[Senate Hearing 119-122]
[From the U.S. Government Publishing Office]
S. Hrg. 119-122
DELIVERING ESSENTIAL PUBLIC HEALTH AND
SOCIAL SERVICES TO NATIVE AMERICANS_
EXAMINING FEDERAL PROGRAMS SERVING NATIVE
AMERICANS ACROSS THE OPERATING DIVISIONS
AT THE U.S. DEPARTMENT OF HEALTH AND
HUMAN SERVICES
=======================================================================
HEARING
before the
COMMITTEE ON INDIAN AFFAIRS
UNITED STATES SENATE
ONE HUNDRED NINETEENTH CONGRESS
FIRST SESSION
__________
MAY 14, 2025
__________
Printed for the use of the Committee on Indian Affairs
GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT
COMMITTEE ON INDIAN AFFAIRS
______
U.S. GOVERNMENT PUBLISHING OFFICE
60-911 PDF WASHINGTON : 2025
LISA MURKOWSKI, Alaska, Chairman
BRIAN SCHATZ, Hawaii, Vice Chairman
JOHN HOEVEN, North Dakota MARIA CANTWELL, Washington
STEVE DAINES, Montana CATHERINE CORTEZ MASTO, Nevada
MARKWAYNE MULLIN, Oklahoma TINA SMITH, Minnesota
MIKE ROUNDS, South Dakota BEN RAY LUJAN, New Mexico
JERRY MORAN, Kansas
Amber Ebarb, Majority Staff Jennifer Romero, Minority Staff
Director Director and Chief Counsel
Lucy Murfitt, Chief Counsel Caroline Ackerman, Legislative
Anna Powers, Senior Professional Assistant
Staff Alanna Purdy, Policy Advisor
Sarah McKinnis, Legislative
Assistant
Katie Bante, Health Policy Fellow
C O N T E N T S
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Page
Hearing held on May 14, 2025..................................... 1
Statement of Senator Cortez Masto................................ 53
Statement of Senator Lujan....................................... 54
Statement of Senator Murkowski................................... 1
Statement of Senator Rounds...................................... 3
Statement of Senator Schatz...................................... 2
Statement of Senator Smith....................................... 51
Witnesses
Alkire, Hon. Janet, Chairwoman, Standing Rock Sioux Tribe;
Representative, National Indian Health Board................... 4
Prepared statement........................................... 6
Charlie, Melissa, Executive Director, Fairbanks Native
Association.................................................... 21
Prepared statement........................................... 23
Daniels, Dr. Sheri-Ann, CEO, Papa Ola Lokahi..................... 31
Prepared statement........................................... 32
Greninger, Hon. Loni, Vice Chairwoman, Jamestown S'Klallam Tribal
Council........................................................ 14
Prepared statement........................................... 16
Simpson, Lucy R., Executive Director, National Indigenous Women's
Resource Center................................................ 27
Prepared statement........................................... 28
Appendix
American Indian Higher Education Consortium, prepared statement.. 67
Baker, Hon. Melvin J., Chairman, Southern Ute Indian Tribe,
prepared statement............................................. 82
Crevier, Francys, Algonquin/CEO, National Council of Urban Indian
Health (NCUIH), prepared statement............................. 70
Garcia, Donnie, Chairman, Albuquerque Area Indian Health Board,
Inc., prepared statement....................................... 65
Kana`iaupuni, Shawn M., Ph.D., President/CEO, Partners in
Development Foundation (PIDF), prepared statement.............. 78
Knowlton, Stephanie, Program Coordinator, Fort Peck Tribal Court,
prepared statement............................................. 69
Letters submitted for the record
Lucero, Esther, MPP, President/CEO, Seattle Indian Health Board,
prepared statement............................................. 80
Lujan, Eileen J., Board Member, National Indian Council on Aging,
prepared statement............................................. 70
Pesina, Andrea, President, National Indian Head Start Directors
Association (NIHSDA), prepared statement....................... 74
Response to written questions submitted by Hon. Ben Ray Lujan to:
Hon. Janet Alkire............................................ 96
Melissa Charlie.............................................. 99
Hon. Loni Greninger.......................................... 107
Response to written questions submitted by Hon. Lisa Murkowski
to:
Hon. Janet Alkire............................................ 93
Hon. Loni Greninger.......................................... 103
Lucy R. Simpson.............................................. 107
Response to written questions submitted by Hon. Brian Schatz to:
Hon. Janet Alkire............................................ 94
Melissa Charlie.............................................. 97
Dr. Sheri-Ann Daniels........................................ 99
Hon. Loni Greninger.......................................... 105
Lucy R. Simpson.............................................. 107
Rowland, Jennifer, prepared statement............................ 80
Sunday-Allen, Robyn, CEO, Oklahoma City Indian Clinic (OKCIC),
prepared statement............................................. 76
United South and Eastern Tribes Sovereignty Protection Fund (USET
SPF), prepared statement....................................... 85
DELIVERING ESSENTIAL PUBLIC HEALTH
AND SOCIAL SERVICES TO NATIVE
AMERICANS--EXAMINING FEDERAL
PROGRAMS SERVING NATIVE AMERICANS
ACROSS THE OPERATING DIVISIONS AT
THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
----------
WEDNESDAY, MAY 14, 2025
U.S. Senate,
Committee on Indian Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 3:39 p.m. in room
628, Dirksen Senate Office Building, Hon. Lisa Murkowski,
Chairman of the Committee, presiding.
OPENING STATEMENT OF HON. LISA MURKOWSKI,
U.S. SENATOR FROM ALASKA
The Chairman. Good afternoon. Calling this oversight
hearing to order.
We are here this afternoon to examine critical programs
within the U.S. Department of Health and Human Services that
are also essential to upholding the Federal Government's trust
responsibility for the health and well-being of Native
communities, but that are not under the Indian Health Service.
As we look broadly at the programs within HHS, we have to
remember that for many Native communities, non-IHS programs are
just as important as those under the IHS. From public health
initiatives to social services, these programs often provide
the only consistent access to basic supports for the most
vulnerable members of Native communities.
So, what programs are we talking about? It is Tribal Head
Start, that helps young children grow up healthy and rooted in
culture, it is LIHEAP, that ensures tribal elders have heat in
the winter and air conditioning in the summer. These aren't
just Federal services, they are really critical components of
the social safety net. My view is that these programs support
family stability, child development and basic dignity.
So today, we are going to also hear about HHS programs like
FVPSA, which is the Family Violence Prevention and Services
Act. This is the primary Federal funding stream supporting
vital crisis services and shelters for those experiencing
family violence.
We will also hear about how tribes are reducing the risk of
costly intervention and foster care removals through child
welfare services and Tribal TANF. These programs help break
intergenerational cycles of trauma, support safe housing and
equip Native families with the tools to thrive.
Many tribes have built these effective programs over
generations, investing their own resources, training their own
workforce so that they better align with their culture and
community needs. These are models of local innovation and
sovereignty, and they deserve both protection and sustained
support.
Given the scope and critical nature of these HHS programs,
we are hearing growing concerns from tribes and Native
communities about the executive order on optimizing the
workforce across the Federal Government and the HHS
announcements about reorganization and RIFs. I hear regularly
from constituents that are asking, how do these proposals
affect me and the delivery of essential services?
I want to acknowledge and thank Senator Kennedy for
recognizing the importance of IHS very early on. He made clear
that they were not going to be subject to those RIFs. Now we
are asking for the same understanding for other programs at
HHS. And that starts with tribal consultation at HHS on these
programs. I think it has to occur early, be consistent and be
meaningful.
We know that when tribes are truly engaged in shaping the
policies and programs that serve their citizens, outcomes
improve, trust deepens, and Federal resources are more
effectively aligned with local priorities. These programs work
best when they reflect the voices of the people that they are
meant to serve.
Forums like this hearing are also important. This is your
opportunity to formally make your case for these programs to
the Legislative Branch. But we also know that HHS will take
notice, too.
I was in a hearing that began at 1:30 before the Health
Committee, and Secretary Kennedy was there. I had alerted him
that we were having this oversight and he said, if he wasn't in
that hearing he would be here as well, which I appreciate. And
I think perhaps some of his team, if they are not here in the
room, they might be watching or listening.
So I think what we learn today is not just going to be
confined to this room, this audience, but broader.
I want to thank all of you for traveling with us to be here
today or if you are here in D.C., your journey is a little bit
easier. But I know your time and expertise are invaluable. The
insights that you share will help inform our continued work to
strengthen Federal programs and uphold the promises made to
Native communities. So I am looking forward to your
testimonies.
I now turn to Vice Chair Schatz for his comments.
STATEMENT OF HON. BRIAN SCHATZ,
U.S. SENATOR FROM HAWAII
Senator Schatz. Thank you, Chair Murkowski. I want to
extend a special warm aloha to Dr. Sherri-Ann Daniels, CEO of
Papa Ola Lokahi. Papa Ola Lokahi is the sole entity responsible
for coordinating Native Hawaiian health care services, and is a
leading voice for health care across the State of Hawaii.
Mahalo for your continued leadership on behalf of Native
Hawaiian people.
Providing health care is one of the Federal Government's
most fundamental trust and treaty responsibilities to American
Indians, Native Hawaiians and Alaska Natives. And delivering on
that promise depends on over a dozen HHS agencies, not just the
Indian Health Service.
For Native Hawaiians in particular, HHS's trust
responsibility extends far beyond just HRSA. But despite a lot
of promises from the Secretary from the Secretary about
strengthening Native health care and addressing longstanding
issues, we have seen that this administration is engaging in
staff layoffs, office closures, funding freezes and proposed
budget cuts that will undermine the quality of care and
overwhelm a health care system that, frankly, is already on the
brink.
Native people are among the most vulnerable in health terms
in the Country, falling behind on almost every metric. They
experience some of the highest rates of cancer, heart disease,
respiratory illness, diabetes, overdose and suicide, and their
life expectancy is the lowest of any racial group in the United
States and nearly 10 years below the national average.
So the status quo was insufficient to begin with. Then came
the sweeping cuts at CDC, NIH, HRSA, SAMHSA, ACF, and other
offices and programs. A CDC team supporting overdose prevention
in tribal communities was reduced from seven staffers to a
single human who is now responsible for managing millions of
dollars in funding. The Healthy Tribes Program, which is
focused on preventing certain chronic diseases, was gutted.
Five HHS regional offices, which served 461 tribes in 22
States, terminated staff and were abruptly closed in March.
All of this means that Native communities have less support
for job training, child care, domestic violence victim
services, suicide and substance abuse prevention, and much
more. These cuts are being carried out without any tribal
consultation whatsoever in plain violation of our trust and
treaty responsibilities.
This is not just a moral question of what we owe Native
people; it is also a question of the law. Let's be clear: the
status quo was already insufficient. The administration's
proposed cuts of nearly $1 billion to Native health care will
make matters worse.
There is bipartisan agreement on this Committee that these
communities need more help. Now is the time to stand together
to protect Native health care.
I want to thank our witnesses, and I look forward to the
hearing.
The Chairman. Thank you, Senator Schatz.
We will now turn to the witnesses. I am going to turn to
our colleague from South Dakota to do the first introduction.
STATEMENT OF HON. MIKE ROUNDS,
U.S. SENATOR FROM SOUTH DAKOTA
Senator Rounds. Thank you, Madam Chair and Vice Chair. I
want to thank our witnesses as well for taking the time to
attend today's hearing and share your perspectives.
Today I am proud to introduce my friend, Chairwoman Janet
Alkire, of the Standing Rock Sioux Tribe.
After retiring as a staff sergeant in the U.S. Air Force,
Chairwoman Alkire returned home to serve the Standing Rock
Sioux Tribe. During this time, she oversaw the daily operations
of tribal government programs while serving two terms as the
Executive Director. In 2021, Janet became the first woman ever
elected by the people as Chairwoman of the Tribe.
Chairwoman Alkire provides an important voice on several
key tribal issues, including health care, public safety and
economic development. In recognition of her leadership and
advocacy, Chairwoman Alkire was named one of USA Today's women
of the year in 2025. Not bad. Congratulations. Matter of fact,
congratulations.
She continues to advocate for her people as a board member
of the National Indian Health Board.
I want to again thank Chairwoman Alkire and all the other
witnesses for attending today's hearing. Thank you, Madam
Chair.
The Chairman. Thank you.
I will make full introduction of everyone, then we will
begin with individual statements. Following Chairman Alkire, we
have the Honorable Loni Greninger. She is the Vice Chair of
Jamestown S'Klallam Tribal Council from Sequim, Washington.
We also have, from Fairbanks, Alaska, Melissa Charlie.
Melissa is currently the Executive Director of Fairbanks Native
Association. She is a tribal citizen of Minto, and has been
involved in many, many leadership capacities in her region.
She is focused and committed to early childhood development
and community wellness. We really appreciate the fact that you
have traveled so far to be with us, Melissa.
Following Melissa, we have Lucy Simpson, the Executive
Director for the National Indigenous Women's Resource Center
from Lame Deer, Montana, as well as Dr. Sheri-Ann Daniels, who
the Vice Chairman has already introduced. I am just going to
try to say it, is the Chief Executive Officer of the Papa Ola
Lokahi, from Honolulu. It is good for us to be working through
the names and doing them correctly to show that respect.
I want to remind everyone that we do have your full
testimony that each member has. We would ask you to try to keep
your comments to five minutes so that we can have questions
following your statements.
So Chairman Alkire, you may begin with your testimony.
STATEMENT OF HON. JANET ALKIRE, CHAIRWOMAN,
STANDING ROCK SIOUX TRIBE; REPRESENTATIVE,
NATIONAL INDIAN HEALTH BOARD
Ms. Alkire. Good afternoon, Chairwoman Murkowski, Ranking
Member Schatz, and distinguished members of the Committee. On
behalf of the National Indian Health Board and the 574
sovereign federally-recognized tribal nations we serve, thank
you for this opportunity to provide testimony today.
My name is Janet Alkire. I serve as the Chairwoman of the
Standing Rock Sioux Tribe. I also serve as the Great Plains
Representative for the National Indian Health Board. I am
Hunkpapa Lakota, a descendant of the Lakota leaders who signed
the 1868 Fort Laramie Treaty.
I am a beneficiary of the treaty and trust obligations
enshrined in that agreement, which continue to shape the rights
of our people in Indian Country.
The Department of Health and Human Services delivers vital
programs to tribal nations and citizens from a part of the
Federal Government's trust and treaty obligations. These
services, many beyond Indian Health Service, are essential to
the health and well-being of our citizens. As tribal leaders,
we are deeply concerned about the ongoing HHS reorganization
and its far-reaching consequences for serving tribal nations
and their citizens.
Despite chronic underfunding, tribal nations, tribal
organizations and Urban Indian Organizations rely on HHS
resources to deliver lifesaving care. Tribes have long
supported efforts to streamline Federal programs, reduce
reporting burdens and direct funding to the Indian health
system.
However, any reorganization must honor treaty and trust
obligations, including meaningful consultation. We have urged
HHS to hold consultations to ensure programs that serve tribal
nations and citizens are protected. To date, the organization
has reduced HHS staff by 24 percent, disrupting grant access,
tribal advisory committees, and causing tribal program staff to
leave.
This has already resulted in the cancellation of over $6
million in grants, jeopardizing critical infrastructure for the
Indian health system. The Great Plains is experiencing a
syphilis epidemic, with rates among Native people rising to
1,865 percent from 2020 to 2022, ten times the national
average. The CDC played a key role in the response, but the
recent restructuring cut nearly 20 percent of its staff,
including those staff supporting our tribal epidemiology
center.
OASH, Office of Infectious Disease, HIV/AIDS Policy also
lost staff, ending a program that awarded $16 million to 18
tribal and Urban Indian Organizations, improved HIV outcomes by
over 90 percent at the Phoenix Medical Center. This leaves us
without essential Federal STI response support.
Additionally, the majority of the staff operating Healthy
Tribes Program under CDC, which oversees several grants,
including good health, wellness in Indian Country, grantees are
receiving conflicting information about their grants and the
programs are in limbo. One tribal grantee has already received
notice of determination. A UIO has reported losing
communication with their project officer and grants manager,
leaving a critical gap in their program.
CDC's Division of Reproductive Health is a huge component
for tracking maternal health and outcomes nationwide, including
Native moms. These staff were also placed on administrative
leave and updates to the pregnancy risk assessment monitoring
system, one of the few national data sources that tracks Native
maternal and infant health disparities, has been paused.
Because of this, we are losing vital tools for identifying
risks, interventions and saving lives.
SAMHSA's Center for Mental Health Services has seen major
staffing cuts. Key tribal behavioral health grants have been
terminated or left in limbo. Even when funding has been removed
temporary disruptions in funding can destabilize programs.
The Great Plains Tribal Leaders Health Board is connecting
with our youth program, which applies traditional Lakota values
to reduce suicide through mentorship and culturally grounded
education is at risk. This program reduced Native youth
suicides in our area by 78 percent from 2019 to 2024.
Successful outcomes like this shows what is at stake.
In conclusion, programs serving tribal nations and their
citizens have a minimal fiscal impact, but are foundational to
improving chronic health conditions in Indian Country. Tribes
share a vision for a healthy America, but tribes must be
consulted in the first instance.
Tribes want to work with HHS. I appreciate what the
Secretary has done so far to protect our health. We want
efficiency to reduce grant reporting, provide direct funding to
tribes instead of reliance on State block grants, expand tribal
self-governance outside the IHS.
We must avoid barriers such as DOGE Defend the Spend, which
increased burdens and withheld funding from programs serving
tribes and its citizens. We can be the solution to a more
efficient HHS.
I thank the Committee for this opportunity to provide this
testimony. Wopila.
[The prepared statement of Ms. Alkire follows:]
Prepared Statement of Hon. Janet Alkire, Chairwoman, Standing Rock
Sioux Tribe; Representative, National Indian Health Board
Chairwoman Murkowski, Ranking Member Schatz, and distinguished
members of the Committee, on behalf of the National Indian Health Board
(NIHB) and the 574+ sovereign federally recognized American Indian and
Alaska Native (AI/AN) Tribal Nations we serve, thank you for this
opportunity to provide testimony on Delivering Essential Public Health
and Social Services to Native Americans. My name is Janet Alkire, and I
serve as the Chairwoman of the Standing Rock Sioux Tribe. I also serve
as the Great Plains Representative to the NIHB. I am Hunkpapa Lakota--a
descendant of the Lakota leaders who signed the 1868 Fort Laramie
Treaty. I am a beneficiary of the Treaty and Trust obligations
enshrined in that agreement, which continue to shape the rights of our
people and Indian Country as a whole. I am also a proud veteran of the
United States Air Force.
The NIHB is concerned about the implementation of reorganization of
the Department of Health and Human Services (HHS) and its significant
implications for Tribal Nations and Tribal-serving programs. HHS
programs, including those agencies and operational divisions outside
the Indian Health Service (IHS), are a critical support to Tribal
Nations, their citizens, and their communities, and HHS programs are an
integral part of the federal trust responsibility to Tribes. For
example, in FY 24, HHS provided Great Plains Area Tribes and Tribal
organizations approximately $124 million in funding, less than 0.002
percent of the HHS budget, which supports life-saving programs that
address some of the most extreme health disparities in the nation.
Although Tribes support efforts to improve efficiency within HHS, any
reorganization, reduction in force, and changes to this funding must be
conducted in a manner that upholds the federal trust and treaty
obligations to Tribal Nations. An obligation for which Tribes have pre-
paid for centuries through land and resources. We have urged HHS to
promptly schedule a series of Tribal Consultations to discuss the
implications for Tribal Nations and ensure that Tribal-serving
programs, set-asides, and staff are preserved.
The United States maintains a unique political, legal, and
historical relationship with Tribal Nations, established and affirmed
by the Constitution, federal law, Supreme Court rulings, and executive
orders. Born out of this relationship is the federal government's trust
responsibility--including the duty to provide the necessary resources
to deliver high-quality healthcare to AI/AN people.
The reorganization of HHS is part of the implementation of
Executive Order 14210, ``Implementing the President's `Department of
Government Efficiency' Workforce Optimization Initiative'', signed on
February 11, 2025. The implementation of this Executive Order through
the reorganization of HHS has resulted in the immediate reduction of
full-time employees at the Department by no less than 24 percent. The
reduction in staff has impacted grant funding access and distribution
to Tribes, the operation of Tribal Technical Advisory Committees, and
is causing remaining Tribal program staff to seek opportunities outside
federal employment. Without Tribal Consultation, Tribal Nations have
already incurred significant harm, including the abrupt cancellation of
no less than $6 million in grants from various HHS agencies--
jeopardizing the sustainability of health and public health systems in
Indian Country.
One pattern NIHB has noted is the preservation of divisions of
Tribal affairs (DTA) within HHS' agencies and operational divisions.
This is a positive recognition of the importance of these offices and
their staff. These DTAs, however, are frequently only engagement-level
offices, and do not host critical programs and funds supporting
services in Indian Country. It is the programmatic offices, discussed
in this testimony, which work to meet the trust and treaty obligations
for healthcare. All of this impacts the ability of HHS programs to
deliver on the trust and treaty obligations to Tribal Nations.
Centers for Disease Control and Prevention
Under this reorganization, several key public health programs have
been impacted, including the National Center for Injury Prevention and
Control (NCIPC) in AI/AN Communities, Healthy Tribes, the Reproduction
Health Division (RHD), and Pregnancy Risk Assessment Monitoring System
(PRAMS). Further, the Center for Chronic Disease Prevention and Health
Promotion would face elimination, including the elimination of its
Maternal and Infant Health branch, Division of Oral Health, Division of
Diabetes Translation, the Division of Cancer Prevention and Control,
and the Office of Smoking and Health. These programs provide critical
support to Tribal providers nationwide on healthcare disparities
impacting our communities.
We have received troubling reports that the seven-member Tribal
Support Team within the NCIPC in AI/AN communities has been reduced to
just one remaining staff member. This small team but essential team,
was responsible for managing $18 million in funding that directly
supports 15-Tribes and Tribal organizations, ten Tribal epidemiology
centers, and seven urban Indian organizations. The NCIPC was one of few
HHS divisions deeply committed to developing tribally centered injury
prevention initiatives, particularly those focused on healing from the
devastating impacts of the overdose crisis in Indian Country. Grantees
under this program have implemented culturally responsive overdose-
prevention strategies including sweat lodges, smudging, talking
circles, engaging in ceremony, and other culturally centered practices.
In many rural and remote areas, these programs represent the only
available treatment services for hundreds of miles. The Tribal Support
Team served as a lifeline for individuals and families and their
dismissal will undoubtedly harm access to treatment for AI/AN
populations.
The proposed cancellation of Healthy Tribes funding agreements and
termination of staff as part of the agency's reduction in force has
already impacted the delivery of three critical projects, including
Good Health and Wellness in Indian Country (GHWIC), Tribal Practices
for Wellness in Indian Country, and Tribal Epidemiology Centers Public
Health Infrastructure. These programs, while representing a minimal
fraction of federal spending, are lifelines in Indian Country. In at
least one instance, a grantee has already received notice of the
termination of the Good Health and Wellness in Indian Country funding.
Some Tribal programs have already received termination notices for
their GHWIC grants.
The dismantling of RHD and the suspension of PRAMS would decimate
the limited maternal and child health surveillance tools available to
AI/AN communities. PRAMS is already not being updated and data not
being tracked due to staff layoffs. PRAMS is one of the few national
data sources that tracks maternal and infant health disparities in AI/
AN populations. Without it, federal and Tribal health agencies will
lose a vital tool for identifying risks, informing interventions, and
saving lives. The provisional data released last month by the National
Center for Health Statistics shows that maternal mortality has started
to rise again after two years of declining mortality rates. \1\ We need
these data sets now more than ever. Likewise, the reduction of RHD
staff has stripped Tribal communities of critical technical assistance.
We are already aware of Hear Her campaign staff being let go
interrupting resources available to pregnant women, families, and
healthcare professionals. It remains unclear whether funding will
continue for Maternal Mortality Review Committees (MMRCs) which are
vital to preventing maternal deaths in local communities.
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\1\ CDC National Center for Health Statistics, April 9, 2025.
Maternal Mortality Surveillance, Provisional Maternal Death Rate.
Accessed 5/11/2025: https://www.cdc.gov/nchs/nvss/vsrr/provisional-
maternal-deaths-rates.htm.
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In reviewing the publicly available information, the new proposed
reorganization of CDC centers would focus funding and efforts into the
National Center for State, Tribal, Local, and Territorial Public Health
Infrastructure and Workforce. We commend the need to provide more
direct funding to Tribes and Tribal organizations for this work, but to
date we have not seen this. In fact, in 2022, the CDC denied Tribes
access to public health infrastructure funding, claiming that funding
had been sent to IHS which was then rescinded from IHS by Congress in
2024. Any refocusing of the agency to send more funding to States and
local governments directly must include direct funding sources to
Tribal programs.
CDC has also seen a nearly 20 percent reduction in staffing which
has had an impact on public health response in Indian Country. CDC,
particularly Commissioned Corps staff, frequently do temporary duty
stations or tours in areas with extreme public health need. Because of
the extreme disparities in Indian Country, there are frequent tours to
address public health needs in our communities. One individual working
with the Great Plains Tribal Epidemiology Center (TEC) raised concern
about several staff from CDC who have been terminated who did several
tours with their TEC to address a public health crisis in their region.
Following the termination of these staff, the individual shared that
the response efforts would not be possible now because those
individuals' positions do not exist anymore. This also includes the
technical assistance their CDC division provides on capacity to test
samples and other clinical/lab approaches to the crisis. Those types of
positions are vital to the work that they have done related to syphilis
and other STIs that may come around again. It is quite concerning;
these positions just do not exist anymore.
HHS also cut funding for the Strengthening Public Health System and
Services in Indian Country that was a data modernization initiative
project. We understand it was due to funding being attached to COVID
supplements, but for Indian Country this funding is vital to modernize
our healthcare infrastructure in the face of chronic underfunding.
Other COVID-linked funding has also been terminated for things
including support of Community Health Representative programs, supplies
including personal protective equipment, and funding for Tribal
vaccination programs. Many of our facilities are outdated and need new
equipment and modern electronic health record systems. Without this
funding Indian Country continues to be left out of modern advancements.
Health Resources and Services Administration
The Health Resources and Services Administration (HRSA) is proposed
to be rolled up into a new Administration for a Healthy America (AHA).
This concerns Tribes as there are a number of programs that Tribes rely
on programs delivered across HRSA's offices and bureaus. HRSA serves as
a grant-making agency but also provides technical support across
workforce, maternal and child health, rural healthcare, and supporting
access to underserved communities, including Tribes.
One of HRSA's primary functions is to develop and support the
healthcare workforce, and as part of that, HRSA administers the
National Health Service Corps and its loan and scholarship programs.
This is one critical source of funding to support providers who work in
Indian Country. The NHSC includes a 15 percent set aside for Tribes to
support recruitment and retention in our underserved communities. In
the middle of April, NIHB held a Tribal Townhall to get a better
understanding of the impacts of the HHS Reorganization on Tribal health
programs. The NHSC Loan Repayment program was raised as an example
where participating Tribal providers has received stop notices on their
repayments. Without the additional resources of the NHSC programs, our
communities will struggle to find providers. The Funding for Indian
Health Professions within the IHS budget is insufficient, and its loan
repayment and scholarship programs are not tax exempt like HRSA's
programs are.
HRSA's Maternal and Child Health programs are another important
source of funding to Indian Country. The President's FY 2026 Proposed
Budget, which begins to spell out what HHS Reorganization will look
like in detail, includes a recommended $274 million reduction to
maternal and child health programs. It explains these funds as
``duplicative'' and that they should be addressed through State block
grants. Most of this funding already goes to the States with no set
asides for Tribes, and consolidating the remaining funds will only
worsen this situation. AI/AN women are three times more likely to die
from pregnancy-related causes than non-Hispanic White (NHW) women \2\
and the AI/AN mortality rate is two times the rate of NHW population.
\3\ HRSA administers the Healthy Start program, which aims to improve
maternal and infant health outcomes, reduce infant mortality, and
address adverse perinatal conditions through Tribally tailored
programming. Several Tribal health programs receive this funding
enabling screenings, nurse visits, and the Tribal Home Visiting
program. Tribes and Tribal health programs only receive small portions
of funding for maternal and child health through programs, so some
Tribes also access funding through State allocations of HRSA funding.
Instead of pushing more funding to the State, we should be creating
Tribal set asides withing the Maternal and Child Health Block Grant.
The proposal to reduce funding and centralize these services at a
critical time for maternal health in Indian Country and the United
States could cause harm to Tribal programs.
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\2\ Petersen EE, Davis NL, Goodman D, et al. Racial/Ethnic
Disparities in Pregnancy-Related Deaths--United States, 2007-2016. MMWR
Morb Mortal Wkly Rep 2019;68:762-765. DOI: http://dx.doi.org/10.15585/
mmwr.mm6835a3
\3\ CDC, 2024. Infant Mortality in the United States, 2022: Data
from the Period Linked Birth/Infant Death File. National Vital
Statistics Reports, vol. 73, no. 5. Table 2.
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HRSA is also responsible for programs providing healthcare in
underserved communities. They do this through a series of programs
including the Health Professions Shortage Area designation process, the
section 340B program for reduce-cost pharmaceuticals, and the section
330 program which funds and provides technical assistance to Community
Health Centers (CHC) and Federally Qualified Health Centers. HHS's
proposal to dissolve HRSA into the new AHA without Tribal consultation
is concerning for the future of these programs. Specifically, 37 Tribal
and Urban Indian organizations participate in the section 330 grant
program, to ensure that their patients receive quality health services.
The proposed reorganization raises concerns about whether HRSA
programmatic support will be maintained or diminished in the
transition, which would affect continuity of care for Tribal citizens.
Some grantees have already reported delays in receiving payments or
only getting short-term grant renewals.
Office of the Assistant Secretary for Health (OASH)
The Office of the Assistant Secretary for Health (OASH) is a
critical operating division for many public health related activities
and programs. In the initial days following the mass termination of
employees within OASH, NIHB tracked staff departures that disrupted the
Office of Minority Health (OMH) and the Office of Infectious Disease
and HIV/AIDS Policy (OIDP). NIHB has heard from numerous Tribal leaders
that their OASH funding has been paused, withheld or terminated without
clear communication or consultation. Combined with the significant
reduction in force, Tribes are concerned about their current access to
resources and technical assistance from OASH. OASH has historically
provided support that is critical for addressing region-specific health
challenges such as chronic disease prevention, maternal health, youth
wellness, and behavioral health services. OASH is also one of the few
HHS divisions with a focus on community-level engagement and cross-
agency coordination.
For example, the OMH provided outreach and support to Tribal
communities and was working to implement a new Center for Indigenous
Innovation and Health Equity (CIIHE) to support the elimination of
health disparities in Tribal communities. This new center, created in
2021, was to help identify and disseminate evidence- and practice-based
interventions for AI/AN populations to improve public and healthcare
delivery in our communities. The CIIHE also include the Tribal advisory
committee (TAC) responsible for advising the Assistant Secretary of
Health. Without any details for what is happening to these programs,
Tribes and TAC members do not know how this program is moving forward.
Until the release of the FY 2026 President's Proposed Budget, it was
believed that OMH was eliminated in its entirety.
The OIDP develops, coordinates, and supports a range of infectious
disease initiatives including Ending the HIV Epidemic in the U.S., the
Minority HIV/AIDS Fund (MHAF), and actions to prevent healthcare-
associated infections. In 2022, AI/AN males were 1.8 times more likely
to have a diagnosis of HIV infection than NHW males and AI/AN females
were 1.6 times more likely to have AIDS. \4\ Many staff who oversaw
HIV/AIDS programming have already been eliminated impacting local
efforts. The Reorganization has terminated staff working on MHAF and
Ending the HIV Epidemic which is undermining lifesaving care and
prevention efforts for AI/AN individuals living with or at risk of HIV/
AIDs. Since 2012, HIV screening among adults/adolescents increased from
31 percent to 57 percent. In 2024, The Phoenix Indian Medical Center
achieved viral suppression of over 90 percent for people living with
HIV, leading Arizona's viral suppression rate. IHS was also able to
develop the national HIV/HCV/STI dashboard to monitor trends and
support outbreak response. Despite these advances, AI/AN communities
remain disproportionately impacted. HCV-related mortality is highest
among Native people. Congenital syphilis has increased by over 5,000
percent in the past decade, leading to preventable infant deaths.
Further, when we look at just the Great Plains Area, from 2020 to 2022,
syphilis rates among AI/AN people surged by 1,865 percent--that is ten
times the national rate. It will now be harder to track these types of
rate changes as well. Further, the staff responsible for tracking HIV,
HCV, and Syphilis data at CDC have been let go, and these data sets are
no longer being maintained. This data has been crucial to understanding
the spread of these diseases, particularly the syphilis epidemic in the
Great Plains. Without MHAF, OIDP, and the CDC's data tracking, IHS and
Tribes are losing their only dedicated federal funding source and
support for HIV, HCV, and STI response.
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\4\ Centers for Disease Control and Prevention (CDC), 2024. HIV
Surveillance Report: Diagnoses, Deaths, and Prevalence of HIV in the
United States and 6 Territories and Freely Associated States, 2022,
v.35. Tables 3a and 1a. https://stacks.cdc.gov/view/cdc/156509 (Back to
top)
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In FY25 alone, MHAF awarded $16 million to 17 Tribal health
organizations, with funding intended through FY29. The loss of this
support would dismantle programs and destabilize essential services,
particularly because these Tribal programs largely treat all STIs
concurrently and often support screenings in clinical environments
during regular check-ups, like for expecting mothers. This is also
coupled with uncertainty for HRSA's Ryan White program to treat HIV/
AIDS, which is often part of the larger strategy on HIV/AIDS/STIs and
is slatted for ``consolidation''. \5\ These programs provide treatment,
testing, and wraparound services that help reduce the spread of HIV and
other STIs and increase access to healthcare services and screenings.
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\5\ Office of Management and Budget, 2025. President's Proposed FY
2026 Budget. Accessed 5/9/25: https://www.whitehouse.gov/wp-content/
uploads/2025/05/Fiscal-Year-2026-Discretionary-Budget-Request.pdf.
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Administration for Community Living
The Administration for Community Living (ACL) plays a critical role
in delivering essential services under the Older Americans Act (OAA)
and is a lifeline for AI/AN Elders, people with disabilities, and other
vulnerable populations. ACL's funding structure ensures that resources
reach communities through state, Tribal, and local programs, supporting
wraparound services that are vital for maintaining independence,
dignity and quality of life. The proposal to eliminating the ACL
division would create gaps in care, destabilizing systems on which
communities have come to rely.
ACL's Office of Older Indians (OOI) oversees the OAA Title VI which
provides support for home and community-based care wrap around services
and nutritional support for Native Elders. These services are the only
direct Tribal programs to offer these important services enabling our
Elders to stay in community. Even though the Indian Health Care
Improvement Act (IHCIA) authorizes funds to support long-term services
for our Elders, Congress has never funded those provisions and no
Administration has ever requested such funding. This means that our
Elders' Programs are severely underfunded in Indian Country. Tribes
frequently turn to the State's Title III and other OAA funding to
support other wraparound services to our Elders. NIHB has heard that
the OOI staff have been preserved, but OOI staff are not responsible
for grant payment processing. As we understand it currently, ACL staff
responsible for the payment of grant awards have been let go without
notice to grantees. This has meant huge disruption to Tribes awaiting
funds.
This means that changes to all of ACL impact Tribal programs. The
proposed HHS reorganization states intent to dissolve ACL and move
programs to the Administration for Children and Families and the
Centers for Medicare and Medicaid Services. This would dismantle core
ACL programs, eliminate the Chronic Disease Self-Management Education
(CDSME) which empowers older adults to manage chronic conditions and
avoid costly medical services, and would transfer the National
Institute on Disability, Independent Living, and Rehabilitation
Research (NIDILRR), weakening evidence-based approaches to care. It is
also unclear what will happen to funding for the Native American
Caregivers Support, a program that provides critical assistance to
families caring for Elders.
ACL is the only agency that has programs working to keep Elders and
those with disabilities in their homes and communities. With the loss
of these programs, more and more preventable injuries and advanced
chronic conditions will fall to the Medicare and Medicaid programs--
frequently at higher costs than the preventive care being cut/reduced.
Keeping our Elders in community is also important for the preservation
of our cultures. Our Elders are the keepers of our knowledge, stories,
and culture; when they remain in community, they have stronger
relationships particularly with our youth who learn from them and carry
on our traditions. Without these programs, more of our Elders would
need to leave community--breaking these important cultural bonds. ACL's
ability to reach our vulnerable communities cannot be replicated by
transferring programs to the ACF and CMS. ACL programs are a critical
lifeline for older adults, AI/AN Elders, and individuals with
disabilities, and the transition of such programs could break the
process and institutions that currently deliver this lifeline of
funding.
National Institutes of Health
HHS Reorganization proposes to retain a much reduced National
Institutes of Health (NIH). The detail for a reorganized NIH can be
found in the President's FY 26 Proposed Budget which proposes a 42
percent decrease from FY 2025 and would eliminates several key
programs. The preservation of the Tribal Health Research Office and
staff has been essential to providing technical assistance to Tribes
and understand the cancelations or pauses of no less than 18 grants,
including one Native American Research Center for Health (NARCH) award.
NARCH is the premier health science grant recognizing excellence in AI/
AN health science research. Of the many Institutes proposed to be
closed in the NIH reorganization, we are concerned that it includes the
National Institute of Nursing Research, National Center for
Complementary and Integrative Health, and National Institute on
Minority Health and Health Disparities, which reports out data on AI/AN
populations. The proposal would also consolidate the remaining 23
institutes into a total of eight.
Tribal and Tribal research programs have already been impacted by
funding cuts, recissions, and direct funding cancelation. Tribes,
Tribal public health agencies, and Tribal research programs must be
exempted from any further disruptions to uphold the federal trust and
treaty obligation.
Substance Abuse and Mental Health Services Administration (SAMHSA)
SAMHSA programs save lives in Indian Country. In the Great Plains
Area, the Great Plains Tribal Leaders Health Board's (GPTLHB)
Connecting With Our Youth (CWOY) program, funded by SAMHSA. Based in
Pennington County, South Dakota, CWOY applies traditional Lakota
values--compassion, wisdom, generosity, and respect--to reduce youth
suicide through mentorship, advocacy, and culturally grounded
interventions. Partnering with the Rapid City Police Department, the
program offers early intervention and long-term support. From 2019 to
2024, CWOY achieved a 78 percent reduction in suicide deaths among
Native youth (ages 10-24), from 9 deaths to just 2. This has resulted
in a consistent year-over-year decline in suicide mortality and an 11
percent drop in suicide-related police calls in 2024. These outcomes
illustrate what is possible when federal investments are tailored to
community needs and delivered in partnership with tribal leadership.
SAMHSA programs also combat the substance use disorder crisis we
are facing. In 2022, 1,543 non-Hispanic AI/AN individuals died from
overdose, which was the highest overdose rate of any racial or ethnic
group. \6\ While we have successes, this data underscores the urgency
of expanding, not reducing, behavioral health resources in Indian
Country.
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\6\ Centers for Disease Control. (2024). Opioid Overdose Prevention
in Tribal Communities. Retrieved from: https://www.cdc.gov/injury/
budget-funding/opioid-overdose-prevention-in-tribal-communities.html
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SAMHSA's Center for Mental Health Services was one of the divisions
within the Agency that saw a massive staffing reduction. CMHS was
responsible for several Tribal behavioral health grant programs,
including the Circles of Care program and part of the Native
Connections grant program. Circles of Care was a program to strengthen
the mental health care infrastructure for Tribal communities. Native
Connections was a youth-focused behavioral health grant to Tribes.
While staff are no longer available, it is not clear what will happen
to these life-line programs; some Tribes have even heard from SAMHSA
staff that their Native Connections grants will be nonrenewed in the
2026 grant year.
The elimination of CMHS is not the only concern we have tracked at
NIHB. Tribal Behavioral Health Grants for Substance Use Disorder for a
particular Tribe were also terminated as reflected on a March 31, 2025
HHS Grants Termination List. Later iterations of the HHS Grants
Termination List \7\ have removed the line-items, which does not
clarify whether these grants have been restored. However, even if such
grants were restored--the act of terminating funding and restoring it
in the middle of a grant year severely impacts the work of the grantee
and can damage the programs reliant on these funds.
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\7\ HHS Grants Termination List can be found at https://
taggs.hhs.gov/Content/Data/HHS_Grants_Terminated.pdf (Last Accessed 5/
9/2025).
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Other critical funding streams for Tribes, such as the Tribal
Opioid Response Grants, have not yet been cut. However, without further
details of the proposal to relocate SAMHSA programs in the new AHA, it
is hard to understand exactly how much further Tribes will be impacted
by the HHS Reorganization to behavioral health programs. Eliminating
these programs will result in irreversible harm during a declared
Public Health Emergency on Opioids. \8\ Tribal behavioral health
systems are already chronically underfunded, and we cannot allow
prevention and treatment programs to disappear when AI/AN populations
need them most.
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\8\ RENEWAL OF DETERMINATION THAT A PUBLIC HEALTH EMERGENCY EXISTS,
March 18, 2025. Accessed 5/9/2025: https://aspr.hhs.gov/legal/PHE/
Pages/Opioid-Renewal-18Mar2025.aspx.
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Centers for Medicare and Medicaid Services
The Centers for Medicare and Medicaid Services (CMS) is a critical
agency in supporting the delivery of the trust and treaty obligations
for healthcare to Tribal Nations. The agency does this through the
administration and regulation of the Medicare, Medicaid, Children's
Health Insurance Program, and the federal and state Marketplaces.
Although the primary mission of the agency is to delivery these
healthcare coverage programs which have up to now been unaffected by
HHS reorganization, other administrative work and activities have been
impacted.
The CMS Office of Minority Health (OMH) had its entire staff
terminated in the days following the announcement of reorganization.
CMS OMH, like all offices of Minority Health throughout HHS, are
statutorily created by the Patient Protection and Affordable Care Act
(ACA). CMS OMH not only had programs supporting rural health and widely
used data, it also housed CMS' work on Health Equity. The CMS Framework
for Health Equity involved significant input by Tribes, particularly
through the CMS Tribal Technical Advisory Group (TTAG). The Framework
is now missing from the CMS OMH webpage, and there are no staff left to
support this work which included Tribal Nations.
CMS Administrative funding also supports critical programs for
outreach and education to support Americans access their healthcare
coverage programs. This includes funding to Tribes to support outreach
and enrollment focused on supporting Tribal citizens accessing Medicaid
and other healthcare coverage. Tribal Nations are concerned that this
funding may be in jeopardy because in the President's Proposed FY 26
Budget proposes doing away with such funding. It reads, ``[The Budget]
eliminates health equity-focused activities and Inflation Reduction
Act-related outreach and education activities.'' Outreach and
enrollment are critical activities and resources for Tribes.
Without additional information or context, it is hard to understand
how this will impact Tribal Nations.
Indian Health Service
Although the Indian Health Service has not been included in public
facing details about the proposed HHS Reorganization and broad
Reduction in Force initiatives, the Agency and its staff are impacted
by the loss of contacts and partners across their sister agencies. The
IHS works with agencies and offices to implement their programs,
provide effective public health programming, support staffing
recruitment and retention, and ensure services are available and
reimbursable. IHS providers, like all physicians and extenders, rely on
the guidance documents outlining standards of care, stable staffing,
and federal health care coverage to deliver the best care to AI/AN
people. When staff at other HHS agencies are terminated, the
government-wide hiring freeze is preventing new employees to fill those
roles depriving the IHS of technical assistance and support for outside
programs.
Although IHS staff have not been included in RIF actions, the
instability of sudden firings across the Department is creating an
environment of uncertainty which is making it even more difficult to
hire and retain providers and other healthcare professionals. The
healthcare industry in general has experienced significant attrition as
providers and healthcare professionals leave the industry, burnt out by
years of difficult work during the COVID-19 pandemic. HHS and IHS must
work to stabilize the workforce to ensure that we are able to attract
and retain the best providers. This includes the maintenance of loan
repayment programs in other federal agencies, such as the Health
Resources and Services Administration's National Health Service Corps
loan repayment opportunities. Further, the IHS has been given few
exemptions from the federal hiring freeze making this even more
difficult and threatens the ability of IHS facilities to retain
sufficient staffing to keep beds operational and accreditation
requirements met.
Finally, the initial proposals for the HHS Reorganization included
the centralization of core functions, including ``Human Resources,
Information Technology, Procurement, External Affairs, and Policy.''
\9\ The IHS is unique because it is one of only four direct healthcare
providers in the federal government, and is the only one in HHS which
provides healthcare nationwide. In fact, IHS is the 18th largest
healthcare system in the United States. \10\ For this reason, the IHS
depends on a separate set of core functions which hire providers,
maintain accreditation, maintain electronic health records, and ensure
access to medications and supplies critical to direct healthcare
services. For this reason, Tribes believe it is inappropriate to
centralize IHS core functions with other HHS agencies. We urge HHS to
maintain IHS' independence to ensure it can continue its work to
improve their core systems and urge the Administration to request
adequate resources for IHS to operate its core functions.
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\9\ U.S. Department of Health and Human Services, March 27, 2025.
``HHS Announces Transformation to Make America Healthy Again''.
Accessed 5/9/2025: https://www.hhs.gov/press-room/hhs-restructuring-
doge.html.
\10\ U.S. Department of Health and Human Services, March 27, 2025.
``Fact Sheet: HHS' Transformation to Make America Healthy Again''.
Accessed 5/9/2025: https://www.ihs.gov/newsroom/ihs-updates/january-2-
2025-ihsupdates-for-tribes-and-tribal-and-urban-indian-organizations/.
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Restructuring of HHS Headquarters and Closure of HHS Regional Offices
HHS regional offices have been reduced from 10 to 5, a
consolidation that now places over 400 Tribes under the jurisdiction of
a single office in the Western United States. This restructuring now
requires Tribes in remote Alaska and Southern California to work with
staff in Denver. Many Tribes have already reported losing access to
essential technical assistance, cross-agency coordination, and
localized programmatic guidance that these regional offices once
provided.
The IHS has a 12-region structure designed to facilitate
operational efficiency and responsive engagement with Tribal
governments. HHS' initial 10-regions also provided regionally-specific
policy support, technical assistance, and trust-based relationships
that support Tribal needs. The closure of numerous regional offices
limit the government's ability to meet its legal obligations, and puts
the health of AI/AN communities at risk. The elimination of regional
offices without consultation violates the principles of Tribal
sovereignty.
