The Indian Health Care Improvement Act (IHCIA) is up for reauthorization. Despite intensive efforts by tribal advocates and Congressional sponsors last year, Congress did not succeed in passing legislation. This year, tribal advocates are hard at work again to move the legislation through Congress. Some of the difficulty last year stemmed from failed negotiations with the Bush Administration to reach agreement on changes they were proposing. This year, tribal and Congressional advocates are initiating conversations to resolve these sticking points and move the legislation ahead. Tribal advocates have said that they will only support changes that do not regress current law. New legislation has not been introduced this Congress and likely won’t until after differences between the Bush Administration and tribal advocates can be resolved.
The National Indian Child Welfare Association in cooperation with the National Indian Health Board, Northwest Portland Area Indian Health Board, and the National Steering Committee on Reauthorization of the Indian Health Care Improvement Act, have joined together to support language for the last two years that would improve Indian children’s access to mental health services. The language encourages Indian Health Service to further utilize the systems of care principles for developing children’s mental health services and to leverage new opportunities for funding under other federal agencies that offer grants to programs using these principles. The systems of care principles are currently operating in 30 tribal and urban Indian communities and are expanding to new tribal communities each year. The principles emphasize culturally competent and community-based services that focus on the specific needs of children and their families. Tribes have found the program to be a good fit where they have been funded to develop the service system, but the opportunities to receive funding under this program need to be expanded for other tribes to be included. An example of the legislative language being proposed and the place where the language would be inserted in last years Senate bill, S.556, appears below (text in bold is proposed language):
1) Section 703(a)(1): IN GENERAL.-The Secretary, acting through the Service, Indian Tribes, and Tribal Organizations consistent with section 701, shall provide a program of comprehensive behavioral health, prevention, treatment, and aftercare, including Systems of Care and Traditional Health Care Practices, which shall include-
2) Section 707(c)(1): IN GENERAL-The Secretary, acting through the Service, Indian Tribes, and Tribal Organizations, may provide intermediate behavioral health services, which may incorporate Systems of Care and Traditional Health Care Practices, to Indian children and adolescents, including-
3) 707(c)(2)(E): “for intensive home- and community-based services, including collaborative systems of care.
4) Section 709(c)(3): “(3) community-based and multidisciplinary strategies, including Systems of Care, for preventing and treating behavioral health problems.
5) Section 714: (10) SYSTEMS OF CARE.-The term ‘Systems of Care’ means a system for delivering services to children and their families that is child-centered, family focused and family driven, community-based and culturally competent and responsive to the needs of the children and families being served. The system of care values prevention and early identification, smooth transitions for children and families, child and family participation and advocacy, comprehensive array of services, individualized service planning, services in the least restrictive environment and integrated services with coordinated planning across the child-serving systems.
An oversight hearing on Indian health was held by the Senate Committee on Indian Affairs on April 13, 2005. The purpose of this hearing was to discuss the overall health status of Indian communities and to lay the groundwork for the IHCIA reauthorization. Testimony provided by the National Indian Health Board included the recommended children’s mental health language listed above.
Additionally, the National Steering Committee is holding a meeting on IHCIA reauthorization in Albuquerque, New Mexico, on April 28, 2005. The purpose of the national meeting is to provide an update on the status of efforts to reauthorize the Indian Health Care Improvement Act, as well as to provide a forum for tribal officials to discuss any issues pertaining to the Indian Health Care Improvement Act. Elected tribal leaders, their representatives, and tribal advocates are encouraged to attend.
For
more information on any of the issues discussed here, please contact either
David Simmons or Chey Clifford-Stoltenberg at (503) 222-4044 or e-mail desimmons@nicwa.org or chey@nicwa.org.