U.S. GOVERNMENT PUBLISHING OFFICE

33–404 PDF WASHINGTON : 2018

S. HRG. 115–402 

THE PRESIDENT’S FISCAL YEAR 2019 BUDGET 

REQUESTS FOR INDIAN PROGRAMS 

HEARING 

BEFORE THE

COMMITTEE ON INDIAN AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED FIFTEENTH CONGRESS 

SECOND SESSION 

APRIL 11, 2018 

Printed for the use of the Committee on Indian Affairs 

( 

(II) 

COMMITTEE ON INDIAN AFFAIRS 

JOHN HOEVEN, North Dakota, Chairman 

TOM UDALL, New Mexico, Vice Chairman 

JOHN BARRASSO, Wyoming 

JOHN MCCAIN, Arizona 

LISA MURKOWSKI, Alaska 

JAMES LANKFORD, Oklahoma 

STEVE DAINES, Montana 

MIKE CRAPO, Idaho 

JERRY MORAN, Kansas 

MARIA CANTWELL, Washington 

JON TESTER, Montana, 

BRIAN SCHATZ, Hawaii 

HEIDI HEITKAMP, North Dakota 

CATHERINE CORTEZ MASTO, Nevada 

TINA SMITH, Minnesota 

T. MICHAEL ANDREWS, Majority Staff Director and Chief Counsel 

JENNIFER ROMERO, Minority Staff Director and Chief Counsel 

(III) 

C O N T E N T S 

Page 

Hearing held on April 11, 2018 .............................................................................. 1 

Statement of Senator Cortez Masto ....................................................................... 41 

Statement of Senator Daines .................................................................................. 43 

Statement of Senator Heitkamp ............................................................................. 35 

Statement of Senator Hoeven ................................................................................. 1 

Statement of Senator Murkowski ........................................................................... 3 

Statement of Senator Smith ................................................................................... 37 

Statement of Senator Udall .................................................................................... 2 

WITNESSES

McGhee, Hon. Robert, Vice President, United South and Eastern Tribes ......... 22 

Prepared statement .......................................................................................... 24 

Payment, Hon. Aaron, Vice President, National Congress of American Indians 

(NCAI) ................................................................................................................... 12 

Prepared statement .......................................................................................... 14 

Tahsuda, John, Principal Deputy Assistant Secretary—Indian Affairs, U.S. 

Department of the Interior .................................................................................. 4 

Prepared statement .......................................................................................... 5 

Weahkee, Rear Admiral Michael, Acting Director, Indian Health Service, 

U.S. Department of Health and Human Services ............................................. 8 

Prepared statement .......................................................................................... 9 

APPENDIX

Herrera, Hon. Dwayne, Governor, Pueblo de Cochiti. letter ................................ 62 

James, Chris, President/CEO, National Center for American Indian Enterprise Development, prepared statement ............................................................ 54 

National Indian Health Board (NIHB), prepared statement ............................... 57 

Response to written questions submitted by Hon. John McCain to John 

Tahsuda ................................................................................................................ 65 

Response to written questions submitted by Hon. Tom Udall to RADM Michael Weahkee ...................................................................................................... 64 

Rose, Ahniwake, Executive Director, National Indian Education Association 

(NIEA), prepared statement ................................................................................ 49 

Santo Domingo Tribal Council—Resolution No: 04–2018–15 .............................. 64 

Written questions submitted by Hon. Tom Udall to: 

Hon. Robert McGhee ........................................................................................ 69 

Hon. Aaron Payment ........................................................................................ 67 

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THE PRESIDENT’S FISCAL YEAR 2019 BUDGET 

REQUESTS FOR INDIAN PROGRAMS 

WEDNESDAY, APRIL 11, 2018 

U.S. SENATE, COMMITTEE ON INDIAN AFFAIRS, Washington, DC. 

The Committee met, pursuant to notice, at 3:00 p.m. in room 

628, Dirksen Senate Office Building, Hon. John Hoeven, 

Chairman of the Committee, presiding. 

OPENING STATEMENT OF HON. JOHN HOEVEN, 

U.S. SENATOR FROM NORTH DAKOTA 

The CHAIRMAN. I call this oversight hearing on the President’s 

Fiscal Year 2019 budget to order. 

Today the Committee will receive testimony on the President’s 

Fiscal Year 2019 budget request for Indian programs. On February 

12th of this year, Congress received the President’s Fiscal Year 

2019 budget request. This oversight hearing provides an opportunity to receive important feedback on funding requests for Indian 

programs. 

The President’s budget outlines the Administration’s plan to 

build a safer and more prosperous Nation. As we consider the 

President’s proposal, we must keep in mind both our Nation’s fiscal 

state and the Federal Government’s trust responsibility to Native 

Americans. 

Last month, the Committee held briefings with Federal agencies 

and tribal organizations to discuss the President’s budget. From 

these briefings, two points were clear. First, as a Nation, we have 

to do a better job of living within our means, and we must use 

every taxpayer dollar responsibly and effectively. Second, we must 

balance the fiscal state of our Nation with the Federal Government’s trust responsibility to Indian tribes, which includes funding 

key programs and services for Native communities. 

There were several positive recommendations put forth in the 

President’s budget. The President’s budget request included modest 

increases for some critical Indian programs, such as an increase in 

funds for health care and the repair and renovation of Bureau of 

Indian Education schools. However, there were also proposed cuts 

to other public safety, education and social services programs. 

As we think through the current state of tribal communities 

across our Nation, we must be mindful of our national debt and 

deficit as well as the needs of tribes. Additionally, we must discuss 

how we can make more effective and efficient use of Federal dollars 

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in Indian Country. To that end today, we will hear from two key 

Federal agencies and two tribal organizations regrading the President’s budget request. 

I want to thank our witnesses for being here today with us. I am 

looking forward to hearing your testimony. 

Before we turn to our witnesses, I want to recognize the Vice 

Chairman for his opening statement. 

STATEMENT OF HON. TOM UDALL, 

U.S. SENATOR FROM NEW MEXICO 

Senator UDALL. Thank you so much, Chairman Hoeven. I really 

appreciate your calling this oversight hearing to discuss the Administration’s budget proposal for fiscal year 2019. 

It is also a timely hearing in light of Congress’ recently-enacted 

Omnibus Appropriations Bill for fiscal year 2018. The Omnibus is 

a step in the right direction toward the Federal Government fulfilling its trust and treaty obligations to Indian Country. Unfortunately, the same can’t be said of the Administration’s fiscal year 

2019 budget proposal. 

The Administration’s rhetoric about respecting tribal sovereignty 

and investing in Indian Country simply does not align with this 

budget proposal. As the head of the Office of Management and 

Budget said recently, the Administration’s budget proposal is only 

a ‘‘messaging document.’’ If that is the case, the Administration 

sent a very concerning message about its priorities for Indian 

Country in fiscal year 2019. 

It is totally inadequate, an insult to Indian Country with sweeping, irrational cuts to tribal programs in an effort to reduce the 

Federal Government. Particularly when programs within DOI and 

HHS, programs that Indian Country specifically sought increases 

for, were instead targeted for cuts. As you can see from this chart 

right here behind me, this Administration proposed gutting all of 

the programs that Indian Country identified as a priority. 

For example, the President’s budget would eliminate the BIA 

Housing Improvement Program. As everyone can see from this 

photo, HIP dollars can have a huge impact in Indian Country. As 

Admiral Weahkee can attest, the housing needs at Zuni, where this 

photo was taken, are tremendous. The photo shows just how far 

HIP dollars can go to provide folks a place to call home. In this 

case, for an elderly Carla Alahuapo. 

HIP and many other BIA programs are pillars of the Federal 

Government’s trust and treaty obligations. But yet again, they 

would be either significantly reduced or eliminated entirely. Infrastructure grant programs in Indian Country also take a hit, like 

the Indian Community Development Block Grant that Pueblos, including Santa Clara and Acoma use for elderly housing needs. Not 

to mention BIE and IHS construction backlogs, which at the Administration’s proposed funding levels would take centuries to address. 

As you can see from these photos, infrastructure needs in New 

Mexico’s tribal communities are very real. These are but a few examples of Indian Country’s overall need. Although the President 

has made law and order a cornerstone of his political message, this 

budget would undermine public safety in Indian Country. Court 

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systems and an effective police force go to the core of self-governance. Yet these programs don’t escape this Administration’s cuts either. Program cuts mean less money for housing block grants, less 

money for hospitals and schools, less money for roads, less money 

for managing Indian Country’s natural resources, all critically important for economic development in Indian Country. 

I am proud that Senator Murkowski and I, along with other appropriators, Senator Hoeven is included in there, put together a responsible omnibus for Fiscal Year 2018 that acknowledges and respects tribal priorities. We increased funding for IHS by half a billion dollars and increased funding for the BIA and BIE by another 

$204 million. These are important steps toward funding levels that 

meet our solemn obligations to Indian Country. 

Thank you to our tribal witnesses for being here today. And 

thank you to the Administration for appearing here. I am glad the 

Administration will have the opportunity to hear directly from tribal representatives at this hearing. Thank you very much, Mr. 

Chairman. 

The CHAIRMAN. Are there other opening statements? Yes, Senator Murkowski. 

STATEMENT OF HON. LISA MURKOWSKI, 

U.S. SENATOR FROM ALASKA 

Senator MURKOWSKI. Just very, very briefly. I appreciate the opportunity to highlight a couple of things where I think we have acknowledgement that there are some things that we entirely disagree with, with this proposed budget, but that there are some 

areas that I think we see some increases that I think are promising. 

I do have some issue with some of the proposals that the Administration has chosen to zero out. Many of our Alaskan tribes depend on programs like the Small and Needy Tribes funding, very, 

very important. Tribal Climate Resilience, you talk to my communities out in places like Kivalina or Shishmaref, those are very important. The Housing Improvement Program, the HIP program, 

critically, critically important for us. Johnson O’Malley, I think we 

also see some major deductions in social services programs that we 

have spent a lot of time coordinating with the agencies and the 

tribes to develop the most helpful and most effective social services 

programs. So I am going to be looking to those to make sure that 

we have appropriate funding. 

There are some areas that I do think I can certainly get behind. 

One is a proposal for a 5 percent set-aside for tribes from the 

Crime Victims Fund to provide services to crime victims. I think 

that is very important. Many say we need more than that. I agree 

with that, but I think that at least puts us going in the right direction. 

I do think we see the Administration placing its support with the 

need to increase the IHS. Again, in no way is it enough, and certainly the Vice Chairman here and my ranking member on Interior 

Appropriations, we know it is not enough. But again, the trend is 

in a much better direction. So we are going to look again to make 

sure that we do right in these accounts. 

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One last area that I do have some concerns with is shifting the 

funding for the special, the diabetes program, the SDPI from mandatory to discretionary, especially when we are hearing from so 

many of our tribes the need to support mandatory funding for IHS 

programs. So I am going to ask for additional clarification from 

IHS on this proposal and why they are advocating that change. 

But I thank those from the agencies today, and again our tribal 

representatives. We have to get moving, as we start moving on the 

appropriations side of things. So this hearing kicks it off, right off 

the bat. So I appreciate the testimony and I appreciate the Chairman and the Ranking Member. 

The CHAIRMAN. Are there other opening statements? If not, then 

we will hear from our witnesses. Our witnesses today are Mr. John 

Tahsuda, Principal Deputy Assistant Secretary for Indian Affairs, 

U.S. Department of the Interior; Rear Admiral Michael Weahkee, 

Acting Director, Indian Health Service, U.S. Department of Health 

and Human Services, Rockville, Maryland; the Honorable Aaron 

Payment, Vice President, National Congress of American Indians, 

Washington, D.C.; and the Honorable Robert McGhee, Vice President, United South and Eastern Tribes, Nashville, Tennessee. 

I want to remind the witnesses that your full written testimony 

will be made part of the official record. So if you could, please keep 

your statement to no more than five minutes, so that members 

have time for questions. And then we will proceed with Mr. 

Tahsuda. 

STATEMENT OF JOHN TAHSUDA, PRINCIPAL DEPUTY 

ASSISTANT SECRETARY—INDIAN AFFAIRS, U.S. 

DEPARTMENT OF THE INTERIOR 

Mr. TAHSUDA. Good afternoon, Chairman Hoeven, Vice Chairman 

Udall, members of the Committee. 

Thank you for the opportunity to discuss the President’s 2019 

budget request for Indian Affairs. I am John Tahsuda, the Principal Deputy Assistant Secretary for Indian Affairs at the Department of the Interior. 

The 2019 budget supports the Administration’s commitment to 

empower tribal communities. This includes focusing on improving 

quality of life, creating educational and economic opportunities, 

promoting efficient and effective governance, preserving and fostering cultural heritage and being a steward of natural resources. 

Indian Affairs plays an important role in carrying out the Federal trust, treaty and other responsibilities to 573 federally-recognized tribes. We serve more than 2 million American Indian and 

Alaska Natives in tribal and Native communities. Interior’s programs maintain strong and productive government-to-government 

relationships with Native communities, helping to promote tribal 

nation-building and self-determination. 

The 2019 budget reflects investments in important programs 

such as education, infrastructure and law enforcement. A major 

component of the 2019 budget is a focus on infrastructure. The 

Public Lands Infrastructure Fund legislative proposal will provide 

up to $18 billion to address Interior’s deferred maintenance backlog 

in Bureau of Indian Education funded schools as well as national 

parks and wildlife refuges. 

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Although many of the schools in the BIE system are operated by 

tribes, the BIE is still responsible for the oversight and maintenance of these school facilities. The estimated deferred maintenance backlog for BIE schools is $634 million, which does not include the cost of replacement for the schools in the worst condition. 

This is why the Bureau and the Department support this proposal 

and look forward to engaging further with Congress on this important issue. 

The budget also promotes tribal self-determination by supporting 

tribal government activities. This includes providing initial Federal 

support for the six Virginia tribes federally recognized by an act of 

Congress in January of this year, as well as fully supporting contract support costs. In addition to support of the Administration’s 

domestic energy dominance and economic development goals, the 

2019 budget request funds the community and economic development activity at $35.8 million and features investments in Indian 

energy activities, including resource management on tribal lands. 

Lastly, the 2019 budget focuses on protecting Indian Country. An 

additional $2.5 million for public safety and justice activities is specifically intended to address the opioid crisis, a top priority for the 

Administration. Funding will provide for the hiring of 17 additional 

drug enforcement officers, who will be instrumental in addressing 

this rising epidemic in Indian communities directly, and will allow 

us to strengthen the Indian Country presence within Federal drug 

task efforts, to keep drugs from entering reservation areas to begin 

with. 

In conclusion, the 2019 budget request maintains strong and 

meaningful relationships with Native communities and strengthens 

government-to-government relationships with federally-recognized 

tribes. The request delivers community services, restores tribal 

homelands, fulfills commitments related to water and other resource rights, executes fiduciary trust responsibilities, supports the 

stewardship of energy and other natural resources, creates economic opportunity and expands access to education. 

Thank you for the opportunity to appear before you today. I am 

happy to answer any questions the Committee may have. 

[The prepared statement of Mr. Tahsuda follows:] 

PREPARED STATEMENT OF JOHN TAHSUDA, PRINCIPAL DEPUTY ASSISTANT

SECRETARY—INDIAN AFFAIRS, U.S. DEPARTMENT OF THE INTERIOR

Good afternoon Chairman Hoeven, Vice Chairman Udall, and members of the 

Committee. Thank you for the opportunity to provide a statement on behalf of the 

Department of the Interior on the President’s Budget Request for Fiscal Year 2019, 

presented to Congress on February 5, 2018. The 2019 Budget Request for Indian 

Affairs is $2.4 billion. 

The Department of the Interior upholds the Federal Government’s unique trust 

responsibilities by fostering government-to-government relationships between the 

Federal government and federally recognized Tribes, American Indians, and Alaska 

Natives. The 2019 budget addresses Federal responsibilities and tribal needs related 

to education, social services, infrastructure, and stewardship of land, water, and 

other natural resources. The budget prioritizes support for programs that serve the 

broadest service population rather than initiatives that are more narrowly focused. 

The President’s budget maintains the Administration’s strong support for the principle of tribal self-determination and efforts to strengthen tribal communities across 

Indian Country. The budget calls for full funding for Contract Support Costs and 

Tribal Grant Support Costs which Tribes incur from managing Federal Indian programs. 

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As the Principal Deputy Assistant Secretary for Indian Affairs, I have the responsibility to oversee the numerous programs within the Bureau of Indian Affairs and 

the Bureau of Indian Education, along with other programs within the immediate 

Office of the Assistant Secretary for Indian Affairs. Indian Affairs plays an important role in carrying out Federal trust, treaty, and other responsibilities to 573 federally recognized Indian Tribes. Our programs serve more than two million American Indians and Alaska Natives in tribal and native communities. The BIA provides direct services and funding for compacts and contracts for Tribes to deliver 

Federal programs for a wide range of activities necessary for community development including natural resource management, law enforcement, and social service 

programs, among many others in Indian Country. The BIE manages a school system 

with 169 elementary and secondary schools and 14 dormitories providing educational services to 47,000 individual students in 23 States and supports 33 BIEfunded tribal colleges and universities. Indian Affairs’ programs are built on strong 

and productive government-to-government relations with Tribes. 

Infrastructure Investment 

Public Lands Infrastructure Fund—Roughly 47,000 American Indian students and 

their families rely on Interior to deliver a quality education in a safe environment, 

but many of our schools are in poor condition. Some schools have structural issues, 

lack basic features like functional doors and windows, or are infested with mold. 

A major component of the 2019 budget is the Public Lands Infrastructure Fund legislative proposal, which will provide up to $18 billion to address Interior’s deferred maintenance backlog in Bureau of Indian Education-funded schools, as well 

as national parks and national wildlife refuges. Although many of the schools in the 

BIE system are operated by Tribes, BIE is still responsible for oversight and the 

maintenance of the school facilities. The estimated deferred maintenance backlog for 

BIE schools is $634 million, which does not include the cost of replacement for the 

schools in the worst condition. 

The Department is taking action to increase revenue from Federal energy leasing 

and development over 2018 budget projections and will keep 50 percent of additional 

revenue that is not allocated for other purposes, for Department infrastructure 

needs. The proposal complements the President’s national infrastructure investment 

initiative and recognizes the strategic importance of long-term investment in America’s treasures. This is why the Bureau and the Department strongly support this 

proposal and look forward to engaging further with the Congress on it. 

Construction—The 2019 request proposes $133.3 million in new funding for Bureau of Indian Affairs Construction activities. The request also assumes the cancellation of $21.4 million in prior year unobligated balances, for a net request of 

$111.9 million. The proposed budget includes $28.3 million for dam safety and maintenance, $6.5 million for irrigation projects, $72.9 million for Education Construction, $10.4 million for Public Safety and Justice projects, and $12.0 million for facilities improvements related to regional and agency offices serving tribal programs operations in Indian Country including construction program management. 

Indian Country Roads—The BIA maintains nearly 29,000 miles of paved, gravel 

and earth surface roads; and more than 900 bridges. The 2019 budget request includes a $28.3 million infrastructure investment in Road Maintenance. 

Promote Tribal Self-Determination 

The 2019 proposed budget provides $291.5 million for programs that support Trib- al Government activities. Within this, the request includes $157.8 million for selfgovernance compact activities for self-governance tribes and $72.6 million to support 

Consolidated Tribal Government Programs for tribes operating under P.L. 93–638 

contracts. 

New Tribes Funding—The budget requests $1.1 million to support new tribes. This includes $960,000 to provide initial Federal support for six Virginia Tribes federally recognized by an Act of Congress in January 2018. 

Contract Support Costs—The 2019 requested funding for Contract Support Costs is $231.0 million. The request fully supports estimated needs assuming BIA program funding at the 2019 request. The 2019 budget continues to request funding 

for CSC in a separate indefinite appropriations account to ensure full funding for 

this priority. 

Tribal Grant Support Costs—The 2019 request includes $74.0 million to fully fund 

estimated Tribal Grant Support Costs for tribes which choose to operate BIE-funded 

schools. 

Protect Indian Country 

Public Safety Programs—The 2019 budget includes a request of $350.1 million for 

Public Safety and Justice Activities, of which $326.6 million directly supports 190 

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law enforcement programs and 96 corrections programs run both by Tribes and by 

the BIA as direct services. The request also includes $22.1 million for Tribal Courts 

and $1.4 million for fire protection activities. 

Within this request is an increase of $2.5 million to address the opioid crisis in 

Indian country. Funding will provide for the hiring of 17 additional drug enforcement officers who will be instrumental in addressing the rising epidemic in Indian 

communities directly and will allow us to strengthen the Indian Country presence 

within Federal drug task force efforts to keep drugs from entering reservation areas 

to begin with. 

Support Indian Communities 

Support Economic Opportunities—In support of the Administration’s domestic energy dominance and economic development goals, the 2019 budget request funds the 

Community and Economic Development activity at $35.8 million and features investments in Indian energy activities, including resource management on tribal 

lands. 

Indian Guaranteed Loan Program—The 2019 budget request for the Indian Guaranteed Loan Program is $6.7 million which will guarantee or insure $108.6 million 

in loan principal to support Indian economic development. 

Human Services Programs—Sustaining families is critical to fostering thriving Indian communities. The Human Services activity request includes $115.4 million for 

programs providing social services which includes $65.8 million for Welfare Assistance, and $46.6 million for Socials Service and Indian Child Welfare Act protections. 

Manage Trust Resources and Lands 

Natural Resource Programs—The 2019 budget request proposes $153.4 million for 

natural resource management programs which include agriculture, forestry, water 

resources, and fish, wildlife and parks activities. 

The BIA helps to support the management of Indian forest lands by 300 Tribes 

across 18.7 million acres. The budget request includes $48.9 million for Forestry 

programs to support development, maintenance, and enhancement of forest resources in accordance with sustained yield principles included in forest management 

plans. The proposed budget includes $28.0 million for BIA’s Agricultural and Range 

program to continue support for multiple use and sustained yield management on 

over 46 million acres of Indian trust land dedicated to crop and livestock agriculture. The request also includes $11.4 million for Fish, Wildlife and Parks and 

$8.6 million for Water Resources management activities. 

Real Estate Services Programs—To meet our fiduciary Trust responsibilities, the 

2019 budget proposes $105.5 million for real estate services programs. The requested funding supports the processing of Indian trust-related documents such as 

land title and records and geospatial data to support land and water resource use, 

energy development, and protection and restoration of ecosystems and important 

lands. The proposed budget includes $11.0 million for probate services to determine 

ownership of Indian trust assets essential to economic development and accurate 

payments to beneficiaries. 

Foster Tribal Student Success 

The BIE serves as a capacity builder and service provider to support Tribes in 

delivering culturally appropriate education with high academic standards to allow 

students across Indian Country to achieve success.. The 2019 budget request includes a total of $741.9 million for BIE programs. Funding includes $625.9 million 

for Elementary and Secondary programs, $92.7 million for Post-Secondary programs, and $23.3 million for Education Management. The budget prioritizes funding 

for core BIE school operations while giving lower priority to activities that do not 

directly support BIE-funded education programs or facilities. 

Land and Water Claims Settlements 

The 2019 budget request prioritizes funding to meet Indian Settlement commitments, and proposes $45.6 million. Interior is committed to honoring enacted Indian 

land and water rights settlements. Settlements often end decades of controversy and 

contention among tribes and neighboring communities. Securing tribal and individual Indian rights to historic land and ensuring permanent access to a clean and 

reliable water supply is important to tribal nationhood, quality of life, economic security, and sustained fundamental cultural values. This request provides sufficient 

funding to complete those payments for the Navajo Trust Fund and the Navajo-Gallup Water Supply Project, both of which have enforceability dates in 2019 for BIA. 

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Conclusion 

This 2019 budget request maintains strong and meaningful relationships with Native communities, strengthens government-to-government relationships with federally recognized tribes, promotes efficient and effective governance, and supports nation-building and self-determination. The request delivers community services, restores tribal homelands, fulfills commitments related to water and other resource 

rights, executes fiduciary trust responsibilities, supports the stewardship of energy 

and other natural resources, creates economic opportunity, and expands access to 

education. 

Thank you for the opportunity to appear before you today. I am happy to answer 

any questions the Committee may have. 

The CHAIRMAN. Rear Admiral Michael Weahkee. 

STATEMENT OF REAR ADMIRAL MICHAEL WEAHKEE, ACTING 

DIRECTOR, INDIAN HEALTH SERVICE, U.S. DEPARTMENT OF 

HEALTH AND HUMAN SERVICES 

Mr. WEAHKEE. Good afternoon, Chairman Hoeven, Vice Chairman Udall and members of the Committee. My name is Michael 

Weahkee, Acting Director of the Indian Health Service. 

I want to thank you for your support and for the opportunity to 

testify on the President’s Fiscal Year 2019 budget. This budget advances our mission to raise the physical, mental, social and spiritual health of American Indians and Alaska Natives to the highest 

level. The IHS provides Federal health services to approximately 

2.2 million American Indians and Alaska Natives from 573 federally-recognized tribes in 37 States. 

The President’s Fiscal Year 2019 budget proposes $5.4 billion in 

totally discretionary budget authority for the Indian Health Service. This is an increase of $413 million above the continuing resolution amount, which was the comparison level at the time that the 

budget request was developed. 

This budget reflects the Administration’s strong commitment to 

Indian Country by protecting direct clinical health care investments. It increases IHS’s discretionary budget authority by 8 percent. In order to prioritize direct clinical health care services, the 

budget proposes to discontinue the Health Education Program and 

the Community Health Representatives Program. The budget request includes $58 million to address accreditation emergencies 

within IHS and to improve quality of care; $955 million for the 

Purchased and Referred Care Program; $80 million for construction 

of two facilities on the health care facility priority list; $159 million 

to staff six new or replacement health care facilities, including 

three joint venture projects; and an estimated $822 million for contract support costs, which remains a separate indefinite appropriation to guarantee full funding. 

The IHS remains committed to addressing behavioral health 

challenges, including high rates of alcohol and substance abuse, 

mental health disorders and suicide in Native communities. The 

proposed budget for these services is $340 million. Further, the 

budget provides $10 billion in new resources across HHS to combat 

the opioid epidemic and serious mental illness. As part of this effort, the budget includes $150 million for IHS grants based on need 

for opioid abuse prevention, treatment and recovery support in Indian Country. 

9 

The Specialty Diabetes Program for Indians is instrumental in 

improving access to diabetes treatment and prevention services in 

Indian communities. Diabetes-related health outcomes have improved significantly. The long-time trend of increasing rates of diabetes ended in 2011, and we have observed a 54 percent decrease 

in new cases of kidney failure due to diabetes among Native adults. 

The budget continues funding for this program at $150 million. 

We are working aggressively to address quality of care issues 

across our system. In spite of ongoing challenges, involving recruitment and retention of providers, aging infrastructure, and rural 

health facilities, today we are able to report progress. The Pine 

Ridge Hospital is back in compliance with a condition of participation for emergency services. The hospital is now in a reasonable assurance period, pending a full survey to determine if it has maintained compliance. 