This consolidation will especially harm rural and remote Tribal
communities, where regional offices often served as a lifeline to
federal programs, helping Tribes navigate complex grant applications,
interpret policies, and respond to time-sensitive funding
opportunities. By eliminating these offices, HHS has created coverage
gaps, increased the burden on remaining offices, and eroded local
institutional knowledge built over years of partnership and trust.
Tribes have already reported being redirected to regional offices in
places like Atlanta for program guidance, an office with little-to-no
knowledge of Tribes or their unique government-togovernment status.
These closures will diminish quality, timeliness, and cultural
relevance of supportive assistance.
These regional office closures also included announcements of the
consolidation of HHS Office of General Counsel regional branches. This
included the closure of the OGC offices in Seattle and San Francisco
which were responsible for a significant portion of the Indian Self-
Determination and Education Assistance Act (ISDEAA) compact and
contract negotiations and review. Over 375 Tribal Nations participate
in IHS self-governance utilizing over 60 percent of the IHS'
appropriation to delivery culturally tailored and quality healthcare.
The reduction of OGC staff and these offices not only removes regional
knowledge and history of the self-governance negotiations process, it
also places significantly more strain on OGC staff in Headquarters.
This could severely delay the execution of ISDEAA contracts and
compacts.
Other recommendations related to the Office of the Secretary will
have impacts on Tribes. One change which stands to dramatically impact
Tribal Nations and their relationship with HHS is the relocation of the
Office of Intergovernmental and External Affairs (IEA). The IEA is home
to HHS Tribal Affairs, the office responsible for supporting the HHS
Secretary's Tribal Advisory Committee, organizing department-wide
Tribal Consultations, and coordinating departmental policies related to
Tribal Nations. Recent critical work from this office has included the
development of the HHS Tribal Consultation Policy, coordination of new
Tribal and TEC data policies, and the hosting of the Annual Tribal
Budget Consultation where the IHS National Tribal Budget Formulation
Workgroup's Annual Tribal Budget Recommendations are released. The
current proposal for reorganization envisions removing this critical
office from direct report to the Secretary to a newly created Assistant
Secretary for External Affairs. The removal of this work from its
current position would significantly reduce the responsiveness of its
work to Tribes and a critical link directly to the HHS Secretary.
Disruptions to Tribal Advisory Councils and Tribal Serving Programs
Tribal Advisory Councils (TACs) have also largely been paused since
January 2025, leaving Tribal Leaders with questions about their future
amid the changes occurring at HHS. Without Tribal Consultation on the
HHS Reorganization, it is not clear how TACs will be structured and
which TACs will continue related to SAMHSA, HRSA, and the OASH Center
for Indigenous Innovation and Health Equity Tribal Advisory Committee
slatted to be reorganized into the new AHA--but without further details
it is hard to know. Our TACs form a critical part of the government-
togovernment relationship and support a robust system of policy input
and feedback as Agencies work to regulate healthcare coverage and
programs.
As discussed at the Secretary's Tribal Advisory Council meeting, we
reiterate our request for exemptions for employees within Tribal
Affairs Offices and Tribal-serving programs. These federal staff are
critical to delivering legally mandated services to AI/AN beneficiaries
and are essential extensions of the government-to-government
relationship. The dismissal of staff from the CDC's Healthy Tribes and
SAMHSA's Circles of Care programs further erodes this relationship.
Current disruptions have left communication gaps between Tribal
Nations and federal offices. Tribal Affairs Offices previously provided
transparency and technical assistance, but today there is often delayed
and miscommunication with federal agencies. As political entities,
Tribal Nations deserve access to proper communication channels and a
list of grants and programs impacted by the reorganization.
Government-to-Goverment Relations Through Tribal Consultation
These Tribal-serving programs have a minimal fiscal impact on the
federal government but are foundational to improving chronic health
conditions in Indian Country. Without formal Tribal Consultation and
meaningful input from Tribal leaders, the HHS Reorganization is likely
to unintentionally impede the effectiveness of these programs and
impinge on the government-togovernment relationship between the United
States and Tribal Nations.
Tribes share the vision for a Healthy America and a more efficient
HHS, but Tribes must be active in these discussions as they impact our
direct relationship with HHS programs and obligated funding for HHS
programs. Some examples of efficiency we see that could be part of the
HHS Reorganization include the reduction of onerous grant and U.S.
Department of Government Efficiency Services (DOGE) reporting
requirements, providing direct funding to Tribes instead of reliance on
State block grant pass throughs, and the expansion of Tribal self-
governance outside the IHS. Tribal Self-Governance has time and again
proven one of the most successful, qualityimproving, and efficient
programs pursued by the United States. Tribes can be the solution, and
fit well into a reorganized HHS. We welcome the opportunity to achieve
these efficiencies and improve services to our communities. These
programs and personnel are not only operational necessities to our
public health systems, they are part of the federal government's legal
and moral obligation to Tribal Nations.
I thank the Committee for this opportunity to provide testimony on
this very important issue, and look forward to working with you further
to ensure the federal government meets and upholds its trust and treaty
obligations to Tribal Nations.
The Chairman. Thank you, Chairman.
Next, we will go to Loni Greninger, the Vice Chair of the
Jamestown S'Klallam Tribal Council.
STATEMENT OF HON. LONI GRENINGER, VICE CHAIRWOMAN, JAMESTOWN
S'KLALLAM TRIBAL COUNCIL
Ms. Greninger. Thank you so much. [Phrase in Native
tongue.]
Honored Leaders, Chair Murkowski, Vice Chair Schatz, thank
you so much for the opportunity, and other members of the
Committee that I know were here. I am grateful for their time
as well.
I want to acknowledge the opening comments that you said
earlier. You are going to be hearing me repeat probably many of
the things that both of you have said already.
And for Vice Chair Schatz in particular, one of the things
I have said at other tables before is, I hate being the first
place in everything like that. Chronic disease, all these
negative impacts, I hate being in first place. I want to be
able to fix that.
So that is one of the reasons why I am here testifying
before you today. So thank you for this opportunity.
For Chair Murkowski, I have family in the great State of
Alaska, so I get to visit your great State often on the Kenai
Peninsula. It is beautiful there.
So I am the current Vice Chair of the Jamestown S'Kallam
Tribe. We are located in Squim, Washington, in the great State
of Washington. I serve currently as the ACF Tech Chair, so I am
pretty intimate with the ACF programs and how those programs
are being implemented on the ground, especially within my
region and in my State and in my community. The Jamestown
S'Kallam Tribe actually has a few of the ACF programs, so I get
to see what those things are doing to my families in the most
positive way possible.
My service to my community comes very honestly. I have
seven generations worth of tribal leadership in my blood, all
going from educational services to child welfare. So for me to
be a social services director at my tribe for five years is one
of my passions. I currently serve as the chair of a few
different tables in Washington State as an Indian policy
advisory chair, serving not only just social services in maybe
a traditional sense but also corrections, department of
corrections and health care authority as well.
I am really glad to be able to be here to speak before you
today.
In ancient times, we as tribes, we have had our own
systems, so to speak, of how we addressed the community level
needs, then the family level needs, then of course the
individual needs. Most of that was addressed in our ancient
times through communal living and also through spirituality.
Because we believe that mental health and emotional health,
that was made whole through the spirituality.
As the relationship between tribal governments and the
United States was growing and it came to be, it was born, it
has evolved over decades and decades and decades. So we have
been learning how to evolve our systems, what does it mean to
blend western systems with our indigenous perspective at the
same time and being able to serve our people with these Federal
services.
So this is why we are here testifying, we are here to try
and figure out how do we blend that all together. And you
mentioned tribal consultation, that is essential to us figuring
out how do we blend these systems together and make these
programs work for us. How do we make these programs fit our
cultural needs and then translate them into Federal-speak so
that we can access Federal funds?
The huge concern of the RIFs at HHS, as well as the
proposed funding cuts, those are the things that are
threatening our ability to be able to do that. These RIFs
happened without tribal consultation. The budget proposal is
happening without tribal consultation. I have lost connections
to my staff in Region 10 at ACF, that means TANF contacts, that
means my ACF regional administrator, gone. Everybody is gone.
And this was all done without consultation and with very little
warning, not only to the tribes but also to the staff.
That also meant that we did not have any transition
planning. There was nobody to tell us, hey, here is your next
contact. For example, Regions 1, 2, 5, 9 and 10 have been
consolidated, they have been eliminated and now they are being
consolidated into the rest of the five.
So me in Washington State, my new regional office is in
Denver, Colorado. And when you eliminate all of Region 10, just
talking about Region 10 by yourself, that is all of Alaska's
more than 200 tribes, Washington's 29, Idaho's 5, Oregon's 9,
that is 250 plus tribes that now Denver is absorbing into their
portfolio.
They don't know who we are, they don't know our lands. So
we need to be able to have people on the ground who know our
land, who know our intimate cultural nuances and our political
nuances. That is what these HHS staff members have been for us,
the technical advisor. They help translate our language into
your language so we can access funds that are obligated to us
through treaty and trust responsibility.
As I conclude here with my remarks, one of the things we
want to see is just consultation. Consultation, consultation,
consultation . We need HHS to understand the impacts that have
already happened because of not having consultation. We know
that there are regulation decisions to come, budget decisions
to come, deregulation decisions to come. And we need to make
sure that tribal voices are at the forefront, that we have our
voices heard, our impacts are heard, so that we can minimize
impacts and we can maybe find some different creative solution
that meets both the Federal goal but also maintains trust and
treaty responsibility for our tribes.
In conclusion, I do want to acknowledge that Secretary
Kennedy, he seems to want to work with tribes, and I am glad
for that. He has advocated for Head Start for us. And we saw
that in the President's latest draft of the budget. So we are
thankful for that. Thankful that LIHEAP is still also being
chatted about as well.
Bu we want to see more. It is more than IHS, right? You
mentioned this earlier. HHS programs as a whole, even if the
word tribe, Native American or Indian isn't in the office name
or in the grant name, it still serves tribes, and we want to be
able to access that and make our communities healthy, so we
continue to blend those systems together, and hopefully get us
out of first place so we can be healthy again.
Thank you for the opportunity to speak before you today. I
will look forward to any questions if you have any for me.
Thank you.
[The prepared statement of Ms. Greninger follows:]
Prepared Statement of Hon. Loni Greninger, Vice Chairwoman, Jamestown
S'Klallam Tribal Council
Introduction
Chair Murkowski, Vice Chair Schatz, and members of the Senate
Committee on Indian Affairs, thank you for the opportunity to testify
in this oversight hearing regarding critical programs that serve tribal
nations like mine, the Jamestown S'Klallam Tribe.
Tribal nations, as sovereign governments, have a government-to-
government relationship with the United States. This relationship is
based upon numerous treaties between tribal nations and the U.S.
government and is enshrined in the U.S. Constitution, \1\ federal law,
and numerous U.S. Supreme Court decisions. As part of the political
relationship with tribal nations, the U.S. has a federal trust
responsibility that is a legal obligation to protect tribal rights,
lands, and resources, and to fulfill its obligations under treaties and
federal laws. This includes providing for the well-being of tribal
citizens through basic programs and services. Access to federal
programs that support the basic needs of Native people is a critical
element of the federal trust responsibility, which includes human
services and behavioral health services provided by the Department of
Health and Human Services (HHS), and an exercise of tribal sovereign
authority to tailor programs to serve communities at the local level.
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\1\ U.S. Constitution, Article VI states, ``This Constitution, and
the Laws of the United States which shall be made in Pursuance thereof;
and all Treaties made, or which shall be made, under the Authority of
the United States, shall be the supreme Law of the Land. . .''
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I have had the privilege of serving my tribe as Vice Chair since
2020 and have worked for my tribe's Social and Community Services
Department from 2017-2022. I currently serve as the Chair of the
Washington State Department of Social and Health Services Indian Policy
Advisory Committee (since 2020), and the Washington State Governor's
Tribal Leaders Social Services Council (since 2020). I also currently
Chair the Administration for Children and Families (ACF) Tribal
Advisory Committee (since 2022). In all of these roles, I am uniquely
positioned to understand both the community impact of HHS's human and
behavioral health services and the federal laws, policies, and
implementation necessary to administer them.
In this testimony, I will focus on the role of human services and
behavioral health services in tribal communities, identify federal
programs that help tribal nations meet community needs, the role of HHS
in providing support and assistance to tribal nations, and the impacts
of recent reorganization efforts by HHS.
Tribal Human Services
Tribal human service programs administer a range of services that
provide core support for tribal community members to meet their basic
needs and improve their well-being to increase their quality and
standard of living. Federal human service programs enable tribal
nations to ensure every citizen can meet basic needs related to
employment, food, housing, medical care, education, and childcare. They
also provide support to ensure community members are protected from
harm, can develop a healthy sense of belonging, have opportunities to
have regular social contact, and more generally, find stability in
their lives. \2\ For people living in unstable and vulnerable
conditions, these services can mean the difference between life and
death in some cases. As tribal nations strive to create communities
where children, families, and elders can thrive, human services play a
vital role in supporting positive change that is accessible and
sustainable.
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\2\ Mayo Health Clinic Health System. (2021). Is Having a Sense of
Belonging Important? https://www.mayoclinichealthsystem.org/hometown-
health/speaking-of-health/is-having-a-sense-of-belonging-important.
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While the types of human services vary widely, there are a number
of key services that are contained within this category of services.
They include, but are not limited to:
prevention services,
child, adult, and victims of crime protection,
in-home family services,
case management and service coordination,
out of home placements for children,
job training and education,
childcare,
housing and food assistance,
participation in court hearings,
intergovernmental coordination and service collaboration
with federal, state or county partners, and
referrals and coordination with other service providers,
such as mental health, substance abuse treatment, child
welfare, juvenile justice, employment assistance and training,
education, food assistance, health care, childcare, housing,
and law enforcement.
Examples of federal programs under ACF that support tribal human
services include the following:
Title IV-B, Subpart 1, Child Welfare Services \3\
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\3\ Title IV-B and Title IV-E refer to programs authorized under
the Social Security Act.
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Title IV-B, Subpart 2, Promoting Safe and Stable Families
Title IV-E Foster Care, Adoption Assistance, Relative
Guardianship, and Prevention Services
Chafee Independent Living Program (youth aging out of foster
care)
Community Based Child Abuse Prevention grants
Tribal Court Improvement Grant Program (tribal juvenile
court proceedings)
Social Services Block Grant (tribes receive pass-through of
state allocations)
Child Support Enforcement
Temporary Assistance to Needy Families
Tribal TANF-Child Welfare grant program (services
integration and coordination)
Native Employment Works grant program
Family Violence Prevention and Services grant program
Child Care and Developmental Fund
Community Services Block Grant
Affordable Housing and Supportive Services Demonstration
grant program
Rural Community Development grant program
Low Income Home Energy Assistance Program grant program
Community Economic Development grant program
Head Start
Tribal Personal Responsibility Education Program grants
(adolescent pregnancy prevention)
Demonstration Grants for Domestic Victims of Human
Trafficking grants
Runaway and Homeless Youth grant programs
Administration for Native Americans social, economic
development, and language preservation grant programs
Key to a well-functioning human service system is the integration
of services from a variety of fields to create a system of programs and
services that address families in a holistic manner. When programs or
services are siloed and don't collaborate well, they struggle to
communicate, adapt to changing client needs, and take advantage of
opportunities to address issues early before crisis sets in. Tribal
human service programs, by their nature, are well-adapted to developing
program efficiencies and innovative ways to serving their citizens.
As an example, the Central Council of the Tlingit and Haida Indian
Tribes of Alaska child welfare program understood many of the families
that are involved with the tribal child welfare system are also
involved with their Temporary Assistance to Needy Families (TANF)
program. They also know that many of the families involved in their
tribal child welfare system have been seen by the TANF program a year
or more before they came to the attention of the tribal child welfare
program. A number of years ago, the tribal child welfare and TANF
programs outlined a strategy to improve the capacity of the TANF
program to assess the risk for child maltreatment with their families
and improve coordination with the child welfare program. The
collaboration utilized an adapted child abuse and neglect risk
assessment tool that TANF staff were trained to administer, which
resulted in the identification of tribal families with child abuse and
neglect risks earlier so they could receive child welfare services.
This resulted in more families getting help earlier, reducing the risk
of trauma to children and their families from foster care removal, and
lowering the risks for more costly and intrusive interventions.
Tribal nations serve a critical role in providing these services
not only for tribal citizens living within their tribal boundaries but
also with state agencies that provide services to tribal citizens
living off tribal lands. In child welfare, tribal assistance helps
states reduce state costs and administrative burden, helps ensure
appropriate and effective services are provided to Native families, and
improves implementation of federal legal requirements, like those
contained in the Indian Child Welfare Act. \4\ In many cases, tribal
human service programs also serve non-Native populations on or near
tribal lands. Tribal programs like TANF, child welfare, and childcare
provide services and support to non-Native populations that would
otherwise not be available in their area or would be much more
challenging to access than state services. When tribal human service
programs have adequate federal support, they are much more likely to be
able to assist states and nearby non-Native communities, as well as
tribal citizens living on tribal lands.
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\4\ U.S. Government Accountability Office (2005). Indian Child
Welfare Act: Existing Information on Implementation Issues Could Be
Used to Target Guidance and Assistance to States. Washington, D.C.:
Government Printing Office. https://www.gao.gov/assets/gao-05-290.pdf
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Tribal Behavioral Health Services for Children and Youth
Trauma is a key factor in the need for tribal human services.
Threats to well-being like child maltreatment, substance abuse,
domestic violence, and homelessness are highly linked to trauma.
Exposure to trauma during childhood creates an adverse childhood
experience (ACE). ACEs measurements help practitioners and researchers
understand the impact of trauma in children and youth that are exposed
to violence, abuse, or neglect. The impact of a traumatic event can
occur through direct contact or by witnessing a traumatic event in the
home or community. \5\ Children and youth who have ACEs can often carry
the negative effects, especially if untreated, into adulthood, which
creates a higher risk for poor health, mental illness, and substance
abuse. \6\ Native populations have one of the highest rates of ACEs, in
one study 2.3 times higher than any other racial group. \7\ Another
measure of the critical need to better address trauma in young Native
people is the extremely high rate of suicide among Native youth between
the ages of 15-19 years of age. \8\ Behavioral health services are
needed to treat existing trauma, prevent exposure to additional harm,
and reduce the need for lengthy and repeated human services
interventions.
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\5\ Centers for Disease Control. (2024). What is Adverse Childhood
Experiences? https://www.cdc.gov/aces/about/index.html#:-:text=
Adverse%20childhood%20experiences%2C%20or%20ACEs,attempt%20or%20die%20by
%20suicide.
\6\ Ibid.
\7\ Giano Z, Camplain RL, Camplain C, Pro G, Haberstroh S, Baldwin
JA, Wheeler DL, Hubach RD. (2021). Adverse Childhood Events in American
Indian/Alaska Native Populations. https://pmc.ncbi.nlm.nih.gov/
articles/PMC8098634/#:-:text=
Results:,educational%20attainment%20reported%20lower%20scores.
\8\ Office of Minority Health. (2021). Mental and Behavioral
Health--American Indians/Alaska Natives. https://
minorityhealth.hhs.gov/mental-and-behavioral-health-american-
indiansalaska-natives.
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In tribal communities, behavioral health services are provided
through a combination of programs and services, such as mental health
or substance abuse prevention and treatment. This can include services
that are based on Western models of practice, tribal cultural models,
or a combination of both. While the Indian Health Service (IHS) is one
of the key providers of funding for tribal mental health services, and
in a small number of tribal communities, directly provides mental
health services, these funding streams are primarily designed for
adults and not for children and youth. While the general number of
professionally trained therapists in Indian Country is low, the number
of child-trained therapists is even lower and well below what is needed
to address at-risk children and youth. Access to state behavioral
health services for Native children is also challenging, especially for
Native children and youth that reside in remote areas of the country.
Adding to this is the extremely limited availability of state-funded,
child-trained therapists that have experience with Native children and
youth. Federal programs, like those funded under the Substance Abuse
and Mental Health Services Administration (SAMHSA), provide vital
resources to tribal nations to develop their own community-based child
and youth mental health and substance abuse prevention and treatment
programs and services.
Examples of federal programs under SAMHSA that support tribal
behavioral health services include the following:
Tribal Behavioral Health Grants Program (two grant programs,
mental health and substance abuse, that seek to prevent
suicidal behavior and substance abuse among Native youth)
Circles of Care grants (developing community based,
children's mental health systems)
Project Launch grants (promote wellness of children ages
birth to eight years of age through positive mental,
behavioral, and cognitive development)
Children's Mental Health Services grants (operate and
enhance community-based children's mental health systems)
Numerous tribal grantees that have received these federal funds
have gone on to develop innovative children's mental health programming
that provides children's mental health services in communities that
previously had none and established financial sustainability by working
collaboratively with states to leverage other federal and state
funding.
HHS Reorganization Efforts and Impacts to Tribal Community Human and
Behavioral Services Programs
While tribal human services programs have demonstrated their
ability to design and operate effective services for their communities,
they also need assistance from federal agencies to achieve their full
potential. The National Indian Child Welfare Association, a leading
tribal organization working to improve tribal human services, conducted
11 listening sessions with tribal leaders and tribal human service
directors from October of 2023 through June of 2024, where many of the
participants shared concerns regarding tribal human service programs
being understaffed, lacking access to appropriate training, and needing
improved support and technical assistance to access federal funding and
ensure tribal programs can provide community-based programs that will
meet federal requirements.
Beginning in February, numerous federal staff at ACF, both in the
regional offices and central office in Washington, DC, had their
positions eliminated based on HHS's reduction in force goals; the
results were eliminating probationary staff, regional offices were
closed, or staff took the buyouts being offered by the Administration.
In some cases, staff who were considered probationary had been working
for many years in another federal job within HHS but were considered
probationary because they had been promoted or had taken a different
job within HHS within the last two years. In ACF's central office in
Washington, DC, there were five senior advisors on tribal engagement
that advised ACF leadership on how to improve the agency's engagement
with tribal nations and improve tribal participation in ACF programs.
This team worked closely with regional ACF office tribal program leads
and was improving ACF consultation and relationships with tribal
nations across the country. As of May, only two staff in the central
office tribal engagement team are still employed, and all but a few of
the regional office tribal program leads have been let go as part of
the regional office closures in five regions. \9\
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\9\ Five regional HHS offices were abruptly closed on April 1 and
staff put on administrative leave pending their termination. The
regional offices closed were regions 1, 2, 5, 9, and 10.
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In addition to elimination of staff in probationary status and
buyouts, firings of whole teams of federal program staff have crippled
program operations for certain ACF programs. For example, it is our
understanding that the entire central office team for the Low Income
Home Energy Assistance Program(LIHEAP) have been dismissed, creating a
void for tribes needing help with the operation of their LIHEAP
programs. This includes operating under their current grant and
preparing for submission of year-end reports and funding applications
for the next fiscal year.
Another facet of HHS staff reductions has been the timing and
process used. According to reports by former federal staff, notice of
staff reductions has occurred with less than 24-hour notice with staff
being ordered to leave their office the same day. This doesn't allow
for an orderly transition of work to other staff or managers and is
demoralizing for both the staff that are fired and for those that
remain. While HHS has talked about rehiring staff in some agencies,
former staff that have experienced the first round of firings are
reporting they are not feeling inclined to return to HHS. This has also
eroded the desire of people new to the federal service to accept
positions at HHS, especially those with higher-level skills and
knowledge applicable to tribal nations.
The HHS regional office closures occurred abruptly causing tribal
human service programs to scramble to find answers to program and
fiscal issues and seek assistance as they develop their new
applications for federal grant programs. The five regions that were
closed served 80 percent of all federally recognized tribes in the
United States. Many tribal human services directors have reported that
even a month later, they haven't been able to talk to a person at ACF
or have their voicemails or emails responded to. This comes at a
particularly difficult time as hundreds of tribes are trying to fill
out their funding applications for next fiscal year's funding and were
in process with regional office tribal program leads to ensure they
could submit a successful application (e.g. Child and Family Services
Plans, Child Care Development Fund, LIHEAP, Title IV, Child Support,
TANF, etc.). Other tribes were working with regional office tribal
program leads to address training needs or develop strategies to
address tribal-state concerns in service delivery.
While in some cases, ACF has referred tribes to other regional
offices, they are often referred to regional staff that already have
full workloads and can't respond to them in a timely manner or have
little to no experience working with tribes and the federal programs
they participate in. The strategy of ``next man up'' in assistance to
tribes, trivializes the necessary skills and knowledge needed to work
effectively with tribes and the years of professional development it
takes to competently provide assistance to tribal nations. In this
current environment, many tribal human services directors fear that
federal assistance will become less focused on the values of supporting
tribal self-determination and program effectiveness, and more on
compliance and process.
Besides existing program work, ACF is also responsible for guiding
implementation of new laws that are approved by Congress. Last year, in
an overwhelming bipartisan show of support, Congress approved the
Supporting America's Children and Families Act (P.L. 118-258). This new
law reauthorized Title IV-B programs under the Social Security Act to
accomplish a variety of goals, including streamlining administrative
requirements for states and tribes, creating new technical assistance
opportunities for states and tribes to improve implementation of the
Indian Child Welfare Act, and improve tribal court participation in
state court proceedings and data collection involving Native children
and families. This historic law will require ACF's best efforts to
develop guidance and provide assistance to states and tribes that will
ensure a smooth and proper implementation. With fewer ACF staff with
experience in tribal child welfare available, especially in areas where
regional offices were closed, there are concerns about how this will
impact the implementation and opportunities for tribal nations under
the Supporting America's Children and Families Act.
An underlying concern in all of these changes at HHS was the lack
of consultation with tribal nations. In almost every situation, tribal
nations found out about these changes after the fact, usually in the
media, well after the decisions had been made. While I and many other
tribal leaders can appreciate your desire to improve the effectiveness
and efficiency of the federal government, something that is important
to tribal leadership too, respecting the nation-to-nation relationship
requires adherence to formal government-to-government protocols, which
begin with consultation before decisions are made that impact our
communities.
Conclusion
While there is great appreciation for HHS's efforts to protect IHS
programs and services from cuts and staff firings, attention also needs
to be given to the implications of HHS's reorganization plans for human
services and behavioral health services programs. None of these
programs operate in isolation, just as our citizens don't live in
isolation either. Our most vulnerable citizens and the programs that
serve them need the assistance of fully qualified staff that understand
their needs and have ongoing working relationships with our tribal
communities. HHS's trust responsibility doesn't stop at IHS. It extends
to all of the agencies of HHS and requires carefully planned
consultation with tribal nations before policy decisions are made and
the consideration of our rights as tribal people under our treaties and
federal law. Consulting with tribal nations provides HHS with greater
opportunities to identify and implement program efficiencies and
establish more effective programs-in essence, tribal consultation will
further our shared goals of achieving government efficiency and reduce
federal bureaucracy, while maintaining the trust responsibility and
continuing to empower tribal sovereignty.
Thank you for the opportunity to testify before you today.
The Chairman. Thank you very much. Well said.
Melissa, welcome to the Committee.
STATEMENT OF MELISSA CHARLIE, EXECUTIVE DIRECTOR, FAIRBANKS
NATIVE ASSOCIATION
Ms. Charlie. Good afternoon, Chair Murkowski and Vice Chair
Schatz and members of the Committee. Thank you for this
opportunity to testify today. My name is Melissa Charlie, and I
serve as the Executive Director of Fairbanks Native
Association, FNA, a Native non-profit organization serving the
Alaska Native community since 1967.
I am here today not only on behalf of FNA, but also to
uplift the critical importance of Tribal Head Start and other
U.S. Department of Health and Human Service programs that serve
Native communities nationwide. At FNA, our Tribal Head Start
program is the foundation of our investment in early childhood
development, cultural identity and family stability. Our
program offers not only education but nourishment, cultural
grounding, health and intervention while offering a healthy
foundation for families who need it the most.
Our classrooms honor Native idendity and language,
instilling pride in our community while preparing children for
academic success. For many families, Tribal Head Start is the
first point of connection for our broader network of services
that address health, nutrition, wellness and family support.
Moreover, our program, like many others, integrates traditional
knowledge, language and values into every single classroom.
We know Tribal Head Start and child care programs across
the Country integrate various programs and grants to stretch
every dollar and create a system of comprehensive community
based services. Many of these include utilizing Head Start with
child care development funds or connecting programs with
language work, at the Administration for Native Americans.
Indian Country is the most dynamic investment that the
Federal Government can make. Our funding is no different. In
addition to Head Start, FNA operates several other critical
programs under HHS, including youth and adult behavioral
treatment programs which provide services that integrate Native
cultural values and practices with evidence based approach
funding from SAMHSA, child welfare community based family
prevention emergency youth shelter services and family and
domestic violence prevention and services under ACF.
And we utilize funding under the current administration for
community living such as Administration on Aging, Title VI
funding, which fosters a healthy and connected elder community
by providing nutrition, support services and caregiver
services.
Yet, despite decades of success, Tribal Head Start and
other programs remain under-resourced compared to other non-
tribal counterparts. We face challenges recruiting and
retaining qualified staff due to wage disparities. We need
updated facilities and modern learning materials and a more
robust professional development, which requires an increase in
stable Federal investment and partnership with tribal
organizations. Now is not the time to divest these programs;
now is the time to invest in Indian Country, the same way the
Federal Government hopes to reinvest in States.
These programs work to form a safety net for our tribal
families who too often exist in a gap where they remain
underserved by State and local communities. Importantly, tribal
programs like these are a direct impact for fulfilling trust
and treaty obligations to tribes.
In our area, the tribes and villages have done so through
Native organizations like FNA. Whether a tribal nation or a
Native organization, we are the best positioned to deliver
these services, because we understand our communities,
histories, strengths, and our needs.
Tanana Chiefs Conference, TCC, is our sister organization,
providing a large array of prevention and clinical services for
the Alaska Native population across interior Alaska. Either in
complement of FNA services or in collaboration with FNA, TCC,
like FNA, relies on Federal funding guaranteed under the
Federal Government's trust obligation to Alaska Natives and
American Indians, which requires the United States to protect
tribal lands, assets, resources, and treaty rights and to
provide certain services such as health care, education, and
housing.
The Federal trust obligation is not one that can simply be
transferred to a State government. It is a legal and moral
obligation of the Federal Government alone.
For FNA and the many tribes across the Country, HHS
programs are not simply support services, they are an active
nation-to-nation partnership, upholding the Federal trust
responsibility to Native children, families and communities.
Today, I urge Congress to protect and maintain the Tribal
Head Start program and other child care funding, and support
such child care development funds, ensuring that these
setasides go directly to tribes or Native organizations and
that they are not rerouted through the States; to protect
SAMHSA funding for tribes like the tribal behavioral health
grants and ACF programs, including by protecting the
Administration for Native Americans through streamlined funding
which is directly provided to tribes and Native organizations;
to support infrastructure investment so tribal providers can
modernize facilities and expand reach.
We stand ready to work with the administration and Congress
to streamline and strengthen these programs with quality
investments.
Thank you for holding this important hearing and for your
continued focus on the health and well-being of Native
communities. I look forward to your questions. [Phrase in
Native tongue.]
[The prepared statement of Ms. Charlie follows:]
Prepared Statement of Melissa Charlie, Executive Director, Fairbanks
Native Association
On behalf of the Fairbanks Native Association (FNA), a Native non-
profit organization based in Fairbanks, Alaska committed to improving
the quality of life for individuals and families by promoting justice,
healing, and wellness in our community, thank you for the opportunity
to provide written testimony on the critical services supported by the
U.S. Department of Health and Human Services (HHS) and the profound
impact these services have on our Alaska Native community.
My name is Melissa Charlie, and I am the Executive Director of FNA.
In addition to my role at FNA, I serve on the Advisory Board of the
Fairbanks North Star Borough Board of Education. I am Athabascan and
Inupiaq, and I am a Tribal member of Minto, Alaska.
FNA was incorporated in 1967 in direct response to the social
service needs of Alaska Natives in Fairbanks during a time when Native
people were increasingly moving to the area from remote villages and
Alaska Native soldiers were returning from military service. Access to
basic health and social services was severely limited. Educational
outcomes were extremely low, and life expectancy for Alaska Natives was
alarmingly short. Because of the work of our early leaders, and thanks
to increased investment in education and healthcare, our community has
made substantial progress across quality-of-life indicators over the
last sixty years.
FNA provides services within the Fairbanks North Star Borough,
which has an Alaska Native and American Indian population of
approximately 10,000 people. Working with our sister organization, the
Tanana Chiefs Conference, our combined efforts serve more than 12,000
Alaska Natives across 42 communities in Interior Alaska.
With support from the U.S. Department of Health and Human Services,
FNA serves our community through three major program areas: early
childhood development, behavioral health services, and community
services. The work we do at FNA is deeply rewarding. We assist
individuals in times of great need--whether they are facing
homelessness, substance abuse, mental health challenges, or grief. From
the womb to the end of life, FNA is here to serve.
As our late founder, Poldine Carlo, often said: ``There is no
greater reward than serving our people.''--Poldine Carlo, founding
member of the Fairbanks Native Association
These programs are essential to addressing the needs of our Native
population and strengthening the overall health, safety, and resilience
of our community. Continued federal support for these HHS programs is
critical to ensure we can meet these needs now and into the future.
Federal Obligations
The federal government's trust obligation to Alaska Natives and
American Indians is a legal and moral commitment rooted in treaties,
statutes, executive orders, and judicial decisions. It requires the
United States to protect tribal lands, assets, resources, and treaty
rights, and to provide certain services, such as healthcare, education,
and housing. This obligation stems from the historical relationship
between tribes and the federal government, in which tribes ceded large
portions of land in exchange for these protections and services. The
trust responsibility may seem to be carried out primarily by federal
agencies like the Bureau of Indian Affairs (BIA) and the Indian Health
Service (IHS), but truly extends across the federal government, and
outside of tribal-specific agencies. The trust obligation emphasizes
the government's duty to act in the best interest of Tribal Nations and
individuals with loyalty, care, and accountability.
FNA is only one of many Alaska Native and American Indian
organizations providing services that are made available under the
federal government's trust obligation. We work in lockstep with Tanana
Chiefs Conference, our sister organization, to provide a large array of
prevention and clinical services for the Alaska Native population
across the Interior of Alaska. TCC's services either complement those
offered by FNA or are provided in collaboration with FNA. Like FNA and
many other Native entities, TCC too relies on Federal funding provided
under federal trust obligations.
The federal government's trust obligation to Alaska Natives and
American Indians involves a complex interplay of legal, financial, and
social responsibilities. While progress has been made in certain
areas--such as tribal self-determination and economic development--
there are still significant challenges, particularly around
underfunding, legal complexities, and the need for more meaningful,
long-term investments in Native communities. The trust obligation is an
ongoing process that requires constant attention, accountability, and
respect for tribal sovereignty.
Despite this legal obligation, the federal government often fails
to fully fund the programs and services essential to Native
communities. This underfunding has led to significant disparities in
health, education, and housing outcomes between Native and non-Native
populations. Due to underfunding in the IHS, BIA, and Bureau of Indian
Education (BIE), tribal organizations are relying on other federal
funding like SAMHSA, HRSA, CDC and others to help support the provision
of essential prevention, behavioral health and clinical services to
decrease these disparities. Proposed cuts to many grants, programs and
services currently provided through funding from these agencies, are of
great concern to all of us and our partner organizations.
The federal government's trust obligation is not one that can be
transferred to state governments. Again, it is a legal and moral
obligation of the federal government alone, which should be honored in
good faith and due diligence.
Tribal Head Start and Early Childhood
At FNA, one of the major services we provide is our Tribal Head
Start Program. FNA's Head Start program promotes cultural identity of
Alaska Native and American Indian families, while equipping all
enrolled children with the educational, physical, and social skills and
tools for a great head start towards school readiness. Students receive
health screening for vision, dental, hearing, physical and cognitive
development--an important early intervention to ensure any additional
services are prioritized. Head Start works with families to connect
with partnering community agencies for additional resources that they
may need to succeed.
While many of these services are key lifelines that Head Start
programs provide children nationwide, there are a few key differences
between Tribal Head Start and other Head Start programs. The main
difference lies in who administers them and the communities they are
designed to serve.
Tribal Head Start programs are administered directly by tribal
governments or tribal organizations. Our programs incorporate Native
culture, language, and traditions into the curriculum and daily
operations. We design our programs to support the cultural preservation
and educational success of our children.
In short, Tribal Head Start is tailored for Native communities,
while general Head Start serves the broader population of low-income
families.
Our Head Start and Early Head Start programs are a strong example
of how Alaska Native culture is thoughtfully woven into early childhood
education. Our children are introduced to our Native languages
throughout these programs through songs, simple phrases, and greetings.
Elders and cultural bearers are regularly invited to share traditional
stories, legends, and oral histories, passing down intergenerational
knowledge.
FNA's program goes beyond education--it builds identity, pride, and
connection to Native heritage from an early age, while meeting all
federal Head Start standards. This is also true for Head Start programs
in rural Alaska, including the Tanana Chiefs Conference regionwide
programs, and other Tribal Head Start programs nationwide.
Other Critical HHS Programs
In addition to Head Start, FNA operates many other critical
programs to fill gaps in services typically provided by state
government for non-Tribal communities. These programs address the needs
of our Native communities by providing the programs the federal
government owes under trust and treaty obligations. Many of our
services are funded under HHS outside of the Indian Health Service.
One program that has been considered for elimination by the
Administration is the Community Services Block Grant. This grant, which
FNA receives under the set-aside for Tribes and Tribal Organizations,
provides services that remove obstacles to the achievement of self-
sufficiency for low-income individuals, families, Elders, and homeless
community members. By providing services that support self-sufficiency
and that address emergency assistance needs, youth development, and
health and nutrition, the program enhances the lives of low-income
individuals with services that meet their needs and empower them with
the resources, knowledge, and skills needed to achieve self-
sufficiency. We urge Congress to protect this program for tribes.
Unlike states, our communities do not have the tax revenue to pick up
the services otherwise provided by the federal government.
Title VI funding through the Older Americans Act provides critical
nutrition and supportive services for elders and caregivers, with 362
enrolled in the program. Through the congregate meals program, FNA
serves approximately 800 hot lunches monthly on weekdays and provides
group programming and information about a range of health, safety, and
nutrition topics relevant to the population. This has been an area
identified as a critical need in the Fairbanks North Star Borough, as
an FNA survey of local elders in 2022 found that for 57.3 percent of
respondents it was often or sometimes true that they could not afford
to eat balanced meals. Additionally, three out of the five most common
chronic conditions in the population are closely linked with nutrition:
high blood pressure, diabetes, and osteoporosis. With more than one in
five elders reporting that they eat alone most of the time, the
congregate meal program also serves a critical function in helping to
reduce isolation and promote social connection among this vulnerable
population. Title VI funding also supports caregivers by connecting
them to information and community resources and providing training,
specialized support, and supplemental services. Given that current
levels of programming are not able to meet the full degree of need for
elder nutrition and support services, the funding that is provided
under Title VI remains a critical resource for supporting the health of
elders in the community.
We also receive funds from the Family Violence Prevention and
Services program, which supports the prevention of and response to
incidents of domestic violence, dating violence, family violence and
their dependents. supports the prevention of and immediate response to
incidents of domestic violence, dating violence, family violence by
providing emergency shelter, supplies, and services to adult victims
and their non-abusing dependents. Domestic and/or family violence
continues to be an area of high need among FNA's service population,
with 58.8 percent of consumers receiving victim services through FNA
Community Services department reporting domestic and/or family violence
in 2024. In Interior Alaska, where housing is limited and the cost of
living is high, Family Violence Prevention and Services funding is
especially critical in providing immediate access to temporary housing
and resources that allow victims and their children to escape violent
situations and meet their basic needs, a first step to achieving
stability, security, and self-sufficiency.
Our Tribal Maternal, Infant, and Early Childhood Home Visiting
Program, which FNA has operated since 2010, except in fiscal years
2015-2017 when funding was not available, uses the evidence-based
Parents as Teachers (PAT) model to provide American Indian and Alaska
Native children and families services that address their critical
maternal and child health, development, early learning, family support,
and child abuse and neglect prevention needs. Serving 30 expectant
families and families with young children aged birth to kindergarten
entry, the Tribal Home Visiting Program is a critical link in the
continuum of early childhood education and family wellness that
coordinates with other existing resources like AIAN Head Start to
support healthy, happy, and successful children and families. As one of
only a few providers offering services in the home for pregnant women
and/or families with children younger than 5 years of age to the over
6,000 children ages 0-5 in the Fairbanks North Star Borough, \1\ the
Tribal Home Visting Program provides critical support for these
children and families whose needs would otherwise go unmet.
---------------------------------------------------------------------------
\1\ U.S. Census Bureau and State of Alaska Department of Labor and
Workforce Development
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FNA's Domestic Violence Prevention program provides primary and
secondary domestic and sexual violence, trafficking, and abuse
prevention programming for youth and adults. The DVP grant funds
support community outreach and awareness events and evidence-based
prevention programming for youth, in collaboration with the local
school district. The DVP program facilitates coordinated community
response to domestic violence prevention and intervention by
emphasizing active collaboration between FNA's Community Services
Department and the Fairbanks Police Department, the Alaska State
Troopers, the District Attorney's Office, a local domestic violence
shelter, and other service providers. Without access to this program,
the community would lose important opportunities to learn about and
connect with services through the many well-attended outreach and
prevention events and activities it supports, and elementary and
secondary aged youth throughout the Fairbanks North Star Borough would
miss out on opportunities to build important life skills and trusting
relationships that develop resilience and set them up for healthy and
fulfilling lives. Through comprehensive prevention and skill-building
programming, education and awareness activities, and community outreach
events, the DVP grant reaches more than 600 youth and more than 1,200
adults annually.
Through its youth and adult services divisions, FNA's Behavioral
Health Services (BHS) Department provides residential and outpatient,
evidence-based prevention, intervention, and treatment services for
more than 1,200 people annually through 18 population-specific programs
funded by grants from the Substance Abuse and Mental Health
Administration, Administration for Children and Families, and Indian
Health Service. Although multiple programs are intentionally designed
to meet the needs of AIAN community members by integrating cultural
values and practices with evidence-based mental and behavioral health
strategies, many BHS programs provide community-wide services for
anyone who needs them. These lifesaving and life-changing programs
include projects funded by 19 active grants from the U.S. Department of
Health and Human Services, including a one one-time Health Resources
and Services Administration Community Project Funding/Congressionally
Directed Spending grant for construction/renovation of the BHS Women's
and Children's residential treatment facility.
FNA's Women's & Children's Center is a residential substance use
disorder and mental health treatment facility for pregnant women and
women with children ages 0-7 years old. Serving the entire state, it is
a four- to six-month program providing individual and group treatment
sessions. The primary outcomes of the program are that mothers learn
how to interact with their children in a substance-free lifestyle, and
that children who have suffered through traumatic incidences related to
an environment of alcohol and drug abuse receive mental health services
to ensure a healthy lifestyle for the entire family. With Community
Project Funding/Congressionally Directed Spending funds administered
through the Health Resources and Services Administration, FNA will be
able to make much-needed updates to the residential facility so that
this unique program can continue to meet the needs of the mothers and
children who participate from across the state of Alaska every year.
Conclusion
The services provided by FNA are essential in promoting the
independence and self-sufficiency of our community. Guided by our
traditional values, we remain committed to serving our people in a
respectful and meaningful way.
But, like other Alaska Native and American Indian tribes and
organizations, FNA's ability to do this important work relies on the
Federal government to uphold its trust responsibility. Adequate and
consistent funding is essential to ensure that these critical services
continue, as is a stable grant administration support infrastructure.
Proposed and already executed DHHS restructuring actions such as
closing and consolidating offices, dismissing federal program officers
and grant managers, and/or converting existing direct grant programs
into block grants administered by states, have very real impacts on
tribes' and tribal organizations' abilities to implement federally
funded programs and services and in turn, on the individuals, families,
and communities we serve. For a person who is experiencing an acute
mental health crisis, grappling with addiction, trapped in a violent
living situation, or struggling to keep a family fed and sheltered, a
temporary lapse in availability of funds or a delay in processing a
federally required grant approval action can mean life or death.
The loss of any FNA programs funded by DHHS would significantly
harm both our community and the clients we serve. Since the pandemic,
youth and social services have struggled to fully recover, and staffing
continues to be a major challenge. Even if programs were cut, the
underlying needs would persist. Gaps in victim services, behavioral
health care, education for children, and family support would place
additional strain on already limited community resources in Fairbanks.
FNA has operated these programs in good faith, relying in part on
the federal government's trust responsibility to support essential
services. These programs are vital to the well-being of families and
the health of our community.
Thank you for this opportunity to share the important and rewarding
work that FNA is doing with Health and Human Services funding. We
believe it is reflective of the work that is being done across the
nation by tribes and tribal organizations. This work is critical to
meet the needs of families, children and communities.
I also want to thank the Alaska delegation, particularly Senator
Murkowski, for their continued support of and advocacy for our work.
Basee'.
The Chairman. Thank you.
Next we turn to Lucy Simpson. Welcome.
STATEMENT OF LUCY R. SIMPSON, EXECUTIVE DIRECTOR, NATIONAL
INDIGENOUS WOMEN'S RESOURCE CENTER
Ms. Simpson. Thank you, Madam Chair Murkowski, Vice
Chairman Schatz, and members of the Committee, for the
opportunity to testify today on the critical role of HHS
programs serving Indian Country.
My name is Lucy Simpson. I am a citizen of the Navajo
Nation and the Executive Director of the National Indigenous
Women's Resource Center. We are a Native-led nonprofit
dedicated to restoring sovereignty and safety for Native women
and families. We serve as the National Indian Resource Center
Addressing Domestic Violence and Safety for Indian Women and
the Tribal Safe Housing Capacity Building Center under the
Family Violence Prevention and Services Act, or FVPSA.
I first want to ground this testimony in what must remain
the guiding principle of the Federal Government's work: its
trust and treaty responsibility to tribal nations. This
responsibility is not abstract; it is a legal and moral
obligation.
HHS plays a crucial role in fulfilling this obligation, not
only by providing public health services through the Indian
Health Service, but also in providing services that address the
public health crisis that is violence against Native people.
Congress reaffirmed this obligation in the Violence Against
Women Act reauthorization of 2005, stating that ``Indian tribes
require additional criminal justice and victim services
resources to respond to violent assaults against women; and the
unique legal relationship of the United States to Indian tribes
creates a Federal trust responsibility to assist tribal
governments in safeguarding the lives of Indian women.''
