CQ: Murkowski Wants Plan to Deal With Tribal Health Facility Costs

Sen. Lisa Murkowski, her chamber's top appropriator for Native American programs, raised alarm Wednesday that federal officials haven't planned for ballooning court-mandated costs for certain tribal health clinics, including those in her home state of Alaska.

The shortfall stems from a 2016 court decision that cracked open more funding for tribally-owned buildings administering Indian Health Service programs. Under a 1975 law, tribes can run federal Indian Health Service programs through locally-owned buildings, in contrast to health facilities serving Native Americans that are owned and run by the IHS itself. These locally-owned facilities receive IHS subsidies including for rental agreements.

In the past, many of these lease payments were small compared to the overall need. That changed when an Alaska health clinic representing multiple tribes sued the federal government after being denied a higher payment, and a federal judge sided with the group in a 2016 court decision.

The decision sent a signal to other tribes that they were eligible for more funding if they were running health programs out of their own buildings, not federal government property. And now, the IHS is facing a wave of new applications for the entitlement.

The fiscal 2019 omnibus (PL 116-6) provided $36 million to support tribal health clinics, including lease payments. IHS officials said at a Senate Interior-Environment Appropriations subcommittee hearing Wednesday that estimated leasing costs alone for fiscal 2020 were $54 million as of the end of April.

IHS Principal Deputy Director Rear Adm. Michael Weahkee said the leasing number could more than double, based on initial conversations with agency and tribal leaders. “We do anticipate that number could be as high as $138 million in fiscal year 2020,” Weahkee told the Senate panel, which is chaired by Murkowski. 

That’s a significant number for the IHS, which has requested total fiscal 2020 discretionary resources of $5.9 billion.

Murkowski pointed out that the agency hasn't even requested the amount of funding it expects will be needed for the upcoming year. The IHS lacks any dedicated funding source for the leases — and the agency has raided other funding sources to make up cost differences in the past. Without more appropriations from Congress, the 2016 court ruling could ultimately reduce the amount of money available for Native American health programs overall.

“Know that I’m very worried about this. Because I only see this number growing,” Murkowski said. “We’ve got to get our arms around what is happening with this, the requirements, the obligations and how we budget accurately for it."

Weahkee said the agency was looking for discretionary funding to meet the needs “without taking any money away from any existing annual funding agreements or direct services." But Weahkee told the subcommittee a major complicating factor was that “we don’t have any single inventory of the buildings that are owned by tribes throughout the country and how many leases are going to come forward.”

By:  Kellie Mejdrich
Source: CQ