The Rosebud Indian Hospital satisfied the requirements of the 

systems improvement agreement with CMS in September of 2017 

and we are now awaiting re-survey of that facility as well. We are 

also addressing concerns, Senator Udall, in your back yard, the 

Navajo area, in the Gallup Indian Medical Center, the Joint Commission and CMS surveys found the hospital emergency department out of compliance with standards and conditions of participation. We moved quickly to address the findings and efforts to restore accreditation of all services surveyed by the Joint Commission 

continue. The facility must now undergo a full CMS survey to ensure Medicare program compliance. 

We have achieved progress in the areas of oversight and management of quality. Key accomplishments include credentialing and 

privileging policy and process modernization, development of a 

standardized patient experience survey, establishment of primary 

care patient wait time standards. I am proud of the efforts and the 

commitment of the staff for the progress that has been made thus 

far. We are firmly committed to improving quality, safety and access to health care for American Indians and Alaska Natives. 

We appreciate all of your support and I am happy to answer any 

questions that you might have. Thank you. 

[The prepared statement of Mr. Weahkee follows:] 

PREPARED STATEMENT OF REAR ADMIRAL MICHAEL WEAHKEE, ACTING DIRECTOR, 

INDIAN HEALTH SERVICE, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Good afternoon Chairman Hoeven and members of the Committee. I am Rear Admiral (RADM) Michael D. Weahkee, Acting Director of the Indian Health Service 

(IHS). Thank you for your support and for inviting me to speak with you this afternoon about the President’s Fiscal Year (FY) 2019 Budget Request for the IHS. This 

budget supports and advances our mission to raise the physical, mental, social, and 

spiritual health of American Indians and Alaska Natives to the highest level. 

The IHS, an agency within the Department of Health and Human Services (HHS), 

is responsible for providing federal health services to approximately 2.2 million 

American Indians and Alaska Natives from 573 federally recognized tribes in 37 

states. The IHS system consists of 12 Area offices, which oversee 168 Service Units 

that provide care at the local level. Health services are provided through more than 

850 facilities managed directly by the IHS, by tribes and tribal organizations under 

authorities of the Indian Self-Determination and Education Assistance Act 

(ISDEAA), 41 Urban Indian health organizations, and through services purchased 

from private providers. 

Our budget plays a critical role in providing for a healthier future for American 

Indian and Alaska Native people. Likewise, it helps us maintain the progress we 

10 

have made over the years. The President’s FY 2019 Budget proposes $5.4 billion in 

total discretionary budget authority for IHS, which is $413 million above the FY 

2018 Annualized Continuing Resolution. It also proposes Program Level funding of 

$6.6 billion, which is $263 million above the FY 2018 Annualized Continuing Resolution. 

Prioritizing Clinical Health Care Services 

The IHS provides comprehensive health care, including but not limited to primary 

medical services, dental care, behavioral health services, community health services, 

and public health services such as environmental health and sanitation facilities, 

through a network of 608 hospitals, clinics, and health stations on and near Indian 

reservations. The budget reflects the Administration’s strong commitment to Indian 

Country. Specifically, the budget protects direct clinical health care investments and 

increases IHS’s discretionary budget authority by eight percent. In order to 

prioritize direct clinical health care services and the staffing of newly-constructed 

health care facilities, the budget discontinues the Health Education Program and 

Community Representatives Program. 

The budget requests an increased level of funding to address accreditation issues 

in the IHS system and improve quality of care. An additional $29 million is requested over the FY 2018 Annualized Continuing Resolution level for a total of $58 

million in funding to assist IHS-operated hospitals that are at risk or out of compliance with the Centers for Medicare & Medicaid Services (CMS) Conditions of Participation. These funds will be used to address CMS findings and may be used to 

sustain operations of any affected service unit. 

The budget increases Purchased/Referred Care program funding that is essential 

for ensuring access to care by our patients by providing $955 million, which is $32 

million above the FY 2018 Annualized Continuing Resolution. This program provides critical health care services through contracts with hospitals and other health 

care providers to purchase specialized or critical care when IHS and tribally-managed facilities are unable to provide the services directly. In addition, it supports 

high-cost medical care for catastrophic injuries and specialized care. 

Alcohol and Substance Abuse, Mental Health Disorders, and Suicide 

The IHS remains committed to addressing behavioral health challenges, including 

high rates of alcohol and substance abuse, mental health disorders, and suicide in 

native communities. The proposed budget for these services is $340 million, which 

is $30 million above the FY 2018 Annualized Continuing Resolution. Further, the 

budget provides $10 billion in new resources across HHS to combat the opioid epidemic and address serious mental illness. As part of this effort, the budget includes 

an initial allocation of $150 million for IHS to provide multi-year grants based on 

need for opioid abuse prevention, treatment, and recovery support in Indian Country. 

Special Diabetes Program for Indians 

The Special Diabetes Program for Indians (SDPI) provides grants for evidencebased diabetes treatment and prevention services across Indian Country. These 

funds have been instrumental in improving access to diabetes treatment and prevention services for American Indians and Alaska Natives. Since 1997: 

• 97 percent of American Indians and Alaska Natives have access to diabetes clinical teams, a 67 percent absolute percentage increase. 

• 95 percent of American Indians and Alaska Natives have access to culturally 

tailored diabetes education programs, a 59 percent absolute percentage increase. 

These efforts have had an impact. Diabetes-related health outcomes have improved significantly in Indian communities since the inception of the SDPI. Within 

our communities, the longtime trend of increasing rates of diabetes ended in 2011. 

The diabetes program has proven successful and has contributed to a decline in new 

cases of kidney failure due to diabetes of 54 percent among Native adults from 1996 

to 2013. In addition, there has been an eight percent reduction in the average blood 

sugar level of American Indians and Alaska Natives with diagnosed diabetes between 1997 and 2015. Improved blood sugar control reduces complications from diabetes. 

The SDPI grant program provides funding for diabetes treatment and prevention 

to 301 IHS, tribal, and Urban Indian health programs. To ensure sustained and additional improvements for the health of American Indians and Alaska Natives, the 

FY 2019 Budget continues funding for this essential program at $150 million and 

shifts funding from mandatory to discretionary. Your continued support of these 

11 

funds is saving lives, improving quality of life, and reducing the cost of care across 

Indian Country. 

Health Insurance Reimbursements 

The budget assumes $1.2 billion in estimated health insurance reimbursements 

from third party collections. The collection of health insurance reimbursements for 

the provision of care to patients covered by Medicare, Medicaid, the Veterans Health 

Administration, and private insurance allows IHS and tribally-managed programs 

to meet accreditation and compliance standards. It also allows IHS to expand the 

provision of health care services by funding staff positions, purchasing new medical 

equipment, and maintaining and improving health care facilities. 

Access to Quality Health Care Services through Improved Infrastructure 

The budget proposes $159 million for staffing of newly constructed health care facilities. This funding will support staffing and operating costs for three Joint Venture Construction Program (JVCP) projects: Muskogee (Creek) Nation Health Center, the Cherokee Nation Regional Health Center in Oklahoma, and the YukonKuskokwim Primary Care in Alaska. Through JVCP agreements, IHS has partnered 

with the tribes to provide funds for staffing and facility operations while the tribes 

have invested in the design, construction, and equipment costs associated with the 

new facilities. These funds will allow the new facilities to expand access to health 

care. These funds also provide staffing for new or expanded IHS constructed facilities, 

including Hau’pal (Red Tail Hawk) Health Center in Arizona, the Fort Yuma Health 

Center Replacement, and the Northern California Youth Regional Treatment Center 

in California. 

The Health Care Facilities Construction budget includes funding to continue construction of two facilities on the priority list: the Alamo Health Center in New Mexico and the Dilkon Alternative Rural Health Center in Arizona. A total of $80 million is requested, $38 million below the FY 2018 Annualized Continuing Resolution. 

Supporting Indian Self-Determination 

The budget supports self-determination by continuing the separate indefinite appropriation account for contract support costs (CSC) through FY 2019. Authorized 

and required by the ISDEAA, CSC funding supports certain operational costs of 

tribes and tribal organizations administering health care service programs under 

self-determination contracts and self-governance compacts. The budget includes an 

estimate of $822 million to fully fund CSC, which is $22 million above the FY 2018 

Annualized Continuing Resolution estimate. Maintaining the flexible funding authority of an indefinite appropriation allows the IHS to guarantee full funding of 

CSC, as required by the law, while protecting services funding for direct services 

tribes. 

Quality of Care 

We are working aggressively to address quality of care issues across our system. 

In spite of ongoing challenges involving recruitment and retention of providers, 

aging infrastructure, and rural health facilities, today we are able to report 

progress. 

As a recent example, at the Pine Ridge Hospital, CMS notified us that its survey 

on February 13–15 found the hospital in compliance with the Condition of Participation for Emergency Services. Pine Ridge IHS Hospital is now in a ‘‘Reasonable Assurance’’ period to demonstrate the ability to maintain compliance. The Joint Commission will conduct a full survey with CMS deeming status to determine if Pine 

Ridge IHS Hospital has maintained compliance with all Medicare participation requirements. Pine Ridge IHS Hospital will be readmitted to participate in the Medicare program upon demonstrating full compliance by the second survey. I am proud 

of the efforts and commitment of the staff at Pine Ridge for the progress made thus 

far. We still have more work to do in the Great Plains to honor our commitment 

to American Indians and Native Alaskans, and I am reassured by the recent 

progress we have made. 

At Rosebud Hospital, after satisfying the requirements of the Systems Improvement Agreement with CMS in September 2017, the hospital is preparing for Joint 

Commission accreditation this spring. Our application for survey was submitted to 

the Joint Commission in January, and we look forward to their review. 

We are also addressing concerns in the Navajo Area at Gallup Indian Medical 

Center. Specifically, the concerns derive from a Joint Commission unannounced survey in November 2017 that also triggered a CMS survey in December 2017. The surveys found the hospital Emergency Department out of compliance with the Joint 

Commission standards and CMS Conditions of Participation. We moved quickly to 

12 

address these issues, and the hospital remedied the Joint Commission’s findings. Efforts to restore accreditation of all services surveyed by the Joint Commission continue. The facility also shifted under CMS’s survey authority for Medicare Program 

compliance and will receive a full CMS survey. 

We developed the Quality Framework with tribal input, and brought together people and expertise from across the Department of Health and Human Services to 

focus efforts on improving the quality of care and patient safety. The Quality 

Framework has been a blueprint for system level improvements of processes and infrastructure to improve quality and safety throughout the agency. We have achieved 

remarkable progress in the areas of oversight and management of quality, modernizing credentialing and privileging policy and processes (aided by new, standardized 

software), accreditation master contracts for hospitals and ambulatory health centers, development of a standardized patient experience survey, and the establishment of primary care patient wait time standards. Following a year of implementation of the Quality Framework, IHS is moving toward sustainment of the gains and 

improvements with the development of a five-year strategic plan to enhance quality 

in all aspects of agency operations. 

I especially want to thank the Congress for the funding that has been provided 

for accreditation emergencies. These funds have been critical to giving IHS the flexibility to address quality issues at impacted facilities and to offset lost third-party 

revenue, which is critical to the operating tempo of our facilities. The requested $58 

million will be used to build on the improvements we have made to date. IHS does 

not have another reserve of funding to meet any significant emergency or emergent 

issues, and our existing reserves are simply not designed to meet a challenge of this 

magnitude. 

Despite all of the challenges, we are firmly committed to improving quality, safety, and access to health care for American Indians and Alaska Natives, in collaboration with our partners in HHS, across Indian country, and Congress. We appreciate 

all your efforts in helping us provide the best possible health care services to the 

people we serve to ensure a healthier future for all American Indians and Alaska 

Natives. 

Thank you and I am happy to answer any questions you may have. 

The CHAIRMAN. Thank you, Admiral. 

Mr. Payment? 

STATEMENT OF HON. AARON PAYMENT, VICE PRESIDENT, 

NATIONAL CONGRESS OF AMERICAN INDIANS (NCAI) 

Mr. PAYMENT. Chairman Hoeven, Vice Chair Udall and members 

of the Committee, on behalf of the National Congress of American 

Indians, thank you for holding this hearing on the President’s Fiscal Year 2019 budget for Indian Programs. 

My name is Aaron Payment. I am the Chairperson for the Sioux 

Ste. Marie Tribe of Chippewa Indians and the First Vice President 

for the National Congress of American Indians. Again, thank you 

for your efforts to protect the Federal treaty and trust obligations 

in the budget in a non-partisan way. We are grateful that the draft 

administrative budget is just a starting point, and that Congress 

will have the final say. 

We once again will be counting on you as we seek the restoration 

of proposed cuts to many tribal programs, formula funding rather 

than grants for Department of Justice funding, set-asides for DOJ 

and the Crime Victims Fund, increases for the Census 2020 and 

other funding detailed in our written testimony. When it comes to 

the funding of tribal programs, we seek only those things promised 

and contractually obligated to us by the Constitution, treaties and 

agreements reached between tribal nations and the United States 

when tribal nations conceded to smaller land bases and the Federal 

Government proposed to safeguard our right to govern ourselves 

and to enable our nations to deliver essential services and the reVerDate Mar 15 2010 13:55 Dec 11, 2018 Jkt 033404 PO 00000 Frm 00016 Fmt 6633 Sfmt 6601 S:\DOCS\33404.TXT JACK
13 

sources to do so the honor and integrity of the Federal Government 

depends on upholding these obligations. 

Many of the proposed draconian cuts in the draft budget threaten to limit or abrogate the treaty and trust obligation and is a clear 

retreat from the Federal commitments made to tribes. We support 

proposals that treat tribal governments equitably, such as the proposed tribal set-asides in the Department of Justice. Tribal parity 

should always be the driving principle for every Federal department or initiative, including addressing the opiate epidemic and 

the building and repairing of our infrastructure. 

We are also heartened to see increases requested for the Indian 

Health Service. NCAI, however, was alarmed to see the proposed 

eliminations of the Indian Community Development Block Grant, 

Johnson O’Malley, Low Income Energy Assistance Program, Community Development Financial Institutions, Tribal Energy Loan 

Guarantee and more. We urge Congress to restore these devastating cuts. 

The Administration’s budget includes many drastic cuts. It includes 50 percent cuts to the BIA. This would take us back to the 

2013 sequestration levels and adjusted for inflation, I have a graph 

here, this is lower than the 2003 levels and 21 percent lower than 

the Fiscal Year 2010 levels. NCAI urges Congress to reject the reductions in the BIA’s proposed budget. Instead, we urge the investment in the programs ranked by tribes as the most in need of increases as part of Fiscal Year 2019 tribal budget formulation for 

which tribes from each BIA region outlined their top 10 budget 

items. 

I like that graph that was shown earlier, and I am going to talk 

about it a little bit. The results of this process show that the BIA, 

Social Services and ICWA scholarships and adult education, tribal 

court and aids to government, tribal government made up the top 

five priorities. Unfortunately, most of the programs identified by 

tribes as needing increases would receive reductions or eliminations in the draft budget. The top 15 items identified by tribes 

are proposed to be eliminated. These are scholarships, adult education, JOM, Housing Improvement Program, Small and Needy 

Tribes. Social Services and ICWA would be cut by 37 percent and 

27 percent. Both are disproportionately larger than the overall reductions in the Department of Interior. 

Further, BIA public safety programs include proposed underfunding for tribal law enforcement at 20 percent, tribal detention 

at 40 percent and tribal courts at 3 percent of proposed needs. Further, NCAI recommends that DOJ eliminate the competitive grant 

process that pits tribes against each other. We recommend using 

appropriations as a base funding for tribes to determine their own 

priorities. NCAI has long advocated for a 10 percent set-aside in 

OJP funding that would streamline the Federal funding process by 

which tribes receive resources. 

We were grateful to see the 3 percent tribal set-aside out of the 

Crime Victims Fund in the Fiscal Year 2018 Omnibus. We are hoping and looking for at least a 5 percent increase in the 2019 budget. 

Our funding pursuant to our Constitution and treaty and trust 

responsibilities is not welfare. Reparations are based on race, but 

14 

was prepaid by the blood, sweat and tears of our ancestors and the 

millions of acres of land, as memorialized in treaties and contracts 

that pledge health, education and social welfare into perpetuity. 

We look forward to working with this Committee on the Fiscal 

Year 2019 budget as it moves through Congress, to ensure Federal 

commitment made to tribes are honored in the budget. 

Megwich, thank you, and I welcome any questions you might 

have. 

[The prepared statement of Mr. Payment follows:] 

PREPARED STATEMENT OF HON. AARON PAYMENT, VICE PRESIDENT, NATIONAL

CONGRESS OF AMERICAN INDIANS (NCAI) 

On behalf of the National Congress of American Indians (NCAI), thank you for 

holding a hearing on the President’s FY 2019 Budget Request for Indian Programs. 

Overall, NCAI calls for restoration of cuts to many tribal programs, formula funding 

rather than grants for both Justice funding and opioids, a set-aside in the Crime 

Victims Fund, increases for Census 2020, and others listed below in our testimony. 

Federal Commitments Funded in the Budget 

Tribes seek only those things promised to us and every citizen by the Constitution, and the solemn treaties and agreements reached between our tribal nations 

and the United States. At the founding, the United States dealt with our tribal governments as sovereign equals. In exchange for Federal protection and the promise 

of certain benefits our ancestors gave forever to the people of the United States title 

to the very soil of our beloved country. To settle the process for admission of new 

states, the thirteen original states agreed to transfer western land claims to the 

United States under the principles in the Northwest Ordinance, including: 

The utmost good faith shall always be observed towards the Indians; their land 

and property shall never be taken from them without their consent; and, in 

their property, rights, and liberty, they shall never be invaded or disturbed, unless in just and lawful wars authorized by Congress; but laws founded in justice 

and humanity, shall from time to time be made for preventing wrongs being 

done to them, and for preserving peace and friendship with them. 

These provisions signify the intent of the Framers to provide for the governance 

of Indian country, a compact between the original States and all that followed. We 

have never asked anything except that these protections be continued. Many of the 

proposed deep reductions in the President’s Budget threaten to limit this protection 

and these benefits. The proposed budget cuts to tribal governmental services, if enacted, would represent a clear retreat from the federal commitments and treaty 

promises made to tribes. 

The President’s budget would cut the Bureau of Indian Affairs (BIA) by about half 

a billion dollars, or 15 percent. BIA Social Services would be reduced by more than 

a third, Indian Child Welfare by more than a quarter, and critical human services 

programs, law enforcement and courts programs, environmental protection, housing, 

and education programs would face unconscionable reductions. Infrastructure programs, such as the Indian Community Development Block Grant would be eliminated, and the Indian Housing Block Grant and road maintenance would be reduced. 

We support proposals that treat tribal governments equitably, such as the proposed set-asides in the Department of Justice for tribes. Tribal parity should be a 

principle for every other department or initiative as well, including addressing the 

opioid epidemic and building and repairing infrastructure. We are also heartened 

to see increases requested for the Indian Health Service (IHS). 

Throughout our testimony, we call on Congress to uphold the federal government’s trust responsibility to tribal nations. When tribal nations agreed to accept 

a smaller land base, the federal government promised to safeguard our right to govern ourselves and to enable tribal governments to deliver essential services and provide them resources to do so effectively. That is the trust relationship embodied in 

the U.S. Constitution. Congress and the Administration is responsible for carrying 

out that trust in the federal budget. 

15 

Summary of Major Changes 

As Congress has the final say on discretionary spending, NCAI notes the following 

proposals in the President’s budget as significant. Some of the proposed eliminations 

include: 

Eliminations 

• Indian Community Development Block Grant (in Housing and Urban Development) 

• Low Income Home Energy Assistance Program (LIHEAP) 

• Indian and Native American Program (INAP in Department of Labor) 

• Community Development Financial Institutions, Native American program 

(Treasury) 

• Tribal Energy Loan Guarantee Program 

• Eliminations within BIA include: 

—Small and Needy Tribes 

—Housing Improvement Program ($10 million) 

—Tribal Climate Resilience 

—Alaska Native Programs 

—Johnson O’Malley Program ($15 million) 

—Scholarships and Adult education ($35 million) 

NCAI requests that Congress restore these eliminations. When programs are zeroed out in the President’s budget, even if they are eventually restored, holdbacks 

of zeroed out programs cause a disruption of high priority programs throughout Indian Country. 

Major Reductions 

• Native American Housing Block Grant cut from $654 million to $600 million, 

-8.2 percent 

• Bureau of Indian Affairs cut by $433 million, or -15.6 percent 

Major Reductions in BIA include 

—Social Services cut by $19 million, or -37 percent 

—Indian Child Welfare Act cut by $5 million, or -27 percent 

—Welfare Assistance cut by $8.4 million, or -11 percent 

—Rights Protection Implementation cut by $14.7 million, or -37 percent 

—Job Placement and Training cut by $4.4 million, or -35 percent 

NCAI requests that Congress reject these proposed reductions. It is a particular 

concern that some proposed cuts target the programs identified by tribes through 

budget formulation as top ranked programs needing increases. 

Proposed Increases 

• Indian Health Service Clinical Services, increase of $353 million to expand direct health care services. 

• IHS would receive $150 million for Opioid multi-year competitive grants based 

on need; this is out of the $10 billion proposal for opioid funding. 

• In the Department of Justice, the budget proposes: 

—$115 million for Indian tribes through a 5 percent set-aside from the Crime 

Victims Fund for providing services to crime victims. Indian tribes have never 

directly received funding from the Crime Victims Fund; 

—A 7 percent set-aside from across the Office of Justice Programs totaling 

$93.8 million for tribal assistance. 

Bureau of Indian Affairs 

The 2019 President’s budget for Indian Affairs is $2.4 billion in current appropriations, a 15.6 percent decrease from the FY 2018 CR level. Nearly every line item 

in the BIA budget would see reductions in the FY 2019 budget request. One increase would be $2.5 million to fight the opioid epidemic, to ‘‘expand BIA capacity 

to address the increase in drug-related activities through interdiction programs to 

reduce drug use, distribution, and drug related crime.’’ The BIA’s budget provides 

funding for tribal base operations, including social services, education, road maintenance, water resources, forestry, law enforcement, tribal courts, and many other 

core governmental services. 

16 

1 Indian Affairs Fiscal Year 2019 Budget Formulation Guidelines, October 2016, accessible at 

http://www.ncai.org/2019lIAlBudgetlFormulationlGuidel-3-.pdf 

The proposed overall level for BIA/BIE would take funding in nominal dollars 

back to the FY 2013 sequestration levels. However, adjusted for inflation, the proposed funding is lower than any enacted amount going back to FY 2003, and 21 percent lower than the level in FY 2010. 

NCAI urges Congress to reject the steep reductions in the BIA’s proposed budget 

and instead invest in the programs ranked as most in need of increases as a part 

of the FY 2019 tribal budget formulation process. Figure 2 shows the roll up of the 

top 19 preferred programs identified by tribes as part of the Tribal Interior Budget 

Council (TIBC). 1


411a1.eps
17 


411a2.eps

Figure 2: 2019 PRIORITY RANKING RESULTS 

Social Services {TPA} 

Indian Child Welfare Act (ICWA}I (TPA) 

Scholarships and Adult Education (TPA) 

Tribal Courts (TPA) 

Aid to Tribal Government (TPA) 

Criminal Investigations and Pollee Services 

Housing Improvement Program (TPA) 

Johnson O'Malley Assistance Grants (JOM) ... 

Road Maintenance (TPA) 

Detention/Correction~ 

Forestry Program (TPA) 

Wildlife & Parks Program {TPA) 

Water Resources Program (TPA) 

Consolidated Tribal Government Program ... 

Welfare Assistance 

Agriculture Program (TPA} 

EQ Program (TPA) 

Small and Needy Tribes 

Indian Guaranteed loan Progam ·Subsidies 

2 

2 

3 

' 

4 

5 

5 

8 

6 

Figure 3: PROPOSED DECREASES IN FY 2019 

·37% 

·27% 

1. 

2. 

Social Services (TPA) 

Indian Child Welfare Act 

9 

9 

9 

11 

10 

·100% 3. Scholarships and Adult Education 

·27% 

-22% 

3. Tribal Courts (TPA) 

3. Aid to Tribal Government 

6. Crimlnallnv. and Pollee Services 

7. Housing Improvement Prog 

•• Johnson O'Malley 

·6% 8. Road Maintenance (TPA) 

·2% 10. Detention/Correction> 

-3% 10. Forestry Program (TPA) 

-3% 12. Wildlife & Parks Program (TPA) 

·3% 13. Water Resources Program (TPA} 

·3% 13. Consolidated Tribal Government Prog 

15. Welfare A5sistance 

15. Agriculture Program (TPA) 

15. EQ Program (TPA) 

15. small and Needy Tribes 

15. Indian Guaranteed Loan Prog 
18 

2 Bureau of Indian Affairs, Office of Justice Services, Presentation 

November 8–9, 2017 to the Tribal Interior Budget Council http://www.ncai.org/PSJlPresentationlTIBClNovl2017.pptx 3Stoltzfus, E. (2014). Child welfare: An overview of federal programs and their current funding. Washington, DC: Congressional Research Service. Retrieved from http:// 

digitalcommons.ilr.cornell.edu/cgi/viewcontent.cgi?article=2327&context=keylworkplace 

As part of the FY 2019 budget formulation process, tribes from each BIA region 

completed a survey to outline which 10 budget lines they would prefer to provide 

increased funding to and why. The results of this process show that BIA Social 

Services, Indian Child Welfare Act (ICWA), Scholarships and Adult Education, Tribal Courts, an Aid to Tribal Government made up the top five. 

Unfortunately, most of the programs identified by tribes as needing increases in 

FY 2019 would receive reductions in the FY 2019 President’s Budget Request. 

Four programs in the top 15 identified by tribes were proposed to be eliminated 

in the President’s Budget: Scholarships and Adult Education, Housing Improvement 

Program, Johnson O’Malley Program, and Small and Needy Tribes. 

Social Services and ICWA would be cut 37 percent and 27 percent respectively, 

both cuts disproportionately larger than the overall reduction for the Department 

of the Interior, which would see a reduction of 16.8 percent. 

For Public Safety and Justice Programs, Indian Country faces funding shortfalls 

in a number of areas while at the same time facing increased need due to a climbing 

drug trend. The BIA submitted a report to Congress in 2016 estimating that to provide a minimum base level of service to all federally-recognized tribes, $1 billion is 

needed for tribal law enforcement, $1 billion is needed for tribal courts, and $222.8 

million is needed to adequately fund existing detention centers. Based on recent appropriation levels, BIA is generally funding tribal law enforcement at about 20 percent of estimated need, tribal detention at about 40 percent of estimated need, and 

tribal courts at a dismal 3 percent of estimated need. 

