevention services.
To further these goals, IHS and VA actively collaborate and
coordinate activities across several broad areas. Our written
testimony cites several of these examples.
In addition to our collaboration work with VA at the
national level, the Director has instructed all of our area
directors to meet with the VA's Veterans Integrated Services
Networks in their areas and to consult with Tribes. We have
included this work in partnership with the VISNs and Tribes at
the local levels to improve the coordinated provision of health
services to the veterans. It is also part of their performance
contracts. Several new collaborative efforts have emerged from
these partnerships and are detailed in our written testimony.
In summary, the MOU has facilitated collaboration at the
national, regional and local levels with the goal of providing
quality access to care for veterans. The reimbursement
agreement will help increase access for all of our veterans.
IHS and VA are committed to working in partnership to improve
the provision and coordination of services in consultation with
Tribes.
I want to recognize the strong support and commitment of
Secretary Shinseki and his staff as we work together to more
effectively serve our common missions. Our American Indian and
Alaska Native veterans deserve our best efforts to honor their
service. While we have made progress, we understand there is
much more to do and both agencies are committed to this work.
Mr. Chairman, that concludes my testimony and I will be
happy to answer any questions.
[The prepared statement of Ms. Roubideaux follows:]
Prepared Statement of Yvette Roubideaux, M.D., M.P.H., Director, Indian
Health Service
Mr. Chairman and Members of the Committee:
Good afternoon. I am Dr. Yvette Roubideaux, the Director of the
Indian Health Service (IHS). I am pleased to have the opportunity to
testify on Programs and Services for Native American Veterans.
As you know, the Indian Health Service (IHS) plays a unique role in
the Department of Health and Human Services because it is a health care
system that was established to meet the federal trust responsibility to
provide health care to American Indians and Alaska Natives (AI/AN). The
mission of the Indian Health Service is to raise the physical, mental,
social, and spiritual health of AI/AN to the highest level. The IHS
provides high-quality, comprehensive primary care and public health
services through a system of IHS, Tribal, and Urban operated facilities
and programs based on treaties, judicial determinations, and acts of
Congress. The Indian health system provides services to nearly 1.9
million American Indians and Alaska Natives through hospitals, health
centers, and clinics located in 35 States, often representing the only
source of health care for many AI/AN individuals, especially for those
who live in the most remote and poverty-stricken areas of the United
States. The purchase of health care from private providers through the
Contract Health Services program is also an integral component of the
health system for services unavailable in IHS and Tribal facilities or,
in some cases, in lieu of IHS or Tribal health care programs. IHS
accomplishes a wide array of clinical, preventive, and public health
activities, operations, and program elements within a single system for
AI/ANs.
American Indians and Alaska Natives have a long and proud record of
service to this Nation. No other population group has a higher level of
participation in military service. American Indian and Alaska Native
Veterans may be eligible for healthcare services from both the Indian
Health Service and the Department of Veterans Affairs (VA). IHS'
patient registration system documents approximately 45,000 veterans
have received care in our system of IHS, Tribal and Urban Indian health
programs. American Indian and Alaska Native veterans have told us they
want better coordination of services between VA and the IHS. IHS is
primarily a rural health system; therefore, in some locations, our
facilities may be a significant distance from VA facilities. In
addition, the eligibility rules for IHS and VA health care services
differ, which may cause confusion about coverage for services. For some
AI/ANs Veterans the complexity of navigating two health care systems
may prevent optimal use of federally funded health services for which
they are eligible through IHS and VA. VA and IHS will continue to work
together to address the input we receive from Tribes and to improve
services for American Indians and Alaska Natives and we are making
progress.
Indian Health Service--Department of Veterans Affairs Collaborations
VA Reimbursement for Services Provided by IHS to Eligible American
Indian and Alaska Native Veterans
IHS and VA are committed to improving access to services and
benefits for AI/AN Veterans. The Department of Health and Human
Services/Indian Health Service and VA have made significant progress in
developing a draft agreement to facilitate VA reimbursement for direct
care services provided to eligible AI/AN Veterans by IHS and
participating Tribal health programs. IHS and VA initiated a
consultation on March 5, 2012 to request input from Tribes on the main
points of the draft agreement between VA and IHS. IHS and VA also held
a consultation session at the IHS Tribal Consultation Summit on March
13-14, 2012 in Washington, D.C. On April 5, 2012, IHS and VA sent a
letter to Tribes with the draft reimbursement agreement and requested
input. The draft agreement focuses on reimbursement for direct care
services provided to AI/ANs at IHS facilities and participating Tribal
facilities. IHS and VA propose that implementation of these agreements
begin with a demonstration project to be followed by national
implementation. Tribes were asked to provide written comments on the
draft agreement and recommendations for the demonstration project; the
deadline for input has been extended to May 25, 2012. The draft
national agreement also informed the recently signed agreements between
VA and Alaska Tribal Health Programs.
The IHS has a unique government-to-government relationship with AI/
AN Native Tribal governments and is committed to regular and meaningful
consultation and collaboration with Tribes. The IHS considers
consultation an essential element for a sound and productive
relationship with Tribes. The initial analysis of comments from Tribes
include requests to include specific types of services in the
agreement, questions about timelines and process, and comments about
reimbursements and copays. IHS and VA are reviewing Tribal input and
plan to proceed soon with the demonstration and national implementation
of the reimbursement agreement.
IHS and VA staff have been working together to prepare for billing
and collection under the agreement. To date, six webinar training
sessions on VA eligibility and enrollment process have been held and
more training on eligibility, enrollment, claims filing, and
reimbursement processing are planned. These collaborative efforts
support outreach of IHS, Tribal, and Urban health programs to assess,
assist and inform AI/AN veterans about potential health benefits.
Indian Health Service--Veterans Health Administration Memorandum of
Understanding
A Memorandum of Understanding (MOU) between the IHS and the
Department of Veterans Affairs (VA) was renewed and signed in 2010 to
establish coordination, collaboration, and resource-sharing between the
two Departments; and it builds upon decades of successful
collaboration. It outlines joint goals and objectives for ongoing
collaboration between IHS and VA to further their respective missions,
in particular, to serve AI/AN veterans who comprise a segment of the
larger beneficiary population for which they are individually
responsible. The purpose of the MOU is to foster an environment that
brings together the strengths and expertise of each organization to
actively improve the care and services provided by both agencies. It
provides a framework for a broad range of IHS-VA collaborations at the
local level by IHS Area Offices and Tribal Health Programs with the
Veterans Health Administration (VHA). The MOU recognizes the importance
of a coordinated and cohesive effort of national scope, while also
acknowledging that implementation of such efforts requires local
adaptation to meet the needs of individual Tribes and communities; and,
VA and IHS have consulted with Tribes on priorities for implementation
of the MOU.
The MOU sets forth 5 mutual goals for serving Native American
Veterans. These goals include (1) increasing access to and improving
the quality of health care and services offered to Native Veterans by
both agencies; (2) promoting patient-centered collaboration and
facilitating communication among VA, IHS, AI/AN Veterans, Tribal and
Urban Indian Health Programs; (3) establishing in consultation with
Tribes, effective partnerships and sharing agreements in support of AI/
AN Veterans; (4) ensuring appropriate resources are identified and
available to support programs for AI/AN Veterans; and (5) improving
health promotion and disease prevention services to AI/AN veterans to
address community-based wellness.
To further these goals, the IHS and VA actively collaborate and
coordinate activities across several broad areas. I will describe our
activities in these areas along with the most recent accomplishments in
each one.
Improve Coordination of Care
IHS and VA staff have been working to improve coordination of care
for AI/AN Veterans served by IHS, Tribal, or Urban Indian health
programs and VA. Six training sessions on VA eligibility requirements
for the IHS, Tribal and Urban Indian health programs have been held to
improve the ability of frontline patient registration, business office,
and Contract Health Service personnel to assist AI/AN Veterans access
VA services. This training focused on how to assist an AI/AN Veteran
seen in an IHS facility with completing the VA eligibility paperwork
and how to assist with accessing VA services.
Development of Health Information Technology
Improving care through the development of health information
technology, including the sharing of technology and the inter-
operability of systems continues as a part of a long history of active
collaboration between the IHS and VA around information technology.
Both agencies continue to actively consult on electronic health record
(EHR) certification and Meaningful Use requirements. IHS staff is
meeting regularly with VA and Department of Defense (DOD)
representatives in planning for the Integrated Electronic Health Record
(iEHR) and designing the EHR interface and care management functions,
with an anticipated implementation plan starting in FY 2014. These
activities will result in the ability of IHS and VA to share medical
records and better coordinate care for AI/AN Veterans that receive care
in both health care systems.
Development and Implementation of New Models of Care Using New
Technologies
Enhancing access through the development and implementation of new
models of care using new technologies is another focus area for IHS and
VA staff. For example, activities include completion of a summary
document on the best practices for providing tele-psychiatry services
to AI/AN veterans, completion of implementation of telemedicine
services to provide connectivity between the Prescott VHA facility in
Prescott, AZ and the IHS in Chinle, AZ on the Navajo Reservation, and
evaluation of an outreach project for homeless veterans.
Improve Efficiency and Effectiveness at the System Level
IHS and VA are focusing on improving efficiency and effectiveness
at a system level through sharing of contracts and purchasing
agreements. Staff is developing pre-approved templates for agreements,
and the standard policies and common agreement procedures to support
local collaboration. The MOU also provides opportunities to strengthen
existing sharing agreements with VA. To illustrate how this supports
local collaboration, the IHS Tucson Area Leadership staff met with the
Southern Arizona VA and a local agreement is being developed as a
result of the national MOU.
Improve the Delivery of Care through Active Sharing of Programs
This focus area aims to improve the delivery of care through active
sharing of care process, programs, and services with benefit to those
served by both IHS and VA. These activities include a focus on Post-
Traumatic Stress Disorder (PTSD) and staffs are currently working on a
satellite broadcast designed to engage and educate VA providers on
cultural considerations that may need to be taken into account when
providing mental health services to AI/AN veterans living in rural
environments. While each Tribe has its own unique culture, there are
similarities across Tribes that providers should be aware of when
providing care to this population. Staff is also focusing on suicide
prevention and working to develop an AI/AN-sensitive Operation SAVE
version, a VA gatekeeper training program, for use in Indian country
this year; staff report 157 Tribal outreach activities provided to
date.
IHS and VA staffs have also undertaken Pharmacy collaborations and
have successfully completed a pilot program between the VA Consolidated
Mail Outpatient Pharmacy (CMOP) and IHS, with expansion to the
following sites: Phoenix, AZ; Claremore, OK; and Yakama, WA, and Rapid
City, SD. In fiscal year 2011, over 19,000 medications were dispensed
through the CMOP program, and, to date, over 50,000 prescriptions have
been dispensed within the IHS, through the CMOP program. The IHS, VA,
and DOD have also partnered to train pharmacy technicians.
Staffs focusing on Long-Term Care services have increased the
number of American Indian and Alaska Native Veterans served through the
VA Home Based Primary Care (HBPC) program with IHS and Tribal Nations
from 55 in December, 2010 to 234 by September, 2011. There are
currently 160 AI/AN veterans actively enrolled in this program.
VA has an ongoing collaboration with Alaska that continues to
enhance our collaborative activities. The Tribal Veteran Representative
(TVR) program has trained 47 people on VA eligibility and benefits, and
to improve coordination of care, support outreach, and co-management of
patients.
Increase Cultural Awareness and Competent Care
Attention to cultural awareness and increasing culturally competent
care for VA and IHS beneficiaries is the focus of IHS and VA staff who
are developing a three tiered cultural awareness training program, with
each tier having a different level of intensity and immersion into
cultural issues.
Training and Workforce Development/Sharing of Staff and Enhanced
Recruitment and Retention of Professional Staff
Increasing capability and improving quality through training and
workforce development, and increasing access to care through sharing of
staff along with enhanced recruitment and retention of professional
staff are also an important focus of collaborations between IHS and VA
staff. Activities include sharing of educational and training
opportunities and resources, and specialty services. VA has made 239
web-based courses and 7 video courses available to IHS. Of these, 124
have been made available through the Department of Health and Human
Services' (HHS) Learning Management System. An additional 215 courses
are currently under review by IHS. In 2012 training programs will
reside outside of firewalls and therefore be more easily accessible to
staff from both agencies.
Address Emergency, Disaster, and Pandemic Preparedness and Response
IHS and VA staff are working together on emergency, disaster, and
pandemic preparedness and response by sharing contingency planning and
preparedness efforts, joint development of materials targeting AI/AN
veterans, and joint exercises and coordination of emergency response.
Current activities include working with the Federal Emergency
Management Agency to supply materials for training of Tribal emergency
response teams.
Development of Joint Implementation Task Force to Identify Strategies
and Plans for Accomplishing the Tasks and Aims of the MOU
The development of a joint implementation task force to identify
strategies and plans to accomplish the tasks and aims of the agreement
continues. IHS and VA leadership meet regularly to address the draft
reimbursement agreement, consultation comments and issues, and regular
meetings of IHS and VA staff on focus areas previously mentioned.
Collaboration with VA at the IHS Area and Local Levels
In addition to our collaborative work with VA at the national
level, I have instructed all of my IHS Area Directors to meet with the
VA Veterans Integrated Services Networks (VISNs) in their Areas and to
consult with Tribes on how to better coordinate services at the Area
and the local levels. We have included this work in partnership with
the VISNs and Tribes at the Area and local levels to improve the
coordinated provision of health services to AI/AN Veterans as an
element in performance contracts.
