An oversight hearing to examine Native communities' priorities for the 119th Congress.

1[Senate Hearing 119-32]2[From the U.S. Government Publishing Office]34                                                         S. Hrg. 119-3256                EXAMINING NATIVE COMMUNITIES' PRIORITIES7                         FOR THE 119th CONGRESS89=======================================================================1011                                HEARING1213                               BEFORE THE1415                      COMMITTEE ON INDIAN AFFAIRS16                          UNITED STATES SENATE1718                    ONE HUNDRED NINETEENTH CONGRESS1920                             FIRST SESSION2122                               __________2324                           FEBRUARY 12, 20252526                               __________2728         Printed for the use of the Committee on Indian Affairs2930[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]3132                   U.S. GOVERNMENT PUBLISHING OFFICE3359-783 PDF                WASHINGTON : 20253435-----------------------------------------------------------------------------------3637                      COMMITTEE ON INDIAN AFFAIRS3839                    LISA MURKOWSKI, Alaska, Chairman40                  BRIAN SCHATZ, Hawaii, Vice Chairman41JOHN HOEVEN, North Dakota            MARIA CANTWELL, Washington42STEVE DAINES, Montana                CATHERINE CORTEZ MASTO, Nevada43MARKWAYNE MULLIN, Oklahoma           TINA SMITH, Minnesota44MIKE ROUNDS, South Dakota            BEN RAY LUJAN, New Mexico45JERRY MORAN, Kansas46                  Amber Ebarb, Majority Staff Director47       Jennifer Romero, Minority Staff Director and Chief Counsel4849                            C O N T E N T S5051                              ----------52                                                                   Page53Hearing held on February 12, 2025................................     154Statement of Senator Cortez Masto................................    4555Statement of Senator Murkowski...................................     156Statement of Senator Schatz......................................     257Statement of Senator Smith.......................................     35859                               Witnesses6061Bird, Kerry D., President, National Indian Education Association.    2662    Prepared statement...........................................    2863Butler, Hon. Rodney, Chairman, Mashantucket Pequot Tribal Nation;64  President, Native American Finance Officers Association (NAFOA)    2065    Prepared statement...........................................    2366Lewis, Kuhio, CEO, Council for Native Hawaiian Advancement.......    3267    Prepared statement...........................................    3368Macarro, Hon. Mark, President, National Congress of American69  Indians........................................................     470    Prepared statement...........................................     671Smith, Hon. William, Alaska Area Representative; Chairman,72  National Indian Health Board...................................    1273    Prepared statement...........................................    147475                                Appendix7677Crevier, Francys, CEO, National Council of Urban Indian Health78  (NCUIH), prepared statement....................................    5179Hines, Aaron, Chair, Northwest Portland Area Indian Health Board,80  prepared statement.............................................    5581Malone, Julie A., Osage Nation Member and Shareholder in the82  Osage Mineral Estate, letter submitted for the record..........    5783Stverak, Jason, Chief Advocacy Officer, Defense Credit Union84  Council (DCUC), letter submitted for the record................    588586    EXAMINING NATIVE COMMUNITIES' PRIORITIES FOR THE 119th CONGRESS8788                              ----------8990                      WEDNESDAY, FEBRUARY 12, 20259192                                       U.S. Senate,93                               Committee on Indian Affairs,94                                                    Washington, DC.95    The Committee met, pursuant to notice, at 2:30 p.m. in room96628, Dirksen Senate Office Building, Hon. Lisa Murkowski,97Chairman of the Committee, presiding.9899           OPENING STATEMENT OF HON. LISA MURKOWSKI,100                    U.S. SENATOR FROM ALASKA101102    The Chairman. Good afternoon. I call this oversight hearing103to order.104    Today we are following a long tradition in this Committee,105and that is kicking off the new Congress with a hearing that is106focused on Native communities' priorities. This Committee is107the only committee in Congress that has the charge to serve the108interests of Native people across our Federal Government, and109we take it seriously.110    The way that we live up to that charge is we listen. We111listen first. And by listening to you as Native leaders112highlight what is important to your communities and the work113that you are doing, the Committee can ensure that our work114aligns. That way, we can make progress together on the most115pressing issues.116    I think this approach works. Over the last few years,117working together, we have made historic bipartisan progress on118important issues like public safety and justice, with the119passage of the Tribal Title in the VAWA 2022, as well as120numerous MMIW initiatives. We are seeing huge investments in121critical infrastructure such as sanitation and broadband122through our work on the Bipartisan Infrastructure Law.123    But there is always, always more to do. The issues and the124needs are wide-ranging, which is why today we have125representatives from many different sectors, including126education, health, finance, and economic development.127    So how we approach these issues may not be the same for128every Native community. We recognize that. We respect that129there are different service delivery and self-determination130models across the Country, whether you are in Alaska or whether131you are in Hawaii, New Mexico, Minnesota. We recognize that.132    I want to take just a few words here this afternoon about133the new administration, because as we are making our new start134in the Congress, the administration is as well. There has been135a flurry of activity already with new OMB directives. Some of136these I know have caused concerns as tribes and Native137communities rely on Federal funding and on tribal programs that138flow from the Federal Government's trust, treaty and statutory139obligations to Native peoples. So know that we are listening.140    I immediately raised your concerns to the new141administration every chance I got, including in my meetings142with the President's nominees. We sent a letter to OMB urging143them to acknowledge that tribes have a unique political status144and to clarify across the Federal Government that as the145administration carries out its initiatives, it does so in a way146that respects this unique political status and the Federal147Government's responsibility to Native people.148    I think they are starting to get it, but we have to be149diligent here. There are many good Federal partners at the150agencies that understand these issues, at the Department of151Interior, with Secretary Burgum. They were the first to issue152that secretarial order. There have been others that have now153followed, so we are going to get there.154    Today's hearing again will help us chart our path forward155together in this Congress. I want to thank those of you that156will be providing your comments to the Committee today. I look157forward to hearing from you, and I welcome those that have158gathered here in our Committee room.159    It is not very often that I walk in and I see a line to160come into the Senate Indian Affairs hearing. So recognizing161that we are talking about priorities and seeing a full house is162just yet one more indicator of the importance of the good work163of this Committee.164    I now turn to my friend and colleague, the Vice Chair, for165his opening statement.166167                STATEMENT OF HON. BRIAN SCHATZ,168                    U.S. SENATOR FROM HAWAII169170    Senator Schatz. Thank you, Chair Murkowski. Leaders from171across Indian Country, Hawaii, Alaska, welcome, and thank you172for joining us today.173    I would also like to extend a warm aloha to Kuhio Lewis,174the CEO of the Council for Native Hawaiian Advancement, CNHA,175which is the leading voice on enhancing Native Hawaiian176cultural, economic, political, and community development177opportunities. Thank you for your leadership for Native178Hawaiians.179    As the strongest voice for Native priorities in the180Congress, this Committee has a responsibility to engage with181and represent all of your interests, not just in Congress, but182across the Federal Government. We made historic bipartisan183gains over the last four years to advance Federal support for184Native communities. That work literally would not have happened185without our partnership.186    That is why it is so important to continue this tradition,187making our first order of business in the 119th Congress to put188Native communities' priorities directly in the spotlight. As in189prior Congresses, today's priorities hearing is a real190opportunity to align what we do with the hard work that you are191doing on the ground, to listen and learn what is working, what192is not, and to begin to build on our bipartisan achievements,193strengthen tribal sovereignty, continue to uphold the Federal194trust and treaty responsibilities to Native communities.195    So I look forward to this conversation. Thank you.196    The Chairman. Thank you, Vice Chair.197    I understand that Senator Smith, you would like to make an198opening statement as well.199200                 STATEMENT OF HON. TINA SMITH,201                  U.S. SENATOR FROM MINNESOTA202203    Senator Smith. Thank you so much, Chair Murkowski and Vice204Chair Schatz.205    I am going to be very brief because I am super interested206in the panel and all of your perspectives. Buzhu, aaniin to the207representatives from Minnesota's 11 sovereign tribal nations. I208am so glad to see you here.209    I want to maybe just put a point on what you said, Chair210Murkowski, about helping the new administration, two things,211one that the strong tradition of bipartisanship on this212Committee I think serves us quite well. I know that everybody213who is here believes in that and understands that these issues214are not partisan issues.215    Second, I want to just say I appreciated very much the work216that I know you are already doing, that we all are doing, to217make sure that this new administration does not catch up in its218funding freezes or stops initiatives that are specific to219Indian Country. Because those initiatives are about the trust220and treaty responsibilities that the Federal Government has to221Native people. It is not about any particular policy or222initiative that might be out there, particularly related to223diversity, equity and inclusion.224    So I am just grateful for your perspective on that, and I225look forward to the panel.226    The Chairman. Thank you, Senator Smith.227    Any other opening statements?228    With that, we will turn to our witnesses. Again, we have a229very esteemed panel, thank you. We will first hear from the230Honorable Mark Macarro, who is the President of the National231Congress of American Indians. NCAI has been meeting in232Wahington, D.C. this week, and I know that many of us had an233opportunity to be in front of your membership.234    He will be followed by the Honorable William Smith, who is235the Chairperson and Alaska Area Representative for the National236Indian Health Board. Chief Bill, it is good to have you back237before the Committee.238    Next, we have the Honorable Rodney Butler. He is the Board239President for the Native American Financial Officers240Association. Welcome, good to see you.241    On the education front, we have Mr. Kerry Bird, who is the242Board President of the National Indian Education Association,243also meeting here in Washington, D.C. this week.244    Then virtually, as Vice Chair Schatz has mentioned, we have245Mr. Kuhio Lewis, who is the Chief Executive Officer of the246Council for Native Hawaiian Advancement.247    So you know, gentlemen, we have your full testimony as part248of our Committee record already. It will be included as part of249that. So we would encourage you to try to keep your comments to250about five minutes, so that we have more opportunities for251questions after you have given us your statements.252    So we will go in the order of introduction, beginning with253President Macarro.254255STATEMENT OF HON. MARK MACARRO, PRESIDENT, NATIONAL CONGRESS OF256                        AMERICAN INDIANS257258    Mr. Macarro. [Greeting in Native tongue.] Thank you, Chair259Murkowski and Vice Chair Schatz, for allowing me to testify to260this Committee on Indian Country's priorities for the 119th261Congress.262    My name is Mark Macarro. I am the Tribal Chairman for the263Pechanga Band of Indians in California. But today I come before264you as the current President of the National Congress of265American Indians, founded in 1944. NCAI is the oldest, largest,266and most representative Indian and Alaska Native organization267serving the broad interests of Indian Country, Indian tribal268governments, and their communities.269    Tribal nations are inherently sovereign governments with270unique legal and political status. This has been long271recognized by Congress and reaffirmed by the United States272Supreme Court. Congress and the administration must continue to273recognize tribal nations as sovereign governments and support274clear directives that reinforce the legal and political status275of tribal nations.276    Federal funding programs that deliver services and277facilitate the sovereignty and self-determination of tribal278nations are created by Federal laws and policies that reinforce279the obligation of the Federal Government to fulfill its trust280and treaty obligations to support tribal nations and their281citizens and their institutions.282    When Congress is acting under its unique obligation toward283tribal nations and their citizens, they have the legal status284as a political class rather than as a suspect racial class285under the principles of constitutional legal analysis. The U.S.286Supreme Court has consistently recognized and upheld the287distinct legal and political status of tribal nations and their288citizens.289    The Department of Interior and Secretary Order 3416290directing its agency on implementation of administration291priorities recognized that the statutory authorities and treaty292and trust obligations of the Department, that is Interior, to293tribal nations, are legal requirements that must not be294impaired. So we ask that Congress and the administration ensure295Federal funding for tribal programs is not paused, reallocated,296reclassified, or de-prioritized when implementing any executive297order or other administration priority.298    Ensure that in limiting the Federal workforce, sufficient299Federal employees are available to deliver on all the trust and300treaty obligations. Tribal nations support this301administration's efforts to alleviate burdensome regulations302and other barriers that hinder tribal self-governance and303economic development, but these efforts must be developed in304close consultation at all levels of government with tribal305nations to ensure there are no unintended consequences.306    Now, to staffing levels and vacancies at IHS. Chronic307Indian health care workforce shortages have continued to plague308tribal citizens and tribal communities. Finding and keeping309qualified health care professionals in tribal hospitals,310clinics, and facilities has been challenging due to current311funding levels and location, primarily rural areas. The recent312U.S. Office, well, I will just say OPM, the recent email from313OPM to approximately 2 million Federal employees has caused314confusion and concern among many, including those who315tirelessly serve in Indian Country.316    Among those Federal employees are health care professionals317within the Indian Health Service. This action has immediate318consequences for tribal citizens and tribal communities that319receive life-saving services through the IHS.320    Reduction to an already short-staffed health care provider321does not honor the legal and political obligations made to322tribal nations and puts lives at risk. We thank Congress for323its recent steps to strengthen its treaty and trust obligations324through its continued support of IHS advance appropriations.325However, reducing health care professionals that serve our326citizens and communities is a step in the wrong direction.327    H.R. 741, the Stronger Engagement for Indian Health Needs328Act of 2025, is a step in the right direction. We urge your329support for this legislation.330    The Federal Government has a fundamental duty to ensure331public safety on tribal lands, rooted in treaty and trust332obligations to tribal nations. This obligation has been333recognized by Congress, notably in the Tribal Law and Order334Act, which underscores the Federal responsibility to prevent335crime in Indian Country. The BIA Office of Justice Services'3362021 report to Congress highlights a critical funding crisis,337revealing that public safety and justice in Indian Country is338currently funded at only 12 percent of actual need.339    The funding shortfall is $3 billion. It indicates a need340for approximately 25,000 additional personnel to ensure341adequate safety and justice services in tribal communities.342    The Federal standard for officers is 2.4 per 1,000 people.343Using the Oglala Sioux Tribe as an example, at .6 officers per3441,000 people and 53,000 tribal members, there is a huge345disparity. These disparities are common amongst all our346especially land-based tribes, and it cannot continue.347    To address these alarming unmet needs, Congress must commit348to providing sufficient funding for public safety and justice349programs in Indian Country, ensuring safe and secure350communities for tribal citizens.351    In closing, I will close with jurisdiction. The public352safety crisis in Indian Country is deeply rooted in historical353jurisdictional challenges, stemming from regulations, statutes354and Supreme Court decisions over the past 150 years. This legal355framework endangers lives by limiting the ability of tribal356nations to effectively police and prosecute criminal357activities, allowing dangerous individuals to evade justice.358    Congress must address and eliminate these barriers faced by359tribal nation law enforcement and justice systems to empower360them in safeguarding their communities.361    I am over time. I appreciate the consideration. My last362sentence is, we really need NAHASDA, to put the shorthand on363housing. Thank you.364    [Laughter.]365    [The prepared statement of Mr. Macarro follows:]366367 Prepared Statement of Hon. Mark Macarro, President, National Congress368                          of American Indians369    On behalf of the National Congress of American Indians (NCAI),370thank you for holding this hearing to address tribal priorities for the371119th Congress. I am Mark Macarro, Chairman of the Pechanga Band of372Indians and President of the National Congress of American Indians373(NCAI).374    In 1944, tribal leaders gathered in response to federal policies375that sought to terminate the legal trust relationship once and for all.376Our forbears organized on the principles of dialogue and consensus, and377we continue those practices today as the oldest and largest378representative organization serving the broad interests of Tribal379Nations and communities. We continue their work to preserve the treaty380and sovereign rights of Tribal Nations, advance the government-to-381government relationship, and remove structural impediments to tribal382self-determination.383    NCAI is honored and grateful to testify in front of the 119th384Congress, and wishes to highlight the following policy priorities:385I. Appropriations386    The promises made by the U.S. Government in treaties and agreements387with Tribal Nations are today known as part of a trust responsibility388that your forbears assumed. It is a sacred responsibility to ensure389that these promises are kept. Last month, the U.S. Government390threatened to stop payment on its promises, forgetting this391responsibility and forgetting that millions of dollars are administered392in Indian Country by Indian Country, because Tribal Nations are parties393to self-governance compacts and contracts. We ask you not to take394lightly actions that break your sacred trust, and to deliver on the395promises of protections that have been guaranteed to us in these very396halls.397    We see the proposed Budget of the U.S. Government for FY 2025, and398note with appreciation that it includes requests for mandatory funding399of Indian Health Services (IHS) and Department of Interior (DOI) to400promote permanency and stability in self-governance. We likewise see401and appreciate the investments under the Bipartisan Law and the402Inflation Reduction Act, and ask that you keep in mind the benefits of403these and similar programs as we proceed with our testimony.404A. Indian Health Service-Expand and Sustain IHS Advance Appropriations405    In a historic first, the FY 2023 Omnibus provided an advance406appropriation for the Indian Health Service. Enactment of Advance407Appropriations for the IHS marked a paradigm shift in the nation-to-408nation relationship between Tribal Nations and the United States. Prior409to that enactment, IHS was the only federal provider of health care410that was on the regular, annual discretionary appropriations process.411Until the entirety of the IHS budget is provided mandatory direct412appropriations, it is critical that Congress continue advance413appropriations. Advance appropriations for the IHS are consistent with414the trust and treaty obligations reaffirmed by the United States in the415Indian Health Care Improvement Act. Until