The BIA Office of Justice Services (OJS) reports that at the end of 2014 and into 

2015, Indian Country faced a drastic increase in violent crime, partially due to a 

change in Uniform Crime Reporting (UCR) definitions, but also due to increasing 

drug trends. 2 Anytime the drug trend climbs, so does violent crime and property 

crime. In 2016 OJS had an increase in methamphetamine seizures of 106 percent 

over the year before and an increase of opioid seizures of 56 percent. With about 

30 BIA criminal investigators nationwide to address that, the opioid and meth 

trends require a much higher level of staffing to adequately address the issue. NCAI 

recommends an increase in funding for BIA law enforcement and detention of $353 

million for FY 2019. 

Similarly, BIA Social Services help to address the underlying such as drug addiction, poverty, and violence that tend to create and perpetuate the circumstances 

that produce victims. Sub-activities include services in the areas of family and domestic violence, child abuse and neglect, and protective services. However, many 

tribes’ Social Services departments are understaffed and experience high turnover 

rate. As an example, in FY 2017, Osage Nation case workers averaged 25–30 cases 

a month each. This exceeds the standard of one case worker for every 15 cases administered. A lack of increased yearly funding tends to hinder these protective services. 

With child welfare, tribal governments receive approximately one-half of one percent of all federal child welfare funds while their children represent approximately 

2 percent of the United States population under the age of 18 and 4 percent of the 

child welfare population. 3 ICWA funding is the foundation of most tribal child welfare programs. In order for AI/AN children and families to get the best possible services at home and in state systems and allow tribes to assist state agencies and 

courts, adequate funding must be provided to tribal governments to support their 

child welfare programs. At the time that ICWA was passed in 1978, Congress estimated that between $26 million-$62 million would be required to fully fund tribal 

child welfare programs on or near reservations.45 Even after recent increases in FY 

2015, current funding levels fall far short of this estimate—especially after adjusting 

for inflation. 

The need for every other program listed in the Figure 2 has similar levels of 

shortfall. NCAI urges Congress to invest in these areas as well as providing an overall increase to the BIA’s budget to support the base budget for core tribal programs. 

Indian Health Service 

One agency that would receive increases in the President’s budget is the Indian 

Health Service. Indian Health Service (IHS). Overall, IHS would receive $5.4 billion, 

19 

4 NCAI Resolution MKE–17–011, Reclassification of IHS Budget to Mandatory Spending Program, accessible at http://www.ncai.org/resources/resolutions/reclassification-of-ihs-budget-tomandatory-spending-program 5 U.S. Department of Health and Human Services FY 2019 Budget in Brief. 

$413 million over FY 2018 CR and an 8 percent increase over the current FY 2018 

CR. However, the proposal would also cut or eliminate several important programs 

at IHS. To put the request in context, the IHS Tribal Budget Formulation 

Workgroup recommended $6.4 billion in FY 2019. 

A troubling proposal would be to move the Special Diabetes Program for Indians 

(SDPI) from mandatory to discretionary. Congress would provide funding to SDPI 

through the annual appropriations process. This proposal moves in opposite policy 

direction of what tribes have been calling for—to make the entire IHS budget mandatory instead of discretionary. 4

The President’s Budget includes $10 billion to combat the opioid epidemic. IHS 

would receive $150 million ‘‘to provide multi-year competitive grants based on need 

for opioid abuse prevention, treatment, and recovery support in Indian Country.’’ 5

Competitive grants are not the best way to administer this funding, and we instead 

request formula funding. 

While the opioid crisis is plaguing communities across the country, studies indicate that American Indians and Alaska Natives (AI/ANs) are impacted at a higher 

rate than other groups. According to the Centers for Disease Control, the drug overdose death rates for AI/ANs in nonmetropolitan areas increased by more than 500 

percent between 1999 and 2015. In addition, pregnant AI/AN women are nearly 9 

times more likely than others to be diagnosed with opioid dependency or abuse. The 

epidemic has even led several tribal communities to declare public health emergencies. 

Indian Country is resilient and determined to eliminate this deadly crisis from 

our communities. Many tribal nations have invested their own limited resources on 

prevention, treatment, recovery, and public safety. However, Indian Country needs 

Congress to uphold its trust and treaty responsibility. Congress missed a significant 

opportunity when it failed to provide direct funding to tribal communities in the 

21st Century Cures Act. While we work diligently to remedy that situation, Congress has the chance to do the right thing at the outset as it finalizes funding for 

fiscal year 2018. 

Accordingly, it is critical that Congress allocates a portion of the $6 billion for 

combatting the opioid epidemic that was included in the recent budget agreement 

to address the unique needs of Indian Country. NCAI strongly encourages Congress 

to allocate funding directly to tribal communities in order to address this crisis in 

a flexible and culturally relevant manner. 

Department of Justice 

The President’s budget proposal for FY 2019 includes funding for several tribal 

programs at DOJ. Specifically, funding in the bill includes: 

• $115 million for Indian tribes through a 5 percent set-aside from the Crime Victims Fund for providing services to crime victims. Indian tribes have never directly received funding from the Crime Victims Fund; 

• A 7 percent set-aside from across the Office of Justice Programs totaling $93.8 

million for tribal assistance. This compares to a 7 percent set-aside from certain 

OJP and OJJDP programs for FY 17 and is a significant increase in funding 

overall over FY 17 levels; 

• $10 million for Community Oriented Policing Services Tribal Law Enforcement. 

In FY 16, this was funded at $30 million. For FY 17, the Attorney General has 

the discretion to take up to 7 percent from COPS programs overall for tribal 

assistance. The FY 19 budget proposal eliminates the COPS Office and merges 

the program into the Office for Justice Programs (OJP). 

• An estimated $39.25 million for the Office on Violence Against Women’s (OVW) 

Grants to Tribal Governments Program through statutory set-asides from other 

appropriated programs. This is a slight increase over FY17 funding levels. 

• An estimated $6.739 million for OVW’s Tribal Coalitions Program through statutory set-asides from other OVW appropriations. This is a slight decrease from 

FY17 funding levels. 

• An estimated $3.5 million for OVW’s Tribal Sexual Assault Services Program 

through statutory set-asides from other OVW appropriations. This is the same 

level of funding as FY 17. 

20 

• $4 million for implementation of Special Domestic Violence Criminal Jurisdiction. This is the same level of funding as FY 17. 

• $1 million for research on violence against Native women. This is the same level 

of funding as FY 17. 

• $500,000 for the National Indian Country Clearinghouse on Sexual Assault. 

This is the same level of funding as FY 17. 

Tribal Grants across the Department of Justice 

NCAI recommends that DOJ eliminate competitive grant funding process and utilize Justice Department appropriations as base funding where tribes and tribal 

courts themselves determine their own priorities. 

One of the most significant issues with DOJ funding is that it is competitive funding awarded at the discretion of DOJ. In order to obtain this funding, tribes—on 

behalf of their justice systems—must compete against each other under DOJ’s priorities and guidelines. In the end, often the tribes that have the financial and human 

resources to employ experienced grant writers end up receiving funding, while the 

under-resourced tribes may be left without. Moreover, tribes cannot count on funding continuing beyond the current grant period, and Indian Country has numerous 

stories of successful programs disappearing at the end of a two- or three-year grant 

cycle. 

Tribal governments have been asking for reforms to the DOJ grant making process for years in order to reduce administrative inefficiencies, improve program effectiveness, and increase the ability of tribal governments to leverage available DOI 

and DOJ funding to best address the comprehensive public safety and justice needs 

in their communities. Beginning in 2012, Congress has responded to this request 

from tribal leaders by appropriating a fixed amount for ‘‘tribal assistance’’ rather 

than appropriating funds for specifically authorized tribal programs. This approach 

gives DOJ considerable flexibility to work with tribal governments to determine how 

best to administer the appropriated funds. In FY 17, Congress shifted from a lump 

sum for tribal assistance to a percentage set-aside model for the first time, creating 

a 7 percent tribal set-aside from some COPS and OJP programs. Appropriators 

carved out several of the largest appropriation lines from the tribal allocation, however, resulting in an overall tribal funding decrease from FY16 levels. Both the 

House and Senate CJS bills for FY18 that are currently pending include a 7 percent 

tribal allocation from across a wider range of OJP and COPS programs. If enacted, 

this would help restore funding levels for DOJ tribal justice programs to a more appropriate level. 

DOJ is currently engaged in government-to-government consultation with Indian 

tribes about its grant-making process, which we hope will improve the effectiveness 

of DOJ funding in tribal communities. 

OJP Tribal Set-Aside 

A flexible tribal set-aside from across OJP programs would allow for a more flexible funding structure at DOJ. In 2010, the Department of Justice launched its Coordinated Tribal Assistance Solicitation (CTAS). CTAS attempts to streamline the 

grant application process for tribes, enabling them to submit a single application for 

DOJ programs, as opposed to previous years in which they were required to submit 

multiple grant applications. However, this streamlined application model still results in multiple grant awards with separate reporting requirements, award periods, 

and grant managers. CTAS will not achieve its intended purpose of streamlining 

tribal grants until it is accompanied by a streamlined funding mechanism. 

NCAI has been advocating for a 10 percent OJP tribal set-aside that would 

streamline the federal funding process by which tribes receive resources to establish 

tribal courts; assist in developing detention facilities; provide legal assistance; develop and maintain juvenile delinquency prevention programs; and provide substance abuse prevention programs. Further, the tribal set-aside gives tribes the 

flexibility to develop a comprehensive strategy on how best to spend those resources. 

It would also create new possibilities for coordinating BIA and DOJ funding to reduce inefficiencies and unnecessary administrative costs. 

Crime Victims Fund 5 percent set-aside 

The Victims of Crime Act (VOCA) is the largest source of federal funding for crime 

victims. Currently, the Crime Victims Fund (CVF) contains more than $12 billion 

collected as fines and penalties in federal criminal cases. In FY 2015, distributions 

from the Crime Victims Fund were increased more than three times to over $2.3 

billion. In FY 2016 2017, distributions increased again to more than $3 billion. Despite having the highest rates of crime victimization in the country, none of these 

funds are directed to tribal governments. Instead, tribal governments are forced to 

21 

rely on pass-through funding from the states. Over the past five years, states have 

passed-through less than 0.5 percent of available funds. NCAI recommends that 5 

percent of CVF distributions should be directed to tribal governments in order to 

ensure that tribal crime victims are able to access victim services and victim compensation. 

Department of Labor, Employment and Training 

The President’s proposed FY 2019 budget zeroes out funding for the Department 

of Labor’s Division of Indian and Native American Programs (DINAP). DINAP is a 

vital workforce development division specifically dedicated to working with tribal 

nations and Native organizations—specifically Workforce Innovation and Opportunity Act (WIOA) Section 166 grantees—to support the provision of quality employment and training services to unemployed and low-income Native people. As the 

only federal employment and job training program that serves American Indians 

and Alaska Natives who reside both on and off reservations, it is imperative that 

funding be maintained at an adequate level for the WIOA Section 166 program. 

Department of the Treasury 

Of great concern to Indian Country is the President’s proposal to eliminate funding for Community Development Financial Institutions (CDFIs) through the CDFI 

Fund. In FY17, Congress appropriated $15.5 million for the Native American CDFI 

Assistance (NACA) Program, which, according to the Treasury Department, translates to $15.395 million in annualized CR funding for FY18. The President’s FY19 

Request would eliminate funding for the NACA program and the three other discretionary CDFI grant programs. 

The Native Initiative of the CDFI Fund is an important program that expands 

access to capital for individuals and small businesses in Indian Country. The NACA 

program makes awards that assist community development financial institutions 

(CDFIs) in increasing their lending services and financial products, and in building 

their own internal capacity to serve their target markets. Native CDFIs provide a 

wide range of low interest loans to microenterprises, small businesses, consumers, 

and for housing and homeownership. Native CDFIs also offer financial education 

and entrepreneurial development training, homebuyer education and foreclosure 

prevention counseling, credit counseling, small business planning, debt relief counseling, counseling to improve financial capability, match savings programs called Individual Development Accounts, and free tax preparation services in Native communities across the country. NCAI urges Congress to restore the Native American 

CDFI Assistance program and appropriate $16 million for the program in FY 2019. 

Department of Energy 

(Dollars in millions) FY 2017 

Enacted 

FY 2018 

Est. 

FY 2019 

Request 

FY2019 

v. 

FY2017 

Office of Indian Energy Policy and Programs (DA) 18 10 10 -8 

Tribal Indian Energy Loan Guarantee Program 9 9 0 -9 

The Office of Indian Energy Policy and Programs provides technical assistance, 

education and capacity building, and financial assistance to tribal governments. It 

also coordinates activities across the Department, and works with tribes, tribal organizations, and other agencies to promote tribal energy initiatives. In FY19, the Department of Energy would receive $10 million to fund the Office 

of Indian Energy Policy and Programs. This marks a significant budgetary cut of 

$8 million dollars compared to FY2017 levels. An $8 million dollar reduction further 

limits the services and amount of resources available to tribes who are planning energy and infrastructure projects. Limitations on tribal energy development continue 

to be problematic for many tribes due to a lack of access to capital, capacity issues, 

and the complicated legal and regulatory structure governing the use of Indian 

lands. 

The Tribal Indian Energy Loan Guarantee Program, which was authorized by the 

Energy Policy Act of 2005, received an appropriation for the first time in FY17. Congress provided $8.5 million for the loan guarantee and $500,000 for administrative 

expenses. The President’s Request would eliminate funding for this program. 

Census Bureau and the 2020 Census 

The U.S. population is enumerated every 10 years and census data are used to 

allocate Congressional seats, electoral votes, and is the basis for funding allocations 

for federally funded programs. Federal funding for Indian schools, Indian education 

programs, Indian health programs, Indian housing programs, water and sewage 

22 

projects, roads and economic development are based on data collected by the Census 

Bureau every ten (10) years. The allocation of congressional seats across the United 

States are directly tied to data collected by the U.S. Census. Public Law No. 94– 

171 data is used for redistricting at the federal, state, and local levels and an accurate count is necessary to ensure that American Indian and Alaska Native voters 

have an equal voice in the political process of non-tribal elections. 

However, in the 2010 Census, the Census Bureau estimates that American Indians and Alaska Natives living on reservations or in Native villages were undercounted by approximately 4.9 percent, more than double the undercount rate of the 

next closest population group. Additionally, uncertainty about FY 2017 funding levels and lack of appropriations resulted in the Census Bureau canceling planned field 

tests on the Standing Rock Reservation in North and South Dakota and the Colville 

Reservation and Off-Reservation Trust land in Washington State, which eliminated 

critical testing of methods for the 2020 Census for counting people in tribal areas 

lacking street addresses, testing methods of making in-person counts in Native 

households, and determining where and how to use oversampling to counteract the 

undercount facing Native people living on reservations and in Native villages. Inadequate funding has compelled the Census Bureau to announce ‘‘pauses’’ and modifications for key 2020 Census activities, which could greatly diminish the Bureau’s 

ability to take an accurate, cost-effective census and is expected to increase the disproportionate undercount of American Indian and Alaska Natives, especially those 

living in rural, low-income, geographically isolated, and/or linguistically isolated 

households. 

The Census Bureau must have a significant funding ramp-up and receive the 

funding on time for the next two years, to ensure a fair and accurate census—one 

that counts all communities including Indian County. 

To keep 2020 Census preparations on track and preserve other vital Census Bureau data, Congress should allocate $4.735 billion for the U.S. Census Bureau in 

FY2019, which is $933.5 million above the president’s request, but only $475.5 million above the Commerce Department’s own cost estimate for 2020 Census activities. 

Here’s the breakdown of our FY2019 funding recommendation (compared to the 

president’s request): 

• +$912.5 million for 2020 Census preparations and early implementation, for a 

total of $3.928 billion 

• +$21 million to restore vital ongoing economic and demographic surveys to their 

FY2017 funding level of $270 million in the Current Population and Surveys 

account 

Conclusion 

For a nation that bases its greatness to a significant degree on its rule of law, 

treaties and intergovernmental agreements carry paramount importance. We look 

forward to working with this Committee as the FY 2019 budget moves through Congress to ensure federal commitments made to tribes are honored in the FY 2019 

budget. 

The CHAIRMAN. Thank you, Mr. Payment. 

Mr. McGhee? 

STATEMENT OF HON. ROBERT MCGHEE, VICE PRESIDENT, 

UNITED SOUTH AND EASTERN TRIBES 

Mr. MCGHEE. Chairman Hoeven, Vice Chairman Udall and members of the Committee, thank you for the opportunity to testify 

today and for your willingness to conduct an oversight hearing on 

the President’s budget request for Fiscal Year 2019. 

My name is Robert McGhee, Vice President of the Porch Band 

of Creek Indians. I am here today in my capacity as the Vice President of the United South and Eastern Tribes Sovereignty Protection Fund. As is acknowledged by the 100th Congress, the United 

States owes an historical debt to tribal nations. This debt includes 

many injustices that Native people have suffered as a result of 

Federal policy, including Federal actions that sought to terminate 

tribal nations and assimilate Native people. 

23 

It also involves a ceding of our land holding and natural resource, oftentimes by force, to the United States, resulting in perpetual trust obligation to tribal nations. These resources are the 

very foundation of this Nation and have allowed the United States 

to become the wealthiest and the strongest world power in history. 

Federal appropriations to Indian Country are simply a repayment 

on this debt. 

This is not merely a question about addressing poverty or needs. 

Our relationship is more than this. This is ultimately a question 

about honor, about fulfilling commitments and promises. A great 

nation keeps its word. America must fulfill its promise to us in not 

just words, but action. 

While this Administration claims to prioritize Indian Country, 

this budget request reveals otherwise. It proposes deep cuts to the 

Bureau of Indian Affairs, eliminates and makes changes to the Indian Health Service programs without consultation, and a host of 

other eliminations and cuts, both directly and indirectly impacting 

Indian Country. 

Like Senator Udall mentioned, we are being told that this request is just a messaging document, and that if Indian Country 

does not agree with its proposals, we should look to Congress to ensure the trust responsibility is delivered upon. While we understand that only Congress has the power to appropriate funds, the 

Administration is sending a powerful negative message to Indian 

Country. In reducing, eliminating and calling into question the constitutionality of Federal Indian programs, this Administration is ignoring and undermining its trust responsibility to tribal nations. 

This is unacceptable. 

Because of our history and our unique relationship with the 

United States, the trust obligation of the Federal Government to 

Native peoples, as reflected in the Federal budget, is fundamentally different from ordinary discretionary spending and should be 

considered mandatory in nature. Recently, some in Congress have 

called for mandatory funding for IHS. We strongly support this 

proposal, which is more consistent with the Federal trust obligation, and urge that this be expanded to include all Federal Indian 

programs. 

Continued underfunding results in tribal nations having to subsidize greater and greater levels of the trust obligation, a violation 

of our sacred agreement that has persisted, regardless of Administration. We urge this Committee and Congressional appropriators, 

as they have previously, to reject the deep cuts found in this President’s request and work to fund the trust obligation. 

Now I would like to turn to some of the specific comments we 

have on the President’s budget request. Regarding the proposals for 

infrastructure package, it is critical that tribal nations have direct 

access to funding available via any infrastructure package. While 

we acknowledge that the President’s infrastructure plan does state 

that some money will be set aside for tribal nations, additional details remain unclear. The President’s plan also proposes to streamline infrastructure permitting. 

We are concerned that without strong tribal consultation and cultural review requirements, these proposals could serve to underVerDate Mar 15 2010 13:55 Dec 11, 2018 Jkt 033404 PO 00000 Frm 00027 Fmt 6633 Sfmt 6601 S:\DOCS\33404.TXT JACK
24 

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), 

mine tribal sovereignty and the protection of cultural resources and 

public health. 

The request also allocates funding from the BIA budget for the 

reorganization of the Department of Interior. The Secretary has yet 

to significantly consult with or provide much detail to tribal nations on the reorganization of the Department. All that we are 

aware of is meetings held with Federal employees and other units 

of government, as well as draft regional plans. 

The request for Indian Affairs is a 15.6 percent decrease from the 

Fiscal Year 2018 CR and a 20 percent decrease from the Omnibus. 

Nearly every line item in the BIA budget would see reductions. 

However, the Interior’s budget justification describes the request in 

the following way: ‘‘The 2019 budget supports the Administration’s 

commitment to help promote tribal nation-building and self-determination, empower tribal communities, foster tribal self-sufficiency, 

create educational and economic opportunities, ensure safe Indian 

communities, preserve and foster cultural heritage, and steward 

natural resources.’’ From our perspective, it is difficult to see how 

any of this can be true, considering the deep reductions and eliminations found in the request. 

The Fiscal Year 2019 budget request for IHS is 8 percent above 

the 2018 CR, a slight decrease from the Omnibus. We strongly support the increases to the chronically under-funded agency. Despite 

these increases, we and others in Indian Country are strongly opposed to the elimination of the Community Health Representatives 

Program, as well as other eliminations and decreases found in the 

request. Finally, the request also proposes to move Special Diabetes Programs from mandatory to discretionary spending. 

In closing, while we take a firm position that all members of 

Congress have an obligation to tribal nations, the members of this 

Committee have a greater role in understanding and working toward fulfilment of this obligation. As leaders who have consistently 

demonstrated a true understanding of this commitment, we implore this Committee to lead the change within Congress that is 

necessary to improve how the United States views, honors and fulfills its promises to Indian Country. The Federal budget is a reflection of this commitment. We recognizes that there are many causes 

and issues that this body considers. However, we ask that you always remember to seek and deliver upon this Nation’s first promise 

to its First People, the trust obligation. Thank you. 

[The prepared statement of Mr. McGhee follows:] 

PREPARED STATEMENT OF HON. ROBERT MCGHEE, VICE PRESIDENT, UNITED SOUTH

AND EASTERN TRIBES

Chairman Hoeven, Vice Chairman Udall, and members of the Senate Committee 

on Indian Affairs (SCIA): thank you for the opportunity to testify today and for your 

willingness to conduct an oversight hearing on the President’s shameful Budget Request for Fiscal Year (FY) 2019. My name is Robert McGhee, Vice Chairman of the 

Poarch Band of Creek Indians. I am here today in my capacity as Vice President 

of the Executive Officers Committee of the Board of Directors for United South and 

Eastern Tribes Sovereignty Protection Fund (USET SPF). 

USET SPF represents 27 federally-recognized Tribal Nations from Texas to Florida to Maine. 1 USET SPF member Tribal Nations are within the Eastern Region 

25 

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), 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), 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), and the Wampanoag 

Tribe of Gay Head (Aquinnah) (MA). 2S. Con. Res. 76, 100th Congress. 

3See https://www.aoc.gov/capitol-hill/native-americans-art 

and Southern Plains Region of the Bureau of Indian Affairs (BIA) and the Nashville 

Area of the Indian Health Service (IHS), covering a large expanse of land compared 

to other regions. Due to this large geographic area, USET SPF Tribal Nations have 

great diversity in cultural traditions, land holdings, and resources. This allows our 

region to mirror the great diversity found in Indian Country nationwide. 

Legal and Constitutional Basis for the Fiduciary Trust Responsibility 

From the earliest days of the United States, the Founders recognized the importance of America’s relationship with Tribal Nations and Native peoples. They wove 

important references to those relationships into the Constitution (e.g., Art. I, Section 

8, Cl. 3 (Indian Commerce Clause); Article II, Section 2, Cl. 2 (Treaty Clause). 

Tribal Nations influenced the Founders in the development of the Constitution as 

recognized by the 100th Congress, when the Senate and the House passed a concurrent resolution acknowledging the ‘‘historical debt’’ the United States owes to Tribal 

Nations. 

’’[O]n the occasion of the 200th Anniversary of the signing of the United States 

Constitution, acknowledges the historical debt which this Republic of the United 

States of America owes to the Iroquois Confederacy and other Indian Nations 

for their demonstration of enlightened, democratic principles of government and 

their example of a free association of independent Indian nations;. . . .’’ 2

One has only to walk the halls of the Capitol to see many works of art and sculpture that depict the central role that Tribal Nations have played in the development 

of America’s national identity. Not depicted on the walls of the Capitol are many 

of the injustices that Native peoples have suffered as a result of federal policy, including federal actions that sought to terminate Tribal Nations, assimilate Native 

people, and to erode Tribal territories, learning, and cultures. Where these injustices 

are depicted, our tragedies are romanticized 3 and told through a revisionist lens. 

The true story involves the cession of vast land holdings and natural resources, oftentimes by force, to the United States out of which grew an obligation to provide 

benefits and services in perpetuity to Tribal Nations. These resources are the very 

foundation of this nation, and have allowed the United States to become the 

wealthiest and strongest world power in history. Federal appropriations to Tribal 

Nations and Native people are simply a repayment on this perpetual debt. 

The Indian provisions in the Constitution were given immediate life in treaties 

that the United States entered into with Tribal Nations beginning with the Treaty 

with the Delaware in 1778 and continuing through another 373 treaties. Additionally, in the first decades of the United States, numerous laws were enacted addressing the details of the Federal-Tribal relationship (e.g., Trade and Intercourse Acts 

of 1790, 1793, 1796, 1799, 1802, and 1834), even as the Federal courts defined the 

Federal government’s trust obligation to Indian nations (e.g., Cherokee Nation v. 

Georgia (1831)). This period reflected an acknowledgement of and respect for our 

independent and sovereign existence, with the United States taking action within 

our lands only after securing our consent, including through treaty-making. 

As it became more powerful and maintaining strong relations with us became less 

necessary, the United States quickly moved from an approach based on consent to 

an approach based upon the notion of domestic dependency and plenary authority. 

Notwithstanding the Constitutional foundation, the federal government engaged in 

many actions that betrayed the treaties and trust obligation to Tribal Nations, such 

as the seizure of Tribal lands and the forced assimilation efforts of the Indian boarding school system. Fortunately, Tribal efforts to exert our sovereign rights in collaboration with our federal partners have led to more enlightened policies since the 

boarding school era, reflected in a host of laws that support Tribal sovereignty and 

are critical to the vitality and well-being of Tribal communities. Regrettably, these 

laws are rarely funded to the level necessary to achieve their intended purposes. 

26 

The chronic underfunding of federal Indian programs continues to have disastrous 

impacts upon Tribal governments and Native peoples. As the United States continues to break its promises to us, Indian Country and Tribal citizens experience 

some of the greatest disparities among all populations in this country—including 

those in health, economic status, education, and housing. The 2003 ‘‘Quiet Crisis’’ 

report issued by the U.S. Commission on Civil Rights (USCCR) revealed deep disparities in funding the federal trust responsibility, and was meant to galvanize action on the part of Congress and the Executive Branch. 15 years later, very little 

has changed. Though there was an effort to reissue the report in 2016, USCCR 

faced its own funding and infrastructure issues, and this was never accomplished. 

Nonetheless, USET SPF expects an updated report would likely have mirrored its 

earlier version. This is not a question about addressing poverty and needs across 

Indian Country. Our relationship is much more than this. This is ultimately a question about honor, about fulfilling commitments and promises. A nation’s 

exceptionalism is grounded in these principles. 