Several new collaborative efforts have emerged from these
partnerships. In Alaska, 47 people in Alaska are trained as Tribal
Veterans' Representatives to help Alaska Native veterans gain access VA
health and other benefits. The Area's goal is to train 100 by the end
of the fiscal year.
The IHS Areas in the northern plains--the Billings and Aberdeen
Areas--are also working collaboratively with VA. The Billings Area
meets regularly with VA to discuss issues related to telemedicine, VA
eligibility rules and regulations, and Tribal Veteran Representative
trainings. The Area also coordinates discussions between the Billings
Area Urban Indian programs and VA because of the large population of
Native American veterans living in the urban towns of Montana and
Wyoming that may be eligible for services at the urban clinics. The
Aberdeen Area continues collaborative efforts to foster strong and
productive working relationships with VA, such as use of the VA mobile
MRI. Agreements are currently in place with the VA for Consolidated
Mail Outpatient Pharmacy Service and Compensated Work Therapy Programs.
The Area and VA are working on a post-traumatic stress disorder DVD and
continue to participate in suicide prevention workgroup conference
calls.
The Bemidji Area works closely with VISN 11 and 12 outreach workers
to provide an information session on VA programs to Tribes in Michigan
and Wisconsin. As a result, Tribal Programs began working with VA
facilities to coordinate care. The acting Area Director and the
Behavioral Health Consultant attended the VA Office of Tribal
Government Relations, Central Region Meeting held in April. Ongoing
meetings with the three VISN's are planned. A meeting with VISN 23
Directors is planned for May and there is a pending meeting with the
Fargo VA to work on coordination of care for beneficiaries of the three
federal sites. The Cass Lake Pharmacy was invited to present on their
Medication Reconciliation process as part of the IHS-VA CMOP webinar
entitled ``Medication Use Crisis'', a joint presentation to VHA and DOD
personnel on May 18. Cass Lake Pharmacy is also seeking to work with
the Fargo VA on medication reconciliation for joint beneficiaries. This
effort is expected to also include the Bemidji Community Based
Outpatient Clinic (CBOC) and the St. Cloud Veterans Administration
Medical Center (VAMC). Area Patient Benefits Coordinators were informed
about the upcoming VA-IHS webinar training on VA Enrollment and
Eligibility.
The IHS Areas in the Southwest--the Navajo and the Phoenix Areas,
are also collaborating with VA on serving American Indian veterans. In
the Navajo Area, the VA VISN 18 (Southwest) developed video
connectivity for direct patient care between the Chinle, AZ IHS
facility and the VA facility in Prescott, Arizona. In the Phoenix Area,
VA has newly established a Native American Coordinator Position. This
Coordinator has met with Phoenix IHS Area leadership and has also
established meetings between one of the VISNs and IHS Service Units
regarding the VA scope of services.
Summary
The MOU has facilitated collaboration between IHS, Tribal and Urban
programs and VA at the national, regional, and local level, with the
common goal of providing quality access to health care services to our
AI/AN Veterans. The reimbursement agreement will help increase access
for AI/AN Veterans. The activities that I have described illustrate a
range of active and effective areas of collaboration. IHS and VA are
committed to working in partnership to improve the provision and
coordination of services for AI/AN Veterans in consultation with
Tribes. I want to recognize the strong support and commitment of
Secretary Shinseki as we have worked together to more effectively serve
our common missions. Our American Indian and Alaska Native Veterans
deserve our best efforts to honor their service through our
collaborative activities to improve access to quality health services.
While we have made significant progress, we understand we have much
more to do, and both agencies are committed to this important work.
Mr. Chairman, this concludes my testimony. I will be happy to
answer any questions that you may have. Thank you.
The Chairman. Thank you very much, Mr. Grinnell.
Mr. Gover, please proceed with your statement.
STATEMENT OF KEVIN GOVER, DIRECTOR, NATIONAL MUSEUM OF THE
AMERICAN INDIAN
Mr. Gover. Good afternoon, Mr. Chairman.
We welcome the opportunity to come and discuss the work of
the National Museum of the American Indian with regard to
Native veterans.
As you know, our responsibility at the NMAI is the
presentation of the history, art and culture of the Native
peoples of the Americas and Hawaii. It stands to reason that
because service in the Armed Forces of the United States is so
deeply embedded in the traditions and history of many of the
Native American nations that we would spend a considerable
amount of our time treating the subject.
A couple of things come to mind about this work. First, you
should know that one of the most popular exhibitions we have
created and sent out into the world to go to various venues was
an exhibition about the Code Talkers of Word Wars I and II.
That exhibition is still traveling throughout the United
States. It has been to many reservations but also many non-
Indian communities. It always comes as a surprise to many
people to see the depth of commitment to service of the Native
Americana community.
Second, having grown up in Oklahoma where the 45th Infantry
was legendary for their service during World War II and many of
the men who served in that division were American Indians,
including my grandfather, we got to see firsthand how deeply
embedded this reverence for service and for our veterans is in
Native culture in Oklahoma. As I grew older and traveled to
other parts of the country, I could see that was practically a
universal thing.
Much in the way Senator Franken was describing this
reverence for veterans and the honoring of veterans, it is
embedded in many elements of contemporary Tribal culture and
ritual and so, again, it will always be a major part of our
work at the National Museum of the American Indian.
I do want to mention a specific statutory authorization
that the Museum has which is to construct and maintain a
National Veterans Memorial at the NMAI. It is an usual statute
in a number of respects in that it specifies a location within
the structure that was authorized by Congress when it
established the National Museum of the American Indian, but
then it goes on to say that fundraising and the conduct of a
competition for the design of such a memorial would be carried
out by the National Congress of American Indians.
NCAI does a great deal of fine work and they have any
number of other things they need to do. It strikes me as
somewhat unlikely to make it to the top of NCAI's priority list
and given that we are literally prohibited from using our own
resources or from raising funds ourselves for such a memorial,
it seems unlikely that we are going to be able to construct
such a memorial within the foreseeable future.
We invite Congress' attention to that issue and your
guidance on how we might proceed going forward.
With that, Mr. Chairman, I thank you again for the
opportunity to testify today. Thank you for your attention to
issues affecting Native veterans. I would be happy to answer
any questions you may have.
[The prepared statement of Mr. Gover follows:]
Prepared Statement of Kevin Gover, Director, National Museum of the
American Indian
Good morning, Mr. Chairman and members of the Committee. I am
honored to be here today to discuss the work of the Smithsonian
Institution's National Museum of the American Indian concerning Native
American veterans. As you might expect, programming, research, and
exhibitions concerning the contributions of Native American veterans is
a large part of our work at the NMAI. Service in the Armed Forces of
the United States is a strong tradition among many Native nations, and
the acknowledgement of Native veterans has therefore become embedded in
the cultures, traditions, and histories of many Native communities.
Our programming at the NMAI has included many events relating to
Native veterans. Just in the few years since I arrived at the NMAI, we
have had Veterans' Day and Memorial Day programming relating to Native
service in the Armed Forces. Our film and video program occasionally
presents films relating to Native veterans, and we have had several
authors of books about Native veterans present their work at the
museum.
Perhaps our most significant treatment of the subject is the
traveling exhibition that the NMAI created. It is titled Native Words,
Native Warriors. The exhibition explores the service of Native American
communication specialists who used their Native languages to develop
codes that could not be broken by the enemies of the United States in
World War I and World War II. Native Words, Native Warriors tells the
remarkable story of Indian soldiers from more than a dozen tribes who
used their Native languages in the service of the U.S. military. The
exhibition was designed to travel to other museums, cultural centers,
and libraries, and through the Smithsonian Institution's Traveling
Exhibition Service, it has found many homes and received enthusiastic
responses from a broad range of audiences.
As you know, the NMAI has also been authorized by Congress to
``construct and maintain a National Native American Veterans'
Memorial.'' Several limitations on that authority make it unlikely that
we will be able to build such a Memorial. First, the statute requires
that the Memorial be located ``within the interior structure'' of the
NMAI's museum on the National Mall. This limits our options in locating
a permanent Memorial, given the limited space available within the Mall
museum.
Second, the statute places a great deal of responsibility on the
National Congress of American Indians, rather than the NMAI, to develop
the Memorial. NCAI is authorized by the law ``to hold a competition to
select the design of the Memorial.'' Further, the statute provides that
the National Congress of American Indians ``shall be solely responsible
for acceptance of contributions for, and payment of expenses of, the
establishment of the Memorial.'' Finally, the statute prohibits any use
of federal funds to pay for any expense related to the establishment of
the Memorial.
Mr. Chairman, the powerful tradition of Native American patriotism
finds its clearest expression in the service of young Native men and
women. It is a key component of modern tribal life, and we could not
present the histories and cultures of Native America without delving
deeply into this subject. We will continue to do so as opportunities
arise.
I would be pleased to answer any questions the Committee might
have.
The Chairman. Thank you very much, Mr. Gover.
Ms. Birdwell, since established last year, the Office of
Tribal Government Relations has been very active in conducting
outreach and seeking to best serve Native veterans. Please
discuss the important role your office would continue to play
moving forward.
Ms. Birdwell. Yes, sir, I am happy to.
Our team at the Office of Tribal Government Relations
always acknowledge that prior to establishment of the office,
there were many people within VA who worked hard over the years
to establish at the local level positive working relationships
with Tribal governments to reach our veterans in Indian
country.
The establishment of the office in many ways strengthens
and enhances the agency's ability to reach veterans in Indian
country, to build a relationship with Tribal leaders and really
ensure that voice is heard in programs and policies implemented
by the Department.
We like to say our office does not do per se health care
benefits or the work of the National Cemetery Administration
but we work very closely with our colleagues nationwide in each
one of those organizations to ensure that if there is a
particular issue, if there is an issue related to training,
information, technical assistance, that we ensure those subject
matter experts and leaders are made available to meet with
Tribal leaders and to meet with those who serve veterans in
Indian country.
We also like to say we want to ensure that VA is part of
the landscape of Indian country, that Tribes know who we are,
what we offer and how to get to us. That, I think, sort of
defines the level of our work within VA.
The Chairman. Thank you very much.
Mr. Grinnell, your testimony mentions that IHS has
estimated 45,000 Indian beneficiaries registered as veterans in
the agency's patient registration system. Is there specific
outreach to these 45,000 veterans to ensure that they are aware
of all the services they have earned at both HS and the VA?
Mr. Grinnell. Yes, Mr. Chairman, there is. One of the
things we are doing in collaboration with the VA is actually
training our business office staff. The VA also has a program,
the Tribal veteran representatives, which helps to further
provide outreach and education. Recently we have had a number
of trainings with them, web sessions and so forth, that are not
only training our staff but also the Tribal Health Program
staff so that more importantly, first and foremost, they are
trying to get veterans enrolled in the VA system and identified
as to what benefits they are eligible for. That close
coordination allows us to try to maximize the benefits veterans
can access.
The Chairman. Thank you very much.
Mr. Gover, you discussed some of the obstacles in
constructing the National Native American Veterans Memorial
authorized by Congress. Is there any way Congress can alleviate
these obstacles without burdening the taxpayers?
Mr. Gover. Mr. Chairman, I believe so. Obviously Congress
and the Administration should review the statute together. If
the question is sufficient Tribal support for such a memorial,
I absolutely believe there will be. If, for example, the NMAI
was authorized to receive contributions for that purpose, just
from the general level of interest that has been expressed to
me from a variety of Tribal representatives, I don't have any
doubt that we would be able to generate private resources to
construct such a memorial. I think it would be relatively
expensive but I believe that level of support exists for the
memorial.
The Chairman. Thank you.
Senator Franken, any questions you may have?
Senator Franken. Yes. Thank you, Mr. Chairman.
Director Birdwell, you spoke at the top about the issue of
trust between the VA and the Native community. Mr. Grinnell,
you talked about the years and decades of work that has been
done between the Health Service and VA. What is the source of
this distrust, in your opinion?
I understand we have this new Memorandum of Understanding
and we are working on reimbursement to the IHS from the VA.
Where does the distrust come from and to what extent are this
Memorandum of Understanding and these kinds of actions
mitigating that distrust?
Ms. Birdwell. That is an excellent question. I think that
some of the areas of mistrust from the VA perspective, maybe
historically one of the analogies sometimes that I make is that
when it comes to the VA, over the last five years, VA has
really ramped up an aggressive effort to really focus on the
needs of veterans in rural areas.
A large number of Tribal communities are in very rural
areas and historically, with VA being more concentrated in
urban locations, I think that it would be fairly accurate to
say that maybe VA did not historically reach out to rural
locations because they were hard to get to, specifically with
Tribal communities because they were hard to get to, the agency
didn't speak the language in terms of understanding some of the
unique cultural issues and it was complicated. Maybe the agency
wasn't aware of the importance of engaging the voice of Tribal
leaders to understand what some of the challenges were in
Tribal communities.
I think the converse was true that the VA was hard to get
to, didn't speak the language, understanding the bureaucracy
and it was complicated. I think in some respects maybe veterans
had a bad experience with the VA because of lack of
understanding, lack of engagement and also maybe not
consistently showing up. Maybe there was mistrust built up over
time that was also synonymous with mistrust of the Federal
Government in general.
That would be what I would say was the basis of some of the
mistrust. I think also the importance of really understanding
the VA and the Indian Health Service have a common consumer,
the Native veteran and to really press through this MOU, which
is much more specific, the one in 2010 than the one in 2003, to
really understand how we can join forces and work together to
build upon each other's expertise where one of us may be
stronger than the other with respect to understanding the
unique cultural needs, the importance of engaging the voice of
Tribal leaders, looking at the infrastructure that may exist
through the IHS health care system that maybe VA has not gone
into that market.