all IHS spending is416mandatory, including funding for full and adequate staffing, NCAI is417supportive of the Workgroup in its request for expanding IHS advance418appropriations to every account in the IHS discretionary budget. This419includes items such as increases from year-to-year that adjust for420inflation, population growth, and the Indian Health Care Improvement421Fund. The IHS need-based funding cost estimate for FY 2026 is422approximately $60.04 billion. \1\423---------------------------------------------------------------------------424    \1\ Workgroup publications available at: https://www.nihb.org/425category/government-affairs/indian-health-service-ihs-budget/, accessed426on: February 10, 2025.427---------------------------------------------------------------------------428    Both IHS and Tribal Nations have the collaborative tools to produce429reliable advance appropriation requests and implement full year advance430appropriations. For this appropriations cycle, Tribal Nations will have431already provided official input on the FY 2027 budget to IHS. This432budget will be presented to the Department of Health and Human Services433this year.434B. Department of the Interior-Bureau of Indian Affairs (BIA)435    The BIA is the primary agency responsible for providing services436throughout Indian Country, either directly or through compacts or437contracts with Tribal Nations. The robust operation of these programs438and services remain essential for the health, safety, and social and439economic well-being of Tribal Nations and surrounding communities.440Unfortunately, chronic underfunding and understaffing of tribal441programs perpetuates systemic issues such as generational poverty in442Indian Country that could be reduced or eliminated by funding tribal443programs in amounts that sincerely meet the federal government's treaty444and trust obligations to Tribal Nations.445    As with IHS, spending for Indian Affairs programs should be446mandatory spending with a form of automatic annual adjustment to447account for inflation and changes in jurisdiction or eligibility as448identified by datasets mutually agreed upon by Tribal Nations and the449federal government. Additionally, inclusion of certain mandatory450account payments under discretionary spending caps, such as Contract451Support Costs and Payments for Tribal Leases, has resulted in a net452drag on the amount of funding provided for tribal programs. This fails453to fulfill treaty and trust obligations to Tribal Nations. Moving454federal spending for these obligations to mandatory spending will455better match the legal obligations of providing such funds and fix the456unintended effects that mandatory obligations through discretionary457spending can have on other discretionary spending (such as lapses in458funding via continuing resolutions). In recent years the growth of459Contract Support Costs and Payments for Tribal Leases is evidence of460how successful these programs are for Tribal Nations, but under the461current discretionary spending they must compete with the other462discretionary spending accounts within Indian Affairs.463    NCAI recommends $27.1 billion for Indian Affairs programs in FY4642026, consistent with the official FY 2026 recommendation of the465Tribal/Interior Budget Council (TIBC). \2\ Within TIBC's FY 2026466recommendations are robust increases for all base-funded programs, and467additional funding to address public safety and justice in tribal468communities. Please keep in mind that such increases have a ripple469effect that also benefit the economic and social wellbeing of our470citizens and all those who visit or do business in our communities.471---------------------------------------------------------------------------472    \2\ TIBC Tribal Representatives' FY 2026 Budget Submission to the473Department of the Interior, April 9, 2024, accessed at: https://474cdn.sanity.io/files/raa5sn1v/production/4759c4e1e12d80bfbcd11d349b24dd86ecf1a89ee23.pdf476---------------------------------------------------------------------------477C. Environmental Protection Agency (EPA)478    As place-based Peoples, Tribal Nations have sacred histories and479maintain cultural practices that tie them to their current land bases480and ancestral territories. As a result, tribal Peoples directly, and481often disproportionately, suffer from the impacts of environmental482degradation.483    50 years after the passage of the Clean Water Act, 52 of 84484eligible Tribal Nations have EPA-approved water quality standards, \3\485which are a cornerstone of the Clean Water Act. Given the disparate486access of tribal communities to safe, clean water, NCAI recommends a487five percent tribal set-aside for each of the National Safe Drinking488Water State Revolving Fund (DWSRF) and the National Clean Water Act489State Revolving Fund (SRF).490---------------------------------------------------------------------------491    \3\ Environmental Protection Agency, EPA Actions on Tribal Water492Quality Standards and Contacts, https://www.epa.gov/wqs-tech/epa-493actions-tribal-water-quality-standards-and-contacts, accessed February49410, 2025.495---------------------------------------------------------------------------496    Additionally, NCAI recommends $145 million be appropriated for the497EPA Tribal General Assistance Program and $30 million for the Tribal498Air Quality Management Program.499D. Reclassify Contract Support Costs and 105 (l) Tribal Leases as500        Mandatory501        Spending502    NCAI, the National Tribal Budget Formulation Workgroup (Workgroup),503and the Tribal Interior Budget Council (TIBC) request such sums as may504be necessary to fully fund statutory and legally obligated Contract505Support Costs (CSC). We hold the position that contract support costs506should be provided through mandatory spending. This must be done as an507interim step until the full IHS and Bureau of Indian Affairs (BIA)508budgets are moved to mandatory funding. IHS and the BIA provided509estimated contract support costs for FY 2026 to the Workgroup and TIBC510at $1.07 billion for IHS and over $421 million for the BIA. Within the511IHS, approximately 60 percent of the budget is operated by Tribal512Nations under the authority of the Indian Self-Determination and513Education Assistance Act (ISDEAA).514    The Act allows Tribal Nations to assume the administration of515programs, services, functions, and activities previously carried out by516the federal government. The IHS and BIA transfer operational costs for517administering programs to Tribal Nations through the ``Secretarial518amount,'' which is the amount IHS and BIA would otherwise have spent to519administer the programs. In other words, the U.S. Government has520contracted with Tribal Nations to fulfill the duties of its trust521obligation to those Nations; this is a workable system that delivers522superior services and it must be defended against cuts and funding523freezes. In addition, Tribal Nations are authorized to receive an524amount for contract support costs that meets the statutory definition525and criteria. If IHS and BIA's budgets continue to be funded through526annual discretionary appropriations, NCAI, the Workgroup, and TIBC527support that the appropriation continue in such sums as may be528necessary, due to the mandatory nature of these contract support costs529obligations.530    The ISDEAA also authorizes IHS and BIA to enter a lease for a531facility upon the request of a Tribal Nation or tribal organization for532the administration or delivery of programs, services, and other533activities under the Act. Lease requests have increased rapidly as the534usage of the program authority has expanded; many of the Tribal Nations535have increasingly entered into 105(l) lease agreements as an immediate536solution to the ongoing issue of insufficient funding for maintaining,537repairing, and reconstructing facilities.538    However, including accounts such as contract support costs and539105(l) leases that are mandatory in nature under discretionary spending540caps has led to a decrease in the amount of funding provided for other541tribal programs. This carries a negative impact on the federal542government's capacity to fulfill its commitments to Tribal Nations.543Tribal Nations fully support requests that all the IHS and BIA budgets544be provided as mandatory spending, but that contract support costs and545payments for 105(l) Tribal Leases be immediately reclassified as546mandatory.547    The CSC & 105(l) leases within the BIA have increased from 9548percent in FY2 015 to 18 percent in the FY2025 President's Budget549Request. The BIA's 105(l) lease program received a 53 percent increase550in the FY 2024 enacted budget. In FY 2019, there were a total of 2, 105551(l) leases and by FY 2023, the number of 105(l) lease renewals and552requests increased to 562.553    Given current 105(l) lease program trends in IHS and BIA, Tribal554Nations have concerns that 105(l) costs could have a detrimental impact555on overall increases for IHS and BIA, including funds for patient care556and trust services. It is with this in mind that the IHS Workgroup and557Tribal Interior Budget Council (TIBC) continues to urge that all the558IHS and Bureau of Indian Affairs budgets be classified as mandatory559spending. Furthermore, they strongly urge that contract support costs560and payments for 105(l) be immediately transitioned to mandatory561spending. These national tribal advisory groups urge this immediate562action to ensure that spending for IHS and BIA under discretionary caps563can prioritize addressing Indian Country inequities made worse by564inadequate budgets.565E. Hold Harmless for DOI--Indian Affairs, IHS and Other Programs for566        the Benefit of Tribal Nations567    The DOI-Indian Affairs and IHS budgets represent only a small568portion of overall Congressional spending compared to the national569budget. While spending cuts or other budget control measures, such as570discretionary spending caps, may severely affect tribal programs, they571would have minimal impact on total federal spending. If Congress572considers funding reductions in FY 2026, it is crucial that the DOI-573Indian Affairs, IHS, and other programs benefiting Tribal Nations be574protected from cuts.575II. Public Safety and Justice576A. Funding for Safer Communities577    Among the essential components of the federal government's treaty578and trust responsibilities to Tribal Nations is the obligation to579protect public safety on tribal lands. Congress has long acknowledged580this obligation, which Congress reaffirmed in the Tribal Law and Order581Act (TLOA) expressly ``acknowledging the federal nexus and distinct582federal responsibility to address and prevent crime in Indian583Country.'' \4\584---------------------------------------------------------------------------585    \4\ Tribal Law and Order Act, 34 U.S.C.  10381(j).586---------------------------------------------------------------------------587    In March of 2024, the Bureau of Indian Affairs--Office of Justice588Services released its 2021 Report to the Congress on Spending,589Staffing, and Estimated Funding Costs for Public Safety and Justice590Programs in Indian Country. \5\ The report fulfills the Bureau of591Indian Affairs (BIA) reporting requirements within the Tribal Law and592Order Act of 2010 by documenting the existing and needed spending,593staffing, and estimated costs for BIA-funded Public Safety and Justice594Programs in Indian Country. The 2018 report identified that public595safety and justice in Indian Country was funded at a mere 14 percent of596need (a $2.33 billion shortfall). According to the 2021 estimates, this597has fallen further to 12 percent (a $3.06 billion shortfall). The $3.06598billion dollar shortfall equates to approximately 25,655 additional599personnel required to adequately serve Indian country.600---------------------------------------------------------------------------601    \5\ U.S. Dep't of the Interior, Bureau of Indian Affairs, Office of602Justice Serv., Report to the Congress on Spending, Staffing, and603Estimated Funding Costs for Public Safety and Justice Programs in604Indian Country, 2021 (Feb. 2024), https://www.bia.gov/sites/default/605files/media_document/2021_tloa_report_final_508_compliant.pdf606---------------------------------------------------------------------------607    This inadequate funding for tribal criminal justice and public608safety has resulted in staggering rates of violent crime and609victimization on many Indian reservations. Congress acknowledges that a610longstanding public safety crisis in America has contributed to an611ever-growing drug crisis and specifically to a public safety and law612enforcement emergency in Indian Country. \6\613---------------------------------------------------------------------------614    \6\ The United States Senate Committee on Indian Affairs. (2009,615June 9). Senate Indian Affairs Committee to conduct hearing on law and616order in Indian Country--Indian Affairs Committee. Indian Affairs617Committee. https://www.indian.senate.gov/newsroom/press-release/618democratic/senate-indian-affairs-committee-conduct-hearing-law-and-619order-indian-country/620---------------------------------------------------------------------------621    A Department of Justice (DOJ) study found that more than four in622five American Indian and Alaska Native (AI/AN) adults have experienced623some form of violence in their lifetime. \7\ Among AI/AN women, 55.5624percent have experienced physical violence by intimate partners in625their lifetime, and 56.1 percent have experienced sexual violence. \8\626NCAI appreciates Congress' enactment of the Violence Against Women Act627(VAWA) Reauthorization Act of 2022, which has helped address violent628crime in Indian Country, reinstating Tribal Nations' authority to629address crime in their communities and providing resources to make up630for lost time. Going forward, robust funding for these VAWA-related631programs and tribal police departments and justice systems is632absolutely essential to improve public safety on the ground in tribal633communities.634---------------------------------------------------------------------------635    \7\ U.S. Department of Justice, Violence Against American Indian636and Alaska Native Women and Men: 2010 Findings from the National637Intimate Partner and Sexual Violence Survey, 2, (2016), https://638www.ncjrs.gov/pdffiles1/nij/249736.pdf.639    \8\ Ibid.640---------------------------------------------------------------------------641    Because BIA base funding is so inadequate, Tribal Nations often642seek short-term, competitive grants to try to make up a portion of the643shortfall. This is especially true with regard to funding for justice644systems, such as tribal courts, which are even more severely645underfunded than policing and detention. Between 2021 and 2024 the DOJ646awarded an average of $84.3 million through its Coordinated Tribal647Assistance Solicitation (CTAS) grant program to Tribal Nations. \9\648While this funding remains as a critical resource to tribal governments649it still falls dramatically short of the estimated need identified in650the 2021 OJS report to Congress stated above.651---------------------------------------------------------------------------652    \9\ ``Coordinated Tribal Assistance Solicitation (CTAS) Awards,''653(October 2024), https://www.justice.gov/tribal/awards.654---------------------------------------------------------------------------655    In 2018, the U.S. Commission on Civil Rights (USCCR) found that656there continues to be ``systematic underfunding of tribal law657enforcement and criminal justice systems, as well as structural658barriers in the funding and operation of criminal justice systems in659Indian Country'' that undermine public safety. Tribal justice systems660must have resources so they can protect women, children, and families,661address substance abuse, rehabilitate first-time offenders, and put662serious criminals behind bars--no matter where those criminals are663from. Well-functioning criminal justice systems, basic police664protection, and services for victims are fundamental priorities of any665government andTribal Nations are no different.666B. Criminal Jurisdiction667    The public safety crisis confronting Indian Country is not a result668of happenstance, but rather the outcome of a series of jurisdictional669challenges created by regulations, statutes, and the Supreme Court over670the past century and a half. Together, this legal framework puts lives671at risk because it prevents Tribal Nations from effectively policing,672arresting, trying, and sentencing bad actors and dangerous criminals.673    Congress should work to remove as many barriers as possible from674Tribal Nation law enforcement officers and justice systems. Allowing675Tribal Nations to fully take the actions necessary to ensure the676public's safety is a cost-effective tactic to reduce crime in America677while respecting and strengthening tribal sovereignty.678III. Infrastructure679A. Housing680    Housing infrastructure in Indian Country continues to lag behind681the rest of the United States. \10\ In what is still the most682comprehensive review of housing needs within Tribal Nations, over 70683percent of existing housing stock in tribal communities is in need of684upgrades and repairs, many of them extensive. \11\ In 2017, the U.S.685Department of Housing and Urban Development (HUD) reported that ``the686lack of housing and infrastructure in Indian Country is severe and687widespread, and far exceeds the funding currently provided to tribes.''688\12\689---------------------------------------------------------------------------690    \10\ U.S. Department of Housing and Urban Development Office of691Public and Indian Housing, Native American Programs, FY25 Congressional692Justifications 13-2,(2024) https://web.archive.org/web/20240930155324/693https://www.hud.gov/sites/dfiles/CFO/documents/2025_CJ_Program_-694_Native_American_Programs.pdf, last accessed February 10, 2025.695    \11\ U.S. Department of Housing and Urban Development, Fiscal Year6962017 Congressional Justifications, 11-12, (2016), https://697web.archive.org/web/20241225104440/https://www.hud.gov/sites/documents/698FY_2017_CJS_COMBINED.PDF, last accessed February 10, 2025.699    \12\ Broken Promises Report, at 137, (2018), https://www.usccr.gov/700pubs/2018/12-20-Broken-Promises.pdf.701---------------------------------------------------------------------------702    The lack of affordable housing contributes to homelessness and703overcrowding. Tribal communities experience overcrowded homes at a rate704of 16 percent, roughly eight times the national average. \13\ HUD705research also shows that such overcrowding has a negative effect on706family health and contributes to the ongoing problems of domestic707violence and poor school performance in Indian Country. \14\ Funding708new construction across the board will help alleviate issues of709overcrowding, but Tribal Nations find that they must spend an ever710larger portion of Federal dollars (and their own matched funding) on711trying to maintain and operate existing stock instead of expanding to712meet needs. \15\ In addition to the historic funding shortfalls, the713location of many tribal communities increases the material and labor714costs of home construction and impose additional housing development715costs upon communities already confronting enormous economic716challenges. \16\ Building materials must often be brought into tribal717communities from miles away over substandard roads or even by air, and718the availability of ``qualified and affordable contractors'' is719limited. \17\ Given these extensive funding needs, it is critical that720Congress (1) support the reauthorization of NAHASDA; (2) permanently721reauthorize the Tribal HUD-VASH Program; and (3) introduce and pass722legislation that aims to increase homeownership rates in Indian723Country.724---------------------------------------------------------------------------725    \13\ U.S. Department of Housing and Urban Development, Housing726Needs of American Indians and Alaska Natives in Tribal Areas: A Report727From the Assessment of American Indian, Alaska Native, and Native728Hawaiian Housing Needs, (2017), https://www.huduser.gov/portal/sites/729default/files/pdf/HNAIHousingNeeds.pdf.730    \14\ Department of Housing and Urban Development (HUD), Fiscal Year7312017 Congressional Justifications, 11-4, https://web.archive.org/web/73220241225104440/https://www.hud.gov/sites/documents/733FY_2017_CJS_COMBINED.PDF.734    \15\ U.S. Department of Housing and Urban Development Office of735Public and Indian Housing, Native American Programs, FY25 Congressional736Justifications 13-3, (2024) https://web.archive.org/web/20240930155324/737https://www.hud.gov/sites/dfiles/CFO/documents/2025_CJ_Program_-738_Native_American_Programs.pdf, last accessed February 10, 2025.739    \16\ Broken Promises Report, at 138, (2018), https://www.usccr.gov/740pubs/2018/12-20-Broken-Promises.pdf.741    \17\ Ibid.742---------------------------------------------------------------------------7431. Support for the reauthorization of the Native American Housing and744        Self-745        Determination Act of 1996 (NAHASDA).746    The Native American Housing Assistance and Self-Determination Act747of 1996 (NAHASDA) is intended to help bridge the gap in housing needs748in Native communities and allow Tribal Nations to exercise self-749determination at the local level. Annual funding for the Native750American Housing Block Grant (NAHBG, also known as ``Indian Housing751Block Grants'' or IHBG)--the key source of funding under NAHASDA--has752remained flat at around $650 million since FY 2010 while housing needs753continue to grow.754    NAHASDA expired on September 30, 2013. Since 2013, NAHASDA755reauthorization legislation has been introduced and has been reviewed756to some degree in each Congress leading up to the 119th Congress, but757unfortunately none of those bills were ever signed into law. NAHASDA758was created to offer flexibility in tribal housing planning, execution759of funds, and the administration of individual housing