The Unique Role of the Senate Committee on Indian Affairs 

While USET SPF takes a firm position that all members of Congress have an obligation to Tribal Nations, the members of this Committee have a greater role in understanding and working toward fulfillment of this obligation. As members of the 

only full Congressional Committee charged with, ‘‘study[ing] the unique problems of 

American Indian, Native Hawaiian, and Alaska Native peoples and. . .propos[ing] 

legislation to alleviate these difficulties,’’ it is incumbent upon every Senator on this 

dais to advocate for and demand the inclusion of Indian Country’s priorities in all 

relevant legislation before the Senate. While we appreciate the amplification of 

these priorities through the work of the Committee via hearings, letters, and relevant legislation, it is equally, if not more, important, that the Members of this 

Committee use this role to elevate our voices in Congress’ other Committees, as well 

as on the Senate floor. Indian Country expects and demands that you carry our 

messages into conversations with colleagues who may be less familiar with the trust 

obligation. 

As leaders who have consistently demonstrated a true understanding of this commitment and obligation, we implore you to lead the change within Congress that 

is necessary to improve how the United States views, honors, and fulfills its promises to Indian Country. The federal budget is a reflection of this commitment. We 

recognize that there are many causes and issues that this body considers. However, 

we ask that you always remember this nation’s first promise to its First People— 

the promise that resulted in an exchange responsible for the vast wealth, power, 

and influence of this country. 

The President’s FY 2019 Request for Indian Programs Violates the Trust 

Responsibility 

In his 2017 Native American Heritage Month proclamation, the President stated, 

’’My Administration is committed to tribal sovereignty and self-determination. 

A great Nation keeps its word, and this Administration will continue to uphold 

and defend its responsibilities to American Indians and Alaska Natives. Together, we will strengthen the relationship between the United States Government and Native Americans.’’ 

A great nation does keep its word. The first step toward fulfillment of America’s 

promises is not just words, but action. While this Administration professes to 

prioritize Indian Country, this Budget Request reveals otherwise. At all levels of the 

Administration, from the Office of Management and Budget (OMB) to BIA to IHS, 

Tribal Nations and others objecting to this draconian budget request are being told 

that the request is just a ‘‘messaging document.’’ 

While we understand that only Congress has the power to appropriate funds, the 

Administration is sending a powerfully negative message to Indian Country. In reducing, eliminating, and calling into question the constitutionality of federal Indian 

programs, this Administration is ignoring and undermining its trust responsibility 

to Tribal Nations. Moreover, the message that this sends to all American citizens 

is one of disregard and dishonor, further exacerbating the challenges we face in educating the nation on our history, sovereignty, and the continued obligation to Tribal 

Nations. Finally, the agencies most directly charged with delivering on the fiduciary 

trust responsibility—BIA and IHS—are demonstrating no accountability for budget 

request numbers and instead, are directing Tribal Nations to advocate for funding 

with Congress. This is a failure on the part of the Administration to take seriously 

its role as trustee. 

27 

Funding Requests and Mechanism do not Reflect Trust Obligations 

Because of our history and unique relationship with the United States, the trust 

obligation of the federal government to Native peoples, as reflected in the federal 

budget, is fundamentally different from ordinary discretionary spending and should 

be considered mandatory in nature. Inadequate funding to Indian Country needs to 

be viewed as unfilled treaty and trust obligations and should not be vulnerable to 

year to year ‘‘discretionary’’ decisions by appropriators. Recently, some in Congress 

have called for mandatory funding for IHS. USET SPF strongly supports this proposal, which is more consistent with the federal trust obligation, and urges that this 

be expanded to include all federal Indian programs. 

We further note the long-lasting effects of continued underfunding for federal Indian programs. The FY 2019 Budget Request fails to reflect a prioritization of trust 

obligations and the related promises that are at the core of our special and unique 

relationship. These unfulfilled treaty and trust obligations will ultimately lead to 

hearings by this very Committee, as the consequences of this Request results in the 

problems and difficulties that SCIA is charged with addressing. 

Constitutionality of Federal Indian Programs 

Several times now, this Administration has called into question the constitutionality of programs or targeted accommodations for American Indians and Alaska 

Natives (AI/AN). As this Committee well knows, all federal Indian programs are 

based on a political, government-to-government relationship between the U.S. and 

Tribal Nations. Appropriations that support programs and services such as this are 

provided in perpetuity in exchange for the millions of acres of land and natural resources ceded, often times by force, to the U.S. In addition, the Executive Branch, 

regardless of party, has a decades-long history of policy-making that includes exemptions or accommodations from federal actions for Tribal Nations and Native people. 

Infrastructure Plan 

For generations, the federal government—despite abiding trust and treaty obligations—has substantially under-invested in Indian Country’s infrastructure, evident 

in the breadth and severity of its unmet infrastructure needs as compared to the 

rest of the nation. While the United States faces crumbling infrastructure nationally, there are many in Indian Country who lack even basic infrastructure, such as 

running water and passable roads. According to a report released in 2017 by National Congress of American Indians, there exists at least $50 billion in unmet infrastructure obligations across Indian Country. Decades of chronic underfunding of the 

federal government’s trust obligations has resulted both in a dangerous lack of infrastructure, as well as infrastructure that is severely degraded. 

If this Congress and Administration intend to modernize and repair infrastructure 

throughout the country, the deep infrastructure needs of Indian Country must be 

addressed. It is critical that Tribal Nations have direct access to any funding available via an infrastructure package. We must not be restricted to partnering or competing with another entity in order to be in receipt of infrastructure dollars. Additionally, in support of Tribal self-determination, these dollars should be eligible for 

inclusion in Self-governance contracts and compacts. 

While we acknowledge that the President’s infrastructure plan does state that 

some funding will be set aside for Tribal Nations within its proposed Rural Infrastructure Program, it remains unclear exactly how much funding is being proposed 

and whether Tribal Nations would have access to other parts of the President’s 

plan. With a renewed focus on domestic issues and putting America first, this focus 

must also include a commitment to rebuilding the sovereign Tribal Nations that 

exist within the domestic borders of the United States. Much like the U.S. investment in the rebuilding European nations following World War II via the Marshall 

Plan, this Congress and Administration should commit to the same level of responsibility to assisting in the rebuilding of Tribal Nations, as our current circumstances 

are, in large part, directly attributable to the shameful acts and policies of the 

United States. 

The President’s plan also proposes to streamline infrastructure permitting processes. While there remain many unknowns associated with these streamlining 

measures, USET SPF is concerned that these proposals could serve to undermine 

Tribal sovereignty, and the protection of cultural resources and public health. We 

note that the Federal Communications Commission is already planning to move forward, over the strong objections of Tribal Nations, with a Report and Order this 

week that restricts Tribal cultural reviews and illegally redefines the meaning of 

‘federal undertaking’ under the National Environmental Policy Act and the National 

Historic Preservation Act. 

28 

Tribal governments must be consulted in any infrastructure project planning or 

permitting on ancestral lands. Any infrastructure build-out in Indian Country and 

beyond must not occur at the expense of Tribal consultation, sovereignty, sacred 

sites, or public health. Consultation must include Tribal consent for projects that 

significantly impact or threaten Tribal interests. This point should be strengthened 

in the law, and not just in regulations. In the short term, we must move beyond 

the requirement for Tribal consultation via Executive Order to a strengthened 

model achieved via statute. In the long term, we must return to the achievement 

of Tribal Nation consent for federal action as a recognition of sovereign equality. 

Interior Reorganization 

USET SPF is deeply concerned that the reorganization of the Department of the 

Interior is moving forward in the absence of Tribal consultation. Although Interior 

Secretary Ryan Zinke recently stated, ‘‘we’re going to go into consultation, as we 

should, and it’s really up to the tribes whether they’re going to participate or not, 

and I respect sovereignty,’’ a consultation has yet to be initiated on the specifics of 

the reorganization plan. The Secretary has yet to significantly consult with or provide much detail to Tribal Nations on the reorganization of the Department, although we are aware of meetings held with federal employees and other units of 

government. Yet, we note that new DOI regions have been proposed and there is 

$900,000 set aside in the BIA Budget Request for its share of initial pre-planning 

responsibilities (with the knowledge that this figure will increase significantly in the 

out years). USET SPF urges this Committee and this Congress to withhold any 

funding for Interior reorganization pending confirmation that the Reorganization 

will not impact funding to Tribal Nations or inherent federal functions, as well as 

meaningful consultation with Tribal Nations resulting in consent for or an exemption from the reorganization. 

Role of Office of Management and Budget in Inadequate Budget Requests 

The Office of Management and Budget (OMB) asserts that over $21 billion in federal dollars funds Indian Country annually. From the perspective of Tribal advocates, including those who serve on budget formulation committees for federal agencies, this number seems to be an over-estimate, with far less actually reaching Tribal Nations and Tribal citizens. We suspect that OMB arrives at this figure by tallying the amount for which Tribal Nations and entities are eligible, regardless of 

whether these dollars actually reach Indian Country. The Tribal Interior Budget 

Council has asked OMB for a full accounting of federal funding distributed to Indian 

Country. To date, OMB has not responded to this request and continues to take the 

position that as an extension of the Executive Branch, it does not have the same 

consultative responsibilities as other federal agencies. USET SPF requests that in 

the spirit of transparency, this Committee consider supporting report language that 

would ensure OMB provides Indian Country with an accurate inventory of its own 

federal funding on an annual basis. In addition, USET SPF contends that Indian 

Country would be better-served by an Indian-specific desk at OMB rather than analysts with portfolios that include other interests. 

FY 2019 Request for the Bureau of Indian Affairs 

The FY 2019 President’s Budget Request for Indian Affairs is $2.4 billion in current appropriations, a 15.6 percent decrease from the FY 2018 CR level. Nearly 

every line item in the BIA budget would see reductions in the FY 2019 budget request. However, Interior’s Budget Justification describes the Request in the following way, 

’’The 2019 budget supports the Administration’s commitment to help promote 

tribal nation-building and self-determination, empower tribal communities, foster tribal self-sufficiency, create educational and economic opportunities, ensure 

safe Indian communities, preserve and foster cultural heritage, and steward 

natural resources. Indian Affairs programs deliver community services, restore 

tribal homelands, fulfill commitments related to water and other resource 

rights, execute fiduciary trust responsibilities, support the stewardship of energy and other natural resources, create economic opportunity, and expand access to education.’’ 

It is difficult to see how any of this could be true, considering the deep reductions 

and eliminations found in the Request. Moreover, on a February 12th conference 

call, Tribal leaders and advocates were told that the BIA budget request supports 

the ‘‘core mission’’ of the Agency, but with nearly every line item receiving a decrease, it is impossible to determine what the Administration deems its ‘‘core mission.’’ According to the BIA’s website, its mission is, ‘‘to enhance the quality of life, 

to promote economic opportunity, and to carry out the responsibility to protect and 

29 

improve the trust assets of American Indians, Indian tribes and Alaska Natives.’’ 

By any measure, this Budget Request fails to uphold these words. 

As National Congress of American Indians notes, overall, Human Services programs would fall by 27 percent, Natural Resource programs by 23 percent, Public 

Safety and Justice by 9 percent, and the Bureau of Indian Education by 16 percent. 

Similarly, the top priorities identified by the Tribal Nations of the Eastern Region 

for FY 2019 would all see drastic reductions or eliminations: 

• Social Services—cut by 37% 

• Scholarships and Adult Education—eliminated 

• Indian Child Welfare Act—cut by 27% 

• Tribal Courts—cut by 28% 

• Aid to Tribal Government—cut by 10% 

One of the few increases would be $2.5 million in the Law Enforcement Special 

Initiatives budget to fight the opioid epidemic by, ‘‘expand[ing] BIA capacity to address the increase in drug-related activities through interdiction programs to reduce 

drug use, distribution, and drug related crime.’’ While USET SPF welcomes any 

funding provided directly to Indian Country to combat the opioid epidemic in our 

communities, including for law enforcement, $2.5 million in what may be one-time 

funding falls short. To increase the number of BIA drug enforcement officers, USET 

SPF has requested no less than $11 million annually. 

FY 2019 Request for the Indian Health Service 

The FY 2019 Budget Request would include $5.4 billion for IHS, $413 million or 

8 percent above the FY 2018 Continuing Resolution. While we acknowledge and 

support increases to this chronically underfunded agency, we also note that for FY 

2019, the Tribal Budget Formulation Workgroup (TBFWG) which meets annually 

and is comprised of Tribal leader representatives from each of the 12 IHS Areas, 

recommended $6.4 billion. 

While we continue to await the IHS’ full FY 2019 Congressional Justification, we 

support increases to several critical IHS line items: an increase for clinical services, 

including an increase of $268 million for Hospitals and Clinics for a total funding 

amount of $2.1; increase of $32 million for purchased/referred care (PRC) for total 

funding of $955 million; and increase of $340 million for Mental Health, and Alcohol 

and Substance Abuse Programs, which is $30 million above current spending levels. 

These line items were the top four funding priorities of Tribal Nations in the Nashville Area of IHS. However, as with overall funding for IHS, it is important to recognize that these increases fall far short of IHS’ obligation to the health of Tribal Nations, as well as the TBFWG’s recommendations. We continue to support and urge 

the adoption of a plan to phase-in full funding for IHS. USET SPF maintains that 

until Congress fully funds the IHS, the Indian Health System will never be able to 

fully overcome its challenges and fulfill its trust obligations. 

Despite these increases, the President’s Budget also proposes cuts and eliminations to other parts of the IHS budget. USET SPF and others in Indian Country 

are strongly opposed to the elimination of the Community Health Representatives 

program and health facilities construction, as well as other eliminations found in 

the Request. 

The Budget Request proposes a total $10 billion in new funding to combat the 

opioid epidemic. Under the proposal, IHS would receive $150 million ‘‘to provide 

multi-year competitive grants based on need for opioid abuse prevention, treatment, 

and recovery support in Indian Country.’’ Considering the disproportionate levels of 

opioid abuse and mortality in Tribal communities, a small amount of funding delivered through competitive grants, while welcome, does not even begin to scratch the 

surface. Further, the source of this funding remains unclear. USET SPF calls upon 

this Committee and this Congress to prioritize substantial direct funding to Tribal 

Nations as it seeks to address the opioid crisis. Among the direct funding proposals 

we support are: S. 2270, the Mitigating METH Act, S. 2545, the Native Health Access Improvement Act, and S. 2437, the Opioid Response Enhancement Act. 

The Request also proposes to move the Special Diabetes Program for Indians 

(SDPI) from mandatory to discretionary spending. When asked for an explanation 

on an ‘‘All-Tribes’’ call, IHS indicated that all health extenders are proposed to be 

moved from mandatory to discretionary. This proposal has not received any Tribal 

consultation, in violation of IHS’ & HHS’ Tribal consultation policies. From USET 

SPF’s perspective, this proposal represents the exact opposite of what we are trying 

to achieve—which is mandatory funding for all federal Indian programs. 

30 

FY 2019 Request for Other Agencies, Operating Divisions, and Line Items 

While some may view ‘‘federal Indian programs,’’ as limited to those administered 

by BIA and IHS, USET SPF maintains that all federal agencies have a trust responsibility to Tribal Nations. In addition and as a practical matter, it is important to 

recognize that Tribal Nations access funding from nearly every federal agency. Reductions and eliminations at other agencies and operating divisions, then, would 

have significant impacts in Indian Country and further compound cuts at BIA and 

IHS. This Administration and Congress must recognize that the President’s Budget 

Request as whole reflects its commitment to Indian Country and the trust obligation. While by no means an exhaustive list of priorities, we would like to highlight 

funding levels for some additional agencies, operating divisions, and line items. 

Centers for Disease Control and Prevention (CDC) 

Outside of IHS, Tribal Nations receive a significant amount of funding from the 

CDC for public health promotion and surveillance, disease prevention, vaccinations, 

and other purposes. As such, the overall 12 percent cut to CDC is troubling. We are 

especially opposed to the proposed elimination of Good Health and Wellness in Indian Country (GHWIC), a $78 million initiative that started in 2014 and continues 

through 2019, supporting the health surveillance and promotion work of Tribal Nations, Tribal organizations, and Tribal epidemiology centers (TECs). USET’s TEC 

and 5 subawardees are supported in part through this initiative. GHWIC interventions focus on reducing tobacco use and exposure, improving nutrition and physical 

activity, increasing support for breastfeeding, increasing health literacy, and 

strengthening team-based health care and community-clinical links. While FY 2019 

proposes to be the final year of a 5-year funding cycle, we expect that participating 

Tribal Nations will continue to sustain health promotion efforts at its conclusion. 

Medicaid Block Grants and Changes to the Affordable Care Act 

The FY 2019 budget request proposes to make major changes to programs authorized under the Patient Protection and Affordable Care Act (ACA). Under the Request, Medicaid spending would be replaced with a block grant to states leading to 

the elimination of the ACA’s Medicaid expansion and drastic cuts in Medicaid over 

the next decade. As this Committee is well aware, Indian Country is universally opposed to this type of proposal, as it would create barriers to AI/AN Medicaid access, 

violating the trust responsibility to provide health care and resulting in deep cuts 

in 3rd party revenue to the already chronically underfunded Indian Health System. 

In addition, the Request proposes to eliminate subsidies for the ACA’s health insurance marketplace, which would pose further barriers to health care access and vital 

3rd party dollars. 

Administration on Children and Families 

The Administration has zeroed out funding for the Rural Community Facilities 

line item in the ACF account. The Administration argues that this program is duplicative and that grantees under this program continue to receive funding in spite of 

underperformance. However, this grant is one of the only sources of funding available to Indian Country to provide Tribal-specific water and wastewater operator 

training, including that provided by USET. When Tribal community members are 

trained as operators, the result is operational continuity, cultural competency, and 

self-determination. Without this funding, Tribes will have to turn to state-certified 

operators who are unlikely to be members of the community, unlikely to stay in the 

job for very long, and do not have knowledge of the unique jurisdictional and legal 

framework that applies to Tribal water systems. We urge appropriators to once 

again provide funds for this invaluable program. 

Department of Justice 

USET SPF was pleased to see and strongly supports a 5 percent Tribal set-aside 

from the Crime Victims Fund in the Request for the Department of Justice. In addition, while we are glad to see support for the Tribal Access to Crime Information 

Program (TAP) in the Request, we note that up to $3 million in funding would be 

sourced from existing Tribal dollars. Indian Country must not be forced to choose 

among critically important Tribal justice programs. TAP funding must be appropriated separately. 

Department of Homeland Security 

Despite a responsibility for emergency management and response in Indian Country, Tribal Nations and Tribal emergency management organizations have limited 

access to direct funding from the Department of Homeland Security (DHS), as the 

current funding mechanisms require Tribal Nations and their emergency management organizations to seek funds through state governments. USET SPF calls upon 

31 

appropriators to work with Tribal Nations to to identify and eliminate both procedural and current eligibility impediments to additional direct DHS funding for Tribal governments. 

Environmental Protection Agency (EPA) 

USET SPF also opposes reductions in funding to Tribal Nations found in the FY 

2019 Budget Request for EPA. Although the Administration continues request increases and a Tribal set aside in the Clean Water State Revolving Fund program, 

the Request proposes a nearly $575 million cut to State and Tribal Assistance 

Grants. While some of this funding was restored in an addendum, it remains troubling that a number of line items specific to Tribal Nations were targeted. 

Department of Commerce 

The Budget requests $9.8 billion for the Department of Commerce, a $546 million 

or 6 percent increase from the 2017 enacted level. However, the Budget would eliminate the Economic Development Administration, which is a primary source of funding for economic development activities in Indian Country, including USET’s own 

Economic Development Department. The Budget also proposes to reduce funding for 

the Minority Business Development Agency from $34 million in FY17 ($33.769 FY18 

CR) to $10 million in FY19, which includes funding and direct services to Tribal Nations and Native people. 

Department of Treasury 

USET SPF opposes in the strongest possible terms the elimination of funding for 

Community Development Financial Institutions (CDFIs) through the CDFI Fund, 

including the elimination of the Native American CDFI Assistance (NACA) Program. While this Administration purports to prioritize the creation jobs and economic opportunities in Indian Country, elimination of the NACA program would 

prove otherwise. As USET works to establish the first Native CDFI serving our entire region, we urge this Congress to ensure our funding is maintained. 

Conclusion 

While USET SPF recognizes this Committee’s strong, long-standing commitment 

to Indian Country, we cannot accept funding for federal Indian programs that continues to fall far short of fiduciary trust obligations. This Committee must use its 

influence to ensure that Congressional appropriators uphold the fiduciary trust obligation to Tribal Nations in FY 2019 and beyond. In pursuit of a relationship more 

reflective of this obligation, USET SPF urges this Committee, Congress, and all 

branches of the federal government to ensure that full funding for the trust obligation is realized in our lifetimes. USET SPF looks forward to partnering with the 

Committee to bring this to fruition. 

The CHAIRMAN. Thank you, Mr. McGhee. We will have fiveminute rounds of questioning. 

First, for Mr. Tahsuda. There is funding in the budget for repair 

of BIE schools, which is good. The 2019 budget request has $18 billion in the public lands infrastructure funds to address public lands 

issues and needed repairs at BIE schools. Talk to me about how 

you are going to consult with tribes in determining which projects 

are selected, and prioritizing the needs and so forth for the schools. 

Mr. TAHSUDA. Thank you, Chairman. We are going through the 

process now, as we did with preparing for the budget, of looking 

at the priority list for deferred maintenance. From that, determining what would be priorities as far as adding to the 2016 list. 

We already have—actually, let me back up. We already have one 

priority list, 2016, which we hope to finish out first as far as construction of new schools. 

Following up on that would be a determination from the deferred 

maintenance backlog as to which schools would be more appropriate to just be replaced. We would consult with the tribes, obviously, in doing that. But we have a significant level of information 

about the condition of the schools and hopefully, the Congress 

passes this and we would then be able to address all these schools 

32 

over a short period of years, instead of having to continually add 

to new priority lists. 

The CHAIRMAN. In the 114th Congress, I introduced, and we 

passed, the Native American Children’s Safety Act. In the 2019 

budget, there is a proposed cut of $19.4 million for Social Services 

programs. My question is, how are you going to be able to not only 

enforce that law, but also what impact would that reduction have 

on making sure that we are keeping Indian children safe in their 

communities, and certainly in foster homes? 

Mr. TAHSUDA. Thank you, Chairman. When Congress passed the 

Native American Child Safety Act, it didn’t specify any additional 

funding for that. So for us, it is an unfunded mandate, which we 

are working to meet. A lot of the work will also be on the tribal 

side of that, and we are in the process of finalizing guidelines that 

they will use as far as meeting the new statute. 

And we work with them through the current programs they have 

to provide, from their side, to provide the training that they need. 

We provide training through our staff as it is now. This has been 

part of the process f working through the consultations, developing 

the guidelines. We have planned out, after the guidelines become 

final, I believe it is June 3rd, under the statute, we have several 

months planned of training with the tribes, so that they will be 

able to implement these new guidelines in short order. 

But we have to work within the funding that we have for that. 

The CHAIRMAN. Mr. Weahkee, the Fiscal Year 2019 budget does 

propose $340 million for mental health, alcohol and substance 

abuse programs. How would you use this? There is an increase 

there. How would you propose to use that? Also, last month our 

Committee held a hearing on opioid abuse. How do you propose to 

do more to address the opioid crisis? 

Mr. WEAHKEE. Thank you, Chairman Hoeven. I believe our first 

step needs to be to sit down and consult with the tribes on where 

the priority areas are in both mental health and in opioids. So our 

plan would be to initiate consultation to discuss where the tribal 

priorities are. We still have significant issues with suicide, with alcohol, substance abuse, methamphetamine use, heroin use and the 

targeted opioid funding is meant to address prevention, treatment 

and recovery support services. That is step one, let’s sit down with 

the tribes and determine what their priorities are. 

The CHAIRMAN. Mr. Payment, talk to me for a minute about the 

importance of the Small and Needy Tribes program, if you would. 

Mr. PAYMENT. First, I really appreciate Senator Murkowski’s reference to Alaska Natives. Too often they get left behind. I have 

made it my personal mission to advocate for them. All tribes have 

been in a similar situation with having lack of resources. So our 

small and needy tribes, the funding is proposed to be cut, actually 

zeroed out in this draft budget. The President’s priority is to zero 

out the Small and Needy Tribes proposal. 

Tribes that need it the most are the ones that are small and 

needy in rural communities. So I don’t support that, NCAI doesn’t 

support that. We stand in unison with our small and needy tribes 

in rural communities. 

33 

The CHAIRMAN. Also, you mentioned several others like Johnson 

O’Malley, adult education, some others. Talk to me about the importance and the effectiveness of those programs. 

Mr. PAYMENT. Johnson O’Malley goes back to right after the enactment of the Indian Reorganization Act as a way of trying to 

undo what the Federal Government did with forced assimilation 

and boarding schools, and bringing back culture and opportunities 

for tribes to program that, so they can bring back self-esteem and 

so that people can, our people can exceed at all levels. Johnson 

O’Malley is a big part of that, and adult education is a big part of 

that, so we can become self-determined. 

In 1974, we passed the Self-Determination Act. It was a dedication and a pledge to move forward, to undo the past and to provide 

for tribes to be able to provide for themselves. So those are critically important programs. 

I would note, there is a real disconnect between the increases 

that we see that we are grateful for in the IHS budget and some 

of the real serious, and I use the word draconian, cuts in the BIA 

side. I know both are not headed up by tribal leaders yet, and we 

are looking forward to filling those positions as soon as possible. 

But there are some real serious and alarming cuts coming out of 

the BIA. We believe it is because of a lack of leadership in the Asia 

position. 

The CHAIRMAN. Both IHS and BIA are two areas where we push 

for more funding, obviously health care and education being so important. 

Mr. PAYMENT. It seems to be registering right now in this Administration in the IHS portion, but not so much on the BIA side. 

The CHAIRMAN. Yes, okay. 

Vice Chairman Udall? 

Senator UDALL. Thank you very much, Chairman Hoeven. As I 

said in my opening, the Administration’s budget simply does not 

reflect Indian Country’s priorities. What results is a ‘‘messaging 

document’’ that tells Indian Country their concerns have fallen on 

deaf ears. Vice President Payment, NCAI’s testimony really highlights how this Administration hasn’t just ignored Indian Country 

priorities, but actually cut or eliminated every single priority funding area. It appears the Administration’s consultation with HHS 

and the Tribal-Interior Budget Council was just a check the box exercise. 

Vice President Payment, do you agree? 

Mr. PAYMENT. I would say that for Interior, yes, I think that the 

obligation to proceed with the Tribal-Interior budget committee 

process, for which I served as an alternate for the Midwest Region, 

was a check the box. When you look at the sheet, and I really appreciate this graph, because a picture says a thousand words. You 

see the priorities that tribes identify in your graph here. And then 

you see the cuts, 100 percent cuts to scholarships and adult education, housing improvement, Johnson O’Malley, small and needy 

tribes. 

Then you see 30 percent cuts. We are losing ground, going back 

to the Self-Determination Act. So somehow, with these consultations of reorganizing the BIA, maybe more attention should have 

34 

been paid to listening to tribal leaders and our needs and trying 

to propose funding that meets our needs. 