That would be my response to that question.
Senator Franken. Mr. Grinnell?
Mr. Grinnell. In terms of the mistrust, some of the
comments we have received from Tribes and individual patients a
lot of times has been about the challenges they experience in
trying to access the system. In some cases, that is both
systems. A lot of times it is because the location of the VA
facility may be further away. The IHS facility may be closer
because many of our facilities are located on the reservation.
The other challenge is the eligibility requirements which I
mentioned in my testimony. There is different criteria that
comes into play both in the VA and the IHS system for certain
types of service, for example contract health service. You have
to be a resident, a member of that Tribe, and so forth.
A lot of times, the feedback we receive from veterans has
been they feel they are shuffled back and forth between the two
systems. We feel the MOU will help us to move closer toward our
mutual goal of trying to address the true needs of our
veterans.
Senator Franken. Thank you.
Mr. Chairman, I know I have gone through my time but
unfortunately, I am going to have to leave after this panel. I
was wondering if I could ask one more question of the panel?
Would that be all right?
The Chairman. Yes.
Senator Franken. Thank you, Mr. Chairman.
Director Birdwell, you did mention one of the barriers was
that so many Native veterans are in rural areas. As I mentioned
in my opening statement, I have a piece of legislation I
introduced with Senator Boozman of Arkansas that addresses
rural veterans' health care including Native veterans in rural
areas.
We are hoping to get action on that bill this year. The
bill is meant to get VA's Office of Rural Health to plan more
strategically and therefore use its resources more prudently to
improve access to health care for rural veterans. My bill
specifically calls on the Office of Rural Health to include in
its strategic plan, plans to coordinate care and share
resources with IHS.
Ms. Birdwell, can you tell me how your Office of Tribal
Government Relations works with the Office of Rural Health
within the VA and the same question for you, Mr. Grinnell. Does
IHS work the VA's Office of Rural Health?
Ms. Birdwell. Yes, sir, the Office of Tribal Government
Relations works very closely with VA's Office of Rural Health.
The Office of Rural Health is the entity within VA that is
tasked to work directly with the Indian Health Service related
to implementation of all of the activities related to the MOU.
Our Tribal government relations specialists are actively
engaged in some of the work group activities related to the
MOU. We meet on a regular weekly, sometimes multiple times in
one week, basis with the Office of Rural Health. We have four
Tribal government relations specialists located in various
places around the country and they are tasked with managing a
portfolio of relationships with Tribes in their regions.
They are really our eyes and ears in many ways on the
ground working directly with Tribes to really assist with
informing the Office of Rural Health what the unique needs are
with respect to veterans in Tribal communities.
ORH, as it is called, in the meantime is doing a fine job
of launching a number of special projects that affect the
American and Alaska Natives. For the last two years, ORH has
expended I think $35 million worth of projects in Tribal
communities nationwide. We have seen quite an expansion in
home-based primary care programs, telehelp and telemedicine
supporting of Tribal veterans, representative training and all
those efforts are achieved through grants through the Office of
Rural Health.
Since our office is tasked with implementing the Tribal
consultation policies, one of the VA-specific consultation
topics is how to engage Tribes in activities related to the VA/
IHS MOU, meaning at the national and local levels. Sometimes we
will meet with Tribal leaders and say we don't hear the good
news stories, we don't hear the outcomes of the work of some of
the ORH grants. Our role is serve as that kind of conduit
between the agency and the Tribes and in this particular
instance with ORH to build awareness of those activities and
how to engage Tribes more effectively.
Senator Franken. Thank you.
Mr. Grinnell?
Mr. Grinnell. The Office of Rural Health is the primary
office within the VA that our area and our clinical staff at
the service unit community level has been working with the VA
and the respective hospitals.
As I mentioned, there have been years of collaboration with
the VA on various things. Some of the more notable items are
telemedicine where you are beginning to see greater expansion.
Our electronic health record and patent management system is
actually a VA product we have utilized and implemented
throughout our entire system.
There are many projects going on locally with lots of
collaboration and it is going towards trying to bring more
services from the VA to the local communities to utilize our
facilities and our staff as well as theirs to try and improve
access to care.
Senator Franken. Thank you all.
Thank you, Mr. Chairman, for your indulgence.
My apologies to the second panel, I do have to leave now.
Thank you.
The Chairman. Thank you very much, Senator Franken.
I want to thank the first panel very much. I have further
questions for you that I will put in the record and have you
respond to them.
Our schedule has just changed. They have moved up the
votes, we need to move on. I want to thank you so much for
being here and helping us with this hearing.
Thank you.
Will the second panel please come forward? The second panel
consists of: Mr. Wayne Burke, Chairman, Pyramid Lake Paiute
Tribe located in Nixon, Nevada; Lt. Col. Kelly McKaughan,
Director, Veterans Advocacy, Choctaw Nation in Durant,
Oklahoma, accompanied by Maj. Nathaniel Cox, Director, Choctaw,
Global Staffing, Choctaw Nation, in Durant, Oklahoma; Ms.
Cheryl Causley, Chairperson, National American Indian Housing
Council located in Washington, D.C.; and Ms. Noelani Kalipi,
President of the TiLeaf Group in Hilo, HI.
I want to welcome you all here today. Chairman Burke, will
you please proceed with your statement?
STATEMENT OF HON. WAYNE BURKE, CHAIRMAN, PYRAMID LAKE PAIUTE
TRIBE
Mr. Burke. Good afternoon, Mr. Chairman. I appreciate the
opportunity and the honor to come before this Committee to give
testimony this afternoon.
My name is Wayne Burke, Chairman of the Pyramid Lake Paiute
Tribe located in the Great Basin area in northern Nevada.
Our Native people have lived and sustained the life of a
warrior. Our ancestors and relatives fought and defended our
Tribal nations to secure food, our homelands and to protect the
young, the old and our families. That warrior spirit is passed
on in our songs, our stories, our dances and our traditions.
Many of our battles against the United States Government,
along with the massacres perpetrated against the Native
Nations, are not found in history books or taught in schools,
but they are passed on through our oral teachings. From the
young to the old, some stories are never to be told again. As
with the old people, the younger generations continue to answer
the call to arms and serve our Tribal and Federal nations
taking that warrior spirit with them.
We serve in the Army, the Air Force, the Navy, the Marines
and the Coast Guard and National Guard. As with all veterans,
representing all the nations under the United States flag, we
serve with honor, dignity and the desire to protect, fight and
to win battles.
With conflicts and the continued threat of terrorism on
those who live in all regions and lands of the globe, the
United States military continues to provide that protection and
service through our men and women who enlist in the Armed
Services.
As our warriors return home, I see the demand and need for
advocacy and support for our veterans. Cultural traditions and
beliefs are significant in the manner in which Tribes and
Native people prepare, sustain, heal and survive war. These
cultural beliefs and ways of life need to be recognized and
used to offer and provide more services and resources to Native
veterans.
It is estimated that more than 12,000 American Indians
served in the United States military during World War I. More
than 44,000 American Indians out of a total Native American
population of less than 350,000 served with distinction between
1941 and 1945 in both European and Pacific theaters of war.
More than 42,000 Native Americans, more than 90 percent of
them volunteers, fought in Vietnam. Native American
contributions to the United States military combat continued in
the 1980s and 1990s as they saw duty in Grenada, Panama,
Somalia and the Persian Gulf.
Per population, more Native veterans serve in the United
States military than any other ethnic group. The Vietnam War
Memorial has a statute of three soldiers representing the
white, black and Hispanic. Our Native warriors should stand
alongside those three statutes as a testimony to our
contributions and brotherhood with all American soldiers we
fought alongside.
The VA must understand and know the population they serve.
Tribes from the north, the south, the east and the west all
have distinct traditions and beliefs. The VA is a complex
system which is intimidating and frustrating for veterans to
navigate. As a young Marine returning from Africa and being
discharged shortly after, I was told I could get my teeth
cleaned 90 days after I discharged and I had some money
somewhere in the GI bill. Services through the Veterans
Administration should be transparent and more accessible.
Veterans need to know what services and resources are available
to them.
Educational benefits and college enrollment has become more
cumbersome, expensive and intimidating. I have spoken to
veteran representatives from colleges in northern Nevada and
they have reported the GI bill and accessing those funds has
become very complex and requires extensive reporting and
knowledge in obtaining and ensuring college courses meet GI
bill regulations. Transfer credits and criteria for higher
education credits is becoming increasing more complicated.
With the growing number of veterans who have served on
foreign shores and been exposed to the harmful effects of
chemical and biological weapons, stress and combat action, we
are not prepared or have limited resources to provide services
from documented cases of Post Traumatic Stress Disorder,
depression, suicide and other emotional mental health issues.
Many of our reservations are found in extreme rural areas of
the country where ambulatory and mental health services are
only available on a very limited basis.
How does a veteran receive a business or home loan? I have
gone to the local Small Business Administration and advised
banks are not approving business loans because of the economic
development. Natives who reside on trust land or reservations
such as Pyramid Lake and other reservations across the country
cannot access loans because banks will not authorize loans to
Indians who live on Tribal lands. Tribes, in many instances,
must waive their sovereign immunity rights to receive
traditional loans from banks.
Next are the advantages and disadvantages of Indian health
services. Big Brother is always watching and regulating. As
Tribal nations we must adhere and conform to the operational
standards of the Federal agencies which regulate health care
which includes appropriations, services, resources and most
importantly, contract health services and paying medical bills.
When bills and contracted health services are not paid in a
timely manner, Tribal members are taken to creditors, are
refused services and wait for authorization from Indian Health
Services.
I have had the opportunity to meet with Dr. Roubideaux,
Director of the Indian Health Service. She so eloquently put it
``We must hold our veterans harmless from the system.'' The
Memorandum of Understanding between the Veterans Administration
and the Indian Health Service was signed in 2010 under the
authority of the Indian Health Care Improvement Act, 25 U.S.C.
1645, 1647 and 38 U.S.C. 523.
Under the current MOU, what is the charge, what is the
authority and who is responsible for ensuring that IHS and the
VA are working in collaboration with Tribal nations and the
government-to-government trust obligations are being met? The
first time I saw this MOU was in 2011. Who or what agency is
ensuring regulation and compliance with the Memorandum of
Understanding?
The Chairman. Mr. Burke, will you please summarize your
statement? You have gone over your time.
Mr. Burke. Excuse me.
One last thing, Mr. Chairman. I come from a reservation on
a street that has broken down fences, rusty cars, rez dogs and
more importantly, family and children who depend on our
programs to protect, serve and provide for sustainable Tribal
nations. My home and my street is the greatest place to live in
this great land.
To those who serve and answer the call to arms, I say,
thank you, God speed and God bless all of us. Dance, pray and
fight with honor.
Thank you.
[The prepared statement of Mr. Burke follows:]
Prepared Statement of Hon. Wayne Burke, Chairman, Pyramid Lake Paiute
Tribe
Our Native people have lived and sustained the life of a warrior;
our ancestors and relatives fought and defended our tribal nations to
secure food, homelands, and to protect the young, the old . . . the
family.
That warrior spirit is passed on in our songs, our stories, our
dances, and our traditions. Many of our battles against the United
States, along with massacres perpetrated against the Native Nations are
not found in history books or taught in schools, but they are passed on
through oral teachings. From young to old . . . some stories are to
never to be told again. As with the old people, the younger generations
continue to answer the call to arms and serve our tribal and federal
nations . . . taking that warrior spirit with them. We serve in the
Army, Air Force, Navy, Marines, Cost Guard, and National Guard. As with
all veterans, representing all the nations under the United States
Flag, we serve with honor, dignity and the desire to protect, fight,
and win battles.
With conflicts and the continued threat of terrorism on those who
live in all regions and lands of the globe, the United States military
will continue to provide that protection and service through our men
and woman who enlist in the armed forces.
As our warriors return home, I see the demand and need for advocacy
and support for our veterans. Cultural traditions and beliefs are a
significant part in the manner in which tribes and Native people
prepare, sustain, heal, and survive war. These cultural beliefs and
ways of life need to be recognized and used to offer and provide more
services and resources to Native Veterans.
Per population, more Native Veterans serve in the United States
Government than any other ethnic group.
Veterans Administration
The VA must understand and know the population they serve. Tribes
from the North, South, East, and West all have distinct traditions and
beliefs. The VA is a complex system which is intimidating and
frustrating for veterans to navigate. As a young Marine returning from
Africa, and being discharged shortly after, I was told I could get my
teeth cleaned 90 days after my discharge, and I had a GI Bill
somewhere. Services through the VA should be transparent and more
accessible. Veterans need to know what services and resources are
available.
Education
Educational benefits and enrolling into college has become very
cumbersome, expensive and intimidating. I have spoken to Veterans'
representatives from colleges in Northern Nevada, and they have
reported the GI Bill and accessing those funds has become very complex,
and require extensive reporting and knowledge in obtaining and ensuring
college courses meet the GI Bill regulations. Transfer credits, and
criteria for higher education credits is becoming increasingly more
complicated.
Mental Health Services
With the growing number of Veterans who have served on foreign
shores, and have been exposed to the harmful effects of chemical/
biological weapons, stress, and combat action; we are not prepared or
have limited resources to provide services from documented cases of
PTSD,depression, suicide, and other emotional/mental health issues.
Many of our reservations are found in extreme rural areas of the
country where ambulatory and mental health services are only available
on a limited schedule.