programs. Under760NAHASDA, Indian tribes and tribally designated housing entities (TDHEs)761can conduct new construction, rehabilitation, and acquire affordable762housing, as well as provide infrastructure updates and various support763services. The Indian Housing Block Grant funds can also be used for764certain types of community facilities. Since its creation, almost76541,500 affordable homes have been built or acquired and an additional766105,000 affordable homes have been restored on tribal lands and in767Alaska Native communities.768    Reauthorization provides more certainty for future appropriations769and better assists TDHEs in developing successful housing options. We770strongly urge you to make your support known to other members of771Congress. We must work together to uphold tribal sovereignty and self-772determination.773    NAHASDA authorizes housing programs such as the IHBG and the Indian774Community Development Block Grant, which enables Tribal Nations and775their housing authorities to design and implement their own housing,776community development, and infrastructure programs. This authorization777has resulted in the construction of tens of thousands of housing units778in Indian Country. As it rests on tribal decisionmaking, NAHASDA has779also resulted in an increase in tribal capacity to address housing and780other needs. It is most important that this Congress enact robust781increases in Native American Programs at HUD.7822. Rollback burdensome Build America, Buy America (BABA) requirements783        for784        tribal housing projects.785    The Build America, Buy America Act (BABA) establishes a domestic786content procurement preference--the ``Buy America Preference'' (BAP)--787which mandates that products purchased for infrastructure projects788funded by federal grants must be produced in the United States. This789legislation was enacted on November 15, 2021, as part of the790Infrastructure Investment and Jobs Act. Tribal Nations and TDHE's have791voiced concerns with BAP and the implications concerning cost792increases, prolonged project timelines, and costly and onerous793compliance burdens. BABA is a bureaucratic unfunded mandate which794undoes the recent funding increases for NAHASDA programs that took a795whole generation to achieve.796    HUD's updated guidance on the Build America, Buy America Act (BABA)797includes waivers and exceptions, such as the ``De Minimis'' waiver,798which allows for a portion of project costs to be exempt from BABA799requirements. Even so, many projects will still face significant cost800increases due to the need to source materials domestically, which are801more expensive and less readily available, especially in rural and802remote areas.803IV. Farm Bill804    Agriculture is a major economic, employment, and nutrition sector805in Indian Country. According to the 2022 Census of Agriculture, nearly80660,000 American Indian or Alaska Native (AI/AN) producers \18\ on more807than 55 million acres for the production of crops, livestock, or both.808\19\ These farms and ranches sold over $3.8 billion of agricultural809products. Agriculture remains the second leading employer in Indian810Country and is the backbone of the economy for many Tribal Nations.811---------------------------------------------------------------------------812    \18\ United States Department of Agriculture, 2022 Census of813Agriculture, Table 52 (2024), https://www.nass.usda.gov/Publications/814AgCensus/2022/Full_Report/Volume_1,_Chapter_1_US/usv1.pdf815    \19\ USDA, 2022 Census of Agriculture, Table 61.816---------------------------------------------------------------------------817    NCAI is a founding and executive committee member of the Native818Farm Bill Coalition, along with the Intertribal Agriculture Council,819the Shakopee Mdewakanton Sioux Community, and the Indigenous Food and820Agriculture Initiative. NCAI fully supports the Native Farm Bill821Coalition, who will also be testifying, and we want to emphasize the822need for more opportunities for self-governance, co-management, funding823flexibility, and direct management and implementation of programs.824    The nutrition title is of particularly high importance to Indian825Country. With 24 percent of AI/AN households receiving Supplemental826Nutrition Assistance Program (SNAP) benefits, 276 Tribal Nations827administering the Food Distribution Program on Indian Reservations828(FDPIR), 68 percent of AI/AN children qualifying for free and reduced829price lunches, and American Indians and Alaska Natives making up more830than 12 percent of the participants in the Special Supplemental831Nutrition Program for Women, Infants, and Children (WIC), the832importance of food assistance in Indian Country cannot be overstated.833Any cuts to SNAP, FDPIR, WIC, or school lunch programs directly834diminish the food available toNative children, pregnant women, elders,835and veterans--who in some cases rely on these programs as their only836source of meals.837    Additionally, food assistance programs like FDPIR must be provided838the means and support to purchase traditional, locally grown food in839their food packages. Traditional and locally grown foods from Native840American farmers, ranchers, and producers promote healthy living,841cultural sustainability, and a revival of traditional practices, all842while fostering economic development. NCAI urges Congress to promote843the expansion and permanent establishment of the Food Distribution844Program on Indian Reservations (FDPIR), grant tribal eligibility to845administer the Supplemental Nutrition Assistance Program (SNAP), and846allow the dual use of both SNAP and FDPIR. To realize many of these847priorities there needs to be an expansion of 638 authority under the848Indian Self-Determination and Education Assistance Act (ISDEAA) broadly849across the Department of Agriculture (USDA) and its programs, as well850as the reduction and elimination of match requirements.851Conclusion852    NCAI appreciates the opportunity to present Indian Country's853priorities for the 119th Congress to the Committee. We look forward to854working with the Indian Affairs Committee and its members during this855Congress to advance the interests of Tribal Nations in accordance with856the federal trust responsibility.857858    The Chairman. Well summed up. Thank you, President Macarro.859    Next, we will go to Chief William Smith, Chief Bill.860861         STATEMENT OF HON. WILLIAM SMITH, ALASKA AREA862     REPRESENTATIVE; CHAIRMAN, NATIONAL INDIAN HEALTH BOARD863864    Mr. Smith. Chairwoman Murkowski, Ranking Member Schatz, and865distinguished members of this Committee, on behalf of the866National Indian Health Board and the 574-plus sovereign867federally recognized American Indian and Alaska Native Tribal868Nations we serve, thank you for the opportunity to provide869testimony on the Tribal Health Priorities for the 119th870Congress.871    My name is Wiliam Smith. I am Eyak, and I am a veteran of872the United States Army. I serve as the Alaska Area873Representative and Chairman of the National Indian Health874Board. I also serve as the Chairman of the Alaska Native Health875Board and the Vice President of the Valdez Native Tribe of876Alaska.877    The U.S. Constitution recognizes three sovereigns: the878Federal Government, States governments and Indian tribes. As879sovereigns, tribes predate the United States and retain the880rights of self-government. The Supreme Court has upheld Indian-881specific legislation determining that it is political in882nature, rather than based on an unconstitutional racial883classification.884    Recent executive orders and guidance have unintentionally885impacted the Indian Health System. We commend the Chairwoman on886her letter to the administration urging the need to meet the887trust and treaty obligation of the Federal Government to888tribes. We concur that the Department of Health and Human889Services should issue a secretarial order that acknowledges the890political status of the tribal nations and their citizens.891    Plainly stated, the Federal trust and treaty responsibility892to tribes exempts all tribal departmental programs from the893impacts of recent executive orders and guidance. Further, we894urge the Committee and Congress to continue to educate and work895with the new administration to fulfill its legal obligations to896tribal nations.897    The Indian Health System continues to be dramatically898underfunded,. Providing the Indian Health Service with full and899mandatory funding will ensure the Federal Government is meeting900its trust and treaty responsibilities and obligations to the901tribal nations for health.902    The Indian Health Service National Tribal Budget903Formulation Workgroup has estimated that full funding for 2026904would be $63 billion. Congress further authorized the Indian905Health System to bill Medicare and Medicaid and the Children's906Health Insurance program to address funding needs.907    As Congress considers Medicare reform, it is essential that908the Federal trust responsibility for Indian health care be909honored at 100 percent FMAP for the services received through910the Indian Health Service and exempting Indian Health Service911is preserved. Exempting Indian Health Service American912beneficiaries from the reforms, including work requirements, is913consistent with the United States' trust and legal914responsibility to tribes.915    Medicare reforms must be delivered and understood for its916impact to Indian Health programs, even though those changes to917not immediately appear to do so. These resources are critical918to address the needs of Indian Country, including behavioral919health. The strain on the available resources for Indian Health920System cannot meet the demand of the rising behavior and health921issues nationwide.922    Using the grant as the primary vessel to deliver behavioral923health funding or any funding limits a tribe's ability to924deliver critical services and can deter patients from accessing925care and lack of access, culture, providing treatment, all926components of the behavioral health crisis in Indian Country.927    We ask Congress to strengthen tribal behavioral health928treatments and programs by increasing resources, providing the929flexibility and self-governance and funding to support930expanding access to tribal traditional healing services.931Historical trauma combined with social, political and932environmental factors has impacted the health status of933American Indian and Alaska Native mothers and infants. Further,934lack of investment has resulted in a higher rate of maternal935and infant mortality.936    Congress should support improving maternal and infant937outcomes for Native mothers and children to provide the funding938set aside in the Maternal and Child Health Service block939grants. Investing in a robust maternal and birth health940workforce will improve data for American Indians and Alaska941Native mothers and infants.942    Many of these recommendations have been highlighted in two943recent reports. The first, the Way Forward Report by Alyce944Spotted Bear and Walter Soboleff Commission on Native Children945and the National Indian Health Board Tribal Prenatal to Three946Policy Agenda.947    Congress should adopt the 2024 health care package948introduced in the 118th Congress. This package includes a949number of tribal priorities, including reauthorization of the950Special Diabetes Program for Indians for two years for $200951million per year and Medicare tribal flexibility.952    Indian Health Service provides scholarships and loan953repayment opportunities incentives for the medical profession954to work in Indian Country. Any tax reform legislation955considered in the 119th Congress should make Indian Health956scholarships and loan programs tax-exempt and be a priority957with other similar programs.958    Tribal sovereignty and the success of self-determination959and self-governance through the adoption of demonstration and960pilot programs. We stand ready to work with this Committee on961this endeavor.962    In conclusion, the Federal Government made promises in963tribal treaties to provide for, among other things, health care964of tribal citizens. These priorities are each a step to meet965those promises and fulfill the trust and treaty responsibility.966    I want to thank this Committee for the opportunity to967speak. The bottom line is, Congress has the ability to look at968the broken promises and see how every treaty was broken. And969they have an obligation to fulfill those deals, because those970like one chief said, we have already paid. We have paid and971paid and paid. We have paid with our land; we have paid with972our lives. And we paid the deals. We have given up our lands,973and the United States has promised they would take care of our974health and education. So, paid in full, that is what we are975looking for.976    Thank you.977    [The prepared statement of Mr. Smith follows:]978979 Prepared Statement of Hon. William Smith, Alaska Area Representative;980                 Chairman, National Indian Health Board981    Chairwoman Murkowski, Ranking Member Schatz, and distinguished982members of the Committee, on behalf of the National Indian Health Board983(NIHB) and the 574+ sovereign federally recognized American Indian and984Alaska Native Tribal Nations we serve, thank you for this opportunity985to provide testimony on the Tribal Health Priorities for the 119th986Congress. My name is William Smith. I am Eyak and I am a veteran of the987United States Army. I serve as the Alaska Area Representative and988Chairman of the National Indian Health Board (NIHB). I also serve as989the Chairman of the Alaska Native Health Board and the Vice President990of the Valdez Native Tribe, of Valdez, Alaska.991Trust and Treaty Obligation992    The U.S. Constitution recognizes three sovereigns: the Federal993government, States, and Indian Tribes. As sovereigns, Tribes predate994the United States, and retain rights of self-government. \1\ When the995United States was established, the Constitution's Indian Commerce996Clause granted Congress the authority to pass legislation specific to997Indian Affairs. \2\ The Supreme Court has upheld Indian-specific998legislation, determining that it is political in nature, rather than999based on an unconstitutional racial classification. \3\ Health care1000reform legislation that reflects the unique federal trust1001responsibility to provide health care for American Indians and Alaska1002Natives is subject to rational basis review and does not violate the1003equal protection clause so long as it is ``tied rationally to the1004fulfillment of Congress' unique obligation toward the Indians.'' \4\1005---------------------------------------------------------------------------1006    \1\ Worcester v. State of Ga., 31 U.S. 515, 559 (1832).1007    \2\ U.S. CONST., art. I,  8, cl. 3; see also Morton v. Mancari,1008417 U.S. 535, 552-55 (1974).1009    \3\ Morton, 417 U.S. at 555; see also Moe v. Confederated Salish &1010Kootenai Tribes of Flathead Reservation, 425 U.S. 463, 479-80 (1976);1011Washington v. Washington State Commercial Passenger Fishing Vessel1012Ass'n, 443 U.S. 658, 673 n.20 (1979); United States v. Antelope, 4301013U.S. 641, 645-47 (1977); Am. Fed'n of Gov't Employees, AFL-CIO v.1014United States, 330 F.3d 513, 520-21 (D.C. Cir. 2003).1015    \4\ Morton, 417 U.S. at 555.1016---------------------------------------------------------------------------1017    Congress has the constitutional authority and responsibility to1018provide for Indian health care. Tribes signed treaties and negotiated1019other agreements with the United States in which they ceded vast1020amounts of territory in exchange for certain solemn promises. These1021promises include protecting Tribal self-government and providing for1022the health and well-being of Indian peoples. \5\ Indian treaties are1023the supreme law of the land, and in carrying out these treaty1024obligations, the United States has ``moral obligations of the highest1025responsibility and trust.'' \6\1026---------------------------------------------------------------------------1027    \5\ See United States v. Winans, 198 U.S. 371, 380-81 (1905).1028    \6\ Seminole Nation v. United States, 316 U.S. 286, 296-97 (1942);1029see also U.S. CONST., art. VI, cl. 2; Worcester, 31 U.S. at 539.1030---------------------------------------------------------------------------1031    Congress has passed numerous Indian-specific laws to provide for1032Indian health care, including establishing the Indian health care1033system and passing the Indian Health Care Improvement Act (IHCIA), 251034U.S.C.  1601 et seq. In the IHCIA, for instance, Congress found that1035``Federal health services to maintain and improve the health of the1036Indians are consonant with and required by the Federal Government's1037historical and unique legal relationship with, and resulting1038responsibility to, the American Indian people.'' Id.  1601(1).1039Congress has also legislated to provide Indians with access to general1040health programs, such as Medicaid, while creating Indian-specific1041protections within those programs that reflect this unique political1042relationship.1043    Congress has full constitutional authority to legislate with regard1044to Indian health care, and should continue to promote Tribal1045sovereignty and uphold the government-to-government relationship1046between the United States and Tribes in fulfillment of its trust and1047legal responsibilities in any health care reform proposal it considers.1048Tribal Impacts of Recent Executive Orders and Guidance1049    Recent Executive Orders and guidance have had inadvertent impacts1050on the Indian health system. From the recent hiring freeze, deferred1051resignation solicitation, and pause on federal financial assistance,1052the Indian health system trying to understand how these orders and1053guidance impact the system while continuing to meet the federal1054government's trust and treaty obligations. For example, the Office of1055Management and Budget (OMB) memorandum (M-25-13) put an immediate halt1056on federal financial assistance, including grants and loans to Tribal1057programs. Despite the memorandum being rescinded under OMB M-25-14, the1058risk of immediate implementation of administrative policies like this1059harm the operation of the Indian health system by restricting critical1060resources. During the pause of federal funding, many Indian healthcare1061clinics were immediately impacted, delaying and pausing services so1062individuals had to be rescheduled. The halt in funding brought many1063back to an era before advance appropriation, readying plans to furlough1064program staff, reduce program hours, and temporarily close specific1065programs. During previous periods of financial pause, staff and1066providers left the Indian health system, seeking job security1067exacerbating clinics which are already understaffed. The Indian health1068care clinic cannot risk any harmful changes during this Administration1069that negatively impact our operations and our ability to serve our1070citizens.1071    Our workforce is also being compromised by the Executive Order1072instituting a federal hiring freeze for civilian employee positions and1073instructing the creation of the plan to reduce the size of the federal1074workforce. This has been accompanied by a deferred resignation1075solicitation which went out to federal employees in Tribal programs and1076the IHS. Currently, IHS has a workforce gap of 30 percent and a 361077percent vacancy rate for physicians, that hinders our ability to1078provide timely care to American Indian and Alaska Native (AI/AN)1079beneficiaries. \7\ On January 31, 2025, NIHB, along with three other1080national Tribal organizations, sent a letter requesting exemptions for1081IHS from any plans, policies, or incentives that freeze hiring or seek1082to decrease the federal workforce, including any planned federal1083layoffs, attrition, or reduction quotas. While we understand that 600-1084series providers may still be hired, there are conflicting reports1085whether this is being honored at present. The Indian health system must1086have the ability to onboard, administer, and operate its programs with1087the staffing necessary to meet accreditation standards and keep1088facility doors open. IHS operations need to be able to bring in staff1089in behavioral health, clinical administration and oversight, community1090health representatives, scheduling, and billing. The Department of1091Veterans Affairs has issued a list of staff exempt from the hiring1092freeze which goes beyond the 600-series of providers. The IHS needs at1093least the same exemptions and more. As the United States has a1094responsibility to care to AI/AN people, it also has a responsibility to1095ensure clinics have their needs met \8\--this includes having the1096appropriate workforce to improve the health status of AI/AN1097beneficiaries.1098---------------------------------------------------------------------------1099    \7\ 25 U.S.C.  1601.1100    \8\ U.S. Government Accountability Office, Indian Health Service:1101Agency Faces Ongoing Challenges Filling Provider Vacancies, GAO-18-580,1102published August 15, 2018, available at: https://www.gao.gov/products/1103gao-18-580, accessed on: January 27, 2025.1104---------------------------------------------------------------------------1105    We commend the Chairwoman for her letter of February 4, 2025 to the1106Administration urging the need to continue to meet the trust and treaty1107obligations of the federal government to Tribes. We concur that the1108Department of Health and Human Services should issue a secretarial1109order which acknowledges the political status of Tribal Nations and1110their citizens, plainly states the federal trust and treaty1111responsibilities to Tribes, and exempts all Tribal departmental1112programs from the impacts of recent Executive Orders and guidance.1113Further, we urge this Committee and Congress to continue to educate and1114work with the new Administration to fulfill its legal obligations to1115Tribal Nations.1116The Indian Health Service Funding1117    AI/ANs experience worse health