By investing in tribal nations and Native-led organizations
as they design and implement community-driven, culturally
grounded services, HHS programs become instruments of tribal
self-determination. Such programs include those funded by
FVPSA, which for more than 40 years has been the cornerstone of
our Nation's response to family and domestic violence. It
remains the only Federal funding source specifically dedicated
to emergency shelter and related services for victims and their
children and is especially important for tribal nations and
American Indian and Alaska Native and Native Hawaiian victims
of violence.
According to the National Institute of Justice, more than
four in five American Indian and Alaska Native women have
experienced violence in their lifetime, and more than half have
experienced sexual violence and intimate partner violence.
These statistics reflect a complex public health and safety
crisis, which often involves jurisdictional confusion, a lack
of law enforcement presence, geographic isolation, historical
trauma, and distrust of systems.
Yet, despite the pervasive levels of violence, many tribal
communities still lack access to the most basic safety
services, with fewer than 60 Native-centered domestic violence
shelters across all of Indian Country.
FVPSA provides essential funding to these tribal shelters,
as well as counseling services, tribal domestic violence
programs, the StrongHearts Native Help Line, and resource
centers like ours, all of which ensure that culturally
appropriate services are available where they are most needed.
But recent and abrupt changes within HHS, specifically the
removal of experienced staff and leadership from agencies and
programs that serve Indian Country, threaten to destabilize the
progress made. Sudden changes in leadership, staffing and
structure, especially without tribal consultation, can disrupt
the continuity of services, erode trust, and delay funding for
these life-saving programs.
At a time when Native women face the highest rates of
murder, rape, and abuse in the Country, preserving
institutional knowledge and maintaining stable, informed, and
responsive leadership is not just a matter of continuity, it is
a matter of life and death. Every day, we hear from frontline
advocates who, with limited resources, are saving lives by
creating safe homes, traditional healing circles, and language-
based advocacy services that allow survivors to heal in ways
that reflect their values and culture.
When we invest in Native women, we invest in the future of
tribal nations. We respectfully urge Congress and HHS to
fulfill your trust and treaty obligations by prioritizing,
strengthening, and expanding all programs that impact the
health and safety of Native peoples, and for HHS to engage in
meaningful government-to-government consultation with tribal
nations before making changes to program structure, leadership,
or funding.
Thank you. [Phrase in Native tongue.]
[The prepared statement of Ms. Simpson follows:]
Prepared Statement of Lucy R. Simpson, Executive Director, National
Indigenous Women's Resource Center
Thank you, Chairman Murkowski, Vice Chairman Schatz, and members of
the Committee, for the opportunity to testify today on the critical
role of Health and Human Services (HHS) programs serving Indian
Country--particularly those programs that address the health and safety
of Native women, families, and survivors of violence.
My name is Lucy Simpson. I am a citizen of the Navajo Nation and
the Executive Director of the National Indigenous Women's Resource
Center (NIWRC). NIWRC is a Native-led nonprofit organization dedicated
to restoring sovereignty and safety for Native women and their
families. We serve as the statutorily mandated National Indian Resource
Center (NIRC) Addressing Domestic Violence and Safety for Indian Women
and the Tribal Safe Housing Capacity Building Center under the Family
Violence Prevention and Services Act (FVPSA).
I first want to ground this testimony in what must remain the
guiding principle of the federal government's work: its trust and
treaty responsibility to Tribal Nations.
This responsibility is not abstract; it is a legal and moral
obligation. HHS plays a crucial role in fulfilling this obligation, not
only by providing public health services through the Indian Health
Service, but also in providing services ``which are necessary to raise
the standard of living and social well-being of the Indian people to a
level comparable to the non-Indian society,'' \1\ including those
programs that address the public health crisis that is violence against
Indigenous people.
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\1\ Administration for Native Americans. U.S. Department of Health
and Human Services, Administration for Children and Families. Retrieved
January 31, 2025, from https://www.acf.hhs.gov/ana
---------------------------------------------------------------------------
Congress reaffirmed this obligation in the Violence Against Women
Act (VAWA) reauthorization of 2005, stating that ``Indian tribes
require additional criminal justice and victim services resources to
respond to violent assaults against women; and the unique legal
relationship of the United States to Indian tribes creates a Federal
trust responsibility to assist tribal governments in safeguarding the
lives of Indian women.'' \2\
---------------------------------------------------------------------------
\2\ Violence Against Women and Department of Justice
Reauthorization Act of 2005, Pub. L. No. 109-162, 901(6), 119 Stat.
2960, 3077 (2006).
---------------------------------------------------------------------------
By investing in Tribal Nations and Native-led organizations as they
design and implement community-driven, culturally grounded services,
HHS programs become instruments of self-determination.
Such programs include the Administration for Children and Families
(ACF) Office of Family Violence Prevention and Services (OFVPS), which
administers FVPSA. For more than 40 years, FVPSA has been the
cornerstone of our nation's response to family, domestic, and dating
violence. It remains the only federal funding source specifically
dedicated to emergency shelter and related services for victims and
their children. FVPSA programs are essential for Tribal Nations and
American Indian, Alaska Native, and Native Hawaiian victims of
violence.
According to the National Institute of Justice, more than 4 in 5
American Indian and Alaska Native (AI/AN) women (84.3 percent) have
experienced violence in their lifetime, and more than half have
experienced sexual violence (56.1 percent) and intimate partner
violence (55.5 percent). \3\ These statistics reflect a public health
and safety crisis. One that is devastatingly complex, often involving
jurisdictional confusion, a lack of law enforcement presence,
geographic isolation, historical trauma, and distrust of systems.
---------------------------------------------------------------------------
\3\ Rosay, Andre B., ``Violence Against American Indian and Alaska
Native Women and Men,'' NIJ Journal 277 (2016): 38-45, available at
National Institute of Justice, Violence against American Indians and
Alaska Natives, National Institute of Justice, http://nij.gov/journals/
277/Pages/violence-against-american-indians-alaska-natives.aspx..
---------------------------------------------------------------------------
Yet, despite the pervasive levels of violence, many Tribal
communities still lack access to the most basic safety services. Fewer
than 60 Native-centered domestic violence shelters exist across all of
Indian Country, and access to specialized legal aid and programs aimed
at improving the mental, emotional, physical, spiritual, and cultural
health of survivors as they seek to rebuild their lives is extremely
limited.
FVPSA funding is often the only lifeline preventing Native
survivors from falling through the cracks. Through NIWRC's role as the
National Indian Resource Center, since 2011, we have responded to
nearly 15,000 requests for technical assistance, hosted more than 700
trainings and community engagement sessions, trained close to 100,000
individuals, and distributed more than 800,000 resources to support
survivors, advocates, and programs nationwide. Our digital resources
have been accessed more than 6 million times, a clear indication of
both the reach and ongoing need for culturally specific, Native-led
solutions.
With continued FVPSA funding, NIWRC leads national efforts to
implement prevention strategies that address the root causes of
violence, promote healthy relationships, and break cycles of
intergenerational trauma--and we are not alone in this work.
FVPSA provides essential funding to Tribal shelters, counseling
services, Tribal domestic violence programs, and resource centers like
NIWRC, including the Alaska Native Tribal Resource Center on Domestic
Violence and the Native Hawaiian Resource Center on Domestic Violence.
These ensure that culturally appropriate services are available where
they are most needed.
Among the most vital efforts supported by FVPSA is the StrongHearts
Native Helpline, a free, confidential, 24/7 service that connects
Native survivors to advocacy, shelter, and support. Organizations like
ours also fill critical data gaps by conducting research, evaluating
program impact, and tracking trends that inform future prevention and
response strategies. Data that too often does not exist elsewhere for
Native communities.
In Fiscal Year 2024, FVPSA supported more than 230 Tribal domestic
violence programs, most of which are the sole service providers in
their communities. Yet, all but 36 of those programs received grants of
just $58,000--barely enough to support one full-time advocate. The
number of eligible Tribes has nearly doubled since 1993, but the Tribal
set-aside has not meaningfully increased. We recommend raising the
Tribal set-aside to 12.5 percent, both to reflect the expanded
eligibility and to build on the proven success of existing programs.
Domestic violence, however, is never an isolated issue. Native
survivors often face multiple overlapping challenges: housing
insecurity, substance use disorders, chronic health conditions,
poverty, and high rates of maternal and infant mortality, all of which
are rooted in historical and intergenerational trauma. \4\ Addressing
this requires a coordinated federal response that bridges healthcare,
social services, and justice systems, with Native voices leading the
way.
---------------------------------------------------------------------------
\4\ Centers for Disease Control and Prevention, Health disparities
affecting American Indian/Alaska Native people, Centers for Disease
Control and Prevention, https://www.cdc.gov/hearher/aian/
disparities.html.
---------------------------------------------------------------------------
Programs like the Maternal, Infant, and Early Childhood Home
Visiting (MIECHV) Program, which includes a Tribal set-aside (TMIECHV)
administered by ACF, are a critical part of that solution. TMIECHV
offers culturally grounded, evidence-based strategies, including
domestic violence screening and social support connections, that
identify and address risk factors early in the lives of Native
families.
In just four years, TMIECHV grantees have demonstrated measurable
improvements across 17 performance indicators, including screening
child injury prevention, maternal health, and domestic violence. \5\
These outcomes underscore the deep connection between public health and
safety--and the vital role of Native-led, community-based programs in
advancing both.
---------------------------------------------------------------------------
\5\ Administration for Children & Families, Tribal Home Visiting
Action Plan, 2020-2023, Administration for Children & Families, https:/
/acf.gov/ecd/data/tribal-home-visiting-action-2020-2023.
---------------------------------------------------------------------------
HHS also provides funding for Tribal Nations and Tribal
organizations to run programs such as the Low Income Home Energy
Assistance Program (LIHEAP) and Temporary Assistance for Needy Families
(TANF). These programs help strengthen Native families by assisting
low-income households in meeting the costs of home energy and helping
needy families care for their children in their own homes or in the
homes of relatives. Funding integrated, culturally appropriate services
such as these is essential to protecting Native women and families and
building healthier, more resilient Tribal communities.
But recent and abrupt changes within HHS, specifically the removal
of experienced staff and leadership from agencies and programs that
serve Indian Country, threaten to destabilize the progress made by
these services. These programs rely on staff who have cultivated
trusted relationships with Tribal Nations, relationships that take
years to build, alongside cultural competence, trauma-informed
expertise, and a deep understanding of the complex realities facing our
communities.
Sudden changes in leadership and staffing, especially without
Tribal consultation, can disrupt the continuity of services, erode
trust, and delay funding for life-saving programs. At a time when
Native women face the highest rates of murder, rape, and abuse in the
country, preserving institutional knowledge and maintaining stable,
informed, and responsive leadership is not just a matter of continuity,
but it is a matter of life and death.
Since time immemorial, Native women have been leaders, caregivers,
knowledge keepers, and protectors of our cultures, languages, and
traditions. Every day, we hear from frontline advocates who, with
limited resources, are saving lives. They are creating safe homes,
traditional healing circles, and language-based advocacy services that
allow survivors to heal in ways that reflect their values and culture.
Most importantly, survivors are able to disclose abuse and access
support in spaces that feel safe, familiar, and trusted. This leads to
better healing outcomes.
Given the unique historical, cultural, geographic, and socio-
economic barriers facing Native people, the federal government must
continue to expand, not scale back, its support for Native-led
domestic, sexual, and family violence prevention and response programs.
These programs are best positioned to foster healing, strengthen social
support networks, and provide trauma-informed care that reflects
Indigenous values and healing practices.
When we invest in Native women, we invest in the future of Tribal
Nations. Continued federal funding for culturally grounded, community-
led solutions is a trust and treaty obligation.
We respectfully urge Congress and the Department of Health and
Human Services to continue to prioritize, strengthen, and expand all
programs that impact the health and safety of Native peoples, and to
engage in meaningful government-to-government consultation with Tribal
Nations before making changes to program structure, leadership, or
funding.
The National Indigenous Women's Resource Center is honored to
support the lifesaving work of Tribal programs across the country.
Thank you for your commitment to safety, justice, and sovereignty. I
welcome your questions.
The Chairman. Thank you.
And finally, Dr. Sheri-Ann Daniels.
STATEMENT OF DR. SHERI-ANN DANIELS, CEO, PAPA OLA LOKAHI
Dr. Daniels. [Greeting in Native tongue.] Aloha, Chairman
Murkowski, and Vice Chairman Schatz. Thank you for the
introduction, and members of the Committee.
Thank you for inviting me today to provide remarks on
behalf of Papa Ola Lokahi, the Native Hawaiian Health Board. We
appreciate the Committee's legacy of strong bipartisanship in
honoring the Federal trust responsibility. I am honored to hear
and learn from other Native American leaders and communities on
this panel, because the comments, stories and challenges that
they shared are what we face as well.
Papa Ola Lokahi was Congressionally and statutorily created
in 1988 to improve the health status of Native Hawaiians, and
the named entity in the Native Hawaiian Health Care Improvement
Act. So I want to be really clear: we are statutorily named and
created to support and uplift the health of Native Hawaiians.
And as a named entity, we have the statutory responsibility
for the coordination, implementation and updating of a
comprehensive health care master plan, the identification and
research of diseases, establishment of a network of health
resources, services and infrastructure through our five-island
community based health organizations, as well as administer a
scholarship for health care professionals.
On the topic of this oversight hearing today, it is in our
written testimony, we highlight the following key messages.
Federal trust responsibility to Native Hawaiians is based on
our unique political status, not on our race. So let me say
that again. There is a trust responsibility to Native
Hawaiians, and that is through policy, funding and consultative
practices, which we often don't get.
Our unique political status is recognized in other
Congressional acts, not just the Native Hawaiian Health Care
Improvement Act. And this is with a population that has grown
29 percent since between the 2010 and 2020 Census. That is
huge.
For almost 40 decades, Papa Ola Lokahi continues fulfilling
our statutory responsibility including our Native Hawaiian
health systems. We do this through funding with HHS.
We talk about IHS, and you are correct that we do not get
any funding through IHS. So the bulk of our funding comes from
HHS through HRSA. And that fulfillment of the Federal trust
responsibility for Native Hawaiians is in the way of programs
and funding, again, primarily through HRSA.
The other HHS areas, including SAMHSA, we would be impacted
through mental health and substance abuse. And we all know what
those statistics are.
In addition to that, we also currently are supporting the
Lahaina wildfires impacted families. So over the last two
years, over 12,000 families, 34,000 people, 3,700
professionals, boots on the ground, and over 140 organizations
had a role in that and continue to have a role in that.
We need to continue to focus on the most vulnerable of
populations, programs that address the health, safety and self-
sufficiency of Native Hawaiian families, and that is CMS. Our
Native Hawaiian population in Hawaii is 21 percent. Yet for
TANF families, 33 percent of them are Native Hawaiian. For
victims of child abuse and neglect, 39.7 percent. Those are
large numbers, greater than our population.
The total Hawaiian population currently receiving Medicaid
equals almost 77,000. That is a lot. Thirty-four percent of
them are children. That is not acceptable. If we talk about our
cultural values and where we put our youngest as well as our
oldest, that is culture. And when we remove those things, we
create other impacts and other concerns down the line.
CDC, the prevention services, tobacco, chronic conditions,
we all know diabetes. Diabetes does not discriminate. It is no
longer just a Native issue. So cutting those services has huge
impacts.
We also want to make sure we continue to advance the
Missing and Murdered Native Hawaiian Women and Girls
initiatives, but it is also with our tribal partners. We know
that a quarter of the missing girls are Native Hawaiian.
We also want to recognize the reality of communities and
the impact it has on health, that health policy should aim to
reduce differences between rural and city areas. It is
especially important because our Native communities, for many
of us, tribes, everyone, our people live in rural areas, often
with limited access to services.
Finally, we need to continue to strengthen our networks. In
our written testimony, we highlight the Native Hawaiian health
network collaborators across our eight major islands. It is not
just us. We recognize it is our Native Hawaiian health systems,
our federally qualified health centers, our community health
centers, hospitals and especially our community based
organizations. We are doing it with everyone, linking arms. And
I think that is important to recognize.
And these are just some of the highlighted examples of the
impacts that HHS in reduction and the things that are happening
could have on our communities. I look forward to answering any
further questions from the Committee.
Mahalo.
[The prepared statement of Dr. Daniels follows:]
Prepared Statement of Dr. Sheri-Ann Daniels, CEO, Papa Ola Lokahi
Aloha e Chairman Murkowski, Vice Chairman Schatz, and Members of
the United States Senate Committee on Indian Affairs (``Committee''),
Mahalo (thank you) for inviting me to provide remarks on behalf of
Papa Ola Lokahi (POL), the Native Hawaiian Health Board (NHHB). In the
spirit of the Committee's legacy of strong bipartisanship in honoring
the federal trust responsibility owed to American Indians, Alaska
Natives, and the Native Hawaiian Community (NHC), collectively ``Native
Americans'', thank you for convening the oversight hearing, and I'm
honored to participate, and to share our collective support with Native
American leaders and communities.
POL was congressionally and statutorily created in 1988 to improve
the health status of Native Hawaiians, through the passage of the
Native Hawaiian Health Care Act, which was later reauthorized as the
Native Hawaiian Health Care Improvement Act (NHHCIA). The
implementation of the NHHCIA provides for: 1) Coordination,
implementation and updating of a comprehensive Native Hawaiian health
care master plan (operationally known as ``E Ola Mau''), including
identification and research of diseases most prevalent among NH; 2)
Establishment of a network of health resources, services, and
infrastructure, through five island community based health
organizations, commonly known and referred to as the Native Hawaiian
Health Care Systems \1\ (NHHCS or ``Systems''); and 3) Administration
of scholarships via the Native Hawaiian Health Scholarship Program
(NHHSP).
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\1\ Comprised of Ho`ola Lahui Hawai`i--Kaua`i Community Health
Center, a federally qualified health center; Ke Ola Mamo, island of
O`ahu; Hui No Ke Ola Pono, island of Maui; Na Pu`uwai, islands of
Molokai and Lana`i; and Hui Malama Ola Na `Oiwi, Hawai`i Island
---------------------------------------------------------------------------
We recognize and are grateful for the commitment and work of the NH
Health Network (NHHN) collaborators across the eight major islands of
the State of Hawai'i, including the Systems, federally qualified health
centers (FQHCs), community health centers (CHCs), community-based
organizations (CBO), and Native Hawaiian serving organizations (NHO),
and the State of Hawaii (Department of Health, Department of Human
Services).
POL's response to the Committee's Oversight Hearing focuses on
examining Federal Programs serving NHs across the Operating Divisions
at the United States Department of Health and Human Services (HHS), and
is divided into the following three sections:
I--Federal Trust Responsibility, Unique Political Status &
Declaration of Policy
II--Impact of Delivering Essential Public Health and Social
Services to
Native Hawaiians
A. Overview of POL's Unique Statutory Role
B. Impact re: Trust & Treaty Obligations, Policy Implementation
for Native Hawaiians
C. Summary of Delivery of Essential Public Health and Social
Services for Native Hawaiian Communities
D. Essential Public Health and Social Services: Via Native
Hawaiian Health Care Systems
E. Essential Public Health and Social Services: During the
Height of COVID-19 via HRSA
F. Essential Public Health and Social Services: For Communities
Impacted by the Lahaina, Maui Wildfires via SAMHSA
G. Essential Public Health and Social Services: For Child
Welfare, Domestic Violence, and Family Needs
H. Essential Public Health and Social Services: Via POL and
Trusted Community Partners
I. Essential Public Health and Social Services: Via Cultural
Healing Model
J. Essential Public Health and Social Services: Via Traditional
Healers & Practitioners
K. Essential Public Health and Social Services: Via Native
Hawaiian Health Professionals
L. Essential Public Health and Social Services: Via Education
Collaborations
III--Continuing Needs, Implementing Master Plan Recommendations and
the Native Hawaiian Health Network
A. Continuing Needs
B. Implementing Recommendations of E Ola Mau--Native Hawaiian
Health Master Plan
C. Native Hawaiian Health Network
Chairman Murkowski and Vice Chairman Schatz, thank you for the
longstanding commitment you have demonstrated individually,
collectively and through your Committee work and leadership to ensure
that the United States upholds its federal Trust and Treaty Obligations
to Native Americans. We acknowledge the Committee's historic and
bipartisan, work that has helped strengthen the overall well-being of
Native Americans.
I--The Federal Trust Responsibility, Unique Political Status &
Declaration of Policy
A. Federal Trust Responsibility
Similar to American Indians and Alaska Natives, Native Hawaiians
never relinquished the right to self-determination despite the United
States' involvement in the illegal overthrow of Queen Lili`uokalani in
1893 and the dismantling of our Hawaiian government. As such, Native
Hawaiians are owed the same trust responsibility as all Native groups
in the United States. The federal trust responsibility extends to all
Native Hawaiians, a population that grew nationwide by 29.1 percent
from the 2010 to the 2020 census data. \2\ To meet this obligation,
Congress--through landmark, bipartisan work of this Committee and its
Members--created policies to promote education, health, housing, and a
variety of other federal programs intended to build, maintain, and
better conditions for the Native Hawaiian Community.
---------------------------------------------------------------------------
\2\ https://www.census.gov/library/stories/2023/09/2020-census-dhc-
a-nhpi-population.html, retrieved May 7, 2025
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B. Unique Political Status
Hundreds of Acts of Congress expressly acknowledge or recognize a
special political and trust relationship to Native Hawaiians based on
our status as the Indigenous, once-sovereign people of Hawai`i. Among
these laws are the Hawaiian Homes Commission Act, 1920 (42 Stat. 108)
(1921), the Native Hawaiian Education Act (20 U.S.C. 7511) (1988),
the Native Hawaiian Health Care Improvement Act (42 U.S.C. 11701)
(1988), and the Hawaiian Homelands Homeownership Act codified in the
Native American Housing Assistance and Self Determination Act, Title
VIII (25 U.S.C. 4221) (2000).
The first Congressional finding of the NHHCIA states, ``(1) Native
Hawaiians comprise a distinct and unique indigenous people with a
historical continuity to the original inhabitants of the Hawaiian
archipelago whose society was organized as a Nation prior to the first
nonindigenous people in 1778.'' \3\ Subsequent Congressional findings
include: ``(17) The authority of the Congress under the United States
Constitution to legislate in matters affecting the aboriginal or
indigenous peoples of the United States includes the authority to
legislate in matters affecting the native Peoples of Alaska and Hawaii;
(18) In furtherance of the trust responsibility for the betterment of
the conditions of Native Hawaiians, the United States has established a
program for the provision of comprehensive health promotion and disease
prevention services to maintain and improve the health status of the
Hawaiian people; and (22) Despite such services, the unmet health needs
of the Native Hawaiian people are severe and the health status of
Native Hawaiians continues to be far below that of the general
population of the United States.'' \4\
---------------------------------------------------------------------------
\3\ The Native Hawaiian Health Care Improvement Act (42 U.S.C.
11701) (1988)
\4\ Ibid
---------------------------------------------------------------------------
C. Declaration of Policy
Congress declared that it is the policy of the United States in
fulfillment of its special trust responsibilities and legal obligations
to the indigenous people of Hawaii resulting from the unique and
historical relationship between the United States and the Government of
the indigenous people of Hawaii (1) to raise the health status of
Native Hawaiians to the highest possible health level; and (2) to
provide existing Native Hawaiian health care programs with all
resources necessary to effectuate this policy. \5\
---------------------------------------------------------------------------
\5\ The Native Hawaiian Health Care Improvement Act (42 U.S.C.
11702) (1988)
---------------------------------------------------------------------------
II--Impact of Delivering Essential Public Health and Social Services to
Native Hawaiians
A. Overview of POL's Unique Statutory Role
For almost four decades, POL, the Native Hawaiian Health Board
(NHHB), has consistently focused on raising the health status of Native
Hawaiians, in executing its statutory charge to:
1. Coordinate, implement and update a Native Hawaiian
comprehensive master plan designed to promote comprehensive
health promotion and disease prevention services to improve and
maintain the health status of Native Hawaiians.
2. Conduct training for Native Hawaiian care practitioners,
community outreach workers, counselors, and cultural educators
to educate the Native Hawaiian population regarding health
promotion and disease prevention.
3. Identify and perform research into diseases that are most
prevalent among Native Hawaiians.
4. Develop an action plan outlining the contributions that each
member organization of Papa Ola Lokahi will make in carrying
out in the policy of the NHHCIA.
5. Serve as a clearinghouse for (1) collecting and maintaining
data associated with the health status of Native Hawaiians; (2)
identifying and researching diseases affecting Native
Hawaiians; and (3) collecting and distributing information
about available Native Hawaiian project funds, research
projects and publications.
6. Coordinate and assist health care programs and services
provided to Native Hawaiians.
7. Administer special projects.
B. Impact re: Trust & Treaty Obligations, Policy Implementation for
Native Hawaiians
In responding to executive orders (EOs) and other policy statements
by this Administration, HHS and the federal government, as a whole,
must honor the federal Trust & Treaty Obligations and Responsibilities
in policy, funding and consultation practices, specifically:
1. Policy. Follow other executive departments (e.g., Interior,
Education, Agriculture), in articulating, via Secretary's
Order, that diversity, equity, inclusion, accessibility and
environmental justice policies do NOT apply to Tribal nations,
tribal citizens and the NH Community and related programs. Most
notably, the HHS Advisory Opinion 25-01, dated February 25,
2025, on ``Application of DEI Executive Orders to the
Department's Legal Obligations to Indian Tribes and Their
Citizens'' excludes NHs.
2. Funding. Recognize that federal Trust responsibility, policy
implementation and program funding is: Congressionally and
statutorily authorized and appropriated; NOT discretionary
spending that Native Americans need to ``apply'' for; exists
beyond Indian Health Services (IHS); and NOT a state obligation
(i.e., state funding should supplement not supplant federal
funding).
3. Consultation Practices. Implement meaningful consultation
practices with Tribal nations, tribal citizens and the NHC,
including announced HHS reorganization activities (e.g.,
consolidation, elimination of HRSA, SAMHSA).
In practice, and by observation, HHS' policy implementation
activities in its related operating divisions, have not been explicit
nor in alignment with the above.
C. Summary of Delivery of Essential Public Health and Social Services
for NHCs
1. Appropriations. Current FY26 appropriations request for the
Native Hawaiian Health Care Program is at $27 million, via HRSA, and
historically funded:
a. Papa Ola Lokahi, Native Hawaiian Health Board--Via HRSA \6\,
BPHC \7\--$10,000,000
---------------------------------------------------------------------------
\6\ Health Resources and Services Administration (HRSA)
\7\ Bureau of Primary Health Care (BPHC)
b. Papa Ola Lokahi, Native Hawaiian Health Board--Native
Hawaiian Scholarship Program via HRSA, BHW \8\--$2,200,000
---------------------------------------------------------------------------
\8\ Bureau of Health Workforce (BHW)
c. Papa Ola Lokahi, Native Hawaiian Health Board--Native
---------------------------------------------------------------------------
Hawaiian Health Care Systems Via HRSA BPHC--$14,800,000
2. Program Commitments, Spending. Described in further detail
below, the following table summarizes the financial program impacts by
HHS operating divisions from 2022 to 2024 which may be at risk, pending
further HHS' reorganization plan details--$16,572,000.
a. Papa Ola Lokahi, Native Hawaiian Health Board--American
Rescue Plan Act (ARPA)--HRSA--$1,566,000
b. Papa Ola Lokahi, Native Hawaiian Health Board--Community
Health Workers, Perinatal Health--HRSA--$801,000
c. Papa Ola Lokahi, Native Hawaiian Health Board--Native
Hawaiian Health Program (NHHP), including Native--HRSA,
including BPHC, BHW--$9,576,000
d. Papa Ola Lokahi, Native Hawaiian Health Board--SAMHSA
Emergency Response Grant (SERG)--SAMHSA, \9\ via the State of
Hawaii, Department of Health--$4,537,000
---------------------------------------------------------------------------
\9\ Substance Abuse and Mental Health Services (SAMHSA)
e. Papa Ola Lokahi, Native Hawaiian Health Board--Center of
Excellence, Tobacco, Aging, Transportation Equity Working
---------------------------------------------------------------------------
Group--Via the State of Hawaii, Department of Health--$92,000
Total HHS' Operating Divisions Related--$16,572,000
D. Essential Public Health and Social Services: Via Native Hawaiian
Health Care Systems
1. Overview. The five NHHCS offer a range of health care and other
services, including primary care, mental health, and fitness programs,
in a way that reflects the culture and priorities of the island
communities they serve. The work of the NHHCSs aims to build trust in
the Native Hawaiian Community, serving as a bridge to Western medicine,
while integrating medical care with traditional Native Hawaiian values,
beliefs, and practices. In the past year, the five Native Hawaiian
Health Care Systems have made a significant impact through their
community outreach and traditional healing efforts.
Collectively, based on the most recent program funding year, the
Systems distributed over 41,900 health education materials, hosted 376
events, and reached more than 39,400 individuals across Hawai`i.
Traditional healing services played a vital role, with over 3,200
people receiving care rooted in Native Hawaiian cultural practices. For
example, Hui Malama Ola Na `Oiwi (HMONO) reached more than 17,000
individuals through just 3 major events, while Ho`ola Lahui Hawai`i
(HLH) provided traditional healing services to 1,571 individuals across
131 events. Ke Ola Mamo (KOM), Na Pu`uwai, and Hui No Ke Ola Pono
(HNKOP) also made notable contributions, with HNKOP engaging more than
15,400 community members through its 173 events, primarily a result of
the Lahaina wildfires in August 2023. These efforts reflect a deep
commitment to culturally grounded care and community engagement,
strengthening health and wellness through Native Hawaiian traditions
and values.
Indian Health Services (IHS) awarded a contract to KOM for
alcoholism and related health care services and coronavirus activities
in 2015 and 2020, respectively. POL is not aware of any other IHS
related activities with the Systems or in the state. \10\
---------------------------------------------------------------------------
\10\ KE OLA MAMO--Coronavirus Contracts--ProPublica, retrieved May
12, 2025
---------------------------------------------------------------------------
2. HLH (Kaua`i) provides comprehensive health services across
Kaua`i County, including primary, dental, pharmacy (with delivery),
behavioral health, substance abuse counseling, chronic disease
management, physical activity and nutrition programs, health
screenings, school-based services, mobile clinic care, family planning,
and traditional healing. Services are delivered island-wide with
central locations in Lihu`e, Kapa`a, and Waimea. In addition to its
designation as a Native Hawaiian Health Care System, HLH operates as a
Federally Qualified Health Center under Section 330 of the Public
Health Service Act. Their culturally grounded approach emphasizes
preventive care, cultural competence through local staffing, and
integration of traditional practices with modern medicine. HLH's
facilities include two clinics, mobile units, a pharmacy, and a fitness
center.
3. KOM (O`ahu) is dedicated to improving the health and well-being
of its clients, with a focus on Native Hawaiians while serving the
entire O`ahu community. Becoming a client is simple and provides access
to a variety of health and wellness programs. KOM offers comprehensive
support, including medical and primary care, traditional healing such
as lomilomi, fitness programs, cultural workshops, and health classes.
Recognizing the disproportionate rates of heart disease, diabetes,
stroke, and cancer among Native Hawaiians, Ke Ola Mamo integrates
cultural values with healthcare to address these disparities. Services
are delivered through one medical clinic, an administrative office, and
four community-based health offices, ensuring care that honors the
cultural and historical connections to health and well-being.
4. Na Pu`uwai, founded on the pillars of Native Hawaiian health
disparity and cardiovascular disease research, serves residents of both
Moloka`i and Lana`i. Na Pu`uwai is dedicated to delivering culturally
responsive primary health, health education and health promotion that
address the unique needs of these communities, its mission, informed by
a foundation in research and advocacy, is to uplift and enhance the
health of Native Hawaiians through an integrative healthcare delivery
model grounded in Native Hawaiian culture, practices, tradition, and
language. Services include primary health, in addition to traditional,
complimentary and integrative medicine. Na Pu`uwai's community
engagement efforts are aimed at improving healthcare access by
informing Native Hawaiians about available services, programs and
resources.
5. HNKOP (Maui) is dedicated to improving the health of Native
Hawaiians and the greater Maui island community by empowering clients
to become their own health advocates, blending medical care with
traditional Hawaiian values and practices. With an emphasis on health
promotion and prevention, HNKOP, offers enabling and wrap-around
services to help community navigate healthcare and connect with
resources. Clinical services include adult primary care, oral health,
and intensive cardiac rehabilitation, supported by wellness programs
such as the Kaiaulu Wellness & Outreach, Hale Ho`oikaika gym, Simply
Health Cafe, and career training through the Kealaho`imai program. What
distinguishes HNKOP is its Kua`ua`u traditional healing program, which
provides lomilomi, ho`oponopono, and la`au lapa`au. Strong community
partnerships further enhance services, offering behavioral health
training, medicinal plant access, and Native Hawaiian birth and
parenting education.
6. HMONO (Hawai`i Island) provides comprehensive, culturally
grounded health services on Hawai`i Island, including primary care,
behavioral health, nutrition counseling, and chronic disease education.
Services are offered at the Hilo-based Family Medicine Clinic, via
telehealth, and through home visits--especially supporting kupuna.
HMONO emphasizes community wellness through traditional healing
programs such as la`au lapa`au gardening and taro cultivation, health
education including yoga, nutrition, and chronic disease management,
and support groups for diabetes and cancer. HMONO also operates a
transportation program with wheelchair-accessible vehicles to ensure
access to medical appointments across the island. Community engagement
is further supported through major events like the Malama Na Keiki
Festival and Ladies' Night Out.
E. Essential Public Health and Social Services: During the Height of
COVID-19 via HRSA
1. Overview. The establishment of POL, the NHHB, as a non-profit
organization allowed eligibility to pursue federal, State, county, and
private sources of funding. Since the first shutdown in the State of
Hawai`i in March 2020, POL (both alone and in partnership with
community organizations) successfully applied for or acted as fiscal
agent for over $2 million dollars throughout various grants. These
grant funds are in addition to the roughly $3.5 million of ARPA funds
that POL distributed to community based organizations (CBOs). POL is
committed to pursuing its mandates and mission through multiple funding
mechanisms to expand opportunities for Native Hawaiian health. POL
engaged its Congressional duties by providing the administration for
the Hawai`i COVID-19 Native Hawaiian & Pacific Islander Response,
Recovery, and Resilience (NHPI 3R) Team, a coalition of over 60
partners engaged on behalf of communities throughout the State of
Hawai`i, from June 2020 to present.
2. ARPA, Na Makawai. Na Makawai is the name of the initiative that
encompassed the work of the five NHHCS, POL, and fifteen Native
Hawaiian serving health entities (20 organizations in total) that
received ARPA funding to provide COVID-19 response and recovery
services and resources throughout the State of Hawai`i. ARPA funding
was administered by HRSA. Notably, ARPA language allowed for funds to
be applied towards health workforce, infrastructure, and community
outreach and education--critical components of the Native Hawaiian
Health Network (NHHN). Given the annual appropriations for federal
fiscal years 2021 and 2022 ($20.5 and $22 million, respectively), a $20
million increase in funding across a two-year span increases the total
funding to the NHHCIA by approximately half. The thoughtful flexibility
and inclusivity of ARPA language and approved activities through HRSA
allowed POL to partner with local organizations across a wide range of
programs and services throughout the State of Hawai`i, which included:
Direct clinical COVID-19 services (vaccination and testing,
mobile care, and mobile events);
Indirect COVID-19 services (outreach, education, and
surveillance; statewide referral hotline for various
resources); and
Increasing or maintaining resources needed to expand COVID-
19 response (workforce, including community health workers;
telehealth capacity and electronic medical records).
In addition, the Na Makawai partners' COVID-19 relief needs
overlapped with preexisting needs in the Native Hawaiian community.
These included: sustaining comprehensive primary health care; mental/
behavioral health; serving rural youth; food insecurity and access
programs; and maternal/childcare. POL connected with health factors
that impact clinical needs, so Na Makawai partnerships have also
supported a broadband infrastructure mapping project so that future
telehealth projects and programs that rely on broadband accessibility
can be informed by and based on high quality, locally collected data.
3. NHPI 3R. The Native Hawaiian & Pacific Islander Response,
Recovery & Resilience Team (NHPI 3R) was established in May 2020 to
collectively address the impact of COVID-19 and recommend and implement
solutions. Established in May 2020, in alignment with the national
response team, to improve the collection and reporting of accurate
data, identify and lend support to initiatives across the Hawaiian
Islands working to address COVID-19 among Native Hawaiians and Pacific
Islanders, and unify to establish a presence in the decisionmaking
processes and policies that impact our communities. More than 60
agencies, organizations, and departments comprise the NHPI 3R Team.
As the response to COVID-19 transitions, the NHPI 3R is pivoting
toward priority issues impacting Native Hawaiian and Pacific Islander
communities in Hawai'i. Capitalizing on the influence and impact such a
collective can have, these working committees continue to meet
regularly: Data & Research, Policy, Communication & Outreach, Health &
Wellness Priorities and the Community Health Worker Collaborative.
F. Essential Public Health and Social Services: For Communities
Impacted by the Lahaina, Maui Wildfires via SAMHSA
1. SERG. SAMHSA Emergency Response Grant (SERG) program is a
SAMHSA-wide grant opportunity, inclusive of mental health and substance
use prevention, response, and recovery services, that authorizes SAMHSA
to act immediately under emergency circumstances that create a
behavioral health crisis, where the crisis overwhelms the behavioral
health system or creates behavioral health service needs that do not
fit existing behavioral health resources. SERG funds are ``funds of
last'' resort and cannot supplant existing resources. SERG funding
enables public entities to address emergency behavioral health crises
when existing resources are overwhelmed or unavailable. \11\
---------------------------------------------------------------------------
\11\ https://www.samhsa.gov/mental-health/disaster-preparedness/
serg, retrieved May 10, 2025
---------------------------------------------------------------------------
2. Lahaina Wildfires & On the Ground Community Impacts. In
collaboration with SAMHSA grantee, the State of Hawai`i, Department of
Health, the SERG collaborator network grew initially from 20 to over 30
providers, contractors, programs, serving the emotional, social and
mental health needs of survivors of the August 2023 Maui
Wildfires. Maui SERG accomplishments, from the initial, on the
ground delivery period February to September 2024: Community Served--
7,298 families and 20,413 individuals; Clinical Care--8,152 urgent
trauma and mental health clinical appointments; Community Outreach--452
events and 2,133 non-clinical appointments; Workforce Development--94
training sessions attended by 2,229 local professionals and;
Collaborative Engagement--Strong partnerships with 14 local
organizations ensured tailored and effective services, especially for
under-served populations. \12\ Year 2 of SERG grants began November
2024 and continue to be monitored.
---------------------------------------------------------------------------
\12\ https://kawaiola.news/columns/i-ola-lkahi/collaborating-to-
support-mental-wellbeing-on-maui/, retrieved May 12, 2025
---------------------------------------------------------------------------
3. Programming. Examples of urgent, on the ground, community
customized programming include:
a. Family Resiliency toolkits rooted in the cultural values and
wisdom of Aloha and focus on the 5 Protective Factors that
support and strengthen families: Parental Resilience, Social
Support, Concrete Support, Understanding of Child Development,
and Social Emotional Competence of Children.
b. Via Radio, Newspaper, TV, Social Media--Developed culturally
and linguistically appropriate materials and activities (e.g.,
family fair, youth empowerment/resiliency building activities);
Provide bilingual community navigators to assist in seeking and
applying for assistance; Conduct media campaigns (placing
educational PSA and events announcements on the radio, social
media, and Filipino community newspapers).
Disseminated information and resources through ethnic media and
also strengthen promotion of services and resources offered by
government and community organizations in Ilokano and Filipino/
Tagalog. Develop culturally and linguistically appropriate
materials and activities to promote health, wellness, and
resiliency (e.g., family fair, youth empowerment, resiliency
building activities, job fair). Conduct media campaigns
(placing educational PSA and events announcements on the ethnic
radio and TV, Facebook, Instagram, Filipino community
newspapers and publications).
c. Workshops for Maui First Responders & Families (and
partnered with 17 external partners).
d. Disaster Behavioral Health Curriculum & Training (and
partnered with 15 SERG orgs and 33 external partners)
e. Cultural Healing & Recovery: Maui Wildfire Disaster (and
partnered with 3 SERG orgs and 7external partners)
G. Essential Public Health and Social Services: For Child Welfare,
Domestic Violence, and Family Needs
Often overlooked, but vital to NH and Hawai`i's health status
include areas addressed by the State of Hawaii's Department of Human
Services (DHS) in which HHS Divisions' funding flows, particularly
Medicaid, covering a range of programming and funding for the most
vulnerable of populations--children, pregnant women, parents of
eligible children, low income adults, former foster care children,
aged, blind and disabled individuals. \13\
\13\ What is Medicaid, retrieved May 12, 2025
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1. Benefit, Employment & Support Services
a. Temporary Assistance for Needy Families (TANF)
b. Temporary Assistance for Other Needy Families (TAONF)
c. Employment & Training
d. Child Care Subsidy Program (Child Care Subsidy or Preschool
Open Doors)
e. Child Care Regulation (also known as Child Care Licensing)
f. Homeless Programs
g. Aid to the Aged, Blind and Disabled
h. Supplemental Nutrition Assistance program (SNAP, formerly
the food stamps program)
i. Hawaii Home Energy Assistance Program (HI-HEAP formerly
LIHEAP)
2. Social Services Division--Adult Protective and Community
Services
a. Adult Services and Programs: case management for elderly
victims of crime program; chore services; adult foster care;
senior companion; respite companion; foster grandparent
program; transportation assistance; courtesy services.
b. Licensing and Certification: nurse aide training and re-
certification.
3. Social Services Division--Child Welfare Services
Missing children website; mandated reporters; family connections;
family court; foster and adoptive care; youth resources.
4. Med-QUEST \14\ Division
---------------------------------------------------------------------------
\14\ QUEST stands for: Quality care; Universal access, Efficient
utilization, Stabilizing costs; and Transforming the way health care is
provided.
The division is responsible for implementing the DHS
responsibilities as the single state agency designated to administer
the Hawaii Medicaid program under Title XIX of the Social Security Act.
POL understands \15\ the following about Native Hawaiian and part-
Hawaiian members served by the Hawaii Medicaid Program: Total Hawaiian
population currently receiving Medicaid equals almost 77,000 which
represents 19 percent of all Med-QUEST members; almost 26,000 (34
percent), children including over 1,400 current and former foster care
children; over 400 pregnant women; over 14,000 (18 percent) parents or
caretakers; about 26,500 (34 percent) adults; about 8,800 (11 percent)
aged, blind or disabled adults; and over 1,100 other individuals.
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\15\ State of Hawaii, Department of Human Services
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H. Essential Public Health and Social Services: Via POL and Trusted
Community Partners
1. Overview. Through presentations, demonstrations, workshops,
kukakuka sessions and working closely with kupuna (elders), POL seeks
to improve awareness of and sensitivity to Hawaiian cultural processes
and the philosophies of spiritual healing, thus assuring that they are
included within the larger health and wellness arena. Whenever
possible, POL collaborates and partners with NH community-based
organizations.
2. Cancer Prevention. POL via `Imi Hale, its research department is
a part of the Native Hawaiian Cancer Network launched in 2000, `Imi
Hale collaborates with key local, state, national and international
partners to reduce cancer incidence and mortality among Native
Hawaiians through the establishment of a core organizational
infrastructure that: Goal 1: Increase knowledge of, access to, and use
of beneficial biomedical procedures in cancer prevention and control
and co-morbid conditions of cancer patients. Goal 2: Develop and
conduct evidence-based intervention research to increase use of
beneficial biomedical procedures to control cancer and co-morbid
conditions. Goal 3: Train and develop a critical mass of competitive
researchers using community-based participatory research (CBPR) methods
to reduce health disparities. `Imi Hale is currently one of 23
Community Networks Program Center (CNPC) sites funded by the National
Cancer Institute's Center to Reduce Cancer Health Disparities.
3. Chronic Conditions. Healthy lifestyles, disease prevention and
health promotion are critical to reducing the impact of chronic disease
and other conditions such as heart disease, hypertension, stroke,
diabetes, kidney diseases, cancer and obesity. In many Hawaiian `ohana
(family), at least one family member is living with a chronic condition
such as diabetes, heart disease, or stroke. Since Western contact,
illnesses and the loss of resources have deeply affected the once-
thriving lahui of Kanaka Maoli, reshaping their way of life. Many
Native Hawaiians in Hawai`i experience a higher prevalence of chronic
disease due to a combination of genetic, environmental, and systemic
factors. While lifestyle choices can influence health, access to
resources, such as `aina for growing food, can be a significant barrier
to making healthier choices.
There are many ways to support overall well-being and reduce the
risk of chronic conditions. Engaging in physical activity, eating
nourishing foods, breastfeeding, and avoiding tobacco are all
beneficial steps. Fortunately, there are numerous resources and
community support systems available to help individuals and families on
their health journey.
POL coordinates, facilitates, contracts and sometimes direct
delivers disease prevention and health promotion programming re:
breastfeeding, nutrition, physical activity, tobacco use, kidney
disease, heart disease, cancer, diabetes.
4. Harm Reduction. POL and the Hawai`i Health & Harm Reduction
Center (H3RC) released a harm reduction toolkit for Native Hawaiians.
This approach to harm reduction focuses on developing a community
understanding of harm reduction, reducing the harms caused by
colonization in Hawai`i, and introducing a cultural approach to
reducing harm and promoting healing.
5. Kupuna Brain Health. Aligned with POL's commitment to improve
the health and well-being of Native Hawaiians and our families, inquiry
into the brain health of kupuna--elders, grandparents, adults 65 and
older--and Alzheimer's Disease and Related Dementias (ADRD) has yielded
insightful observations, a rich body of knowledge, and targeted
recommendations to agencies that address the interests of elders in
Hawai`i. The welfare of our kupuna impacts the well-being and
resiliency of the entire family.
6. LGBTQIA+. The Hawaiian `ohana as well as our lahui had roles for
each person. Whether kane, wahine, or mahu, each person had a kuleana
in the Hawaiian `ohana. Mahu have long held an important traditional
role as caretakers-of other `ohana members, of cultural and historical
knowledge, and as respected contributors to the lahui. However, since
Western-Colonial contact, we've seen a decrease in health outcomes for
our mahu (aka LGBTQ) community.