Business and Mortgage Loans
How does a Veteran receive a business or home loan? I have gone to
the local Small Business Administration and I was advised banks are not
approving business loans because of the economic environment. Natives
who reside on trust land (Reservations) such as Pyramid Lake and other
reservations, cannot access loans because banks will not authorize
loans to Indians who live on tribal lands. Tribes in many instances
must waive sovereign immunity to receive traditional loans from banks.
Indian Health Services
The advantage and disadvantage . . .. Big Brother is always
watching and regulating. As Tribal Nations, we must adhere and conform
to the operational standards of federal agencies which regulate health
care, which includes appropriations, services, resources, and most
importantly contract health services and paying the medical bills. When
bills and contracted health services are not paid in a timely manner,
Tribal members are taken to creditors, are refused services, and wait
for authorization from Indian Health Services. I have had the
opportunity to meet with Dr. Roubideaux--Director IHS, she so
eloquently put it: ``We must hold our Veterans harmless from the
system.''
The Memorandum of Understanding between the VA and IHS was signed
in 2010, under the authority: The Indian Health Care Improvement Act,
25 U.S.C. Section 1645, 1647; 38 U.S.C. Sections 523(a), 6301-6307,
8153. *
---------------------------------------------------------------------------
* The information referred to can be found at http://www.ihs.gov/
announcements/documents/3-OD-11-0006.pdf
---------------------------------------------------------------------------
Under the current MOU, what is the charge, the authority, and who
is responsible for ensuring the IHS and VA are working in collaboration
with Tribal Nations, and the government-to- government/trust
obligations are being met. The first time I had ever heard or seen of
this MOU was in 2011. Who or what agency is ensuring regulation and
compliance with the MOU?
Our Elected Tribal Leaders and Government
The Tribes continue to manage and support their communities through
existing 638 contracts, Federal grants, and revenue generated
programming, and economic development. Under continued resolutions,
regulations, and federal statutes, Tribal governments continue to meet
the demands of those we serve, or to the best of our abilities.
I have no doubt in my mind that our Tribal Nations have the ability
and resources to collaborate and assist the Federal Government and
Federal agencies in effecting and supporting policies and regulations
that can support our Veterans.
My Request of This Committee
Appropriate funding and authorize Veteran liaisons/caseworkers to
represent and work with Tribal Nations in establishing and providing
transportation, services/resources, and secure education and training
for Native Veterans and programs such as the VA, Disabled American
Veterans, and all regional Veteran Service Offices. These liaisons/
caseworkers would assist all Native Veterans in obtaining, securing,
and accessing benefits and services. Educating agency staff and
establishing a network of services and funding for continued services
and resources.
I am very grateful for the support of Nevada Senators Harry Reid,
Dean Heller, and Governor Brian Sandoval in their support and
acknowledgement of our veteran's issues in Indian Country. I would also
like to thank Lt. John Hansen (retired) Disabled American Veterans
Service Officer for the collaboration and services he provides to
several of the 27 Northern Nevada Tribes, and the work he has done in
advocating for our Veterans.
In Closing
I come from a reservation, on a street that has broken down fences,
rusty cars, rez dogs, and more importantly, families and children who
depend on our programs to protect, serve, and provide for sustainable
tribal nations. My home and my street is the greatest place to live in
this great land.
To those who serve and answer to the call to arms I say thank you,
god speed, and god bless all of us. Dance, pray, and fight with honor.
Attachment
The Chairman. Thank you so much, Mr. Burke.
Mr. McKaughan. will you please proceed?
STATEMENT OF LT. COL. KELLY McKAUGHAN, DIRECTOR,
VETERANS ADVOCACY, CHOCTAW NATION; ACCOMPANIED BY MAJ.
NATHANIEL COX, DIRECTOR, CHOCTAW GLOBAL STAFFING, CHOCTAW
NATION
Mr. McKaughan. Good afternoon, Mr. Chairman.
My name is Kelly McKaughan, Director of the Choctaw Nation
Veterans Advocacy Program. I have Major Nathaniel Cox with me.
Chief Pyle and Assistant Chief Batton both send their regrets
that they were otherwise detained and weren't able to come and
speak themselves.
To begin, I want to talk about the Choctaw Nation. We
talked a while ago about rural areas. The Choctaw Nation covers
the southeastern most counties of Oklahoma. It is very rural, a
large area, we have large counties covering over 11,000 square
miles. The Choctaw Nation has over 250,000 members currently.
The reason I am here and the reason our program was started
was Chief Pyle came to me one day and said our veterans aren't
getting services. They don't know what they are eligible for,
they don't have people coming to them and they don't like to go
to outside services such as the VA. Maybe they will come to the
Choctaw Nation and use their own people.
Therefore, in 2005, Chief Pyle, along with our Tribal
council, established our program, the Veterans Advocacy
Program, to try to assist those people who are being missed.
Chief Pyle has said many times, we want to get those people who
are being missed right now. That is why we were established.
We noticed there was a need for an actual application
process. If you don't apply to the VA, you don't get
disability. We try to provide that service to them if they
don't want to go to the VA. Since our Tribal members have to
travel so far, sometimes up to four hours, to a VA facility in
Muskogee, Oklahoma, they are not going to do it. We have
advocates who go out, meet them at their homes or our senior
citizen centers. We do disability and compensation claims for
them, help them get grave markers. Some World War I or II
veterans never had a grave headstone at all. Those are some of
the services we provide that were somehow missed.
Health care is a big deal. The problem is they have to go
to the health care facility. Again, in rural Oklahoma, it is
difficult for them to get that far. We can't really assist with
that. We also provide special events. We have an annual
Veterans Day celebration where we honor our veterans every year
which they are very appreciative. We give them a gift, a jacket
of some kind.
We have that at our council grounds and have a veterans
memorial that was old and worn out. We are in the process right
now of upgrading that memorial, making it more proper for our
veterans.
We also have annual events at each center to honor the
Native veterans. A lot of the old Vietnam veterans didn't get
recognition they needed, so we try to recognize them and show
how important they are to us still.
Our Veterans Advocacy Program is not a recognized service
organization so a lot of our work is referrals, simply getting
the veteran to the right person, the VA, the veteran service
officer. Oklahoma doesn't have counties but has regions. We get
them there and that way they get the proper help they need.
Another thing we do for our veterans--it is actually
serving members now, which I am still a member of the National
Guard and I just come back from overseas--we actually give care
packages. We send it out to all Native Americans and any
servicemember's family which asks, we send it. We have had
requests to send specific items like handheld radios, some
specialty knives they have asked for. One big thing was a
sonogram machine that the military would not provide to this
unit and we did.
That is what we are doing to try to help. Pending your
questions, that is all I have.
[The prepared statement of Mr. McKaughnan follows:]
Prepared Statement of Lt. Col. Kelly McKaughan, Director, Veterans
Advocacy, Choctaw Nation
The Chairman. Thank you so much, Col. McKaughnan.
Ms. Causley, please proceed with your statement.
STATEMENT OF CHERYL A. CAUSLEY, CHAIRWOMAN, NATIONAL AMERICAN
INDIAN HOUSING COUNCIL
Ms. Causley. Good afternoon, Chairman Akaka, Vice Chairman
Barrasso and distinguished members of the Senate Committee on
Indian Affairs.
I would like to thank you for conducting this oversight
hearing.
My name is Cheryl Causley. I am an enrolled member and
Director of Housing for the Bay Mills Tribe of Chippewa
Indians. I appear before you today in my capacity as Chairwoman
of the National American Indian Housing Council.
NAIHC's primary goal is to support Native housing entities
in their efforts to provide safe, decent, affordable,
culturally appropriate housing for Native people, including our
distinguished Native veterans.
As the members of this Committee know, Native Americans
represent a small percentage of the U.S. population. Throughout
history, however, a high percentage of Tribal members have
volunteered to serve in all branches of the United States
military. In fact, some Native Americans were serving in the
American Armed Forces before they were even granted
citizenship. In times of national need, Native Americans have
been the first to answer the call and step forward to protect
this great country that we all call home.
Our Native American people will never forget PFC Lori Ann
Piestewa. Lori was a member of the Hopi Tribe who served in
Iraq and was the first American female soldier to die in
combat. Her spirit, her memory will always live in the minds
and hearts of all of our people.
While our communities show deep respect for our Native
veterans in combat, it is a sad reality that often when they
return to our homelands, they face another extraordinary
challenge in fulfilling one of the most basic needs--they come
home to find a place to live.
In 2005, we actually held a news conference in this
building, in this room and brought two Native veterans who
recently had returned from tours of duty in Iraq. They provided
a deeply emotional statement that they returned home to their
reservations to living conditions in Indian country that were
worse than those they faced in Iraq.
As noted in a 2005 Washington Post article, Staff Sergeant
Julius Tulley from the Navajo Nation shared this statement: ``I
am not here to bash my Commander in Chief, nor am I here to
speak out against the military. I am here to say that I have
gone to war, I have put my life on the line, my brothers put
their lives on the line. I want to say, look, I have done my
part, my family has done their part. Now, I want something in
return.'' His want should have been simple. He wanted a house
to live in.
Yesterday, Mr. Tulley shared with us that after seven
years, his conditions in his home in his community of Blue Gap,
Arizona have not changed. According to Tulley, at every Native
veterans' meeting, the issue of housing is still a major
concern.
He also shared that he is diagnosed with Post Traumatic
Stress Disorder and has yet to receive any treatment, even
though he has made consistent requests over the last seven
years. He shared, ``I'd like to go. I would still like to go,
but I think they forgot about me.''
Tulley's story is common throughout Indian country.
Unfortunately, with the lack of resources and data, it is very
difficult for us to measure the true, unmet needs of our Native
heroes. NIHC strives to work with the leadership of this
important Committee and Congress to recognize the acute housing
needs that continue to exist in our Tribal communities and how
this impacts Native veterans. Let me give you three examples.
A survey conducted in 11,500 households in the Navajo
Nation revealed that 2,726 were households that included at
least one Native American veteran. Severe overcrowding coupled
with wounded veterans returning home to caretakers has added
tremendous stress on a community that has continued to
experience a serious housing shortage.
American Indians are significantly over-represented among
the homeless populations in Minnesota. According to two
separate Minnesota studies, American Indians make up one
percent of the population but are 11 percent of the off-
reservation homeless adult population. Furthermore, American
Indians make up 20 percent of the homeless veterans throughout
Minnesota.
In Montana, Native Americans make up 6.3 percent of the
population, but according to the Montana Veterans Foundation
data, in 2009 Montana had 475 homeless vets, 54 of which were
Native American. Also in 2009, they had 43 homeless females, 25
who were veterans, 9 were Native American women.
Consider these needs against a backdrop that includes the
following observation from the GAO in a February 2010 report.
NAHASDA's first appropriation in fiscal year 1998 was $592
million; the average funding was $633 million between 1998 and
2009. However, the GAO report underscored that when accounting
for inflation and constant dollars, the allocation for Indian
housing has generally decreased since the enactment of NAHASDA.
The needs in Indian country have not lessened since this
report. In fact, the Census actually shows that we have an
increased need with growth in every younger population. The
Census reported that the American Indian and Alaskan Native
population increased by 26.7 percent. Our median income was
roughly $15,000 lower than the rest of the Nation and
furthermore, 28.4 percent of Natives were in poverty.
Bottom line, funding for Indian housing has not increased
while the need in our population and Tribal communities is on
the rise. The funding trend is stifling not only in housing
development but economic development, job creation and an
opportunity to build sustainable communities.
Our veterans have courageously served our country and
should not be left behind in their communities, their homelands
because we lack safe and decent housing.
Thank you.
[The prepared statement of Ms. Causley follows:]
Prepared Statement of Cheryl A. Causley, Chairwoman, National American
Indian Housing Council
Good afternoon Chairman Akaka, Vice Chairman Barrasso, and
distinguished members of the United States Senate Committee on Indian
Affairs. Thank you for inviting me to attend today's oversight hearing
on Programs and Services for Native Veterans. My name is Cheryl Causley
and I am the Executive Director of the Bay Mills Indian Housing
Authority. I am an enrolled member of the Bay Mills Indian Community in
Brimley, Michigan. Today, I appear before you in my capacity as
Chairwoman of the National American Indian Housing Council (NAIHC). I
wish to thank the Committee for this opportunity to appear before you
today to discuss programs for Native Veterans.
Before I speak directly about the housing programs that affect our
Native veterans, permit me to remind the Committee about the NAIHC.
NAIHC is the only national, tribal non-profit organization dedicated
solely to advancing housing, physical infrastructure, and economic and
community development in Native American communities throughout the
United States.
The NAIHC was foundeded 1974 and has, for 38 years, served its
members by providing invaluable training and technical assistance (T/
TA); sharing information with Congress about the issues and challenges
that tribes face in terms of housing, infrastructure, community and
economic development; and working with key Federal agencies to help
meet the challenges of improving the housing conditions in tribal
communities.
The membership of NAIHC is comprised of 271 Indian Housing Block
Grant (IHBG) recipients, representing 463 tribes and tribal housing
organizations. The primary goal of NAIHC is to support Native housing
entities in their efforts to provide safe, decent, affordable,
culturally appropriate housing for Native people, including our
distinguished Native Veterans.
As the members of the Committee know, Native Americans represent a
small percentage of the United States population. Throughout history,
however, a high percentage of tribal members have volunteered to serve
in all branches of the United States military. Many tribal nations are
traditional, warrior societies, and this tradition has translated into
an extraordinarily high level of patriotism in Native America--of
dedication and commitment to service in the United States armed forces.
In fact, some Native Americans were serving in the American armed
forces before they were even granted citizenship. In times of national
need, Native Americans have been the first to answer the call and step
forward to protect this great country that we all call home. Yet,
sadly, Native Veterans often return to their homelands to face
extraordinary challenges in finding a place to live.