outcomes compared with the rest of1118the U.S. population. AI/ANs continue to experience historical trauma1119from damaging federal policies, including those of forced removal,1120boarding schools, and taking of Tribal lands, and continuing threats to1121culture, language, and access to traditional foods. These compounding1122events have resulted in AI/AN populations experiencing high rates of1123poverty, high unemployment rates, barriers to accessing higher1124education, poor housing, lack of transportation, geographic isolation,1125and lack of economic mobility which all contribute to poor health1126outcomes. Historic and persistent under-funding of the Indian health1127system has resulted in problems with access to care and has limited the1128ability of the Indian health system to provide the full range of1129medications and services that could help prevent or reduce the1130complications of chronic diseases.1131    IHS exists to serve the health care needs of AI/ANs and to address1132those disparities. Despite the efforts of IHS, the Centers for Disease1133Control and Prevention (CDC) reported that the life expectancy for AI/1134ANs has declined by nearly 7 years, such that the life expectancy for1135our People is only 65.2 years, which is the same life expectancy of the1136total U.S. population in 1944. This is 11.2 years less than the non-1137Hispanic White population's life expectancy of 76.4 years. Today the1138Indian health system includes 43 Indian hospitals (51 percent of which1139are Tribally operated) and 650 Indian health centers, clinics, and1140health stations (86 percent of which are Tribally operated). \9\ When1141specialized services are not available at these sites, health services1142are purchased from public and private providers through the IHS-funded1143purchased/referred care (PRC) program. Additionally, 41 urban Indian1144programs offer services ranging from community health to comprehensive1145primary care.1146---------------------------------------------------------------------------1147    \9\ Indian Health Service. (2024). The Indian Health Care System--1148Fact Sheet. Retrieved from: https://www.ihs.gov/sites/newsroom/themes/1149responsive2017/display_objects/documents/factsheets/IHSProfile.pdf1150---------------------------------------------------------------------------1151    Year after year, the federal government has failed AI/ANs by1152drastically underfunding the IHS far below the demonstrated need. For1153example, in 2023, IHS spending for medical care per user was only1154$4,078, while the national average spending per user was $13,493. This1155correlates directly with the unacceptable higher rates of premature1156deaths and chronic illnesses suffered throughout Indian communities.1157This is despite years of statements to this effect. In 2018, the U.S.1158Commission on Civil Rights found that: ``Federal funding for Native1159American programs across the government remains grossly inadequate to1160meet the most basic needs the federal government is obligated to1161provide. Native American program budgets generally remain a barely1162perceptible and decreasing percentage of agency budgets.'' \10\1163---------------------------------------------------------------------------1164    \10\ U.S. Commission on Civil Rights. ``Broken Promises: Continuing1165Federal Funding Shortfall for Native Americans.'' December 2018.1166Available at: https://www.usccr.gov/files/pubs/2018/12-20-Broken-1167Promises.pdf1168---------------------------------------------------------------------------1169    During the last four years, bipartisan collaboration between1170Congress and the Administration has resulted in just a 11.6 percent1171increase to the IHS budget, although actual inflation has been1172significantly higher. In reality, many of the increases in funding over1173the past several years have barely supported population growth, rising1174medical inflation, staffing funding for specific new/expanded1175facilities, and the rightful funding of legal obligations such as1176Contract Support Costs (CSC). For example, based on the House and1177Senate budgets drafted for consideration for FY 2025, CSC and section1178105(l) leases made up 87-93 percent of the increase assessed. These1179costs will continue to grow following the Becerra v. San Carlos Apache1180Tribe and Becerra v. Northern Arapaho Tribe Supreme Court rulings. A1181more significant funding increase, including necessary investments in1182adequate facilities, modernized infrastructure, and a qualified1183workforce, is needed so that quality healthcare services can be1184delivered in a safe manner within all AI/AN communities. Only then will1185we expect to see a noticeable correlating improvement in health1186outcomes for our people.1187    The IHS National Tribal Budget Formulation Workgroup has estimated1188that full funding for the Indian health system should be $63 billion in1189FY 2026. Providing full and mandatory funding will ensure the federal1190government is meeting its trust and treaty obligations to Tribal1191Nations for health care. As a step toward achieving this goal, we1192request Congress to make common sense budgetary changes to help advance1193the IHS budget by immediately reclassifying CSC and section 105(l)1194lease payments to mandatory appropriations. We further request Congress1195support and enact full and mandatory funding for the Indian Health1196Service.1197Maintaining Federal Funding for Medicaid Provided Through the Indian1198        Health System1199    As Congress approaches Medicaid reform, it should ensure that any1200reform proposal honors the federal responsibility for Indian health1201care, rather than passing that obligation on to the states through per1202capita allocations, block grants, mandatory work requirements, or other1203mechanisms that may be under consideration. The United States has a1204unique trust responsibility to provide Tribal health care, founded in1205treaties and other historical relations with Tribes, and reflected in1206numerous statutes. In recognition of that federal obligation, Congress1207amended the Social Security Act over 40 years ago in 1976 to authorize1208Medicare and Medicaid reimbursement for services provided in IHS and1209Tribally operated health care facilities. \11\ The House Report1210explained that ``These Medicaid payments are viewed as a much-needed1211supplement to a health care program which has for too long been1212insufficient to provide quality health care to the American Indian. [.1213. .]''1214---------------------------------------------------------------------------1215    \11\ 42 U.S.C.  1395qq and  1396j1216---------------------------------------------------------------------------1217    At the same time to meet the trust responsibility, Congress acted1218to ensure that States would be reimbursed at a 100 percent federal1219medical assistance percentage (FMAP) for Medicaid services to American1220Indians and Alaska Natives that are received through the Indian health1221system. The House Committee observed that since the United States1222already had an obligation to pay for health services to Indians as IHS1223beneficiaries, it was appropriate for the U.S. to pay the full cost of1224their care as Medicaid beneficiaries. The Committee noted that because1225the 100 percent FMAP provision was limited to services provided by or1226through the Indian health system, it was being provided for IHS1227eligible Indians and Alaska Natives for whom the United States has an1228obligation and who are already eligible for ``full Federal funding of1229their services.'' \12\ This key provision ensures that the1230responsibility to pay for Medicaid services to AI/ANs remains with the1231federal government, and is not shifted onto the States. The Committee1232recognized that many States with large native populations also have1233large amounts of public land, and thus a limited tax base for providing1234health services, making it doubly unfair to shift the federal health1235obligation to them.1236---------------------------------------------------------------------------1237    \12\ H.R. REP. No. 94-1026, pt. III, at 21 (1976), as reprinted in12381976 U.S.C.C.A.N. 2782, 2796.1239---------------------------------------------------------------------------1240    Medicaid reimbursements are critically important in filling the gap1241created by chronic underfunding of IHS and are a critical source of1242funding for Tribes seeking to take over IHS hospital systems through1243self-governance agreements. Medicaid funds provide $1.2 billion to the1244IHS, \13\ and provides coverage for 36 percent of non-elderly AI/ANs1245and over half of AI/AN children. \14\1246---------------------------------------------------------------------------1247    \13\ FY 2025 Congressional Justification, Indian Health Service.1248    \14\ ``Medicaid's Role in Health Care for American Indians and1249Alaska Natives'', MACPAC. February 2021. Accessed 1/28/25, https://1250www.macpac.gov/wp-content/uploads/2021/02/Medicaids-Role-in-Health-1251Care-for-American-Indians-and-Alaska-Natives.pdf1252---------------------------------------------------------------------------1253    As important as Medicaid is to the Indian health system, Medicaid1254reimbursements received through the Indian health system only represent1255a fraction of one percent of total Medicaid funding. For instance, IHS1256Medicaid spending in 2025 is projected to be only 0.21 percent of total1257Medicaid spending. As a result, preserving full federal funding for1258Medicaid services received through the Indian health system will not1259adversely affect the overall effort to cap and control federal Medicaid1260spending. Per capita caps and changes to FMAP, even when limited to the1261general population or Medicaid expansion, can cause States to reduce1262eligibility requirements or services levels, which also impact Indian1263health programs adversely.1264    It is critical that Congress maintain full federal funding of1265Medicaid services provided in IHS and Tribal healthcare facilities.1266Tribal healthcare delivery systems need Medicaid funding to be1267financially viable, as many of their patients are low income and have1268no other form of coverage. Indian health facilities see anywhere from126930 to 60 percent of their funding from Medicaid alone. Tribal1270healthcare delivery systems are the only systems that can ensure1271coordinated, quality of care for the beneficiaries they serve, and the1272only providers with the incentive to ensure that care is not1273fragmented. Tribal healthcare providers reinvest in their communities,1274and Tribal healthcare delivery systems are essential to local Tribal1275communities and economies. Ensuring full federal funding for Medicaid1276services received through the Indian health system is also essential to1277Tribal self-governance. Self-governance Tribes have achieved some1278remarkable health care improvements and efficiencies, but without the1279ability to bill Medicaid, those systems are not financially viable.1280    As Congress considers Medicaid reform, it is essential that the1281federal trust responsibility for Indian health care be honored and 1001282percent FMAP for services received through the Indian health system is1283preserved. This policy position has been previously been supported by1284the National Governor's Association during past Medicaid reform1285efforts. \15\ Exempting AI/AN beneficiaries from such reforms,1286including work requirements, is consistent with the United States trust1287and legal responsibilities to Tribes. Medicaid reform must be1288deliberative and understand that it will impact Indian health programs,1289even when those changes do not immediately appear to do so.1290---------------------------------------------------------------------------1291    \15\ National Governors Association, Resolution HHS-18, ``Indian1292Health Services,'' March 1, 2006.1293---------------------------------------------------------------------------1294Address the Behavioral Health Crisis in Indian Country1295    American Indian and Alaska Native populations carry generations of1296historic trauma which continue to impact our communities through myriad1297medical and behavioral health. The removal of Tribal nations from their1298lands, the breaking of cultural and familial bonds through removal of1299AI/AN children to boarding schools, and the broken promises of the1300federal government have contributed to some of the greatest disparities1301in mental health and substance use disorder diagnoses in our1302communities. AI/AN populations experience the highest rate of misuse1303for opioids, prescription pain relievers and other medication misuse.1304Since 2018, AI/AN opioid overdose deaths have increased by 174 percent.1305Despite an increase in Tribal Opioid Response (TOR) awards, competitive1306funding is difficult for many Tribes to acquire. The strain of readily1307available resources for the I/T/U system cannot meet the demand of1308rising behavioral health issues nationwide.1309    Use of grants as the primary vehicle to deliver behavioral health1310funding, or any other funding, limits Tribal providers' ability to1311deliver clinical services, reporting requirements deter patients from1312accessing care, and lack of access to culturally competent providers1313and treatments all compound the behavioral health crisis in Indian1314Country. We ask Congress to strengthen Tribal behavioral health1315treatment and programs by increasing resources, providing for1316flexibility and self-governance of funding, and support expanded access1317to Tribal traditional healing services.1318    HHS/IHS should invest in culturally centered and Tribally driven1319behavioral health programming and facilities. For example, HRSA can1320support infrastructure outside of state-awards to support aging and1321dilapidated behavioral health facilities that are Tribal and Native-1322operated. IHS can expand the types of projects eligible under the Joint1323Venture Construction Program (JVCP) to include standalone behavioral1324health and substance use disorder (SUD) treatment facilities. Provide1325additional and proactive technical assistance to Tribal Nations to1326access and apply for available funding to treat and prevent SUD and1327modify existing standards for cultural considerations such as extending1328timelines and allowing for non-evidence-based practices as our cultural1329models are often underreported.1330    Allow for behavioral health funding to be flexible and broadly1331applicable to behavioral health conditions. Current grants silo funding1332and prevent its use in treating mental health and SUD conditions1333together, limit integrated care with medical teams, and prevent1334polysubstance treatment or culturally informed approaches.1335    Investment in critical workforce development is essential to moving1336forward by ensuring HHS Divisions support AI/AN workforce development1337by authorizing and expanding additional provider types like behavioral1338health aides and tax exemption the IHS Scholarship and Loan Repayment1339programs as an incentive for participation. Also, midlevel providers1340should receive equal compensation with other provider types under1341Medicare and Medicaid.1342    Finally, we recommend reduce federal bureaucracy by allowing SAMHSA1343programs to be available to Tribal Nations by amending access to the1344Alcoholic and Substance Abuse Block Grant (SUBG), under SAMHSA, to be1345available to Tribal Nations. Further, make common sense reforms to the1346Government Performance and Results Act (GPRA) to allow Agencies to1347lower reporting barriers for access to behavioral health services.1348Protecting the Next Generation1349    Congress should support improved maternal and infant outcomes for1350Native mothers and children by providing a funding set-aside in the1351Maternal Child Health Services Block Grant, investing in a robust1352maternal and birthing health workforce, and improving data on AI/AN1353mothers and infants.1354    Historical trauma compounded with social, economic, political, and1355environmental factors have impacted the health status of AI/AN mothers1356and infants. The lack of federal investments, culturally appropriate1357workforce, and quality data on AI/AN maternal and infant health stifle1358effective programming to improve health outcomes for our next1359generation.1360    Many Native women miss prenatal care visits due to lack of1361accessible services and lack of trust with their provider. Giving birth1362in Indian Country frequently means leaving your family, home, and1363support system to travel hundreds of miles to the nearest birthing1364center or hospital. For Native mothers with complicated pregnancies,1365this could mean months away from home. When expecting mothers have to1366travel so far from home to give birth, it can immediately complicate a1367pregnancy. Many times, new mothers may begin labor, drive hundreds of1368miles to reach their birthing hospital and then be turned away because1369they are not far enough along in labor to be admitted. Other times,1370Native women are stereotyped in their prenatal visits causing them to1371avoid necessary services. Due to preconditions like diabetes and1372hypertension, untreated conditions during pregnancy can increase a1373women's risk of maternal mortality.1374    As a result, AI/AN women are three times more likely to die from1375pregnancy-related causes than non-Hispanic White women. Further, AI/AN1376infants are born prematurely, underweight, and twice as likely to die1377before the age of one.1378    To address these disparities, HHS must create set-asides for Tribal1379and Native-led organizations, invest in a robust maternal health1380workforce, and improve data on AI/AN mothers and infants to address1381socioenvironmental factors that inhibit healthy outcomes for our next1382generation of AI/AN populations. The funding in the MCH Block grant can1383be used to increase mid-wife and doula training to support a larger1384birthing workforce in Native and rural communities. Improving access to1385the birthing workforce can also help Native moms-to-be also stay in1386their communities to deliver, which supports cultural traditions and1387keeps mothers and newborns closer to supportive networks which can1388improve infant health outcomes.1389    We must provide Tribal set-aside for the Maternal Child Health1390Services Black Grant. Today, this funding goes to state governments and1391leaves out Indian Country. There is a need for expanded prenatal health1392education. This extra funding can provide screening for suicide, SUD,1393and intimate-partner violence during prenatal and perinatal care. This1394funding would also improve continuum of care coordination with1395medication assisted treatment (MAT) providers. It would also provide1396health promotion efforts to reduce maternal and infant mortality.1397    Congress and the Administration should invest in workforce1398development for maternal health. Create a temporary set-aside in the1399IHS Loan Repayment Program for doulas and midwives. Require cultural1400humility training for providers who regularly engage with AI/AN1401populations. Work with Tribal Colleges and Universities to build a1402pipeline of AI/AN practitioners.1403    Maternal and child health data is often inaccurate or incomplete,1404leading to underrepresentation of the true impact of AI/AN maternal and1405child health needs. IHS and state data systems should report on1406maternal and child health. Additionally, mandate the collection of race1407and ethnicity data from IHS awardees.1408    Many of these recommendations have been highlighted in two recent1409reports, the first The Way Forward: Report of The Alyce Spotted Bear &1410Walter Soboleff Commission on Native Children and the NIHB's Tribal1411Prenatal-3 Policy Agenda. Further, the care for our children does not1412stop at birth, post-natal care for new mothers is critical for1413providing education and access to beahvioral health resources that help1414mothers and their children. As children age, many of them access health1415care through school-based clinics. More should be done to meet1416children's needs by providing care where they are and by providing1417access to behavioral health services that help them understand the1418links of historical trauma to suicide and other behavioral health1419indicators and seek to connect them with cultural traditions which can1420strengthen their identities and links to community.1421Adoption of the 2024 Healthcare Package1422    An early iteration of the Further Continuing Appropriations and1423Disaster Relief Supplemental Appropriations Act of 2025 (H.R. 10455),1424introduced in the 118th Congress on December 17, 2024, included a1425series of popular and critically important healthcare legislation. Many1426of the proposals included long-time requests and priorities of Indian1427Country.1428    The Special Diabetes Program for Indians (SDPI) would have received1429a two-year extension at $200 million per year. Until last year, SDPI1430had been flat-funded for over 20 years at $150 million per year. This1431program is the only public health program to have reduced the instances1432of diabetes, and has to date save $520 million for Medicare in the1433prevention of end stage renal disease. The piecemeal, short-term1434extensions of this valuable public health program jeopardize program1435stability and make it difficult to plan for staffing and programmatic1436activities. Adopting a long-term extension with an increase is a long-1437standing request of Tribal Nations.1438    Medicare telehealth flexibilities would have been extended through1439December 31, 2026. Among other important Medicare flexibilities1440included in the package, Medicare telehealth has become a significantly1441important tool to provide health care services for Elders. Because1442Indian Country exists across vast expanses of rural and frontier,1443having access to telehealth services, particularly audio-only services,1444can improve access to distant site specialty care and supports better1445monitoring of chronic conditions. Extension of these flexibilities will1446continue