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Medicare and Medicaid Funding in Jeopardy
USET and other organization are asking for help lobbying for tribal consultation on the changes to Medicare and Medicaid funding to Indian country. The rules have changed that leave it to State’s to set work requirements for eligibility for Medicaid funding through the 1115 waiver process. This could severely impact Indian Health service funding. Therefore AI/AN Medicaid recipients must be made exempt from these barriers to accessing the health care to which they are entitled, and CMS has a duty to ensure that this occurs as a part of the waiver process. Medicaid currently represents 67% of 3rd party revenue at IHS, and 13% of overall IHS spending. Tribal organization are advocating that any proposed changes to the administration of Medicaid must be preceded by comprehensive consultation with Tribal Nations. Currently, the 1115 waiver process requires that states engaged in Tribal Consultation prior to submission of 1115 Demonstrations to CMS. CMS must ensure Tribal consultation with Tribal Nations occurs at both the state and federal levels before state waiver applications can proceed.
Congress springs into action with an omnibus bill, and concerns rise about the 2019 appropriations
At the relief of Indian County Congress passes an Omnibus bill in March, holding the course and adding a little money to the Indian Affairs budget. It was an uncertain, beginning to the year, that saw continuing resolutions, potential government shutdowns, a deal to raise budget caps, and a last-minute veto threat from the President. At the end the legislation provides $1.3 trillion in omnibus appropriations for the remainder of Fiscal Year (FY) 2018.
Congressional appropriators rejected the deep cuts proposed in the President’s FY 2018 Budget Request, including those for federal Indian programs. Some of these provisions include:
- Bureau of Indian Affairs (BIA): BIA is funded at a total of $3.01 billion, an increase of $203.8 million or 7.1%.
- Indian Health Service (IHS): IHS is funded at a total of $5.5 billion, an increase of $497.9 million or 10%.
- Victims of Crime Act (VOCA) Funding: The bill contains a 3% set aside for Tribal Nations within the VOCA fund, or $133 million for the delivery of victim services in Indian Country.
- Opioid Epidemic: From a total of $1 billion in new grant funding to address the opioid crisis directed at state and Tribal governments, $50 million is set aside for Tribal Nations. In addition, $5 million is set aside for Tribal Nations to provide medication-assisted treatment. Finally, $7.5 million is provided for the BIA’s Law Enforcement Opioid initiative.
Significant increases:
- Infrastructure: spending would increase for BIA and IHS construction, BIA road maintenance, and a $100 million competitive grant program is added under Native American Housing Block Grants (NAHBG) in addition to the $655 million provided for the NAHBG formula grants.
- Road Maintenance: will receive a 14 percent increase to $34.6 million.
- Restoration of the Tiwahe initiative: at the fiscal year 2017 enacted level.
- Violence Against Women Act: $2 million to implement both training and specific Tribal court needs, and $13 million to address the needs of Tribes affected by Public Law 83- 280.
- BIA Construction: would increase by $162 million to $354.1 million, an 84 percent increase.
- Opioid initiative:5 million for the Bureau of Indian Affairs Law Enforcement.
See Link: Budget Report
An interesting strategy has been proposed this last week to handle 2019 appropriations bills. Nearly, 16 Republican senators announced a willingness to work through August recess to complete spending bills and confirm more of President Donald Trump’s nominees. Sen. David Perdue of Georgia, who has led the effort, hinted that a letter to Majority Leader Mitch McConnell of Kentucky would be forthcoming. “The Senate should immediately begin work on one or several consolidated appropriations bills, so they can be openly debated and amended accordingly,” the senators wrote. “Our defense priorities are bipartisan, and they should come first.”
That letter signals a willingness by the conservatives to bundle spending bills together, perhaps using the “minibus” strategy in which several regular appropriations measures get combined on the floor. Normally, senators would not want the chamber in session well into August during an election year, with lawmakers eager to be home and meeting with constituents and voters. The Republicans seem to want to avoid a last minute continuing resolution to keep the government funded past the end of September and they want to confirm a large number of Trump nominations as August approaches. Some of the 77 confirmations that took place by unanimous consent or voice votes as the August recess got underway in 2017 might have happened without a cancellation threat since that’s been the normal practice of the Senate.
These 16 senators, however, believe the threats affected the behavior of Senate Democrats. “Our diligence was rewarded with reason, and that can happen again,” the senators wrote.
Meanwhile dozens of Indian Country leaders were on Capitol Hill last week to present their budget priorities to key members of Congress before the Appropriations subcommittee on Interior. The testimony from tribes and Indian organization, representing every region of the nation, had a consistent message – Indian Country needs additional funding as part of the federal government’s trust and treaty responsibilities. The panel’s Republican and Democratic leaders, for the large part, have embraced that goal.
After hearing from the tribal witnesses, the House Appropriations subcommittee on Interior will spend the next month or so drafting the Interior appropriations bill. The package is typically released sometime in June, with lawmakers aiming to get it passed before October 1, the start of fiscal year 2019.
Was the Budget Deal a good Deal for the American Public: Are lawmakers worthy of praise for passing a Budget?
The long awaited Budget Deal has finally passed out of both Houses of Congress. But what has really happened. The answer is in most ways, not much to crow about. While, Budget Chairs, Ryan and Murray, worked hard to coral unity in their political parties, and did in fact avoid, another potential government shut down, and perhaps will avoid further sequester cuts to Domestic Programs. The reality is the deal is not much to be proud of.
After accounting for inflation, non-defense discretionary funding (Domestic Programs) is slated to fall in 2015 nearly back to the 2013 post-sequestration level. By 2016, funding will have dropped below the 2013 post-sequestration level, meaning that all of the gains from the Murray-Ryan deal will be gone. The 2016 funding level is $105 billion – or 18 percent – below the 2010 level, after adjusting for inflation.
While the Budget deal restores some funding to defense and domestic spending, it mostly halted a downward trend of sequester cuts, but it did little to build up to the levels that keep up with inflation or the growing needs.
So while Murray-Ryan was a positive step, policymakers ultimately will need to revisit the funding limits in current law to prevent the further erosion of funding for critical programs.
As one of the Washington Post staff writers recently blogged:
It cuts the pensions of federal workers and military retirees while keeping wide open egregious tax loopholes that benefit the wealthiest. It reduces domestic discretionary spending to Bush-era levels. It does absolutely nothing to create jobs at a time when unemployment remains our biggest economic problem.
Negotiators didn’t even extend unemployment benefits – set to expire three days after Christmas – for1.3 million long-term unemployed workers(and millions of their children), …… Meanwhile, conservatives and progressives agree that letting unemployment benefits lapse would further imperil our fragile economic recovery. In addition to being needlessly cruel, this deal is just plain bad policy…..Simply doing something doesn’t mean that you’re doing the right thing. Washington Post Blog
The end result is the work of Congress is far from done. All agree headway has been made, avoiding bad consequences of sequester, more choice is now given to committees to fund programs. But where are we really? That question won’t be answered by January 15, 2014. Congressman Ryan on Meet the Press last week called the deal a baby step, and he is right. There is still uncertainty, for government employees, contractors, Indian Nations and the many that are dependent on Federal Funding for essential programs. The only fact known is that there is still a need for a grand solution that looks at tax reform for sources of revenue and reform of key programs such as Medicare and Social Security. Real lawmaking will require more effort than what we are seeing from the current Congress.
Native Law Policy 