Our first Americans face some of the worst housing and living
conditions in the country, and the availability of affordable,
adequate, and safe housing in Indian Country falls far below that of
the general U.S. population. Veterans return home to find too few
housing opportunities and are put on a wait list for tribal housing--a
list that includes many families who have been waiting many, many years
to access affordable housing.
There is an agreement among most members of Congress, HUD, tribal
leaders, and tribal organizations that there is a severe housing
shortage in tribal communities; that many homes are, as a result,
overcrowded; that many of the existing homes are in need of repairs--
some of them substantial; that many homes lack basic amenities that
many of us take for granted, such as full kitchens and plumbing; and
that at least 250,000 new housing units are needed in Indian Country.
These issues are further complicated by the status of Indian lands,
which are held in trust or restricted-fee status. As a result, private
financial institutions will generally not recognize tribal homes as
collateral to make improvements or for individuals to finance new
homes. Private investment in the real estate market in Indian Country
is virtually non-existent, with tribes almost entirely dependent on the
Federal government for financial assistance to meet their growing
housing needs. The provision of such assistance is consistent with the
Federal Government's well-established trust responsibility to American
Indian tribes and Alaska Native villages.
The Native American Housing Assistance and Self-Determination Act
(NAHASDA) was enacted to provide tribes with new and creative tools
necessary to develop culturally appropriate, safe, decent, affordable
housing. NAIHC and its membership appreciate the investment and
continuing efforts that this Administration and the Congress have made
since NAHASDA became law in 1996. However, despite the increase in
overall spending within the Department of Housing and Urban
Development, the Administration has proposed level funding for the
Indian Housing Block Grant (IHBG) at $650 million for FY 2013.
Were the President's budget proposal to be accepted, it would mark
the third consecutive year that the funding for Indian housing would be
flat-lined. We will work with the Congress, including the leadership of
this important Committee, to recognize the acute housing needs that
continue to exist in tribal communities and how this impacts Native
Veterans. Let me give just three examples.
A recent survey conducted of 11,500 households on the Navajo Nation
Reservation revealed that 2,726 were households that included at least
one veteran. Severe overcrowding, coupled with wounded veterans
returning home to family caretakers, has resulted in a tremendous
stress on housing needs. We also know that Native veterans have a great
need for housing assistance in off-reservation and urban areas
throughout the country.
American Indians are significantly overrepresented among the
homeless population in Minnesota, according to studies conducted by the
Amherst H. Wilder Foundation and the Corporation for Supportive
Housing's American Indian Supportive Housing Initiative. American
Indians make up 1 percent of the Minnesota population, but 11 percent
of the off-reservation homeless adult population. Furthermore, American
Indians make up 20 percent of the homeless Veterans throughout
Minnesota according to another Wilder Foundation study.
In Montana, Native Americans make up 6.3 percent of the population.
According to the Montana Veterans' Foundation data, in 2009, Montana
had 475 homeless veterans, 54 of whom were Native American. Also in
2009, Montana was home to 43 homeless females, 25 of whom were
veterans. Nine of the 25 were Native American women.
Consider these needs against a backdrop that includes the following
observation from the Government Accountability Office (GAO) in their
Report 10-326, Native American Housing, issued in February 2010 to the
Senate Banking Committee and the House Committee on Financial Services:
NAHASDA's first appropriation in fiscal year 1998 was $592
million, and average funding was approximately $633 million
between 1998 and 2009. The highest level of funding was $691
million in 2002, and the lowest was $577 million in 1999. For
fiscal year 2009, the program's appropriation was $621 million.
However, when accounting for inflation, constant dollars have
generally decreased since the enactment of NAHASDA. The highest
level of funding in constant dollars was $779 million in 1998,
and the lowest was $621 million in 2009.
The needs in Indian Country have not lessened since this report was
issued just over two years ago. In fact, the Department of Commerce's
Bureau of the Census clearly shows that the needs continue to increase
along with a growing and ever-younger population. In a report prepared
in November 2011, the Census reported that:
The nation's American Indian and Alaska Native population
increased by 1.1 million between the 2000 Census and 2010
Census, or 26.7 percent, while the overall population growth
was 9.7 percent;
The median income of American Indian and Alaska Native
households was $35,062 compared with $50,046 for the nation as
a whole.
The percentage of American Indians and Alaska Natives that
were in poverty in 2010 was 28.4 percent compared to the 15.3
percent for the nation as a whole.
The percentage of American Indian and Alaska Native
householders who owned their own home in 2010 was 54 percent
compared with 65 percent of the overall population.
I wish to conclude this testimony by thanking Chairman Akaka, Vice
Chairman Barrasso, and all of the members of the Senate Committee on
Indian Affairs. NAHASDA is not just about constructing houses, it is
about building tribal communities--communities where health and safety
are a top priority and where education can thrive. However, the path to
a self-sustaining economy is not achievable without a robust housing
sector, and tribal housing conditions cannot be improved without
adequate funding. Veterans who have so courageously served should not
be left behind because their communities--there homelands--lack safe
and decent housing.
We often here people say, ``thank you for your service.'' Let's
make sure these words are not hallow. We can best say thank you to our
veterans by making sure they have a home to return to after serving our
Nation. I know we can count on you to support our efforts. Together, we
can continue the important work of building vibrant communities in
Indian Country.
The Chairman. Thank you very much.
Ms. Kalipi, will you please proceed with your statement?
STATEMENT OF D. NOELANI KALIPI, PRESIDENT, TILEAF GROUP
Ms. Kalipi. Aloha, Chairman Akaka, Vice Chairman Barrasso
and distinguished members of the Senate Committee on Indian
Affairs.
My name is Noelani Kalipi and I am a Native Hawaiian
veteran having served on active duty in the United States Army.
Of the approximately 117,000 veterans living in Hawaii, a
significant number are Native veterans who were born and raised
in Hawaii. Like our Native brethren in Indian country and
Alaska, Native Hawaiians have a cultural and spiritual tie to
our lands. We seek to live on our land and will find a way to
survive in our homeland because no matter how challenging the
economic conditions, no matter how bad or scarce the jobs are,
our family ties and our relationship to our lands are
intricately tied to the essence of our being.
The State of Hawaii depends on imported fossil fuels for
more than 75 percent of its electricity generation and imports
85 percent of its food. This means the State of Hawaii
currently imports 2 million meals per day. We have a serious
food security and energy security issue in Hawaii and we have a
wonderful opportunity for Native Hawaiian veterans to lead the
way in addressing this.
The Hawaii Veteran to Farmer Pilot Program begins in a week
and the first 12 participants are Native Hawaiian veterans with
agricultural leases within the Hawaiian Homelands Trust.
Participants will receive hands-on training on all aspects of
farming and participate in an educational curriculum that
focuses on the business aspects of successful farming
operations including marketing, accounting and best practices.
This is a win-win situation where Native Hawaiian veterans
can lead the way in addressing critical needs in Hawaii while
incorporating cultural and traditional practices, creating
jobs, generating revenue and creating additional opportunities
for economic development and empowerment.
Mr. Chairman, as a Native Hawaiian and as a veteran, I
thank you for all you have done over your career to assist and
empower all veterans but in particular, Native veterans. Your
insight as a Native veteran has been invaluable in facilitating
programs in recognition of the Federal trust relationship
between the United States and its Native peoples.
Establishment of the VA Native American Direct Home Loan
Program, for example, serves as an important precedent in
demonstrating how Federal programs can be modified to provide
the delivery of benefits and services to Native veterans living
on trust lands.
We thank you for all that you have done.
Mahalo.
[The prepared statement of Ms. Kalipi follows:]
Prepared Statement of D. Noelani Kalipi, President, TiLeaf Group
Aloha Chairman Akaka, Vice-Chairman Barasso and Distinguished
Members of the Senate Committee on Indian Affairs. Thank you for
providing me with the opportunity to share information with you about
the Veteran to Farmer initiative we are implementing on the island of
Hawaii.
Background
My name is D. Noelani Kalipi and I am a Native Hawaiian Veteran. I
work with TiLeaf Group, a native social enterprise. We work with native
and non-native companies and organizations focused on projects,
services and programs that contribute to the well-being of native
communities. A substantial portion of our activity is focused on
economic development and empowerment in native communities involving
energy, agricultural and data security initiatives.
I served on active duty in the United States Army Judge Advocate
General's Corps (JAGC) where I was stationed at Fort Stewart, Georgia,
home to the 3d Infantry Division (Mechanized). As a young JAGC
attorney, I served in a number of positions. I found my experience with
the Trial Defense Service (TDS) to be the most insightful. As a TDS
attorney, I represented soldiers facing non-judicial punishment,
administrative separation, or courts-martial. I learned very quickly
about the trials and tribulations faced by soldiers and their families
as they struggled to balance rigorous training and deployment schedules
with demands and challenges of everyday life. While many military
members thrive in these conditions, I worked primarily with those who
encountered difficulties. These experiences served me well in my
professional career which has led me to work with military members and
Veterans in various capacities.
Native Veterans
Native Veterans have a strong tradition of military service despite
the often tragic circumstances underlying the history between the
federal government and their native governments. Native Veterans have
served at the highest rate per capita of any population in the United
States. According to the Department of Veterans Affairs (VA), studies
have also shown that Native Veterans suffer disproportionally from the
consequences of service, including higher rates of disorders related to
combat exposure.
According to the U.S. Census Bureau's American Community Survey,
27, 800 Veterans identified themselves as single-race Native Hawaiian
and Other Pacific Islanders. Four out of five of these Veterans are 65
years old or younger. This means we have a relatively young population
of Native Hawaiian and Pacific Islander Veterans. Additionally, given
the multicultural population in Hawaii, a large number of Native
Hawaiians identify themselves in the multi-race category. We therefore
know that we have a significantly larger population of Native Hawaiian
Veterans in the United States.
Of the 117,000 Veterans living in Hawaii, a significant number are
native Veterans who have been born and raised in Hawaii. Like our
native brethren in Indian Country and Alaska, Native Hawaiians have a
cultural and spiritual tie to our lands--we seek to live on our lands
and will find a way to survive in our homeland because no matter how
challenging the economic conditions or how scarce the jobs are, our
family ties and our relationship to the `aina or land, is intricately
tied to the essence of our being.
Hawaii Island 21st Century Roadmap
The State of Hawaii is composed of islands in the Pacific Ocean.
The nearest metropolitan population is located more than 2500 miles
away. Hawaii depends on imported fossil fuels for more than 75 percent
of its electricity generation \1\ and imports 85-90 percent \2\ of its
food. This means that the State of Hawaii currently imports more than
two million meals per day. If the barges were to be stopped, Hawaii has
approximately 2-3 weeks of fuel for electricity and 7 days of locally
grown food.
---------------------------------------------------------------------------
\1\ Renewable Energy in Hawaii June 2011, Hawaii Economic Issues,
Economic Report 2011, Department of Business, Economic Development &
Tourism, June 2011.
\2\ Food Self-Sufficiency in Hawaii, A Hawaii Department of
Agriculture White Paper, Hawaii Department of Agriculture, December
2008.
---------------------------------------------------------------------------
Energy and food security, therefore, are key priorities for the
people of Hawaii. The volatility in oil prices impact all aspects of
commerce in Hawaii as the cost of importing items and the cost of
electricity are factored into all products and services. These
additional costs make it very difficult for any Hawaii-based business
to be competitive with its counterparts on the continent and greatly
impact the standard of living for individuals living in rural
communities.
Given our geographic isolation coupled with our dependence on
imports for vital needs such as electricity and food, Hawaii is on the
precipice of a future that can be either very good or very bad. It can
be very bad if we retain the status quo and fail to proactively address
our energy and food security challenges.
On the other hand, Hawaii is blessed to have robust, renewable
resources that can be utilized for electricity generation. On my island
of Hawaii, we have geothermal, solar, wind, and hydropower resources
that can be utilized to generate enough electricity to make our island
completely energy self-sufficient. We also have abundant water
resources and fertile soil that can revitalize a once vibrant
agricultural industry. Whether we change our behavior and utilize these
natural resources in a manner that meets our needs while preserving
them for use by future generations is the key to whether we contribute
to a vibrant, thriving or depressed economic future on our island.
Native Hawaiians play a vital role in shaping this future.
Many of us look back to our native kupuna, or elders, for guidance
on how to move forward. The ancient Native Hawaiians were incredibly
scientific people. They had identified the stars and constellations and
used them for navigation across the Pacific Ocean. They had developed a
calendar that dictated when to fish, when to plant and what to plant,
so that their subsistence needs were met in abundance while still
preserving Hawaii's precious natural resources. They had identified
hundreds of thousands of species of plants and animals and had named,
categorized and learned how to use them. Native Hawaiians worked
comprehensively and collaboratively, using complex engineering methods
to maximize the use of resources such as water for everything from
agriculture to advanced forms of aquaculture.
As we look back to move forward, our native communities can see the
vast opportunities available for the perpetuation of our native
culture, language, practices, and traditions. We know that our elders
were not so mired in tradition that they refused innovation. Our
ancestors were incredibly intelligent and if they were here today, they
would not hesitate to couple their incredible wisdom with today's
technology to figure out how to sustain our population and be
responsible stewards of the environment. As Hawaii is increasingly
viewed as the ``test bed'' or ``pilot'' for energy and agricultural
security, our native communities have become much more active and are
certainly willing to be the ``tip of the spear'' that leads this fight
for survival.