to support improved health outcomes for our Elders.1447    Additional legislative reauthorizations and policy changes were1448included in the initial legislation. These reauthorizations are1449critical to providing services to our Elders, our nation's and Indian1450Country's readiness for future public health crises, and supporting1451behavioral health, and more. Among the legislation and policy changes:1452Medicaid pharmacy payment reform, reauthorization the Older Americans1453Act, the Pandemic and All-Hazards Preparedness Act (PAHPA), and the1454SUPPORT Act. Without adoption or reauthorization, these programs will1455continue to be in limbo.1456Expand Tribal Self-Governance Beyond IHS at the U.S. Department of1457        Health and Human Services1458    Fifty years ago, Congress passed the Indian Self-Determination and1459Education Assistance Act (ISDEAA), 25 U.S.C.  5301 et seq. Through the1460passage of ISDEAA, Congress enabled Tribes to contract and compact to1461run their own health care programs while also preserving Tribes' right1462to choose that services continue to be provided directly by the Indian1463Health Service. ISDEAA has proven to be one of the most important1464policy choices that has restored to Tribes their rightful sovereignty1465to determine and improve the health and well-being of our People.1466    In 2000, P.L. 106-260, included a provision directing HHS to1467conduct a study to determine the feasibility of a demonstration project1468extending Tribal Self-Governance to HHS agencies other than the IHS.1469The HHS Study, submitted to Congress in 2003, determined that a1470demonstration project was feasible. In the 108th Congress, Senator Ben1471Nighthorse Campbell introduced S. 1696, the Department of Health and1472Human Services Tribal Self-Governance Amendments Act, that would have1473allowed these demonstration projects. The legislation unfortunately did1474not advance out of that Congress, but it continued an important1475discussion on the success and feasibility of Tribal self-determination1476and self-governance beyond IHS. A second study was completed in 2011 by1477the U.S. Department of Health and Human Services Self-Governance Tribal1478Federal Workgroup which reiterated the feasibility and underscored the1479need for legislation. Since 2024, the HHS Secretary's Tribal Advisory1480Committee Tribal Self-Governance Expansion Workgroup has worked to1481build momentum for a demonstration proposal and proposed legislative1482language. On the 50th anniversary of ISDEAA, it is time to reaffirm1483Tribal sovereignty and the success of self-determination and self-1484governance.1485Indian Health Service Scholarship and Loan Repayment Program Reforms1486    IHS provides scholarship and loan repayment opportunities as an1487incentive for medical professionals to work in the Indian health system1488due to chronic short staffing issues. Unlike other similar federal1489programs, these payments are taxable. This means, that the agency is1490paying taxes on top of the loan and scholarship payments, which means1491fewer providers are able to be given loan repayment and scholarship1492under the current appropriations. In the IHS's FY 2025 Congressional1493Justification, it estimated that if the scholarship and loan repayment1494programs were tax exempt, it could have awarded an additional 218 loan1495repayment contracts. Further, this program does not provide for part-1496time commitments or include mid-level providers which could further1497extend the reach and bring more providers in to help address the1498chronic provider shortage at Indian health facilities. Any tax reform1499legislation considered in the 119th Congress should make reforms to the1500IHS scholarship and loan repayment programs to increased their success1501in support of an adequate workforce for Indian health.1502Conclusion1503    The above highlighted Tribal priorities are not exhaustive, but1504they can be accomplished in the 119th Congress. These priorities, if1505enacted by Congress, will bring us a step closer to meeting the trust1506and treaty obligation of the federal government to Tribal Nations. The1507federal government made promises in its Tribal treaties to provide for,1508among other things, the healthcare of Tribal citizens. The policies and1509legislation outlined throughout this testimony will help repair one1510portion of the broken promises of the federal government and will1511support a step towards healthier Tribal communities.15121513    The Chairman. Thank you, Chief Smith.1514    Welcome, Mr. Butler.15151516STATEMENT OF HON. RODNEY BUTLER, CHAIRMAN, MASHANTUCKET PEQUOT1517                   TRIBAL NATION; PRESIDENT,1518         NATIVE AMERICAN FINANCE OFFICERS ASSOCIATION1519                            (NAFOA)15201521    Mr. Butler. [Greeting in Native tongue] Chairman Butler,1522Mashantucket Pequot, President of NAFOA. Good afternoon, my1523friends. My name is Chairman Butler, and I am from the1524Mashantucket Pequot Tribe, and I am also here as the president1525of NAFOA.1526    Chair Murkowski, Vice Chair Schatz, and distinguished1527members of the Senate Committee on Indian Affairs, I thank you1528for the opportunity to testify today as the president of NAFOA,1529founded as the Native American Finance Officers Association, on1530our economic priorities for the 119th Congress. This hearing on1531the needs of tribal communities is crucial now, with a new1532administration, a new Congress, and new opportunities and1533challenges.1534    For over 40 years, NAFOA has worked to grow tribal1535economies and strengthen tribal finance through advocacy,1536education, and policy development. Our member tribes and tribal1537enterprises represent the diversity of Indian Country's1538economic landscape, including tribal gaming, energy projects,1539agricultural ventures, Federal contracting, and many, many1540more.1541    First, we will continue to emphasize that the relationship1542between the Federal Government of the United States and tribal1543nations is rooted in a political relationship between1544sovereigns, not a racial or any other classification. The1545Supreme Court unanimously affirmed this in Morton v. Mancari1546and has consistently upheld this tenet. This political1547relationship, recognized within the United States Constitution,1548forms the foundation for modernizing the Federal treatment of1549tribal governments and their enterprises.1550    The recent issuance of executive orders and subsequent1551funding pause raised significant concern among tribal nations.1552Tribes across the Country reported challenges with access to1553critical systems, a lack of information from Federal agencies,1554and considerable uncertainty about the potential impacts of1555such actions.1556    Regardless of the percentage of the total budget, a pause1557in Federal funding, whether temporary, prolonged, or permanent,1558impacts the ability of tribes to offer crucial programs and1559services to our tribal citizens. To this end, I want to thank1560you in particular, Chair Murkowski, for the letter that you1561sent to OMB recognizing our unique status and requesting a1562government-wide exemption that acknowledges that tribal nations1563must not be impacted by executive orders related to DEI.1564    At NAFOA, we remain committed to monitoring the impacts of1565Federal actions and helping our member tribes with tools and1566resources to navigate adverse Federal policies. We urge1567Congress and the administration to ensure all tribal programs1568and Federal offices serving tribal nations remain fully1569operational and adequately staffed. This includes recognition1570that tribal program funding fulfills legal obligations,1571protection of funding streams supporting tribal economic1572development, and maintenance of Federal staffing levels needed1573for program delivery.1574    The continuation of vital technical assistance programs,1575preservation of agency expertise in tribal matters, and1576protection of tribal-specific program offices are essential for1577supporting tribal economic growth.1578    It is important to mention that tribally-owned entities1579under the umbrella of the tribal government are critical to1580create jobs and to supplement funding for tribal programs that1581are underfunded in the Federal budget.1582    In addition to protecting trust and treaty obligations, we1583urge Congress to advance tribal tax parity legislation that was1584introduced by our good friend, Senator Cortez Masto, with1585tremendous bipartisan support. Over the past several1586Congresses, the NAFOA has worked with both the Senate and the1587House on legislation to address longstanding disparities in the1588treatment of tribal governments and tax policy.1589    Based on feedback from Congress and our tribes, we have1590made important revisions to our legislative proposals that we1591are confident will allow for inclusion of key provisions in the1592upcoming tax package that will be considered by Congress.1593    Congress must address longstanding disparities between1594State and tribal governments, and ensure that tribal1595governments are treated under the same provisions as States for1596key tax purposes, including excise taxes, bond issuance,1597pension plans, general welfare benefits and charitable1598organizations. Unfortunately in recent years the disparity1599between States and tribes has only increased. According to the1600Brookings Institute, from 2014 to 2020, State governments1601issued $47 billion annually in non-taxable municipal bonds,1602compared to only $84 million by tribal governments.1603    Finally, empowering tribal governments by providing them1604full parity with State and local governments in accessing tax-1605exempt bond financing will enhance job creation, generate1606sorely-needed governmental revenue for social services,1607stimulate infrastructure and business development on tribal1608lands, and accelerate the diversification and resiliency of1609tribal economies, particularly in private sectors.1610    Another critical provision in our legislative1611recommendation is the creation of the annual $175 million New1612Market Tax Credit for low-income tribal communities. The New1613Market Tax Credit program attracts private capital to1614economically distressed communities by providing tax credits to1615investors. Unfortunately, tribes are too often unable to access1616these credits. Our recommendation is a set-aside for these1617credits for Indian Country.1618    Finally, we recommend that any tax legislation considered1619by Congress include tribal Low-Income Housing Tax Credits. This1620program provides tax incentives for developers to create1621affordable housing, but credits are often unavailable to1622tribes.1623    We recommend these and other tax priorities be included in1624the larger tax framework being considered by Congress this1625year. By modernizing the tax code's treatment of tribal1626governments and providing targeted economic development1627incentives, tribal tax legislation will help tribes generate1628governmental revenue and deliver essential services to build1629stronger reservation economies.1630    We also urge Congress to make sure the Treasury1631Department's Office of Tribal and Native Affairs become1632permanent and continue the Tribal Treasury Advisory Committee.1633These entities are essential partners for tribal governments1634and their business entities. They allow for efficient and1635effective consultation, communication and ensuring that tribes1636can access tax incentives and economic development tools.1637    We also support the effort to reclassify both contract1638support costs for the Tribal 105(l) lease program, to1639mandatory, which is consistent with the statutory language in1640court decisions. This reclassification will allow tribal1641governments to continue to exert tribal control over the1642provisions of programs within their communities and exercise1643self-determination over tribal government infrastructure.1644    Lastly, NAFOA encourages Congress to increase the amount1645available to tribes through the Department of Interior's Indian1646Loan Guarantee Program and authorizing language that would1647allow it to work with the New Market Tax Credits. As currently1648written, tribes cannot take advantage of the New Market Tax1649Credits if going through the Indian Loan Guarantee Program.1650This simple fix will have a significant impact on the ability1651of tribal nations to access capital.1652    In closing, the Federal Government's trust and treaty1653responsibility and obligations must be upheld through concrete1654action to support tribal economic development and financial1655sovereignty. NAFOA's recommendations represent an important1656step toward fulfilling these obligations, and creating1657sustainable tribal economies that benefits both the Federal1658Government and tribal governments.1659    I thank you again for your time today. [Phrase in Native1660tongue.] Thank you all.1661    [The prepared statement of Mr. Butler follows:]16621663Prepared Statement of Hon. Rodney Butler, Chairman, Mashantucket Pequot1664      Tribal Nation; President, Native American Finance Officers1665                          Association (NAFOA)1666Introduction1667    Greetings Chairwoman Murkowski, Vice Chair Schatz, and Members of1668the Senate Committee on Indian Affairs. Thank you for the opportunity1669to testify today on behalf of NAFOA, founded as the Native American1670Finance Officers Association, on our organization's priorities for 20251671and the 119th Congress. This hearing on the needs of tribal communities1672is crucial now, with a new Administration, a new Congress, and new1673opportunities and challenges. For over 40 years, NAFOA has worked to1674grow tribal economies and strengthen tribal finance through advocacy,1675education, and policy development. Our member tribes and tribal1676enterprises represent the diversity of Indian Country's economic1677landscape, including tribal gaming, energy projects, agricultural1678ventures, federal contracting, and more.1679Trust and Treaty Obligations1680    First, we will continue to emphasize that the relationship between1681the Federal Government of the United States and the Tribal Nations is1682rooted in a political relationship, not a racial or any other1683classification. The Supreme Court unanimously affirmed this in Morton1684v. Mancari and has consistently upheld his tenet. This political1685relationship, recognized within the U.S. Constitution, forms the1686foundation for modernizing the federal treatment of tribal governments1687and their enterprises.1688    The recent issuance of executive orders and subsequent funding1689pause raised significant concern among Tribal Nations. Tribes across1690the country reported challenges with access to critical systems, a lack1691of information from federal agencies, and considerable uncertainty1692about the potential impact of such actions. We recognize there are1693varying degrees of effect on Tribal Nations regarding federal funding--1694where a substantial portion of some tribes' budgets are federal funds,1695and others have limited federal funding. Regardless of the percentage1696of the total budget, a pause in federal funding, whether temporary,1697prolonged, or permanent, impacts the ability of tribes to offer crucial1698programs and services to tribal citizens. At NAFOA, we remain committed1699to collecting and sharing stories of impact and helping our member1700tribes with tools and resources to navigate future federal funding1701issues.1702    We recognize the challenges that lie ahead for the federal budget.1703We urge Congress and the Administration to ensure all tribal programs1704and federal offices serving Tribal Nations remain fully operational and1705adequately staffed. This includes recognition that tribal program1706funding fulfills legal obligations, protection of funding streams1707supporting tribal economic development, and maintenance of federal1708staffing levels needed for program delivery. The continuation of vital1709technical assistance programs, preservation of agency expertise in1710tribal matters, and protection of tribal-specific program offices are1711essential for supporting tribal economic growth.1712Tax Parity1713    In addition to protecting Trust and Treaty obligations, we urge1714Congress to advance Tribal Tax Parity legislation. During the 117th1715Congress, Senator Cortez Masto introduced S. 5048, the Native American1716Tax Parity and Relief Act, and last year NAFOA worked with her office1717and Congresswoman Gwen Moore to introduce H.R. 8318, the Tribal Tax1718Investment and Reform Act. I want to express our support for the1719proposed legislation that would create vital tax parity between tribal1720governments and state governments while strengthening tribal economic1721development opportunities. I would like to highlight three of H.R.17228318's critical changes.1723    First, Section 3 of 8318 addresses longstanding disparities by1724treating tribal governments under the same provisions as states for key1725tax purposes, including excise taxes, bond issuance, pension plans,1726general welfare benefits, and charitable organizations. As the Treasury1727Tribal Advisory Committee aptly states in its 2020 Subcommittee on Dual1728Taxation Report, Tribal Nations ``pre-date the formation of the United1729States and possess inherent and treaty-recognized sovereignty. As a1730fundamental aspect of that sovereignty, Tribal Nations possess immunity1731from being taxed by the United States federal and state governments.1732Moreover, Tribal lands subject to the jurisdiction of Tribal1733governments are not subject to direct taxation by outside1734governments.''1735    Unfortunately, in recent years, the disparity between states and1736tribes has only increased. According to the Brookings Institution, from17372014 to 2020, ``state governments issued $47 billion annually in non-1738taxable municipal bonds, compared to a total of $84 million by tribal1739governments. This equates to a 559-fold gap in using tax-exempt1740government bonds.''1741    Finally, ending this discriminatory treatment of tribal governments1742by providing them full parity with state and local governments in1743accessing tax-exempt bond financing will enhance job creation, generate1744sorely needed governmental revenue for social services, stimulate1745infrastructure and business development on tribal lands, and accelerate1746the diversification and resiliency of tribal economies, particularly in1747their private sectors. In addition, restoring parity would ``create1748spillover benefits for non-tribal citizens in those areas.''1749    The cost to the federal government would be low. According to the1750Congressional Budget Office, ``increasing tax-exempt bond access for1751tribes would reduce federal tax revenue by an estimated $77 million1752over 10 years. In comparison, the estimated total cost of the federal1753tax exemption for municipal bonds was $27 billion in fiscal year17542022.''1755    Another critical change 8318 makes is creating an annual $175m New1756Market Tax Credit (NMTC) for low-income Tribal Communities. NMTC1757Program attracts private capital to economically distressed communities1758by providing tax credits to investors. Unfortunately, tribes are too1759often unable to access these credits. Since the NMTC program's1760inception, Native CDEs have had to compete against non-Native CDEs in1761what has proven to be an unlevel playing field for NMTC allocations.1762This section addresses the low rate of NMTC availability in Indian1763Country by creating a credit set aside. Establishing this set aside1764will enable more Tribal Nations and communities to grow the proven1765benefits that those who have already leveraged this important financing1766tool have generated.1767    Finally, Section 9 of this legislation increases the effectiveness1768of Tribal Low-Income Housing Tax Credits (LIHTC). The LIHTC program1769provides tax incentives to developers to create affordable housing, but1770credits are often unavailable to tribes. This section modifies the1771definition of a difficult development area to include an Indian area to1772determine eligible basis, thereby explicitly including Tribes in the1773LIHTC program criteria. A good example of the success of this program1774is the Knik Homes #1 project in Wasilla, Alaska. Developed by the Knik1775Tribe the project includes the construction of 32 new elder townhome1776units. The total project costs are $18.7 million--almost $7 million of1777which was covered by LIHTC equity and an AHP grant.1778    Congress should pass this legislation to fulfill its trust and1779treaty obligations and support tribal economic sovereignty. The1780legislation recognizes tribal governments face unique challenges in1781accessing capital and developing sustainable economies due to1782historical disadvantages and statutory restrictions. By modernizing the1783tax code's treatment of tribal governments and providing targeted1784economic development incentives, this legislation would help tribes1785generate governmental revenue, deliver essential services, and build1786stronger reservation economies. The provisions are carefully crafted to1787respect tribal sovereignty while creating practical tools for tribal1788governments to meet their citizens' needs. With strong bipartisan1789support from Indian Country, this legislation represents an important1790step toward tax fairness and tribal self-determination.1791    NAFOA's staff has been collecting and recording examples of the1792practical, on-the-ground impact that the Tribal Tax Parity bill would1793make. I would be happy to share those examples with Members of the1794Committee, as NAFOA understands it is essential to demonstrate why1795these changes matter, how they impact our communities, and the1796potential impact of inaction.1797Treasury Matters1798    NAFOA strongly urges Congress to make the Treasury Department's1799Office of Tribal and Native Affairs permanent and to continue the1800Tribal Treasury Advisory Committee (TTAC). These entities are essential1801for providing technical assistance and guidance, supporting tribes in1802accessing tax