Earlier, we heard Mr. Tahsuda saying they are trying to do with 

what they have. Well, that is not the job of the trustee. The trustee 

is to advocate to meet the needs of the tribes. If it is not coming 

out of the trustee, where can it come from? Thankfully, Congress 

has a role in this. 

Senator UDALL. Thank you. The chart you are referring to I 

think are the ones also we have up here on the left hand side of 

the dais. 

The Administration’s budget cuts are deep and wide and almost 

no area is spared, including infrastructure. It eliminates Indian 

Country development block grants, reduces Indian housing block 

grants and cuts road maintenance and funding for important water 

projects. The Administration proposes to make up for these cuts 

through other proposals, like the Infrastructure fund. 

Mr. Tahsuda, it is my understanding that this fund is supposed 

to address the $600 million BIE maintenance backlog. Is that 

right? 

Mr. TAHSUDA. Yes, sir. Senator, the fund will address that. But 

the proposal is relatively broad, though. I think we would be happy 

to work with Congress to expand it. Again, there are a number of 

schools that it would be more fiscally responsible to replace than 

continue to keep maintenance going on. That would be something 

we would appreciate working with Congress on, to have the authority to do that as well. 

Mr. UDALL. When we talk about addressing the backlog, the Administration’s proposed fund doesn’t address the $4.1 billion BIE 

construction backlog, is that correct? 

Mr. TAHSUDA. I am not sure where that number comes from. We 

have the deferred maintenance backlog and we have the remaining 

schools on the 2016 priority list. 

Senator UDALL. That number that I used, Mr. Tahsuda, that 

number was given to us by the BIE director at the briefing where 

they briefed us. So that is your Interior Department number. You 

have proposed here a $600 million BIE maintenance backlog. But 

in fact, the actual construction backlog is $4.1 billion, is that correct? That is the number we were given. I just need a yes or no 

answer on that. 

Mr. TAHSUDA. If you wrap that all together with all the replacement schools, including the ones that are currently on the list, that 

is probably close to the number. 

Senator UDALL. For Vice President Payment, do you support cutting infrastructure line items and replacing them with this fund? 

Mr. PAYMENT. I support funding the need as identified through 

budget priorities, through past testimony, on the record. It almost 

feels like a bait and switch. So I don’t support the promise of something else down the road in exchange for not funding it now. I believe that we have identified the priorities in past Administrations 

and in this Administration, and funding it now, not on the promise 

that we might fund it some day.′′ 

Senator UDALL. Vice President McGhee, what priority areas 

would you want this infrastructure fund to include? 

35 

Mr. MCGHEE. The USET tribes have looked at various ways, we 

are pleased that there is BIE education money in there and health 

facilities money. But we shouldn’t have to choose. We have priorities all across there. So the tribal infrastructure that we are looking at is physical infrastructure, jobs, public safety, justice infrastructure, communications and such. There are many more concerns than just those two that were funded within this fund. I 

think it is one of those things that we shouldn’t have to decide between the two. Infrastructure funding is necessary, but it is not 

about two programs. It is about across Indian Country and the 

Federal obligation to help us build those infrastructures. 

Senator UDALL. Thank you very much. I yield back to Senator 

Murkowski. 

Senator MURKOWSKI. [Presiding.] Thank you. Since I have the 

gavel and I am generous and magnanimous, I am turning to Senator Heitkamp. 

STATEMENT OF HON. HEIDI HEITKAMP, 

U.S. SENATOR FROM NORTH DAKOTA 

Senator HEITKAMP. I want to thank my colleagues, Senator Murkowski, but I also want to greatly thank my colleagues, Senator 

Smith and Senator Cortez Masto. I have another appointment and 

I of course always have burning questions. I promise they will be 

questions, not diatribes. 

I want to start with one of my greatest concerns, as you know, 

which is public safety. I have had a chance to visit with a lot of 

you, addressing the challenges. I understand your staffing and your 

challenging needs. 

But I don’t understand this budget. So in 2016 BIA submitted a 

report to Congress estimating that to provide a minimum, a minimum, base level of public safety and judicial services to all federally-recognized tribes, it would cost approximately $2.3 billion. And 

so currently, BIA has only met a fraction of that. 

If BIA knows that we need additional increased funding, and 

that we haven’t met that need, to meet baseline, and that is the 

words of BIA, are we sending a message to our tribes that their 

public safety isn’t as important as the public safety of any other citizen in this Country? We will start with you, Mr. Tahsuda. 

Mr. TAHSUDA. Thank you, Senator. Law enforcement is obviously 

a very important priority for this Administration. It is obviously 

important for those who live on reservation communities. The number that you cited I think includes a broad range of situations that 

exist around Indian Country. As you know, the jurisdictional map 

that is Indian Country varies greatly. And so we have some large 

land-based reservations—— 

Senator HEITKAMP. Can I just interrupt? I don’t have a lot of 

time. How can you possibly say you are getting enough to protect 

Native women, Native children and Native people when you are actually looking at almost a decrease in public safety? 

Mr. TAHSUDA. Well, we are focusing on the—— 

Senator HEITKAMP. No, these numbers are yours. 

Mr. TAHSUDA. Yes. 

Senator HEITKAMP. Two point three billion, that is your number, 

that is BIA’s number. So if that is your number for baseline supVerDate Mar 15 2010 13:55 Dec 11, 2018 Jkt 033404 PO 00000 Frm 00039 Fmt 6633 Sfmt 6601 S:\DOCS\33404.TXT JACK
36 

port, then why isn’t that in the budget? Why isn’t that number the 

request for the budget? Because the biggest challenge that I have 

in my State is public safety. I just talked to the police chief of 

Belcourt. He is begging, begging for help. I have people all over 

North Dakota in Indian Country begging for help. 

I need you guys to be the advocates. I need you guys to say, we 

are going to do the minimal amount that we need to provide public 

safety, and that includes places where people can be incarcerated. 

So I don’t want to hear about how it can’t get done. I want to 

hear how you are advocating. I think Mr. Payment made a great 

point, which is, you are the trustee. You should be the advocate. 

I get that you may not want to fund housing, or you may not want 

to fund education, but fundamentally, keeping people safe has to 

be the highest priority. Security has to be the highest priority. 

Without that, we don’t have the opportunity for anything else. 

And we need an advocate. Can you promise me, and I know this 

is tough, we need to take it back to the Secretary, we need to take 

it back to Mulvaney. I have talked to the Attorney General, Jeff 

Sessions, about this. This cannot get ignored. The Department of 

Justice needs to step up, BIA needs to step up if we are going to 

protect women and children in Indian Country. 

And if we are not willing to step up, then let’s just admit that 

they are second class citizens. They aren’t entitled to the same protection that people in this Country are entitled to. 

Can you say you are going to take our concerns back? 

Mr. TAHSUDA. I will take your concerns back. They are part of 

the discussion that we have. And again, we are trying to focus on, 

and I can’t speak to what happened before I came to the Department, but—— 

Senator HEITKAMP. Do you agree, do you personally agree with 

the $2.3 billion? 

Mr. TAHSUDA. I would have to go back, I am not sure where that 

number came from. I know there were prior efforts to put funding 

into area where we don’t have clear law enforcement jurisdiction. 

I am not sure if that is part of what was in that number. But we 

also have core responsibilities, including core jurisdictional responsibilities. 

Senator HEITKAMP. If you don’t agree with that number, can you 

get me the number that you think? Can you give me a needs assessment, talking to, in consultation with all the other tribes on 

what it is going to take to get basic law enforcement services in Indian Country in this Country? 

Mr. TAHSUDA. Well, I think our budget reflects two goals, one of 

which is to strengthen law enforcement in the areas where we have 

clear jurisdiction, and we are, as you know, on several of your reservations, we don’t have the sufficient force there to do that. That 

is something we are working strongly on, as you suggested in our 

phone call the other day. We are turning over the rock the fifth 

time in certain matters. Part of this is training and getting more 

officers through our system. 

So it is not a simple answer of just saying, throw more money 

at it. It is trying to analyze how we are doing the job most efficiently and are we putting those resources to the best use. That is 

what we are trying to do. 

37 

Senator HEITKAMP. If you can just indulge me, one more question. Would you agree that right today, in North Dakota, which is 

what I know the most about, we have inadequate, grossly inadequate law enforcement services in Indian Country? 

Mr. TAHSUDA. I think we have some difficulties, I will admit. It 

is a challenging environment. Again, we struggle to get people 

through the system and to identify where they can go, where they 

will be most effective. So it is also, in Indian Country, a march. We 

have a force that is probably less than most other law enforcement 

agencies deal with, and we have the greater territories to cover. 

More scarce populations. So that is a factor that — 

Senator HEITKAMP. And some of the highest rates of violent 

crime in this Country. 

Mr. TAHSUDA. Yes. 

Senator HEITKAMP. The highest rates of drug use. 

Mr. TAHSUDA. Yes. 

Senator HEITKAMP. The highest rates of criminality and the lowest rates of protection by law enforcement. That is what I see in 

my State. So we have to fix this, and we need an advocate in your 

job. Thank you. 

Mr. TAHSUDA. Toward that end, Senator, we have in the budget 

funding for an additional 17 drug enforcement officers. I hope that 

we get support for that. 

Senator HEITKAMP. [Remark off microphone.] 

Mr. TAHSUDA. Yes. Yes, they work in concert with other drug enforcement task forces. 

Senator HEITKAMP. I could use 17 just in North Dakota. 

Senator MURKOWSKI. Well, and not to pile on here, but it is one 

thing to have drug enforcement agents. But if you have nobody 

that is able to follow through with the prosecution, what happens 

in my State, because we don’t have sufficient law enforcement, because we do not have the protection and public safety that Senator 

Heitkamp has been talking about, the bad guys come in and get 

away with bloody murder because they can, because we don’t have 

the resources to follow through with the protection. 

I am going to turn to Senator Smith, because I know that she 

also has to go to another hearing. 

STATEMENT OF HON. TINA SMITH, 

U.S. SENATOR FROM MINNESOTA 

Senator SMITH. Thank you very much, Chair Murkowski. I would 

just note that I am hearing on both sides of the aisle here a sense 

of real concern about the budget levels and this overall budget. I 

am not going to go down that path again as everyone else has. 

Though I really have to say, I note with great interest the message that Vice President Payment and Vice President McGhee 

bring, which is that this is not just a question of priorities and 

scarce resources. This is a question of the solemn trust and obligation and agreement between the United States and our tribal nations. I think that is the message that I have here, not a message 

document that is a budget. So I want to say I really appreciate 

that, very much appreciate that. 

But I want to ask about something actually that Senator Murkowski brought up at the beginning. I would like to go back to the 

38 

Special Diabetes Program funding. This is something of great interest to me because I am interested in taking this model, which I understand has been so successful, and applying it to the terrible 

challenges that we have with opioid and treatment and recovery in 

Indian Country. I am working with members of this Committee to 

develop legislation that would create a special behavioral health 

program, so that tribes can access the resources that they need, 

and using that diabetes program as a model for that strategy, so 

that we can have good, strong, locally-driven, culturally-specific 

and results and evidence-based programs. 

So my question to you is, can you tell us, I am kind of looking 

at you, Vice President Payment, but anybody can respond. We are 

concerned, of course, about this shift from mandatory to discretionary funding. Could either of you just give me a sense of what 

impact that would have? What would be different if we made that 

shift? 

Mr. PAYMENT. First of all, earlier, so we get glows and grows, 

and I talked very favorably about some of the proposed increases 

in IHS. So it is not an attack on IHS. Four years ago I testified 

in this Committee on the need to make Special Diabetes permanently reauthorized, mandatory and advanced appropriations for 

our health services. So we prepaid health, the health portion of 

health, education and social welfare is embodied in the treaties. 

And we prepaid that with our land. 

So the Special Diabetes is one of the best-ranked, evaluated programs in terms of its return on investment, mainly because it empowers people to take care of their own health and acknowledge 

the types of statistics and data they should be looking at. So it is 

one of the very best programs that we have seen. 

I don’t support means testing for Indian programs and services, 

but I would say that Special Diabetes would meet anybody’s means 

test. 

In looking at the budget, Interior and IHS, it is inconsistent. 

There is almost a schizophrenic approach to proposing this budget. 

So going backward in time, making it from mandatory to discretionary, is not consistent with tribal leaders. I said previously on 

HHS Secretary Tribal Advisory, it is something we have been advising this Administration and the past Administration that it has 

needed to be mandatory and advance appropriated. 

So I would like to hear how that changed and like to hear if tribal leaders have expressed at the tribal HHS Secretary Advisory 

Council if something has changed, or what fundamentally changed 

at IHS that they have a different position on it now. It is not what 

tribes want. 

Senator SMITH. Would either of you like to respond to that and 

help me understand why there would be a shift from mandatory to 

discretionary? 

Mr. WEAHKEE. Thank you, Senator Smith, I think that is in our 

ball park. 

In the Special Diabetes Program for Indians, it is the only mandatory line that we have within the Indian Health Service budget. 

It is part of a greater Administration decision to move a number 

of different programs from the mandatory to discretionary side of 

the budget. So it is an Administration policy decision. 

39 

Senator SMITH. Fundamentally, that would probably relate in 

less resources for the Special Diabetes Program, yes? 

Mr. WEAHKEE. The Administration supports the amount, which 

is $150 million. I think that in terms of how this would impact programming, there are concerns with funding level, if it goes into discretionary, impacts from continuing resolutions, planning, ability to 

plan for grants. These were some of the things that tribal leaders 

have expressed to me as concerns. But the movement would enable 

the Administration to make choices about their priorities and putting the dollars into their area of highest priority. 

Senator SMITH. I see I am out of time. I want to thank you for 

your responses, but I am not convinced that this is a good idea, to 

make a move from mandatory to discretionary. It strikes me that 

it will end up in less support for something we know works very 

well. 

Thank you very much, Madam Chair. 

Senator MURKOWSKI. Thank you, Senator Smith. 

Mr. Weahkee, you mentioned that one of the reasons behind this 

move from mandatory to discretionary was that you have effectively seen that the program has been working, that you are seeing 

a leveling of the diabetes. I have asked to get some better statistics 

within the Alaska Native community. Because it is my understanding that we are still faced with very, very serious issues as 

it relates to diabetes, both Type I and Type II. 

So this is the first I have heard that we are actually getting to 

a better place. So if you have any information that you can share 

with us, I would certainly appreciate that. 

I wanted to ask a question of you, Mr. Tahsuda. This relates to 

housing. Several of us mentioned the reduction in the BIA Housing 

Improvement Program, the HIP program. I don’t think that we are 

unique in Alaska when it comes to the situation of housing. We 

just completed a statewide housing assessment and the percentage 

of overcrowded homes is twice the national average. There are 

more than 79,000 households that spend more than 30 percent of 

their income on housing, approximately 14,600 homes that are energy-inefficient, meaning they are burdened with high energy costs. 

We then get the health impact study back that shows us what 

is happening with a deteriorating level of health within crowded 

households. When you have 15 people in a two-bedroom home, the 

spread of disease. When you have the example that I was using is, 

somebody is doing small engine repair in the middle of the house 

because it is winter time and you need to be inside, you have 

chemicals, you have issues that are in your air that is just wrong 

and unhealthy. 

The need is just so critical. The need, everywhere that I go, in 

every community, is almost staggering in some places. 

So we keep hearing the benefits of this program. And yet we zero 

it out within this particular budget. What is the logic here? 

Mr. TAHSUDA. Thank you, Senator. One of the efforts that we 

have made in the Department in this Administration is to focus on 

our core responsibilities, core operations first and identify how we 

can best meet those. 

40 

I think it is no secret that the Bureau of Indian Affairs has 

struggled over the years in adequately meeting even its core responsibilities. That is something we are committed to. 

Things like housing programs, there is a whole department that 

is dedicated to that. For us to put resources into something that 

is a very small part of our programs, but not be focused on our core 

operations is something that we have identified that we need to do 

better. We are looking at doing that, both through the budget and 

how we administer the program. 

Senator MURKOWSKI. And I would challenge you on this. I take 

it back to a trip that I took with a Secretary of Education, this was 

Rod Paige back in the Bush days. He was up in the State to look 

specifically to education. He came out in a very rural, very remote 

place called Gambell, Alaska, out on St. Lawrence Island in the 

middle of the Bering Sea. He looked around and realized that, if 

I don’t have housing for teachers, I can’t keep a teacher in a school, 

which means the kids can’t get educated. If I don’t have adequate 

housing, I have disease, I have issues that relate to health that increases my costs here. If I don’t have adequate housing—we moved 

forward on a housing initiative a dozen years ago. But it was 

multi-agency, it was multi-department. Because everything was so 

inextricably tied back to adequate housing. 

SO I hear what you are saying about core functions. I don’t disagree. But I also think that you need to look outside of the silos, 

all of you, when we are thinking about how we provide for the 

health, safety and well-being. And Admiral, you say you want, this 

budget provides for the physical, the mental, the spiritual health 

to the highest level. Well, think about it as it encompasses so many 

different aspects. 

Very quickly, because my time is just about out, and this is to 

you, Rear Admiral, YKHC is building a facility in Bethel. You 

know this is going to require a large staffing package. Your budget 

includes the staffing package for Fiscal Year 2019 at about $60 million. 

The reason I am asking this question is because the Fiscal Year 

2018 initial budget request was way off in its estimate of total 

need. You originally requested $20 million, but the need was 

roughly $60 million. As Chair of that Interior Appropriations Committee, we are paying pretty close attention to that. So I am asking 

for the assurance that the amount you are requesting for Fiscal 

Year 2019, including the funds that YKHC is looking for, fully 

meets the staffing needs for the facilities that you anticipate to 

open in Fiscal Year 2019? 

Mr. WEAHKEE. Thank you, Senator, and yes, ma’am, these numbers are updated, assuming there are no slips in opening dates, 

beneficial occupancy dates. Those numbers are projected to meet all 

the needs for staffing currently. 

Senator MURKOWSKI. We sure hope you are right on that. Thank 

you, Mr. Chairman. 

The CHAIRMAN. [Presiding.] Thank you, Senator Murkowski, and 

thank you for presiding. I appreciate it. 

Senator Cortez Masto. 

41 

STATEMENT OF HON. CATHERINE CORTEZ MASTO, 

U.S. SENATOR FROM NEVADA 

Senator CORTEZ MASTO. Thank you. Let me follow up on some 

of the concerns with affordable housing. In Nevada, this is a crisis. 

It is happening in Nevada in not only our urban but rural areas 

and our tribal communities as well. Obviously, it is an issue across 

the Country. 

One of my primary concerns, however, is also with the HUD 

VASH vouchers. Mr. Tahsuda, and I will ask Mr. Payment as well. 

The President’s budget proposes a nearly 50 percent cut to the 

HUD VASH vouchers for Native Americans, to $3 million. Yet in 

2015 alone, Nevada received HUD VASH vouchers worth more 

than $2 million. Can you please tell me the potential impact these 

cuts would have on our veterans and your concerns or thoughts on 

how you are going to address it? 

Mr. Payment, I don’t know if you would like to go first. 

Mr. PAYMENT. Sure. Again, I earlier talked about this inconsistency, or almost schizophrenic approach to proposing a Federal 

budget. We hear a lot from the Administration about the needs and 

concerns of our veterans. We serve the Nation at the highest rate 

of any racial-ethnic population, as part of our warrior tradition. As 

such, we have advocated for HUD VASH so that we can address 

those needs in our tribal communities. Our veterans are equal veterans as everybody else. This program is critically needed. We 

fought for it, we won it in the reauthorization of NAHASDA if that 

ever happens. 

So I do think it is a retreat from the commitment to our veterans, for sure. 

Senator CORTEZ MASTO. Mr. Tahsuda? 

Mr. TAHSUDA. That is not a program that is part of our portfolio. 

Senator CORTEZ MASTO. Thank you. So let me ask you this, then. 

There are also concerns about Native American housing, the block 

grants by $54 million. The concerns that I have there that I am 

hearing from this Administration. Again, affordable housing across 

this Country, this is something that we have seen, whether it is 

workforce housing or needs in our tribal communities. I don’t understand how we are putting forth a budget that is going to cut any 

type of needs in our community. 

Let me move on, because I know something, Mr. Tahsuda, that 

is in your wheelhouse. I constantly hear, but I have not seen any 

discussion, but I heard a little bit about this from Mr. McGhee, 

which is, the DOI reorganization effort. 

One thing I do know about it is BIA budget includes $900,000 

to support the DOI reorganization effort. But what I just heard 

from, I believe it was either Mr. McGhee or Mr. Payment, the tribal communities have not been brought into the discussion on what 

this looks like. I know I have not, and many people in my community have concerns about the reorganization and its impact. 

Can you enlighten me? What is the reorganization? What is the 

$900,000 used to support it? What are we looking at? 

Mr. TAHSUDA. Thank you, Senator. The reorganization is department-wide. It would be the largest reorganization of the department at least since Teddy Roosevelt was President. Our part in 

that obviously has to do with the relationship with the tribes and 

42 

sort of how we geographically administer our responsibilities to 

them. 

So the Secretary is committed from day one that the tribes would 

be consulted with, and they would not only get to look at the maps 

that everybody has but we will discuss with them how - 

Senator CORTEZ MASTO. Have you consulted with them yet? 

Mr. TAHSUDA. We have not. 

Senator CORTEZ MASTO. Do you intend to? 

Mr. TAHSUDA. We do. In fact we are finalizing plans to go out 

in a few months and start this process. This is not something that 

happens overnight. We wanted to proceed sort of carefully. 

We also have been talking internally with our regional directors, 

who work very closely with the tribal leaders in their regions to try 

to identify some things that would be good to discuss at a consultation. So that will be prepared and be going out in a few weeks 

through the tribal leaders with some suggested dates and locations 

to do that consultation. 

The $900,000 is in some ways a placeholder. One of the concepts 

in the reorganization is unified regions where you could have some 

common leadership in a region across the bureaus that are in that 

region. To do that requires little bit of planning. 

Senator CORTEZ MASTO. Are these management areas that I hear 

about, common management areas? 

Mr. TAHSUDA. Yes, that is one way to describe them. But it 

would be really to get better decision-making when you have different bureaus that weigh in on a particular matter that is before 

the Department. We often have that, where you have BLM land 

next to a tribal reservation or something, we have to do. 

So the idea is that that would be a more efficient way to reach 

the decision-making on behalf of everybody. 

Senator CORTEZ MASTO. Thank you. I know my time is about up. 

Let me just add one additional thing. I was just out at a Moapa 

Indian reservation in Southern Nevada. Same thing, concerns that 

I hear that I understand my colleagues talked about were the cuts 

to our law enforcement and basic law enforcement needs in our 

tribal communities. I cannot think of better use of this money than 

going into more money for victims of crime, more money for law enforcement, more money for the needs of our tribal communities who 

quite often are left behind when it comes to their law enforcement 

needs. 

So I am hoping that as we look at this and we are looking at putting money back into this that the opportunity to continue to support our tribal communities, our women and our children and victims and law enforcement, is something that the agencies are going 

to focus on as well. So thank you. I know my time is up. 

The CHAIRMAN. Vice Chairman, do you have any further questions for the witness? 

Senator UDALL. Yes, since we are on the second round, and we 

have Senator Daines here. We have to take care of him on the first 

round, right? 

The CHAIRMAN. Yes, Senator Daines, pardon me. I am sorry. 

Take six minutes. 

[Laughter.] 

43 

STATEMENT OF HON. STEVE DAINES, 

U.S. SENATOR FROM MONTANA 

Senator DAINES. Thank you, Mr. Chairman and Ranking Member Udall. I was certainly very pleased last month when Secretary 

Zinke visited the Blackfeet Reservation to authorize the first transfer of funds for the Blackfeet Water Rights Settlement. It was a 

long time coming. I worked with Secretary Zinke back when he was 

Congressman Zinke, when he was in the House, I was in the Senate. We got that across the finish line. 

As you know, though, in order for the settlement to be effective, 

all funds must be appropriated by the 2025 deadline. Unfortunately, we won’t get there on the current rate of funding proposed 

in the President’s budget. To get back on track, over $50 million 

must be appropriated for the settlement each year. 

Mr. Tahsuda, will the Department of Interior work with me to 

secure as much funding as possible to implement the settlement so 

it can become enforceable by the 2025 deadline? 

Mr. TAHSUDA. Thank you, Senator. Yes, implementation of the 

Blackfeet Water Settlement is a high priority for the Secretary. As 

you know, and to be supportive of your efforts in any way that we 

can to make sure that access to those settlements funds are appropriated in a timely fashion. 

We generally do that across the board, because you know we 

have statutory deadlines like that that come up with various water 

settlements as they come up. We work to try to meet those. 

Senator DAINES. Can I also get your commitment to propose 

more funding for the settlement in both the Bureau of Reclamation 

and Bureau of Indian Affairs accounts in future budget requests, 

to ensure the settlement is implemented in a timely manner? 

Mr. TAHSUDA. Well, Bureau of Rec is a little out of my league, 

but I will certainly bring that back to the Secretary. I know we 

have a commitment from our Bureau, at least, in working on that. 

I am sure Bureau of Rec will be interested in working on that as 

well. 

Senator DAINES. I appreciate it. It is going to take a team effort, 

combined effort of the Administration, as well as the Montana Congressional delegation, to finally see this settlement put into action. 

Thanks for your help on that. 

I would like to turn now to the physical maintenance needs in 

a certain school in the Northern Cheyenne Tribal Reservation, and 

that is in Busby, Montana. Specifically, it has rusty pipes, a dysfunctional kitchen where they can’t cook the kids’ food, the asbestos 

in the building. And because of it all, the low morale among the 

students and teachers. 

And it really begs the question, how can we expect Native students to succeed if we can’t create the most basic environment that 

promotes learning? 

My question is, Mr. Tahsuda, will the Department support a legislative proposal consistent with the proposed Public Lands Infrastructure Fund in the President’s budget request to support the repair and replacement of BIE schools that are in poor condition? 

Mr. TAHSUDA. Thank you, Senator. Yes, I think we are happy to 

work with Congress to determine the best way to implement that. 

As I mentioned earlier, we have the $634 million backlog on deVerDate Mar 15 2010 13:55 Dec 11, 2018 Jkt 033404 PO 00000 Frm 00047 Fmt 6633 Sfmt 6601 S:\DOCS\33404.TXT JACK
44 

ferred maintenance. So in the best fiscally responsible manner, it 

would probably be appropriate to look at some of those schools and 

replace them rather than keep up with deferred maintenance, 

which ends up being more expensive than having a new school facility. 

So certainly, we are happy to work with you and the Chairman 

and Vice Chairman and the Congress to give us the authority we 

need to address the schools in the best way possible. The Secretary 

cares very much about this. As you know, he has been to several 

tribal schools now. It is a high priority. 

Senator DAINES. Yes. What are the needs the Department sees 

as most pressing as you look across the BIA system? I know you 

have mentioned 2016 and other lists in response to Chairman 

Hoeven. But I am looking for more detail. 