TiLeaf Group is just one of many partners involved in developing
and implementing the Hawai'i Island 21st Century Economy Roadmap, a
comprehensive plan that seeks to develop a viable, robust, and self-
sufficient economy for Hawaii Island. The Roadmap has been developed by
Rivertop Solutions, LLC over the past two years with the participation
of key stakeholders on the island. It includes 29 projects, each with a
viable business model and plan which allows the project to succeed on
its own, and more importantly, to support the rest of the projects in
the roadmap, thereby building a comprehensive, self-sufficient
infrastructure on the island that yields economic success and community
empowerment.
Addressing Agricultural Capacity on Hawaii Island
Many Hawaii farmers are struggling to compete with imported foods
because of the high price of electricity. On my island of Hawaii, for
example, we paid an electric rate of 40 cents per kilowatt hour in the
month of April 2012 in comparison to the national average of 11 cents
per kilowatt hour. \3\ If we want to increase our agricultural
capacity, we need to find a way for farmers to be competitive with
their counterparts on the continent.
---------------------------------------------------------------------------
\3\ ``April Electric Rates Up on All Islands Except One,'' Star-
Advertiser, April 12, 2012.
---------------------------------------------------------------------------
A critically important facet of the Hawaii Island 21st Century
Economy Roadmap is revitalizing Hawaii's agricultural capacity by (1)
developing processes that lower input and processing costs, (2)
increasing educational and apprenticeship programs that help transition
individuals into farming, and (3) generating market demand through the
commitment of large businesses, organizations, government agencies. It
is essential that we are able to match market demand with increased
agricultural capacity to ensure economic growth and to sustain
progress.
Richard Ha, a Native Hawaiian Vietnam Veteran who owns and operates
Hamakua Springs Farm, one of the more successful farming operations on
Hawaii Island, summarizes the situation succinctly: ``The farmer will
farm if the farmer can make money. If the farmer cannot make money, the
farmer cannot farm.'' Given the volatility of oil prices and its
devastating impact on Hawaii's economy, Mr. Ha has focused on helping
Hawaii to stabilize its electric generation prices by utilizing
Hawaii's robust renewable resources. He was motivated to actively help
his community to address energy and food security following the spike
in oil prices in 2008 which radically increased the cost of fuel,
electricity, and fertilizer and caused his farm workers to ask him for
loans to pay for gas to get to work.
The first pilot project from the Hawaii Island 21st Century Economy
Roadmap is the Pu'ukapu Agricultural Community Facility which includes
an anaerobic digester, post-harvest facility, and certified kitchen.
The anaerobic digester will process organic waste to produce methane
which will be utilized to generate electricity and soil amendments
which will serve as low cost fertilizer. The electricity will power a
Post-Harvest facility, complete with processing equipment and
refrigeration. A certified kitchen will also be included in the
facility to provide for the manufacture of value-added products such as
sweet potato chips and tomato paste. The facility improves agricultural
capacity by providing low-cost fertilizer and low-cost electricity
which enables post-harvest processing by local farmers, which has
traditionally been cost-prohibitive. Such post-harvest processing
enables farmers to sell produce to larger markets, including the
Department of Defense, University of Hawaii at Hilo, grocery stores and
resorts.
This facility will be located on the Hawaiian Home Lands trust in
Waimea, Hawaii. Congress created the Hawaiian Home Lands trust in 1921
via the Hawaiian Homes Commission Act which set aside approximately
200,000 acres for residential, agricultural, and pastoral homesteading
by qualified Native Hawaiians. The trust lands are noncontiguous and
are located on each of the islands. Each homestead community has a
homestead community association, composed of lessees and family
members, with democratically elected leadership.
The Pu'ukapu Community Agricultural Facility will be owned and
operated by the Homestead Community Development Corporation (HCDC), a
statewide nonprofit owned and operated by several homestead community
associations on Kauai, Oahu, and Hawaii Island. The Waimea Hawaiian
Homestead Association, which represents the homestead community in
which this facility is located, will be the lead on managing this
project for HCDC. Native Hawaiians, therefore, are not only
participating, but managing and leading the way towards increased
agricultural capacity and creating economic development and empowerment
opportunities that simultaneously address food and energy security.
Veteran to Farmer Initiative
The Hawaii Veteran to Farmer Initiative can address not only
Hawaii's food security challenges but also the growing food security
challenges across the nation. The average age of a farmer in Hawaii is
60 years old and the U.S. average is similar. The United States
Department of Agriculture has loan programs in place to aid the
addition of 100,000 new farmers every year because in the next decade,
half of the current farmers are expected to retire. Rebuilding the
nation's ability to feed itself is a critical component of the strength
of our country.
Young Veterans consistently have higher than average unemployment
rates. Not only are their unemployment rates higher than average, but
there are numerous other social and personal welfare indicators where
Veterans and families of returning Veterans also rank higher than
average such as substance abuse, homelessness, and domestic violence.
These figures all show there is a need to better support the transition
of Veterans from the areas of conflict where they served, back into
civilian life.
There is a definite need to introduce a younger generation into
agriculture careers with most of the U.S. farmers approaching
retirement. Though only one sixth of the U.S. population is in rural
communities, nearly 45 percent of the military comes from rural
communities; so many Veterans have strong background knowledge of
agriculture. Native Veterans represent the highest proportion of rural
Veterans. Additionally, in Hawaii, four out of five of the individuals
who identified themselves as Native Hawaiian or Other Pacific Islander
Veterans, were under the age of sixty-five, indicating a younger
population of Veterans.
Horticulture has been used as a therapy tool for decades.
Horticulture therapy is a proven method of reducing stress and anxiety,
improving coping skills and motivation. It also promotes confidence and
hopefulness among other qualities important for Veterans suffering from
post-traumatic stress disorder and traumatic brain injuries. In
addition to providing a path to a career well-suited to re-integrating
the Veterans, the Hawaii Veteran to Farmer initiative can provide a
structure that includes routine monitoring by VA certified healthcare
providers who will have routine contact with program participants, as
needed, to ensure that treatment for physical and mental health of the
Veterans and their families is on track.
The Hawaii Veteran to Farmer initiative provides: (1) a certificate
level hands-on farming skills training curriculum, (2) classroom-based
business training, (3) business start-up support, and (4) as-needed
health monitoring and assessments for Veterans. A key goal of the
program is to enable Veterans to develop the necessary skills and
provide opportunities that utilize these skills in farming while
acknowledging the difficulties many face in transitioning back to
civilian life after military service. Completion can enable Veterans to
both create new farm businesses, and to meet the requirements to
acquire the leases and loans needed to start a farm.
The Hawaii Veteran to Farmer pilot program supports the Pu'ukapu
Agricultural Community Facility because it increases the agricultural
capacity that will be serviced by the facility. The program pilot
begins in June 2012 and the first 12 participants include homesteaders
who are Native Hawaiian Veterans and who have been granted agricultural
leases within the Hawaiian Home Lands trust. The pilot will be
completed in December 2012.
Each program participant will be provided the supplies necessary to
build at least one greenhouse on their property. Participants will
receive hands-on training on all aspects of farming from building the
greenhouse to germination, drip-irrigation methods, and harvesting.
They will also participate in an educational curriculum that focuses on
the business aspects of successful farming including marketing,
accounting, and business relations.
The hands-on training has been developed and will be taught by Mike
Hodson, a Native Hawaiian homesteader who owns and operates a
successful organic vegetable farm, WoW Farms, on his agricultural
homestead. The educational curriculum is being developed in
collaboration with the University of Hawaii system and agricultural
industry. Classes for this pilot program will be held at a Native
Hawaiian educational facility located in the homesteader community,
thereby making access easy for program participants.
Each participant in the pilot program has committed to, upon
completion, ``paying it forward'' by continuing to participate as
instructors so that the model can grow exponentially. At the end of the
pilot we will have 12 working farms. If each participant helps even
just two additional Native Hawaiian Veteran homesteaders with the
practical hands-on training, there could be 24 additional working farms
within the next two years in this rural homestead community.
The pilot program will be used to refine and finalize the
curriculum and to develop the required documentation to certify the
program with various federal agencies. At least eight additional
homestead communities have been identified by the State of Hawaii for
participation in the program. While the pilot and its initial rollout
focuses on participation by Native Hawaiian Veterans, non-native
Veterans who have access to lands for farming or who seek to work on
farms are eligible to participate. This is truly a community
empowerment and community economic development model that can grow
exponentially in a relatively short period to address our food security
and economic development challenges in our rural communities.
This program involves many, many stakeholders throughout Hawaii.
The Roadmap and the Pu'ukapu Agricultural Community Facility involve
participation by Native Hawaiian leaders, Native Hawaiian
organizations, State agencies and officials, Federal agencies and
officials, County agencies and officials, and community-based
organizations involved in food security, agricultural industry, energy
security, economic development and workforce training. As we continue
to progress, more interest is generated and we continue to expand the
number of partners and collaborators in this project.
The fact that the tip of this spear to address food and energy
security is being led by Native Hawaiian Veterans is not only symbolic,
it just and it is right. This is a win-win situation where Native
Hawaiian Veterans can lead the way in addressing critical needs in
Hawaii while incorporating cultural and traditional practices, creating
jobs, generating revenue, and creating additional opportunities for
economic development and empowerment.
Conclusion
Mr. Chairman, as a Native Hawaiian Veteran, I thank you for all
that you have done over your career to assist and empower Veterans, but
in particular Native Veterans.
Your insight as a native Veteran has been invaluable in
facilitating programs in recognition of the federal trust relationship
between the United States and its native peoples. The establishment of
the VA Native American Direct Loan program, for example, helped Native
American Veterans to utilize the VA loans for homeownership on native
lands. While there are additional barriers to increased participation
in the program, the establishment of the VA Native American Direct Loan
program serves as important precedent in demonstrating how federal
programs can be modified to support the delivery of benefits and
services to native Veterans living on native lands.
The definition of trust lands utilized since 1992 as part of the VA
Native American Direct Loan program has continued to help native
communities. The 2008 Farm bill codified this definition of trust lands
as ``Substantially Underserved Trust Areas'' and authorized certain
programs within the USDA's Rural Development program to issue low-
interest loans and grants on these lands. This is a vitally important
tool to economic development and empowerment on native lands. If this
definition can be expanded to apply to other USDA and federal programs,
it could greatly incentive private capital to invest in native
communities and on projects on native lands.
Your unwavering support for the recognition of the accomplishments
of native Veterans from the Navajo Code Talkers to the young Hawaiian
men sent to colonize Baker, Jarvis, and Howland Islands to Medal of
Honor recipients have served to memorialize the important contributions
of native Veterans in defending and honoring our nation. We also
greatly appreciate your efforts as a longstanding member, and as the
Chairman of, the Senate Committee on Veterans' Affairs, in striving to
maintain the commitment of the United States to its military members
and Veterans, but especially the native Veterans.
As a beneficiary of the Montgomery GI Bill, you truly understand
its value to Veterans and we applaud your accomplishments in
strengthening the program to meet the needs of today's Veterans.
Innovative programs like the Veteran to Farmer initiative can be
successful because your insight, thereby resulting in economic
development, community empowerment, jobs and food security in native
and rural communities.
The Chairman. Thank you very much.
I am going to have to wrap up right now, ten minutes ago
the vote was called but we finished you because we have a
series of votes that we will be taking. I want to thank you
again. You are doing community work that is incredible and I
encourage you, in Hawaiian, [phrase in Hawaiian], that you
strive for the highest as you continue to work with our Native
veterans.
I am looking forward to the next update from the Veterans
Administration, the Indian Health Service and others about how
you are working in the spirit of [phrase in Hawaiian],
collaboration and cooperation as you are doing with health
services and veterans affairs to maximize the reach of
resources available to our Native veterans.
Please remember, the hearing record is open for written
testimony for two weeks. Your full statements will be placed in
the record. I have questions that I wanted to ask you that I am
going to put in the record for you to respond to.
I want to thank you so much. We tried to move this up so we
could take more time but they have moved the votes up also. I
thank you so much for being so patient and for your responses
today. You have been helpful and we will continue to work
together to try to bring some things about that can help our
Native veterans and of course our indigenous peoples.
Mahalo nui. Thank you very much. Aloha and safe trip home.
This hearing is adjourned.
[Whereupon, at 2:07 p.m., the Committee was adjourned.]
A P P E N D I X
Prepared Statement of Hon. Lisa Murkowski, U.S. Senator from Alaska
Thank you Chairman Akaka and Vice Chair Barrasso, I would like to
thank you for holding this important and timely hearing on programs and
services for Native veterans. Last year in June I requested the
Committee hold a hearing to examine the VA's record of service to
Native veterans and its progress toward implementing the several tools
provided by Congress to improve access and quality to VA programs in
Indian Country, and at last year's Alaska Federation of Natives
Convention I stayed at the Veteran's listening session until the last
Alaskan had shared their story.
This hearing is timely because it comes just before Memorial Day
and on the heels of the historic signing of a Memorandum of
Understanding between 14 Alaska Native tribal Healthcare providers and
the VA. The MOU seeks for the first time to allow rural Alaska veterans
to receive healthcare benefits at Native health clinics instead of
hundreds of miles from home. Alaska Native health providers have long
been concerned that they must subsidize care to rural veterans from
limited federal Indian Health funds. The agreement was crafted in
consultation with and facilitated by the Alaska Native Health Board,
it's something I've been pushing through my Care Closer to Home
initiative through MILCON appropriations, and I hope that the MOU helps
the VA reassume its responsibility to veterans.