Papa Ola Lokahi includes our mahu `ohana in our commitment to the
health and well-being of Native Hawaiians and all our families. We are
identifying the health disparities and through programs, public policy
and partnerships, we are developing strategies to address: Increased
risk for depression, anxiety and mental health challenges; Increased
risk for substance use/misuse.; Increased societal stigma around care
(e.g. HIV, MPOX, etc.); Limited, and sometimes prohibited access to
gender-affirming care.
In 2023 alone, roughly 500 anti-LGBTQ bills were introduced within
state legislatures across the United States, including six bills
introduced in Hawai`i that would limit and criminalize vital gender-
affirming care that our trans and mahu `ohana members need.
7. Nutrition and Food Systems. Promoting nutrition education,
research, and policy related to food access, food sovereignty, and food
systems. POL efforts build on the foundation established in E Ola Mau,
Native Hawaiian Health Master Plan, emphasizing food sovereignty,
community-based education, and sustainable nutrition practices to
promote lifelong well-being. The 2023 E Ola Mau Update reaffirmed the
commitment to these principles, incorporating contemporary research and
community-driven solutions to further address nutritional health,
chronic disease prevention, and overall wellness.
8. `Ohana (Family) Well Being. From keiki (children) to kupuna,
this strand focuses on adverse childhood experiences, dental health,
sexual and reproductive health.
9. Substance Use, Recovery, and Behavioral Health. This strand
focuses on substance use, recovery, addictions, and related mental
health and wellness. Disproportionate numbers of our Native Hawaiian
population have been consistently over-represented among those who are
seeking or thrust into Western treatment for substance use disorders
and mental health issues. Existing systems of care continue to assign
treatment within the same western frameworks that have led to this
consistent over-representation, and do not account for the unique needs
of the Native Hawaiian Community, and are not anchored in Hawaiian ways
of knowing and being.
Research shows that this inequitable health status results from
several complex and interconnected social determinants of health,
including historical trauma, discrimination, and lifestyle changes.
Research also indicates that re-envisioning treatment for the Native
population, utilizing cultural re-connection and methodologies that
speak to Native perspectives, is more influential in creating positive
health outcomes for Native peoples
10. Tobacco and Vaping Control and Prevention. Taking action to
lower tobacco and vaping rates among Native Hawaiians. Big Tobacco, or
commercial tobacco, has historically ravaged Native Hawaiian
communities, wreaking havoc and harm to our people from keiki to
kupuna. Seen as one of the top markets for menthol tobacco products
since the 1960s, remnants still linger throughout our islands. In
addition to combustible commercial tobacco, young people (minors and
young adults) are being targeted by e-cigarette companies.
Although makahala (Native Hawaiian tobacco) has been used in la`au
lapa`au, commercial tobacco as well as its subsequent nicotine-related
products such as e-cigarettes (also known as ESD, ENDS), have been
imported into Native Hawaiian communities since Western-Colonial
contact. Since its import, tobacco, and more recently e-cigs, have
infiltrated and ravaged through our kaiaulu (communities). The 2021
Youth Risk Behavioral Survey shows that Native Hawaiian youth are
particularly vulnerable to the Tobacco Industry's targeted marketing.
I. Essential Public Health and Social Services: Via Cultural
Healing Model
The Ahupua`a model emphasizes relationship among people and the
environment, identifying protective and risk factors, and promoting
collective healing. Recognizing Native Hawaiians' holistic worldview,
which includes strong connections and reciprocal relationships between
the land, community, and spirituality, is key to developing effective
healing methods The ahupua`a model provides a framework for
implementing these interventions or methods and fostering a thriving
Native Hawaiian Community.
By embracing a culturally grounded approach, we can empower and
uplift our lahui to reclaim and celebrate the unique cultural strengths
that have kept our people healthy and thriving for generations, leading
to more impactful and meaningful interventions for healing and growth.
J. Essential Public Health and Social Services: Via Traditional Healers
& Practitioners
1. Overview. POL supports the efforts of kupuna (elder) healing,
and the organizing support of cultural masters and traditionalists
toward the understanding, support and perpetuation of the Native
Hawaiian healing knowledge, attitudes, values, beliefs and practices.
POL advocates for the preservation of such traditions to ensure that
the rights and cultural integrity of these practices are respected and
appropriately protected.
2. Approach. Through community-based presentations, demonstrations,
workshops, kukakuka (discussion) sessions and working closely with
kupuna (elder) of the geographic area, POL seeks to improve awareness
of and sensitivity to Hawaiian cultural processes and the philosophies
of spiritual healing, thus assuring that they are included within the
larger health and wellness arena. Whenever possible, POL networks and
partners with organizations in the medical communities. The traditional
healing program keeps apprised of both Hawai`i legislative and
congressional actions impacting and affecting these practices, responds
to requests and inquiries, and provides technical assistance to the
Systems as well as other community-based organizations as requested.
POL welcomes kupuna wisdom to provide the support for its cultural,
spiritual and historical foundation. This foundation seeks the
knowledge of the source of illness which lies within our ancestral past
and environment. The wisdom of this knowledge understands that healing
and wellness embraces the principles and protocols of our Native
Hawaiian cultural and healing practices and compels respect for our
kupuna.
3. Declaration of Practice, June 2024, Lihu`e, Kaua`i. More than 70
practitioners and advocates of Native Hawaiian healing traditions
gathered on Kaua`i to maintain the integrity of Hawaiian healing
knowledge. The chairs of five elder councils of Hawaiian healing
practitioners signed Ke Kuahaua Mauli Ola, a Declaration of Practice to
preserve, protect and perpetuate the cultural integrity and ancestral
traditions passed down through generations of healers. The declaration
is a response to the growing appropriation of Hawaiian healing
knowledge and practices by usurpers who don't genuinely understand the
protocols, the genealogy, the community recognition, the continued
lineage of healers, and most importantly, that healing is a spiritual
practice.
K. Essential Public Health and Social Services: Via Native Healthcare
Professionals
1. Native Hawaiian Health Scholarship Program
a. Overview. Established within the Native Hawaiian Health Care
Act, the NHHSP provides awards to Native Hawaiian students
seeking degrees in the health care professions. The purpose is
to increase the number of Native Hawaiians in health and allied
health professions, thereby increasing access to health care
delivery for those who seek it. The program recruits and
nurtures professionals in-training for primary health care
disciplines and specialties most needed to deliver quality,
culturally competent health services to Native Hawaiians
throughout the State of Hawai`i. The merit-based program awards
scholarships dedicated to providing primary health services to
Native Hawaiians and communities in Hawai`i.
b. Impact by the Numbers. Over the past almost three decades,
318 scholars via 347 scholarships awarded resulted in 244
program alumni in the fields of clinical psychology, dentistry,
dental hygiene, dietetics/nutrition, nursing, medicine,
physician assistant and social work. Fifty-one (51) scholars
are supported by NHHSP staff, thru three primary phases of
their journey to serving communities---education, in-service
and in community placement.
c. Impact via Native Voices. Hear the voices of in-education,
in-service and alumni scholars below:
(i) Scholar A, In-Education, Physician's Assistant (PA),
Community Area: TBD: ``The Native Hawaiian Health Scholarship
equips me with the financial stability necessary to excel as a
physician's assistant and effectively serve the rural
communities of Hawai'i. The scholarship alleviates my financial
concerns, ensuring that I can pursue my studies without the
burden of part-time employment after attending classes Monday
to Friday, 8 a.m. to 4 p.m., to cover my living expenses. While
the financial support is substantial, the most valuable aspect
of this program is the opportunity to connect and learn from
esteemed and future leaders in Hawaiian healthcare. The I Ola
Lahui lecture series provided me with invaluable insights into
the path to leadership as a Native Hawaiian in healthcare. This
scholarship not only benefits me personally but also
contributes to the greater well-being of the lahui by enabling
me to serve the community as a physician's assistant upon
completion of my studies.''
(ii) Scholar B, In-Service, Registered Nurse (RN), Community
Area: Maui ``The NHHSP helped me obtain my nursing license to
serve my rural community of Hana, Maui. The financial,
emotional, and mental support allowed me to focus on my
education and complete my program successfully. It also lifted
the financial burden, allowing me to focus on my family.''
(iii) Scholar C, Alumni, Family Nurse Practitioner (FNP),
Community Area: Kaua`i ``The Native Hawaiian Health Scholarship
Program has been invaluable to me and my family. Without this
scholarship I would not have pursued my Master's degree and
would never have become a nurse practitioner serving as a
primary care provider and hospice/palliative care provider for
my community. Had I not received this scholarship I would have
had to decline my acceptance to the Master's program because it
was going to be near impossible to afford my tuition as I would
have had to quit my full time job and become a full time
student. I was also making a choice between purchasing a home
(remaining an RN) and pursuing my education (becoming an APRN).
When I received the notification of my acceptance for the
Scholarship program my family and I were overjoyed as we felt
that the decision was made for us and my education was what I
was meant to pursue. The scholarship program afforded me the
ability to become a full-time student and still be able to help
care for my then 3 year old son. The primary challenge I had
with the scholarship program was related to taxes the years
following my award. However, through the help of an accountant
I was able to file correctly and was able to afford the taxes
in the end. This was such a small bump in the road compared to
the hurdles I faced going to school and being able to afford to
provide for my family as well as afford my tuition. I am
grateful for this program and feel blessed to continue to be
able to be a part of the community it helped me to find.''
(iv) Scholar D, Alumni, Masters in Nursing (MSN), Community
Area: Moloka`i ``The NHHSP assisted my Masters In Nursing
Program from 2011-2013. Because of the assistance of this
program, I was able to obtain a management position as a Branch
Coordinator of the only Home Care Agency on the island of
Molokai serving a majority of the Hawaiian Population. I am
fortunate to serve the people on a rural island and community
who lack the medical resources other islands are privileged to.
Because of this scholarship, I have been able to make a
difference in my community.''
(v) Scholar E, Alumni, Bachelor of Science in Nursing (BSN),
Community Area: Maui, Moloka`i: ``I was a registered nurse
working at Hui No Ke Ola Pono, Inc. The NHHSP allowed me to
pursue my BSN degree while continuing to work full time. I
continued to work for Hui No Ke Ola Pono, Inc. serving the
Native Hawaiian community. The BSN degree allowed me to move
back home to Moloka` and serve the community that helped to
raise me. I had the privilege and honor to work with Dr.Aluli,
the person who had been instrumental in obtaining the Native
Hawaiian Health funding and testified in Washington DC to
advocate for the health of our lahui. In my current position, I
am able to advocate for our island and help to find solutions
for our island's health needs. All this was possible first to
Ke Akua for opening the doors and providing the open door to
the NHHSP.
2. Department of Native Hawaiian Health, John A. Burns School of
Medicine, University of Hawaii--Manoa \16\
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\16\ Presentation to the Board of Trustees of the Office of
Hawaiian Affairs by DNNH, JABSOM, May 1, 2025
a. Overview. For the past five decades, Ho`ona`auao, the
medical education division, has been dedicated to developing
physicians who are committed to improving the health of Hawai`i
through the `Imi Ho`ola Post-Baccalaureate Program and the
Native Hawaiian Center of Excellence. Over 350 physicians (38
percent NH) who serve communities across Hawaii, the Pacific,
and the continental U.S., were produced by the program and in
the current year, 52 medical students currently enrolled, 47
pre-medical students preparing to apply to medical schools and
2,300 K-12 students engaged through recruitment and outreach
events.
b. Executive Order Impacts. The following information was
shared with the Board of Trustees at the Office of Hawaiian
Affairs:
Already Lost
Stop order on 20yr+ NIH longitudinal grant on diabetes ($208K/
year)
Discontinuation of biomedical sciences mentorship pathway
program ($2SOK/year)
Minority Health Training Grant for students in health sciences
(New--$270K/year)
Loss of data infrastructure and specialized research staff
At Risk
Current Funding: $5.4M
Pending Funding: $6.6M
Disruption/halt of health research for Native Hawaiians
Reduced support for NH students pursuing medicine, behavioral
health, and health science careers
Disruption of partnerships with NH communities
Future Outlook
Declining rates of NH student recruitment into health fields
Reduction of community-based clinical and health science
outreach
NH will experience widening health inequities without a voice
in academic medicine
Loss of informed health policy regarding Native Hawaiians
L. Essential Public Health and Social Services: Via Education
Collaborations
POL collaborates with other sectors, including education, resulting
in the United States Department of Education, Native Hawaiian Education
Program, \17\ award in 2001, a grant to POL, totaling $1.879 million
for the Resilient Communities, Families and Schools project. Also known
as the `Ohana (Family) Resilience Program, approximately 20 community-
based vendors were contracted, serving sites included in communities
near community health centers on the islands of Hawai`i (in the
communities of Mountain View, Honaunau, West Hawaii, East Hawaii) and
O`ahu (in the communities of Waianae, Waimanalo) to ensure equitable
access to disadvantaged communities by strengthening community
partnerships, promoting trauma sensitive practice and enhancing
coordination of wrap-around prevention/intervention services for
children and families.
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\17\ To address and support the educational needs of Native
Hawaiians, as demonstrated through the 1983 Native Hawaiian Educational
Assessment Report, Congress enacted the Native Hawaiian Education Act
(NHEA)
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POL, Native Hawaiian Health Care System, Hawai`i Department of
Education, University of Hawai`i Hilo Center for Place-Based
Socioemotional Development, Hawai`i Afterschool Alliance, Ceeds of
Peace, and HawaiiKidsCAN committed to support five (5) Title I
elementary schools located in rural and remote communities where
poverty, substance abuse and unemployment are pervasive with limited
access to health and further education. On average, 69 percent of
students identify as Native Hawaiian or Pacific Island ancestry and 90
percent of students are eligible for free and reduced lunch.
Accelerating the unique challenges of rural and remote places,
COVID-19 exacerbated existing stressors on youth, family and
communities. In response to the impacts of COVID-19, the purpose of the
resiliency hubs for communities, families and schools, was to promote
equitable access to education by empowering schools in disadvantaged
and/or rural communities to strengthen community partnerships, promote
trauma sensitive practice and enhance coordination of wraparound
prevention/intervention services for children and families.
III--Continuing Needs, Implementing Master Plan Recommendations and the
Native Hawaiian Health Network
A. Continuing Needs
Despite Congress' declaration that it is the policy of the United
States in fulfillment of its special trust responsibilities and legal
obligations to the indigenous people of Hawaii, health disparities
persist and programming needs in the following areas are at risk:
1. SAMHSA Emergency Response Grants (HHS>SAMHSA)
Currently in Year 2 of the implementation of SERG grants (beginning
November 2024), and the six-month period reporting in progress,
emerging data includes (pending final review and confirmation): over
5,400 families served in the community, associated with almost 14,400
individuals; about 4,400 urgent trauma and mental health clinical
appointments; almost 475 events, over 3000 non-clinical appointments;
over 90 training sessions attended by almost 1,700 local professionals;
and over 140 unduplicated organizations.
2. Rural Health Disparities in Hawai`i'--Native Hawaiian Health Systems
(HHS, HRSA>BPHC, Federal Office of Rural Health Policy)
The following plain language summary is provided by the Economic
Research Organization at the University of Hawai`i report ``Rural
Health Disparities in Hawai`i'', \18\ published in August 2024:
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\18\ Rural Health Disparities in Hawai`i--UHERO, retrieved May 12,
2025
``Health can be different in rural and city areas for many reasons.
For example, rural places might not have as many healthcare services.
This makes it harder for people to get good care. But rural areas are
closer to nature and often have close communities. This can be good for
health. Studies on how rural living affects health in the US have shown
mixed results. There have not been any studies for Hawai`i before. This
report looks at health differences between rural and city areas in
Hawai`i. We used data from a health survey done in June 2023: the UHERO
Rapid Survey. We looked at things like age, gender, race/ethnicity,
income, education, and disability to see how they relate to health and
rural living. We found some big differences in health between rural and
city residents in Hawai`i. Living in a rural area was strongly linked
to overall health. The effect was bigger for physical health than
mental health. People with disabilities and people with low incomes in
rural areas faced the biggest health differences. Our findings suggest
that health policies should aim to reduce differences between rural and
city areas. It is especially important to help groups like people with
disabilities and people with low incomes in rural areas. These groups
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need additional support.''
Continuing supports via NHHN organizations (POL, Systems, FQHCs,
CHCs, CBOs, NHOs, universities, State of Hawaii) can collectively
address rural health disparities.
3.Disproportionate Representation in Programs that Address the Health,
Safety and Self-Sufficiency of Native Hawaiian Families \19\
(HHS>CMS)
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\19\ Audit, Quality Control & Research Office Research Staff.
(2024). Databook. State of Hawaii Department of Human Services. https:/
/humanservices.hawaii.gov/wp-content/uploads/2025/04/DHS-Databook-
FY2024.pdf
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a. 33 percent of Temporary Assistance for Needy Families (TANF)
clients in June 2024 were Native Hawaiian. This is higher than
Hawaiians' proportion of the total state population of 21 percent.
b.In State Fiscal Year (SFY) 2024, 39.7 percent of confirmed
victims of child abuse or neglect were Hawaiian.
c.In the same year, 41.6 percent of children in foster care are
Native Hawaiian.
d.42.8 percent of incarcerated youth were Hawaiian.
e.Total Hawaiian population currently receiving Medicaid equals
almost 77,000 which represents 19 percent of all Med-QUEST members;
almost 26,000 (34 percent), children including over 1,400 current and
former foster care children; over 400 pregnant women; over 14,000 (18
percent) parents or caretakers; about 26,500 (34 percent) adults; about
8,800 (11 percent) aged, blind or disabled adults; and over 1,100 other
individuals.
4.Missing and Murdered Native Hawaiian Women and Girls \20\ (HHS>HRSA)
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\20\ Cristobal, N. (2022). Holoi a nalo Wahine `Oiwi: Missing and
Murdered Native Hawaiian Women and Girls Task Force Report (Part 1).
Office of Hawaiian Affairs; Hawai`i State Commission on the Status of
Women: Honolulu, HI.
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Pursuant to H.C.R. 11, the Hawai`i State Commission on the Status
of Women (CSW) convened a Task Force to study Missing and Murdered
Native Hawaiian Women and Girls (MMNHWG). The Missing and Murdered
Native Hawaiian Women and Girls Task Force (MMNHWG TF) was administered
through the Hawai`i State CSW and the Office of Hawaiian Affairs and
was comprised of individuals representing over 22 governmental and non-
governmental organizations across Hawai`i that provide services to
those who are impacted by violence against Kanaka Maoli.
The MMNHWG TF had the responsibility of understanding the drivers
that lead to Kanaka Maoli women and girls to be missing and murdered,
to propose solutions, and to raise public awareness about violence
against Kanaka Maoli.
The findings and recommendations in the report were provided to
members of the MMN-HWG TF for review and their insights were included.
Any disparate agreement with the findings and recommendations will be
noted.
a. 21 percent of Hawai`i's total population (N= 1,441,553)
identifies as Native Hawaiian (U.S. Census Bureau, 2021).
b. 10.2 percent of the total population of Hawai`i identifies
as a Native Hawaiian female, with 47.6 percent of this
population identified as females under the age of 18 (U.S.
Census Bureau, 2021).
c. More than a quarter (1/4) of missing girls in Hawai`i are
Native Hawaiian (JJIS, 2001 2021).
d. Hawai`i has the eighth highest rate of missing persons per
capita in the nation at 7.5 missing people per 100,000
residents (Kynston, 2019).
e. The average profile of a missing child: 15 year old, female,
Native Hawaiian, missing from O`ahu (MCCH, 2022).
f. The majority (43 percent) of sex trafficking cases are
Kanaka Maoli girls trafficked in Waikiki, O`ahu (Amina, 2022).
g. 38 percent (N= 74) of those arrested for soliciting sex from
a thirteen-year-old online through Operation Keiki Shield are
active-duty military personnel (Hawai`i Inter net Crimes
Against Children Task Force, 2022).
h. In 2021, the Missing Child Center Hawai`i (MCCH) assisted
law enforcement with 376 recoveries of missing children. These
cases are only 19 percent of the estimated 2,000 cases of
missing children in Hawai`i each year (MCCH, 2021).
i. On Hawai`i Island, Kanaka Maoli children ages 15-17,
represent the highest number of missing children's cases, with
the most children reported missing in area code 96720, Hilo
(Hawai`i Island Police Department, 2022).
j. From 2018-2021, there were 182 cases of missing Kanaka Maoli
girls on Hawai`i Island, higher than any other racial group (N=
1,175) (Hawai`i Island Police Depart-ment, 2022).
k. 57 percent of participants served through the Mana`olana
Program at Child & Family Services are Native Hawaiian females
who have experienced human trafficking (Ma na`olana, CFS, 2021-
2022).
Continued collective, systemic and community-based efforts are
needed to address MMINHWG issues.
B. Implementing Recommendations of E Ola Mau--Native Hawaiian Health
Master Plan (HHS, HRSA)
1. E Ola Mau 2023 Recommendations Overview. \21\ The E Ola Mau
(EOM) report (NHH Master Plan) provides comprehensive recommendations
aimed to address and improve the overall well-being of the Native
Hawaiian community. It is generated through the efforts and commitment
of a multidisciplinary collective of practitioners across the pae
`aina. The structure of the 2023 report followed the key areas of
health and well-being covered in the earlier report, including the new
addition of recommendations made in the racism, data governance, and
workforce development chapters. The recommendations emphasize the
importance of integrating Native Hawaiian culture with modern
healthcare systems to create a holistic approach to well-being. This
includes increasing the availability of culturally appropriate services
and resources, and supporting community-based efforts.
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\21\ https://www.papaolalokahi.org/wp-content/uploads/E-Ola-Mau-
2023-Recommendations-all-workgroups.pdf, retrieved May 12, 2025
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Additionally, the report advocates for a strengths-based approach
to wellness, increased monitoring and evaluation of the
recommendations, and interdisciplinary collaboration. The overarching
goal of these recommendations is to reduce health disparities and
promote a healthier, more vibrant future for Native Hawaiians.
2. Racism & Well-Being. EOM teams reviewed the literature
connecting racism with each chapter (e.g., oral health, behavioral
health, historical and cultural context) that existed in previous EOM
reports and identified specific recommendations for each section. While
this chapter is new to the 2023 report, racism has been implicit in the
previous reports. Recommendations from 1985 called for culturally
sensitive approaches to health programs and interventions and the need
to address Native Hawaiian concerns relating to land, urbanization, the
justice system, self-determination, economic self-sufficiency,
environmental protection, education, housing, transportation, energy,
historical and archaeological sites, lawai`a `ana (fishing), mahi`ai
`ana (farming), and language and culture. The 2019 report called for
disaggregated data, Kanaka workforce development, and more culturally
grounded ways of supporting Native Hawaiian health There are
recommendations for: Racism: Historical & Culture Perspectives; Mental
and Behavioral Well-Being; Medicine; Nutrition, Oral Health, Data
Governance, Workforce Development, Resilience; and Mental & Behavioral
Wellbeing; Nutrition, Policy & Advocacy; and Community Education.
C. Native Hawaiian Health Network (HHS>HRSA, SAMHSA, CMS)
Continuing the work of the collective, the Native Hawaiian Health
Network (NHHN), is vital for raising the health status of Native
Hawaiians and Hawai`i, and POL, the NHHB, acknowledges the following
organizations and the long standing commitment to Hawai`i's
communities:
1. The Native Hawaiian Health Care Systems
a. Ho`ola Lahui Hawai`i--Kaua`i Community Health Center, also a
federally qualified health center.
b. Ke Ola Mamo, island of O`ahu;
c. Hui No Ke Ola Pono, island of Maui;
d. Na Pu`uwai, islands of Molokai and Lana`i; and
e. Hui Malama Ola Na `Oiwi, Hawai`i Island.
2. Federally Qualified Health Centers (island), alphabetically and
with multiple sites and modes within their communities \22\
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\22\ https://npidb.org/organizations/ambulatory_health_care/
federally-qualified-health-center-fqhc_261qf0400x/hi/, retrieved May
12, 2025
a. Community Clinic of Maui (Maui)
b. Hamakua-Kohala Health (Hawai`i Island)
c. Hana Health (Maui)
d. Kalihi Palama Health Center (O`ahu)
e. Ko`olauloa Health Center (O`ahu) f. Kokua Kalihi Valley
Comprehensive Family Services (O`ahu)
g. Lanai Community Health Center (Lana`i)
h. Molokai Ohana Health Care (Molokai)
i. Wahiawa Center for Community Health (O`ahu)
j. Waianae Coast Comprehensive Health Center (O`ahu)
k. Waikiki Health Center (O`ahu)
l. Waimanalo Health Center (O`ahu)
m. West Hawaii Community Health Center Inc. (Hawai`i Island)
n. WHCHC Hawaii Island Community Health Center (Hawai`i Island)
3. Community Health Centers
CHCs are the cornerstone of the health care system in Hawai`i,
providing essential services to the most vulnerable populations. CHCs
are non-profit organizations, and exist in federally-recognized areas,
where residents have barriers to getting health care. They also
actively reinvest in the development of the communities they operate
in. A comprehensive array of services including: primary medical care,
behavioral/mental health care, dental services, diagnostic services,
prescription drugs, case management, language assistance, culturally-
competent and sensitive care, health education, including nutrition
counseling, and assistance with program applications, including housing
and cash assistance. \23\
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\23\ https://www.hawaiipca.net/what-is-a-chc, retrieved May 12,
2025
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4. State of Hawaii, Department of Health and Department of Human
Services
Both department are integral to working with each other and the
community at large to accomplish public health goals and objectives.
5. Native Hawaiian Organizations
POL, the NHHB, recognizes the almost 200 NHOs currently on the U.S.
Department of the Interior, Office of Native Hawaiian Relations'
Notification List \24\ which are vital, community and cultural
connections to the Native Hawaiian community.
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\24\ https://www.doi.gov/sites/default/files/documents/2025-04/
nhol-complete-list-final-web.pdf, retrieved May 12, 2025
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6. Community Based Organizations
Too numerous to name organizationally, the network of CBOs
intersect with all of the above named and includes community
collaborators in education, health, housing, social services, land and
ocean at all governance levels--community, county, state, federal,
international.
POL, the NHHB, acknowledges all who have been and/or are a part of
the NHHN, individually and organizationally, and welcome all and
commits to strengthen the health status of NHs and Hawai`i.
The Chairman. Thank you very much, all of you. We
appreciate your testimony and what you bring to the
conversation here today.
I want to start with tribal consultation, because it has
been mentioned by Chairwoman Alkire and Loni Greninger as well.
I think all of you reference it, and again, we are seeing
changes that are going on. I believe it was you, Chairwoman,
that indicated that a letter had been sent urging tribal
consultation in light of the reductions in staffing and the
cuts.
I am assuming that if there has been response to that, that
initial consultations have yet not been made. Can you clarify
for me where we are on that?
Ms. Alkire. Yes. I just want to say thank you to the ladies
here also. We come here to make these statements, and thank
you, Committee, for hearing what we have to say.
But we know really what we have to say has to come from our
heart. Our people have always struggled with the fact of
consultation. And I think all our organizations, we send these
letters but we haven't heard anything yet. And I think that is
the issue. And that is the issue I think all of America is
dealing with, with all these issues that we have these are
saving lives.
The consultation for tribal leaders and those involved with
these grants that are receiving these grants and implementing
these programs out in the rural communities, that is the voices
that need to be told how important these programs are that save
the lives for our people.
The Chairman. And that is why we are having this
conversation with you, representing the many voices within,
from your tribes, tribal communities, your regions. As I
mentioned, Secretary Kennedy was before the Health Committee
today and it is very important for him to be there to be
presenting the budget as we know it at this point in time.
But this feedback is so necessary. We have talked about, we
are seeing what is happening with the proposals for
consolidation, the Administration for a Healthy America will
consolidate the Office of Assistant Secretary for Health, HRSA,
SAMHSA, ATSDR, NIOSH, and so many of these agencies that are
really very critical to the services that are provided to our
tribal communities.
So what I am hearing is they are acting first, you are
responding, saying we need to know what is going on, and true
consultation is not a responsive action. It is being there at
the beginning so that some of this input, the imperative of
Tribal Head Start, the imperative of FVPSA, the imperative of
LIHEAP, that that is factored in before the decisions are being
made.
So I want to make sure that for the record, what we are
hearing from you as leaders in your respective areas is that
that outreach is yet to be had. Is that probably correct? I see
everybody nodding their heads.
Vice Chair Greninger, I want to ask, because you have great
detailed insight into the ACF Tribal Advisory Committee, given
your role there. Given the reduction of tribal engagement staff
that we are seeing there at ACF, going from five to now just
two, and then the loss of the regional tribal program leads,
what is this meaning on the ground for you? You mentioned the
consolidation within the regions, so Alaska, Washington, and
some of the other impacted areas are now reporting into Denver.
Just quickly, what is the impact of all of this? What do
you think is needed to restore effective tribal advisory
functions during this reorganization? Because we have a
reorganization going on. It is just pretty public here. Tribal
advisory role is pretty key.
How do we make this more effective?
Ms. Greninger. Those are great questions. So the effect of
what we are seeing now with the RIFs, those particularly five
advisory staff that you are talking about come from the ACYF
within ACF. So they were the ones who were actually helping ACF
leadership-wide be able to understand tribal nuances, what does
it take for us to participate in grants.
It was also helpful in the consultation setting where we
could help form agendas together, make it a collaborative
process rather than just it is a one-sided Federal process.
Consultation is both of us coming together, right?
So with the RIFs of those particular staff, what is walking
out the door is tribal nuance knowledge, institutional
knowledge and then intimacy with the tribes. All of that, all
of the advisory is walking out the door, unfortunately. So we
are left behind with staff who maybe have minimal knowledge or
no knowledge, and they are learning it as they go. And it takes
a long time to understand tribes.
So that is one of the areas that I have a huge concern
about.
But what can it take in the meantime? Gosh, if we could get
those staff back. I don't know what process that would take.
But if we can get those particular staff back, that would be
wonderful.
And having the consultation process may be ACF specifically
with tribes, HHS broadly with tribes, each branch of HHS with
tribes, so we can dig into those particular programs and those
nuances, that is going to be most helpful, because we have lost
those advisory staff.
The Chairman. I know I am over my time, but I think this is
a question that my colleagues would agree is worth drilling
down on. Because the Secretary has said to individuals within
HHS that have been RIFd, terminated, that if they so desire,
they can move over within the IHS sphere. Does that make sense?
Or are you talking about levels of expertise where a body just
isn't a body?
Ms. Greninger. That is a great question. I would be
concerned that IHS becomes all things Indian for HHS because
IHS is strictly about health. When HHS programs in tribes, it
is all HHS offices. So I need expertise in each branch of HHS.
The Chairman. Very good. Thank you.
Vice Chair?
Senator Schatz. Thank you, Chair Murkowski. It occurs to
me, obviously you are the Chair and you can tell us how to work
together on a bipartisan basis, but it seems to me this hearing
is calling for some follow-up and using the convening authority
of the Senate Committee on Indian Affairs. Because nobody is
talking to anybody.
We could suppose how things might work better and we might
have some pretty good ideas, but it starts with you knowing who
to call and that person having any authority or knowledge at
all. So I am not a believer of, just get everybody into a room
and it is going to work out, but I do think that is probably a
necessary condition for success, that we start to have a
dialogue and know who our points of contact are and kind of
what the path forward is.
I commit to you, Chair, I do my fair share of partisan
fighting, this is not the place for that. I will try to make
sure that we keep it on the substance of the matters. Thank you
for your leadership here.
Dr. Daniels, welcome. Papa Ola Lokahi is authorized to
coordinate health care programs and services for Native
Hawaiians, subcontracting with Native Hawaiian and community
health organizations. Are there any other entities authorized
to do this work under the statute?
Dr. Daniels. There are no other entities.
Senator Schatz. So as the only entity coordinating care for
Native Hawaiians across the State, what is your service
population and what happens if HRSA's funding gets cut?
Dr. Daniels. Our service population is targeting Native
Hawaiians, although because we get Federal dollars, we cannot
limit access. So it is community.
Just in our five Native Hawaiian health care systems, we
are serving over 70,000 individuals at touch points. That is
clinical, non-clinical, that is outreach. We know in our
communities face to face going out to where they are, that is
what we know we have to do. Traditional practices, all of those
things roll up into those numbers.
That does not include our network partners. So it is not
just the five systems. Papa Ola Lokahi actually reaches out and
we contract with other FQHCs. So we recognize we can't be the
do-all and be-all, that our community doesn't only see one type
of provider. So reaching out to the FQHCs, our community health
centers, our hospital and institutions, we are creating
bridges, we are partnering with them. But also our community
based organizations across the State.
So adding those numbers in, those touch points grow. And we
know that that is how our community gets help, and accesses
care. And to adjust that to already be fearful about cuts in
funding, people are scared and nervous.
And having those reach-outs allow us to one, keep a pulse
on what is happening with our community, so that we can report
back. But also then we can get the stories, which we did
provide in our written testimony, from communities in all
different areas.
Senator Schatz. Thank you.
Everyone is tracking that there is a House bill that will
cut Medicaid by about $700 billion. There are carve-outs for
Alaska Native and Indian tribes. There are no carve-outs for
Papa Ola Lokahi or for Native Hawaiian health. I am wondering
if you could speak to the impact of Medicaid cuts for Native
Hawaiians.
Dr. Daniels. Good question, Senator. I want to say this,
because I think that one comment was, we speak from our heart.
The fact that there is an exclusion of Native Hawaiians is
unacceptable. That should stir something in all of us, that we
talk about being Native communities, yet we exclude. And that
is not acceptable.
So just at the offshoot, the exclusion of Native Hawaiians
in that House carve-out, it perpetuates the belief that within
departments and agencies that we do not exist. And I am sure
some of our other tribal communities might feel that way, these
moments of not existing. And we cannot perpetuate that.
But I think the biggest pieces is in passing these,
imposing these new hurdles, that is what I am going to call
them. It is just that, they are hurdles. They impact
eligibility, they slow access to identification of needs, they
slow access to services. We don't need any more slowdowns.
And specifically, if you talk about the work requirements,
employment is one of the social determinants of health. And if
we are talking these things, we are saying these things, all of
this adds to our community and the people we work with.
Already, Native employment rates are among the lowest in
our State. And you couple that with the highest health
disparities. Doesn't look good, it doesn't fit. And so
basically health plus employment are seen as separate issues,
and they are not. They are tied in together. Employment equals
health and health equals employment.
Senato Schatz. Thank you. There are a lot of very valid
complaints about the health care system. I have never met a
single soul who has asked for more paperwork, and that is a lot
of what the House bill does.
The Chairman. So, Senator Lujan was actually here first,
but he just kind of walked in. If you want to catch your breath
and let Senator Smith go.
STATEMENT OF HON. TINA SMITH,
U.S. SENATOR FROM MINNESOTA
Senator Smith. Thank you, Chair Murkowski, and Vice Chair
Schatz, for this hearing today. And thank you so much to all of
you for being here and for providing your testimony.
I think that now is a very good time to be talking about
HHS programs and how they should be benefiting Naive people as
part of our trust and treaty responsibilities, and to
acknowledge that what the Trump administration is doing, what
Secretary Kennedy is doing, and gutting and reorganizing, the
department is directly hurting communities, Native communities
in this process.
I think it is so ironic, because during his confirmation
process, Secretary Kennedy talked a lot about being a champion
for Native people. He talked about his own father; he worked
hard to build his reputation for being a leader who was going
to keep Native people in his mind. But yet in his role so far
the reality has been very different.
I am really struck by the stunning lack of consultation
that you all have described in your testimony. And again, we
all know here that that tribal consultation is not an optional
thing to do because it is nice to do, it is part of our legal
trust and treaty responsibilities, recognizing your sovereign
nation status to do that.
So whether it comes to suicide prevention or HIV prevention
or ICWA or elder programs, all of these are vital to the health
and well-being of Native communities. God knows, IHS needs
reform and improvement and more funding. But to be clear, that
is not all that we are talking about here.
So I am grateful for this hearing and the opportunity to
talk about this. Because I think in many cases, I know from the
nations that I represent in Minnesota that these are issues of
life or death and have such direct consequences on what happens
to people and their lives.
So I want to follow up, I appreciated very much the
question that Chair Murkowski sneaked in at the end of her
time, I want to just follow up on that. There has been this
information about how senior career officials who are tobacco
regulators, research scientists and others at NIH, as those
jobs are being eliminated, have been offered jobs in far-flung
locations in IHS. As I was reading this, I found this offensive
to the individuals who don't have, and these are clinical jobs
for the most part, I think. And that these clinical jobs would
be offered to be filled where we already have such a great
shortage of staff and people with folks that don't have
clinical experience.
So I want to just ask any witness if you could comment on
this, what impact do you see this has? And how do you view this
from your perspective? I will just open that up to anybody.
Chair Alkire, would you like to take this?
Ms. Alkire. Yes. In preparation for coming here, all of us
ladies here, we all have an area. One of the things in my
regard was to talk to our CEO at our IHS facility, and talk
about the impact that it has had in regard to staffing and the
loss of providers. I am glad that Secretary Kennedy is going
ahead and letting up a little bit on the hiring freeze, but it
needs to be across the board, especially for those types of
providers that we need, to provide that health care.
The staffing is so important for these facilities. It is
even like, if we can't even hire a maintenance janitor, that
means the hospital is not safe. These kinds of basic things.
Senator Smith. Of course.
Ms. Alkire. So yes, I think all the ladies could agree on
that. There is a huge need.
Senator Smith. And sending a research scientist who
specializes in tobacco cessation research to an IHS facility
when what is needed is not research but clinical care doesn't
really solve any problem, does it?
Ms. Greninger. May I?
Senator Smith. Yes, please.
Ms. Greninger. I think one thing we also need to remember
is when we are eliminating researchers, tribal researchers in
particular, now we are talking about another historical issue
of concern.
Senator Smith. Yes.
Ms. Greninger. Research has been used against tribes and in
unethical ways, it has been implemented in our communities. So
if we are going to be eliminating positions of research that
have that tribal nuance and that knowledge --
Senator Smith. That is right, it is kind of a double
whammy.
Ms. Greninger. Absolutely. And the nexus for programs and
ACF, I have actually, in this last budget consultation last
month with HHS, I was wondering, how can I make a better
connection between NIH and ACF programs? Because data is huge.
That is a huge issue for us. Child welfare data, especially
when we have children in the State systems.
Senator Smith. Right.
Ms. Greninger. And in our own systems. So to hear that
those particular positions were also being eliminated, just
because I am not in NIH intimately doesn't mean I am not
concerned and I don't see the connection to other programs
across HHS and my tribal community.
Senator Smith. Thank you very much. Thank you very much,
Chair Murkowski.
The Chairman. Thank you. Senator Cortez Masto?
STATEMENT OF HON. CATHERINE CORTEZ MASTO,
U.S. SENATOR FROM NEVADA
Senator Cortez Masto. Thank you, Madam Chairwoman.
Can I jump back, Dr. Daniels, I want to touch on something
that you were, a conversation you were engaging with Senator
Schatz. FQHCs. Medicaid funding to FQHCs is in jeopardy. If
they don't get their funding, they could close their doors.
Most people don't realize, in Nevada we have 28 federally
recognized tribal communities. Not every one of my tribal
communities has a health center. They just can't afford it.
They just can't do it.
So they rely on FQHCs. And sometimes those FQHCs are a two-
hour drive for them.
So we are not just, a carve-out, which we talked about, is
not enough. It is really important that we provide a system of
health care for our tribal communities, indigenous communities,
that the can not only access, that is reliable, that is
affordable.
So can you talk a little bit about these Medicaid cuts? It
is not just the impact to tribal communities themselves, but
surrounding communities where there is a system of health care
that could be devasted, particularly in our rural communities.
If you would touch on that?
MS. Daniels. Absolutely. I think you brough up a very good
point, that it is just not the Medicaid. Because if FQHCs or
others are impacted, it also includes the retention and
recruitment of staff. But then they can't, we have several
FQHCs that are in high rural areas that they supplement housing
for those providers.
We have one island that access to it is on little nine-
seater planes. And providers are coming in. Those things are
all going to be impacted.
So then, where does our community go? Off-island? We
already have health deserts. Not the same way as I think South
Dakota, but similar. We have water between the islands, but
when pregnant women can't give birth on the islands, how does
that--so we already now are eliminating another access point.
Senator Cortez Masto. That is right.
Dr. Daniels. That is a challenge.
The one thing that we recognize is the network. So I think
oftentimes FQHCs and other health entitles are siloed. We do
what we do in our community and that is it. And we have
recognized that we no longer can do that. That if resources go
down, we are going to need each other, and to support and pool
our resources so we can continue to serve our community.
But when those keep getting like pinned off, it is really
hard to keep doing that. Then our communities grow. And our
providers don't grow. There is still only a handful. But the
number that is coming grows.
So I think it is all of these domino effects, when we start
picking up, and it might seem very minimal that we are going to
adjust or take off on Medicaid on things, but then we might not
see it today or tomorrow, but we are going to see it as people
start having to close, not even close doors, but close
services. Maybe they are not doing the five types of services,
maybe it is only two. And that becomes a problem.
For us, then we start looking at if that service isn't
provided on their island, where do they go? And do they have
access to pay for a $200 ticket to fly to the next island?
Senator Cortez Masto. Right. And it is the same, listen, it
is the same in rural communities as well. In Nevada, sometimes
you have to drive four hours just to get access to health care.
That is if you have a car, and you can get off work to be able
to access it.
So it is a system that will shut down that is essential for
providing health care that quite honestly, you have worked so
hard to put together because of a lack of resources and a lack
of providers and a lack of geography that brings everybody
together like you have in an urban area.
I appreciate this. I want to touch on--my time is running
out--mental health. Mental health. I cannot stress this enough.
I am so concerned about the cuts to mental health services that
we fought for in our communities.
There is a program called Native Connections. I know about
it because in my State, I have talked with so many of my Native
community members, there is a nine-year old girl in Nevada,
Urban Indians, who is struggling with mental health. She did
not, could not get the care from the school or a pediatrician.
But it was the Native Connections program that, according to
her father, got his daughter back. It is a Native Connections
program.
So I don't know if any of you are familiar with it or if
you could talk about it. But please stress the importance of
why funding for programs, particularly on this mental health
and Native Connections, is so important.
Ms. Alkire. Thank you. I am so glad you brought that up.
So, it is clear to me that programs like Native Connections
save lives. Thank you for that. From my tribal community, two
last week, two suicide ideations happened with a fifth and
sixth grader. These programs are so important right now to save
lives.
So suicide rates for Native youth are four times higher
than any other racial or ethnic group. Native Connections
allows awardees to tailor culturally appropriate programming to
reduce suicide, substance use, and impact of trauma in tribal
communities. Native Connections empowers Native youth by
strengthening community ties and providing, as I said,
culturally responsive support.
Through this program, youth engage in models that promote,
through protective factors, like personal wellness and positive
self-image, and a strong sense of cultural identity. Without
this funding, intervention and support services for Native
youth will become even more limited.
This puts Native youth, many of whom experience
discrimination, trauma, and loss of loved ones, at greater risk
for resources available for them to heal. So I think it is so
important, life-saving. So thank you for that question.
Senator Cortez Masto. Thank you. Thank you, Madam Chair.
The Chairman. Senator Lujan?
STATEMENT OF HON. BEN RAY LUJAN,
U.S. SENATOR FROM NEW MEXICO
Senator Lujan. Thank you, Madam Chair. And thank you and
Vice Chair Schatz for this important hearing.
To each of our honorable and distinguished witnesses, thank
you for taking time to be here away from other
responsibilities, and especially from home. I know that this is
not easy.
Madam Chair, before I begin, being more aware that
Secretary Kennedy would have liked to have been here and that
his staff may be here, or may be watching, I want to point out
what a disappointment I believe this administration has been to
the Indian Health Services. Recently, when Secretary Kennedy
was in Winter Rock, Arizona and in Gallup, New Mexico, he was
just minutes away from one of the oldest IHS centers in Gallup,
New Mexico.
If he would have gone there, he would have seen this. What
it says is, do not drink the water. Do not use the water for
consumption. Failure to follow this advisory could result in
illness. Do not use the ice, and then ``made from tap water''
for drinking and patient care. Don't use it for baby formula,
for brushing teeth, for making ice, care, until further notice.
The way that I was raised is you make time for what is
important. And he didn't make time.
The other thing I would share with Secretary Kennedy is, it
has been over 60 days that members of the United States Senate
sent you a letter about the measles outbreak in America where
many of our constituents are not just sick but some have died.
Respond to the letter. Keep your word. When you were asked
in Committee if you would respond to letters sent by members of
the United States Senate, you took an oath and said yes. Keep
your word. I am just very disappointed there.
Ms. Charlie, as an alum of Head Start, I am one of only two
in the United States Senate that went to Head Start. I often
joke I thought everybody went to Head Start. I didn't know you
got to be poor enough to go.
I believe in early childhood education. I believe the
United States Senate, this is a place that Head Start can get
you, in addition to other responsibilities we have around the
world. Research has demonstrated that high quality early
childhood education programs increase child educational
achievement later in life and significantly reduce the
likelihood of adult poverty.
Right now, there are conversations taking place about going
after one program or another. There are statements on social
media that are later redacted and things of that nature. What
can you share with us about the importance of early childhood
education and programs like Head Start to the livelihoods of
kids and others that you are honored to represent and speak
for?
Ms. Charlie. Head Start is critical for the kids that we
serve. At FNA we serve 224 kids. We provide interventions, we
work with the school district, with the special education
department. We do the 45-90 days dental health screenings. We
provide referrals with health care and other specialists
needed.
So we provide early intervention for the kids so when they
get into school, they are not delayed. The school doesn't have
the capacity to do what we do. They don't even screen for IEPs
until third grade.
They don't have the capacity to provide the services that
we do at Head Start. So it is critical, it provides structure
for them, it develops routines for them. So they are ready when
they get into school.
Not only that, it supports the whole family. Our program
supports grandparents coming in and volunteering, we are
culturally based, we do a lot of cultural activities. We
created a book with Denaka [phonetically] lesson plans. We were
working on a digital app to give access to that, to anybody who
wanted it.
So it is important. And the school just doesn't have the
capacity or resources to do what we do.
Senator Lujan. I appreciate that strong testimony.
I would argue, all of us on this dais, including those that
are not present right now, we all care greatly for Native
American mothers and for babies, which is why I am outraged by
the fact that 92 percent of Native American women that die from
pregnancy related deaths are considered preventable. Just let
that sit for a second.
And that the CDC has seen a 20 percent reduction in
staffing, leaving more vulnerabilities out there, this could
all be preventable.
Ms. Alkire, can you speak to how the reduction in force at
IHS and the reorganization in programs like the Pregnancy Risk
Assessment Monitoring System will have on people going forward,
namely moms and babies?