incentives and economic development tools, and developing1803guidance on general welfare programs and tribal enterprises. They also1804play a crucial role in ensuring appropriate tribal consultation on tax1805and economic policies and facilitating government-to-government1806engagement. Additionally, authorizing changes need to be made that1807would allow the IRS to give in-depth information and technical1808assistance to tribes, similar to the types of technical assistance1809available with many other tribal programs, as well as a place where1810tribes can receive guidance and clarification on tax, particularly tax1811credit, issues.1812    NAFOA strongly encourages the Treasury to complete regulations on1813tribal entities with the abovementioned improvements and asks the1814Treasury to finalize general welfare benefit regulations with enhanced1815guidance on trust arrangements and program interactions. We also ask1816the Committee to protect funding and staffing for programs supporting1817tribal economic development, support the modernization of tax1818provisions affecting tribal governments and enterprises, and ensure1819tribal consultation requirements are maintained and strengthened.1820    To help ensure that tribal voices are heard at the Treasury, NAFOA1821urges this Committee to advance legislation making the Office of Tribal1822and Native Affairs (OTNA) permanent with dedicated funding and1823staffing, as the OTNA is one of the best examples of federal outreach1824and assistance. Established in 2022, the OTNA's mission is (1) to1825advise on Tribal policy and program implementation, (2) to coordinate1826Tribal consultations, and (3) to manage the Treasury Tribal Advisory1827Committee (TTAC). Currently, the office has a budget of $2 million and1828employs 8 staffers, and even in a short time, it has already had a1829positive impact that far exceeds its cost.1830General Welfare Exclusion Rulemaking1831    The proposed regulations implementing the Tribal General Welfare1832Exclusion Act require finalization with several critical improvements.1833We need supplemental guidance on trust arrangements and deferred1834benefits to help tribes develop sophisticated benefit structures. Clear1835standards for using trusts to provide general welfare benefits and1836guidance on the interaction between tribal general welfare benefits and1837other federal program eligibility are essential. The development of1838detailed training plans in consultation with tribes and TTAC, the1839establishment of formal transition periods when lifting audit1840suspensions, and the focus on prospective enforcement rather than1841challenging past tribal programs will ensure smooth implementation.1842Tribally Chartered Corps Rulemaking1843    The proposed Treasury regulations regarding wholly-owned tribal1844entities represent significant progress but require completion with1845several key provisions. We need explicit confirmation that tax1846treatment extends to all subsidiary entities wholly owned through1847tribal parent entities and clear guidance that tribally chartered1848entities can assert the same excise tax benefits as their owning1849tribes. Additionally, the Treasury must provide guidance on entities1850owned in part by persons other than tribes and recognize diverse tribal1851corporate structures beyond Section 17 corporations.1852Appropriations Reclassification1853    Unfortunately, the federal funding and appropriations cycles have1854lacked consistency in recent years. With the current challenges facing1855federally funded programs, NAFOA recommends changing tribally funded1856programs under the discretionary classification to the mandatory1857classification. Reclassifying programs would help tribes with financial1858planning and make budget forecasting far more accurate, something that1859is very important to the business development of tribes that have an1860oversized reliance on federal programs and funds. One of the programs1861that NAFOA strongly supports for reclassification is the Contract1862Support Costs and Payments for Tribal Leases. For the last two years,1863the President's Budgets has called for reclassification of these1864programs and Congress's S. Rept. 118-83.1865Tribal Energy Development1866    Tribal Nations are poised to contribute significantly to energy1867development in the United States. It is critical that tribes can fully1868participate in the clean energy transition through their tribally1869chartered entities and have access to the Inflation Reduction Act (IRA)1870Elect/Direct Pay energy credits as Congress intended. This requires1871addressing administrative burdens in current elective pay systems for1872clean energy tax credits and creating clear pathways for tribal-private1873partnerships in renewable projects. The economic potential for tribes1874in this sector is substantial, but we need proper structures to access1875these opportunities.1876    Access to capital remains a fundamental challenge for tribal1877economic development. Implementing set-asides within the New Markets1878Tax Credit program for tribal projects, recognizing tribal areas as1879difficult development areas for housing credit purposes, and1880modernizing the Indian Employment Tax Credit would significantly1881enhance tribes' ability to finance crucial projects and create1882sustainable economies.1883Indian Loan Guarantee Program1884    NAFOA encourages Congress to increase the amount available to1885tribes through the Department of Interior's Indian Loan Guarantee1886Program (ILGP) and an authorizing fix that would allow it to work with1887the NMTC. NAFOA knows the issues and challenges Tribal Nations1888encounter when accessing capital for economic development projects. As1889currently written, tribes cannot take advantage of the NMTC if going1890through the Indian Loan Guarantee Program. This is a major oversight1891with a simple fix that would cost almost nothing to remedy and would1892have a significant impact on the ability of Tribal Nations to access1893capital.1894Carcieri1895    Lastly, NAFOA supports bipartisan legislation that addresses and1896fixes the Carcieri decision. To quote the recent intertribal1897organization letter, ``It must be acknowledged and understood that at1898its core, the Carcieri decision is an attack on the Indian1899Reorganization Act (IRA) of 1934, which Congress enacted to stop the1900massive loss of Tribal homelands inflicted by the General Allotment Act1901of 1887 (Allotment Act).'' It is our hope that this Congress will enact1902the fix.1903Closing1904    The federal government's trust and treaty obligations must be1905upheld through concrete action to support tribal economic development1906and financial sovereignty. These recommendations represent an important1907step toward fulfilling these obligations and creating sustainable1908tribal economies.1909    Thank you for your attention to these vital matters affecting1910tribal economies and sovereignty. I am happy to answer any questions.19111912    The Chairman. Thank you.1913    We go to Mr. Kerry Bird.19141915 STATEMENT OF KERRY D. BIRD, BOARD PRESIDENT, NATIONAL INDIAN1916                     EDUCATION ASSOCIATION19171918    Mr. Bird. Chair Murkowski, Vice Chair Schatz, esteemed1919members of the Committee, good afternoon. My name is Kerry1920Bird, and I am President of the National Indian Education1921Association. I am a citizen of the Sisseton Wahpeton Oyate of1922South Dakota and a descendant of the Lumbee Tribe of North1923Carolina.1924    On behalf of the students, educators, and tribal nations1925NIEA serves, I appreciate the opportunity to testify today on1926the critical issues surrounding Native education and the1927Federal Government's trust and treaty obligations to American1928Indians, Alaska Natives and Native Hawaiians.1929    Sovereignty is the foundation of effective education in1930Indian Country. The Federal Government's trust responsibility1931to Native education is a foundational obligation firmly1932established through treaties, laws, and legal precedents. But1933today, Native students in both BIE schools and public schools1934face chronic underfunding and deteriorating infrastructure.1935Worse yet, Federal policies often fail to support the inherent1936sovereignty of tribal nations in managing their own educational1937systems, leaving communities stuck in bureaucratic red tape.1938    To address these issues, we urge Congress to take decisive1939action in five key areas. First and foremost, Congress must1940affirm the political status of Native students. The Federal1941trust and treaty obligations to tribal nations for education1942and the Federal trust obligations to Native Hawaiian education1943are not discretionary commitments. They are legal obligations.1944    This duty has been reaffirmed through centuries of1945legislation, beginning with the Civilization Fund Act of 1819,1946codified as a Federal directive in the Snyder Act, and later1947strengthened under the Indian Self-Determination and Education1948Assistance Act as well as the Tribally Controlled Schools Act1949of 1988.1950    The trust responsibility to individual Native students in1951public schools has also been reinforced through the Johnson-1952O'Malley Act of 1935, Title VI of the Elementary and Secondary1953Education Act of 1965, and the Native Hawaiian Education Act of19541988.1955    Tribal nations and Native communities should be empowered1956to design educational systems that reflect their values,1957traditions, and economic priorities. These programs are not1958simply a matter of cultural pride, but also critical to the1959future and economic success of our communities.1960    Second, we need stable and adequate funding. Our schools1961require consistent investment, not fluctuating annual budgets1962that create uncertainty. Advance Appropriations would ensure1963that Native education programs are shielded from budgetary1964disruptions, allowing for long-term planning and success.1965Additionally, Congress must protect Title VI, Johnson-O'Malley1966and Impact Aid programs, ensuring Native students in public1967schools receive the resources they are owed.1968    Third, we must expand self-governance and education and1969empower tribal nations to control their education systems.1970Extending Public Law 477 and 638 across more Federal programs1971would give tribes greater autonomy over education.1972    Additionally, 105(l) lease funding should be moved to1973mandatory appropriations to assure tribes can build, repair and1974maintain schools independently while ensuring the Federal1975Government meets its fiduciary responsibilities.1976    Fourth, early childhood education is a critical foundation1977for lifelong success. The Alyce Spotted Bear Commission on1978Native Children has emphasized the urgent need for culturally1979relevant early childhood programs that address the unique needs1980of Native communities. The report highlighted the importance of1981improving access to Head Start and other early education1982services that are responsive to Native languages, culture, and1983values.1984    Congress must prioritize implementing the Commission's1985recommendations, which are vital for providing Native children1986with crucial developmental and educational opportunities.1987    Finally, I want to highlight the urgent need to improve BIE1988school facilities. Unlike DOE or Department of Defense schools,1989which receive significant investment, many BIE schools are1990operating in unsafe, outdated buildings. To ensure that Native1991students have safe learning environments, tribal nations must1992have access to consistent funding for construction and1993renovation, whether through direct appropriations, the Great1994American Outdoors Act, or expanded 105(l) lease agreements.1995    Members of the Committee, the stakes are high. By1996supporting Native education, you are not only investing in the1997future of our youth, but also strengthening the resilience and1998sovereignty of tribal nations, and ultimately, the success of1999the United States. I urge you to act now to uphold trust and2000treaty obligations and ensure that Native students receive the2001education they deserve.2002    Thank you, and I look forward to your questions.2003    [The prepared statement of Mr. Bird follows:]20042005    Prepared Statement of Kerry D. Bird, President, National Indian2006                         Education Association2007    On behalf of the National Indian Education Association (NIEA), and2008the students, educators, and Tribal Nations we serve, thank you for2009this opportunity to provide testimony regarding the critical issues2010surrounding Native education and the Federal government's trust and2011treaty obligations to American Indians and Alaska Natives and the2012Federal trust obligation to Native Hawaiians. Sovereignty is the2013cornerstone of effective education in Indian Country, and the federal2014trust responsibility to Indian education is one of the most fundamental2015commitments the United States government has made. This responsibility,2016deeply embedded in over 150 years of treaties, statutes, and cases, has2017been integral to ensuring that Native students receive the support and2018resources needed for educational success. Education is not merely a2019tool for individual success it is the foundation for the future of our2020Nations.2021    Native students in Bureau of Indian Education (BIE)-funded schools,2022as well as those in public schools serving Native populations, are2023subjected to overcrowded classrooms, deteriorating facilities, and that2024does not respond to the needs of the local communities or cultures. In2025many instances, Federal policies do not sufficiently recognize or2026support the inherent sovereignty of Tribal Nations in managing their2027own educational systems, often leaving Native communities at the mercy2028of bureaucratic red tape and restrictive federal oversight. This2029oversight results in a lack of agency for Native peoples over their own2030educational systems, which should be driven by cultural, linguistic,2031and community-specific priorities.2032    NIEA urges this Committee to act on these critical issues. By2033making meaningful investments in Native education, updating outdated2034policies, and recognizing the inherent sovereignty of Tribal Nations,2035we can begin to close the gaps in educational opportunity and outcomes2036for Native students. This includes prioritizing funding and flexibility2037for BIE schools and Tribal Education Agencies, protecting the status of2038Native education programs across the government, and removing2039administrative barriers that hinder Native communities from fully2040controlling and shaping their educational systems. The stakes are high,2041not just for Native students but for the future of our communities and2042our shared future as a Nation. By supporting Native education, we are2043not only investing in the future of our youth but in the strength and2044vitality of Tribal Nations and the United States as a whole.2045I. Affirming the Political Status of Native Students2046    The first step in improving Native education is affirming the2047political status of Native students. The political status of Native2048students--whether American Indian, Alaska Native, or Native Hawaiian--2049is deeply intertwined with their communities' sovereignty and their2050relationship with the U.S. government. These communities have a unique2051and complex legal and political standing that must be recognized and2052respected in the development of federal education policy. Native2053students face unique challenges, and their education must be designed2054with their cultural heritage and future economic success in mind. The2055federal trust responsibilities to American Indians, Alaska Natives, and2056Native Hawaiians, are an essential part of this relationship,2057obligating the U.S. government to protect the resources, lands, and2058rights of Tribal Nations and Native communities, including ensuring2059access to education.2060    Congress has long understood this unique duty, reaffirming the2061political status of Native students through centuries of legislation,2062beginning with the Civilization Fund Act of 1819, codified as a Federal2063directive in the Snyder Act of 1921, and later revised under the Indian2064Self-Determination and Education Assistance Act of 1975 (ISDEAA), P.L.206593-638, and the Tribally Controlled Schools Act of 1988, P.L. 100-297.2066Meanwhile, the trust responsibility to individual Native children in2067public schools has been reinforced in federal law since the Johnson2068O'Malley (JOM) Act of 1935, followed by P.L. 81-874 (1950), Title VI of2069the Elementary and Secondary Education Act of 1965, the Indian2070Education Act of 1972, and the Native Hawaiian Education Act of 1988.2071Congress must continue to advocate for policies that reaffirm the2072political status of Native students. This can be achieved by providing2073greater flexibility and control to Tribal communities in areas such as2074curriculum development, governance, teacher recruitment, and funding2075allocation. Tribal Nations should be empowered to make decisions that2076reflect their values, traditions, and educational priorities. These2077programs are not simply a matter of cultural pride but also critical to2078the future economic success of Native communities, as they help to2079preserve and promote valuable skills and traditions.2080II. Ensuring Stable and Adequate Funding for Native Education2081    A critical element of fulfilling the federal government's trust2082responsibility, the Federal government must ensure that funding for2083Native education is adequate, stable, and protected. The Federal2084government must commit to long-term, consistent funding that supports2085Native education programs and ensures that Native students have access2086to the resources they need to succeed. This includes support for Tribal2087Education Agencies (TEAs), which play a crucial role in operation of2088Tribally Controlled Schools, Tribal charter schools, and the2089development and implementation of education programs for Native2090students, as well as funding for programs like Head Start, Johnson-2091O'Malley, and Native language revitalization efforts. TEAs provide2092invaluable resources that help close educational gaps for Native2093students, but they cannot operate effectively without adequate funding.2094    The financial stability of Tribal education programs is a2095foundational element of ensuring longterm success for Native students.2096To achieve this, it is critical that Congressional appropriations for2097Tribal education remain stable and predictable through Advance2098Appropriations. Advance Appropriations provide guaranteed, consistent2099funding for federal programs, allowing Tribal governments and2100educational institutions to plan and implement long-term projects2101without the uncertainty of fluctuating annual budgets. This stability2102is particularly crucial in education, where programs rely on2103predictable funding to address the unique needs of Native students.2104Without stable, guaranteed funding, Native communities often face2105interruptions in services, delays in programming, and difficulty in2106maintaining quality educational standards. Advance Appropriations would2107protect these programs from the uncertainty of the annual budget cycle2108and ensure that Tribes can meet the educational needs of their youth2109without disruption.2110    In addition, funding for Native education programs should protected2111across the entire Federal government. Funds for programs like Title VI,2112Title I grants, and the Johnson-O'Malley program must be fully funded2113to addresses the unique needs of Native students who do not attend BIE2114schools but still maintain a political relationship with the Federal2115government. These programs are critical to closing the achievement gap,2116but their effectiveness is undermined when funding is not consistent2117and when there are no guarantees that resources will be allocated where2118they are most needed.2119III. Expanding Self-Governance in Education Through P.L. 477 and 6382120        Authorities2121    One of the most effective ways to empower Tribal Nations in2122managing educational programs is to expand self-governance authority2123through P.L. 477 and 638. These policies allow Tribes to take on2124greater control and responsibility over federal programs that impact2125their communities, creating more flexible and culturally relevant2126solutions for Native students.2127    Under P.L. 102-477, Tribes have the ability to consolidate multiple2128federal programs under a single compact or contract, offering a2129streamlined approach to service delivery. Expanding this authority2130throughout the Administration for Children and Families (ACF) would2131allow for better integration of education programs such as Head Start2132and Native language revitalization efforts under the Administration for2133Native Americans (ANA). By consolidating funding streams and reducing2134the administrative burden of navigating multiple federal requirements,2135Tribes can tailor these programs to meet the specific needs of their2136communities, fostering greater community involvement and long-term2137sustainability.2138    Similarly, fully extending 638 authority to more federal programs--2139particularly those within the U.S. Department of Agriculture (USDA),2140like Child Nutrition Services--will provide Tribes with the autonomy to2141design and administer programs that are culturally appropriate and2142responsive to their community's unique needs. This would enable Tribes2143to manage their own nutrition services for students, ensuring that the2144meals provided are nutritious and reflective of cultural preferences,2145which directly impacts student health and academic success.2146    By expanding both P.L. 477 and 638 authority, Tribes can exercise2147greater sovereignty and selfdetermination in the administration of2148education-related programs, leading to more efficient, effective, and2149culturally relevant services. These efforts will help bridge the gap in2150educational disparities and support the success of Native