The Ponca Tribe operates the Fred LeRoy Health and Wellness Center in Omaha, Nebraska. Photo by Kevin Abourezk

Health | National | Politics

Shutdown ends but the battle for Indian health care funding continues

Tuesday, January 23, 2018

Special Diabetes Program for Indians runs out of money in March

Short-lived shutdown speaks to bigger funding issues
By Kevin Abourezk
@Kevin_Abourezk

The recent federal government shutdown exposed shortcomings within the Indian health care system, including the vulnerability of tribal health care programs to such shutdowns.

But the ending of the shutdown on Monday doesn’t mean the fight is over for those concerned about Indian health care, particularly regarding the fate of a federal program designed to help Native Americans suffering from diabetes and regarding funding for urban Indian health care facilities.

When Congress failed to pass the continuing resolution needed to keep the government running, federal health officials decided to keep funding flowing to Indian Health Service facilities. However, they decided to withhold funding for tribal health care programs, meaning tribes that operate their own health facilities through contracts with IHS weren’t funded during the shutdown.

Most tribal health programs likely had enough reserve funding to remain operational during the shutdown, including the Ponca Tribe’s two clinics in Omaha and Norfolk, Nebraska.

Larry Voegele (left), CEO of the Fred LeRoy Health and Wellness Center in Omaha, Nebraska, and Larry Wright Jr., chairman of the Ponca Tribe, stand together inside the clinic. Photo by Kevin Abourezk

Larry Voegele, CEO of the tribe’s health department, said the tribe had enough reserve funding, primarily built up through collection of insurance payments, to keep its health care facilities open.

“It’s not a terrible situation for us,” he said, shortly before the end of the shutdown. “I suppose if the shutdown went a really long time and it drained those resources we would possibly have to make some hard decisions, but we’re not anywhere near that point.”

The National Indian Health Board sounded the alarm prior to the government shutdown, saying tribal health care was facing funding delays until a new continuing resolution or a budget bill was passed.

The Senate and House of Representatives passed the continuing resolution Monday before President Donald Trump signed it into law. The continuing resolution will keep the government funded until at least February 8.

After the shutdown began Friday at midnight, hundreds of thousands of federal employees were furloughed. The U.S. Department of Health and Human Services issued a shutdown contingency plan, describing what health programs would continue to receive funding.

Voegele said the Ponca Tribe currently operates all aspects of its health programs, except for the internet technology needed to run those programs. He said the tribe briefly discussed what might happen if the shutdown had lasted for several months and eventually depleted its health funding reserves.

“Even if we ran out of that, we could get a loan to help cover these expenses in the meantime,” he said.

He said the shutdown likely won’t have any lasting impacts on the tribe, considering the Poncas should be able to get reimbursed for the expenses it incurred during the shutdown by claiming those costs as allowable expenses under its federal contract.

Voegele said he is more concerned about the fate of the tribe’s diabetes program after Congressional leaders failed to include funding for the Special Diabetes Program for Indians in the continuing resolution that was approved Monday.

American Indian (AI) and Alaska Native (AN) adults suffer from the highest rates of diabetes in the United States. Source: Centers for Disease Control and Prevention

The Ponca Tribe’s diabetes program is funded through the federal Special Diabetes Program for Indians, as are most tribal diabetes programs.

Voegele said the Ponca Tribe’s program employs a full-time dietician and a registered nurse/case manager. They help the tribe’s patients manage their diabetes through medical nutrition therapy and case management services.

They also work to ensure the tribe’s other health providers are working to help their patients who suffer from diabetes better manage their disease.

“I know they’re nervous about whether or not they’ll have jobs,” he said of the program’s two employees.

He said he’s hopeful the tribe could continue to fund the program should it fail to be funded. If Congress doesn’t approve funding for it, the Special Diabetes Program for Indians is set to run out of money on March 31. However, that likely would require the tribe to divert funding to the program from funds now set aside for other services, Voegele said.

He said the program is one of the many ways the Ponca Tribe serves its patients beyond the exam rooms of its two clinics. “It’s something that our staff has a lot of experience doing and I hope we can continue to provide these kinds of services,” he said.

Congressional leaders from New Mexico are seeking to make other improvements to Indian health care.

In November, Sen. Tom Udall and Rep. Ben Ray Luján – both Democrats – introduced legislation in both houses of Congress seeking to increase funding for urban Indian health care programs. S.240, the Urban Indian Health Parity Act, would ensure urban Indian health facilities receive the same reimbursement rates for Medicaid patients as IHS- and tribally run facilities.

Currently, IHS- and tribally run facilities receive higher reimbursement rates for Medicaid patients.

"The federal government has a treaty responsibility to ensure every Native American has access to quality, affordable health care — whether they live in an urban community like Albuquerque or Farmington or on a reservation," Udall, who introduced S.240, said in a news release. "This legislation is a common-sense measure to ensure parity between IHS facilities so Native Americans on and off the reservation have access to the care they need."

Luján introduced H.R.4443, the House version of the bill.