Ms. Alkire. [Remarks off microphone.]
Senator Lujan. In the area of maternal health, with moms
and especially with babies, with looking at 92 percent of those
that we lose, it is all preventable.
Ms. Alkire. Right.
Senator Lujan. And there are more conversations around
programs like the Pregnancy Risk Assessment Monitoring System
getting financial support or not, some of the layoffs at HHS.
Do you have any thoughts of taking those programs away or
making it harder, what kind of impact would that have on moms
and babies?
Ms. Alkire. Yes, actually there are several, and we provide
a lot of this in the testimony, because this is such an
important issue for us.
The investments from HRSA, this is one of the conversations
I had with the CEO in regard to young moms, where I come from.
She said the issue is that a lot of them, these programs fill
the gaps, because IHS does provide services. But these programs
that HHS provides, they fill the gaps for a lot of our tribes
with these grants.
And one of them is to help young moms get some prenatal
care, get some education. Because the issue, I think, in having
such scary statistics that we have is that a lot of these are
young moms, and they don't come to the hospital until they are
going to have the baby.
So a lot of them need this education. They need these
programs, these grants that are out there, to provide that
connection for them to learn what is coming, even to see the
baby's growth. And that way it provides more of a connection
for the mom to see how important it is to take care of
themselves and take care of the baby. That is what these grants
provide.
So HRSA is an investment in Healthy Start that saves lives.
By supporting tribally tailored programs, it helps reduce
infant mortality and address adverse perinatal conditions in
American Indian and Alaska Native populations. Healthy Start is
a vital lifeline for rural and remote communities. It provides
essential services like health screenings, nurse visits and
support through tribal home visiting programs, which I think is
so important right there, to ensure new and expecting mothers
receive the care they need.
Programs like this help bring knowledgeable staff into our
communities, so expecting mothers and new moms do not have to
drive, as we said, three or four hours away to get support for
pre- and post-natal care. Without HRSA funding, the tribal
maternal and health safety net is at risk.
Losing these dedicated resources would weaken critical
support for Native families at a time when these services are
essential, more than ever. Many young mothers, as I said, don't
show up until they are ready to have their baby. So perinatal
care is often not even sought.
This program puts babies on the radar, so home visits can
be conducted. As I said, it helps connect them. These programs
are successful of collaboration and also culturally appropriate
programs, because I think it just helps with identity issues
for the mother and the baby and just the family. Super
important.
Senator Lujan. Thank you.
Madam Chair, just in closing, thank you for your
leadership, for putting a face on the people across the Country
that we are so honored to represent and for fighting for them.
More of that is what we need. I want to say thank you to you
and to Vice Chair Schatz for that. Thank you.
The Chairman. Thank you, Senator Lujan.
Significant issues that we are talking about, maternal
mortality, how we are able to ensure that the programs that are
so important for, again, so many that are so vulnerable.
We talked about mental health. I want to talk about
domestic violence for just a moment. This is a matter that I
raised with the Secretary at the hearing at 1:30. I mentioned
FVPSA. This is the primary Federal funding source for our
domestic violence shelters and our support services and our
tribal communities. Obviously, essential for emergency shelter,
crisis intervention. We understand all too well up north why
these are priorities.
I received a letter back, it was dated April 2nd from the
Alaska Native Women's Resource Center, about the impacts of the
layoffs at the FVPSA office the concerns about what it means to
have the director of that placed on administrative leave.
I am going to enter this into the record, as well as an
attached letter that was directed to Secretary Kennedy about
the same subject.
When I mentioned this to the Secretary, he indicated his
clear support for making sure that when it comes to domestic
violence, shelters for women and the most vulnerable, that it
is not his intention to be cutting programs. And I don't recall
his words specifically, but it was something along the lines of
he didn't think that they had cut programs.
But I also recognize that in budgets that are proposed,
that is one thing. But sometimes you can effectively eliminate
the effectiveness of a program if you don't have people there,
right? If there is nobody there to process the grant
application, if there is nobody there to answer the phone or to
respond to your email about what the status of your grant is.
So let me direct this one to you, Ms. Simpson. Can you
describe how the Office of Family Violence and Prevention has
been key in implementing FVPSA in our tribal communities and
then what happens when you don't have, okay, let's just say the
program is still there, but you don't have the folks to
implement it? What happens to those you are trying to serve?
Ms. Simpson. Thank you for the question. The Office on
Family Violence Prevention and Services, we call it OFVPS, the
OFVPS office under former director Dawson's leadership has been
instrumental in recognizing the need for culturally grounded
and Native led programs for survivors of violence. The OFVPS
office ensures that over 230 tribes and tribal domestic
violence programs receive FVPSA formula grants that allow them
to provide emergency shelter and crisis intervention services.
OFVPS also partners with Native led organizations like
NIWRC to provide training and technical assistance and
resources to tribal grantees and advocates that can build the
capacity of tribal organizations so that our communities have
access to long-term and specialized care that meets their
unique needs. In this way, OFVPS helps to carry out the Federal
trust obligation.
When Director Dawson was abruptly placed on administrative
leave, not only did that impact the office's ability to move
forward, but that was felt all the way down to the individual
tribal grantees. There was a significant gap of communication,
silence between program officers and the tribal programs in
terms of what the new, what this was going to mean for ongoing
funding.
There was a lot of uncertainty from grantees, because none
of the new solicitations have gone out. The continuation
applications that normally are released in March haven't been
released yet, so programs are unsure what the funding is going
to be. So it is good to hear that Secretary Kennedy has assured
that those programs will maintain funding. But that hasn't been
expressed to any of the programs yet.
There are a lot of questions about what is now allowable
and what is not allowable. That information that we haven't
gotten guidance; tribal programs haven't gotten guidance yet.
So it has caused many programs to kind of feel the need to halt
services, because they are worried that they might do something
wrong and then lose their funding and get their grants
terminated the way things have happened at the Department of
Justice.
So it creates a lot of uncertainty and stress and fear
within these tribal programs. The substantial reductions in
force will, if there are more, it will surely interrupt the
essential functions of these prevention efforts across Indian
Country. These RIFs threaten decades of improvements in the
public health response.
Tribal programs rely on OFVPS staff who have cultivated
trusted relationships with the tribal nations. This can take
years to build. The institutional knowledge is immense.
This long-term relationship building has also led to many
OFVPS staff developing cultural competence, significant
cultural competence, trauma-informed expertise and a deep
understanding of the complex realities that face our Native
communities. So when we lose those staff, when we lose the
communication with those staff, then we are resulting in gaps
of silence and tribes unable to be able to move forward with
their domestic violence programming.
So it is pretty significant. Also, I think that the loss of
leadership, a direct result of that is the funding delays that
tribes have experienced. It resulted in many programs where the
possibility of being forced to shut down or lay off staff, and
we do know that there have been programs that have had to lay
off staff, because of the long gap in receiving their funding
through drawdowns as well as the uncertainty of being able to
maintain funding into the future.
The Chairman. We have heard some of that, where the
uncertainty with the funding coming, let's just say it has been
put on a pause, or a freeze, or just the uncertainty, and in so
many of these, with so many of these programs, if you have a
shelter that you are trying to run, usually you don't have a
lot of cushion. You are able to pay your staff salaries that
month and maybe the following month. You are able to get the
food, the supplies for maybe that month, maybe the following.
But there is not, again, a cushion in the event that these
funds don't come through. And if you can't provide the
services, you can't open the doors and you can't provide the
safety that is sought.
Ms. Charlie, I know that there at FNA you utilize the FVPSA
funding to help those that you serve in doing everything from
temporary housing and safety for survivors. So I am going to
ask you a question that kind of ties into FVPSA but goes just a
little bit more. Because I mentioned the issue of LIHEAP, the
Low Income Heating and Energy Assistance. This is a program
that has been zeroed out, and for us in Alaska, it makes a
difference. You need to stay warm in the winter. I would
imagine that in some of the areas that you represent, it is
about air conditioning in the summer, in order for your elders
to be safe in their own homes.
One of the things that we have heard is that the assumption
with this proposed budget was that the greater focus on energy
production, it would lower the cost of energy to people's homes
and so thus the LIHEAP assistance would not be necessary.
That may be true in the future. I don't know that we have
an easy button on this to reduce energy costs around the
Country, much less in a place that is as expensive as Alaska or
Hawaii. But Melissa, if you can just share for the Committee
record the expense that a family basically faces in staying
warm in a place like Fairbanks, Alaska, and what it would mean
if you weren't able to access this LIHEAP funding.
Ms. Charlie. Like you said, the cost of living in Fairbanks
and Alaska is extremely high. There are places in Alaska that
one gallon of heating fuel can run from $5 to anywhere over $10
a gallon. And that is for heating fuel.
We do have an elders program; we do a lot of case
management. We do deal with a lot of elders who not only have
food insecurity but can't pay their energy bill. They can't pay
their rent. So this is the case management that we provide. We
also do it with the FVPSA funds for emergency shelter, because
as women leave a domestic violence situation with just the
clothes on their back, they can't afford temporary housing, not
in Fairbanks and especially in Remo, Alaska. So it is really
critical.
For the energy assistance, it is a huge impact on all of
the families we serve, not just the elders, but the families in
Head Start. The cost of living in Fairbanks is extremely high,
and the surrounding areas is much higher. So it would be
devastating to everybody we serve, across all of our programs.
The Chairman. Thank you.
Senator Lujan, do you have follow-on questions?
Senator Lujan. No, thank you, Chair Murkowski.
The Chairman. Okay. I am just going to keep going here for
just a few more minutes, because I think one of the things that
we share as members of this Committee when we think about the
many challenges that we see across Indian Country, and the
barriers to things like economic opportunities and strong
education, is the issue of mental health, behavioral health,
and the lack of services that are then made available.
We have had a little bit of conversation about some of the
statistics related to suicide, and I agree with you, Vice Chair
Greninger, we are tired of being number one in so many of these
really awful, awful statistics.
So, SAMHSA's Center for Mental Health Services has faced
pretty significant RIFs, and now with this proposed elimination
of SAMHSA overall, I would like to hear from you about the
impacts on the delivery of culturally responsive programs to
tribal communities.
Ms. Greninger. Thank you for the question. SAMHSA is
important in particular because when you look at SAMHSA mental
health programs compared to IHS programs, IHS does have mental
health dollars but it is focused on adult mental health. And
SAMHSA has children and family mental health.
So that is where it is super critical for us tribes to have
those dollars so that we can specifically tailor our mental
health to our children and our young families.
So I would highlight Circles of Care as one of those
particular programs.
The other great thing about SAMHSA mental health programs
is tribes don't have to compete for them. In other programs, we
have to, which is really sad for us. We hate competing against
our brother and sister nations.
So those are the two biggest things, to be able to focus on
youth and the non-competitiveness of SAMHSA. So the ability for
us to even have culturally relevant services, that kind of
flexibility within SAMHSA grants is what allows us to get to
that spirituality piece that I was talking about in my
comments, where we can bring in the songs and the language and
are filling in that emotional and spiritual piece of the holes
in our hearts that frankly, medical care from the western
perspective cannot touch.
That is why we are always going after those dollars,
bringing in drum-making kits, bringing in regalia-making kits,
teaching our kids language, bringing in the language teachers.
That is all part of mental health, as well as doing, I am going
to say, more traditional forms of treatment, such as counseling
and things like that. That is all essential too.
But bringing in those spiritual healers as well to teach us
the songs and to help heal our hearts and spirits in that way,
those SAMHSA dollars can help us in those ways as well.
The Chairman. Important point about not having to compete,
which is significant.
Dr. Daniels, you looked like you were wanting to say
something.
Dr. Daniels. You mentioned the Center of Excellence. I
think we all have part of that. So at Papa Ola Lokahi, we
actually are a pass-through with the State for the center of
excellence, and ours is called the Ohana Center of Excellence,
which is an AANHPI Center of Excellence.
What has been happening is with the RIFs and the changes,
that program has been asked to scrub the information that they
have put on for communities to access. So things around
webinars or culturally appropriate programming that goes onto
those websites are at risk.
So our communities cannot access it. And it is not just
communities; it is the professionals that are working within
those communities that it is a TA type of opportunity for them.
So that center of excellence is at risk.
Then also, SAMHSA also funds Emergency The Surge, which is
the Lahaina Wildfire Disaster monies, same thing, that those
kinds of opportunities to get creative and really focus in on
communities are being kind of shifted off. So I agree with the
SAMHSA kind of understanding and how they support communities.
The Chairman. I think part of what we were hoping to
accomplish today was again to remind not only those in the
administration but just to remind all of us of the many, many
programs that are available that are critically important to
Native people, whether you are in Hawaii, Alaska or elsewhere
around the Country, that are outside of the IHS system. We have
talked about SAMHSA, we talked about young people, early Head
Start.
We really haven't had that much of a discussion about
elders. Clearly, the Older Americans Act, while it doesn't say
anything about Natives in the title, but clearly, those
services, whether it is the congregant meal services, the
caregiver support, these are vitally important. I don't know, I
know Melissa, probably FNA does a fair amount with the Title
VI, the tribal program there within the Older Americans Act. Do
you want to speak to how important these programs are for our
elders?
Ms. Charlie. Yes. At FNA, we do have an elders program at
community service. We do receive Title VI funding. We provide
800 meals a month, Monday through Friday. And we also assist
with food boxes. They have a garden for food insecurity.
And we serve over 300 elders in our program. We do a lot of
case management, if they can't pay their rent, if they can't
pay their fuel bill.
But what I really love about our elders program is they are
really integrated into everything that we do at FNA. They are
at the school tanning moose hide, they are at our Head Start
program teaching them how to make fire bread and cut berries.
They are at certain schools that they are the grandparents for
certain classrooms. They are teaching them how to jig; they are
doing songs and dance.
They are just really involved in everything that we do at
FNA. I really love that program, because it is important that
we take care of our elders. We are all going to be elders one
day.
And so it is a really amazing program. They love the
program; they love to come together and congregate and eat and
just be together. Otherwise, they would be home alone.
Every time we invite them to talk at our annual meeting,
they are there, they are speaking. And they own their program.
They develop their agendas and meeting and topics that they
want to do. It is a really amazing program. It really builds
and makes them happy to be able to come together.
The Chairman. I love the fact that they are there with the
kids as well.
I want to ask a question about efficiency. Because we are
operating in an administration that has taken a very keen eye
toward efficiency and we all know that we can and should do
more when it comes to more efficient operations.
So I think we have something to advertise when we are
talking about the 477 program. I look at that as a model for
tribal self-governance. It really demonstrates how tribes can
exercise their sovereign authority. It is the integration of
employment, of training, of human services into one just
efficient, streamlined plan.
So I think this is probably directed to you, Vice Chair
Greninger, about how, I guess the progress that we have made
over the years in expanding HHS program participation in tribal
477 plans. And how important you think it could be in this
administration, again, one that is really keenly focused on how
we can do a better job in reducing inefficiencies and
eliminating kind of the overlap and the overlay. If we have
multiple programs here, consolidation is good, let's make sure
we are consulting on it all, let's make sure it makes sense.
But talk a little bit for the Committee here about the
value of the tribal 477 program.
Ms. Greninger. Absolutely, thank you for the question.
I think I am going to steal the words from my chairman, Ron
Allen. He said if there is anyone who understands how to run
things efficiently, it is the tribes, because we are all
wearing multiple hats, smaller governments and trying to
stretch the dollar as far and wide as possible.
So 477 is really critical to tribes because it allows us
the flexibility to self-govern, we can take these funds from
the Federal Government and we can issue them into our community
the ways that we see fit.
The other important part of that is we are talking about
efficiency, is the reporting structures. Data and reporting is
much more streamlined. It is a reduced burden for us,
especially the smaller tribes, such as Jamestown. We aren't 477
per se, but we will advocate for it. I am more of a 638 tribe.
But when we talk about HHS programs in particular, we have
been working with ACF specifically to increase those particular
programs. What we would love to see is if all of HHS programs
and ACF programs could be in 477 because of that streamline
factor, and it gives us that self-governance benefit.
ACF has worked with us, and I think we are up to about
five, five programs in 477. I would like to highlight for this
Committee that there are going to have to be conversations to
talk about the barriers, probably, with some of the regulations
and maybe part of the statutory pieces of this.
With Head Start, we have had some concerns about that. Head
Start was able to be put into 477. But there was discussion on,
are we meeting statutory requirements when we put Head Start
under 477 when we are really seeing some of these data burdens,
reporting burdens, statutory burdens, health and safety
burdens, things like that.
But I think that those are conversations that tribes want
to have, and if there is statutory requirements we need to look
at and evaluate those, I think those conversations should be
happening.
So we are hoping that HHS will remain open to adding more
programs into 477.
The Chairman. So let me ask on that, do you think, or maybe
it is too early to know whether there is somebody within HHS
that is dedicated, I guess, to be able to support tribes in
integrating HHS programs into their 477 plans?
Ms. Greninger. I think I will need to follow up with you on
that. I want to say that ACF has like maybe two or three staff
that are dedicated to 477 right now. But I can follow up with
you on that.
The Chairman. The reason I ask, and I think the Vice Chair
noted it at the beginning of his questions, or maybe it was the
end of them, that this input that we are getting from you today
is really important that it be an iterative process, that it
not just be this conversation today but that we build on this,
that as you are bringing information to us, we are able to feed
that up to let them know it is going to be really important
that you have somebody within your department that is tasked to
these things.
Then further, that that individual that has been named, you
all know who is on point there. We can be that intermediary.
But it shouldn't be for more than just the fact of getting a
name and then being able to pass that on.
So I think it is going to be important again that we are
working with the folks at HHS, the folks in the Secretary's
office, in recognizing and acknowledging the many, many, many
programs within HHS that have implications for our tribal
citizens and Native people.
So how we do this going forward, we are going to kind of
rely on those of you, the many that you represent. There is
still much that is going on within this reorganization that we
are all just learning about.
And the fact that we don't have yet a full president's
budget, we just have a skinny budget, we are operating off of a
continuing resolution and we are hoping that the departments
are going to be following their operational plan, and if not,
that there is reprogramming.
There is just so much that is just uncertain. I think the
message that I would like to leave with all of you is, amidst
this uncertainty, know that we all have to kind of link arms
and get through this together, even though the frustration at
times may be really, really hard to deal with, because you
can't seemingly get answers.
I know we want to try to give benefit of the doubt as
administrations are getting stood up. We are very, very slow in
moving these nominations through the Floor. It is a process. It
could be made easier, but we are where we are.
So you may be the Secretary that is accountable, but you
might not have your full teams in place to do the execution, to
do the kind of consultation that I think we are talking about
that you need and demand, and rightly demand.
So, not making excuses for the administration, they have to
answer on their own. But I do know that the Secretary has
indicated to me that these matters are priorities to him. We
want to take him at his word for that. And that he will assign
teams that work with us to better the lives of our Native
peoples, wherever they may be.
So I am really appreciative for what you have brought here
today. If there are additional matters that the Committee
needs, I know that questions for the record will continue to
come in. We would ask you to try to help us out with that.
I started off my morning with the Administrator of the EPA
and we were asking him about various grants that have been
paused or frozen or are still under review. And I just told him
that we would like a list. We want to know from your
perspective where things are.
Because if something has been terminated, that is one
thing. If something is still under review, that is another
thing. Maybe you can hold on and keep your folks on it, your
shelter for another month, if you know that there is still a
likelihood that that funding is going to come through.
But if it has been terminated, then decisions are being
made for you. So if you have specifics that you want to share
with us that we can then elevate, know that we also can perform
that role as well.
Thank you to each of you for making the trip and thank you
for the leadership that you provide respectively.
With that, the Committee stands adjourned.
[Whereupon, at 5:17 p.m., the hearing was adjourned.]
A P P E N D I X
Prepared Statement of Donnie Garcia, Chairman, Albuquerque Area Indian
Health Board, Inc.
Thank you, Chairman Lisa Murkowski, Vice Chairman Brian Schatz and
respected members of the Committee for the opportunity to provide this
written testimony on behalf of the member tribes of the Albuquerque
Area Indian Health Board, Inc. (AAIHB). As Congress knows, Indian
tribes have a unique political and legal status recognized by the U.S.
Constitution. Elimination or disruption of federal funding for Indian
country has a huge impact on the ability of tribes and tribal
organizations to provide essential services to American Indians and
Alaska Natives. Indeed, the problems that face communities nationwide
are far more severe for Indian communities, with tribes having far
fewer resources to address basic health care needs and larger problems
like substance abuse, mental health and other issues. AAIHB
acknowledges and appreciates that there has been broad bi-partisan
Congressional support for addressing health and wellness issues facing
Indian country.
AAIHB was established in 1980 and is a consortium of several
federally recognized tribes in New Mexico and Southern Colorado. \1\
AAIHB provides direct health care services to not only citizens of
member tribes, but to citizens of other tribes in the surrounding
Albuquerque area. AAIHB's purpose is to assess and advocate for the
well-being of 27 tribal communities through the improved development of
public health services and health education. AAIHB is almost entirely
funded--about 86 percent--through various programs under the U.S.
Department of Health and Human Services. Approximately two-thirds of
that funding falls outside of the Indian Health Service (IHS).
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\1\ Member tribes include the To'Hajiilee Band of Navajos, the
Ramah Band of Navajos, the Jicarilla Apache Nation, the Mescalero
Apache Tribe, the Ute Mountain Ute Tribe and the Southern Ute Indian
Tribe. For financial purposes the AAIHB is considered a government
because the AAIHB board of directors is appointed by members of tribal
governments.
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For example, our health programs significantly rely on funding
directly from the National Institutes of Health (NIH), the Substance
Abuse and Mental Health Services Administration (SAMHSA), and the
Centers for Disease Control and Prevention (CDC). While we receive a
small amount of state and private foundation funding, the loss of our
federal funding would force us to reduce or completely terminate health
care services and related educational and research programs. A summary
of these non-IHS programs that AAIHB receives is set forth below.
CDC Healthy Tribes Program:
--Approximately $1.2 million for Good Health and Wellness in Indian
Country
--Approximately $990,000 for Tribal Epidemiology Center Public
Health Infrastructure
CDC Division of Injury Prevention:
--Approximately $200,000 for alcohol impaired driving
prevention
--Approximately $671,000 for tribal opioid prevention
CDC Division on HIV Prevention:
--Approximately $1.3 million
SAMSHA Tribal Opioid Response:
--Approximately $1.5 million
NIH Native Collective Research Effort to Enhance Wellness (N
Crew):
--Approximately $497,000
NIH Community Partnerships to Advance Science for Society:
--Approximately $989,429
Some of our funding streams noted above provide much needed
research within Indian country to address addiction, substance abuse
and pain, including for related factors like mental health and
wellness. Understanding and addressing these issues is critical to a
Healthy America for tribal communities. Secretary Kennedy recently
testified that ``reducing the initiation of drug use, particularly
among young people, and increasing the number of individuals receiving
evidence-based treatment, leading to long-term recovery from substance
abuse disorders, [is] a top priority.'' \2\
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\2\ Statement of Robert F. Kennedy, Jr. Secretary, U.S. Department
of Health and Human Services on the President's Fiscal Year 2026
Budget, Committee on Appropriations, Subcommittee on Labor, Health and
Human Services, Education, and Related Agencies, at 4 (May 14, 2025).
See https://docs.house.gov/meetings/AP/AP07/20250514/118230/HHRG-119-
AP07-Wstate-KennedyR-20250514.pdf.
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Eliminating or reducing those funding streams because they appear
to be duplicative or too small for national impacts, ignores the
uniqueness and size of Indian country compared to the country as a
whole. For example, funding from N Crew for tribes and tribal
organizations was a direct result of tribal consultation and the need
for tribally led research as it relates to substance abuse and pain in
Indian country. AAIHB receives other funding that may seem duplicative,
but it is not and the funding is needed in Indian country. AAIHB for
instance also receives federal grants that focus on opioid addition
from the CDC and SAMSHA, but unlike the N Crew funds used for research,
the CDC grants focus on surveillance and public health practice while
the SAMSHA grant is issued directly to tribes to strengthen capacity of
tribal behavioral health programs, as noted below.
We urge Congress to protect all of these funding streams and
recognize that tribes and tribal organization receive funding from many
sources and while it may seem duplicative it is not and all of the
funding is needed to address health issues throughout Indian country.
Indeed, Congress acknowledges the chronic underfunding of health and
wellness related programs throughout Indian country. Rather than
eliminating or reducing funding streams for research within Indian
country, these funding streams must be protected and could even be
consolidated--without reduction to tribes and tribal organizations--to
eliminate the need to seek funding from multiple grant sources.
The Community Health Education and Resiliency Program (CHERP) at
AAIHB provides trauma-informed and strengths based capacity building in
STI/HIV prevention, opioid and substance use prevention, positive youth
development, and mental health. Our program tailors to community needs
to equip tribal public health professionals with the skills, resources,
and tools to implement effective interventions and services. This
program is funded mostly through SAMHSA and CDC grants. CHERP hosts a
Wellness Conference, which is the only conference of its kind devoted
to addressing HIV prevention, testing, and biomedical treatments, along
with harm reduction strategies and substance use disorders within
tribal communities. This allows for education and capacity building
that is uniquely geared towards Indian country.
Within AAIHB is the Albuquerque Area Southwest Tribal Epidemiology
Center (c), which is 1 of only 12 tribal epidemiology centers
nationwide. More than half of the funding for AASTEC comes from non-IHS
programs. For example, AASTEC operates a Good Health and Wellness in
Indian Country Program with funds provided by the Centers for Disease
Control and Prevention--Healthy Tribes Program. Through that program
AASTEC provides leadership, technical assistance, training, and other
health resources to AAIHB's 27 tribal communities to promote community
level changes that support health and wellness and prevent and manage
type 2 diabetes, heart disease, and stroke and their associated risk
factors, such as commercial tobacco use, physical inactivity, and
unhealthy diet. More specifically for example, AASTEC provides 10
direct tribal sub-awards for community projects that are critical to
improving health and wellness in tribal communities. We have
significant concerns regarding this funding moving forward. All CDC
staff within this program have been subject to a reduction in force
(RIF) and the CDC Division of Population and Health, which is the
division that oversees this program, is being proposed for elimination
as part of the Administration's reorganization plan.
Similarly, as noted above, AASTEC receives important funding from
the CDC Division of Injury Prevention. This funding assists with (1)
building important collaboration among and between tribes and external
partners, (2) building public awareness aimed at educating tribal
communities on the burdens of motor vehicle accidents and alcohol-
impaired driving, as well as risk reduction strategies, (3)
strengthening the capacity ability within the tribal public health
workforce to implement best practices, and (4) improving data
collection and access to data. These evidence-based programs are
essential for our tribal communities because unintentional injuries
remain the leading cause of mortality for American Indian and Alaska
Natives nationwide from birth through middle age. We are concerned
about this funding because all staff within the CDC Division of Injury
Prevention have been RIF'd. It is also important to note that the
various RIFs that are occurring are concerning not only with respect to
the status of funding moving forward, but the RIFs also result in the
loss of institutional knowledge and result in the diminished capacity
of federal staff who not only understand Indian country but provide
important expertise and technical assistance with tribes and tribal
organizations.
Heavy reliance on non-IHS funding streams to serve our tribal
communities is not unique to AAIHB. Tribes throughout Indian country
rely on these funding streams as well. Eliminating funding streams that
tribes and tribal organizations, like AAIHB rely on will only further
exacerbate the health disparities that American Indian and Alaska
Natives face. While we understand that programs may be consolidated,
any such consolidation should not result in less funding for Indian
country. As Congress considers the FY 2026 Budget we urge you to
protect all non-IHS funding sources depended on by tribes and tribal
organizations. Thank you.
______
Prepared Statement of the American Indian Higher Education Consortium
The American Indian Higher Education Consortium (AIHEC) is
comprised of 34 accredited Tribal Colleges and Universities (TCUs) in
the United States (U.S.). On behalf of the TCUs, the following comments
are submitted to the U.S. Senate Committee on Indian Affairs in regard
to their May 14, 2025, oversight hearing on examining Federal programs
serving Native Americans at the U.S. Department of Health and Human
Services (Department) programs. AIHEC's mission is to provide
leadership and influence public policy on American Indian higher
education issues, including promoting and strengthening Indigenous
languages, cultures, communities, and Tribal Nations.
About Federal Trust and Treaty Obligations
Rooted in treaties and authorized by the United States
Constitution, the federal government's unique responsibilities to
Tribal Nations have been repeatedly reaffirmed by the Supreme Court,
legislation, executive orders, and regulations. \1\ The trust
responsibility establishes a clear relationship between Tribal Nations
and the federal government. \2\
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\1\ The Court has consistently held that the federal government has
a trust responsibility to Tribes, which has formed the foundation for
federal/Tribal relations. See Seminole Nation v. United States, 316
U.S. 286 (1942), United States v. Mitchell, 463 U.S. 206, 225 (1983),
and United States v. Navajo Nation, 537 U.S. 488 (2003).
\2\ In Worcester v. Georgia, 31 U.S. 515 (1832), the Supreme Court
explicitly outlined that the relationship between the federal
government and the Tribes is a relationship between sovereign nations
and that the states are essentially third-party actors.
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This legal duty and trust responsibility applies across all
branches of the federal government. These trust and treaty obligations
are owed to Tribal Nations and their citizens and do not have an
expiration date. Health and Education are central components of the
federal trust and treaty obligations promised to Tribal Nations, Tribal
citizens, and Tribal communities. The federal government has long
endeavored to uphold this duty through the appropriations process and
through the enactment of laws such as the Snyder Act of 1921, the
Indian Self-Determination and Education Assistance Act of 1975, and the
Tribally Controlled Colleges and Universities Assistance Act of 1978.
About Tribal Colleges and Universities
In a bold expression of sovereignty, Tribal Nations began
chartering their own institutions of higher education--Tribal
Colleges--in the 1960s. The first Tribal College, like all that
followed, was established for two reasons: the near complete failure of
the U.S. higher education system to address the needs of--or even
include--American Indians and Alaska Natives; and the need to preserve
our culture, our language, our lands, our sovereignty--our past and our
future. The guiding vision of the Tribal College Movement is an
education system founded on traditional knowledge and focused on a
prosperous future through job creation and strengthening our
communities.
Currently, TCUs operate more than 90 campuses and sites in 16
states, which make up over 80 percent of Indian Country. These
institutions serve students from over 250 federally recognized Tribal
Nations and embody a vital component of Tribal higher education. All
TCUs offer certificates and associate degrees; 22 offer bachelor's
degrees; 9 offer master's degrees; and one offers a doctoral degree.
Programs range from liberal arts to technical and career programs and
are created to address the needs of Tribal Nations and rural economies.
TCUs train professionals in high-demand fields, including early
childhood education, law enforcement, agriculture, natural resources
management, information technology, and healthcare. By teaching the job
skills most in demand in our communities, TCUs are laying a solid
foundation for Tribal economic growth, with benefits for surrounding
communities and the nation as a whole. As open enrollment, community-
based institutions, Tribal Colleges welcome all students and proudly
became a part of the nation's land-grant university family in 1994.
TCUs provide accessible and affordable options for higher education
for Tribal citizens and other rural students by offering low tuition
rates and fees; 97 percent of TCU graduates are debtfree. Additionally,
most TCU students are first-generation and low-income, with 78 percent
relying on Pell grants-far above the national average. \3\
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\3\ American Indian Higher Education Consortium (2023). Retrieved
from: American Indian Measures of Success (AIMS)
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TCUs also serve other community members through various community-
based programs and services each year, such as library services, job
training, High School equivalency program instruction and testing,
health promotion, Head Start and K-8 immersion programs, financial
literacy, community gardens, youth and college prep, summer camps, and
civic programs.
Key Program Within the U.S. Department of Health and Human Services
Administration for Children and Families--Office of Head Start:
Tribal Colleges and Universities Head Start Partnership Program. The
TCU-Head Start Partnership program was re-established in FY 2020 at
$4,000,000 and has been flat-funded at $8,000,000 for FY 2023 and FY
2024 (funding for FY 2025 has yet to be disbursed). The purpose of the
TCU-Head Start Partnership Program is to increase the number of
qualified education staff working in American Indian and Alaska Native
Head Start programs. The program accomplishes this goal by increasing
access to higher education degrees in early childhood education.
Through this unique and successful partnership, TCUs lead and are able
to build a larger network through their subawardees by:
1. Building Early Childhood Education Career Pathways in Tribal
communities;
2. Addressing the employment needs of American Indian and
Alaska Native Head Start Programs while being responsive to the
cultures and languages of Tribal Nations through a ``Growing
Our Own'' Approach; and
3. Meeting the unique needs of individual Tribal communities
and supporting staff in American Indian and Alaska Native
programs to acquire the competencies that ensure children's
academic development while also supporting cultural identity.
This program reaffirms the mission of TCUs by increasing self-
determination and providing services to their respective Tribal
community. Through this program, TCUs have been able to successfully
train early childhood educators and Head Start teachers in high-demand
areas across Indian Country. In 2021, 71.7 percent of Head Start
teachers nationwide held a bachelor's degree, but only 42 percent met
this requirement in Indian Country (Head Start Region 11).
Additionally, only 39 percent of assistant teachers in Region 11 met
the associate-level requirements, compared to 76 percent nationally.
TCUs offer a cost-effective solution to this gap. From 2000 to 2007,
the program provided scholarships and stipends to help Head Start
teachers enroll in TCU Early Childhood Education programs.
Currently, this program is able to fund six TCUs to increase access
to both entry-level credentials and early childhood education degrees
for teachers working in American Indian and Alaska Native Head Start
Programs. As an example, Navajo Technical University (NTU), located in
Crownpoint, New Mexico, offers a Bachelor of Science degree that
specializes in early childhood multicultural education. Since the Fall
of 2020, NTU has been able to confer over 50 degrees or certificates in
early childhood multicultural education. \4\ Additionally, as of the
Spring of 2024, the University had over 85 students enrolled in the
program, which includes both fulltime and part-time students.
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\4\ Navajo Technical University. Bachelor of Science: Early
Childhood Multicultural Education. Retrieved from: https://
www.navajotech.edu/wp-content/uploads/2024/11/Early-Childhood-Mult-Edu-
BS-Enrollment-Data.pdf
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Another example, Salish Kootenai College (SKC), located in Pablo,
Montana, offers a wide range of early childhood education degrees and
certificates such as Early Childhood (birth to age 8), Early Childhood
P-3 (preschool-grade 3), Elementary (K-8), Secondary programs (grades
5-12) in Science and in Mathematics, and a Master's program in
Curriculum and Instruction. These degree programs provide an
opportunity for candidates to become highly qualified professional
educators who serve students in diverse school settings. At SKC,
students are held to high standards, where the goal is excellence--not
simply completion. Their student cohorts live, study, and work closely
with each other and form personal and professional relationships that
last far beyond the college classroom.
AIHEC's Concerns on the Potential Termination of the Head Start Program
for Fiscal Year 2026
AIHEC and other organizations were alarmed to learn that the budget
pass back from the Office of Management and Budget to the Department
contemplates completely doing away with Head Start altogether for FY
2026. This would not only be catastrophic in the immediate term for the
individual Tribal communities served, but it would have long-lasting
and cascading effects throughout all of Indian Country for years to
come.
The need for degree or certificate programs is vital to Head Start
Region 11, which represents Indian Country. As mentioned previously, in
2021, only 42 percent of primary teachers met the requirement of
holding a bachelor's degree, and only 39 percent of assistant teachers
held an associate's degree in the region. TCUs are closing this gap as
24 institutions offer certificates, associates, or bachelor's in early
childhood education, which represents 11 different states. According to
the National Indian Health Start Association, through the TCU Head
Start Partnership, it is expected that the program will confer over 700
graduates with an early childhood education degree by 2028.
Students who attend Tribal Colleges are most often non-traditional
and potentially have families. As TCUs provide a wide range of student
services, such as childcare services through their Head Start programs,
students are able to partake in available support services that assist
with decreasing any financial and economic burdens outside of their
education. If Head Start programs are shut down, the enrollment numbers
will significantly decline for these older, nontraditional students. As
Region 11 of Head Start is comprised of the American Indian and Alaska
Native programs, which are most often the only daycare or childcare
facilities located within the region. These programs not only provide
childcare or early childhood education services, but they also impact
the community through cultural and language reclamation, economic
stability, and long-term positive outcomes for Native children and
families. Therefore, the elimination of Head Start would be detrimental
to Tribal communities, along with the nation's TCUs, as they provide
vital degree programs and professional development as it relates to
early childhood education.
Conclusion
TCUs provide thousands of American Indian and Alaska Native
students with access to highquality, culturally appropriate
postsecondary education opportunities, including critical early
childhood education programs. The modest federal investment in TCUs has
paid significant dividends in employment, education, and economic
development. AIHEC appreciates the Committee for hosting this vital
oversight hearing. AIHEC remains committed to working collaboratively
with the Committee as a trusted resource to ensure that Tribal Nations
and Tribal citizens have a say in shaping their education and their
future.
______
Prepared Statement of Stephanie Knowlton, Program Coordinator, Fort
Peck Tribal Court
AI/AN Head Start Programs
Good Morning.
I am a community member, a tribal member, and an employee of Fort
Peck Indian Reservation. It has come to my attention that we may lose
our Head Start programs in Indian Country. This is very sad that
political issues are now affecting our ability to educate our native
children on Fort Peck.
This program has been the most successful program for our children
teaching not only the fundamental foundation but basic life skills that
are detrimental to our community and their self growth. As you know,
children are our future, and they need to be nurtured and placed on the
highest level of care and support. Without our Head Start, this will
set us back decades and remind us that we are controlled by people who
have not lived our lives or walked in our trenches.
I have worked in the schools. As an advocate. BIA Social Services
Child Protection worker and now a program coordinator with the Fort
Peck Tribal Court.
I have seen first hand the benefits of our Head Start programs.
Knowing that this may come to an end is heartbreaking and very
disappointing for our children and the people who have worked hard in
their careers to lead by example for successful children.
Head Start is important because it provides low-income families
with high-quality early childhood education , health, and family
support services, leading to improved school readiness, cognitive and
social emotional development, and long term success for children and
families. It also addresses systemic issues that can hinder a child's
development, such as poverty, limited access to health care, and lack
of parenting resources.
Thank you for taking the time to read my concerns for our children.
Your attention and time are greatly appreciated and I am hopeful for
some positive outcome.
______
Prepared Statement of Eileen J. Lujan, Board Member, National Indian
Council on Aging
Dear Senators. Congressman,
My name is Eileen J. Lujan Pueblo Indian from Taos Pueblo ,
Southwest Region of New Mexico. I serve on the National Indian Council
on Aging (NICOA) as a board member. On May 22nd-23rd, 2025 NICOA board
members were present in several of Senators offices. Expressing our
concerns about very unsettling decisions being made by President Trump
and his staff. Sorry to say but you have no idea how an Indian Pueblo
or reservation lives day to day. This does not sit well with me as an
elderly voting member. It is very alarming to the elderly population
that certain services will be cut or wiped off. Such as with in the
Affordable Care Act, Medicaid, Health Insurance. Other services
Medicare, Social Security, SNAP. Other departments, Indian Health
Service, Bureau of Indian Affairs, Natural Resources, Education
Department. Older Americans Act which affects the Title VI nutrition
services, Senior Community Service Employment Program (SCSEP).
We can no longer accept this treatment. Where did the TRUST
RESPONSIBILITY, and GOVERNMENT to GOVERNMENT RELATIONSHIP GO. United
States Government you are not upholding your responsibility. We as
Indian people are not going anywhere we are here to stay. Please take a
closer look and hear yourself talk when making these decisions. I thank
you for being able to write this today.
______
Prepared Statement of Francys Crevier, Algonquin/CEO, National Council
of Urban Indian Health (NCUIH)
My name is Francys Crevier, I am Algonquin and the Chief Executive
Officer of the National Council of Urban Indian Health (NCUIH), a
national representative for the 41 Urban Indian Organizations (UIOs)
contracting with the Indian Health Service (IHS) under the Indian
Health Care Improvement Act (IHCIA) and the American Indians and Alaska
Native patients they serve. On behalf of NCUIH and these 41 UIOs, I
would like to thank Chairman Murkowski, Vice Chairman Schatz, and
Members of the Committee for your leadership in improving health
outcomes for American Indian and Alaska Native people and for the
opportunity to provide testimony in response to the Senate committee on
Indian Affairs May 14 hearing titled, ``Delivering Essential Public
Health and Social Services to Native Americans--Examining Federal
Programs Serving Native Americans Across the Operating Divisions at the
U.S. Department of Health and Human Services''
Overview of Urban Indian Organizations
The term ``urban Indian'' refers to any American Indian or Alaska
Native person who is living in an urban area, either permanently or
temporarily. UIOs were created by urban American Indian and Alaska
Native people with the support of Tribes, starting in the 1950s in
response to severe problems with health, education, employment, and
housing. \1\ Congress formally incorporated UIOs into the Indian Health
System in 1976 with the passage of IHCIA. UIOs are an integral part of
the Indian health system, comprised of the Indian Health Service,
Tribes, and UIOs (collectively I/T/U), and provide essential healthcare
services, including primary care, behavioral health, and social and
community services, to patients from over 500 Tribes in 38 urban areas
across the United States.
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\1\ Relocation, National Council for Urban Indian Health, 2018.
2018_0519_Relocation.pdf(Shared)-Adobe cloud storage
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UIOs only receive funding from one line item in the IHS budget, the
Urban Indian Health line item, which accounts for approximately 1
percent of the IHS budget. As such, UIOs rely heavily on funding from
grants in various Health and Human Services (HHS) agencies to ensure
they are able to provide their communities with the quality of care
they require.
Proposed Health and Human Services Restructuring and Funding Cuts
Many UIOs rely on funding and partnerships through key HHS
divisions such as the Health Resources and Service Administration
(HRSA), the Substance Abuse and Mental Health Services Administration
(SAMHSA), the Centers for Medicare and Medicaid Services (CMS), and
various Division of Tribal Affairs (DTA) offices. These divisions play
a critical role in supporting programs and services vital to urban
American Indian and Alaska Native populations. The value of HHS
programs outside of IHS cannot be overstated, as they are essential for
UIOs in fulfilling the federal trust and treaty obligation to provide
health care services to American Indian and Alaska Native people. \2\
The proposed reorganization and restructuring of HHS, combined with the
administration's recommended 26.6 percent cut in agency funding, \3\
will bring significant changes to several operating divisions, with
potentially serious consequences for UIOs.
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\2\ 25 U.S.C. 1601(1)
\3\ Office of Management and Budget, Fiscal year 2026 Discretionary
Budget request (May 2025), retrieved from: https://www.whitehouse.gov/
wp-content/uploads/2025/05/Fiscal-Year-2026-Discretionary-Budget-
Request.pdf
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It is particularly concerning that, to date, HHS has not held
Tribal consultation or urban confer on the HHS restructuring. The lack
of tribal consultation and urban confer is a failure to fulfill the
U.S. Government trust and treaty obligations to Tribal Nations and
programs serving Tribal citizens. Given the scope and potential impact
of this restructuring, it is imperative that HHS engage in meaningful
consultation with both Tribes and UIOs to ensure transparency and to
address serious concerns about the consequences of such a significant
public health and policy shift.
Health Resources and Services Administration
The Health Resources Services Administration (HRSA) plays a vital
role in delivering healthcare to geographically isolated, economically
disadvantaged, and medically underserved populations. Presently, there
are 11 UIOs that receive HRSA Community Health Program funding through
the 330 grant program. \4\ The proposed dissolution of HRSA and its
integration into the new Administration for a Healthy America (AHA)
raises serious concerns about the future of these essential programs.
It remains unclear whether the programmatic support provided by HRSA
will be preserved or diminished during this transition, which poses a
direct threat to the continuity of care for UIO patients.
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\4\ Tribal/Urban Indian Health Centers, HEALTH RES. & SERV. ADMIN,
https://www.hrsa.gov/about/organization/offices/hrsa-iea/tribal-
affairs/tribal-urban-indian-health-centers (last visited Mar. 11,
2025).
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Additionally, recipients of the 330 grant program are required to
provide care to non-American Indian and Alaska Native patients. As
such, NCUIH, on behalf of UIOs, has requested guidance and
clarification from HRSA on complying with the recent Executive Orders
(EOs) on diversity, equity, and inclusion (DEI). \5\ This guidance and
clarification is especially important in light of the recent Advisory
Opinion from HHS Office of the Secretary General Counsel (OGC) which
states that the recent EOs do not apply to HHS' legal obligation to
provide healthcare for American Indian and Alaska Native people. \6\
While the Advisory Opinion provides some clarity on how the
Administration applies the DEI EOs to American Indian and Alaska Native
health, it is still unclear how agencies within HHS, including HRSA,
will apply this guidance in practice when enforcing these EOs,
particularly as it relates to UIOs who receive HRSA Community Health
Program funding. UIOs require this guidance to ensure their programs
can operate effectively and without interruption as implementation of
EOs could impact or affect HRSA funding if the UIO is not in
compliance. HRSA has yet to respond to the request for guidance and
clarification.
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\5\ Exec. Order No. 14151, 90 Fed. Reg. 8,339 (Jan. 29, 2025),
https://www.govinfo.gov/content/pkg/FR-2025-01-29/pdf/2025-01953.pdf;
Exec. Order No. 14168, 90 Fed. Reg. 8,615 (Jan. 30, 2025), https://
www.govinfo.gov/content/pkg/FR-2025-01-30/pdf/2025-02090.pdf; Exec.
Order No. 14173, 90 Fed. Reg. 8,633 (Jan. 31, 2025), https://
www.govinfo.gov/content/pkg/FR-2025-01-31/pdf/2025-02097.pdf.
\6\ Dep't of Health & Human Serv., Advisory Opinion 25-01,
Application of DEI Executive Orders to the Department's Legal
Obligations to Indian Tribes and Their Citizens (2025), https://
ncuih.org/wp-content/uploads/HHS-Advisory-Opinion-25-01.pdf.
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Substance Abuse and Mental Health Services Administration
American Indians and Alaksa Native people experience
disproportionately high rates of alcohol, substance use and mental
health disorders, suicide, violence, and behavior-related morbidity and
mortality compared to the rest of the U.S. population. \7\ In fact,
American Indian and Alaska Native people experience serious
psychological distress at a rate 2.5 times more than the general
population over a month's time. \8\ These poor outcomes impact American
Indian and Alaska Native people no matter where they live. For example,
according to a 2020 report from the Centers for Disease Control and
Prevention, non-Hispanic American Indian and Alaska Native people had
the highest rates of drug overdose deaths in both urban and rural
counties compared to other races, at 44.3 per 100,000 and 39.8,
respectively. \9\
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\7\ Fact Sheet: Behavioral Health, INDIAN HEALTH SERV. (2023),
https://www.ihs.gov/sites/newsroom/themes/responsive2017/
display_objects/documents/factsheets/BehavioralHealth.pdf.