students by2151ensuring that educational programs are aligned with community values2152and priorities.2153IV. Improving BIE Facilities and Resources2154    The Bureau of Indian Education is a primary mechanism through which2155the federal government provides education to Native students. Unlike2156Department of Defense (DOD) schools, which receive significant funding2157for modern facilities and ongoing renovations, BIE schools are often2158operating in buildings that are outdated and, in some cases, hazardous2159for students and staff. In many cases, BIE schools lack basic2160infrastructure, such as heating and ventilation, and face ongoing2161challenges with building maintenance and teacher recruitment.2162    In 2019, a study by the Department of the Interior estimated that2163addressing the most critical maintenance issues in BIE schools would2164require more than $639 million. However, even after this immediate2165funding is provided, BIE schools would still face a funding shortfall2166of over $1 billion to address the full scope of the infrastructure2167needs. This disparity is an ongoing injustice, as Native students2168should have access to the same quality of education facilities as their2169peers in other parts of the country.2170    Tribal Nations often face significant barriers in securing and2171maintaining funding for school facility construction, repair, and2172renovation through traditional funding mechanisms. We urge Congress to2173consider providing additional funding for the BIE school facilities,2174including through the reauthorization of the Great American Outdoors2175Act (GAOA) Legacy Restoration Fund, and streamlining the process for2176accessing these funds. Investing in facilities is an investment in the2177future of Native students and their communities.2178V. Enhancing Tribal Control Over Education Infrastructure: 105(l)2179        Leases2180    Making 105(l) leases mandatory appropriations offers Tribes an2181alternative model for improving school infrastructure. Under Section2182105(l) of ISDEAA, Tribes can lease school facilities to the federal2183government as part of self-governance compacts or contracts. This2184allows Tribes to build, repair, and maintain schools independently2185while ensuring the federal government meets its fiduciary duties. The2186leases are essentially payment agreements between Tribes and the BIA,2187BIE, or IHS, compensating Tribes based on the ``fair market value'' of2188their facilities for use in federal programs. However, because these2189payments are currently discretionary, they increasingly face the2190possibility of being offset by cuts to other Tribal programs. To2191encourage Tribal participation in 105(l) leasing and give Tribes more2192control over their facilities, these payments should be made mandatory.2193Doing so would reduce bureaucratic delays, empower Tribes with self-2194determination over education infrastructure, and address the current2195backlog in school maintenance.2196VI. Tribal Head Start, Early Childhood Education, and the Alyce Spotted2197        Bear Report2198    Early childhood education is a critical foundation for Native2199students' future success, yet Tribal Head Start and other early2200childhood education programs often face chronic underfunding and2201barriers to full participation. The Alyce Spotted Bear and Walter2202Soboleff Commission on Native Children, through its 2019 report,2203highlighted the urgent need for culturally relevant early childhood2204education programs that are responsive to the unique needs of Native2205communities. The report underscored the importance of improving access2206to Head Start programs and other early education services, ensuring2207they reflect Native languages, cultures, and values.2208    To address these needs, Congress must increase funding for Tribal2209Head Start programs, which provide crucial developmental and2210educational opportunities for Native children. Additionally, enhancing2211access to early childhood education by supporting Tribally operated2212programs and ensuring they meet the specific needs of Native2213communities will help improve the overall educational outcomes for2214Native students. Many of these programs were outlined in the final2215Alyce Spotted Bear Commission Report and should be fully implemented.2216Federal investment in these programs not only prepares children for2217academic success but also strengthens the cultural fabric of Native2218communities by providing children with a connection to their heritage2219from a young age.2220VII. Ensuring Culturally Relevant Education and Teacher Retention2221    In order to create an education system that is truly responsive to2222the needs of Native students, it is essential that Tribal Nations have2223the ability to develop their own curricula and educational assessments.2224Currently, many BIE schools are required to use standardized2225assessments that do not take into account the cultural and linguistic2226backgrounds of Native students. This often leads to unfair evaluations2227of student achievement and reinforces disparities in academic outcomes.2228By allowing BIE-funded schools to develop and use their own2229assessments, we can better support Native students in their educational2230journey.2231    Furthermore, it is crucial to invest in teacher retention and2232professional development programs across all levels of education. The2233Native American Teacher Retention Initiative (NATRI) has been2234successful in increasing the number of Native teachers and providing2235ongoing support to those in the profession. Continued support for NATRI2236and similar programs will help address the teacher shortages in Native2237communities and ensure that Native students have educators who2238understand and respect their cultural backgrounds. Programs such as2239this should be expanded to include recruitment and retention programs2240for Early Childhood Education (ECE), where typical teacher shortages2241are exacerbated even further. These programs should include mentoring,2242leadership development, and professional growth opportunities to2243support teachers' long-term success in the classroom.2244VIII. The Other 93 Percent: Addressing the Educational Needs of Native2245        Students in Public Schools2246    While BIE schools serve a significant portion of Native students,2247the majority--about 93 percent--attend public schools. Title VI of the2248Elementary and Secondary Education Act (ESEA) is a vital resource for2249Native students in public schools. Title VI programs play a crucial2250role in addressing the unique educational needs of Native students.2251Title VI grants fund vital resources for Native students, including2252after-school programs, academic support, dropout prevention2253initiatives, and assistance with college access testing. Equally2254important is the inclusion of Native Hawaiian Education and Alaska2255Native Education programs, which aim to address the specific needs of2256Native Hawaiian and Alaska Native students.2257    Additionally, Title I grants, which target disadvantaged students,2258are particularly vital for Native students who often face socioeconomic2259challenges in schools across the Nation. BIE Schools also receive this2260funding. There have been many recent conversations regarding the future2261and the structure of these grants. It is essential that the role these2262grants play in fulfilling the trust and treaty obligations to Native2263education are not redirected to the States. Here, TEAs again play an2264important role and should be eligible to receive the funding directed2265at their students, similar to State Education Agencies (SEAs) or Local2266Education Agencies (LEAs).2267    Maintaining robust funding for these programs is critical, as they2268provide essential resources and services that public schools might2269otherwise lack. Programs such as Title VI are essential because they go2270above and beyond what the BIE and JOM can serve, including descendants2271of federally recognized tribes, as well as state-recognized tribes,2272ensuring that more Native students can benefit from these programs and2273also affirming the Federal government's commitment to meeting the2274unique needs of Native communities within the broader public education2275system.2276IX. Protecting Impact Aid and Supporting Tribally Controlled Schools2277    Impact Aid is a federal program designed to support school2278districts that serve students whose families live on federal lands or2279who are military dependents. For many Native communities, Impact Aid is2280a critical funding source that helps bridge the gap between what local2281districts can raise through taxes and what is required to provide2282quality educational services. However, the current structure of the2283program does not adequately account for Tribally controlled schools,2284which do not have access to traditional tax revenue. Additionally,2285while Native students living on federal lands are eligible for Impact2286Aid, Native Hawaiians are not, even though they face similar2287challenges.2288    NIEA advocates for expanding the Impact Aid program to include2289Tribally Controlled Schools, as these schools are in a unique position.2290They are run by Tribal Nations, which do not have the same access to2291tax revenue as other school districts. Allowing these schools to2292benefit from Impact Aid would provide essential funding that could be2293used to improve educational opportunities for Native students.2294    Furthermore, while American Indians and Alaska Natives are2295recognized as federally impacted children, Native Hawaiians, even those2296living on Hawaiian Homesteads, are excluded from these benefits. This2297is a significant gap in the system, and it is essential that Congress2298take steps to ensure that Native Hawaiians are not excluded from2299federal educational support.2300X. Expanding Educational Opportunities Through Charter Schools and2301        Self-Determination2302    Charter schools have become a valuable tool for Native communities2303seeking to regain control over the education of their children.2304Tribally run charter schools offer Native students a culturally2305relevant curriculum, focused on language revitalization, cultural2306identity, and the educational priorities of their communities. Charter2307schools also allow for innovative approaches to education, such as2308project-based learning and community partnerships, which are essential2309for the success of Native students. Allowing Tribal Nations and TEAs to2310be recognized as authorizers for Native charter schools on their lands2311or within their communities will help provide an education system that2312aligns with the values and needs of Native students, while also2313offering flexibility to adapt to the diverse educational needs across2314Indian Country.2315    This is especially so, given the 1995 moratorium on additional BIE2316schools, and the lack of funding which exists even if the moratorium2317were to be lifted. For all of the Tribes who do not have BIE schools in2318their communities, and even for those that do, supporting and expanding2319access to charter schools for Native students is an important step2320toward promoting selfdetermination and create additional choice in2321Native education.2322Conclusion2323    The federal government has a sacred trust responsibility to Native2324peoples, particularly when it comes to education. By honoring the2325commitments made to Native students and strengthening sovereignty in2326education, we can ensure that Native students receive an education that2327will not only improve economic outcomes but also strengthen the2328resilience of Native communities for generations to come.23292330    The Chairman. Thank you, Mr. Bird.2331    Now we go virtually to Hawaii. Mr. Lewis, welcome.23322333  STATEMENT OF KUHIO LEWIS, CEO, COUNCIL FOR NATIVE HAWAIIAN2334                          ADVANCEMENT23352336    Mr. Lewis. Aloha, mahalo nui loa to Chair Murkowski and to2337our very own Senator and Vice Chair Schatz, as well as esteemed2338members of the Committee. I am Kuhio Lewis; I am the Chief2339Executive Officer of the Council for Native Hawaiian2340Advancement. I want to extend a deep mahalo to you, Chair2341Murkowski, for your steadfast support for our Native people2342across America.2343    For background, our organization is actually the sister or2344the mirror to AFN, or the Alaska Federation of Natives. We2345gather community, we identify priorities to them, and we2346elevate them. We have 1,600 members as part of our2347organization's network. We are a HUD-certified counseling2348agency. We are the largest Native CDFI in Hawaii and we manage2349large-scale workforce programs, housing projects, financial2350aid, and we also help manage tourism in our islands. Currently,2351we are playing a pivotal role in helping Maui recover from the2352devastating wildfires.2353    CNHA also operates a policy center, and we help connect2354people with decision makers.2355    Just by way of our comments, the Federal Government has a2356special political and trust relationship with the Native2357Hawaiian community following the overthrow of our Queen and the2358annexation of the kingdom, the illegal annexation of our2359kingdom of Hawaii, and the seizure of our trust lands. These2360are the same trust principles that Congress has recognized and2361it owes the Native people of the United States. In lieu of a2362government-to-government relationship, the Federal Government2363fulfills this trust obligation to Native Hawaiians by working2364with Native Hawaiian organizations like ours and many others2365out there, as well as the Native Hawaiian community at large.2366    Compared to other groups in Hawaii, Native Hawaiians face2367some of the greatest disparities. We have the shortest life2368expectancy, we are the most likely to live below the poverty2369line, we experience significantly higher rates of unemployment,2370we are the most incarcerated. And one unfortunate statistics2371is, recently there are more Native Hawaiians now living outside2372of our homeland of Hawaii than in our homeland.2373    So we are losing more and more. We already lost our2374monarchy, our lands, our culture, and now we are losing our2375people. The cost of living, the unaffordable housing prices,2376the lack of career opportunities, have pushed our Native2377Hawaiian people out of their homeland.2378    While great strides have been made, more work needs to be2379done to support our Native people. The inclusion of Native2380Hawaiians in programs like the Office of Indian Energy,2381increased funding to support programs like NAHASDA so we can2382build housing, ensuring that trust principles are met and2383Native Hawaiians can stay in their homelands is critical. These2384funding mechanisms allow us to leverage private funds as well,2385so that we can further support our people.2386    In closing, similar to what others have said, NAHASDA funds2387are critical to our advancement. There have been tremendous2388happenings in recent years with respect to NAHASDA. So as well2389as for our Native Hawaiian education funds, it has helped to2390perpetuate and cultivate the continuation of our Hawaiian2391language programs, which was something that was lost. And our2392Native Hawaiian support that we get from Congress is also2393critical.2394    So what we are asking for is the continued recognition and2395support of our Native Hawaiian people in Hawaii. We will do our2396part to continue to support our people.2397    Thank you, Chair, thank you Committee members. I am2398available for questions.2399    [The prepared statement of Mr. Lewis follows:]24002401  Prepared Statement of Kuhio Lewis, CEO, Council for Native Hawaiian2402                              Advancement2403    Mahalo nui loa, Chair Murkowski, Vice Chair Schatz, and esteemed2404members of the Senate Committee on Indian Affairs for convening this2405hearing on Native priorities.2406    Founded in 2001, the Council for Native Hawaiian Advancement (CNHA)2407is a member-driven, 501(c)(3) nonprofit organization dedicated to2408advancing the cultural, economic, political, and community development2409of Native Hawaiians throughout the United States. As a Native Community2410Development Financial Institution, a HUD-Certified Housing Counseling2411Agency, and a National Intermediary, CNHA fosters greater opportunities2412for economic growth and self-sufficiency through three primary2413divisions: Community Programs, Kako`o Maui, and Kilohana, a tourism-2414focused initiative.2415    CNHA takes pride in advocating for some of the most pressing issues2416facing the Native Hawaiian Community today, including the rising cost2417of living, lack of affordable housing, access to economic prosperity,2418and disaster resiliency in light of the 2023 Maui wildfires.2419Additionally, we are deeply concerned about these issues contributing2420to the increasing outmigration of Native Hawaiians from their homeland.2421    CNHA is honored to provide insight into the needs of the Native2422Hawaiian Community and our federal trust responsibility. Mohala i ka2423wai ka maka o ka pua--Unfolded by the water are the faces of the2424flowers. \1\ Just as flowers thrive where there is water, so do2425communities flourish when they have necessary resources and support.2426---------------------------------------------------------------------------2427    \1\ Mary Kawena Pukui, `Olelo No`eau: Hawaiian Proverbs & Poetical2428Sayings #2178 (1983).2429---------------------------------------------------------------------------2430    We respectfully urge the Committee to support equitable funding and2431programmatic opportunities for the Native Hawaiian Community; permanent2432reauthorization of existing Native Hawaiian legislation; and2433development of meaningful consultation policies that ensure Native2434Hawaiian voices are heard in federal decision-making.2435Overview of the Native Hawaiian Community2436    Native Hawaiians are the Indigenous people of the Hawaiian Islands2437with a unique culture, language, and tradition. Estimates of up to one2438million Native Hawaiians built a thriving, complex society capable of2439sustainably supporting itself in one of the most remote locations in2440the world. Contact with European settlers beginning in 1778 devastated2441the Native Hawaiian population due to the introduction of illnesses2442such as measles, smallpox, polio, tuberculosis, and venereal diseases.2443By 1920, the Native Hawaiian population had dwindled to just under244424,000. \2\ This rapid decline, coupled with a loss of culture,2445language, land, and political leadership, pushed Native Hawaiians to2446the lowest socioeconomic levels in their homeland. After generations of2447revitalization efforts, community resilience, and political advocacy,2448the Native Hawaiian Community has been slowly recovering from the2449impacts of these travesties. Yet, there is still much work to be done2450to overcome past, present, and future struggles.2451---------------------------------------------------------------------------2452    \2\ Sara Kehaulani Goo, ``After 200 years, Native Hawaiians Make a2453Comeback'' Pew Research Center. (Apr. 6, 2015), https://2454www.pewresearch.org/fact-tank/2015/04/06/native-hawaiianpopulation/.2455---------------------------------------------------------------------------2456    Compared to other groups, Native Hawaiians face some of the2457greatest disparities. In Hawai`i, Native Hawaiians have the shortest2458life expectancy, are the most likely to live below the poverty line,2459and experience significantly higher rates of unemployment, impoverished2460conditions, and incarceration. \3\ Native Hawaiians are the only ethnic2461group in Hawai`i with consistently more people leaving than entering2462the islands over the past fifteen years. \4\2463---------------------------------------------------------------------------2464    \3\ Noreen Mokuau et al., Challenges and Promises of Health Equity2465for Native Hawaiians (2016).2466    \4\ Shawn Malia Kana`iapuni et al., Ka Huaka`i Native Hawaiian2467Education Assessment (2021) https://www.ksbe.edu/ka_huakai/.2468---------------------------------------------------------------------------2469    Today, there are over 650,000 Native Hawaiians living across the2470globe. The highest concentration of Native Hawaiians is in Hawai`i,2471with more than 20 percent of Hawai`i residents identifying as Native2472Hawaiian. \5\ The 2020 Census identified that, for the first time, a2473majority of Native Hawaiians live outside of Hawai`i. \6\ As shown in2474the table below, Nevada, California, Washington State, and Utah all2475have large concentrations of Native Hawaiians. \7\2476---------------------------------------------------------------------------2477    \5\ America Counts Staff ``Hawaii Added More Than 94,000 People2478Since 2010'' U.S. Census Bureau (Aug. 25, 2021) https://www.census.gov/2479library/stories/state-by-state/hawaii-population-change-between-census-2480decade.html#race-ethnicity.2481    \6\ Native Hawaiian Research Hui ``New census data confirms more2482Native Hawaiians reside on the continent than in Hawai`i'' Office of2483Hawaiian Affairs (Sep. 22, 2024) https://www.oha.org/news/new-census-2484data-more-native-hawaiians-reside-continent/.2485    \7\ Brittany Rico, Joyce Key Hahn, and Paul Jacobs ``Chuukese and2486Papua New Guinean Populations Fastest Growing Pacific Islander Groups2487in 2020'' U.S. Census Bureau (Sep. 21, 2023) https://www.census.gov/2488library/stories/2023/09/2020-census-dhc-a-nhpi-population.html.24892490  Selected Counties with Large Populations of Native Hawaiian Residents2491------------------------------------------------------------------------2492                  County                     Number of Native Hawaiians2493------------------------------------------------------------------------2494Honolulu County, HI                         200,4552495Hawaii County, HI                           59,3202496Maui County, HI                             39,5922497Clark County, NV                            23,1922498Los Angeles County, CA                      15,9832499San