Mr. TAHSUDA. For the BIE system? 

Senator DAINES. Right. 

Mr. TAHSUDA. Clearly, infrastructure is the most pressing. But 

we also have a need to address teacher recruitment, infrastructure 

for teachers. As you know, many of the schools are in very rural 

locations. Getting good, qualified teachers to go to those locations 

often requires having housing available for them as well. So being 

able to provide the facilities for the kids, facilities for the teachers. 

And we have some internal ideas about how we can do a better 

job of recruiting teachers as well. I don’t think historically the BIE 

has been able, through its own internal policies, has been able to 

do the best job of recruiting the teachers that we need. 

Senator DAINES. Lastly, I am going to take the Chairman up on 

this extra minute, the BIA proposed budget also includes $2.5 million to address the opioid crisis in Indian Country. In Montana, 

and among Montana’s Indian tribes, meth is actually more of our 

issue. They are both a problem; meth is the bigger problem. The 

Fort Belknap Indian Community, for example, is in a state of emergency over the meth epidemic. In fact, the Crow Tribe saw a methfueled triple homicide just last summer. 

Mr. Tahsuda, will this funding also be used to combat the meth 

crisis? 

Mr. TAHSUDA. Thank you, Senator, are you talking about the 

$2.5 million? 

Senator DAINES. Yes. So along with the opioid questions, will you 

also address the meth issue? 

Mr. TAHSUDA. Yes, Senator. I would say, yes, we will be. Senator, 

as you know, the drugs don’t separate themselves out when they 

come in. They often come in together. And in fact, I don’t know if 

you saw earlier today, but the Secretary, along with the White 

House, made an announcement last week, we ran a major interdiction effort in New Mexico. In addition to other drugs, 48 pounds 

of meth was part of the confiscation. 

So certainly, while you call it an opioid effort, our attention is to 

address the drug epidemic in general on the reservations, particularly with our law enforcement resources. 

Senator DAINES. Thank you very much. Thanks, Mr. Chairman. 

The CHAIRMAN. Vice Chairman Udall? 

Senator UDALL. Thank you, Mr. Chairman. 

45 

Tribes are disproportionately impacted by rapidly-changing climates. I see that in New Mexico with my tribes. The tribes, I really 

feel, in many cases, on some of my visits, the tribes are at ground 

zero for things like drought, wildfires, fishery disasters. These 

things are happening all across the United States. 

So given that tribes play a vital role in adapting to climate 

change, and given that 95 million acres of land managed either by 

tribes or for the benefit of tribes by the United States, and mind 

you, that is 11 million more acres than the entire National Park 

Service manages, Mr. Tahsuda, given the important role tribes can 

play in addressing climate change, why did Interior eliminate the 

Tribal Climate Resilience Program? 

Mr. TAHSUDA. Thank you, Vice Chair. Again, the primary thrust 

of the budget, the underlying theme is focusing on our core operations, core priorities. 

Senator UDALL. This is a core priority for tribes. 

Mr. TAHSUDA. What is a core priority, I think, Senator, is addressing the impacts. We have, we follow the science and the law 

when it comes to these matters. We have a responsibility to address the situation on the ground. We provide resources to the 

tribes to do that. We provide them through, for grazing lands, we 

have, again, we try to help the tribes address those. In most instances, they are best addressed, they are in the best position to 

identify those impacts. Our job really is to assist them in addressing those. That is what we see as one of our core, not just a core 

priority but a trust responsibility. 

Senator UDALL. I can just tell you from the things that I see on 

the ground in New Mexico, the resources are not there in any of 

the programs. This is severely, severely, underfunded. So eliminating a program like this Tribal Climate Resilience Program really hits to the heart of what tribes are trying to do to survive and 

continue their way of life. 

The Centers for Disease Control and Prevention recently reported that the rate of Hepatitis C infection tripled between 2010 

and 2015, mostly due to the use of needles by a growing number 

of drug users. These secondary health complications of substance 

abuse, things like increased rates of bloodborne infectious disease 

and of neonatal abstinence syndrome can prove just as costly to 

treat and just as deadly for many Native communities. 

Mr. Weahkee, does IHS have any data on changing numbers of 

IHS patients presenting with opioid use-related bloodborne infectious diseases like Hepatitis C and HIV–AIDS, or house statistics 

on rates of neonatal abstinence syndrome? 

Mr. WEAHKEE. Thank you, Senator Udall, for the question. With 

regard to Hepatitis C infection rates, we know nationally that approximately one in 30 baby boomers is infected. Our initial data 

tells us that we have approximately 34,000 patients in Indian 

Country infected with Hepatitis C. We know it is very costly to 

treat. 

We are just now beginning to look at the tie between opioid use 

and rates of Hepatitis C and HIV–AIDS. So we are gathering the 

body of evidence to be able to come back and provide you with more 

finite information. 

46 

Senator UDALL. Please do that and give us a very full answer in 

the record. We would really appreciate that. 

Vice Chairman McGhee, do you believe that IHS and other agencies at HHS are requesting enough funding resources to deal with 

these related health complications in tribal communities we were 

just talking about? 

Mr. MCGHEE. Even though we have had some increases, of 

course those increases are not enough. We talked about the increases, but yet we have also eliminated certain programs. We 

eliminated the Community Health program, that is a program that 

is vital to our Tribe, we use that program a lot. And if we are looking at the opioid crisis, if we are looking at these drug epidemics, 

like the meth problem that Senator Daines was talking about, 

there are various programs that all could work together. The other 

one is the Health Education Program that was eliminated, too. 

All these programs could work together for us to determine what 

the issues are and how can we impact those issues. We need to look 

at the possibility of saying, okay, these programs are needed. We 

appreciate the increase that were made, but these programs that 

were eliminated are needed because they were doing an effective 

job by going into the community and addressing the problems and 

seeing what they are. 

So I think, as Senator Murkowski related, all these things are 

connected. When you look at all of things, you have to look at the 

holistic approach to the issues that are impacting tribal nations, especially when it comes to health care. And it is holistic. We cannot 

look at one without looking at the other one. 

I think this goes back to, she was talking about housing needs, 

she was talking about infrastructure needs. All of these have an 

impact, so when there is a cut or elimination of a program, you are 

impacting the tribes. 

Senator UDALL. Vice President Payment, do you have any 

thoughts on this same issue? 

Mr. PAYMENT. We were talking about the reductions and the incidence of Hepatitis C. I was just thinking, I am from a large family; I have three brothers that have Hepatitis C and two are deceased. So I think the urgency might be lost in the statistics a little 

bit. 

Again, the budget proposal is good. So in some ways, there is a 

term in public policy called satisfice. And satisficing, because it is 

better than what we have had. But if you look at the budget formulation and self-governance committees and direct service tribes’ 

groups and the advocacy of what is actually needed to fulfill the 

trust responsibility. We are only scratching the surface. 

So certainly, any kind of cuts to programs and services that have 

demonstrated their utility is not warranted and not supported by 

tribal Indian Country. 

Senator UDALL. Thank you. I want to express my thanks to the 

entire panel today. Thank you very much, Mr. Chairman. 

The CHAIRMAN. I would also like to express my thanks to all of 

you for being here today. 

With that, if there are no more questions, then we will conclude 

the hearing. The hearing record will be open for two weeks and 

47 

members can submit additional questions in writing. We would ask 

that you respond to them as promptly as you can. 

With that, again, thank you, and we are adjourned. 

[Whereupon, at 4:22 p.m., the Committee was adjourned.] 

(49) 

A P P E N D I X 

PREPARED STATEMENT OF AHNIWAKE ROSE, EXECUTIVE DIRECTOR, NATIONAL INDIAN

EDUCATION ASSOCIATION (NIEA) 

Dear Chairman Hoeven: 

On behalf of the National Indian Education Association (NIEA), I respectfully submit the following comments in response to the President’s Fiscal Year (FY) 2019 

Budget Request for programs that impact Native students. 

NIEA is the most inclusive national organization advocating for improved educational opportunities for American Indian, Alaska Native, and Native Hawaiian 

students. Our mission centers on ensuring that Native students have access to a 

high-quality academic and cultural education, a goal that is only possible if Congress upholds the federal trust responsibility to tribes. 

The Federal Trust Relationship 

Congress has a federal trust responsibility for the education of Native students. 

Established through treaties, federal law, and U.S. Supreme Court decisions, the 

federal government’s trust responsibility to tribes includes the obligation to provide 

parity in access and equal resources to all American Indian and Alaska Native students, regardless of where they attend school. The President’s Budget Request for 

FY 2019 represents a rupture in the federal trust responsibility, an obligation 

shared between the Congress and the Administration for federally-recognized tribes. 

The President’s FY 2019 Budget for Native Education Programs 

NIEA has significant concerns regarding the proposed budgets for the Department 

of Interior and the Bureau of Indian Education (BIE) as well as the Department 

of Education (DoED). Overall, the President’s Budget for FY 2019 proposed a 19 

percent cut to the BIE and a five (5) percent cut to the DoED. These cuts disproportionately impact Native students, reducing tribal funding for resources and programs that support college, career, and community readiness. 

The Administration’s budget reflects steep cuts of over $172 million in funding for 

BIE education programs and $165 million for BIE school construction and facilities 

improvement. Severe cuts and elimination of key programs, including the JohnsonO’Malley program, ISEP formula funds, post-secondary scholarships, early childhood 

education, and juvenile justice detention centers, represent a failure to uphold the 

BIE’s fiduciary responsibility through the federal trust relationship. 

Despite estimates of over $1.3 billion in need for construction at Bureau funded 

schools, the President’s Budget completely eliminates funding for school and education facilities construction. Instead, the budget proposes $72.8 million to repair existing schools, which currently have a maintenance backlog of over $640 million. 

Such steep cuts to funding for safe and healthy classrooms for Native students 

amount to extreme neglect of Native students and families. 

Similarly, the President’s Budget for FY 2019 fails the 92 percent of Native students in public schools by cutting over $602 million from programs that impact Native students. The proposed budget slashes and eliminates critical education programs in Native communities, including Title VI Indian Education Grants, Native 

Hawaiian and Alaska Native education programs, Tribal Colleges and Universities, 

Impact Aid, and Title I. 

The BIE and DoED must uphold their constitutional obligations to tribal nations 

by fully funding programs that serve the unique academic and cultural needs of Native students. Tribes and Native communities must have access to the resources 

necessary for Native students to engage and thrive in the classroom and beyond. 

The following funding levels for key federal education programs would promote Native student success in the classroom and beyond: 

50 

DEPARTMENT OF THE INTERIOR 

INTERIOR—ENVIRONMENT APPROPRIATIONS BILL

Education Construction—Provide $430 million for Bureau of Indian Education (BIE) school construction and repair. An increase of $191.7 million 

above FY 2018 enacted. 

• This funding category includes school construction, facilities improvement and 

repair, and replacement school construction. 

• The Department of the Interior’s Office of Inspector General published in September of 2016, an evaluation titled ‘‘Condition of Indian School Facilities,’’ estimated the cost of fixing the dilapidated BIE schools, concluding that more than 

$430 million would be needed to fix the problems already identified. 

Broadband Internet Access—Provide $40 million to extend broadband 

Internet access. An increase of $21.15 million above FY 2018 enacted. 

• Less than ten percent of Indian Country has access to broadband Internet technology and 60 percent of BIE schools do not have adequate digital broadband 

access, or computer access, to be aligned with college and career readiness 

standards. 

• Expand e-rate for BIE schools, Native majority schools and Tribal Colleges and 

Universities. 

Johnson O’Malley—Provide $42 million for full funding. An increase of 

$27.1 million above FY 2018 enacted. 

• The Johnson O’Malley program has provided grants to supplement basic student needs by assisting with the unique academic and cultural needs of Native 

students since 1934. 

• The federal government allocated $125 per student in JOM funding in 1995. 

Current funds (FY 2017) provide less than $63.80 per student, which are often 

the only source through which Native students—including those in public 

schools—can engage in basic education activities. 

Juvenile Detention Education—Provide $620,000 for juvenile detention 

education in BIA-funded facilities. An increase of $120,000 above FY 2018 enacted. 

• This essential funding is used to provide educational services to detained and 

incarcerated youth at 24 BIA-funded juvenile detention facilities. 

• One of the best methods to rehabilitate individuals is through education and 

eliminating this program creates additional costs by increasing the rate of 

criminal recidivism. 

Student Transportation—Provide $73 million for student transportation 

in the BIE system. An increase of $16 million above FY 2018 enacted. 

• BIE schools incur disproportionately high costs in transporting Native students 

to and from school due to the often-rural location of BIE facilities. 

• These high costs often lead to funding shortfalls, which then must either go unpaid or funded by diverting funds from other education programs. 

Tribal Grant Support Costs—Provide $90 million for tribal grant support 

costs for tribally-operated schools. An increase of $9 million above FY 2018 enacted levels. 

• Tribal Grant Support Costs fund the administrative costs of existing triballyoperated schools. 

• Full funding is critical as these funds help tribes expand self-governance and 

tribal control over education programs. Schools must divert critical teaching and 

learning funding to cover any shortfalls in operational costs. 

Facilities Operations—Provide $109 million for BIE facilities operations. 

An increase of $42.4 million above FY 2018 enacted. 

• BIE schools use this funding for costs such as electricity, heating fuels, communications, GSA vehicle rentals, custodial services, and other vital operating expenses. 

• For years, schools have only received roughly 50 percent of funding needed for 

these expenses. This shortfall is unacceptable as costs continue to rise for vital 

services. 

51 

Facilities Maintenance—Provide $76 million for BIE facilities maintenance. An increase of $16.5 million above FY 2018 enacted. 

• BIE schools use this funding for the preventative and routine upkeep, as well 

as for unscheduled maintenance of school buildings, grounds, and utility systems. 

• Underfunding of maintenance continues to be an issue as buildings are in poor 

conditions and cannot maintain proper standards. 

Indian School Equalization Program (ISEP)—Provide $431 million for the 

Indian School Equalization Program. An increase of $24 million above FY 2018 

enacted. 

• These funds provide the core budget account for BIE elementary and secondary 

schools by covering teacher salaries, aides, principals, and other personnel. 

• ISEP funds are often reallocated to cover the program cuts in other areas of 

education. 

• ISEP must have adequate funding to ensure all program needs are fulfilled and 

must not be reduced to provide funds for new initiatives that have not been vetted by tribes. 

Bureau of Indian Education Immersion Demonstration Grants—Provide 

$5 million for BIE immersion programs. An increase of $3 million above FY 

2018 enacted. 

• According to UNESCO, 74 Native languages stand to disappear in the next decade, with only 20 Native languages being spoken by 2050. 

• Providing Immersion Demonstration Grant funds protects the cultural and linguistic heritage of Native students in education systems by providing Native 

students immersion learning in order to strengthen language, improve academic 

outcomes, and become future leaders of their tribes. 

Tribal Education Agencies/Departments—Provide $10 million to fund 

Tribal Education Agencies/Departments. An increase of $7.5 million above FY 

2018 enacted. 

• This funding assists Tribal Education Agencies (TEAs), who are uniquely situated at the local level to implement innovative education programs that improve 

Native education. 

• TEAs would use this much-needed funding to develop academic standards, assess student progress, and create math and science programs that require high 

academic standards for students in tribal, public, and BIE schools. 

Institute of American Indian Arts (IAIA) and Center for Lifelong Education—Provide $9.9 million to the Center & Museum under the American 

Indian, Alaska Native, and Native Hawaiian Culture and Art Development 

Act. Level funding with FY 2018. 

• IAIA is the only fine arts institution that awards bachelor and master degrees 

devoted to the study of contemporary Native American and Alaska Native arts. 

• IAIA has graduated more than 3,800 students from federally-recognized tribes 

and beyond. Of the $16.9 million requested, provide $11.8 million. 

Haskell Indian Nations University (HINU) and Southwestern Indian Polytechnic (SIPI)—Provide $25.0 million to HINU and SIPI under the Snyder 

Act. An increase of $6.7 million above FY 2018 enacted. 

• These institutions are federally chartered and funded separately from the other 

tribal higher education institutions and require additional funding considerations. 

• Of the $37.8 million requested, a one-time payment of $14.8 million is needed 

to forward fund these institutions, so that they can receive their institutional 

operating funds on an academic calendar (July 1), rather than the federal fiscal 

year (October 1). 

DEPARTMENT OF EDUCATION 

LABOR, HEALTH AND HUMAN SERVICES AND EDUCATION APPROPRIATIONS BILL

ESSA Title I, Part A: Local Education Agency Grants—Provide $20 billion 

for Title I, Part A. An increase of $4.2 billion above FY 2018 enacted. 

52 

• Title I of the Every Student Succeeds Act (ESSA) provides critical financial assistance to local educational agencies and schools with high percentages of children from low- income families that ensure all children meet challenging state 

academic standards. 

• ESSA’s appropriation for FY2018 is $15.5 billion. However, in order to counter 

annual inflation and sequestration, a drastic increase in funding is needed to 

meet the needs of Native students and students from low-income families. 

ESSA Title VI: Indian Education Formula Grants—Provide $198 million 

for Title VI, Part A. An increase of $92.7 million above FY 2018 enacted. Authorized funding for Title VI, Part A for FY2017 is $105.3 million. Increases are needed 

as this critical grant funding is designed to supplement the regular school program 

and assist Native students so they have the opportunity to achieve the same educational standards and attain parity with their non-Native peers. 

• Title VI funds support early-childhood and family programs, academic enrichment programs, curriculum development, professional development, and culturally-related activities. 

• As Native students lag far behind their non-Native peers in educational 

achievement, increased funding is necessary to address this substantial gap. 

ESSA Title VI, Part A, Subpart 2: Special Programs and Projects to Im- prove Educational Opportunities for Indian Children—Provide $67.9 million for Title VI, Part A, Subpart 2: Special Programs and Projects to Improve Educational Opportunities for Indian Children. 

• ED’s Native Youth Community Projects initiative provides better comprehensive, community-driven strategies to improve college and career-readiness of 

Native youth. 

ESSA Title VI, Part A, Subpart 3: Language Immersion and National Activities—Provide $10 million for Title VI, Part A, Subpart 3. An increase of 

$3.1 million above FY 2017 enacted. 

• Under the ESSA, language immersion programs are funded in public schools. 

It is well documented that Native students are more likely to thrive in environments that align with their language and culture. 

ESSA Title VI, Part B: Native Hawaiian Education Program—Provide 

$36.4 million Title VI, Part B. 

• The Native Hawaiian Education program empowers innovative culturally appropriate programs to enhance the quality of education for Native Hawaiians. 

When establishing the Native Hawaiian Education Program, Congress acknowledged the trust relationship between the Native Hawaiian people and the 

United States. 

• These programs strengthen the Native Hawaiian culture and improve educational attainment, both of which are correlated with positive economic outcomes. 

ESSA Title VI, Part C: Alaska Native Education Equity Assistance Program—Provide $36.4 million for Title VI, Part C. 

• Alaska does not receive any BIE funding, making this source of funding the 

only resource available for Alaska Native tribes and organizations to provide 

supplemental programs that address the achievement gap for Alaska Native 

students. 

• This funding is crucial to closing the gap between Alaska Native students and 

their non- Native peers as eligible activities include professional development 

for educators, activities carried out through Even Start programs and Head 

Start programs, family literacy services, and dropout prevention programs. 

ESSA Title VII: Impact Aid—Provide $2 billion for Title VII. An increase of 

$589 million above FY 2018 enacted. 

• Impact Aid provides direct payments to public school districts as reimbursement 

for the loss of traditional property taxes due to a federal presence or activity, 

including the existence of an Indian reservation. 

• With nearly 93 percent of Native students enrolling in public schools, Impact 

Aid provides essential funding for schools serving Native students. 

School Construction—Provide $500 million for school construction. Provide funding for school construction consistent with the Trump Administration’s 

53 

focus on infrastructure by providing funding in communities where significant concentrations of Native students attend public schools. 

• With 93 percent of Native students in public schools and more than 40 percent 

of Native students in rural communities with limited capacity for bonding, investing in Indian Country via schools will help prepare Native students for the 

21st century economy. 

HEA Title III: Tribal Colleges and Universities—Provide $65 million ($30 

million in discretionary funding and $30 million in mandatory funding) for 

Title III–A grants under the Higher Education Act for Tribal Colleges and 

Universities. 

• Titles III and V of the Higher Education Act, known as Aid for Institutional 

Development programs, support institutions with a large proportion of financially disadvantaged students and low cost-per-student expenditures. 

HEA Title III: Tribal Colleges and Universities: Adult/Basic Education— 

Provide $8 million for American Indian Adult/Basic Education at Tribal 

Colleges and Universities, from existing funds appropriated for state block 

grant funding. No such set-aside from existing funds included in FY 2018 enacted. 

• Despite an absence of dedicated funding, TCUs must find ways to continue to 

provide basic adult education classes for those American Indians that the 

present K–12 Indian education system has failed. 

• There is a wide-ranging need for adult basic education and literacy programs 

and TCUs need adequate funding to support the ever increasing demand for 

adult education and remediation program services. 

HEA Title III, Part F: Native American-Serving, non-Tribal Institutions— 

Provide $10 million for non-tribal, Native-serving institutions of higher 

education. An increase of $1.7 million above FY 2018 enacted. 

• Funds provided under this line item serve as the primary source of federal 

funding for Native-serving, non-tribal institutions of higher education. 

• With nearly 100 institutions potentially qualifying as Native-serving, non-tribal 

institutions, an increase in funding will provide the opportunity for more Native-serving institutions to better serve their students and increase graduation 

rates among Native students. 

Perkins: Tribally Controlled Post-Secondary Career and Technical Institutions—Provide $10 million for postsecondary career and technical institutions program funds under Carl Perkins Technical and Career Education 

Act. An increase of $1.7 million above FY 2018 enacted. 

• Vocational education/training programs are very expensive to conduct, but are 

vital to preparing a future workforce that will operate safely and efficiently contributing greatly to the global economy. 

• Currently, two TCUs participate in this funding program: United Tribes Technical College in North Dakota, and Navajo Technical University in New Mexico. 

The TCUs urge Congress to appropriate $10 million for Sec. 117 of the Act. 

Infrastructure Proposal for BIE School Construction 

Though NIEA is pleased to see BIE schools included in the $18 billion ‘‘Public 

Lands Infrastructure Fund’’ proposal from President Trump, we remain concerned 

that the means for obtaining funds could infringe on public lands. If the proposal 

were to fully respect tribal sovereignty and provide the full funding that BIE schools 

need—more than $640 million in immediate funding and at least $1.3 billion in 

funding for construction and maintenance—then NIEA will of course be interested 

in learning more about the proposal. If, however, the proposal is for funding that 

does not respect the inherent sovereignty of tribes, we could not support it. 

NIEA is concerned about steep cuts to education construction for BIE schools 

without any details or tribal input regarding the current infrastructure proposal. As 

expressed by Chairman Payment of the Sault Ste. Marie Tribe of Chippewa Indians 

during the hearing, the Administration has slashed critical construction and maintenance funding for the BIE in exchange for the possibility of future funding in the 

infrastructure proposal. The proposed infrastructure package does not abrogate the 

federal trust responsibility to fund construction for BIE schools in the federal budget. Though current funding levels fail to fully address the $640 million need for construction, the need for construction and repair in BIE schools is too great to wait 

for a possible infrastructure package without ongoing funding to address construcVerDate Mar 15 2010 13:55 Dec 11, 2018 Jkt 033404 PO 00000 Frm 00057 Fmt 6601 Sfmt 6621 S:\DOCS\33404.TXT JACK
54 

tion needs. Native students must have access safe and healthy classrooms where 

they can learn and thrive. 

Conclusion 

With these concerns and through these recommendations on the President’s FY 

2019 Budget Request for Indian programs, NIEA looks forward to working with the 

Chairman to pass a budget that serves the unique needs of the only students that 

the federal government has a direct responsibility to educate—Native students. 

PREPARED STATEMENT OF CHRIS JAMES, PRESIDENT/CEO, NATIONAL CENTER FOR

AMERICAN INDIAN ENTERPRISE DEVELOPMENT

The National Center for American Indian Enterprise Development (‘‘The National 

Center’’ or ‘‘NCAIED’’) appreciates this opportunity to present our views on the 

President’s Budget Requests for Fiscal Year (FY) 2019 for Indian Programs that 

most directly affect business, economic and energy development in Indian Country. 

With over 40 years of assisting American Indian Tribes and their enterprises with 

business and economic development, the National Center has evolved into the largest national Indian specific business organization in the United States. Driven by 

our motto—’’We Mean Business of Indian Country’’—we are actively engaged in 

helping Tribes and native enterprises and entrepreneurs realize their business 

goals. We fulfill our mission by assisting with business, financing and contracting 

needs, including trainings, business development and other guidance, marketing 

tools, access to capital, and procurement technical assistance. In addition to our 

American Indian Procurement Technical Assistance Center (AIPTAC), we will be expanding our procurement and technical assistance to new areas and developing the 

Native Edge Institute to offer one-on-one counseling to Native businesses and entrepreneurs. We are revamping our Native Edge online portal and will add a lending 

component through participation of Community Development Financial Institutions 

(CDFIs). Our growing annual Reservation Economic Summits (RES) will continue 

to offer conference sessions, training workshops, Buy Native Procurement Matchmaking, Trade Show, and other networking opportunities. 

Overview of FY 2019 Budget Requests for Indian Programs 

The National Center views many of the FY 2019 Budget Requests for Indian Programs with skepticism and opposes the deep cuts or elimination of several key programs that support business, economic, housing and community development in Indian Country. Programs that should be strengthened, not eliminated, include HUD’s 

Indian Community Development Block Grant Program, and Labor’s Indian and Native American (Jobs) Program. Given the federal trust obligations to sovereign tribal 

governments, the federal budget must provide the essential support that federal offices and programs need to fulfill those obligations, and that means maintaining 

current or increasing funding levels. Our recommendations include examples of the 

programs worthy of greater resources because of their targeted support for tribes 

and Indian communities specifically. 

Federal Support as Leverage for Business and Economic Development in 

Indian Country 

The National Center’s previous budget views on the FY 2017 and 2018 Budget 

Requests noted many of the programs that address our key priorities. We are 

pleased that the FY 2018 Omnibus Appropriations agreement increased funding for 

advance several of our priorities, but the FY 2019 Budget Requests propose cuts, 

some drastic, to these important programs. We urge the Senate Committee on Indian Affairs to consider our recommendations below and incorporate them into its 

own recommendations to the Senate Budget and Appropriations Committees: 

Business and Procurement Technical Assistance 

• Procurement Technical Assistance Program: In the FY 2019 Department of Defense (DOD) appropriations for Title III, Operations and Maintenance—DefenseWide, Congress should provide the FY 2018 enacted level of $38.5 million for 

the Defense Logistics Agency’s Procurement Technical Assistance Cooperative 

Agreement Program to support the Procurement Technical Assistance Centers 

(PTACs) that operate across the country, and continue to set aside a specific 

amount for American Indian PTACs (AIPTACs). This funding helps leverage 

private matching funds of PTACs and AIPTACs to provide procurement technical assistance to small business contractors seeking contracts with federal, 

state, local and tribal governments. To enable AIPTACs to assist contractors 

seeking opportunities afforded by hikes in defense spending, and to match the 

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authorized funding level for AIPTACs, our FY 2019 recommendation: At least 

$38.5 million for all PTACs, including $4.5 million for AIPTACs. 