\8\ Id.
\9\ Merianne Rose Spencer et al., Urban-Rural Differences in Drug
Overdose Death Rates, 2020, NAT'L CTR. FOR HEALTH STAT. (July 2022),
https://www.cdc.gov/nchs/data/databriefs/db440.pdf.
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SAMHSA programs play a critical role in addressing these outcomes,
saving lives and improving behavioral health outcomes across Indian
Country. However, both the reorganization and the President's proposed
budget include substantial cuts to SAMHSA's three major centers: the
Center for Mental Health Services (CMHS), the Center for Substance
Abuse Treatment (CSAT), and the Center for Substance Abuse Prevention
(CSAP).
Notably, CMHS funds several Tribal behavioral grant programs,
including the Native Connections program. The Native Connections
program is youth-focused behavioral health grant, with 17 UIOs as
recipients of the grant. The programs have been influential in reducing
suicides among American Indian and Alaska Native youth. Unfortunately,
many UIOs have heard from SAMHSA staff that their Native Connections
grants will not be renewed in the 2026 grant year. This expected loss
of funding is deeply concerning, as it would undermine efforts to
address the behavioral health crisis facing our communities.
Centers for Disease Control and Prevention
The recent reorganization efforts and reduction in force at the
Centers for Disease Control and Prevention (CDC) have had a significant
negative impact on Tribal and Urban programs, including the Healthy
Tribes initiative, which provides a culture-first approach to health
promotion/disease prevention in American Indian and Alaska Native
communities and funds key grants for UIOs through the Tribal Practices
for Wellness in Indian Country (TPWIC) and Good Health and Wellness in
Indian Country (GHWIC) programs.
For example, one UIO recipient of both TPWIC and GHWIC has
indicated that all their Project Officers, Grant Managers and
Indigenous subject matter experts have been put on administrative
leave. The UIO has not received any communications or guidance relating
to these changes, leaving the UIO unclear about the status of their
current funding, as well as the their ability to plan, implement, or
forecast for essential public health initiatives.
While TPWIC and GHWIC represent only a small fraction of federal
spending, they provide essential support for chronic disease
prevention, increased physical activity, and reduction of commercial
tobacco use in Tribal and urban American Indian and Alaska Native
communities. The loss or interruption of these culturally responsive
programs threatens to further exacerbate already poor health outcomes
for and undermines the federal trust responsibility to American Indian
and Alaska Native people.
Office of the Assistant Secretary for Health
American Indian and Alaska Native people have the highest rate of
undiagnosed HIV cases compared to other racial/ethnic groups in the
U.S., \10\ and according to IHS, as many as 34 percent of the American
Indian and Alaska Native people living with HIV infection do not know
it. \11\ UIOs are an important resource for urban American Indian and
Alaska Native people for HIV/AIDS testing and referral to appropriate
care.
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\10\ IHS Awards New Cooperative Agreements for Ending the HIV and
HCV Epidemics in Indian Country. (2022, September 27). Retrieved
January 5, 2023, from https://www.ihs.gov/sites/newsroom/themes/
responsive2017/display_objects/documents/HIV-Funding-
PressRelease09272022.pdf
\11\ Indian Health Service, HIV/AIDS in American Indian and Alaska
Native Communities. Retrieved August 8, 2023, from: https://
www.ihs.gov/hivaids/hivaian/#:-
:text=The%20IHS%20National%20HIV%2FAIDS,Get%20tested%20for%20HIV.
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The Office of Infectious Disease and HIV/AIDS Policy (OIDP), housed
within the Office of the Assistant Secretary for Health (OASH),
administers key programs such as Ending the HIV Epidemic in the U.S.
and the Minority HIV/AIDS Fund, which are primary sources of support
for IHS HIV and sexually transmitted infection (STI) response efforts.
Alarmingly, OASH is currently slated for elimination under proposed
restructuring plans. The loss of this office would endanger critical
programmatic support for UIOs working to combat HIV/AIDS in urban
American Indian and Alaska Native communities. Continued funding and
programmatic support are essential to preventing the spread of HIV and
STIs. Without sustained investment, our communities face a heightened
risk of worsening health outcomes.
Indian Health Service
Although IHS staff have not been subject to recent Reduction in
Force actions, the broader pattern of abrupt terminations and staffing
changes across HHS has created uncertainty and unease. This has
compounded the long-standing recruitment and retention challenges
within IHS, particularly for providers and clinical personnel,
especially since IHS continues to operate under a hiring freeze with
extremely limited exemptions, making it difficult to fill critical
vacancies.
While IHS was exempted from the Deferred Resignation Program, it
was not exempt from the Voluntary Early Retirement Authority or the
Voluntary Separation Incentive Program. As a result, staff have
departed and cannot be replaced under current restrictions. Many of
these vacancies are essential to supporting operations. For instance,
one Area Office has an urban coordinator vacancy that remains unfilled
due to the freeze, which is now affecting the efficiency and
effectiveness of health care delivery for urban American Indian and
Alaska Native people across the region. The ongoing instability
regarding staffing authority and exemptions pose real risks to IHS's
ability to maintain and improve service delivery in Indian Country.
Centers for Medicaid and Medicare Services Office of Minority Health
(CMS OMH)
As part of the restructuring efforts, CMS OMH has been eliminated.
The shuttering of this office will impact revolutionary research that's
been done in support of American Indian and Alaska Native people. For
example, CMS OMH supported research on Traditional Healing and Medicaid
\12\ prior to the newly approved Medicaid waivers. \13\ Data on
American Indian and Alaska Native people is already scarce, and we
can't afford cuts to critical research.
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\12\ Nat'l Council of Urban Indian Health, Recent Trends in Third-
Party Billing at Urban Indian Organizations: Thematic Analysis of
Traditional Healing Programs at Urban Indian Organizations and Meta-
Analysis of Health Outcomes (2023), https://ncuih.org/research/third-
party-billing/#tab-id-11. Urban Indian Organizations (UIOs) rely on
reimbursement from third-party payers to sustain operations and provide
necessary health services to American Indians and Alaska Natives (AI/
ANs) living in. . .
\13\ Press Release, Ctrs. for Medicare & Medicaid Serv., Biden-
Harris Administration Takes Groundbreaking Action to Expand Health Care
Access by Covering Traditional Health Care Practices (Oct. 16, 2024),
https://www.cms.gov/newsroom/press-releases/biden-harris-
administration-takes-groundbreaking-actionexpand-health-care-access-
covering.
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Conclusion and Request
In conclusion, the proposed restructuring and funding cuts across
HHS operating divisions represent a significant threat to the health
and well-being of urban American Indian and Alaska Native communities.
UIOs rely on critical support from HRSA, SAMHSA, CDC, OASH, CMS OMH,
and other HHS divisions to fulfill the federal trust responsibility and
provide culturally competent, life-saving care to their patients. The
lack of Tribal consultation and urban confer surrounding these changes
is deeply concerning and undermines the government's obligation to
engage meaningfully with the communities these policies affect. NCUIH
urges the Committee to hold HHS accountable for its trust and treaty
obligations to American Indian and Alaska Native people and to ensure
UIOs are fully included in decisionmaking processes. We respectfully
request that Congress protect and strengthen funding for UIOs across
all HHS divisions and ensure HHS provides transparency and
collaboration before moving forward with any reorganization that would
jeopardize the health of American Indian and Alaska Native people.
______
Prepared Statement of Andrea Pesina, President, National Indian Head
Start Directors Association (NIHSDA)
Chairman Murkowski, Vice Chairman Schatz, and Members of the
Committee:
Thank you for the opportunity to submit testimony on behalf of the
National Indian Head Start Directors Association (NIHSDA) regarding the
delivery of essential public health and social services to Native
communities. We deeply appreciate the Committee's attention to the role
that federal programs administered by the U.S. Department of Health and
Human Services (HHS) play in supporting the health, development, and
well-being of American Indian and Alaska Native (AIAN) children and
families.
NIHSDA represents over 150 Tribal Head Start and Early Head Start
programs across the United States, serving more than 20,000 Native
children annually. These programs are not only early education
services--they are comprehensive, community-driven systems of care that
provide critical health screenings, nutrition support, mental health
services, and family engagement in a culturally rooted and sovereign
framework.
They are essential public health and social service providers,
uniquely situated to meet the needs of Native children and families in
Tribal communities. Core services include:
Comprehensive Health Screenings: Including vision, hearing,
developmental, dental, behavioral, and immunization checks,
ensuring early detection and follow-up care.
Preventive Health and Nutrition Services: Programs provide
healthy meals, growth monitoring, and nutrition education
tailored to local and cultural dietary needs.
Mental and Behavioral Health Services: On-site mental health
consultation, trauma-informed supports, and social-emotional
learning integrated into the classroom environment.
Family Services and Case Management: Programs conduct family
needs assessments and provide referrals to housing, food
assistance, substance abuse recovery, and domestic violence
services.
Parent and Caregiver Support: Services include parenting
education, goal setting, and advocacy to promote self-
sufficiency and strengthen family well-being.
Emergency and Wraparound Support: Assistance with
transportation, clothing, and other urgent needs, especially in
crisis situations.
Culturally Responsive and Sovereignty-Driven Approaches:
AIAN programs partner with Tribal health departments,
incorporate traditional practices and healing, and reflect the
values, governance, and priorities of their communities.
These essential services not only support children's immediate
development but also address long-standing disparities in health
access, educational outcomes, and economic opportunity. AIAN Head Start
programs are often one of the few consistent providers of preventive
health and social services in Tribal communities.
Head Start is an Essential Health and Social Service
Head Start is a cornerstone public health and social service in
Tribal communities. AIAN programs have long addressed deeply rooted
disparities in access to healthcare, early intervention, and early
education. Head Start's two-generational model strengthens families,
improves long-term outcomes, and helps fulfill federal trust
obligations to Native peoples.
Despite this, Tribal programs often face disproportionate
challenges, including:
Limited and Constrained Funding: NIHSDA remains deeply
concerned about the future of Head Start in light of recent
federal actions and the release of the administration's
``skinny'' budget on May 2, 2025. While the budget did not
explicitly propose eliminating Head Start, it offered no
reassurance about sustained or increased funding--and the full
FY 2026 budget, expected later this month, may still include
harmful cuts. These omissions are troubling and risk
destabilizing nearly 60 years of investment in children,
families, and communities. The stakes are especially high for
American Indian and Alaska Native (AI/AN) programs, which could
face significant consequences.
AI/AN communities already face some of the highest rates of
poverty, housing insecurity, limited healthcare access, and educational
disparities in the country. Reductions in Head Start services would
exacerbate these inequities and risk undoing decades of progress
achieved through community-driven, culturally grounded programs. These
services are a lifeline for Native children and families, and any cuts
would disproportionately affect the most vulnerable populations.
Today, 481 AI/AN Head Start centers operate in 26 states, providing
vital services to children and families and employing thousands--
teachers, family service workers, bus drivers, cooks, and more. These
programs serve as economic engines in Tribal communities, enabling 73
percent of participating families to work, attend school, or complete
job training. Without sustained federal investment, these families risk
losing both child care and jobs--further weakening Tribal economies.
This would have devastating consequences, not only for the children and
families directly impacted but also for the broader community and
economy.
NIHSDA strongly urges Congress to continue funding Head Start at
robust levels, ensuring that both the base program and the Tribal set-
aside are maintained and increased. We recommend that the federal
government include a 3.2 percent Cost of Living Adjustment (COLA) in FY
2026 to help programs retain qualified staff, manage rising operational
costs, and ensure the delivery of high-quality services. These
investments in Head Start are critical to improving educational
outcomes, promoting self-sufficiency, and addressing the deep-seated
disparities in AI/AN communities.
The Critical Role of the AIAN Regional Office (Region XI):
The separate Regional Office for AIAN Head Start programs
within the Office of Head Start (Region XI) is vital to
ensuring culturally competent, responsive, and respectful
oversight. This office supports Tribal sovereignty by working
government-to-government with Tribal Nations and is uniquely
positioned to navigate the complexities of operating Head Start
programs in diverse and sovereign Tribal contexts. NIHSDA
strongly supports the continued operation--and strengthening--
of this dedicated regional structure.
Dedicated AIAN Training and Technical Assistance (TTA):
Tribal Head Start programs benefit from a separate, culturally
grounded TTA system that understands the historical, cultural,
and logistical context in which these programs operate.
Maintaining a dedicated AIAN TTA system is critical to building
Tribal capacity, supporting continuous quality improvement, and
ensuring that Tribal programs are not expected to conform to
models that do not reflect their community values or realities.
Recommendations for HHS and Congressional Action
We respectfully urge the Committee to champion the following
actions:
1. Retain and Strengthen the Tribal Head Start Set-Aside
--Maintain the Tribal set-aside and increase the overall Head
Start appropriation to ensure that it reflects actual need and
cost in Native communities.
2. Protect and Support Region XI and AIAN TTA
--Continue funding and support for the AIAN Regional Office at
the Office of Head Start (Region XI), and maintain a dedicated
TTA system to serve AIAN grantees with culturally grounded,
community-specific expertise.
3. Center Tribal Voices in Policy and Program Design
--Require meaningful and consistent Tribal consultation in the
development of federal policies and systems impacting Tribal
early childhood programs, and invest in Tribal-led innovation,
evaluation, and system-building efforts.
Conclusion
For 60 years, Tribal Head Start and Early Head Start programs have
served as foundational systems of care and opportunity for Native
children and families. These programs honor cultural identity, promote
educational success, and strengthen Tribal communities. The federal
government must uphold its trust responsibility by ensuring equitable,
stable, and culturally grounded support for these services.
NIHSDA strongly opposes any proposals to eliminate or reduce
funding for AI/AN Head Start programs in the FY 2026 budget or future
fiscal years. Any such cuts would have a catastrophic impact on Native
communities, dismantling critical services for children and families
and violating the federal trust responsibility to Tribal Nations.
We thank the Committee for its commitment to oversight and for
recognizing the vital role of Tribal Head Start in delivering essential
health and social services to Native children and families.
______
Prepared Statement of Robyn Sunday-Allen, CEO, Oklahoma City Indian
Clinic (OKCIC)
My name is Robyn Sunday-Allen, I am Cherokee and the Chief
Executive Officer of the Oklahoma City Indian Clinic (OKCIC), the
largest Urban Indian Organizations (UIO) in the continental US serving
only American Indian and Alaska Natives. OKCIC contracts with the
Indian Health Service (IHS) under the Indian Health Care Improvement
Act (IHCIA) and the American Indians and Alaska Native patients they
serve. On behalf of OKCIC, I would like to thank Chairman Murkowski,
Vice Chairman Schatz, and Members of the Committee for your leadership
in improving health outcomes for American Indian and Alaska Native
people and for the opportunity to provide testimony in response to the
Senate committee on Indian Affairs May 14 hearing titled, ``Delivering
Essential Public Health and Social Services to Native Americans--
Examining Federal Programs Serving Native Americans Across the
Operating Divisions at the U.S. Department of Health and Human
Services''
Proposed Health and Human Services Restructuring and Funding Cuts
The Oklahoma City Indian Clinic relies on funding and partnerships
through key HHS divisions such as the Substance Abuse and Mental Health
Services Administration (SAMHSA), the Centers for Medicare and Medicaid
Services (CMS), the Centers for Disease Control and Prevention (CDC)
and various Division of Tribal Affairs (DTA) offices. These divisions
play a critical role in supporting programs and services vital to urban
American Indian and Alaska Native populations. The value of HHS
programs outside of IHS cannot be overstated, as they are essential for
UIOs in fulfilling the federal trust and treaty obligation to provide
health care services to American Indian and Alaska Native people. \1\
The proposed reorganization and restructuring of HHS will bring
significant changes to several operating divisions, with potentially
serious consequences for UIOs.
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\1\ 25 U.S.C. 1601(1)
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It is particularly concerning that, to date, HHS has not held
Tribal consultation or urban confer on the HHS restructuring. The lack
of tribal consultation and urban confer is a failure to fulfill the
U.S. Government trust and treaty obligations to Tribal Nations and
programs serving Tribal citizens. Given the scope and potential impact
of this restructuring, it is imperative that HHS engage in meaningful
consultation with both Tribes and UIOs to ensure transparency and to
address serious concerns about the consequences of such a significant
public health and policy shift.
Substance Abuse and Mental Health Services Administration
American Indians and Alaska Native people experience
disproportionately high rates of alcohol, substance use and mental
health disorders, suicide, violence, and behavior-related morbidity and
mortality compared to the rest of the U.S. population. \2\ In fact,
American Indian and Alaska Native people experience serious
psychological distress at a rate 2.5 times more than the general
population over a month's time. \3\ These poor outcomes impact American
Indian and Alaska Native people no matter where they live. For example,
according to a 2020 report from the Centers for Disease Control and
Prevention, non-Hispanic American Indian and Alaska Native people had
the highest rates of drug overdose deaths in both urban and rural
counties compared to other races, at 44.3 per 100,000 and 39.8,
respectively. \4\
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\2\ Fact Sheet: Behavioral Health, INDIAN HEALTH SERV. (2023),
https://www.ihs.gov/sites/newsroom/themes/responsive2017/
display_objects/documents/factsheets/BehavioralHealth.pdf.
\3\ Id.
\4\ Merianne Rose Spencer et al., Urban-Rural Differences in Drug
Overdose Death Rates, 2020, NAT'L CTR. FOR HEALTH STAT. (July 2022),
https://www.cdc.gov/nchs/data/databriefs/db440.pdf.
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SAMHSA programs play a critical role in addressing these outcomes,
saving lives and improving behavioral health outcomes across Indian
Country. However, both the reorganization and the President's proposed
budget include substantial cuts to SAMHSA's three major centers: the
Center for Mental Health Services (CMHS), the Center for Substance
Abuse Treatment (CSAT), and the Center for Substance Abuse Prevention
(CSAP).
Notably, CMHS funds several Tribal behavioral grant programs,
including the Native Connections program of which the Oklahoma City
Indian Clinic is an awardee. The Native Connections program is a youth-
focused behavioral health grant. This program has been influential in
reducing suicides among American Indian and Alaska Native youth.
Unfortunately, many UIOs have heard from SAMHSA staff that their Native
Connections grants will not be renewed in the 2026 grant year. This
expected loss of funding is deeply concerning, as it would undermine
efforts to address the behavioral health crisis facing our communities.
Centers for Disease Control and Prevention
The recent reorganization efforts and reduction in force at the
Centers for Disease Control and Prevention (CDC) have had a significant
negative impact on Tribal and Urban programs, including the Healthy
Tribes initiative, which provides a culture-first approach to health
promotion/disease prevention in American Indian and Alaska Native
communities and funds key grants for UIOs through the Tribal Practices
for Wellness in Indian Country (TPWIC) and Good Health and Wellness in
Indian Country (GHWIC) programs.
For example, the Oklahoma City Indian Clinic, which receives both
TPWIC and GHWIC funding, is currently running these programs without
the support of Project Officers, Grant Managers, and Grant Evaluators.
These positions were eliminated due to a Reduction in Force. As a
result, we have received very little communication or guidance about
these changes, leaving us uncertain about the status of our current
funding. This lack of clarity also hinders our ability to plan,
implement, and forecast essential public health initiatives.
Additionally, the absence of key staff makes it difficult to report
project outcomes to Congress in a clear and effective manner, which
could impact future funding decisions.
While TPWIC and GHWIC represent only a small fraction of federal
spending, they provide essential support for chronic disease
prevention, increased physical activity, and reduction of commercial
tobacco use in Tribal and urban American Indian and Alaska Native
communities. The loss or interruption of these culturally responsive
programs threatens to further exacerbate already poor health outcomes
for and undermines the federal trust responsibility to American Indian
and Alaska Native people.
Office of the Assistant Secretary for Health
American Indian and Alaska Native people have the highest rate of
undiagnosed HIV cases compared to other racial/ethnic groups in the
U.S., \5\ and according to IHS, as many as 34 percent of the American
Indian and Alaska Native people living with HIV infection do not know
it. \6\ UIOs are an important resource for urban American Indian and
Alaska Native people for HIV/AIDS testing and referral to appropriate
care.
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\5\ IHS Awards New Cooperative Agreements for Ending the HIV and
HCV Epidemics in Indian Country. (2022, September 27). Retrieved
January 5, 2023, from https://www.ihs.gov/sites/newsroom/themes/
responsive2017/display_objects/documents/HIV-Funding-
PressRelease09272022.pdf
\6\ Indian Health Service, HIV/AIDS in American Indian and Alaska
Native Communities. Retrieved August 8, 2023, from: https://
www.ihs.gov/hivaids/hivaian/#:-
:text=The%20IHS%20National%20HIV%2FAIDS,Get%20tested%20for%20HIV.
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The Office of Infectious Disease and HIV/AIDS Policy (OIDP), housed
within the Office of the Assistant Secretary for Health (OASH),
administers key programs such as Ending the HIV Epidemic in the U.S.
and the Minority HIV/AIDS Fund, which are primary sources of support
for IHS HIV and sexually transmitted infection (STI) response efforts.
Located in Oklahoma and serving the American Indian population, both
identified as a high risk state or population for the EndHIV
initiative, the Oklahoma City Indian Clinic is particularly concerned
about the ramifications of budgetary cuts to such an important program.
Alarmingly, OASH is currently slated for elimination under proposed
restructuring plans. The loss of this office would endanger critical
programmatic support for UIOs working to combat HIV/AIDS in urban
American Indian and Alaska Native communities. Continued funding and
programmatic support are essential to preventing the spread of HIV and
STIs. Without sustained investment, our communities face a heightened
risk of worsening health outcomes.
Indian Health Service
Although IHS staff have not been subject to recent Reduction in
Force actions, the broader pattern of abrupt terminations and staffing
changes across HHS has created uncertainty and unease. This has
compounded the long-standing recruitment and retention challenges
within IHS, particularly for providers and clinical personnel,
especially since IHS continues to operate under a hiring freeze with
extremely limited exemptions, making it difficult to fill critical
vacancies.
While IHS was exempted from the Deferred Resignation Program, it
was not exempt from the Voluntary Early Retirement Authority or the
Voluntary Separation Incentive Program. As a result, staff have
departed and cannot be replaced under current restrictions. Many of
these vacancies are essential to supporting operations. For instance,
one Area Office has an urban coordinator vacancy that remains unfilled
due to the freeze, which is now affecting the efficiency and
effectiveness of health care delivery for urban American Indian and
Alaska Native people across the region. The ongoing instability
regarding staffing authority and exemptions pose real risks to IHS's
ability to maintain and improve service delivery in Indian Country.
Centers for Medicaid and Medicare Services Office of Minority Health
(CMS OMH)
As part of the restructuring efforts, CMS OMH has been eliminated.
The shuttering of this office will impact revolutionary research that's
been done in support of American Indian and Alaska Native people. For
example, CMS OMH supported research on Traditional Healing and Medicaid
\7\ prior to the newly approved Medicaid waivers. \8\ Data on American
Indian and Alaska Native people is already scarce, and we can't afford
cuts to critical research.
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\7\ Nat'l Council of Urban Indian Health, Recent Trends in Third-
Party Billing at Urban Indian Organizations: Thematic Analysis of
Traditional Healing Programs at Urban Indian Organizations and Meta-
Analysis of Health Outcomes (2023), https://ncuih.org/research/third-
party-billing/#tab-id-11. Urban Indian Organizations (UIOs) rely on
reimbursement from third-party payers to sustain operations and provide
necessary health services to American Indians and Alaska Natives (AI/
ANs) living in. . .
\8\ Press Release, Ctrs. for Medicare & Medicaid Serv., Biden-
Harris Administration Takes Groundbreaking Action to Expand Health Care
Access by Covering Traditional Health Care Practices (Oct. 16, 2024),
https://www.cms.gov/newsroom/press-releases/biden-harris-
administration-takes-groundbreaking-actionexpand-health-care-access-
covering.
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Conclusion and Request
In conclusion, the proposed restructuring and funding cuts across
HHS operating divisions represent a significant threat to the health
and well-being of urban American Indian and Alaska Native communities.
The Oklahoma City Indian Clinic relies on critical support from SAMHSA,
CDC, OASH, CMS OMH, and other HHS divisions to fulfill the federal
trust responsibility and provide culturally competent, life-saving care
to their patients. The lack of Tribal consultation and urban confer
surrounding these changes is deeply concerning and undermines the
government's obligation to engage meaningfully with the communities
these policies affect. The Oklahoma City Indian Clinic urges the
Committee to hold HHS accountable for its trust and treaty obligations
to American Indian and Alaska Native people and to ensure UIOs are
fully included in decisionmaking processes. We respectfully request
that Congress protect and strengthen funding for UIOs across all HHS
divisions and ensure HHS provides transparency and collaboration before
moving forward with any reorganization that would jeopardize the health
of American Indian and Alaska Native people.
______
Prepared Statement of Shawn M. Kana`iaupuni, Ph.D., President/CEO,
Partners in Development Foundation (PIDF)
Thank you, Chairman Murkowski, Vice Chairman Schatz, and members of
the Committee for the opportunity to provide testimony on behalf of
Partners in Development Foundation (PIDF) in support of programs at the
U.S. Department of Health and Human Services (HHS), that support the
Native Hawaiian community, including funding for programs that support
Native Hawaiian children and youth through the Administration for
Native Americans (ANA), an office within the Administration for
Children & Families (ACF).
Background about PIDF
Partners in Development Foundation (PIDF) is an IRS Section
501(c)(3) public charity incorporated in the State of Hawai`i in 1997
to inspire and equip families and communities for success and service
using timeless Native Hawaiian values and traditions. Since inception,
PIDF has provided free programs for at-risk communities across our
state in the areas of multi-generational education (early education
through adult), strengthening families and communities (full-service
community school programming, workforce development, and a safehouse
for adjudicated teens), and island resiliency (natural farming project
providing training and youth mentoring for opportunity youth).
In our years of experience providing our ten programs to keiki,
young people and families, we see the challenges our community faces in
trying to address the needs of their families while struggling to find
positive solutions to the crises in education, housing, and managing
the high cost of living in this state. Therefore, at PIDF, every
program we offer is more than an educational service--it is an act of
aloha, deeply rooted in Hawaiian cultural values such as malama `aina
(caring for the land), kuleana (responsibility), and `ike kupuna
(ancestral wisdom). Our journey over the last 28 years, touching more
than 175,000 lives, has shown us that meaningful, culturally responsive
education can break the cycle of poverty, trauma, and marginalization.
One such notable program is Ka Pa`alana in which young infants and
toddlers experiencing homelessness gain stability and school readiness
through Ka Pa`alana's accredited early learning program, delivered
directly on beaches/shelters/transitional housing alongside vital
caregiver education and support.
The Importance of USDHHS: Administration for Native Americans
For decades, HHS has provided essential funding to organizations
like PIDF, supporting the advancement and well-being of Native Hawaiian
children and youth, through ACF's ANA funding programs. Without
programs like these, communities across Hawaii will lose access to
federal support for the planning, designing, restoration, and
implementing of native language curriculum and education projects to
support Hawaiian language preservation goals; the development of self-
determining, healthy, culturally and linguistically vibrant, self-
sufficient communities; community-driven projects designed to
revitalize the Hawaiian language to ensure its survival and continuing
vitality for future generations; culturally appropriate strategies to
meet the social service needs and well-being of Native Hawaiians across
the state; and the creation of a sustainable local economy to enhance
the economic independence of Native Hawaiians.
Like many organizations in Hawaii predominantly serving Native
Hawaiian children and youth, PIDF leverages federal grant programs
administered by ANA, which have included language revitalization and
immersion programs, as well as social and economic development
programs. PIDF has received ANA grant funding for years to provide
services in various areas of need:
language access for the first and original written Hawaiian
language resource which has been foundational for Native
Hawaiian families but was previously out-of-print (CFDA 93-587,
Grant 90NL0248, Baibala Hemolele, 09/30/02-02/28/06),
recruitment, training and preparation of 144 Native Hawaiian
foster parents across the state to meet the needs of the large
number of Native Hawaiian children in foster care (CFDA 93-612,
Grant 90NA7748, Kokua Ohana, 09/30/04-09/30/06),
creation of a culturally-sensitive math and science
curriculum delivered through a mobile computer lab serving
houseless families in conjunction with the Ka Pa`alana Homeless
Family Education Program (CFDA 93-612, Grant 90NA7931, `Ike
No`eau, 09/30/07-09/29/10),
development of Native Hawaiian culture-based toddler and
preschool curriculum that meets national standards and empowers
30 homeless Native Hawaiian fathers through a Native Hawaiian
parent education curriculum focused on the role of fathers
(CFDA 93-612, Grant 90NA8188, Ka Pa`alana Homeless Family
Education Program, 09/30/11-09/29/14),
development of a Native Hawaiian health curriculum called
Ola Mau for 0-5 year olds and their caregivers/families in the
Ka Pa`alana Program (CFDA 93-612, Grant 90NA8259, Ka Pa`alana
Homeless Family Education Program, 09/30/14-09/29/17),
expansion of Ka Pa`alana services in Keaukaha (East Hawaii
on Hawaii Island) (CFDA 93-612, Grant 90NA8366, Ka Pa`alana
Family Education Program in Keaukaha, 09/30/19-09/29/22), and
delivery of the Ka Pa`alana program including emergency
preparedness for East HI Island and Leeward Oahu's Malama
Mobile outreach sites (CFDA 93-612, Grant 90NA8474, Makaukau Ka
Pa`alana, 09/30/22-09/29/25).
Data: Demonstrating Effectiveness of ANA-funded Programs
Some data highlights from the most recent of these critical and
relevant ANA grants have demonstrated positive impact and an increase
in knowledge and family wellness.
While 67.9 percent agreed or strongly agreed that they did
not know very much about the topic before the parent education
class, 94.5 percent agreed or strongly agreed that they had a
better understanding of the topic after the class. Topics
covered Parenting tips, child development, preschool
engagement, STEAM curriculum, literacy strategies, mental
health support, discl
While 74.7 percent agreed or strongly agreed that they did
not know very much about the topic before the adult education
classes (including classes on how to take of health for
caregivers and their family), 99.3 percent agreed or strongly
agreed that they had a better understanding of the topic after
class.
The Hawaii State School Readiness Assessment indicates to
what extend the child is ready for Kindergarten with primary
focus on literacy skills. On a scale from 1 to 4, with 4 being
a perfect score, the overall mean score of the 33 participants
was 3.76 which indicates most of these children have mastered
literacy skills. There were 22 (66.7 percent) participants that
scored a 4 for all four measures.
As part of the Emergency Preparedness curriculum, 38 (84.4
percent) adult participants improved their knowledge of fire
safety after attending the class, and 28 (82.4 percent) adult
participants improved their knowledge of hurricane preparedness
after attending the class.
Conclusion
It is imperative that programs at HHS that serve Native communities
continue to provide necessary support for these important activities
that serve and support the Native Hawaiian families and communities.
Thank you for the opportunity to provide testimony to the Committee's
hearing on federal programs across HHS that serve Native Americans. I
look forward to working with the Committee on this important issue.
______
Prepared Statement of Jennifer Rowland
We Need Headstart In Native Country
Federal budget discussions have raised concerns for Native early
childhood education. Considerations for a restructuring of HHS have
proposed the elimination of Head Start, which includes a set-aside for
Tribal Nations and Tribal organizations.
For nearly 60 years, AI/AN Head Start programs have provided early
learning, family support, and community-driven services to Native
children from birth to age five. These programs help families access
health care, support school readiness, and preserve Tribal languages
and traditions. In Tribal communities, Head Start and Tribal programs
are frequently the only childcare available.
If this program is eliminated:
Nearly 20,000 Native children could lose access to critical
early education
More than 6,000 Head Start staff may lose their jobs
Tribal Nations could face setbacks in community-based
efforts to support families and preserve culture
______
Prepared Statement of Esther Lucero, MPP, President/CEO, Seattle Indian
Health Board
Chairman Murkowski, Vice Chairman Schatz, and members of Senate
Committee on Indian Affairs (SCIA), my name is Esther Lucero, and I am
of Dine and Latina descent, currently living in an urban Indian
community in Seattle, Washington. I am the third generation in my
family living outside our reservation. Since 2015, I have served as the
President & Chief Executive Officer of the Seattle Indian Health Board
(SIHB), one of 41 Indian Health Service (IHS) designated urban Indian
organizations (UIO) nationwide, a network designed to serve the health
needs of the 76 percent of American Indian and Alaska Native (AI/AN)
people residing in urban areas. Over the past 16 years, I have
dedicated my professional career in healthcare to serving AI/AN
communities.
I am also a delegate to the Washington state American Indian Health
Commission, a member of the King County Board of Health, the City of
Seattle Indigenous Advisory Council, and the AstraZeneca Health Equity
Advisory Councill. I am honored to have the opportunity to submit my
written testimony today for the SCIA Oversight Hearing.
Seattle Indian Health Board
SIHB is a UIO and Federally Qualified Health Center (FQHC) and
serves over 5,000 people living in the Greater Seattle, Washington area
with specialized services for AI/AN people. We are part of the IHS/
Tribal 638/UIO healthcare system (I/T/U) and honor our responsibilities
to work with our Tribal and federal partners to serve all Tribal
people, regardless of where they reside. Urban Indian Health Institute
(UIHI) is the research division of SIHB, a public health authority, and
one of twelve Tribal Epidemiology Centers (TEC) in the country--the
only one that serves UIOs nationwide. UIHI conducts research and
evaluation, collects and analyzes data, and provides disease
surveillance for Tribes and the 41 UIOs nationwide. As a UIO and TEC,
our role is to address the community health and public health needs of
the over 76 percent of AI/AN people who live in urban areas.
Fully Fund the Indian Health Care System
To truly fulfill its trust and treaty obligations, the federal
government must fully fund the I/T/U system. The National Tribal Budget
Formulation Workgroup calculates that to meet this goal in FY 2026,
Congress must appropriate $63.04 billion to the Indian Health Service,
including $770.53 million for the Urban Indian Health line item and
$474.47 million for the Hospitals and Health Clinics: TECs line item.
However, until full funding for IHS is achieved, Congress must
continue to invest in the critical programs that supplement the IHS
budget but are not administered by IHS. For example, Healthy Tribes, a
Centers for Disease Control and Prevention (CDC) program, supports
chronic disease prevention in Indian Country. While not administered by
IHS, its funding is crucial for the health of AI/AN communities.
Numerous other programs administered by the Substance Abuse and Mental
Health Services Administration (SAMHSA), the National Institutes of
Health, the Health Resources and Services Administration, and other
divisions of the U.S. Department of Health and Human Services (HHS)
directly benefit AI/AN communities and cutting their funding also has a
direct negative impact on AI/AN communities. The proposed $33.3
billion, or 26.2 percent, reduction in the HHS budget, including a
proposed reduction of $139.8 million to SAMHSA programming will
disproportionately harm Indian Country. I urge Congress to maintain
funding for HHS and its divisions.
Advance Appropriations
I urge you to once again support advance appropriations for the I/
T/U system. It is the only federal healthcare system without mandatory
appropriations, and failure to include advance appropriations
jeopardizes the health and wellbeing of AI/AN communities relying on
IHS, Tribal, and UIO facilities for their health care needs.
Protect Medicaid
Congress must protect Medicaid expansion for AI/AN communities.
Medicaid is a critical component to the fulfillment of the federal
government's trust and treaty obligations to AI/AN people. In 2023,
31.3 percent of AI/AN people including 48.7 percent of AI/AN children
aged 0-19 years old were enrolled in Medicaid. \1\ Medicaid funding
helps bridge chronic shortfalls in funding for IHS. For many Indian
health facilities, Medicaid funding accounts for 30-60 percent of total
revenue, underscoring its vital role in supporting health care services
for AI/AN populations. In 2024, 50 percent of our relatives (patients)
seen at SIHB were Medicaid beneficiaries, and our facilities' Medicaid
revenue was $4.9 million, or, 47 percent of our third-party revenue.
Clinical services paid for by Medicaid accounted for $1.5 million,
while pharmacy Medicaid payments accounted for $3.4 million. As an FQHC
we are required to re-invest these revenues back into our health
service system--and we do that in innovative ways, such as traditional
medicine, that we know reduce the rates of chronic diseases. Medicaid
ensures that all eligible members of the AI/AN community receive health
care services critical to their well-being no matter where they live
and I urge you to oppose any cuts to this important program.
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\1\ Davis, W. (2025), AI/AN Medicaid Enrollment & Funding, National
Indian Health Board (NIHB).
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Missing and Murdered Indigenous Women and People
As I am aware of your deep commitment to addressing the crisis of
Missing and Murdered Indigenous Women and People, I would also like to
bring attention to the President's proposed reduction of $107 million
in funding for U.S. Department of the Interior law enforcement
programming currently supporting Tribal operations. This is counter to
efforts, including those carried out under Trump's first
administration, to combat one of the greatest crises affecting Indian
Country.
I thank you for your continued leadership on issues affecting
Indian Country and remain a committed partner with you in this regard.
______
Prepared Statement of Hon. Melvin J. Baker, Chairman, Southern Ute
Indian Tribe
Greetings, Chairman Murkowski, Vice Chairman Schatz, and members of
the Committee. My name is Melvin J. Baker. I am the elected Chairman of
the Southern Ute Indian Tribe (``Tribe'') on the Southern Ute Indian
Reservation in southwestern Colorado. Thank you for the opportunity to
provide written testimony concerning the need to fully fund Health and
Human Services (HHS) programs serving Indian Country. Given the
critical impact Tribal health programs have on communities like ours,
the Tribe strongly urges Congress to protect funding for HHS. Without
adequate HHS funding, the Tribe's ability to serve its members and
other Native Americans living within our community is severely
diminished.
The Tribe is one of two federally recognized Tribes in the State of
Colorado. Our Reservation is home to thousands of Native Americans,
including Tribal members, first descendants, and those affiliated with
other federally recognized Tribes, who are eligible to receive health
services through the Indian Health Service (IHS). The federal
government has a legal and moral trust obligation to provide health and
social services to the Ute people and other Natives in our community.
This obligation is grounded in long-standing treaties, statutes such as
the Indian Health Care Improvement Act and the Indian Self
Determination Act, executive orders, and judicial precedent. HHS is the
principal federal agency responsible for fulfilling this trust. The
federal trust responsibility to provide healthcare to Tribes must
extend not only to the IHS but to all HHS agencies that support tribal
health. As you noted in your May 9 letter to HHS Secretary Kennedy,
threats to these programs or ``termination of staff responsible for
managing these programs threatens the health, safety, and well-being of
Native communities,'' \1\ including the Tribe's. Funding and staffing
cuts would disrupt care, reverse hard-won public health gains, and
violate sacred trust obligations to Tribes that the United States is
required by law to meet.
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\1\ Letter to HHS on non-HIS RIFs and reorganization, Senators Lisa
Murkowski and Brian Schatz, May 9, 2025, at 1, available at: Letter to
HHS on non-IHS RIFs and reorganization
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Upholding this trust obligation is critical as Native Americans
already suffer serious disadvantages in the healthcare space. We have
long experienced significant and unacceptable health disparities when
compared with other Americans. \2\ These discrepancies remain prevalent
today, but they find their roots in historical trauma that flows from
forced relocation and assimilationist policies. Such trauma contributes
directly to higher rates of poverty, unemployment, and lack of access
to quality education and healthcare experienced by Native communities
today. \3\ These socioeconomic inequities in turn lead to higher rates
of chronic conditions such as heart disease, diabetes, cancer, and
obesity. \4\ Life expectancy for Native Americans is 10 years lower
than the United States average. \5\ Not only is life expectancy
shortened, but these disparities operate to reduce quality of life for
Native Americans while alive. For example, Native Americans experience
disproportionately higher rates of mental health and substance abuse
issues. \6\ Suicide rates are significantly higher among American
Indian youth than other youth populations. \7\ Many of these health
disparities were exacerbated by the COVID-19 pandemic and have long
been made worse by the persistent, chronic underfunding of Indian
health care--a problem that dates back decades. \8\
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\2\ Tribal Public Health Week 2025: Health Equity Starts Here--In
Truth, Action, and Sovereignty, National Indian Health Board, April 9,
2025, available at: Tribal Public Health Week 2025: Health Equity
Starts Here--In Truth, Action, and Sovereignty--National Indian Health
Board
\3\ National Indian Council on Aging, Inc., American Indian Health
Disparities, last accessed on May 21, 2025, available at: American
Indian Health Disparities
\4\ Indian Health Service, Disparities, October 2019, available at:
Disparities/Fact Sheets; U.S. Department of Health and Human Services
Office of Minority Health, Obesity and American Indians/Alaska Natives,
last edited Feb. 13, 2025, available at: Obesity and American Indians/
Alaska Natives/Office of Minority Health
\5\ National Vital Statistics Reports, Vol. 74, Number 2, at 50,
April 8, 2025, available at: https://www.cdc.gov/nchs/data/nvsr/nvsr74/
nvsr74-02.pdf
\6\ American Addiction Centers, Alcohol and Drug Use Among Native
Americans, updated May 2, 2025, available at: Substance Abuse
Statistics for Native Americans; A Path Forward to Fully Fund Tribal
Nations by Embracing the Trust Responsibilities and Promoting the Next
Era of Self-Determination and Health Care Equity and Equality, Victor
Joseph and Andrew Joseph, Jr., at 31, April 2024, available at:
NIHB=FY26-Budget.pdf
\7\ Tribal Public Health Week 2025: Health Equity Starts Here--In
Truth, Action, and Sovereignty, National Indian Health Board, April 9,
2025, available at: Tribal Public Health Week 2025: Health Equity
Starts Here--In Truth, Action, and Sovereignty--National Indian Health
Board; NMSU study finds high suicide rates among American Indian,
Alaska Native children, Carlos Carrillo Lopez, Dec. 9, 2024, available
at: NMSU study finds high suicide rates among American Indian, Alaska
Native children
\8\ Am. J Public Health June 2014, Donald Warne and Linda Bane
Frizzell, available at: American Indian Health Policy: Historical
Trends and Contemporary Issues--PMC
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Despite the health imbalances that have plagued generations of
Native Americans, Indian Country has seen significant and real progress
in closing these gaps and providing Tribal communities with better-
quality healthcare. Much of this progress is thanks to funding from HHS
and other federal programs given directly to Tribes so that we may
direct how we treat the health needs of our communities. Empowering
Tribes to operate their own health programs through self-governing
contracts or compacts is a critical tool for achieving better health
outcomes for our people. As Tribes, we know best how to care for our
members.
By law, the federal government must continue to empower us to
provide culturally sensitive and quality care for our patients. Federal
funding opportunities like those provided by HHS honor Tribal
sovereignty by allowing the Tribe's governments to be an equal partner
in shaping the public health systems and policies that affect our
people. The Tribe takes this partnership seriously.
As a result, our Tribal Health Department operates a robust health
program pursuant to a Title I self-determination contract. The Tribe's
patients are included in the one million Native Americans who rely upon
coverage by Medicaid and the Children's Health Insurance Program. \9\
The Tribe's programs depend upon HHS funding and Medicaid reimbursement
for health services to function and provide basic services to its
patients. The proposed massive cuts to Medicaid funding would devastate
Native communities and risk severe reductions in essential health care
for Tribal members. \10\ Medicaid funding has allowed the Tribe to make
major strides in adequately addressing disparities in Tribal healthcare
and to provide Tribal members with culturally competent healthcare that
is aimed at tackling the unique health challenges faced by the Ute
people and other Native Americans in our communities.
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\9\ Medicaid.gov, Indian Health & Medicine, last visited May 21,
2025, available at: Indian Health & Medicaid/Medicaid
\10\ Medicaid cuts would decimate Native American programs, tribal
health leaders say, CBS News, Jazmin Orozco Rodriguez, March 14, 2025,
available at, Medicaid cuts would decimate Native American programs,
tribal health leaders say--CBS News.
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As a result of this funding, the Tribe's Health Department can
provide all-inclusive, high-quality health care to over 2000 Native
Americans in our community and the surrounding areas with the goal of
elevating the health status of all Native people served by the
Department. In operating a modern, sophisticated health clinic, the
Tribe offers comprehensive and integrated direct care programs,
including mental health and substance abuse treatment, referred
services, and public health initiatives. Through these programs, the
Tribe provides a multitude of critical health services to its patients,
including: adult and pediatric primary care; adult and pediatric
immunizations; dental and optometry care; physical therapy; urgent care
and nurse triage appointments; 24/7 triage phone lines; lab and x-ray
services; pharmacy services; women's health and reproductive services;
referrals and consultations to specialist care; and specialty clinics
for nephrology, gastroenterology, rheumatology, and audiology.
Additionally, the Tribal Health Department provides home health care
nurses and community health workers to eligible patients and provides
medical care for Tribal inmates at our Detention Center.
Without HHS funding, the Tribe would be unable to sustain essential
programming or meet the unique needs of its patients. For example, the
Tribe routinely receives grant funding from the Substance Abuse and
Mental Health Services Administration (SAMHSA), such as Tribal Opioid
Response and Native Connections grants. SAMHSA grants allow the Tribe
to fund programs to address the high rates of suicide, substance use,
and intergenerational trauma that continue to persist in our
community--efforts that are vital to the Tribe's ability to safeguard
the health of our people. These funds also allow the Tribe to support
the continuum of prevention, harm reduction, treatment, and recovery
support services for opioid use disorder and co-occurring substance
abuse disorders. These programs are critical as Native Americans
continue to suffer the highest rate of fatal opioid overdoses in the
United States. \11\ The Tribe's Behavioral Health Division further
relies on SAMHSA grants to pay salaries for many of the Tribe's
behavioral health staff. Without this funding, the Tribe will not have
the personnel it needs to address critical behavioral health conditions
prevalent in its patient population. An inability to address these
conditions would have disastrous consequences for the health of Tribal
patients because adequate behavioral health treatment is directly
linked to positive health outcomes overall. When we fail to treat these
conditions, we fail our patients. Lack of adequate funding must never
be the cause of such failures.
