Indian Health Service Budget Update and IIJA Consultation Highlights

Indian Health Service Budget Update TRIBAL SELF-GOVERNANCE ADVISORY COMMITTEE FEBRUARY 9, 2022 JILLIAN CURTIS, CHIEF FINANCIAL OFFICER, IHS

Infrastructure Investment and Jobs Act Consultation Update 2

Infrastructure Investment and Jobs Act (2021) The IHS provided a virtual learning session on the Infrastructure Investment and Jobs Act (IIJA) funding on December 9, 2021 at the monthly IHS Tribal and Urban Indian Leader call. The IHS then conducted virtual Tribal Consultations on the IIJA on December 14 and 22, 2021, and January 5, 2022. The IHS accepted written comments through January 21, 2022 and received 26 written submissions for the IIJA consultation. Goal 3: Management and Operations, Obj. 3.3: Improve communication within the organization with tribes, urban Indian organizations, and other stakeholders, and with the general public. 3

IIJA Consultation Common Themes Common themes from Tribal Consultation noted that the IHS should: Use the data in the SDS to allocate funds, and follow the direction of the IIJA by providing support for economically infeasible projects, Prioritize allocation of funds where the majority can be used to immediately construct projects, Provide sufficient funding for planning and design activities to get projects ready to fund, and weigh these resources toward projects that address higher deficiencies, Goal 3: Management and Operations, Obj. 3.3: Improve communication within the organization with tribes, urban Indian organizations, and other stakeholders, and with the general public. 4

IIJA Consultation Common Themes (continued) Common themes from Tribal Consultation noted that the IHS should: Coordinate with Tribes and other federal Agencies like USDA and EPA to develop a plan to address ineligible costs and discuss how to maximize community benefit of the projects, Create a plan to address the full need for SFC projects in Tribal Communities, and remove any unnecessary limitations that were previously used to allocate limited funding, and Continue to seek annual, ongoing funding to address the full scope of SFC needs, including requesting any additional administrative costs necessary to implement the IIJA funds. Goal 3: Management and Operations, Obj. 3.3: Improve communication within the organization with tribes, urban Indian organizations, and other stakeholders, and with the general public. 5

IIJA Consultation Limited Concerns Concerns about exiting legal, regulatory, or policy aspects of the SFC program: Reduce regulatory barriers that are preventing homes and communities from being served, Remove cost caps and include economically infeasible projects, Prioritize projects that address the highest existing deficiencies, not satisfy expediency, and do not pass over larger more complex projects regardless of cost, Permit IIJA funding to support ineligible costs and fund all sanitation needs beyond eligible homes, Goal 3: Management and Operations, Obj. 3.3: Improve communication within the organization with tribes, urban Indian organizations, and other stakeholders, and with the general public. 6

IIJA Consultation Limited Concerns (Continued) Concerns about exiting legal, regulatory, or policy aspects of the SFC program: Eliminate the use of the Best Practice Score in the Sanitation Deficiency System, Do not fund projects sequentially from the Sanitation Deficiency System, Do not create a grandfathered list for SFC like the 1993 Health Care Facilities Construction Priority List, and open up funding to all projects, not just those currently in the SDS, and Do not pass over projects in any given year if they do not have matching contributions to cover ineligible costs or if they are facing construction supply chain or labor shortages. Goal 3: Management and Operations, Obj. 3.3: Improve communication within the organization with tribes, urban Indian organizations, and other stakeholders, and with the general public. 7

IIJA Next Steps IHS is reviewing and preparing responses to comments from Tribal Consultation. IHS will use the recommendations provided in Tribal Consultation to finalize an allocation methodology. IHS will announce its decisions via Dear Tribal Leader Letter. Goal 3: Management and Operations, Obj. 3.3: Improve communication within the organization with tribes, urban Indian organizations, and other stakeholders, and with the general public. 8

Mandatory Funding Consultation Update 9

Mandatory Funding Consultation/Confer HHS and IHS conducted Tribal Consultation and Urban Confer on mandatory funding proposals for the IHS on from August 25 through September 3. This consultation and confer will inform future President s Budgets, which are the official statement of the Administration s policies. The IHS and HHS are reviewing comments from the consultation and confer sessions, as well as 42 written comment submissions, to identify next steps. Goal 3: Management and Operations, Obj. 3.3: Improve communication within the organization with tribes, urban Indian organizations, and other stakeholders, and with the general public. 10

Mandatory Funding Common Themes Common themes from Consultation and Confer comments include: A Tribal Workgroup on mandatory funding approaches, Mandatory funding provided through an authorizing bill with a multi-year appropriation, and Support for acting fast in light of current opportunities, balanced with refining analyses and proposals over time. Goal 3: Management and Operations, Obj. 3.3: Improve communication within the organization with tribes, urban Indian organizations, and other stakeholders, and with the general public. 11

Mandatory Consultation/Confer Next Steps IHS sought volunteers from the National Tribal Budget Formulation Workgroup for a Mandatory Funding Policy sub-work group. The purpose of this workgroup is to identify key questions and areas for additional analysis to inform recommendations regarding mandatory funding for the IHS IHS will summarize comments from consultation and confer via Dear Tribal Leader Letter. Goal 3: Management and Operations, Obj. 3.3: Improve communication within the organization with tribes, urban Indian organizations, and other stakeholders, and with the general public. 12

FY 2022 Congressional Action 13

FY 2022 Hill Action The current Continuing Resolution expires on February 18th. Congress is considering an extension through March 11th. FY 2022 House Bill: Provides +$1.8 billion above FY 2021. Does not include advance appropriations. Silent on reclassification of Contract Support Costs and Tribal Lease Payments to mandatory. FY 2022 Senate Bill: Provides +$1.4 billion above FY 2021. Includes Advance Appropriations. Report Language supports reclassification of Contract Support Costs and Tribal Lease Payments to mandatory. Goal 3: Management and Operations, Obj. 3.3: Improve communication within the organization with tribes, urban Indian organizations, and other stakeholders, and with the general public. 14

FY 2023 & FY 2024 Budget Formulation 15

FY 2023 and FY 2024 Budget Formulation FY 2023 President s Budget The FY 2023 President s Budget is still under development. FY 2024 National Tribal Budget Formulation National Work Session February 10 & 11, 2022 (Zoom) Goal 3: Management and Operations, Obj. 3.3: Improve communication within the organization with tribes, urban Indian organizations, and other stakeholders, and with the general public. 16

Supplemental Funding IDC Rates Update 17

Supplemental Funds and IDC Rates At the Contract Support Cost Advisory Group meeting on January 28, we discussed supplemental funding and IDC Rates with representatives from the Interior Business Center. OMB was unable to join, and IHS will relay key questions from the conversation to OMB. Key Question for OMB: Is there a plan to address IDC rates for supplemental funding beyond the CARES Act? Goal 3: Management and Operations, Obj. 3.3: Improve communication within the organization with tribes, urban Indian organizations, and other stakeholders, and with the general public. 18

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