• 5 percent Indian Incentive Program: Congress should continue to include in Defense Appropriations, Title VIII—General Provisions, mandatory funding for 

this important program that supports defense procurement objectives by affording eligible DOD prime and higher-tier contractors an incentive payment of 5 

percent of the value of contract work awarded to and performed by subcontractors owned by American Indian, Alaska Native, or Native Hawaiian individuals 

or communities. Prior years’ funding of $15 million annual resulted in $1.7 billion worth of work subcontracted to native-owned companies, yet a substantial 

backlog remains (well over $30 million in qualified incentive payment requests). 

Working down this backlog will require a sustained funding effort, and the $20 

million just approved for FY 2018 is a first step in that direction. To keep decreasing the backlog, and align with higher DOD procurement spending, our FY 

2019 recommendation: $20 million for the 5 percent Indian Incentive Program. 

• Minority Business Development Agency: The FY 2019 Budget Request proposes $10 million for the MBDA at the Department of Commerce, and reform of its 

service delivery model and re-orient its focus on policy, advocacy research and 

public/private partnership. 

Operating as an Executive Order agency, MBDA has funded some Native American-focused MBDA Centers and has provided the only funding ever made available for the statutorily authorized Office of Native American Business Development (ONABD). The FY 2018 enacted level for MBDA is $39 million for MBDA, 

with conference report language directing that no less than 50 percent of its 

funding be awarded through competitive agreements, external awards and 

grants. Just as level funding for MBDA is important, we strongly believe, as 

noted below on p. 4, that funding should be provided for the ONABD as authorized in the Senate-passed ‘‘Indian Community Economic Enhancement Act’’ (S. 

1116). That bill places the ONABD within the Office of the Secretary of Commerce where it belongs, not under the purview of the MBDA. Our FY 2019 recommendation: $39 million for MBDA, with more support for Native-focused 

Business Centers. 

• Administration for Native Americans: We are pleased that the FY 2019 Budget Request proposes $52 million for ANA, including its effective competitive grant 

program to implement Social and Economic Development Strategies (SEDS), 

and that the Senate just passed S. 1116 to reauthorize ANA and enhance the 

SEDs program. Our FY 2019 recommendation: At least $52 million for ANA. 

Leveraging Federal Funds to Increase Access to Capital 

• Indian Loan Guarantee Program: Once again, needed funding for this key DOI loan guarantee program faces a proposed cut for FY 2019, down to $6.597 million with a cap of $108.55 million in aggregate loan value. Congress has been 

adding funds to this essential program, just approving $9.27 million for FY 

2018, with a higher aggregate loan cap of $123.6 million, to help meet Indian 

Country’s financing needs. This program successfully incentivizes and leverages 

private sector lending for tribal, tribal enterprise and other native business 

projects for business expansion, economic or energy development. With a great 

track record of successful projects, the program produces a $16 return on each 

$1 of the federal investment. Our FY 2019 recommendation: $15 million to support as much as $250 million in private sector financing for Indian Country 

projects, including small infrastructure projects. 

• Tribal Energy Loan Guarantee Program: After many years, Congress finally appropriated $9 million for FY 2017 for this important program to leverage private financing for energy project development in Indian Country. Sadly, the $9 

million was rescinded, but Congress approved $1 million for FY 2018 and the 

Department of Energy’s Loan Programs Office is conducting listening sessions 

to arrive at the best approach to implementing the Tribal Energy Loan Guarantee Program, even though the FY19 Budget Request proposes to eliminate it. 

Our FY 2019 recommendation: $9 million to implement this key program. 

• Native CDFIs: The FY 2019 Budget Request proposes to eliminate funding for 

Community Development Financial Institutions (CDFI) Fund grants, including 

grants for Native CDFIs as part of the Native American CDFI Assistance initiative, and provide only limited funding to support management of the CDFI 

Bond Guarantee Program, New Market Tax Credits, and certification and compliance for Native and other CDFIs. As barriers to capital access are nowhere 

more steep than in Indian Country, greater support (not less) for Native CDFI 

grants is critically necessary to make available more small and micro loans for 

56 

individuals and small businesses, and to facilitate financial literacy and more 

entrepreneurial development training, in Indian communities. Congress just approved $250 million for the CDFI Fund, and of the $161 million for financial 

and technical assistance grants, $16 million was provided for Native CDFIs as 

well as a waiver of the non-federal match requirement. Our FY 2019 recommendation: $20 million for Native CDFI grant funding. 

• New Market Tax Credits: The FY 2019 Budget Request proposes insufficient 

support for the CDFI Fund generally, and for the New Market Tax Credit 

(NMTC) program. What should be provided is a set aside for, or emphasis on 

investments into, underserved tribal communities as the National Center and 

other national native organizations have urged. Our FY 2019 recommendation: 

Increased support for NMTCs and set aside of NMTC allocations for project development in Indian Country. 

Support for High Level Federal Offices Focused on Native American Affairs 

As noted in our previous years’ budget recommendations, the National Center is 

convinced that business, economic, community and energy development advances in 

Indian Country when there is a high level Office within a key federal department 

or agency to focus its resources on Native American initiatives. Most of the key federal departments have supported such a high level office, although the FY 2019 

Budget Request reduces that support. Most unfortunate, the Department of Commerce (DOC) still has no operational Office of Native American Business Development (ONABD), as authorized in Public Law 106–464, to help facilitate access to 

the Department’s plentiful resources to promote commerce, international trade and 

tourism for Indian Country. As already noted, we strongly support speedy enactment of S. 1116 to elevate and fund this Office so that it can coordinate all of Commerce’s programmatic activities, as well as initiatives with other key federal departments, to increase business and economic development, trade and tourism in Indian 

Country! 

Below are the National Center’s views on funding for these essential Offices: 

• Commerce—Office of Native American Business Development: The ONABD 

should be placed in the office of the Secretary, with a $2 million budget, as authorized in Senate-passed S. 1116. Our FY 2019 recommendation: $61 million 

for DOC’s Departmental Management, within which $2 million should be set 

aside for the ONABD. 

• DOI—Office of Indian Energy and Economic Development: The FY 2019 Budget 

Request continues to underfund the economic development activities of this important office. In addition to funds for energy development-related initiatives, 

funding should be increased for the Economic Development Division of OIEED 

so that it can enhance its economic development initiatives and implement programming for Native Business Incubators, as proposed in Senate-passed S. 607. 

Our FY 2019 recommendation: $7 million more for OIEED. 

• SBA—Office of Native American Affairs: The FY 2019 Budget Request includes 

$1.5 million for Native American Outreach, down from $2 million enacted for 

FY 2018. This line item supports SBA’s Office of Native American Affairs, headed by an Assistant Administrator to manage the outreach activities. Such activities include multi-agency workshops, Native supplier events, and facilitation of 

Native contractors’ participation in SBA’s 8(a), HUBZone, women-owned business, veteran and service disabled veteran-owned, and other small business contracting programs. Our FY 2019 recommendation: $2 million for Native American Outreach. 

• USDA—Office of Tribal Relations: The FY 2019 Budget Request proposes $2 

million for the Office of Partnerships and Public Engagement, into which USDA 

has lumped four previously separate programs, including the statutorily authorized Office of Tribal Relations (OTR), previously funded at $500,000 or higher. 

The OTR has led many successfully initiatives to coordinate USDA programs 

to assist tribes and native agricultural enterprises, and target USDA’s assistance to enhance agricultural financing and market access, and promote business, economic, community and infrastructure development in Indian Country. 

We are pleased that Congress continued at least level funding of USDA’s Rural 

Development programs that have so effectively provided assistance to Indian 

communities, but we oppose the cuts proposed in the FY 2019 Budget Requests. 

Our FY 2019 recommendation: $500,000 at least for the OTR specifically, and 

preserve funding for the RD programs that best assist Indian community development. 

57 

• DOE—Office of Indian Energy Policy and Programs: The FY 2019 Budget Request of $10 million falls woefully short of what the OIEPP needs and the level 

of $18 million provided for FY 2018. We commend this Committee for having 

endorsed a higher funding level for this important office, and urge it to do so 

again. Our FY 2019 recommendation: $20 million for the OIEPP. 

Thank you for the opportunity to present these views and reiterate our requests 

to increase support for the above programs that invest federal dollars as leverage 

to multiply exponentially the amount of tribal and private capital invested in Indian 

Country. 

PREPARED STATEMENT OF THE NATIONAL INDIAN HEALTH BOARD (NIHB) 

Chairman Hoeven, Vice Chairman Udall, and Members of the Committee, the National Indian Health Board (NIHB) thanks you for holding the hearing, ‘‘The President’s FY2019 Budget Request for Indian Programs.’’ On behalf of NIHB and the 

573 federally-recognized Tribes we serve the National Indian Health Board (NIHB) 

submits this testimony for the record. NIHB is a 501(c)3, not for profit, national 

Tribal organization founded by the Tribes in 1972 to serve as the unified, national 

voice for American Indian and Alaska Native (AI/AN) health in the policy-making 

arena. Our Board of Directors is comprised of distinguished and highly respected 

Tribal leaders in AI/AN health. They are elected by the Tribes in each region to be 

the voice of the Tribes at the national level. 

The Federal Trust Responsibility 

The federal promise to provide Indian health services was made long ago. Since 

the earliest days of the Republic, all branches of the federal government have acknowledged the nation’s obligations to the Tribes and the unique trust relationship 

between the United States and Tribes. 

The Indian Health Service is the primary agency by which the Federal Government meets the trust responsibility for direct health services. IHS provides services 

in a variety of ways: directly, through agency-operated programs and through Tribally-contracted and operated health programs; and indirectly through services purchased from private providers. IHS also provides limited funding for urban Indian 

health programs that serve AI/ANs living outside of reservations. Tribes may choose 

to receive services directly from IHS, run their own programs through contracting 

or compacting agreements, or they may combine these options based on their needs 

and preferences. 

Today the Indian healthcare system includes 46 Indian hospitals (1⁄3 of which are 

Tribally operated) and nearly 630 Indian health centers, clinics, and health stations 

(80 percent of which are Tribally operated). When specialized services are not available at these sites, health services are purchased from public and private providers 

through the IHS-funded purchased/referred care (PRC) program. Additionally, 34 

urban programs offer services ranging from community health to comprehensive primary care. To ensure accountability and provide greater access for Tribal input, IHS 

is divided into 12 geographic Service Areas, each serving the Tribes within the Area. 

It is important to note that Congress has funded IHS at a level far below patient 

need since the agency’s creation in 1955. In FY 2017, national health spending was 

$9,207 per capita while IHS spending was only $3,332 per patient. 

The Federal Government has yet to live up to the trust responsibility to provide 

adequate health services to our nation’s indigenous peoples. Historical trauma, poverty, lack of access to healthy foods, loss of culture and many other social, economic 

and environmental determinants of health as well as lack of a developed public 

health infrastructure in Indian Country all contribute to the poor state of American 

Indian and Alaska Native (AI/AN) health. This underfunding of the IHS is clearly 

visible when examining the health disparities for AI/ANs. Among AI/ANs, the rate 

of drug overdose deaths is twice that of the general population, according to the 

IHS. Deaths from prescription opioid overdoses increased four-fold from 1999 to 

2013 among AI/ANs. According to the Office of Minority Health, from 2009–2013, 

AI/AN men were almost twice as likely to have liver and inflammatory bowel disease (IBD) cancer as non-Hispanic White men and are 1.6 times as likely to have 

stomach cancer as non-Hispanic White men, and are over twice as likely to die from 

the same disease. AI/AN women are 2.5 times more likely to have, and almost twice 

as likely to die from, liver and IBD cancer, as compared to non-Hispanic White 

women. In 2015, AI/ANs were three times more likely to die from hepatitis C than 

non-Hispanic whites, and twice as likely to die from hepatitis B. In 2014, suicide 

was the second leading cause of death for AI/ANs between the ages of 10 and 34 

58 

1Office of Minority Health. Minority Population Profiles, American Indian and Alaska Natives. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=39. Accessed on March 21, 

2018. 2The full FY 2019 Tribal Budget Request is available at http://nihb.org/legislative/budgetlformulation.php 

and adolescent AI/AN females have death rates at almost four times the rate for 

White females in the same age groups. 1

In FY 2017, the IHS per capita expenditures for patient health services were just $3,332, compared to $9,207 per person for health care spending nationally. Even 

other federally funded health systems do better than IHS. The Veterans’ Health Administration’s direct health care budget is 14 times that of the IHS yet served only 

4 times the population with direct care services. 

Tribes are grateful for the recent increases to the IHS Appropriation over the last 

several years, but note that the increases have not allowed for significantly expanded services or improvements in equipment, buildings or staffing. While the IHS 

annual appropriated budget has increased by $2.2 billion (about 52 percent) since 

FY 2008 much of this increases simply covers needs associated with population 

growth, inflation, full funding of Contract Support Costs and maintaining current 

services. This leaves little extra money for making actual improvements in health 

services or to build public health infrastructure for American Indians and Alaska 

Natives. We are only 2 percent of the population. Congress, please take the courageous and ethical step of adequately funding health care for this country’s first peoples. 

The following testimony reflects the IHS Tribal Budget Formulation Workgroup 

recommendations for FY 2019. 2 The Tribal workgroup is comprised of American Indian and Alaska Native Tribal leaders, technicians and researchers, nationwide, 

who come together each year to form Indian Country’s priorities as they relate to 

IHS. Through this process and product, this testimony reflects, therefore, the national Tribal voice. 

Indian Health Service Budget 

Tribes recommend $32 billion to fully fund IHS, to be phased in over 12 years. 

This includes amounts for personal health services, wrap-around community health 

services, facilities, and capital investments. Within this $32 billion is: $17.37 billion 

for Medical Services; $1.82 billion for Dental and Vision Services; $4.07 billion for 

Community and Public Health Services; $8.77 billion for facility upgrades and upfront costs (non-recurring investments). The Workgroup’s top 5 areas for program 

expansion at IHS for FY 2019 include: 

1) Hospitals and Clinics 

2) Purchased/Referred Care 

3) Mental Health 

4) Alcohol and Substance Abuse and 

5) Dental Services 

Hospitals and Clinics—In FY 2018, Tribes recommend $2.3 billion for Hospitals 

and Clinics (H&C) which is $246 million over the FY 2018 enacted level. Adequate 

funding for the Hospitals & Clinics (H&C) line item is the top priority for fiscal year 

2020, as it provides the base funding for the 650 hospitals, clinics, and health programs that operate on Indian reservations, predominantly in rural and frontier settings. This is the core funding that makes available direct medical care services to 

AI/ANs. Increasing H&C funding is necessary as it supports medical care services 

provided at IHS and Tribally-operated facilities, including emergency care, inpatient 

and outpatient care, medically necessary support services, such as laboratory, pharmacy, digital imaging, information technology, medical records and other ancillary 

services. In addition, H&C funds provide the greatest flexibility to support the required range of services needed to target chronic health conditions affecting AI/ANs 

such heart disease and diabetes, treatment and rehabilitation due to injuries, maternal and child health care and communicable diseases including influenza, HIV/ 

AIDS, and hepatitis. 

Health IT—One area within the H&C line item is the area of Health Information 

Technology (HIT). IHS does not receive dedicated and sustainable funding for the 

agency to adequately support health IT infrastructure, including full deployment of 

electronic health records (EHRs). The current Resource and Patient Management 

System (RPMS), is a comprehensive suite of applications that supports virtually all 

clinical and business operations at IHS and most Tribal facilities. No new funds 

have been appropriated to support operations and maintenance for the RPMS suite. 

This has resulted in a mass exodus of Self Governance Tribes who have opted to 

59 

3 Beals, J., Novins, D.K., Whitesell, N.R., Spicer, P., & Mitchell, C.M., & Manson, S.M. (2005). 

Prevalence of mental disorders and utilization of mental health services in two American Indian 

reservation populations: Mental Health disparities in a national context. American Journal of 

Psychiatry, 162, 1723–1732. Walls, M. L., Johnson, K. D., Whitbeck, L. B., & Hoyt, D. R. (2006). 

Mental health and substance abuse services preferences among American Indian people of the 

northern Midwest. Community Mental Health Journal, 42, 521-535. 

withdraw their IT shares to seek other commercial HIT solutions which promise to 

more readily address their needs. In fact, this has caused a domino effect in that 

the IHS agency technology budget is decreasing more rapidly because of the withdrawal of these shares. Without a viable solution, IHS Health IT system will be left 

behind, and IHS patients will be put at risk. With the VA’s announcement to move 

toward a commercial-off the shelf EHR, it is critical that IHS receive parallel appropriations to facilitate the replacement of RPMS, since our system is based on VA’s 

VistA program. 

Purchased/Referred Care—In FY 2019, Tribes recommend $1.2 billion for the Purchased/Referred Care (PRC) program. This is $282 million above the FY 2018 enacted level. The PRC budget supports essential health care services from non-IHS 

or non-Tribal providers. In FY 2015, PRC denied over $423.6 million in services— 

that is 92,354 needed health care services that AI/ANs were denied from receiving. 

This core funding is still a top priority for the Tribes, as some service Areas rely 

heavily on PRC dollars, and we hope to see it continued as a priority in FY 2019. 

These deferrals are real lives. The shortage of PRC funds directly contributes to the 

opioid crisis in Tribal communities. The deferral of care due to funding and workforce shortages has pushed more and more Tribal members towards prescription 

opioids to treat health conditions that would otherwise successfully be treated with 

non-opioid therapies. This endless cycle of deferral and opioid dependency is a direct 

result of the underfunding of the IHS system, and must be stopped. 

Mental Health—In FY 2018, Tribes are recommending $207,791 million. This is $107.9 million above FY 2018 enacted. This significant increase is needed to enhance the capacity of Tribal communities to develop innovative and culturally relevant prevention programs that are greatly needed in Tribal communities. Research 

has shown that AI/ANs do not prefer to seek mental health services that rely solely 

upon Western models of care; which suggests that AI/ANs are not receiving the 

services they need. 3 For example, NIHB spoke with a young woman from the Pine 

Ridge Reservation who courageously shared her story about her multiple suicide attempts. She went to an inpatient psychiatric facility in Rapid City, but did not feel 

that she received healing. It wasn’t until she attended a Lakota cultural healing 

camp that her life turned around. She said, ‘‘It made me feel powerful. I got to learn 

about my culture and it made me feel closer to who I am.’’ But the camp operates 

through donations and community support. Congress should provide dedicated funding for these types of activities. The geographic remoteness of most Tribal communities demands unique and innovative treatment options to address comprehensive 

mental health, substance abuse and psychiatric services. 

Alcohol and Substance Abuse—In FY 2019, Tribes recommend $207.8 million for 

the Alcohol and Substance Abuse budget. This is $100 million above the FY 2018 

enacted level. Of the challenges facing AI/AN communities and people, no challenge 

is more far reaching than the epidemic of alcohol and other substance abuse. For 

instance, the state of Minnesota reported that pregnant AI/AN women were 8.7 

times more likely to be diagnosed with maternal opioid dependency, and that AI/ 

AN infants were 7.4 times more likely to be born with neonatal abstinence syndrome (NAS)—meaning that the repercussions and trauma of this crisis are 

intergenerational. Other secondary impacts include the undue burdens imposed on 

many AI/AN families struggling with opioid and substance use disorders, the children forced into foster care, and the kinship care networks that are strained beyond 

their ability. As NIHB recently testified before this committee, the current opioid 

and substance abuse epidemic represents one of the most pressing public health crises affecting Tribal communities. While this epidemic is affecting many communities 

throughout America, it has disproportionately impacted Tribes and has further 

strained the limited public health and healthcare resources available to Tribes. Successful treatment approaches include traditional healing techniques that link the 

services provided to cultural practices and spiritual support. However, we now know 

that inadequate funding for alcohol and substance abuse services has a ripple effect 

on other services, such as overloading the agency’s outpatient clinics, urgent care 

departments, and emergency departments with unnecessary visits (typically funded 

by Hospitals and Health Clinic funds and third party collections). 

Dental Health—For FY 2019, Tribes recommend $251.9 million for Dental Health. 

This is $56.6 million above the FY 2018 enacted level. In the general U.S. popuVerDate Mar 15 2010 13:55 Dec 11, 2018 Jkt 033404 PO 00000 Frm 00063 Fmt 6601 Sfmt 6621 S:\DOCS\33404.TXT JACK
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4 25 U.S.C. 1616l(d) 

5 ‘‘Federal Indian Trust Responsibility: The Quest for Equitable and Quality Indian 

Healthcare—The National Tribal Budget Formulation Workgroup’s Recommendations on the Indian Health Service Fiscal Year 2018 Budget.’’ June 2016. P. 64. 

lation, there is one dentist for every 1,500 people, but in Indian Country, there is 

only one dentist for every 2,800 people. Nationally, American Indian children have 

the highest rate of tooth decay than any population group in the country. On the 

Pine Ridge Reservation, the W.K. Kellogg Foundation found that 40 percent of children and 60 percent of adults suffer from moderate to urgent dental needs, including infections and other problems that could become life-threatening. Nationally, 59 

percent of AI/AN adult dental patients have untreated decay, this is almost three 

times as much as U.S Whites. It is not uncommon to hear stories of elderly patients 

waiting out in the cold for one of just a few dental appointments available in one 

day. Or, for patients to wait for months to get an appointment. Patients get frustrated with this system and often abandon the search for care altogether. This delayed or deferred care has long-term impacts over a patient’s overall health and 

wellbeing. 

NIHB and the Tribes continue to support the expansion of Dental Therapists 

(DTs) to Tribes outside of Alaska as a safe, reliable, cost-effective means for Tribal 

members to access oral health services. Some Tribes in the lower 48 have created 

programs outside of IHS funding to allow them to utilize DTs, but sadly, provisions 

in the Indian Healthcare Improvement Act (IHCIA) 4 make it difficult to use IHS 

resources to use these effective providers. People with healthy teeth and healthy 

smiles feels better about themselves and experience better overall health outcomes. 

Our communities need our people and especially our youth to smile again. We encourage the Committee to work with the other relevant authorizing Committees to 

repeal this section of the law so that IHS and Tribes can utilize scarce discretionary 

dollars in the most cost-effective way possible. 

Facilities: In FY 2019, Tribes recommend prioritizing facilities funding in FY 

2019. Increases will be used to increase maintenance and improvement on IHS facilities, speed up the funding of projects on the IHS Healthcare priority list, and improve sanitation conditions in Tribal communities. IHS facilities represent some the 

oldest health facilities in the nation and at current rates of funding, a new facility 

built today would not be replaced for another 400 years. 5 Investments in facilities 

will allow the care provided in our communities to be on par with other health systems in the United States. In Alaska, for example over 5,000 rural homes are considered unserved by running water and wastewater. Individuals, instead, must rely 

on ‘‘honey buckets’’ to dispose of waste. This is just unacceptable. The FY 2019 

Budget Request proposes a decrease of $361.7 million from the FY 2018 enacted facilities budget. NIHB emphatically opposes this decrease and encourages Congress 

do continue to build funding for facilities in FY 2019. 

FY 2019 President’s Budget Request 

The FY 2019 President’s Budget Request includes $5.4 billion for the IHS discretionary spending in FY 2019. This represents $113.7 below the FY 2018 enacted 

budget. While we appreciate the proposals to increase funding for direct care and 

substance abuse, several items in the FY 2019 request are of particular concern for 

NIHB and the Tribes. 

Community Health Representatives/Health Education: 

The FY 2019 request eliminates funding for the Community Health Representative and Health Education programs. Tribes are unambiguously opposed to this cut. 

While the budget notes that the cut was proposed in order to ‘‘prioritize direct 

health care services,’’ it is important to note that CHRs are direct care. CHRs provide services like in-home patient assessment of medical conditions, providing glucose testing or blood pressure tests to determine if the patient should seek further 

care, and providing transportation for medical care. They also help interpret prescriptions which is critical to patient safety and the elimination of this program 

would be detrimental to the health and wellbeing of many Tribal communities. 

There are more than 1,600 CHRs representing over 250 tribes in all 12 IHS Areas 

and exported CHR program data in FY 2016 demonstrated that CHRs conducted 

340,270 home visits and provided 1,102,164 patient contacts/services on a variety 

of health related conditions. However, it is likely that there are far more contacts 

are made in reality but not reflected in data due to reporting challenges associated 

with the RPMS system. 

The purpose of the Health Education program is to provide preventive health education, emergency response and public health, chronic and communicable disease 

61 

education. In addition, health educators serve as liaison between individual, health 

care providers, and community organizations to coordinate resources and services to 

promote health education programs. IHS receives little funding for preventative efforts, and these programs represent one of the few consistent investments in an essential public health service—helping to provide education efforts to community 

members in remote areas who may never otherwise encounter a health professional. 

In March 2018, NIHB sent a survey to Tribes to collect information on the importance of CHRs and Health Educators in their communities. We received a record 

370 responses. Over 92 percent of respondents noted that that could not provide 

health services at the same level without CHRs. As one survey participant noted, 

Both [CHR and Health Education] programs are essential to the communities 

they serve. Without their services preventive education and screenings will not 

be known. There would be no other resource for community members to go to 

for information or to have their questions answered quickly. It is extremely 

hard for patients to ask questions to their provider, because there is a time 

limit on one patient visit. Many of our elders and youth will fall through the 

cracks and chronic diseases will increase significantly. 

In FY 2019, the TBFWG recommends CHRs are funded at $92.2 million, which 

is an increase of $29.3 million above the FY 2018 enacted level. The group recommends that Health Education is funded at $35.9 million, an increase of $16 million from FY 2018 enacted budget. 

Special Diabetes Program for Indians: 

The FY 2019 President’s budget also proposes to move the Special Diabetes Program for Indians (SDPI), and other health programs, from the mandatory side of 

the budget to discretionary funding. This major policy shift was made with no consultation with Tribes, and the budget offers no explanation of this change. NIHB 

and the Tribes remain concerned that this shift will make this highly successful program have less stable funding opportunities, and create additional pressure on the 

already strained IHS discretionary budget. Without a commensurate increase in 

other areas of the discretionary side of the budget, or to the 302(b) allocation of the 

Interior, Environment and Related Agencies Appropriations Subcommittee, SDPI 

funds are at serious risk. With a decrease of 54 percent in End Stage Renal Disease 

of for AI/ANs over a 20 year period, SDPI represents one of the greatest public 

health success programs this country has ever seen. It is simply irresponsible to 

make such a major shift without first understanding the ramifications that such a 

change would have. NIHB opposes this proposal and encourages Congress to fully 

reject it as well. 