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\11\ NCHS Data Brief No. 457, December 2022, Merianne Rose Spencer,
M.P.H, Arialdi M. Minino, M.P.H., and Margaret Warner, Ph.D, at 3,
available at: https://www.cdc.gov/nchs/data/databriefs/db457.pdf
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Additionally, the Tribe works closely with the Albuquerque Area
Indian Health Board and the Southwest Epidemiology Center. These
organizations receive federal grants and distribute subawards to the
Tribe to address substance use issues and to provide technical
assistance. We also use HHS funding to operate Shining Mountain Health
and Wellness program--a fully grant funded community and clinic-based
program that has a primary focus on chronic disease management and
prevention, including for diabetes, women's health, and maternal-child
health. Shining Mountain offers dynamic services, including nutrition
education, cooking classes, foot care education and exams, membership
at SunUte Community Center--the Tribe's state-of-the art fitness
facility, and meal planning assistance, all based on the fluctuating
and unique needs of the Tribal community. The Tribe's ability to
continue providing these services is conditioned on its ability to
receive HHS grants. These include the Special Diabetes Program for
Indians coordinated by the IHS Division of Diabetes, and Center for
Disease Control (CDC) grants, such as the Good Health and Wellness in
Indian Country funding which is coordinated through the Healthy Tribes
program and aimed at delivering holistic, culturally responsive,
community-driven interventions for preventing, managing, and
controlling chronic diseases like diabetes. Cuts to the CDC's Healthy
Tribes program have already reverberated throughout Indian Country and
have halted culturally tailored public health initiatives that the
Tribe relies upon to serve its members. Further cuts to similar
programming through IHS would negatively impact the Tribe's ability to
maintain its public health capacity and would limit its ability to
prevent or treat manageable health conditions.
The Tribe also needs key agencies that serve Tribal communities,
including the Health Resource and Services Administration (HRSA), to
receive adequate funding. HRSA's loan repayment program allows the
Tribe to compete for providers with nearby communities that are located
in less remote areas. The Tribe's Reservation is relatively isolated in
southwestern Colorado. It is hard enough to recruit qualified providers
to deliver vital healthcare services to the Tribe's patients. As a
result, the Tribe is already short on providers. Cuts to programs like
HRSA would make this situation even worse.
The Tribe's ability to operate these vital, life-saving programs
and provide critical healthcare to Tribal patients is dependent on the
federal government meeting its obligation to fund Indian healthcare.
Cuts to HHS, Medicaid, or other essential federal programs--including
any staff cuts that impact the federal government's ability to process
Tribal funding in a timely manner--comes with real human costs. As a
matter of human dignity, the Tribe's patients deserve to be treated by
high-quality professionals operating in robustly funded programs. But
the reality is, the Tribe, like many Native communities, is forced to
operate on an extremely thin margin due to decades of federal
underfunding of Tribal health programs. Cutting already inadequately
funded HHS programs risks reversing the significant gains the Tribe has
made in achieving long-lasting healthy outcomes for its patients.
As a sovereign government, the Tribe's primary responsibility--and
one I take seriously as the Chairman--is to ensure the health and
safety of our people. As a separate sovereign who has a legal
responsibility to provide health care to Native Americans, the United
States must coordinate with the Tribe to help us meet this
responsibility. This means that Congress must preserve and strengthen
HHS funding for Tribal health programs. These programs are not
discretionary--they uphold federal legal commitments and are vital for
public health equity and Tribal sovereignty.
As such, we urge HHS to prioritize the protection and sustainment
of funding and programming to support Tribal health and wellness across
all HHS agencies and ensure this funding is flexible and responsive to
Tribal priorities. We further request that HHS reinstate personnel and
preserve key HHS programs that provide vital support to Tribes and
Tribally designated organizations. And we urge HHS to protect and
expand Tribal eligibility for funding through HHS programs and to
create a funding mechanism that supports long-term sustainability
rather than short-term projects.
The Tribe greatly appreciates its partnership with HHS and our
joint efforts to protect critical funding, services, and staff that
allow Tribes to deliver quality healthcare to Tribal patients. We
remain committed to our shared vision of a healthy America that must
include a specific focus on Tribes. Tribal patients are often the most
vulnerable among us and they need continued commitment from the federal
government to fully fund the programs and staff that serve their unique
needs. At the very least, that requires meaningful and proactive
consultation with Tribes when considering HHS program changes, budget
and workforce cuts, or new initiatives. The federal government's trust
responsibility permits nothing less.
In closing, I strongly urge HHS to support Tribal sovereignty and
uphold HHS's Tribal Consultation Policy, which necessitates that HHS
work in partnership with Tribes to ensure they have unfettered access
to the critical resources needed to address current and future public
health challenges that will support, strengthen, and sustain the health
and wellness of our people. We look forward to working with you to meet
these challenges head on for the betterment of our people.
Thank you for the opportunity to submit this written testimony.
______
Prepared Statement of the United South and Eastern Tribes Sovereignty
Protection Fund (USET SPF)
On behalf of the United South and Eastern Tribes Sovereignty
Protection Fund (USET SPF), we write to provide the Senate Committee on
Indian Affairs with testimony for the record of the oversight hearing
``Delivering Essential Public Health and Social Services to Native
Americans--Examining Federal Programs serving Native Americans across
the Operating Divisions at the U.S. Department of Health and Human
Services'' (HHS) held on May 14, 2025. As the Committee is aware, this
is a chaotic and confusing time for the Health and Human Services
System, including the Indian Health System, which together have the
responsibility of fulling trust and treaty obligations to Indian
Country. Recent HHS reorganization and reduction in force (RIF)
efforts, potential threats to funding and programs, and an overall lack
of Tribal consultation on any of these issues have caused significant
confusion and greatly impacted the ability of Tribal Nations to provide
programs and services to our communities. This testimony focuses on the
urgent need for Congress to exercise its oversight authorities over HHS
and protect the various funding and resources provided to Indian
Country.
USET SPF is a non-profit, inter-tribal organization advocating on
behalf of thirty-three (33) federally recognized Tribal Nations from
the Northeastern Woodlands to the Everglades and across the Gulf of
Mexico. \1\ USET SPF is dedicated to promoting, protecting, and
advancing the inherent sovereign rights and authorities of Tribal
Nations and in assisting its membership in dealing effectively with
public policy issues.
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\1\ USET SPF member Tribal Nations include: Alabama-Coushatta Tribe
of Texas (TX), Aroostook Band of Micmac Indians (ME), Catawba Indian
Nation (SC), Cayuga Nation (NY), Chickahominy Indian Tribe (VA),
Chickahominy Indian Tribe-Eastern Division VA), Chitimacha Tribe of
Louisiana (LA), Coushatta Tribe of Louisiana (LA), Eastern Band of
Cherokee Indians (NC), Houlton Band of Maliseet Indians (ME), Jena Band
of Choctaw Indians (LA), Mashantucket Pequot Indian Tribe (CT), Mashpee
Wampanoag Tribe (MA), Miccosukee Tribe of Indians of Florida (FL),
Mississippi Band of Choctaw Indians (MS), Mohegan Tribe of Indians of
Connecticut (CT), Monacan Indian Nation (VA), Nansemond Indian Nation
(VA), Narragansett Indian Tribe (RI), Oneida Indian Nation (NY),
Pamunkey Indian Tribe (VA), Passamaquoddy Tribe at Indian Township
(ME), Passamaquoddy Tribe at Pleasant Point (ME), Penobscot Indian
Nation (ME), Poarch Band of Creek Indians (AL), Rappahannock Tribe
(VA), Saint Regis Mohawk Tribe (NY), Seminole Tribe of Florida (FL),
Seneca Nation of Indians (NY), Shinnecock Indian Nation (NY), Tunica-
Biloxi Tribe of Louisiana (LA), Upper Mattaponi Indian Tribe (VA) and
the Wampanoag Tribe of Gay Head (Aquinnah) (MA).
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Introduction
USET SPF is deeply concerned by recent Administration actions and
reorganization efforts at HHS and their collective impacts on Tribal
Nations. Across the Department, Tribal programs continue to be reduced
or eliminated unexpectedly and federal employees that provide services
to Tribal Nations continue to be terminated without Tribal
consultation. This is despite Secretary Kennedy's commitment during his
confirmation hearing to ``make sure that all the decisions [at HHS] are
conscious of their impacts'' on Tribal Nations. Unfortunately, while
many of these actions and policies are not directed at Indian Country
specifically, we have been inadvertently harmed because the
Administration's implementation actions have been so broad and, often,
have not accounted for the legal obligations of the United States in
its relationship with Tribal Nations.
As a result of the cession of vast land and natural resources by
Tribal Nations to the United States--oftentimes by force--the United
States is legally obligated to provide certain benefits and services,
including healthcare, to Tribal Nations and Native people in
perpetuity. The delivery of Tribal programs and services, the provision
of federal funding to Tribal Nations and Tribal organizations serving
Tribal Nations, and the federal employees necessary for the provision
of those programs and services are integral to the delivery of federal
trust and treaty obligations. These resources provided to Indian
Country are not discretionary--they are legal obligations rooted in the
trust and treaty relationship, the U.S. Constitution, and long-standing
federal statutes. Despite this truth, at no point has the United States
every fully delivered upon this sacred promise and responsibility. The
actions to the HHS system serves to further exacerbate data supported
heath disparities experienced across Indian Country.
Despite some of the messaging we have heard from the
Administration, we are not ``all the same,'' nor are we mere
stakeholders. Rather, as the Committee is well aware, the United States
has unique obligations to Tribal Nations and Native people that
necessitates our disparate treatment. As the Administration implements
its priorities, it is necessary for Congress to fulfill these
obligations by protecting funding and resources for the Indian Health
System in the budget and appropriations processes.
Exercise Oversight Authority to Ensure Proper Tribal Consultation at
HHS
At the root of many of the issues Tribal Nations are facing from
HHS reorganization and reform efforts is the overall lack of proper
Tribal consultation at HHS. Part of the federal trust and treaty
obligations is a duty to engage in government-to-government
consultation with Tribal Nations during the development and prior to
the enactment of any federal actions that may have Tribal implications.
Despite this legal obligation, HHS has failed to engage in meaningful
Tribal consultation while proposing and enacting drastic changes to
agency budgets, programs, and staffing.
Tribal Nations support this Administration's efforts to alleviate
burdensome regulations and other barriers that hinder Tribal self-
governance and economic development, but these efforts must be
developed in close consultation with Tribal Nations to ensure there are
no unintended consequences on us. This is particularly important at
this juncture as HHS considers its proposed agency reorganization plan
and other efforts to reform how programs and services are delivered
through HHS. Tribal Nations are served by programs and staff across
HHS, not just by the Indian Health Service (IHS); therefore, all
efforts to reorganize HHS must start with and include robust Tribal
consultation. Without Tribal consultation on reorganization, it is
unclear how HHS intends to protect Tribal programs and resources and
ensure there are no disruptions to service delivery. HHS has stated
that its activities are not meant to affect its legal obligations to
Tribal Nations, but it is impossible to know how a reorganization
effort of this magnitude could affect delivery of those obligations
without Tribal consultation. USET SPF shares important goals with HHS
and this Administration such as reducing chronic disease prevalence and
increasing access to healthy foods, but existing programs and resources
that support those goals are being threatened by HHS reorganization
efforts and our focus on shared priorities is being necessarily
redirected to address these threats.
USET SPF and other advocates in Indian Country have repeatedly
called on HHS to fulfill its Tribal consultation obligations as this
Administration engages in government reform efforts. During the most
recent HHS Secretary's Tribal Advisory Committee (STAC) meeting in
April 2025, a senior advisor to the Secretary committed to holding at
least one Tribal consultation on the recent HHS reorganization efforts.
However, in the month since the STAC meeting, HHS has yet to schedule
or provide any information on this Tribal consultation. We appreciate
Committee Chair Murkowski and Vice Chair Schatz for their May 9, 2025,
letter to HHS reiterating that meaningful consultation on any changes
to HHS that may impact Tribal healthcare is ``crucial to ensure that
health disparities are not further exacerbated'' and we urge the
Committee to continue exercising its oversight authorities over HHS to
hold the Department accountable for its commitments and obligations to
conduct robust Tribal consultation.
HHS Reorganization and Reduction in Force Concerns
Beyond the lack of Tribal consultation on these actions, USET SPF
is concerned by the recent efforts at HHS to drastically reduce the
federal workforce, radically reorganize the Department and its
divisions, rescind funding, and alter or eliminate federal programs. We
remind Congress and the Administration that any Tribal program or
funding delivered to Tribal Nations--including through Tribal
organizations serving Tribal Nations--is provided in furtherance of the
United States' trust and treaty obligations. The federal employees
necessary for the functioning of those Tribal programs and the
disbursement of those Tribal funds are also part of the trust and
treaty obligations. The loss of numerous federal employees who
supported Tribal Nations in HHS Regional offices and across the
Department has had serious impacts on the delivery of programs and
services in Indian Country.
The closure of HHS Regional offices 1 (Boston) and 2 (New York),
which collectively served nearly half of USET SPF's member Tribal
Nations, eliminated critical support for program delivery and technical
assistance in Tribal communities. Elimination of these employees has
also created communication gaps between Indian Country and HHS,
creating uncertainty and confusion around grant and program resources.
These issues have, in turn, forced some Tribal Nations and
organizations to pause or cancel programs in our communities to try to
avoid endangering our funding and resources. The loss of these
employees also means the loss of years of relationship building and
knowledge sharing between Tribal Nations and HHS at the regional level.
With these employees goes vast institutional knowledge and cultural
competency that will likely take years to rebuild. USET SPF requests
that the Committee reinforce our concerns with HHS reorganization and
reduction in force efforts as they relate to the Department's trust and
treaty obligations to Tribal Nations and the need for a regional HHS
presence to execute on those obligations.
Increased Efficiency Through Tribal Self-Governance Expansion
We understand that these reorganization and reduction in force
efforts at HHS are part of the Administration's goals to increase
government efficiency. The Indian Self-Determination and Education
Assistance Act (ISDEAA) has been an important tool that puts federal
funding into Indian Country's hands so that we may run federal programs
more efficiently and effectively to serve our own communities. However,
ISDEAA contracting and compacting is currently limited to certain
federal agencies and programs.
Self-governance expansion beyond IHS at HHS has been a long-
standing priority in Indian Country. Tribal Nations have successfully
administered complex healthcare programs for decades, but self-
governance limitations at HHS have prevented us from taking over other
aspects of our health systems from the federal government. A
feasibility study conducted in 2013 found that self-governance
expansion at HHS is possible, but would require Congressional action,
and efforts to advocate for this change with HHS and Congress have
stalled over the years.
With the Administration's current focus on government efficiency
and increased local control over programs and services, it is the
perfect opportunity to renew Tribal self-governance expansion efforts
at HHS. USET SPF urges the Committee to work with Tribal Nations and
HHS to extend ISDEAA authorities to all agencies and programs at HHS at
serve Tribal Nations, Tribal citizens, or Tribal communities.
Threats to Indian Country in Budget and Appropriations
USET SPF remains concerned about FY 2026 appropriations for the
Indian Health System, given a leaked proposal in the Office of
Management and Budget (OMB) HHS 2026 Discretionary Budget Passback to
substantially reduce funding for the IHS and other HHS offices and
programs that deliver crucial services to Indian Country and the
subsequent lack of detail on the IHS budget in the President's Skinny
Budget Request. The HHS System that serves Indian Country is already
chronically underfunded, understaffed, and under-resourced; therefore,
any reduction in resources has the potential to create dire
consequences for the health of Tribal Nations and our communities.
In the leaked OMB Passback, for IHS alone, the Administration
proposed a nearly 30 percent reduction to the IHS base allocation for
FY 2026--a cut that would dismantle essential services and affect
service quality and access across Indian Country--and proposed to
eliminate advance appropriations for the agency. IHS is currently
underfunded by 90 percent or more according to some estimates, has a
staff vacancy rate of 30 percent, and operates out of significantly
older facilities than other U.S. health systems. If the IHS budget were
to be cut by the proposed $896 million, these issues would only be
exacerbated. Fortunately, advocacy opposing the IHS budget cuts was
possibly successful, as the fact sheet for the President's skinny
budget request stated that ``The budget preserves federal funding for
the [IHS].'' However, the Skinny Budget Request offers no detail on the
IHS budget, creating continued uncertainty.
The Skinny Budget Request is also silent on whether the
Administration will propose to maintain advance appropriations for the
IHS or continue to support its earlier proposal in the Passback to
eliminate this practice. Advance appropriations have provided critical
budgetary certainty for the IHS and its enactment in FY 2024 marked a
historic shift in the nation-to-nation relationship between Tribal
Nations and the federal government. Prior to FY 2024, IHS was the only
federal healthcare provider without advance or mandatory
appropriations, subjecting Tribal citizens to increased risk of harm or
death from delays in the annual appropriations process. The elimination
of advance appropriations would be a violation of the federal
government's obligations to Tribal Nations and a massive step backwards
in federal Indian policy. USET SPF urges Congress to maintain IHS
advance appropriations, regardless of whether the proposal is included
in the forthcoming President's budget request.
Beyond IHS, the Administration is proposing to eliminate key HHS
agencies and programs that provide critical services to the most
vulnerable populations in Indian Country. Tribal behavioral health
grants and the Circles of Care Children's Mental Health Program at the
Administration for Children and Families (ACF) and other resources for
combatting opioid use disorders at the Substance Abuse and Mental
Health Services Administration (SAMHSA) are proposed to be cancelled,
despite the disproportionate prevalence and mortality rates of mental
health issues, substance use disorders and suicidality in Tribal
communities. Other programs slated for elimination or reduction like
Head Start, the Low-Income Home Energy Assistance Program (LIHEAP),
Community Services Block Grants, and Temporary Assistance for Needy
Families (TANF) are all lifelines for Tribal Nations. These programs
are essential to maintaining healthy communities and economies in
Indian Country, where the rural and remote nature of many of our
communities often results in a lack of early childhood education and
employment opportunities.
Tribal Nations are already forced to operate with vastly
insufficient resources due to decades of chronic underfunding,
especially for the essential services provided through the annual
appropriations process. By nearly every measure and indicator, Tribal
Nations, our citizens, and communities face a lower quality of life
than others in the U.S. The proposed disruption of what little
resources are flowing will only exacerbate these issues and deepen the
divide between Indian Country and the rest of the country. Unless
dedicated Tribal set-asides, Tribal funding, and Tribal Advisory
Committees are preserved, either through existing agencies, new
departments, or new mechanisms (such as an expansion of self-governance
authority), underfunded Tribal programs will face compounding
reductions that will require large-scale service cuts. History has
shown those cuts will inevitably increase health disparities and
negative outcomes in Indian Country. USET SPF calls upon Congress to
uphold its trust and treaty obligations and, at minimum, protect the
limited resources already provided for the Indian Health System, which
includes the IHS budget as well as other programs and services at HHS
that support Indian Country.
Protect Resources for Chronic Disease Prevention and Mitigation in
Indian Country
USET SPF supports this Administration's goals to reduce chronic
disease prevalence and severity in Indian Country, as AI/AN people
experience the highest rates of chronic disease prevalence and
mortality among all U.S. populations, but proposed cuts to chronic
disease prevention and mitigation programs threaten the success of this
goal.
For example, HHS is currently proposing to eliminate the Center for
Chronic Disease Prevention and Health Promotion at the Centers for
Disease Control and Prevention (CDC). If the Center for Chronic Disease
Prevention is eliminated, so will its Maternal and Infant Health
branch, Division of Oral Health, Division of Diabetes Translation, the
Division of Cancer Prevention and Control, and the Office of Smoking
and Health, all of which play critical roles in reducing chronic
disease prevalence in Indian Country. Further, HHS has terminated most
of the staff within the Healthy Tribes Program (HTP) at CDC, which
includes the Good Health and Wellness in Indian Country (GHWIC)
program, Tribal Practices for Wellness in Indian Country (TPWIC)
program, and the Tribal Epidemiology Centers Public Health
Infrastructure program. Through its various programs, the HTP supports
holistic, culturally responsive methods for preventing and managing
chronic diseases like type 2 diabetes and high blood pressure, supports
food access and nutrition education services, and supports Tribal
Nations' public health capacity and infrastructure, among others--all
of which are supposedly priorities for this Administration. The HTP
provides critical, cost-saving chronic disease prevention and
mitigation resources each year, but the elimination of program staff
puts the HTP and its work at risk. If the HTP program is eliminated or
otherwise limited by staffing constraints, vitally important chronic
disease prevention programs at hundreds of Tribal Nations could be at
risk of being eliminated or limited as well, which is of major concern
for a population that suffers disproportionately from chronic disease.
USET SPF also urges Congress to protect and increase support for
the Special Diabetes Program for Indians (SDPI), one of the most
successful chronic disease reduction and prevention programs in the
U.S. In the decades since its creation, SDPI has greatly reduced
diabetes prevalence, severity and mortality in Tribal communities while
diabetes prevalence in the general population has only increased. This
has saved millions of dollars in health care costs for diabetes-related
complications. However, despite SDPI's proven, evidence-based success,
the program has only received meager and insufficient funding increases
over time. Prior to 2024, SDPI had been flat funded at $150 million for
the last 20 years, and the slight increase to $160 million annually is
negligible due to inflation and rising costs from the program's
expansion. USET SPF requests that Congress significantly increase SDPI
funding and permanently reauthorize this critical and exceedingly
successful program. Additionally, we urge Congress to implement Tribal
Nations' authority to receive SDPI funds through self-determination and
self-governance contracts and compacts. Currently, program dollars are
delivered through grant mechanisms which fail to honor the federal
trust obligation by treating Tribal Nations as grantees rather than
sovereign governments. With the authority to receive SDPI funds
directly through Indian Self-Determination and Education Assistance Act
(ISDEAA) contracts and compacts, Tribal Nations will be able to use
SDPI dollars more efficiently as less staff time will be needed to
complete grant-related tasks and can be dedicated to program delivery.
We urge Congress to not only protect but expand support for and
access to critical programs like the SDPI and HTP that work to reduce
chronic disease prevalence in Indian Country. USET SPF is strongly
supportive of the Administration's goals to reduce chronic disease
prevalence, but these goals cannot be achieved without the programs and
resources that are relied on and proven successful in Indian Country.
Preservation of Medicaid as Fulfillment of Trust and Treaty Obligations
Medicaid is one of the major programs through which the federal
government fulfills its trust and treaty obligation to provide for AI/
AN healthcare. It serves a third or more of the AI/AN population in the
United States, and reimbursements from the Medicaid program constitute
a significant portion of IHS and Tribal health care program budgets.
While the Indian Health System makes up less than 1 percent of overall
federal spending on Medicaid, it is also estimated that Medicaid
billing constitutes from 30 percent up to 60 percent of the operating
budgets at most IHS and Tribal health facilities. These funds provide a
critical bridge in funding between the underfunded IHS and other health
care systems; therefore, any limitations or reductions in Tribal access
to Medicaid--including work requirements, per capita funding caps and
block granting--could have dire consequences for the Indian Health
System. Any effort to reduce federal spending on Medicaid must not
impact AI/AN eligibility and access or quality of care within the
Medicaid program for AI/AN people.
The federal government has an obligation to protect Tribal access
to Medicaid resources and provide appropriate exemptions from work
requirements and per capita funding caps for AI/AN Medicaid
beneficiaries. USET SPF has urged HHS to ensure that states include
these exemptions in any state plan amendments to Medicaid and have
advocated with Congress to include statutory exemptions in any
legislation intended to reform Medicaid to more concretely preserve AI/
AN access to the program.
USET SPF was pleased to see that the current reconciliation bill
text contains a clear exemption for AI/AN beneficiaries from Medicaid
work requirements. The bill also does not impose annual per capita caps
or block granting on the Medicaid program, which would have created
significant issues for the Indian Health System. USET SPF is strongly
supportive of this exemption and these provisions must be maintained in
any final version of the bill containing work requirements or other
limitations on Medicaid.
Conclusion
Congress has a responsibility to protect the HHS System from
harmful rescissions, budget cuts, and program eliminations and to
ensure increased, sustainable resources for AI/AN healthcare. Our
people prepaid for our healthcare through the cession of vast lands and
resources to the United States, which created the federal government's
trust and treaty obligations that exist in perpetuity. The proposed
cuts to the IHS and other parts of the HHS budget that support service
and program delivery in Indian Country are not only inappropriate but
also a direct violation of the U.S.'s obligations to provide for AI/AN
healthcare. Congress must exercise its oversight and appropriations
authorities to ensure that Indian Country is not wrongfully harmed in
the efforts to reform the federal government and budget. USET SPF
stands ready to support Congress and the Administration in its
priorities to reduce disease prevalence and promote healthier
communities, but these efforts must honor the federal trust and treaty
obligations to Tribal Nations.
______
Alaska Native Women's Resource Center
April 2, 2025
Dear Senator Murkowski,
I am writing today to express our concerns regarding the recent
placement of Shawndell Dawson, Director of the Office of Family
Violence and Prevention Services (OFVPS), on administrative leave as of
March 31, 2025. We are very worried about this unexpected leadership
change and its potentially devastating impact on critical services for
survivors.
The Alaska Native Women's Resource Center (AKNWRC) is the OFVPS-
designated Alaska Tribal Resource Center and works closely with Tribes
and communities across our state. Through this work, we have witnessed
firsthand how OFVPS, under Director Dawson's leadership, has been
instrumental in addressing the disproportionately high rates of
violence experienced by our people. Director Dawson has demonstrated an
undeniable commitment to honoring our Tribes and, in particular,
honoring Tribal sovereignty, while ensuring that federal resources
reach our most needed and historically underserved communities. Her
dedication to meaningful engagement and consultation with our Tribes
has led to programs that are both culturally appropriate and effective.
The impact that this leadership change will have on our Tribes and
Tribal communities is very unsettling. As you know, Alaska Native
communities face unique challenges in addressing domestic violence and
sexual assault due to our geographic isolation, limited infrastructure,
and limited funding opportunities. The OFVPS is crucial in supporting
our communities through specialized funding, culturally responsive
training, and technical assistance that acknowledges these unique
challenges.
Additionally, the OFVPS has been instrumental in implementing
critical provisions of the Family Violence Prevention and Services Act
to Tribal communities. Through dedicated funding streams for Tribal
shelters, advocacy services, and culturally specific prevention
initiatives, the OFVPS has created a network of support that honors our
traditional healing practices while providing essential resources for
survivors. Director Dawson's guidance has ensured these programs
operate with cultural sensitivity and meaningful Tribal engagement and
consultation. The disruption in leadership threatens to undermine the
trust and partnership that has been carefully nurtured and developed
between OFVPS and Tribes across Alaska, and any interruption or change
in direction could have devastating consequences for survivors, their
families, and their communities.
As a longtime advocate and champion for survivors of domestic
violence and sexual assault and as a Senator who has consistently
demonstrated your commitment to Alaska Native issues, you understand
the critical importance of stable, informed leadership in addressing
these complex challenges.
We respectfully urge you to:
Inquire into the circumstances surrounding Director Dawson's
placement on administrative leave and advocate for transparency
in this process;
Utilize your position as Chair of the Senate Committee on
Indian Affairs and other committees to ensure that the OFVPS
maintains its commitment to Tribes and culturally appropriate,
trauma-informed approaches;
Work to ensure that funding for Tribal programs remains
robust and that implementation proceeds without unnecessary
disruption; and
Request information about any transition plan and
qualifications of incoming leadership, particularly regarding
their experience working with Tribal nations.
Finally, I have included a copy of a letter sent to the Secretary
of Health and Human Services yesterday, signed by 72 organizations,
including Tribal coalitions and nonprofit organizations, state
coalitions, national organizations, and specialized groups focused on
domestic violence and sexual assault prevention and response, urging
the Secretary to change course, reinstate Director Dawson, and ensure
the stability of the work of the OFVPS.
The safety and well-being of Alaska Native survivors and families
experiencing violence must remain a priority. Leadership changes should
never come at the expense of those who depend on these essential
services or undermine the progress made in recognizing the sovereign
right of our Tribes to address violence in ways that align with our
cultural values.
Thank you for your continued dedication to these critical issues
affecting Alaska Native communities. I welcome the opportunity to
discuss these concerns with you or your staff in greater detail and
look forward to hearing your response and learning how you plan to
address these concerns.
With gratitude,
Tami Truett Jerue, Executive Director
______
April 1, 2025
The Honorable Robert F. Kennedy, Jr.,
Secretary, Health and Human Services,
U.S. Dept. of Health & Human Services,
Washington, DC.
Dear Secretary Kennedy,
We understand that Shawndell Dawson, Director of the Office of
Family Violence Prevention and Services (OFVPS), was placed on
administrative leave on March 31. The undersigned organizations are
calling on you to reinstate Director Dawson and express our grave
concern about the impacts this will have on the nation's response to
domestic violence and sexual assault.
This goes far beyond a personnel issue or individual position in
terms of its potential to disrupt an essential leadership function of
this work but instead threatens decades of a successful public health
response to domestic violence.
The work of the OFVPS office is specialized. OFVPS administers the
Family Violence and Prevention Act (FVPSA), which is at the heart of
our nation's response to domestic violence and supports lifesaving
services, including shelters, hotlines, counseling, and domestic
violence programs throughout the states and territories. OFVPS has more
recently administered funds for sexual assault programs that are
essential to keeping their doors open. The functions of the OFVPS
office are unique to the field and leadership requires broad expertise
of both domestic violence and sexual assault. Moreover, Director Dawson
and the OFVPS office have had a critical role in addressing the
intersections of domestic violence and sexual assault with other health
issues.
We must ensure the stability of the work and consistent leadership
is essential to any efforts to pursue efficiency. Losing that
consistency will hamstring efforts to respond to domestic violence and
sexual assault. The field, made up of over 2000 local domestic violence
and sexual assault agencies, will be closing out a billion dollars of
grants in the next several months and is currently awaiting grant
awards. OFVPS administers over $250 million a year. These dollars would
be in jeopardy without experienced leadership. This effort requires
leadership with a history and understanding of the grantees and
services.
We urge you to change course and prevent the potentially
devastating impacts on the domestic violence and sexual assault service
delivery system.
Sincerely,
Alaska Native Women's Resource Center
Alaska Network on Domestic Violence and Sexual Assault
Alliance of Tribal Coalitions to End Violence
American Samoa Alliance Against Domestic and Sexual Violence
Arizona Coalition to End Sexual and Domestic Violence
Arkansas Coalition Against Sexual Assault
Asian Pacific Institute on Gender-Based Violence
ASISTA
Battered Women's Justice Project
California Partnership to End Domestic Violence
Caminar Latino
Colorado Coalition Against Sexual Assault
Delaware Alliance Against Sexual Violence
Delaware Coalition Against Domestic Violence
End Domestic Abuse Wisconsin
Esperanza United
First Nations Women's Alliance
Florida Council Against Sexual Violence
Futures Without Violence
Georgia Coalition Against Domestic Violence
Georgia Network to End Sexual Assault
Hawaii State Coalition Against Domestic Violence
Idaho Coalition to End Sexual and Domestic Violence
Illinois Coalition Against Domestic Violence
Illinois Coalition Against Sexual Assault (ICASA)
Indiana Coalition Against Domestic Violence
Indiana Coalition to End Sexual Assault
Iowa Coalition Against Domestic Violence
Iowa Coalition Against Sexual Assault
Jane Doe Inc.
Jewish Women International
Just Solutions
Legal Momentum
Louisiana Foundation Against Sexual Assault
Louisiana Coalition Against Domestic Violence
Maine Coalition Against Sexual Assault
Maryland Coalition Against Sexual Assault
Maryland Network Against Domestic Violence
Michigan Coalition to End Domestic and Sexual Violence
Minnesota Indian Women's Sexual Assault Coalition
Montana Coalition Against Domestic and Sexual Violence
National Alliance to End Sexual Violence
National Organization of Asians & Pacific Islanders Ending
Sexual Violence
National Center on Domestic Violence, Trauma, and Mental Health
National Congress of American Indians--Violence Against Women
Taskforce
National Indigenous Women's Resource Center
National LGBTQ Institute on IPV
National Network to End Domestic Violence
National Organization of Sisters of Color Ending Sexual Assault
National Resource Center on Domestic Violence
Native Women's Society of the Great Plains
Nevada Coalition to End Sexual and Domestic Violence
New Mexico Coalition of Sexual Assault Programs
New Mexico Coalition Against Domestic Violence
New Jersey Coalition to End Domestic Violence
New York State Coalition Against Domestic Violence
North Dakota Domestic and Sexual Violence Coalition
Ohio Alliance to End Sexual Violence
Ohio Domestic Violence Network
Oregon Coalition Against Domestic and Sexual Violence
Pennsylvania Coalition Against Domestic Violence
Pouhana O Na Wahine
Puerto Rico Coalition Against Domestic Violence and Sexual
Assault
Respect Together
Rights4Girls
Rhode Island Coalition Against Domestic Violence
StrongHearts Native Helpline
Tahirih Justice Center
Texas Association Against Sexual Assault
Ujima, The National Center on Violence Against Women in the
Black Community
Vermont Network Against Domestic and Sexual Violence
Violence Free Colorado
Washington State Coalition Against Domestic Violence
West Virginia Coalition Against Domestic Violence
Wyoming Coalition Against Domestic Violence and Sexual Assault
VALOR
ZeroV, Kentucky United Against Violence
______
Rural Alaska Community Action Program, Inc., (RurAL CAP)
May 12, 2025
Senator Lisa Murkowski, Chairman of the Senate Committee on Indian
Affairs:
Since its founding in 1965, Rural Alaska Community Action Program,
Inc., (RurAL CAP) has been a cornerstone for low-income Alaskans to
access economic opportunity, both directly providing essential services
in early education, housing, and health and well-being and partnering
with statewide leaders on system building opportunities. Our programs
offer innovative, community-driven solutions that are crucial for the
sustainable development of Alaska--for us, a vision of Alaskans
benefiting from Alaskan economic potential and an improved quality of
life in our state.
The grants and technical support provided by Health and Human
Services (HHS) enable us to provide critical services to Alaskans.
While we are a private, non-tribal entity, the majority of our service
recipients are Alaska Native from communities both urban and rural,
reflecting Alaska's unique composition of more tribes than any other
state in the US. Today, we would like to focus on our operational
relationship with HHS using our Head Start programs' 60-year history as
an example.
Since 2020, RurAL CAP Head Start and Early Head Start has provided
the following to Alaskan families:
Services to Alaskan Families
1,903 children in RurAL CAP Head Start and Early Head Start
received critical cognitive, social, and educational
development
--1,570 of those children are Alaska Native (82.5 percent)
1,416 Alaskan families received Head Start and Early Head
Start services
76 families experiencing housing insecurity enrolled in Head
Start and Early Head Start
1,856 children received age-appropriate developmental
screenings
1,713 health screenings were conducted
279,316 meals served
Employment and Local Workforce Development
285 Alaskans employed serving in their own communities
through Head Start
--These are Alaskan jobs, staffed by Alaskans, often in rural
communities where opportunities for employment can be hard to
come by
173 Staff members are former Head Start graduates
Innovations in Workforce Development
1 Teacher Apprentice at Homer Head Start
6 more apprentices scheduled to begin next year in 6 rural,
off-road communities
--Teacher Apprenticeships help address the ongoing childcare
crisis in Alaska while creating pathways to long-term, self-
sufficiency through on-the-job training in rural communities
Impact Story
``After unexpectedly losing my husband three years ago I was
left alone with our two babies. I was unable to work. I was
grieving and honestly just trying to survive in any way that I
could. Head Start gave us socialization, new friendships. They
offered speech services to my daughter Jade who has now
surpassed her goal by 13 percent, and she's even started
reading before going to kindergarten. I cannot stress enough
how vital Head Start has been in helping my tiny broken family
find our new normal, and I hope that Head Start is available
for families just like mine for many years to come.''
--Turena, Homer Head Start parent
RurAL CAP remains committed to efficiently creating pathways to
self-sustainability, workforce development, and finding innovative
solutions to the challenges facing Alaska. Thank you for the
opportunity to highlight the significance of our Head Start programming
in improving the lives of working Alaskans.
Best regards,
Tiel Smith, CEO
______
Response to Written Questions Submitted by Hon. Lisa Murkowski to
Hon. Janet Alkire
Question 1. Staffing reductions have affected the ability of Tribal
Epidemiology Centers (TECs) to maintain vital surveillance tools and
data sets, such as Pregnancy Risk Assessment Monitoring System. How can
Congress ensure that TECs maintain their capacity to collect and
analyze critical public health data that informs tribal health
decisionmaking particularly during this period of reorganization?
Answer. In order to maintain TECs capacities to collect and analyze
critical public health data, Congress should ensure that TECs are
recognized and treated as public health authorities, as required by
HIPAA (25 U.S.C. 1621m(e)). Additionally, HHS must continue to manage
and respond to TECs requests for any data held or administered by any
division at HHS, in accordance with this statutory mandate.
Question 2. What are the specific health outcomes CDC Healthy
Tribes programs were achieving in Tribal communities and what
alternatives might exist to maintain these critical public health
initiatives current funding structures are dismantled?
Answer. The CDC Healthy Tribes programs are widely successful in
improving a wide range of health outcomes for Tribes with a program.
The Healthy Tribes programs enable Tribes to customize each program to
fit the needs of each individual Tribe. This flexibility allows each
site to create programming that meets local cultural and traditional
values. In Oklahoma, the Southern Plains Tribal Health Board has
utilized funding to invest in a Caring Van that offers preventative
health care and health education offering immunizations, dental
screenings, and HIV/AIDS screenings. In one year, the Caring Van
completed 294 screenings.
As part of Culture is Prevention, the Great Lakes Inter-Tribal
Epidemiology Center is partnering with the Great Lakes Inter-Tribal
Council to offer resource gathering and development of a 36-bed
Adolescent Recovery and Wellness Center.
Healthy Tribes is irreplaceable. No other federal or state program
provides the comprehensive community-driven support that Healthy Tribes
delivers. It is the only federal initiative that invests in the day-to-
day multi-sector needs of Tribal communities which focuses on disease
identification and prevention.
Question 3. Public Health Service Commissioned corps officers
assigned at CDC have historically provided temporary duty assistance in
Tribal communities during public health emergencies. Given their
critical role in addressing urgent issues like sexually transmitted
infection outbreaks in the Great Plains region, what strategies would
most effectively preserve this rapid response capability while ensuring
officers receive appropriate cultural competency training for effective
service in Tribal communities?
Answer. This type of surge staffing with Commissioned Corps
Officers is critical to our communities. Because of the underfunding
and high vacancy rates, surge staffing is frequently the only process
to get sufficient response during a public health crisis. Federal
employees who provide services to Tribal Nations should be exempted
from the Reduction in Force (RIF) and hiring freezes. Tribal leaders
continue to make this request known to Secretary Kennedy. These
employees are critical to delivering legally mandated services to
American Indian and Alaska Native beneficiaries and are essential
extensions of the government-to-government relationship. Once assigned
to Tribal communities, officers receive education on local cultural
values and traditions, with cultural competency defined by each Tribal
Nation.
Question 4. Recent staff reductions at the Public Health Service
Commissioned Corps Headquarters have raised concerns about essential
support functions including payroll processing, officer assignments,
and special pay administration. These changes potentially impact not
only the approximately 1,200 PHS officers serving at Indian Health
Service and Tribal facilities but also the nearly 6,000 officers
serving across critical public health programs at HHS and non-HHS
agencies. How might these administrative disruptions affect the Corps'
ability to recruit, retain, and deploy qualified healthcare
professionals to address ongoing health disparities in Tribal
communities and what measures could be implemented to stabilize this
critical workforce?
Answer. Public Health Service Commissioned Corps Officers are
critical to providing services at the IHS and Tribal health care
facilities and assisting the federal government in meeting the Trust
and Treaty obligations. Instability in the program and in federal
hiring have caused a lot of chaos, which drives potential new officers
away. Additionally, the number of Public Health Service Officers has
decreased in recent years, which has severely limited staff for the
public health process in Indian Country.
______
Response to Written Questions Submitted by Hon. Brian Schatz to
Hon. Janet Alkire
Question 1. Secretary Kennedy has taken steps to ``overhaul''
agencies across HHS--including those that serve Native communities. We
heard from several witnesses that because many grants have been
canceled and HHS regional offices abruptly closed, Tribes have been
left without assistance with implementing critical programs, including
those that support victims of domestic violence. Did HHS engage in
consultation with Tribes regarding any of the changes that have been
implemented, including its RIF or reorganization efforts?
Answer. No, the Department of Health and Human Services did not
engage in consultation with Tribes regarding any of the changes that
have been implemented, including HHS' reduction in force or
reorganization efforts.
Question 2: Earlier this month, I sent a letter with Chair
Murkowski and Senator Merkley to Secretary Kennedy about our concerns
with the continued hiring freeze and staff reductions at IHS which are
exacerbating existing staffing issues and the delivery of healthcare
services. What impacts have you seen at IHS facilities? Please be
specific.
Answer. The hiring freeze and staff reductions have had many
impacts on the Indian Health Service. First, the IHS has a vacancy rate
for physicians at 36 percent and 44 percent for behavioral health
providers. These providers are critical to delivering services and have
some exemption from the hiring freeze. Furthermore, 43 percent of our
IHS facilities would need to close their doors if they lose a single
provider. With that said, the exemption for hiring has been capped by
DOGE to less than 500 for the agency. This is not enough to meet the
demand of the IHS. IHS has experienced staff attrition of 4-5x the
typical rate, which is exacerbating current understaffing within the
agency and we expect without a change in course on the current hiring
freeze, facilities will likely need to at least temporarily close in
the near future.
Additionally, other key positions are not exempt from the hiring
freeze, such as janitorial staff, administrative reception, or coders,
billers, and Purchased and Referred Care (PRC) staff. These positions
must be included in a broader exemption for the IHS. These key
positions not only help IHS facilities meet accreditation requirements,
but our PRC staff pay medical bills owed by IHS and ensure Tribal
citizens can get the referred care they need. Without them, our
citizens face lack of care or worse bill collections for debts owed by
the federal government.
Question 2a. In your opinion, how will these impacts and/or
continued staffing uncertainties affect federal agencies' ability to
provide legally required health care for Native communities?
Answer. In addition to the loss of staff at the Indian Health
Service, many Tribal Offices and Tribal Support Teams have been reduced
or eliminated impacting Tribal grants and communication with federal
agencies. These offices and staff serve as a lifeline for Tribal
citizens and their dismissal will harm public health programs serving
Native communities. The number of HHS regional offices has been reduced
from 10 to 5, placing over 400 Tribes under the jurisdiction of a
single office in the Western United States.
Additionally, the termination of staff working with the Great
Plains Tribal Epidemiology Center has directly halted critical public
health response efforts. OASH staff who oversaw HIV/AIDS programming
have also been terminated impacting local efforts to provide lifesaving
care and prevention efforts for American Indian and Alaska Native
individuals living with or at risk of HIV/AIDs. Due to uncertainty in
funding for Head Start, one Tribe reported the loss of three staff
causing them to close their facility. Finally, dismissal of staff from
the CDC's Healthy Tribes and SAMHSA's Circles of Care harms local
behavioral health initiatives that provide prevention, intervention,
and treatment efforts.
Question 3. During a May 14th House appropriations hearing,
Secretary Kennedy called distribution of ultra-processed foods in
Indian Country a ``genocide'' against Native Americans. But this
rhetoric doesn't match the Trump administration's actions, e.g. gutting
the Centers for Disease Control and Prevention (CDC)'s Healthy Tribes
program, which focuses on chronic disease prevention through nutrition,
its proposed massive funding cuts to HHS, and staffing reductions,
including at the Administration for Community Living (ACL), which
administers Title VI funding through the Older Americans Act. How does
the CDC's Healthy Tribes program support chronic disease prevention?
Please be specific.
Answer. The CDC Healthy Tribes programs are widely successful in
improving the prevention of chronic diseases. The Healthy Tribes
programs able to customize each program to fit the needs of each
individual Tribe. This flexibility allows each site to create
programming that meets local cultural and traditional values. In
Oklahoma, the Southern Plains Tribal Health Board has utilized funding
to invest in a Caring Van that offers preventative health care and
health education offering immunizations, dental screenings, and HIV/
AIDS screenings. In one year, the Caring Van completed 294 screenings.
The Alaska Native Tribal Health Consortium collaborates with regional
Tribal health organizations to increase colorectal cancer screening.
This partnership has resulted in an increase of screening from 46
percent in 2020 to 62 percent in 2024 in Alaska Native populations.
Question 3a. How do ACL programs, including Title IV programs
authorized by Older Americans Act, support nutrition services and
health promotion across Indian Country?
Answer. The Administration for Community Living funds and
administers a wide range of nutrition services and health promotion
programs across Indian Country. They provide transportation services,
home-delivered nutrition services, congregate nutrition services,
information, referral, and outreach services, in-home services,
caregiver counseling and support group services, and caregiver respite
services. These are all essential to ensuring Native Elders can remain
and thrive in their own communities. The Native Elder programs within
ACL's OAA Title VI administration are the only federally funded wrap
around services for Native Elders and are offered in conjunction with
other Medicaid services that support keeping our Elders in community.
Question 3b. What do the administration's current and proposed
funding cuts mean for Tribal health, specifically related to chronic
disease prevention and health promotion?
Answer. The Administration's current and proposed funding cuts will
mean many Tribal chronic disease prevention and health promotion
programs will shut down. Tribes will be limited in their scope of
services and may eventually need to ration resources, like limiting
prevention services to provide more urgent levels of care. Lack of
funding, staff, and data will make it harder to specifically address
disease disparity in our communities.
Question 4. Federal agencies were directed to take down critical
health data to comply with President Trump's DEI Executive Order.
Although HHS issued an advisory opinion clarifying that the President's
Executive Orders regarding DEI do not apply to programs serving
American Indian and Alaska Natives (AI/AN), AI/AN data has been deleted
from public view, including data on how many Native youth are
struggling with mental health and thoughts of suicide, where disease
outbreaks are happening, what's making moms and babies less healthy,
and how we can combat chronic health issues. How does losing this kind
of data and information (now and in the future) impact HHS' ability to
deliver health care services to Native communities?
Answer. The Department of Health and Human Services has issued an
Advisory Opinion which clearly states that Tribes and their citizens
are not DEIA and that the obligations to Tribes should not be abridged.
Under this opinion, American Indian and Alaska Native data should not
be impacted. However, this is not reality and we must work to get data
back online. Losing access to critical data sources significantly
hinders Tribal communities' ability to effectively respond to emerging
health challenges. Without timely and accurate data, Tribes would be
unable to identify and address rising health issues, let alone
implement health education and prevention programs. The inability to
access and analyze data would also undermine Tribe's ability to secure
resources and funding, as data is essential for justifying requests for
support and demonstrating a need. Without critical information, it
weakens Tribal leaders' ability to make informed decisions and our
ability to protect the health and well-being of our communities.