Under the agreement, the VA will reimburse the participating Native
health care entities for the services they provide, and it will also
allow non-Native veterans to get care at the participating tribal
health facilities. As our military heroes start to come home, it is
increasingly important that we renew our commitment to ensure that the
promises made to our Veterans, particularly our Native Veterans, are
promises that we honor.
In November of 2007, during my tenure as Vice-Chair, I presided
over a field hearing before the Senate Committee on Indian Affairs in
Anchorage, Alaska. That hearing, about ``Health Care for Alaska Native
Veterans .'' offered important insights into the concerns voiced by
Alaska Native and non-Native veterans from across the state. I am proud
of provisions in the GI bill that authorizes a year of advance
appropriations for VA healthcare so the VA is able to start the federal
fiscal year with enough funding. And I am proud of our success in
getting TRICARE to delay the implementation of their policy requiring
``drive time waiver'' for retirees living more than 30 minutes or 100
miles from a base hospital. I will continue to advocate for the needs
of military children and for mental health services for our veterans,
to support families because empowering veterans is a key part of
America's future success.
Nearly 24,000 American Indians and Alaska Natives are now serving
as active duty personnel across the Armed Forces, and I'm glad we are
holding this hearing to discuss issues they will face. Alaska is home
to over 77,000 veterans. We proudly claim that Alaska is home to more
veterans as a percentage of our total population than any other State
in the Nation. We know that over the next five years more than a
million military service members will return home. As we welcome them
home as heroes, I encourage employers to recognize them when hiring--
recognize their skills, experience, leadership, and values that will
help reinvigorate our communities and economy. I am proud to say that
my personal office employs five current and former military veterans
from branches of the Army, Navy, Coast Guard, and Marines. I would like
to take a moment to thank those who have served and who currently
serve, and their families, as well as pay my respects to the courageous
men and women who have given the ultimate sacrifice, their lives,
defending our safety and our liberties.
______
Prepared Statement of Jefferson Keel, President, National Congress of
American Indians
______
Prepared Statement of Papa Ola Lokahi Native Hawaiian Health Board
______
Prepared Statement of Richard Allen Adame, Sergeant First Class,
Retired U.S. Army, Prairie Band Potawatomi Nation Veteran
______
Response to Written Questions Submitted by Hon. Daniel K. Akaka to
Stephanie Birdwell
Question 1. The 2010 MOU built upon and seeks to improve the 2003
MOU. Will the VA/IHS MOU need to be updated every few years to best
serve Native veterans?
Answer. The VA/IHS MOU will need to be updated every two to three
years. The Joint Implementation Task Force is charged with this duty
and ensures the update will take place. The MOU provides the foundation
of understanding between IHS and VA which defines purpose, priorities
and specific areas of focus for working together to improve, access,
quality of care, collaborations, sharing of resources and programs to
serve American Indian/Alaska Native (AI/AN) Veterans. As
accomplishments are documented and progress improves, changes and
adjustments will be made to keep up with the needs of the population
served.
Question 2. Can you please discuss the importance of having
accurate data to properly serve Native veterans? Are there areas where
you can improve data collection and analysis to better serve Native
veterans?
Answer. It is important to maintain up-to-date and accurate data to
properly serve Native Veterans and meet their needs. The Office of
Rural Health (ORH) collects data from all Veterans Integrated Service
Networks twice a year and maintains an inventory of programs,
activities, and projects. ORH coordinates MOU workgroup activities,
attends their meetings, and obtains quarterly status updates and
reports of accomplishments from the workgroup leaders. Also, ORH tracks
the numbers and types of sharing agreements that advance the goals
ofand objectives of the MOU between VA and IHS and between VA and
Tribes. Sharing agreements are developed at local health care
facilities continuously through the year. A list of the agreements is
reported to ORH twice a year to track and trend progress in meeting MOU
goals and objectives. Information communicated to VA leadership is
utilized to support activities and improve Native Veteran care and
services.
Question 3. In your testimony, you discussed the updated VA/IHS
MOU. Are there mechanisms in place to measure the effectiveness the MOU
has had and will have in the future?
Answer. The MOU Metrics Report is used to measure the effectiveness
of the MOU. At the present time, three metrics have been defined to
monitor performance progress and success across all MOU workgroups. The
three distinct metrics are: (1) The number and types of programs
developed between VA and IHS and between VA and Tribes, (2) The number
and types of outreach activities provided to help and impact AI/AN
Veterans, their families, caregivers and communities, and (3) the
number and types of sharing agreements developed between VA and IHS and
between VA and tribes. This data will be reported annually. The first
report will be completed by August 31, 2012 and will be reported to the
Senate Appropriations Committee, target date September 30, 2012.
Question 4. In March 2012, Secretary Shinseki assured me that he
would look into ways to work with Native Hawaiian health care systems
and Native American Veterans systems to provide services to Native
Hawaiian Veterans who live in rural parts of Hawaii. To your knowledge,
has any progress been made on this effort?
Answer. The VA Pacific Islands Health Care System (VAPIHCS) has
approximately 45,000 Veterans enrolled throughout our 4.5 million
square mile Pacific Ocean area of responsibility, including Hawaii
(Oahu, Maui, Kauai, Big Island, Molokai and Lanai), American Samoa,
Guam and the Commonwealth of the Northern Mariana Islands (CNMI--
Saipan, Tinian and Rota). These 45,000 enrollees are made up of people
from many cultures, including Native Hawaiian, other Polynesian, Asian
and European based cultures.
In addressing the health care needs of all Veterans in the Pacific,
VAPIHCS has put forth an effort to establish new and close working
relationships with the Federally Qualified Health Centers (FQHCs) on
Maui, Kauai, Big Island, Molokai and Lanai. These FQHCs, while close in
proximity to our existing Community Based Outpatient Clinics, offer a
variety of health care services to native Hawaiians including native
Hawaiian Veterans.
We have a well established relationship, over many years, with the
leadership of Papa Ola Lokahi, a consortium of providers that make up
the Native Hawaiian Health Care (NHHC) Clinic System, throughout
Hawaii.
We have an initiative in place with the NHHC System for VA to
actively enroll Native Hawaii Veterans into VAPIHCS.
______
Response to Written Questions Submitted by Hon. John Barrasso to
Stephanie Birdwell
Question 1. In 2010, the Indian Health Service and the Department
of Veterans Affairs established a Memorandum of Understanding outlining
a plan for coordination, collaboration, and resource sharing. However a
prior interagency agreement for the same purposes has been in existence
since 2003. Tribes have contended that no action has been taken by the
Indian Health Service and the Department of Veteran Affairs to improve
services, despite the existence of these two agreements. How will the
2010 Memorandum of Understanding be implemented more effectively than
the prior agreement?
Answer. VA/IHS workgroups have been established to accomplish the
work of the MOU. These workgroups include: Services and Benefits,
Coordination of Care, Health Information Technology, New Technologies,
System Level Agreements, Payment and Reimbursement, Sharing of Care
Processes and Services, Cultural Competency Awareness, Training and
Recruitment, Emergency and Disaster, and Oversight. Each of these
workgroups has a defined purpose, goals, objectives and action plans.
These workgroups are proactively meeting to discuss their purpose,
goals, objectives and action plans and ways to enhance them. Each
workgroup has defined membership and leaders. They meet regularly and
their accomplishments are tracked and reported quarterly to the MOU
Oversight Workgroup. This information is used to improve care and
services for Native Veterans.
Question 2. The 2010 Caregiver and Veterans Omnibus Health Services
Act allows, in certain circumstances, electronic transfers of health
records of Indian Veterans between Indian Health Services and VA. This
Act was intended, in part, to provide seamless health care services to
these Veterans. What is the status on the implementation of this Act?
Answer. Section 303 of Public Law (P.L.) 111-163 (Caregivers and
Veterans Omnibus Health Services Act of 2010) permits VA to carry out
demonstration projects to examine the feasibility and advisability of
alternatives to expand care for Veterans in rural areas. The
demonstration projects could include (1) a partnership between VA and
the Centers for Medicare and Medicaid Services of the Department of
Health and Human Services (HHS) at critical access hospitals to
coordinate care for rural Veterans, (2) a partnership between VA and
HHS at community health centers to coordinate care for rural Veterans,
or (3) expanding coordination with IHS to expand care for American
Indian and Alaska Native (AI/AN) Veterans. VA would be required to
ensure that the demonstration projects are carried out at facilities
that are geographically distributed throughout the United States. VA is
required to submit a report to Congress, no later than 2 years after
enactment, on the results of the implemented demonstration projects.
VA has not implemented any new demonstration projects under this
discretionary authority. However, there are considerable efforts
underway to improve rural health care under other authority that builds
on existing agreements with HHS and IHS. For example, VA and IHS have
established a task force to explore using existing authorities to
expand coordination between the two agencies. In addition, VA's Office
of Rural Health (ORH) currently supports a number of projects already
that involve expanded access and collaborations with other parties,
including HHS and IHS. ORH activities include funding for Community
Based Outpatient Clinics; enhancing primary care for women Veterans in
rural areas; expansion of tele-health services including tele-renal,
tele-psychiatry, tele-dermatology, tele-mental health, tele-
rehabilitation, tele-amputee, tele-pharmacy, tele-PolyGram and tele-
radiology; expansion of Home-Based Primary Care (HBPC); expansion of
Outreach Clinics; services to homeless Veterans and expansion of mental
health services. ORH also funds the pilot program required by section
403 of P.L. 110-387, the Veterans' Mental Health and Other Care
Improvements Act of 2008, Project ARCH, or Access Received Closer to
Home, under which covered health services are provided to covered
Veterans through qualifying non-VA health care providers. Additionally,
the Veterans Rural Health Resource Centers (VRHRC) are developing local
partnerships and innovative programs to address the needs of Veterans
in rural and highly rural areas. Veterans Integrated Service Networks
are also sponsoring a number of efforts to increase access for Veterans
in these areas. VA advised the House and Senate Veterans' Affairs
Committees of the decision not to develop any new demonstration
projects under section 303 on May 17, 2012.
Question 3. A 2010 Department of Labor report, mandated by the
Veterans Benefits Improvement Act of 2008, found that Native American
Veterans living on tribal lands were often unaware of employment
programs available to them. In addition to finding that increased
awareness of these programs is needed within Native American
communities, the report also found that increased collaboration is
needed between the several Federal agencies (Department of the
Interior, Department of Labor, and Department of Veterans Affairs) that
maintain employment services programs serving Native American Veterans.
Among other things, the report recommends consolidating these programs,
at least to some extent, by creating ``one-stop Veterans helps shops''
on Indian reservations. What is your agency doing to address the issues
highlighted in this report?
Answer. In an effort to ensure that Native American Indians,
particularly those living on Indian reservations and in rural areas,
are aware of services provided by VA's Vocational Rehabilitation and
Employment (VR&E) benefits, VR&E Service has taken the following steps:
Collaborate with other offices within VA, such as the Center
for Minority Veterans, Benefits Assistance Service, the Office
of Tribal Governmental Relations (OTGR), and ORH to promote
outreach efforts specifically targeted to Native Americans;
Attended the first Eastern Region Summit sponsored by OTGR
to provide information on VR&E services and build stronger
relationships with stakeholders to better serve Veterans and
their families;
Presented information on VR&E benefits and services during
the 2012 Consortia of Administrators for Native American
Rehabilitation (CANAR) Mid-Year Conference, which was held June
17-20, 2012;
Presented at the following Native American events:
--VA Alaska Tribal Consultation, May 25, 2012
--Lincoln Consultation, June 17, 2012; and
Developed a Memorandum of Understanding between VR&E and the
Alaska Consortium of Tribal Vocational Rehabilitation.
Question 4. What is the status on implementing the recommendations
in this report, including collaborating with the other Federal agencies
to create ``one-stop Veterans help shops'' on Indian reservations? If
these recommendations are not currently being implemented, please
explain why.
Answer. The Department of Labor (DOL) is responsible for
establishing ``One-Stop Career Centers,'' including new locations on
Indian reservations. VA collaborates with DOL to ensure the ``One-Stop
Career Centers'' are publicized on VR&E's VetSuccess.gov transition and
employment Web site as well as VA's eBenefits Web site. VR&E Service
will also ensure that information regarding ``One-Stop Career Centers''
is provided during outreach events with Native American Veterans.
______
Response to Written Questions Submitted by Hon. Daniel K. Akaka to
Cheryl A. Causley
Question 1. Last Congress, we enacted the Indian Veterans Housing
Opportunity Act to ensure that amounts received by Indian veterans for
disabilities resulting from military service would not be included in
calculating family income for housing purposes. Are there other
barriers Congress can remove to allow greater housing opportunities for
Native veterans?
Answer. Indian Country is enormously grateful to this Committee for
showing your full support and championing the passage of the Indian
Veterans Housing Opportunity Act of 2010. This law ensures that Indian
veterans who receive federal disability and survivor benefits are not
denied support under NAHASDA. The passage of this legislation
demonstrates that when Congress and Tribes work together we can find
tangible solutions that will help our Native Veterans.
As you may recall, this law ensures that Indian veterans who
receive federal disability and survivor benefits are not denied support
under NAHASDA. This is good, but it only applies to NAHASDA. We
understand that similar legislation needs to be passed so that Native
veterans and their families are eligible to receive housing services
from the BIA's Housing Improvement Program (HIP). NAIHC is researching
the issue, but we believe that neither Indian veterans nor their
families should be denied services through the BIA-HIP because the
veteran or family is receiving federal disability or survivor benefits.
Question 2. In your testimony, you cited housing data related to
Native Veterans only in certain states. Is there a need for more
comprehensive data related to the housing needs of Native veterans?