Opioid Funding and use of Competitive Grants 

The FY 2019 President’s Budget Request also proposes $150 million in competitive grants to ‘‘combat the opioid epidemic and address serious mental illness.’’ This 

is part of the total $10 billion that the Department of Health and Human Services 

would receive. Firstly, this funding is a mere 1.5 percent set aside for AI/ANs despite the disproportionate disease burden in Tribal communities and the federal 

trust responsibility to Indian Country. Instead, the budget should focus on including 

at least 10 percent set aside for Tribes across all opioid related programs. 

Secondly, Tribes are universally opposed to this funding being distributed in the 

form of competitive grants. The health needs of Indian people are chronic and multifaceted; such needs deserve to be addressed through committed, stable funding. In 

contrast, grant programs are temporary, unreliable, non-recurring, and unable to 

address the ongoing critical needs of Tribal communities. Under the grant making 

process, some Tribes receive assistance and benefit from somewhat consistent increases, while other Tribes do not. This creates two pools of Tribes—those that have 

technical experience and financial resources receive funding, while many others 

without this capacity see no benefit in appropriated increases. The strings attached 

to federal grants in terms of reporting, limitations on use of funds, and timelines 

distract from patient care. Since 2008, 50 percent (about $40 Million) of the increases to the total Behavioral Health budget (Mental Health and Alcohol & Substance Abuse Programs) is due to a growth in special grant programs and initiatives 

rather than increases to existing Behavioral Health programs. Instead of project or 

disease specific grant funds, the IHS needs to prioritize flexible, recurring base 

funds. 

Grants create a ‘‘disease de jour’’ approach, where the funding is tied only to an 

identified hot topic issue. For instance, if a patient presents with an ‘‘unfunded’’ diagnosis that is not covered by grants for specific disease categories that patient is 

left without many alternatives. This does not bode well for the many chronic disVerDate Mar 15 2010 13:55 Dec 11, 2018 Jkt 033404 PO 00000 Frm 00065 Fmt 6601 Sfmt 6621 S:\DOCS\33404.TXT JACK
62 

eases from which AI/ANs disproportionately suffer. For example, a large focus on 

the methamphetamine epidemic 10 years ago may have distracted from the rise in 

patients addicted to prescription pain medicine, thus contributing to the opioid crisis 

in Indian Country today. While the United States generally is now facing an opioid 

crisis, a particular service unit in one IHS area may struggle most with alcohol addiction and under the grant making process cannot redesign the available programs 

and services to meet Tribal community needs. As such, IHS should never use a 

grant program to fund ongoing critical Indian Health needs. 

Other Sources of Indian Health Funding 

Medicaid 

While the above recommendations address the IHS budget, the federal trust responsibility for health extends beyond the IHS. For example, Medicaid system is a 

critical lifeline in Tribal communities. Moving Medicaid to a block grant system, as 

proposed in the President’s FY 2019 Budget Request, will have major fiscal impacts 

on Tribal health reimbursements, and would devastate Tribal health. Decreasing 

Medicaid decrease scarce resources available to cover our cost of care, and further 

restrict the eligible patient population. This puts an unequal burden on the IHS 

budget which is so reliant on these resources to make up our funding shortfalls. We 

urge Congress to ensure that American Indians and Alaska Natives are exempt 

from any burdens put on Medicaid like work requirements, so that fiscal strain 

doesn’t unintentionally fall back to the IHS. American Indians and Alaska Natives 

already have access to health care through the IHS, so work requirements only 

serve to inhibit the use of Medicaid in Tribal communities. 

Good Health and Wellness in Indian Country 

The President’s FY 2019 Budget request eliminated substantial funding from the 

National Center for Chronic Disease Prevention at the Centers for Disease Control 

and Prevention (CDC) along with zeroing out the Good Health and Wellness in Indian Country (GHWIC) program (currently funded at $16 million). The Good Health 

and Wellness in Indian Country Program is CDC’s largest investment in the 

wellbeing of American Indian and Alaska Natives. GHWIC funding must be restored. The twelve Tribes and eleven Tribal organizations in the program have utilized community-driven, culturally adapted strategies to improve public health in 

their communities. GHWIC is a lifeline for these communities who would otherwise 

have no public health investment. In fact, it is the only dedicated funding for AI/ 

ANs at CDC. CDC has told Tribal leaders on March 1, 2018 that they are replacing 

GHWIC with the proposed ‘‘America’s Health Block Grant.’’ That funding has no indicated set aside for Tribes or epi-centers so there is zero guarantee that this funding would reach AI/AN communities. Instead, Congress should reject this elimination of GHWIC and double the size of the program to $32 million in FY 2019. 

LIHEAP and SNAP 

In addition, NIHB remains concerns about the proposed cuts in the FY 2019 

budget to the Low Income Heating and Energy Assistance Program (LIHEAP) and 

the Supplemental Nutrition Assistance Program (SNAP). LIHEAP is a critical resource for low-income AI/ANs to heat their homes which contributes to the health 

and well being of AI/ANs. There are 153 Tribes and tribal organizations who receive 

these funds directly in the amount of approximately $37 million. The budget would 

also make major changes and cuts to SNAP which would cut 22 percent of the program and $213.5 billion over the next decade. The proposal would also would redesign SNAP by using a portion of benefits to buy and deliver a package of commodities to SNAP households. Indian Country knows all too well the scourge of using 

nonperishable commodities instead of fresh food, and it is reflected in high rates of 

diabetes, heart disease and other chronic health issues among AI/ANs. Instead, Congress should grant authority to empower tribes to run their own SNAP programs 

through self-governance and support funding and programs targeted at local agriculture, community gardens, and access to fresh food. 

Conclusion 

Thank you again for holding this important hearing and for the opportunity to 

offer testimony for the record. You can find a more detailed FY 2019 IHS Budget 

Request at www.nihb.org. 

DWAYNE HERRERA, GOVERNOR; EVERETT P. HERRERA, LT. GOVERNOR

Cochiti Pueblo, NM. April 16, 2018 

Congressman Steve Pearce, 

63 

Rayburn House Office Building, Washington, DC. 

Congresswoman Michelle Lujan Grisham, 

Cannon House Office Building, Washington, DC. 

Congressman Ben Ray Lujan, 

Rayburn HOB, Washington, DC. 

Senator Tom Udall 

Hart Senate Office Building, Washington, DC. 

Senator Martin Heinrich, 

Hart Senate Office Building, Washington, DC. 

RE: THE ELIMINATION OF IHS COMMUNITY HEALTH REPRESENTATIVE (CHR) 

AND HEALTH EDUCATION PROGRAMS IN PRESIDENT’S 2019 IHS BUDGET. 

Dear Honorable Senators, Congresswoman, Congressmen: 

As the Governor of the Pueblo de Cochiti, I write this letter based on the understanding that the President’s 2019 IHS Budget has eliminated the Community 

Health Representative (CHR) and the Health Education line items. In a small rural 

reservation like Cochiti Pueblo, I know the CHR program allows us the only health 

providers that we have to address almost all of our health issues. They are the only 

health providers that live in our community and provide all types of services or give 

the community the knowledge and access to services. This Pueblo only receives 2 

primary care clinic days a week from the Indian Health Service. The CHRs are 

available for many and any health questions we have as tribal leaders and educate 

us about Obamacare, Medicare, IHS, MCOs and any research and outside providers 

giving our community members health care. They have been doing this since the 

program was started in 1968. We recently testified about the CHR program elimination at the DHHS tribal consultation but to date, have not heard any response 

from the agency. Therefore let me re-emphasize some critical points of both line 

items by the following points: 

• The CHR program is a 50 year old line item in the IHS. The CHR program is 

authorized under the Indian Health Care Improvement Act (IHCIA) and this 

legislation is now permanent federal legislation. Attached is the NMSCCHRA 

testimonies and the Pueblo wholeheartedly support both testimonies. As tribal 

leaders we expect federal agencies to follow funding guidelines established by 

Appropriations Committees especially those line items that have a significant 

tribal impact nationally. 

• The CHR program is familiar to all tribal members and use the CHRs for their 

various health issues and needs. The Cochiti CHR program has always been administered, operated and staffed by ‘Commtmity based’ tribal health providers 

under our Public Law 93–638 contract The CHR program is a basic public 

health service providing direct medical services, prevention and intervention 

under the Pueblo’s management structure. We have daily access to our CHR 

staff as they speak our tribal language and know all the community members 

of Cochiti Pueblo. The Cochiti staff serve as dental assistants, enrollment guides 

for Medicaid, Medicare and Private insurance, Emergency Management coordinators, health educators, transportation to dialysis/medical appointments, 

translators, homecare advocates and many other community health services 

that are started and completed by the staff. 

• Cochiti is a small Tribe and not a gaming Tribe. We rely on federal funds to 

not only provide services but also have benefitted from the PL 638 funding including Contract Support Costs funding—Direct Contract support and Indirect 

Cost on a yearly basis. The overhead funds pays for the Tribal leadership, HR, 

Finance, Housekeeping salaries in addition to facilities and Other administrative costs such as audits, trainings, travel, supplies out of Indirect costs. For 

a small Pueblo like Cochiti, it sustains and impacts our Tribal government immensely. I can attest to the fact that I rely on the CHRs on assistance and clarification when outside health agencies, governments, vendors, MC0s, IHS, Veterans Administration and other interested health partners approach our tribal 

administration. Our staff are community members and I trust their input on 

health matters and services. 

The elimination of the two line items will have a major impact to the Pueblo de 

Cochiti as our PL 638 contracted programs. As the Governor of Cochiti Pueblo, I 

respectfully request the CHR and Health Education line items remain in the IHS 

budget and be increased in the overall IHS budget. 

Respectfully submitted, 

64 

DWAYNE HERRERA, 

Governor, Pueblo de Cochiti. 

SANTO DOMINGO TRIBAL COUNCIL—RESOLUTION NO: 04–2018–15 

CONTINUED SUPPORT OF AND REINSTATEMENT OF THE COMMUNITY HEALTH REP- RESENTATIVE (CHR) AND HEALTH EDUCATION LINE ITEMS IN THE PRESIDENT’S 2019

INDIAN HEALTH SERVICE BUDGET

WHEREAS, the Santo Domingo Tribe is a federally recognized tribe with inherent sovereign authorities to develop laws, plans, and essential health programs to 

meet our community needs, and has successfully administered the Community 

Health Representative Program (CHR), Emergency Medical Services (EMS), and Behavior Health Services funding through the Indian Health Service (IHS) under PL 

93–638 Indian Self-Determination Act and as authorized under the Indian Health 

Care Improvement Act (IHCIA); and 

WHEREAS, Santo Domingo Tribe has provided direct medical services, patient 

care, delivery of patient medication, non-emergency transportation for appointments, health education & prevention, interfacing with other public health & environmental services at the local community level and language interpretation by 

local staff; and 

WHEREAS, the CHR has been and continues to be a focal point and cornerstone 

of most medical, public health, behavioral, environmental, emergency patient care 

in our tribal community with working knowledge of our community cultural values, 

norms and activities; and 

WHEREAS, the CHR funding has supported, since its inception in 1968, the most 

essential primary healthcare, education, and environmental services that has become a crucial and important institutional and effective community-based health 

program; and 

WHEREAS, Santo Domingo’s CHR program has recently provided 4,184 home 

visits, 1085 non-emergency transports to health facilities, and hosted 325 educational and special events in our community; and 

WHEREAS, the tribal leadership has relied on the CHR’s for health interpretation, evaluations, input, health literacy, health insurance issues, health education, 

federal and state partnership initiatives; and 

WHEREAS, the CHR’s are the only health providers and advocates when the 

local limited clinic hours and service providers are not available or accessible for 

health services and emergencies; and 

NOW THEREFORE, BE IT RESOLVED that the Santo Domingo Tribe directs 

the 2019 President’s Indian Health Service budget reinstate the CHR and Health 

Education line items and increase the current funding amounts including the overall Indian Health Service budget; and 

BE IT FUTHER RESOLVED that the US House of Representatives and US 

Senate assure that the mainstay of basic healthcare providers in our local tribal 

communities remain in the IHS budget and support the overall IHS budget as long 

as the United States has a responsibility to provide health services to the Native 

Americans under the various federal laws and federal protections afforded to Tribes. 

CERTIFICATION 

The foregoing resolution was enacted by the Santo Domingo Tribe Tribal Council 

on April 23, 2018 by a unanimous vote at a duly called meeting which a quorum 

of the Tribal Council was present. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. TOM UDALL TO

RADM MICHAEL WEAHKEE

Opioids and IHS Clinical Services 

Question 1. The Centers for Disease Control and Prevention recently reported that 

the rate of Hepatitis C infections tripled between 2010 and 2015—mostly due to the 

use of needles by a growing number of drug users. Does IHS have any data on 

changing numbers of IHS patients presenting with opioid use-related bloodborne infection diseases like Hepatitis C and HIV/AIDS? 

Answer. IHS does not have data on the changing numbers of IHS patients presenting with opioid or substance abuse-related blood borne infectious diseases like 

hepatitis C (HCV) or HIV/AIDS. Moreover, IHS does not have the ability to monitor 

this correlation with its existing EHR infrastructure or personnel. However, IHS, 

in collaboration with the Centers for Disease Control and Prevention (CDC), is curVerDate Mar 15 2010 13:55 Dec 11, 2018 Jkt 033404 PO 00000 Frm 00068 Fmt 6601 Sfmt 6621 S:\DOCS\33404.TXT JACK
65 

rently undertaking a vulnerability study looking at the risk of HIV or HCV transmission from injecting drug use. 

Question 1a. Does IHS have any statistics on how rates of neonatal abstinence 

syndrome have changed over the course of the ongoing opioid crisis? 

Answer. IHS has a limited capacity to evaluate American Indian and Alaska Native neonatal abstinence syndrome or neonatal opioid withdrawal syndrome rates. 

The majority of American Indian and Alaska Native births occur at tertiary referral 

hospitals making data sharing between the referral hospital and IHS challenging. 

IHS is currently evaluating the prospect of future collaborations and strategies to 

capture this data from other available data sets and partnerships. 

Question 2. Your testimony states that IHS sought to ‘‘prioritize direct clinical 

health care services’’. Please explain how that priority—and the Department’s priority of addressing the opioid crisis—would allow tribal communities to respond to 

substance abuse-related health complications? 

Answer. Efforts to prioritize direct clinical health care services are important for 

helping tribal communities address the health complications of substance abuse. As 

part of this process, IHS will continue working with tribes, through consultation and 

collaboration, to improve access to prevention, treatment, and recovery support services, including medication-assisted treatment. For many patients, primary care is 

the first point of entry into the health care system. Primary care and direct clinical 

health care enable patients to gain access to behavioral health support and other 

supports necessary for evidence-based care. IHS has a holistic approach, integrating 

physical, mental, spiritual, and cultural components. Additionally, direct care can 

help patients gain access to overdose-reversing drugs and support more effective 

methods of dealing with pain without using prescription opioid medications. Most 

importantly, as opioid use disorder is treated more effectively, we know from research and experience that secondary health complications decrease dramatically. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. JOHN MCCAIN TO

JOHN TAHSUDA

Colorado River Indian Tribe, Arizona 

Question 1. Water resources are critically important to western Tribes and my 

home State of Arizona. I understand that the Colorado River Irrigation Project 

(CRIP) on the CRIT reservation is operating at 53 percent efficiency. According to 

CRIT, the BIA is responsible for conducting priority maintenance in the CRIP system but failed to so from December 2017, and January and February of this year. 

Can you explain why BIA proceeded with the ‘‘dry-up’’ of the CRIP but did not conduct the maintenance work covered in the irrigation plan? 

Answer. The BIA Colorado River Agency (CRA) Irrigation Project did complete a 

significant amount of the maintenance identified in the Tribe’s Draft Plan, as submitted. Maintenance activities were conducted on approximately 9 laterals and several sub-laterals, and included inspections; adjusting, repairing, or removing and replacing turnout check gates; cleaning, adjusting or replacing staff gauges; identifying additional gates to replace; repairing canal lining with placement of approximately 400 yards of gunite material; adding headwalls; replacing a major culvert 

on 6th Avenue; and re-grouting existing turnout rings and placing new turnout 

rings. 

The Tribe’s Five Year Plan was submitted to the BIA in final draft as a deliverable for the Irrigation Engineering & Support Services Program, Self-Determination 

Contract (No. A15AV00449) between the BIA and the Tribe. The attached chart, derived from tables submitted in the draft plan, shows the status of the recommended 

maintenance items after maintenance work was conducted during the 2017 and 

2018 dry ups. 

Question 1a. Were there any BIA staffing shortages associated with the delays in 

repairing the CRIP system? 

Answer. The Project is currently operating with 32 staff positions filled out of the 

total 64 approved positions. We have been moving to fill many of the vacate positions. All Irrigation System Operator (ISO) and Heavy Equipment Operator vacant 

positions are currently advertised on USAJobs and will continue to be until filled, 

which is a new approach. Applications will be reviewed every two weeks, and eligible candidates will be referred to the hiring official for consideration until all positions are filled. 

Question 1b. The Tribe has asked BIA to increase its maintenance fees for CRIP. 

What is the status of those increases? 

66 

Answer. The Tribe provided a comment on May 26, 2017, in response to 2017 Proposed O&M rate (FRN 82–18774) recommending the O&M rate be increased from 

$54/acre to $60.25/acre. The BIA Irrigation System Manager determined there was 

adequate project funding for maintenance and rehabilitation work during 2017, and 

thus made the decision to postpone a Project O&M assessment rate increase for 

2018. BIA will evaluate the Tribe’s recommended rate increase during the required 

budget planning process with the project water users, taking into consideration additional staff hired in the interim. The Tribe’s request will be included for discussion 

during that rate setting process. 

White Mountain Apache Tribe, Arizona. 

Question 2. As you may know, the WMAT is on high-risk status for failing to submit audits to the BIA on 638 services. The tribe is currently on a cost-reimbursement basis with BIA. My understanding is that the Tribe is working to provide the 

needed audits, but is still seeking information from BIA on how to be removed from 

the agency’s high-risk list and avoid re-assumption of services. Please provide a letter to the WMAT indicating what remaining steps the tribe must take to achieve 

compliance. 

Answer. The BIA will provide this information to the Tribe in the near future. 

Attachment 

67 

*RESPONSES TO THE FOLLOWING QUESTIONS WERE NOT AVAILABLE 

AT THE TIME THIS HEARING WENT TO PRINT* 

WRITTEN QUESTIONS SUBMITTED BY HON. TOM UDALL TO

HON. AARON PAYMENT

Infrastructure 

Question 1. Interior’s budget includes a new ‘‘The Public Lands Infrastructure 

Fund,’’ the aim of which is to provide up to $18 billion to address what Interior calls 


411a3.eps
68 

the department’s ‘‘deferred maintenance backlog,’’ according to a press release from 

the agency. The fund would support necessary repairs and improvement in national 

parks, national wildlife refuges, and BIE schools. Does NCAI have priority areas for 

this Infrastructure Fund, if enacted? 

Question 2. The President’s FY 2019 budget proposal for the Department of Housing and Urban Development (HUD)’s Indian Housing programs administered by the 

Office of Native American Programs (ONAP) proposes significant cuts to Indian 

housing programs($131.2M in cuts overall). One specific program, the Indian Community Block Grant (ICBG) was zeroed out because the Administration believes the 

program is duplicative of other HUD programs such as the Native American Housing Block Grant under NAHASDA. The ICBG is used by tribal housing authorities 

to leverage NAHASDA dollars for critical infrastructure improvements to homes. 

Does NCAI believe the ICBG program is duplicative or simply not needed? 

DOI Reorganization 

Question 3. Secretary Zinke proposes dividing Interior’s various bureaus into 13 

geographic regions across the country based on watershed and other natural resource boundary lines, an idea modeled on John Wesley Powell’s proposal that state 

boundaries follow watersheds. Interior intends for these changes to improve agency 

collaboration and efficiency by shifting more authority from Washington to communities out West and by aligning regional offices for agencies like the National Park 

Service and the Bureau of Land Management. 

a. Does NCAI have views on Interior’s proposed reorganization, especially its potential impact on BIA regions and other agencies that service Indian tribes, such 

as the Bureau of Land Management? 

b. Has NCAI formally communicated these views to Interior? 

Natural Resources Management 

Question 4. Tribes manage 11 million more acres of land than the entire National 

Park Service (with 95 million acres of land managed either by tribes or the United 

States). Cuts to these natural resource management programs will affect everything 

from agriculture and forestry to water resources and wildlife and fish conservation. 

Yet Interior’s proposed budget would cut funds for natural resources management 

by $46 million. Please explain why it is important that the federal government fully 

fund these natural resources programs. 

Question 5. Previously funded at $9.9 million in FY 2017 and FY 2018, the BIA 

Tribal Resilience Program (formerly the ‘‘Tribal Climate Resilience Program’’) provides federal resources to Tribes to build capacity and resilience through leadership 

engagement, delivery of data and tools, training and tribal capacity building. Direct 

funding supports goes to tribally designed resilience training, adaptation planning, 

vulnerability assessments, supplemental monitoring, capacity building, and youth 

engagement. Interior’s budget proposal eliminates this program. Please explain 

NCAI’s views on the Tribal Resilience Program? 

Opioids 

Question 6. The President’s FY 2019 Budget Proposal includes a number of steep 

cuts to Indian Programs (e.g., -$131 million in HUD Native Housing Programs from 

FY2017 levels, -$22 million in cuts to BIA human services programs from FY 2017 

levels, and -$27 million in cuts to BIA public safety and justice programs). How do 

cuts to federal funding for tribal housing, human services, and public safety programs impact tribes’ ability to continue efforts to combat the opioid and substance 

abuse crisis facing many communities in Indian Country? 

Question 7. Within HHS, the President’s FY 2019 Budget Proposal lists addressing the opioid epidemic as the first priority discussed in its Budget in Brief document for the Department. The proposal also includes reserving $150 million of the 

total $10 billion in proposed opioid funding for the Secretary’s use in Indian Country. The Centers for Disease Control and Prevention recently reported that the rate 

ofHepatitis C infection tripled between 2010 and 2015—mostly due to the use of 

needles by a growing number of drug users. What impact would lack of sufficient 

funding for IHS clinical and preventive health combined with repeal of the Affordable Care Act and Medicaid Expansion—one of the President’s FY2019 Budget Proposals for CMS—have on tribes? 

69 

WRITTEN QUESTIONS SUBMITTED BY HON. TOM UDALL TO

HON. ROBERT MCGHEE

Infrastructure 

Question 1. Interior’s budget includes a new ‘‘The Public Lands Infrastructure Fund,’’ the aim of which is to provide up to $18 billion to address what Interior calls 

the department’s ‘‘deferred maintenance backlog,’’ according to a press release from 

the agency. The proceeds within the fund would go towards 150 Bureau of Indian 

Education schools in 23 states. The FY19 proposal cuts BIE funding from $885M 

to $741M, a reduction of $144M (or about 16 percent). Does USET support cutting 

infrastructure line items and replacing them with this Fund? 

DOI Reorganization 

Question 2. Secretary Zinke proposes dividing Interior’s various bureaus into 13 

geographic regions across the country based on watershed and other natural resource boundary lines, an idea modeled on John Wesley Powell’s proposal that state 

boundaries follow watersheds. Interior intends for these changes to improve agency 

collaboration and efficiency by shifting more authority from Washington to communities out West and by aligning regional offices for agencies like the National Park 

Service and the Bureau of Land Management. 

a. Does USET have views on Interior’s proposed reorganization, especially its potential impact on BIA regions and other agencies that service Indian tribes, such 

as the Bureau of Land Management? 

b. Has USET formally communicated these views to Interior? 

Public Safety 

Question 3. The Bureau of Indian Affairs distributes funding for law enforcement 

in Indian Country based on historical allocations. The BIA considers a number of 

factors to determine the budget increases to meet the areas with the greatest need. 

These factors include population, size of land base, staffing levels/shortages, violent 

crime rate, volume of calls, and prevalence of drug/gang activity. But law enforcement in Indian Country is severely underfunded and many tribal communities face 

high violent crime rates. The Administration is proposing a 7 percent cut to law enforcement funding in Indian Country. This cut will affect the hiring of more officers 

and worsen the response time to victims of crime. In addition to restoring funding 

and increasing budget allocations, how can Congress ensure that tribal communities 

are safer? 

Natural Resources Management 

Question 4. Tribes manage 11 million more acres of land than the entire National 

Park Service (with 95 million acres of land managed either by tribes or the United 

States). Cuts to these natural resource management programs will affect everything 

from agriculture and forestry to water resources and wildlife and fish conservation. 

Yet Interior’s proposed budget would cut funds for natural resources management 

by $46 million. Please explain why it is important that the federal government fully 

fund these natural resources programs. 

Question 5. Previously funded at $9.9 million in FY 2017 and FY 2018, the BIA 

Tribal Resilience Program (formerly the ‘‘Tribal Climate Resilience Program’’) provides federal resources to Tribes to build capacity and resilience through leadership 

engagement, delivery of data and tools, training and tribal capacity building. Direct 

funding supports goes to tribally designed resilience training, adaptation planning, 

vulnerability assessments, supplemental monitoring, capacity building, and youth 

engagement. Interior’s budget proposal eliminates this program. Please explain 

NCAI’s views on the Tribal Resilience Program? 

Opioids 

Question 6. The President’s FY20 19 Budget Proposal includes a number of steep 

cuts to Indian Programs (e.g., -$131 million in HUD Native Housing Programs from 

FY 2017 levels, -$22 million in cuts to BIA human services programs from FY 2017 

levels, and -$27 million in cuts to BIA public safety and justice programs). How do 

cuts to federal funding for tribal housing, human services, and public safety programs impact tribes’ ability to continue efforts to combat the opioid crisis? 

Question 7. Within HHS, the President’s FY 2019 Budget Proposal lists addressing the opioid epidemic as the first priority discussed in its Budget in Brief document for the Department. One of the key pieces of combatting the opioid epidemic 

is putting more resources towards prevention—both addiction prevention and prescription misuse. But IHS’s proposed budget would cut preventative health funding 

by $71 million from FY 2017 levels—including a complete zeroing out of IHS health 

70 

education funding. Is there a misalignment between the Administration’s stated 

goal of addressing prevention as part of its opioid response plan and its cutting of 

preventative health at IHS? 

Question 8. Within HHS, the President’s FY 2019 Budget Proposal lists addressing the opioid epidemic as the first priority discussed in its Budget in Brief document for the Department. The proposal also includes reserving $150 million of the 

total $10 billion in proposed opioid funding for the Secretary’s use in Indian Country. The Centers for Disease Control and Prevention recently reported that the rate 

of Hepatitis C infection tripled between 2010 and 2015—mostly due to the use of 

needles by a growing number of drug users. What impact would lack.of sufficient 

funding for IHS clinical and preventive health combined with repeal of the Affordable Care Act and Medicaid Expansion—one of the President’s FY 2019 Budget Proposals for CMS—have on tribes? 

Æ