Question 5. For the first time ever, in FY23, IHS received advance
appropriations following years of advocacy from Tribes and Tribal
Organizations. An initial pass back of the President's proposed FY26
Budget (the ``skinny budget'') threatened to end advance appropriations
while decimating IHS funding by 30 percent compared to FY25. Why is it
important that the federal government maintain advance appropriations
for IHS?
Answer. IHS Advance Appropriations has been critical to creating
stability for IHS, Tribes, and urban Indian organizations. The
predictable funding helps Tribes plan long-term for programs and staff
and provide a guarantee that health programs will not be subject to
stops in funding or reductions. Advance appropriations is important
because it meets the treaty and trust obligations to tribes and secures
stability for our programs, communities, providers, and our health.
Question 5a. If the President's proposed FY26 Budget is adopted,
and funding cuts are implemented across HHS, what impacts should Indian
Country brace for?
Answer. Indian Country will need to brace for severe impacts if the
President's proposed budget for FY26 is adopted. Most urgently, Tribes
could lose millions of dollars from critical programs at HHS.
Additionally, the IHS would no longer have funding certainty, which is
provided by advance appropriations.
Question 5b. Could Tribes meet their communities' needs as proposed
in the skinny budget?
Answer. No, Tribes would not be able to meet their communities'
needs as proposed in the skinny budget or the President's Budget
without reduction to programs.
______
Response to Written Questions Submitted by Hon. Ben Ray Lujan to
Hon. Janet Alkire
Question 1. How will the reduction in workforce and Health and
Human Services (HHS) reorganization impact Pregnancy Risk Assessment
Monitoring System (PRAMS) and other key public health programs?
Answer. In addition to the Indian Health Service, several other
departments within the Department of Health and Human Services provide
critical healthcare services to Tribal communities. A reduction in
force would result in many key public health programs, including the
Pregnancy Risk Assessment Monitoring System (PRAMS) to halt efforts.
The PRAMS data set is one of the few points of information on AI/AN
pregnancy risk which is critical to identifying and addressing
pregnancy risks and disparities in our communities. It is critical that
all programs serving Tribal communities are protected from the
reduction in force, so that they can continue providing key public
health services to Indian Country.
Question 2. Implementing reduction in force measures, like
eliminating the Office of Minority Health and other key Medicare and
Medicaid services goes against their promise and their federal legal
responsibilities to Tribes--can you discuss how the Center for Medicare
and Medicaid Services supports critical Tribal programs?
Answer. Since IHS is already severely underfunded, Medicaid serves
as a critical funding stream for Indian health care providers,
including Urban Indian Organizations. Medicaid is essential to
sustaining Tribal health care services. For some clinics, it accounts
for 30-60 percent of their operating budgets, making it a critical
source of funding to sustain services for our Tribal citizens. IHS's
projected Medicaid is only 0.21 percent of total federal Medicaid
spending. We are encouraged by bipartisan efforts to protect Tribal
citizens in Medicaid reform, including the House Energy and Commerce
text exempting Tribal Citizens from work requirements, and we urge the
Senate to maintain these protections.
We also have seen the Administration re-instate offices like the
CMS Office of Minority Health understanding the statutory requirements
to keep such offices open within HHS agencies under the Patient
Protection and Affordable Care Act (P.L. 111-148). We hope this will
continue in relation to programs supporting our Tribal communities.
______
Response to Written Questions Submitted by Hon. Brian Schatz to
Melissa Charlie
Question 1. Secretary Kennedy has taken steps to ``overhaul''
agencies across HHS--including those that serve Native communities. We
heard from several witnesses that because many grants have been
canceled and HHS regional offices abruptly closed, Tribes have been
left without assistance with implementing critical programs, including
those that support victims of domestic violence. Did HHS engage in
consultation with Tribes regarding any of the changes that have been
implemented, including its RIF or reorganization efforts?
Answer. I can only speak on behalf of the Fairbanks Native
Association. No consultation was offered regarding these changes. One
day, our federal grant administrators were accessible; the next, they
were no longer available. We have historically maintained strong,
collaborative relationships with our federal partners, working together
to deliver meaningful services to our members. The abrupt termination
of this relationship-without prior notice-was both unsettling and
counterproductive for everyone involved.
Question 2. Secretary Kennedy frequently touts that HHS exempted
the Indian Health Service from the hiring freeze in place across the
federal government. However, not only is the exemption limited to only
certain clinical positions, it is still in place across other HHS
agencies that serve Native communities' health care needs. In addition,
HHS has engaged in a series of staff layoffs, and additional Reductions
in Force (RIFs) are looming. Your testimony stated that staffing
uncertainties are crippling programs for children. How do efforts to
reduce federal staff affect Head Start programs serving Tribes, and how
will future reductions exacerbate existing challenges?
Answer. As grant recipients, particularly for Head Start programs,
we are required to navigate an increasingly uncertain fiscal landscape,
often without clear insight into what changes may come from the federal
level day to day. In good faith, we submitted grant modifications
designed to enhance services for the children and families we serve
while maximizing the use of federal funds. These changes were approved
shortly before the recent reduction in federal staffing.
Like many others, we have been addressing workforce shortages since
the pandemic and are only now beginning to rebuild, with an increase in
both teachers and associate teachers that will enable us to expand
enrollment. This recovery strategy was developed collaboratively with
our Head Start grant management team.
Unfortunately, that team is no longer functioning cohesively due to
hiring freezes and job uncertainty. Reductions in the federal workforce
risk undermining the trusted relationships built over time and will
inevitably disrupt service delivery to those most in need-our children
and their families.
Question 3. During a May 14th House appropriations hearing,
Secretary Kennedy called distribution of ultra-processed foods in
Indian Country a ``genocide'' against Native Americans. But this
rhetoric doesn't match the Trump administrations actions, e.g., gutting
the Centers for Disease Control and Prevention (CDCYs Healthy Tribes
program, which focuses on chronic disease prevention through nutrition,
its proposed massive funding cuts to HHS, and staffing reductions at
the Administration for Community Living (ACL), which administers Title
VI funding through the Older Americans Act. What do the
administration's current and proposed funding cuts mean for Tribal
health, specifically related to chronic disease prevention, nutrition
services, and health promotion?
Answer. Our Title VI program provides nutritious meals to our
elders--often the only complete meal they receive each day. These meals
include fresh fruits and vegetables, which can be difficult to afford
for those on fixed incomes. This service is a vital preventive health
measure that supports the overall well-being of our elders and helps
reduce avoidable medical visits.
In addition to promoting physical health, the program offers
valuable opportunities for social interaction, helping to combat
isolation and support mental health.
Eliminating or reducing this program, or any of its related
services, would likely result in increased costs in other areas, such
as healthcare, due to the adverse effects on the physical and emotional
well-being of our elder community members.
This one example is representative of the impacts any funding cuts
would have on Tribal health services across the board.
Question 4. For the first time ever, in FY23, IRS received advance
appropriations following years of advocacy from Tribes and Tribal
organizations. An initial pass back of the President's proposed FY26
Budget (the ``skinny budget'') threatened to end advance appropriations
while decimating IHS funding by 30 percent compared to FY25. Why is it
important that the federal government maintain advance appropriations
for IHS?
Answer. Maintaining advance appropriations for the Indian Health
Service (IHS) is critically important to ensure the continuity and
stability of health care services for American Indian and Alaska Native
communities.
Historically, IHS funding was subject to delays and disruptions
caused by the annual federal budget process and government shutdowns.
These disruptions directly threatened access to essential health
services, compromised staffing and retention, and undermined long-term
planning.
Advance appropriations, which provide funding one fiscal year ahead
of time, allow IHS programs and tribal health systems to operate
without interruption, regardless of delays in the federal budget
process. This stability is essential for maintaining:
Continuity of care for chronic and acute health conditions
Reliable staffing and recruitment of health professionals
Timely procurement of medical supplies and services
Tribal self-governance and planning under self-determination
agreements
Most importantly, advanced appropriations honor the federal
government's legal and moral obligation to provide health care to
tribal nations, as established through treaties, statutes, and trust
responsibilities. They uphold the federal trust responsibility and
support the delivery of consistent, quality care in Native communities.
Question 4a. If the President's proposed FY26 Budget is adopted,
and funding cuts are implemented across HHS, what impacts should Indian
Country brace for?
Answer. While I can only speak on behalf of Fairbanks Native
Association (FNA), it is clear that such drastic funding reductions
would severely compromise our ability to provide essential services.
The Indian Health Service (IHS) is already significantly underfunded,
and any further cuts would force impossible decisions about which
critical services to eliminate--despite the persistent and growing
unmet health needs in our communities.
It is important to emphasize that IHS funding is not discretionary
funding. It is a legal and moral obligation of the federal government,
grounded in treaties, federal statutes, executive orders, and the
federal trust responsibility to American Indian and Alaska Native
peoples. This obligation must be honored with consistent and adequate
funding, not subject to arbitrary reductions.
Question 4b. Could Tribes in Alaska meet their communities' needs
as proposed in the skinny budget?
Answer. This question would be more appropriately addressed if the
essential needs of our people were already being met. However, defining
what constitutes an ``essential need'' is complex. Are immunization
services more critical than diabetes management? Is treating a broken
bone more urgent than providing behavioral health related services?
These are not either-or choices, all are vital, and all are currently
underfunded.
Each tribe must determine its own priorities based on the specific
needs of its community. For the Fairbanks Native Association (FNA), any
reduction in funding would have a deeply negative and far-reaching
impact on the health and well-being of those we serve.
______
Response to Written Questions Submitted by Hon. Ben Ray Lujan to
Melissa Charlie
Question 1. How has federal funding for Indian Head Start programs
improved school readiness and mental health outcomes for Native
American children?
Answer. Since its inception in 1965 as part of the federal
government's War on Poverty, the Head Start program has provided
critical early childhood education and comprehensive support services
to millions of children and families across the nation, giving them a
``head start'' in life.
At Fairbanks Native Association (FNA), our Head Start program goes
beyond traditional classroom instruction. We offer a holistic, child-
centered approach that includes individualized support tailored to each
child's developmental needs. Our goal is to ensure every child is fully
prepared to transition into kindergarten with confidence and readiness.
In addition to educational programming, we provide essential health
and wellness services, including referrals to behavioral health
support, vision and dental screenings, and regular developmental
assessments. We also actively engage families as partners in their
child's learning, recognizing that strong family involvement is key to
long-term success.
I will also add that as a Tribal Head Start program, FNA integrates
a strong cultural component that honors and fosters the cultural
strengths of the children and families we serve. We incorporate Alaska
Native languages, teach traditional dances, and celebrate cultural
heritage in meaningful ways throughout our curriculum and activities.
This culturally responsive approach promotes a sense of identity,
belonging, and pride, which supports the overall well-being of our
children and their families--socially, emotionally, and spiritually. By
grounding our program in culture, we empower families and help children
thrive in all areas of life.
Through these coordinated efforts, FNA Head Start helps lay a
strong foundation for lifelong learning, well-being, and success.
______
Response to Written Questions Submitted by Hon. Brian Schatz to
Dr. Sheri-Ann Daniels
Question 1. Secretary Kennedy has taken steps to ``overhaul''
agencies across HHS-including those that serve Native communities. We
heard from several witnesses that because many grants have been
canceled and HHS regional offices abruptly closed, Tribes have been
left with assistance with implementing critical programs, including
those that support victims of domestic violence. Did HHS engage in
consultation with POL or the Native Hawaiian Community regarding any of
the changes that have been implemented, including its RIF or
reorganization efforts?
Answer. HHS did not engage in consultation with POL regarding its
RIF or reorganization efforts. We have conferred with a number of
Native Hawaiian Organization partners who receive funding from the
Administration for Native Americans and Administration for Children and
Families. These partners also reported that they were not consulted. We
are not aware of any other organizations or individuals in the Native
Hawaiian community that were consulted by HHS.
Question 2. House Republicans are proposing devastating Medicaid
cuts. In Hawai`i, about 1 in 4 Native Hawaiians rely on Medicaid, and
while the House bill includes a carve out for American Indians and
Alaska Natives, it does not include any exemptions for Native Hawaiians
in clear violation of the federal government's trust responsibility.
How will imposing new hurdles, such as work requirements and additional
cuts to Medicaid, affect Native Hawaiian health care in Hawai`i?
Answer. The work requirements ``hurdle'' indeed will be a
``hurdle'' impacting Native Hawaiians, without the same carve out as
American Indians and Alaska Natives. As noted by HHS's Office of
Disease Prevention and Health Promotion, \1\ social determinants of
health (``SDOH'') are the conditions in the environments where people
are born, live, learn, work, play, worship and age, that affect a wide
range of health functioning, and quality-of-life outcomes and risks.
The SDOH domain of Economic Stability indicates the following goal: \2\
Help people earn steady incomes that allow them to meet their health
needs. The unemployment rate in Hawai`i in 2025 and 2026 is projected
to be 2.9 percent, declining to 2.8 percent in 2027 and then 2.7
percent in 2028. \3\ Native Hawaiians on Medicaid in Hawai'i are caught
in a viscous circle of needing employment to enable access to
healthcare services for management of individual chronic disease
conditions plus dependents who are overrepresented in special health
and social services needs (0-3 years old), early childhood (3-5 years
old), and special education (5 to 22 years old).
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\1\ Office of Disease Prevention and Health Promotion. ``Social
Determinants of Health.'' Healthy People 2030, Office of Disease
Prevention and Health Promotion, odphp.health.gov/healthypeople/
priority-areas/social-determinants-health. Accessed 1 June 2025.
\2\ Healthy People 2030. ``Economic Stability--Healthy People
2030.'' Health.gov, odphp.health.gov/healthypeople/objectives-and-data/
browse-objectives/economic-stability. Accessed 1 June 2025
\3\ ``DBEDT Economists Lower Hawaii Economic Growth Projections.''
State of Hawaii Department of Business, Economic Development & Tourism,
2025, dbedt.hawaii.gov/blog/25-20/. Accessed 1 June 2025.
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The poverty rate of Native Hawaiians in Hawaii is relatively high,
even though they are employed at about the same rate as the state's
total population. \4\ Over 144,000 Native Hawaiians and Pacific
Islanders are below the 138 percent poverty threshold for Medicaid. \5\
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\4\ Hofschneider, Anita. ``Poverty Persists among Hawaiians despite
Low Unemployment.'' Honolulu Civil Beat, 19 Sept. 2018,
www.civilbeat.org/2018/09/poverty-persists-among-hawaiians-despite-low-
unemployment/. Accessed 1 June 2025.
\5\ Karthick. ``By the Numbers: Economic Hardship--AAPI Data.''
AAPI Data, 7 Mar. 2025, aapidata.com/featured/by-the-numbers-economic-
hardship/. Accessed 1 June 2025.
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POL understands the following about Native Hawaiian and part-
Hawaiian members served by the Hawai`i Medicaid Program administered by
the State of Hawaii's Department of Health: More than 70,000
individuals that identify as Native Hawaiian are enrolled in Med-QUEST,
which represents approximately 17 percent of total Medicaid enrollees
(and 20 percent of those who chose to identify their ethnicity); Almost
26,000 (34 percent) children which includes more than 1,400 current and
former foster care children; more than 400 pregnant people; over 14,000
(18 percent) parents or caretakers; about 26,500 (34 percent) adults;
and about 8,800 (11 percent) aged, blind or disabled adults.
While these statistics indicate that Native Hawaiians are generally
represented in Medicaid enrollment at rates comparable to our
representation in the state's population. Medicaid enrollment is more
pronounced on the rural islands. \6\ On O`ahu, 26.5 percent of the
total population is enrolled in Medicaid. In contrast, nearly half--43
percent--of Hawai`i Island and over half--56 percent--of Moloka`i are
enrolled in Medicaid. \7\ Each of these islands also have the highest
percentages of Native Hawaiians, with Hawai`i Island's population made
up of 29.6 percent Native Hawaiian and Moloka`i's population comprised
of 65.1 percent Native Hawaiians. \8\ Given these numbers, it is clear
that hurdles, barriers and cuts to Medicaid will have a pronounced
impact on Native Hawaiian Medicaid enrollees, especially those in rural
communities.
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\6\ Audit, Quality Control & Research Office Research Staff. State
of Hawaii Department of Human Services Databook. Dec. 2024. Percentages
of island population covered by Medicaid are as follows: 34 percent
Kauai, 26.5 percent Oahu, 43 percent Hawaii Island, 33.8 percent Maui,
56 percent Molokai, 29 percent Lanai)
\7\ Id.
\8\ Office of Hawaiian Affairs. ``Native Hawaiian Data Book:
Population.'' Ohadatabook.com, 2025, www.ohadatabook.com/
go_chap01.23.html. Accessed 19 June 2025.
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In addition to the high representation of Native Hawaiians and
Medicaid enrollees, these islands tend to be considered more rural with
significant barriers to accessing health care. Hawai`i Island residents
often face long drives (60 to 100 miles one way) just to access primary
and urgent care services. Moloka`i has significant healthcare
professional and facilities shortages with many residents needing to go
off island to receive the care they need. This is exacerbated by
commuter air transportation options for disabled and elderly being
severely limited or non-existent for flights to and from Moloka`i.
Again, additional hurdles and disruptions to Medicaid coverage will
only exacerbate the significant health care access issues on each of
these and other islands.
Question 3. After federal agencies were directed to take down
critical health data to comply with President Trump's DEI Executive
Order, data regarding American Indian, Native Hawaiian, and Alaska
Health Native health was deleted from public view, including data on
how many Native youth are struggling with mental health and thoughts of
suicide, where disease outbreaks are happening, what's making mothers
and babies less healthy and how we can combat chronic health issues.
How does losing this kind of data and information (now and in the
future) impact HHS' ability to deliver health care services to Native
communities?
Answer. Losing the data negatively impacted HHS' ability to deliver
health care services to Native communities because the actions:
incorrectly conflated Trust responsibilities with DEI policy;
intentionally created a vacuum of community-based implementation data,
sharing and learning; and paternalistically prevented Native
communities from being solution partners and providers.
A. Trust Responsibilities are based on Political Relationships and not
DEI Initiatives
1. Federal Trust Responsibility. Similar to American Indians and
Alaska Natives, Native Hawaiians never relinquished the right to self-
determination despite the United States' involvement in the illegal
overthrow of Queen Lili`uokalani in 1893 and the dismantling of our
Hawaiian government. As such and as established by more than 150
federal laws, Native Hawaiians are owed the same trust responsibility
as other Native groups in the United States. The federal trust
responsibility extends to all Native Hawaiians, a population that grew
nationwide by 29.1 percent from the 2010 to the 2020 census data. \9\
To meet this obligation, Congress--through landmark, bipartisan work of
this Committee and its Members--created policies to promote education,
health, housing, and a variety of other federal programs intended to
build, maintain, and better conditions for the Native Hawaiian
Community.
\9\ US Census Bureau. ``Chuukese and Papua New Guinean Populations
Fastest Growing Pacific Islander Groups in 2020.'' Census.gov, 21 Sept.
2023, www.census.gov/library/stories/2023/09/2020-census-dhc-a-nhpi-
population.html. Accessed 7 May 2025.
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2. Unique Political Status. More than 150 Acts of Congress
expressly acknowledge or recognize a special political and trust
relationship to Native Hawaiians based on our status as the Indigenous,
once-sovereign people of Hawai`i. Among these laws are the Hawaiian
Homes Commission Act, 1920 (42 Stat. 108) (1921), the Native Hawaiian
Education Act (20 U.S.C. 7511) (1988), the Native Hawaiian Health
Care Improvement Act (42 U.S.C. 11701) (1988), and the Hawaiian
Homelands Homeownership Act codified in the Native American Housing
Assistance and Self Determination Act, Title VIII (25 U.S.C. 4221)
(2000).
3. Declaration of Policy. Congress declared that it is the policy
of the United States in fulfillment of its special trust
responsibilities and legal obligations to the indigenous people of
Hawaii resulting from the unique and historical relationship between
the United States and the Government of the indigenous people of Hawaii
(1) to raise the health status of Native Hawaiians to the highest
possible health level; and (2) to provide existing Native Hawaiian
health care programs with all resources necessary to effectuate this
policy. \10\
\10\ The Native Hawaiian Health Care Improvement Act (42 U.S.C.
11702) (1988)
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B. Intentionally Created a Vacuum in Community-based Implementation
Data, Sharing and Learning
Billions of dollars, over the past five decades, have been and
continue to be invested in Native community health professionals and
providers, facilities, interventions, strategies, and initiatives.
Community data, particularly that, which disaggregates Native
populations, triangulates the researched native community with
researchers and research organizations and the health care professional
community, to recognize and understand problems as well as co-
construct, community-based solutions. The data vacuum hinders HHS'
ability to deploy resources and programs and meet the Federal Treaty
and Trust responsibilities, effectively, including consultation
practices.
C. Paternalistically Prevented Native Communities from Being Solution
Partners and Providers
1. E Ola Mau. The Native Hawaiian Health Needs Assessment (1985)
was a landmark report that provided a comprehensive assessment of
Native Hawaiian health, offering recommendations related to the health
needs of Native Hawaiians. It provided the initial roadmap to local,
state, and federal agencies on how each could contribute to the health
and well-being of Native Hawaiians, was foundational in the passing of
the Native Hawaiian Health Care Act of 1988, and the establishment of
Papa Ola Lokahi. The assessments conducted in the original E Ola Mau
and subsequent versions of the document since then are not possible
without current and reliable data. The availability of data has enabled
Papa Ola Lokahi and other Native Hawaiian-serving agencies to monitor
the health status of Native Hawaiians, allowing us to identify areas of
need and growth, as well as strengths and resiliencies. Chapter topics
in E Ola Mau have expanded over the years to address these needs, now
including recommendations for workforce development, health education,
and data governance.
E Ola Mau has not only been used to create policy change, but it
has also had an impact at the community level, and this would not be
possible without the availability of data. E Ola Mau is heavily
referenced among community leaders and Native Hawaiian-serving
organizations as evidence of need in grant funding applications,
establishment of services, and in academic literature. E Ola Mau has
been a catalyst for change for Papa Ola Lokahi, as well as other Native
Hawaiian-serving organizations, communities, and individuals, all of
which have been made possible by the availability of reliable data.
2. COVID-19. One key example of the ways in which data that focuses
on native communities helps community and government partners identify
and address issues that have impacts on the broader population is the
data collected and used during the COVID-19 pandemic. By May 2020, data
indicated that Native Hawaiians and Pacific Islanders (NHPIs) had
higher rates of confirmed COVID-19 cases. \11\ These important data
points drove a coalition of organizations and government agencies to
allocate resources and develop tactics to address the high rates of
infection and mortality. Papa Ola Lokahi is proud to have helped these
efforts, which became known as NHPI 3R for Response, Recovery and
Resilience. NHPI 3R mobilized efforts to ensure the State Department of
Health was collecting and analyzing accurate and relevant data. From
there, NHPI 3R was able to work with government agencies to identify
immediate needs of the community and deliver community-based and
networked assistance, including testing, educational materials and
social supports.
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\11\ Kaholokula, Joseph Keawe`aimoku, et al. ``COVID-19 Special
Column: COVID-19 Hits Native Hawaiian and Pacific Islander Communities
the Hardest.'' Hawai'i Journal of Health & Social Welfare, vol. 79, no.
5, May 2020, p. 144, pmc.ncbi.nlm.nih.gov/articles/PMC7226312. Accessed
19 June 2025.
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In March 2021, the CDC identified that NHPIs had the highest death
rate of any racial or ethnic group in 18 of 20 states that reported
deaths of our communities. \12\ At the same time, the State of Hawai`i
Department of Health was not yet regularly reporting vaccination rates
broken down into racial or ethnic groups. NHPI 3R, along with other
community members, pushed the Department of Health for relevant data
reporting. When data was available, our state saw that Native Hawaiians
and Pacific Islanders had the lowest vaccination rate coupled with the
highest infection rate. \13\ NHPI 3R worked with the Department of
Health and other community partners to build messaging and programming
that would resonate with our communities. Papa Ola Lokahi partnered
with the Department of Health to help disperse funds to increase
vaccination rates among NHPIs. Further, these efforts spurred
organizing and capacity-building of community health workers, which has
continued to positively impact our communities.
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\12\ Seto, Brendan K. et al. ``Differences in COVID-19
Hospitalizations by Self-Reported Race and Ethnicity in a Hospital in
Honolulu, Hawaii.'' Preventing Chronic Disease, vol. 19, 2022,
www.cdc.gov/pcd/issues/2022/22_0114.htm#:-
:text=As%20of%20March%202021%2C%20Native, retrieved June 16, 2025
\13\ Hofschneider, Anita. ``Pacific Islanders, Including Hawaiians,
Disproportionately Missing out on Vaccines.'' Honolulu Civil Beat, 17
Mar. 2021, www.civilbeat.org/2021/03/pacific-islanders-including-
hawaiians-disproportionately-missing-out-on-vaccines/. Accessed 19 June
2025.
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The data at both state and federal levels that focused solely on
Native Hawaiians and Pacific Islanders was vital for Papa Ola Lokahi
and our partners, including the NHPI 3R coalition, to understand what
our communities needed to address COVID-19 in our communities. Further,
these data also allowed both the State of Hawai`i and the federal
government to allocate resources in more effective ways. These data
helped not just to move needed investments into Native Hawaiian
communities. The targeted allocation of resources helped to reduce
COVID-19 infections across Hawai`i and in Hawaiian communities across
the other 49 states.
3. Maternal Mortality. Another prime example of the way in which
disaggregated data yields powerful insights is the maternal mortality
rate. For years, Black American birthing people were known to have the
highest rates of maternal mortality. This allowed for HHS and other
organizations to tailor programs, resources and services to address the
disparity. It was not until the last couple of years that Asian
American, Native Hawaiian and Pacific Islander populations were
disaggregated that our community was forced to face the harsh truth
that our communities faced the highest maternal mortality rates in the
nation from 2017 to 2019--more than 50 percent higher than Black
Americans. \14\ In years since, Native Hawaiian and Pacific Islander
populations have not yet been disaggregated, but we have seen multiple
years where American Indian and Alaska Native communities also have the
highest rates of maternal mortality. \15\ These data sets are critical
for our communities as well as the federal government to identify
problems and address them effectively. For us to develop solutions
after all, we must first understand the problem and its root causes.
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\14\ CDC. ``Data from the Pregnancy Mortality Surveillance
System.'' Maternal Mortality Prevention, 29 Apr. 2025, www.cdc.gov/
maternal-mortality/php/pregnancy-mortality-surveillance-data/
index.html?cove-tab=1. Accessed 19 June 2025.
\15\ Id.
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Mahalo hou (thank you again) for providing the opportunity for POL,
the NHHB, to respond to the three questions for the record from Vice
Charman Schatz, as a follow up to the above referenced Committee
Oversight Hearing; and we stand ready and available to provide any
follow up information.
______
Response to Written Questions Submitted by Hon. Lisa Murkowski to
Hon. Loni Greninger
Question 1. As of 2022, there are seventy-six approved Tribal
Temporary Assistance for Needy Families (TANF) programs operating
across the United States. These programs serve more than 285 Federally
recognized Tribes and Alaska Native Villages, providing culturally
tailored services that promote self-sufficiency and community
wellbeing. What is the critical role of Tribal TANF programs in
supporting the most vulnerable in your communities and how is the
flexibility of Tribal TANF key in achieving self-sufficiency?
Answer. Tribal TANF programs provide much more than employment and
training resources in Tribal communities. They often are actively
engaged with child welfare, health, youth services, education, and
behavioral health programs. As one of the four main purposes of TANF,
these programs focus on services and support to ensure needy children
can be cared for in their homes. A number of Tribal TANF programs have
regular engagement with these other service providers to identify risk
factors early on for children and families that can lead to greater
crisis and involvement in service systems like child welfare. TANF
often sees at risk families long before other service systems identify
the families and with proper support can engage multiple systems to
identify concerns that threaten family stability and ensure that
services that promote economic self-sufficiency contribute to the
strengthening of families and community wellness overall. TANF's
flexibility to respond quickly, utilize culturally based services, and
engage various systems effectively is key to serving children and
families in need in Tribal communities. Operating a Tribal TANF program
empowers us with flexibility and autonomy to design and administer a
culturally relevant program that better serves the specific needs of
our Tribal citizens strengthening Tribal sovereignty, Self-
Determination, and improving overall community well-being.
Question 2. One of the critical functions of ANA is to provide
language grants. Preserving and revitalizing Native languages is
critical to sustaining Native history, culture, and philosophy. There
are significant impacts from the teaching of Native languages on
academic outcomes, social indicators, and community wellbeing. Alaska
has three active Ester Martinez Immersion grants currently, spanning
Southeast, Southcentral, and Western Alaska. Two of these grants
support language immersion through early childhood education, serving
children ages 0-5. What is the role of ANA Native Language Grants like
Ester Martinez Immersion in enhancing child development and building
strong communities?
Answer. Language is crucial to a child's development of their sense
of self and their relationship to their family, community, and the
world around them. Our languages are structured to show our
relationships with those around us, and express concepts unique to our
communities and cultures. The Federal Indian boarding school era wiped
out much of our Indigenous language knowledge, and COVID-19 has claimed
the lives of many of the remaining elders that were fluent speakers of
our languages. It is impossible to fully describe the impact that
losing our language and elders has had on our community. The
generational trauma of Indigenous language loss is well documented, and
we live and observe this trauma every day in our Tribal communities.
ANA Native Language grants, such as the Esther Martinez Immersion
Grant, provide essential funding to Tribal Nations to develop and
implement language learning models that incorporate family and elders
into methods-based curricula and assessments to revitalize our language
in pre-Kindergarten aged children. Indigenous language use and
revitalization is well understood to improve health disparities in
Tribal communities, as well as improve mental health outcomes. Tribal
communities have always known that culture is healing, and ANA Native
Language grants empower our sovereignty to rebuild the loss of our
language, culture, and community, starting with our youngest, most
vulnerable members.
The Jamestown S'Klallam Tribe has actively revitalized our Klallam
language through various initiatives, including documentation,
education, and community engagement. The Tribe established the Klallam
Language Program in 1992, recording our elders and transcribing the
language. This foundational work provided a basis for creating teaching
materials and curricula. The program has since expanded to include
language classes in local schools for pre-school to high school aged
children. These programs are vital to ensure that our younger
generations learn the language. Adult language classes and online
resources contribute to language learning beyond high school. Some
positive impacts of the Klallam Language Program are increased language
proficiency, improved academic success for Tribal students and
community empowerment. It has helped create local networks and
employment opportunities. The Tribe's efforts have influenced education
of surrounding non-Native communities and others who visit our area
with the introduction of bilingual street and Tribal campus signs.
There is a system in place for training and certifying Klallam language
teachers as qualified instructors that can continue to ensure the
language's survival and transmission to future generations. This is
essential because while our Klallam language is undergoing
revitalization, it is still critically endangered. The Jamestown
S'Klallam Tribe's commitment to language revitalization demonstrates a
dedication to preserving our cultural heritage and ensuring our
language continues to thrive.
Question 3. What is the importance of the CDC's Tribal Practices
for Wellness in Indian Country funding and how has this funding
benefitted the Jamestown S'Klallam Community?
Answer. The CDC Healthy Tribes program is important to the
Jamestown S'Klallam Tribe because it provides a framework and resources
that support the Tribe's goal of enhancing the health, social strength,
and self-reliance of our citizens and community members. Traditional
lifestyle and healing practices are essential to the overall well-being
of our Tribe and our citizens, and these programs provide us with the
opportunity to re-engage our ancient ways and utilize them in
contemporary time. The CDC program prioritizes cultural values,
traditions, and practices as central to health and wellness and this
aligns with our Tribe's mission to serve the unique needs of our
community with cultural sensitivity. Our identity as Tribal people is
healed and strengthened and our bodies and physical health is improved
with the healthy foods that we harvest, hunt, and cultivate on our
Tribal homelands and in our ancestral waters. The Healthy Tribes
Program recognizes the disproportionately high rates of chronic disease
and shorter life expectancy faced by American Indian/Alaska Native (AI/
AN) people often linked to historical trauma and lack of resources. By
promoting community-led, culturally responsive interventions, we can
address the root causes of these health disparities and improve health
outcomes. We have been able to lower the incidence of disease and lower
stress through traditional dancing, traditional foods, and harvesting
activities.
Funding and resources are used in various ways:
Salaries for staff that have the expertise needed to plan
both small- and large-scale events, teach classes, and
coordinate the First Foods Ceremony and all food harvesting and
preparations.
Stipends are provided to Tribal cultural and spiritual
leaders, usually our Tribal elders and wisdom keepers who teach
classes, lead songs and teach and facilitate sacred traditional
ceremonies.
Supplies include seeds and tools needed to help grow and
support our community garden and seasonal feasts. We create
safe pathways for citizens and community members of all
abilities to come to the garden and participate and actively
contribute to harvesting activities and the cooking of meals.
The garden serves as an intergenerational gathering place for a
plethora of activities including physical education,
nutritional and medicinal education, a learning space for
singing, drumming and dancing, and Ceremony, and a place for
cultural education of traditional harvest practices, food
preservation methods, and proper harvesting seasons. Garden
activities and opportunities for learning are offered on a
weekly basis. Food education includes harvesting, preparing,
preserving, cooking and storing. We teach our citizens and
community members various food preservation methods such as how
to freeze dry, dehydrate, smoke and can foods.
Cultural classes have specific themes and are hosted frequently,
usually on a quarterly basis. For example, every January we focus on
winter wellness and teach our citizens and community members about the
healing and nutritional properties of various plants and animals--we
make natural cough and cold medicines such as cough honey (a natural
throat coat and cough suppressant), Devils Club Tea (a natural
expectorant), Cedar steams (natural sinus cleanser) and healthy and
nutritious soups like duck soup where we gain health benefits from the
meat, bones and vegetables.
The First Food Ceremony is our largest garden event of the year
with at least seventy participants ranging in age from our youngest
Tribal citizens to our elders. During the Ceremony, a variety of
activities take place, and individuals may participate in a variety of
roles from assisting staff with harvesting, preparing the foods for
cooking, cooking the meal, singing and drumming, speaking the names of
our food in our language, and the act of gift giving. During the
Ceremony we celebrate the beginning of our traditional seasonal
calendar that includes only three seasons as we combine both fall and
winter into a single season that begins in November. We provide samples
of the major food groups and listen to the language speakers teach us
the Klallam words for deer, duck, berry, water, crab, camas, and fish.
Then we share the seasonal feast together and celebrate with songs.
The Tribe hosts multiple cooking classes, clam digs, seaweed and
forest plant harvests throughout the year. There are a number of inter-
Tribal events where we gather with our sister Tribes and learn about
their ancient harvest and cooking practices like cooking pits for camas
bulbs and using watertight bentwood boxes with hot stones to cook soup.
Our staff learn these traditional practices and bring that knowledge
back to our community to share with our citizens and community members.
These grants are essential for cultural preservation and because
they play a significant role in helping us learn ancient methods and
knowledge systems that are not known in western cultures. Holistic and
traditional health and education systems touch our hearts and
revitalize our soul in a deeper and more meaningful way than western
systems due to our belief in the interconnectedness of body, mind, and
spirit.
______
Response to Written Questions Submitted by Hon. Brian Schatz to
Hon. Loni Greninger
Question 1. Secretary Kennedy has taken steps to ``overhaul''
agencies across HHS--including those that serve Native communities. We
heard from several witnesses that because many grants have been
canceled and HHS regional offices abruptly closed, Tribes have been
left without assistance in implementing critical programs, including
those that support victims of domestic violence. Did HHS engage in
consultation with Tribes regarding any of the changes that have been
implemented, including its RIF or reorganization efforts?
Answer. There was no Tribal consultation on HHS reorganization
efforts or decisions ahead of implementation. HHS has just scheduled a
listening session on this topic on July 16-17, 2025, but a listening
session is not the same as robust, Nation-to-Nation consultation with
transparent information-sharing and engagement with Tribal leaders.
Question 2. Secretary Kennedy frequently touts that HHS exempted
the Indian Health Service from the hiring freeze in place across the
Federal government. However, not only is the exemption limited to only
certain clinical positions, it is still in place across other HHS
agencies that serve Native communities' health care needs. In addition,
HHS has engaged in a series of staff layoffs, and additional Reductions
in Force (RIFs) are looming. Your testimony stated that staffing
uncertainties are crippling programs for children. How do efforts to
reduce Federal staff affect services for Native children and families,
and how will future reductions exacerbate these challenges?
Answer. Tribal Nations take seriously the program requirements and
expectations that come with Federal programs, but they work to utilize
available flexibility within Federal programs to create functional and
responsive programs that work in their communities. In order for Tribal
Nations to successfully balance the need to meet requirements,
administrative and programmatic, that come with Federal funds and
create effective programming, they rely on HHS staff to partner with
them to discuss, design, and implement programs with Federal funding.
This is particularly true in child welfare and behavioral health
services, where many Federal programs have limited recognition of
Tribal needs or service delivery systems. The relationship between
Federal agencies and Tribal Nations is an ongoing relationship with
ongoing needs that require collaboration throughout the year. Tribal
Nations invest significantly into developing positive and meaningful
relationships with Federal staff, which in turn become more
knowledgeable and helpful in helping Tribal Nations meet Federal
requirements and develop effective programs. Most of this work occurs
between Federal staff in the regional offices and Tribes in their
region. Beginning in February with the prohibition of external
communication in HHS, loss of Tribal staff within the Central Office in
DC, and the closing of five regional HHS offices, hundreds of Tribes
have been scrambling for months to complete and submit their Federal
program reports and applications and make contact with Federal staff
that can provide meaningful assistance to them. The impacts to Native
children and families if Tribal Nations cannot submit their materials
on time to ensure they will receive funding in the future are profound.
For example, recipients of Title IV-B child and family services funding
are required to submit certain reports by June 30 of each year, but due
to the communications freeze, loss of staff, and regional office
closures, many Tribes that are new to the program have not received
sufficient technical assistance to complete the required reports. As a
result, these Tribes are at risk of losing access to these vital child
and family services funds in FY 2026. In addition, many Tribal Nations
will have to lay off staff in sensitive program areas, like child
welfare, and will have to make hard decisions about whether they can
participate in state child welfare cases involving their member
children and families. When Tribal Nations have to pull back from their
work, states will also suffer, because they rely greatly on Tribal
expertise and services to support Native children and families who are
in state systems.
Question 3. For the first time ever, in FY23, IHS received advance
appropriations following years of advocacy from Tribes and Tribal
Organizations. An initial passback of the President's proposed FY26
Budget (the ``skinny budget'' threatened to end advance appropriations
while decimating IHS funding by 30 percent compared to FY25.
a. Why is it important that the Federal government maintain advance
appropriations for IHS?
b. If the President's proposed FY26 Budget is adopted, and funding
cuts are implemented across HHS, what impacts should Indian Country
brace for?
c. Could Tribes meet their communities' needs as proposed in the
skinny budget?
Answer. Advance appropriations have been a truly life-changing
improvement for our clinic and patients. It has allowed us to provide
more consistent day-to-day care, as well as plan for a future expansion
of our healthcare services. Without advance appropriations, we return
to a time when shutdowns forced us into financial hardship. Across
Indian Country, clinics would drastically reduce or discontinue
services indefinitely, while our patients go without healthcare. This
is inconsistent with the trust and treaty responsibility. It is a
violation of Tribal sovereignty because we cannot fully exercise our
Self-Governance if our funding is held back by unrelated political
disputes in Washington, D.C. Simply put, the cuts proposed in the draft
``skinny budget'' would be devastating to our clinic and our patients
who rely on us for consistent, high-quality healthcare. We would be
forced to roll back essential services, and our patients would not have
the same access to comprehensive healthcare services. Furthermore, this
would force us into the impossible situation of determining which
services must be pared back. In short, we would not be able to meet
community needs if any cuts were enacted.
We were relieved to see that the final FY 2026 President's Budget
Request did not propose widespread cuts to the IHS, but the proposed
flat-funding of most accounts is still concerning to us. As you know,
this is effectively a cut when you take increased patient needs and
high medical inflation into account. This Indian health system is
already so chronically underfunded, leading to Tribal communities being
disproportionately impacted by obesity, diabetes, heart disease,
cancer, substance use disorder, and other preventable conditions. In
our communities, the life expectancy is ten years shorter than that of
the rest of the United States. The trust and treaty obligation demands
that we receive increases to our budget, not flat-funding or cuts.
We understand that this year, Congress is dealing with a tight
budget environment. However, the trust and treaty obligation exist
irrespective of the goal to limit Federal spending. In fact, the IHS
budget remains so small in comparison to the Federal budget that cuts,
rescissions, sequestrations, and freezes do not result in any
meaningful savings in the national debt, but they do harm Tribal
Nations and our citizens.
Response to Written Questions Submitted by Hon. Ben Ray Lujan to
Hon. Loni Greninger
Question 1. Despite Nationwide efforts to improve access to
behavioral health services in Indian country, Native Americans still
have one of the highest suicide rates in the country, can you talk
about how Federal programs like Substance Use and Mental Health
Services Administration (SAMHSA) has made an impact in addressing these
disparities in Tribal communities? How will cuts to SAMHSA harm Tribal
communities?
Answer. Federal funding for behavioral health services,
particularly for Native children and youth services, has been extremely
limited for many years. In addition, Tribal Nations have struggled to
find Federal behavioral health funding that is flexible enough that
Tribal traditional healing services can be supported. SAMHSA, while not
having only a few programs that address the behavioral health needs of
Native children and youth, has created a number of programs that have
provided some of the first Federal funding for Tribes to plan for and
implement traditional healing services in connection with more
mainstream interventions to address historic and intergenerational
trauma. The Circles of Care grants, Children's Mental Health Services
grants, and Tribal Behavioral Health Programs (two programs, one
focused on preventing youth suicide and other on addressing substance
abuse) have provided Tribal funding that is child and youth specific
and allows Tribal communities to utilize Tribal traditional healing
methods. The combination of these grant programs has helped Tribal
grantees establish greater stability and resources in an area where
there have historically been few and raise the capacity to address
mental health and substance abuse risks. These programs have been
helpful in creating Tribal models in behavioral health that future
Tribal grantees can draw upon in developing programs for their
communities. Cuts to these programs and Federal staff that support
Tribal grantees will extinguish much of the important work that Tribal
Nations have done to decrease disparities and likely increase risk
levels for suicide and substance abuse in affected communities.
______
Response to Written Questions Submitted by Hon. Lisa Murkowski to
Lucy R. Simpson
Question 1. As of 2022, there are 76 approved Tribal Temporary
Assistance for Needy Families. (TANF) programs operating across the
United States. These programs serve more than 285 federally recognized
Tribes and Alaska Native villages, providing culturally tailored
services that promote self-sufficiency and community wellbeing. What is
the critical role of Tribal TANF programs in supporting the most
vulnerable in your communities and how is the flexibility of Tribal
TANF key in achieving self-sufficiency?
Answer. Tribal TANF programs not only address the immediate
economic needs of low income families, many of which are survivors of
violence, but also promote long-term self-sufficiency of these
families. Due to the high rates of violence and lack of safe housing
and economic opportunity in Indian Country, some families need help
meeting their basic needs and many are faced with rebuilding their
lives after escaping abuse. Tribal TANF allows Tribes to design and
administer their own programs that reflect the unique needs of their
communities. This flexibility has made TANF highly successful in
providing services that are culturally relevant, trusted, and
effective, making it an excellent example of Tribal self-determination
and the federal government's trust and treaty obligation at work.
______
Response to Written Questions Submitted by Hon. Brian Schatz to
Lucy R. Simpson
Question 1. Secretary Kennedy has taken steps to ``overhaul''
agencies across HHS--including those that serve Native communities. We
heard from several witnesses that because many grants have been
canceled and HHS regional offices abruptly closed, Tribes have been
left without assistance with implementing critical programs, including
those that support victims of domestic violence. Did HHS engage in
consultation with Tribes regarding any of the changes that have been
implemented, including its RIF or reorganization efforts?
Answer. No, the Department of Health and Human Services has not
engaged in consultation with Tribes regarding any of the changes that
have been implemented, including its Reductions in Force and
reorganization efforts.
Question 2. Secretary Kennedy frequently touts that HHS exempted
the Indian Health Service from the hiring freeze in place across the
federal government. However, not only is the exemption limited to only
certain clinical positions, it is still in place across other HHS
agencies that serve Native communities' health care needs. In addition,
HHS has engaged in a series of staff layoffs, and additional Reductions
in Force (RIFs) are looming. Your testimony stated that staffing
uncertainties are crippling programs for children. How do efforts to
reduce federal staff affect Tribal services to support victims of
domestic violence, and how will future reductions exacerbate these
challenges?
Answer. The reductions in force (RIFs) issued by HHS have
interrupted essential functions of sexual assault and domestic violence
prevention efforts, threatened decades of improvements to our public
health response to these issues, and risked the loss of vital
institutional knowledge. Tribal programs rely on federal staff who have
spent years cultivating trusted relationships with Tribal Nations, as
well as developing their cultural competence, trauma-informed
expertise, and a deep understanding of the complex realities Native
communities face. Additional RIFs will cause a monumental loss of
institutional knowledge concerning Tribes and Native victims and
destabilize the work that has been done to make Native communities
safer over the last four decades.
Changes to leadership within HHS have also created uncertainty for
Tribal grantees due to the abrupt nature and lack of consultation and
communication. Notably, Shawndell Dawson, Director of the Office of
Family Violence Prevention and Services (OFVPS), was placed on
administrative leave on March 31.
The OFVPS office, under Director Dawson's leadership, has been
instrumental in recognizing the need for culturally grounded and
Native-led programs for survivors of violence. Over 230 Tribes and
Tribal DV programs receive Family Violence Prevention and Services Act
(FVPSA) formula grants to provide emergency shelter and crisis
intervention services. OFVPS, which administers FVPSA grants, also
partners with Native-led organizations like NIWRC to help build the
capacity of and provide training and technical assistance to Tribal
grantees and advocates so Native communities can access long-term,
specialized care. Director Dawson's abrupt placement on administrative
leave was felt within the OFVPS office and down to individual Tribal
grantees, causing deep uncertainty as they attempted to move forward in
their work. The issuance of Non-Competing Continuations--the funding
continuation for programs with multi-year grants or cooperative
agreements--and new funding for grants that terminate at the end of
this fiscal year have been significantly delayed, with little to no
communication with the programs relying on this funding. Programs
continue to face concerns about laying off staff or closing entirely if
this funding is not received, which would have a disastrous impact on
the number of resources available to victims in Indian Country.