Presented by Cathy Abramson Chairperson, National Indian Health Board

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1 Presented by Cathy Abramson Chairperson, National Indian Health Board

2 Sequestration FY 2014 Budget Contract Support Costs Purchased/Referred Care (PRC) Mental Health Alcohol and Substance Abuse Other issues: Definition of Indian in the Affordable Care Act Special Diabetes Program for Indians

3 On March 1, 2013, the Indian Health Service became subject to a 5.1 percent overall cut and a 2 percent cut from the Special Diabetes Program for Indians Total Loss: $228 million IHS is the only direct medical service agency that was subject to this amount of cut. Medicare, Medicaid, Children s Health Insurance Program (CHIP) and Veterans Affairs were all either exempt or received a smaller cut

4 Why is IHS subject to sequestration but others are not? Initial predictions were based on the 1985 sequester model which would have only impacted IHS with a 2 percent cut The Office of Management and Budget determined that IHS was not exempt and that IHS would be subject to the full sequestration cut for FY 2013.

5 What does this mean for Indian Country? Overall, the White House predicted that the cuts will mean 3,000 fewer Tribal inpatient admissions and 804,000 fewer outpatient visits each year. IHS has not released detailed budget numbers

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7 Indian Health Service Funding FY (Dollars in Thousands) FY2013 FY2012 After Recissions / Sequestration Enacted FY2011 FY2010 $3,900,000 $4,000,000 $4,100,000 $4,200,000 $4,300,000 $4,400,000

8 NIHB needs your help! A form is in your NIHB packet to provide your Tribe s story about sequestration. How many patients will go untreated? What health services will you deny cut back? Will you have layoffs of health professionals? Will you close any health clinics?

9 President Recommends $4.4 billion for the Indian Health Service in FY 2014 This is a $124 million (3 percent) increase from FY 2012 enacted levels According to the IHS Tribal Budget Formulation Workgroup, the total needs budget for IHS would be $26.1 billion NIHB supports the Workgroup s recommendation for FY 2014 to fund IHS at $5.3 billion

10 In June 2012, the Supreme Court ruled in Salazar vs. Ramah Navajo Chapter that the U.S. Government must pay each Tribe s contract support costs even if Congress has not appropriated enough funds The FY 2014 Budget recommends that the federal government enter into individual contracts with each Tribe for CSC funds and provides an additional $500,000 for new compacts

11 NIHB does not support this change without thorough strategically focused consultation with Tribes This process severely undermines Tribal selfgovernance NIHB recommends a 2-year study on this issue before any major policy adjustments are made on CSC

12 President Obama s budget has asked for a 1.3 percent increase, or $5.8 million, for FY 2014 NIHB calls on Congress to fund CSC at an additional $8.3 million

13 Formally known as Contract Health Services FY 2014 Administration request: $879 million FY 2014 NIHB request: $1.01 billion PRC is grossly underfunded, which prevents the IHS from purchasing the care needed and adequately addressing the rate of medical inflation. Increased PRC funding will allow IHS recipients to receive better access to health care.

14 FY 2014 Budget request for Mental Health is $79.9 million: Increase of $185,000 for pay costs $4.1 million for mental health staffing at newly constructed health facilities NIHB requests $121 million for Mental Health funding for FY 2014 Additional funding is needed to increase the incidence of suicidal behavior reporting by health care professionals.

15 SDPI was reauthorized by Congress through September 2014 at the current funding level of $150 million. 2% sequester reduction of $3 million for FY 2013 In June, NIHB will launch the SDPI reauthorization campaign for FY Stay tuned to for information on how you can become involved in the SDPI renewal effort.

16 The definitions of the word Indian in the ACA, is inconsistent with the current system for delivery of Indian health. Many AI/ANs will not receive the benefits and special protections intended for them in the law, including full coverage of health care services NIHB recommends that all definitions be standardized to the same definition used by the Centers for Medicare and Medicaid Services NIHB needs you to contact your Representatives and tell them about this important issue!

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