Answer. There is little to no housing information or housing data
available on Native veterans and there is no funding available to
collect that housing information or data. Indian Country is in dire
need of accurate and reflective data to help us build a solid case for
support, but to also help tribal communities in prioritizing and
planning housing projects for Native veterans.
However, there are solutions to this problem. First, provide
funding to tribes and tribal housing programs to collect information on
Native veterans. Second, build training and technical assistance
programs so tribes have the tools necessary to build an appropriate
database on the scope and needs of Native veterans. Third, develop
partnerships and collaborations among various agencies at the local,
regional and national level to share information and data. For example:
at the local level, the tribal veterans affairs office, local veterans
organizations and tribal housing authorities can come together to share
information and data on Veterans in their community--often these
offices and programs are separate; and at the national level, the
federal agencies need to build interagency working groups to
collaborate services for Native veterans. The Department of Veterans
Affairs and HUD should have joint agreements to share information and
data, and create initiatives to fund and support tribes in this effort.
Question 3. Ten years ago, the GAO released a report identifying
barriers for Native American veterans seeking to use the Native
American Veterans Direct Home Loan Program. To your knowledge, have
those barriers been removed and are Native American veterans utilizing
the program at a greater rate?
Answer. The VA Direct Home Loan Program has the potential to be an
important tool for housing development in Indian Country. The program
has, however, been underutilized as noted in the August 2002 GAO report
on Native American Housing.
Barriers that remain are as follows:
Insufficient income or credit history to qualify Native
Veterans for the direct loan.
Lack of infrastructure on tribal land, especially in more
remote reservation locations, and land availability for those
tribes that have insufficient ``buildable'' land.
Difficulty in securing a clear title for home site leasing
purposes on tribal land.
There have been notable improvements. The loan limits have
increased to $417,000--when the 2002 GAO report was issued, the maximum
loan was $80,000. Also, the Department of Veterans Affairs is making a
concerted effort to get information about the Direct Loan Program to
tribes, tribal housing entities, and tribal members. I was pleased to
see that Ms. Stephanie Birdwell, the VA's Director of Tribal Government
Relations, appeared before the Committee to testify on behalf of the
VA. Stephanie has worked with NAIHC and the National Congress for
Americans Indians to make sure that VA Direct Loan Program training
sessions take place during our annual meetings. She has also worked
diligently with other national Indian organizations to ensure that the
VA's tribal programs are available and that needed technical assistance
is conducted to ensure access to the VA programs.
______
Response to Written Questions Submitted by Hon. John Barrasso to Cheryl
A. Causley
Question 1. In 2002, the Government Accountability Office released
a report identifying several issues affecting the use of the Native
American Veterans Direct Home Loan Program. These issues included,
among others, land fractionation-where multiple interests in a tract of
land make mortgaging difficult, if not impossible. In addition, a 2006
report by the Department of Veterans Affairs found that Native American
veterans are less likely to own their own homes than veterans in
general. Do you think there has been improvement in addressing any of
these problems identified in either report?
Answer. As has been stated in our response to Chairman Akaka's
questions, there has been an improvement in the way the Department of
Veterans Affairs administers the Native American Direct Loan program,
especially the increase in the loan limits, and in VA's notable
outreach to tribes and tribal organizations. However, Federal agencies
could greatly improve access to housing programs with better
coordination and communication among themselves. There are multiple
Federal programs for housing assistance. A February 2012 General
Accountability Office (GAO) report identified 51 areas where programs
could be more effective in providing housing services , including the
areas of affordable housing (low income), green building, and housing
counseling programs. Tribes and their housing departments are keenly
aware that some programs within HUD, USDA, and the Veterans
Administration often serve the same purposes yet rarely coordinate
their programs or administrative requirements.
Question 1a. How should the issues identified in these reports be
addressed?
Answer. There are two primary areas that need to be considered when
addressing the issues identified in these reports. The first is the
need for data and the second is the need for infrastructure development
in tribal areas.
Tribes need guidance on the nature of the data required by Congress
and the Administration. Tribes consistently hear the refrain, ``you
need to give us more data!'' However, tribes rarely receive guidance on
what kinds of data are actually useful to policy makers and
Administration officials. In the absence of such guidance, there is no
consistency to the data that is collected and reported across the
country. Meaningful data must be focused and consistent across the
board, and data should center on building a robust, reliable, and
representative quantification of the tribal housing conditions and
needs. It is noteworthy that twenty years ago the final report of the
National Commission on American Indian, Alaska Native and Native
Hawaiian Housing, the Commission explained that, ``Various agencies
have presented testimony establishing the current housing needs for
Native Americans at somewhere near 100,000 units of new housing. Almost
no specific information exists that would profile, tribe by tribe, the
typical family waiting for assistance.'' We now estimate that there are
250,000 units needed in Indian Country, and still, the Federal
government has not found nor identified a means by which to provide
this information.
Sound physical infrastructure is vital for housing to be an engine
of economic development. Challenges to physical infrastructure
development include access to capital and financing, conflicting
statutory and regulatory provisions, and a need for comprehensive
planning. HUD does not collect grantees' infrastructure plans nor does
it measure their investments in infrastructure for affordable homes
funded by the Indian Housing Block Grant program (See GAO Report
February 2010). There is an acute need for sanitation-related
infrastructure for Indian housing in general, and the GAO survey
indicated a significant need for sanitation infrastructure for HUD
assisted housing. Nothing in Indian County compares to the tax base
available to municipal, county, and State governments. There are
limited examples of tribes and tribal communities developing a revenue
stream through taxation and providing basic community development and
infrastructure. Bonding and other methods to raise capital are
desperately needed for infrastructure development.
______
Response to Written Questions Submitted by Hon. Daniel K. Akaka to
Randy Grinnell
Question 1. Your testimony covers many areas in which the IHS and
VA collaborate and coordinate services. For a Native veteran seeking
healthcare services, is there a one-stop shop available at IHS?
Answer. If an American Indian or Alaska Native (AI/AN) Veteran is
eligible for IHS, they can go to the nearest IHS facility for
healthcare services. If their need for services exceeds local capacity,
referral to the VA or private sector may be required.
Question 2. Will the VA/IHS MOU need to be updated every few years
to best serve Native veterans?
Answer. The 2010 MOU provides a framework for a broad range of IHS-
VA collaborations which is national in scope, with implementation
requiring local adaptation. As new opportunities present themselves,
updates to the existing MOU may be appropriate. The VA/IHS MOU will
also be reviewed on an annual basis by both agencies.
Question 3. Can you please discuss the importance of having
accurate data to properly serve Native veterans? Are there areas where
you can improve data collection and analysis to better serve Native
veterans?
Answer. Accurate data is important to properly serve Native
Veterans. Many AI/AN Veterans are eligible for health care services
from both the Veterans Health Administration (VHA) and the Indian
Health Service (IHS). Having accurate data helps IHS and VHA provide
quality healthcare services that are comprehensive, coordinated and
continuous. Exchanging data with the VA will improve data accuracy and
therefore services to AI/AN Veterans. For example, IHS meets regularly
with VA and DOD in planning for the Integrated Electronic Health Record
(iEHR); VA, DOD, and IHS staffs are designing the EHR interface and
care management functions. These activities will result in the ability
of IHS and VA to share medical records with appropriate privacy
protections and better coordinate care for American Indians and Alaska
Native Veterans that receive care in both health care systems.
Question 4. Are there mechanisms in place to measure the
effectiveness the MOU has had and will have in the future?
Answer. The IHS/VA MOU sets forth five mutual goals for serving AI/
AN Veterans. These goals include: (1) increasing access to and
improving the quality of health care and services offered to Native
Veterans by both agencies; (2) promoting patient-centered collaboration
and facilitating communication among VA, IHS, AI/AN Veterans, Tribal
and Urban Indian Health Programs; (3) establishing, in consultation
with Tribes, effective partnerships and sharing agreements in support
of AI/AN Veterans; (4) ensuring appropriate resources are identified
and available to support programs for AI/AN Veterans; and (5) improving
health promotion and disease prevention services to AI/AN Veterans to
address community-based wellness. VA and IHS staff are working together
to support these goals and have established action items and target
dates for deliverables. Where appropriate, VA and IHS staff also
document outreach activities resulting from the MOU partnerships and
the number of AI/AN Veterans impacted by such activities. IHS Senior
leaders are required in their performance evaluations to describe
measurable activities and accomplishments that promote implementation
of the VA-IHS MOU each year.
______
Response to Written Questions Submitted by Hon. John Barrasso to Randy
Grinnell
Question 1. In 2010, the Indian Health Service and the Department
of Veterans Affairs established a Memorandum of Understanding outlining
a plan for coordination, collaboration, and resource sharing. However,
a prior interagency agreement for the same purposes has been in
existence since 2003. Tribes have contended that no action has been
taken by your agency to improve services despite the existence of these
two agreements. How will the 2010 Memorandum of Understanding be
implemented more effectively that the prior agreement?
Answer. The IHS/VA MOU sets forth five mutual goals for serving AI/
AN Veterans, as outlined above. To further these goals, IHS and VA
staff actively collaborate and coordinate activities targeted at the
twelve strategic objectives. These strategic objectives include: (1) to
increase access to services and benefits of IHS and VA; (2) to improve
coordination of care, including co-management, for AI/AN Veterans
served by both IHS, Tribal, or Urban Indian health programs and VA; (3)
to improve care through the development of health information
technology; (4) to enhance access through the development and
implementation of new modules of care using new technologies; (5) to
improve efficiency and effectiveness of both VA and IHS at a system
level; (6) to increase availability of services, in accordance with
law, by the development of payment and reimbursement policies and
mechanisms; (7) to improve the delivery of care through active sharing
of care process, programs, and services; (8) to increase cultural
awareness and culturally competent care for VA and IHS beneficiaries;
(9) to increase capability and improve quality through training and
workforce development; (10) to increase access to care through sharing
of staff and enhanced recruitment and retention of professional staff;
(11) to address emergency, disaster, and pandemic preparedness and
response; and (12) to accomplish the broad and ambitious goals of this
agreement through the development of a joint implementation taskforce.
Following the release of the MOU in November, 2010, the IHS Director
instructed each of the IHS Area Directors to meet with their regional
VA counterparts on how to better coordinate services between IHS and
the VA under the MOU in their respective regions and their progress is
measured in their annual performance evaluations.
Question 2. The 2010 Caregiver and Veterans Omnibus Health Services
Act allows, in certain circumstances, electronic transfers of health
records of Indian Veterans between Indian Health Service and the
Department of Veterans Affairs with appropriate privacy protections.
This Act was intended, in part, to provide seamless health care
services to these Veterans. What is the status on the implementation of
this Act?
Answer. Since the VA-IHS 2010 MOU, VA and IHS staff have been
working on twelve strategic objectives to improve AI/AN Veteran's
health services and care. Strategic objectives 3 and 4 highlight
efforts to improve health care services:
Strategic Objective 3: Health Information Technology
Purpose: Development of Health Information Technology
Major Tasks: Share technology; interoperability of systems;
develop processes to share information on development of
applications and technologies; and develop standard language
for inclusion in sharing agreements to support this
collaboration.
Accomplishments:
Consultation on EHR Certification and Meaningful Use: the
agencies continue to actively consult on EHR Certification and
Meaningful Use requirements.
ICD-10 Development and Implementation: staff have met to
design system changes to VistA and Resource & Patient
Management System (RPMS) in preparation for transition to ICD-
10.
Bar Code Medication Administration: staff have met to define
scope, support agreement, and needs to leverage VA experience
with Bar Code Medication Administration in support of potential
use in IHS and Tribal hospitals.
VA-DOD EHR: IHS meets regularly with VA and DOD in planning
for the Integrated Electronic Health Record (iEHR); VA, DOD,
and IHS staffs are designing the EHR interface and care
management functions. These activities will result in the
ability of IHS and VA to share medical records with appropriate
privacy protections and better coordinate care for American
Indians and Alaska Native Veterans that receive care in both
health care systems.
Both agencies will be participating in health information
exchange through the Nationwide Health Information Network
(NwHIN). NwHIN is a group of federal agencies and private
organizations that have come together to securely exchange
electronic health information. NwHIN ``onboarding'' (process to
join the Exchange) is underway in IHS and should be complete
for all federal facilities by the summer of 2013. Through NwHIN
Connect, IHS and Tribal providers will be able to download
(``pull'') summary of care documents for any VA patient (or,
for that matter, any patient whose private sector provider
participates in Health Information Exchange (HIE)), and vice
versa. Also, as part of Meaningful Use, IHS will be adopting
the Direct Exchange protocols, which will allow IHS providers
to deliver patient records to any trusted entity such as a VA
hospital or provider. This solution is scheduled for
implementation in 2014.
Strategic Area 4: Implementation of New Technologies
Purpose: Development and implementation of new models of care
using new technologies.
Major Tasks: Tele-health services; mobile communication
technologies; enhanced telecommunications infrastructure; share
training programs to support these models of care; and share
knowledge gained from testing new models.
Accomplishments:
Completed best practices for providing telepsychiatry
services to AI/AN Veterans.
Established videoconferencing connectivity between Prescott
VA and the IHS Chinle facility to implement telemedicine
services, connection made Aug. 2011.
Coordination of network-to-network connectivity for
videoconferencing with Work Group 3--Health Information
Technology.
Explored mVET program (a VA program that targets prevention
of acute crises which lead to death among homeless Veterans)
within the context of the MOU collaborative (Work Group 4--to
enhance access through the development and implementation of
new models of care using new technologies), to provide homeless
vets with a smart phone with ``life-line'' apps.