Diego County, CA                        10,9652500King County, WA                             7,8672501Pierce County, WA                           6,6482502Sacramento County, CA                       5,3782503Salt Lake County, UT                        3,8462504------------------------------------------------------------------------25052506Federal Trust Responsibility for the Native Hawaiian Community2507    Congress has consistently and expressly acknowledged a special2508political and trust relationship with Native Hawaiians based on our2509status as the Indigenous, once-sovereign people of Hawai`i. These are2510the same trust principles that Congress has recognized is owed to all2511Native peoples of the United States. The federal trust relationship2512with the Native Hawaiian Community was established through the illegal2513annexation of the Kingdom of Hawai`i \8\ and reaffirmed by the 19592514Admission Act. \9\ The federal trust responsibility has been included2515in more than 150 legislative measure, including but not limited to:2516---------------------------------------------------------------------------2517    \8\ Joint Resolution to Provide for Annexing the Hawaiian Islands2518to the United States, H.R.J. Res. 55-51, 55th Cong., 30 Stat. 7502519(1898).2520    \9\ Admission Act of 1959, Pub. L. No. 86-3, 73 Stat. 4.25212522   Hawaiian Homelands Homeownership Act (HHHA) \10\2523---------------------------------------------------------------------------2524    \10\ Codified as Title VIII of the Native American Housing and2525Self-Determination Act (NAHASDA) (25 U.S.C. 4221 et seq.) (2000). Finds2526that ``the United States has a special responsibility for the welfare2527of the Native peoples of the United States, including Native2528Hawaiians'' and ``under the treatymaking power of the United States,2529Congress had the constitutional authority to confirm a treaty between2530the United States and the government that represented the Hawaiian2531people, and from 1826 until 1893, the United States recognized the2532independence of the Kingdom of Hawaii, extended full diplomatic2533recognition to the Hawaiian Government, and entered into treaties and2534conventions with the Hawaiian monarchs to govern commerce and2535navigation in 1826, 1842, 1849, 1875, and 1887.''25362537   Native Hawaiian Health Care Improvement Act (NHHCIA) \11\2538---------------------------------------------------------------------------2539    \11\ Native Hawaiian Health Care Improvement Act (42 U.S.C. 117012540et seq.) (1988). Establishes a program to maintain and improve Native2541Hawaiian health ``[i]n furtherance of the trust responsibility for the2542betterment of the conditions of Native Hawaiians'' and acknowledges2543that ``[t]his historical and unique legal relationship has been2544consistently recognized and affirmed by the Congress through the2545enactment of Federal laws which extend to the Hawaiian people the same2546rights and privileges accorded to American Indian, Alaska Native,2547Eskimo, and Aleut communities.''25482549   Native Hawaiian Education Act (NHEA) \12\2550---------------------------------------------------------------------------2551    \12\ Native Hawaiian Education Act (20 U.S.C. 7511-7517) (1988).2552Recognizes that ``Congress does not extend services to Native Hawaiians2553because of their race, but because of their unique status as the2554indigenous people of a once sovereign nation as to whom the United2555States has established a trust relationship'' and ``the political2556status of Native Hawaiians is comparable to that of American Indians2557and Alaska Natives.''25582559   Native American Graves Protection and Repatriation Act2560        (NAGPRA) \13\2561---------------------------------------------------------------------------2562    \13\ Native American Graves Protection and Repatriation Act (252563U.S.C. 3001 et seq.).25642565   National Historic Preservation Act (NHPA) \14\2566---------------------------------------------------------------------------2567    \14\ National Historic Preservation Act (16 U.S.C. 470 et seq.).25682569   Native American Languages Act (NALA) \15\2570---------------------------------------------------------------------------2571    \15\ Native American Languages Act (25 U.S.C. 2901 et seq.).25722573   Native American Tourism and Improving Visitor Experience2574        (NATIVE) Act \16\2575---------------------------------------------------------------------------2576    \16\ Native American Tourism and Improving Visitor Experience2577(NATIVE) Act (25 U.S.C. 4351 et seq.).25782579    Congress determines which Native groups are receive a formal trust2580responsibility, while the Executive Branch administer the enacted2581programs and policies to fulfill this obligation. American Indians and2582Alaska Natives have tribal governments to help the federal government2583to administer these programs. In lieu of a central Native Hawaiian2584government, the federal government works with Native Hawaiian2585Organizations and the Native Hawaiian Community.2586    Congress has defined the term ``Native Hawaiian'' in multiple2587statutes. The Native American Housing Assistance and Self-Determination2588Act (NAHASDA) defines Native Hawaiian as ``any individual who is (A) a2589citizen of the United States; and (B) a descendant of the aboriginal2590people, who, prior to 1778, occupied and exercised sovereignty in the2591area that currently constitutes the State of Hawaii, as evidenced by2592(i) genealogical records; (ii) verification by kupuna (elders) or2593kama`aina (long-term community residents); or (iii) birth records of2594the State of Hawaii.'' \17\2595---------------------------------------------------------------------------2596    \17\ 25 U.S.C.  4221(9)2597---------------------------------------------------------------------------2598    Native Hawaiian Organizations often refers to any organization that2599serves and represents the interests of the Native Hawaiian Community;2600has a primary and stated purpose for the provision of service to the2601NHC; and has expertise in Native Hawaiian affairs. Native Hawaiian2602Community often refers to the distinct Native Hawaiian indigenous2603political community that Congress has recognized and for which Congress2604has implemented a special political and trust relationship.2605Importantly, none of these definitions have a geographic restriction to2606the State of Hawai`i. Federal policies must take into account that the2607Native Hawaiian Community exists throughout the country and Native2608Hawaiians live in every state.2609Federal Priorities that Advance the Cultural, Economic, and Political2610        Well-Being of the Native Hawaiian Community2611    Consistent with the special and political trust relationship, the2612federal government owes a duty of care to the Native Hawaiian2613Community. As detailed below, the Council for Native Hawaiian2614Advancement respectfully urges the Committee to support equitable2615funding and programmatic opportunities for the Native Hawaiian2616Community; permanent reauthorization of existing Native Hawaiian2617legislation; and development of meaningful consultation policies that2618ensure Native Hawaiian voices are heard in federal decisionmaking.2619Equitable Funding and Programmatic Opportunities for the Native2620        Hawaiian2621        Community2622    Congress has authorized a patchwork of programs to deliver and2623coordinate services to Native Hawaiian communities. However, our2624experience is that when Native Hawaiians are not specifically2625identified and funding is not set aside, the needs of our communities2626are more likely to be overlooked or excluded. We urge this Committee to2627strengthen and expand legislation to achieve parity with other Native2628American groups and further support the advancement of cultural,2629economic, and political well-being of Native Hawaiians. Native2630Hawaiian-serving organizations should be empowered and utilized as an2631effective service-delivery system to the extent possible. If certain2632funding must ultimately pass through State and County agencies, the2633trust responsibility to Native Hawaiians should be specifically2634identified and acknowledged.2635    One example of existing equitable funding is the Native American2636Languages Act (NALA). Language revitalization is a cornerstone to2637cultural perpetuation for Indigenous communities. NALA established2638federal policy in support of the survival of, and use as the medium of2639education, all Native American languages including `Olelo Hawai`i.2640Through Hawaiian language funding, programs like `Aha Punana Leo have2641been able to successfully provide immersion programs growing the next2642generation of fluent `Olelo Hawai`i speakers. We urge this Committee to2643increase funding for Native languages and enable Native American2644language medium pathways in all federally supported educational2645programs.2646    One opportunity for increased funding equity is programs that2647affect the economic well-being of Native Hawaiians. There are several2648economic development and access to capital programs that serve Native2649Hawaiians, including the Department of the Treasury, Native American2650Community Development Financial Institutions, Minority Depository2651Institutions, and the Native Hawaiian Revolving Loan Fund. The Native2652Hawaiian Community has also benefitted from the Treasury's Emergency2653Rental Assistance, Homeowner Assistance Fund, Capital Projects Fund and2654Small Business Credit Initiative, Emergency Capital Investment Program,2655Rapid Response Program, and Native American CDFI Assistance Program. We2656urge this Committee to support expanded funding for these critical2657initiatives integral to improving economic opportunities for Native2658Hawaiians.2659    Another opportunity for greater programmatic equity is the2660inclusion of Native Hawaiians in existing protections for Indigenous2661women and girls. Native Hawaiian women and girls experience violence at2662disproportionate rates. \18\ Hawai`i has the eighth highest rate of2663missing persons per capita, with the reported cases of missing children2664being 77 percent female and 84 percent Native Hawaiian. \19\ However,2665Native Hawaiians have largely been left out of the federal policy2666discourse and resource allocation to address violence against2667Indigenous communities. 2022 was the first year Native Hawaiians were2668formally recognized by a U.S. President as belonging to Indigenous2669populations disproportionately impacted by interpersonal and systemic2670violence that leads to Native women and girls going missing and being2671murdered. We urge the Committee to include Native Hawaiians in federal2672policy initiatives, funding, and legislation aimed at responding to the2673crisis of missing and murdered Indigenous women and girls and violence2674against women.2675---------------------------------------------------------------------------2676    \18\ Missing and Murdered Native Hawaiian Women and Girls Task2677Force Report. https://www.oha.org/wp-content/uploads/MMNHWG-2678Report_Web.pdf.2679    \19\ Id.2680---------------------------------------------------------------------------2681    Finally, it is critical that Native Hawaiians are included in data2682disaggregation efforts throughout all federal government initiatives.2683Native Hawaiians are often grouped alongside Asian Americans and Other2684Pacific Islanders in a way that obfuscates relevant Native Hawaiian2685statistics. This is also true when a catch-all multiracial category is2686used, as Native Hawaiians are more likely than other groups to identify2687with an additional race or ethnicity group. \20\ We urge this Committee2688to promote data disaggregation efforts across federal race and2689ethnicity standards.2690---------------------------------------------------------------------------2691    \20\ Joshua Quint et al., ``The Hawai'i NHPI Data Disaggregation2692Imperative: Preventing Data Genocide Through Statewide Race and2693Ethnicity Standards'' Hawaii Journal of Health & Social Welfare (Oct.26942023). https://pubmed.ncbi.nlm.nih.gov/37901675/.2695---------------------------------------------------------------------------2696Permanent Authorization of Existing Native Hawaiian Legislation2697    In addition to the inclusion on Native Hawaiians in larger bills,2698Congress has also utilized programs specific to the Native Hawaiian2699Community through federally funded Native Hawaiian-serving2700organizations, such as the Office of Hawaiian Affairs, the Department2701of Hawaiian Home Lands,2702    Papa Ola Lokahi, the Native Hawaiian Health Care Systems, and the2703Native Hawaiian Education Council to deliver and coordinate services to2704Native Hawaiian communities. Over the past several decades, the HHA,2705the NHHCIA, and the NHEA has provided resources to the Native Hawaiian2706community through a variety of programs and services. We urge this2707Committee to permanently reauthorize all of these Acts.2708    Firstly, the Department of Hawaiian Home Lands (DHHL) is a state2709agency created by federal statute with the mission to develop and2710deliver land and housing to Native Hawaiians. In 2000, Congress enacted2711the Hawaiian Homelands Homeownership Act (HHHA) in 2000, establishing2712the Native Hawaiian Housing Block Grant program and the Section 184A2713Loan Guarantees for Native Hawaiian Housing through NAHASDA. These2714programs deliver funds for new construction, rehabilitation,2715infrastructure, and various support services. DHHL has also been able2716to use these funds for emergency rental assistance for eligible Native2717Hawaiians; rental subsidies for lower-income elderly, rehabilitation of2718homes primarily for elderly or disabled residents; homeownership2719opportunities for lower-income working families; and homeownership and2720rental counseling to address barriers experienced by Native Hawaiians.2721    These is a growing housing crisis in Hawai`i. The average price for2722a single-family home in Hawai`i is $843,185. \21\ In 2022, home buyers2723needed to earn nearly 180 percent of the state's median income (or2724$150,000 per year) to afford the median home. \22\ Of the 28,155 Native2725Hawaiians in rental united in Hawai`i, 54.9 percent of them are cost-2726burdened and paying more than 30 percent of their income to rent. On2727O`ahu, 42 percent of individuals included in the annual Point-in-Time2728count of unsheltered homeless were Native Hawaiians.2729---------------------------------------------------------------------------2730    \21\ Hawaii Housing Market, Zillow. https://www.zillow.com/home-2731values/18/hi/.2732    \22\ Stewart Yerton, ``It's Actually More Expensive To Buy A Home2733In Hawaii These Days Than You Thought'' Honolulu Civil Beat (June 28,27342023) https://www.civilbeat.org/2023/06/its-actually-more-expensive-to-2735buy-a-home-in-hawaii-these-days-than-you-thought/.2736---------------------------------------------------------------------------2737    The housing crisis is also true for many DHHL beneficiaries.2738According to DHHL's recently completed 2020 Beneficiary Study, 56.82739percent of the nearly 10,000 lessees or beneficiary families who2740received homestead awards are currently below the 80 percent HUD AMI.2741Of applicants or beneficiary families waiting to receive a homestead2742award, 51 percent of the over 28,000 applicants are below the 802743percent HUD AMI, an increase from 45 percent in 2014. In addition,2744about 16 percent of applicants below the HUD's 80 percent of Area2745Median Income (AMI). reported that they receive Section 8 and 7 percent2746reported that they received rental assistance. The impacts of the2747pandemic are expected to further exacerbate these needs. We urge this2748Committee to support permanent authorization, increased funding for,2749and expansion of the NHHBG and 184A Loan Guarantee programs.2750    Secondly, similar to our Indigenous relatives on the continent,2751these are significant health disparities amount Native Hawaiian2752populations. In response to these disparities, Congress enacted the2753Native Hawaiian Health Care Improvement Act (NHHCIA) in 1988. The2754NHHCIA established the Native Hawaiian Health Care program, which funds2755the Native Hawaiian Health Care Systems administered by Papa Ola2756Lokahi. The Systems provide primary health care, behavioral health, and2757dental services on Kaua`i, O`ahu, Maui, Moloka`i, and Hawai`i, as well2758as health education, health-related transportation, and other services.2759The NHHCIA also established the Native Hawaiian Health Scholarship2760Program, which has awarded more than 300 scholarships to Native2761Hawaiians pursuing careers in designated health care professions,2762supported culturally appropriate training, placed scholars in2763underserved Native Hawaiian communities.2764    There is also an urgent need for several amendments to the NHHCIA.2765This includes:27662767   Removing the matching requirements applied to the Systems2768        for parity with other Native health care providers;27692770   Making the NHHCSs eligible for 100 percent of the Federal2771        Medial Assistance Percentage (FMAP) as well as the Prospective2772        Payment System (PPS) reimbursement rate;27732774   Expanding Federal Tort Claims Act to Papa Ola Lokahi, the2775        Systems, and their employees in parity with other Native health2776        care providers;27772778   Allowing federal program funding to be used to collect and2779        analyze health and program data which currently falls under the2780        ten percent administrative cost cap for the program;27812782   Allowing the Systems to be a specific eligibility group for2783        supplemental federal funding streams; and27842785   Providing a tax exemption for the Native Hawaiian Health2786        Scholarship Program.27872788    We urge the Committee to support permanent reauthorization of,2789increased funding to, and technical amendments to the NHHCIA to address2790avoidable inequalities and health care disparities.2791    Finally, the Native Hawaiian Education Act has been monumental in2792providing resources to a collective of educational organizations2793supporting the unique needs of Native Hawaiian students. The program2794has helped address gaps in funding that state and private sources have2795historically been unable to adequately meet. A 2021 profile analysis of2796NHEP grantees from 2010 through 2018 cohorts reported data from grantee2797programs and services to Native Hawaiian communities are student,2798parent, and teacher focused. In 2017 and 2018, NHEP grants served279998,996 participants (including 77,808 students, 18,429 parents, and28002,759 teachers). 100 percent of grantee programs have been targeting2801Native Hawaiians and 42 percent target low-income populations. NHEA-2802funded programs have been agile and innovative to provide a continuum2803of services for students and their families despite receiving little to2804no supplemental funding from the Coronavirus Aid, Relief, and Economic2805Security Act via the State.2806    There is also an urgent need for several amendments to the NHEA.2807This includes:28082809   Clarification that the 5 percent limitation in section2810        6205(b) of the Elementary and Secondary Education Act on the2811        use of funds for administrative purposes shall apply only to2812        direct administrative costs.28132814   Authorization to use NHEA funds for construction,2815        renovation, and modernization of any public elementary school,2816        secondary school, or structure related to a public elementary2817        school or secondary school that serves a predominantly Native2818        Hawaiian student body.28192820   Priority funding recommendations to enable the U.S.2821        Department of Education to provide grant funding aligned with2822        the needs and priorities for improving educational outcomes for2823        Native Hawaiians by: (a.) determining funding priorities for2824        each grant competition based on the data-driven priority2825        recommendations submitted to the Department by the Native2826        Hawaiian Education Council through its annual report; (b.)2827        identifying educational needs that remain unmet through a2828        transparent, evidence-based process; and c. developing a peer2829        review process for each grant competition, including2830        identifying reviewer criteria and culturally-appropriate2831        training, and developing an application scoring rubric.2832        Fulfillment of these requests would enable Native Hawaiian2833        Education Program (NHEP) recipients to further bolster Native2834        Hawaiian education.28352836    We urge the Committee to support permanent reauthorization of,2837increased funding to, and technical amendments to the NHEA.2838Development of Meaningful Consultation Policies2839    Executive Order 13175 outlines the underlying principles for2840formulating or implementing policies with implications for a native2841community. \23\ In application to the Native Hawaiian Community, this2842policy recognizes that the United States (1) respects and furthers its2843special political and trust relationship with the Native Hawaiian2844Community; (2) must continue to work with the Native Hawaiian Community2845on a government-to-sovereign basis to address concerns related to self-2846governance, Native Hawaiian trust resources, and other Native Hawaiian2847rights; and (3) recognizes the right of the Native Hawaiian Community2848to self-government and supports Native Hawaiian sovereignty and self-2849determination. \24\2850---------------------------------------------------------------------------2851    \23\ Executive Order 13175, Consultation and Coordination with2852Indian Tribal Governments, Nov. 6, 2000.2853    \24\ ``Requirement to Consult with the Native Hawaiian Community''2854U.S. Department of the Interior Office of Native Hawaiian Relations,2855https://www.doi.gov/hawaiian/requirement-consult-native-hawaiian-2856community.2857---------------------------------------------------------------------------2858    Although the Native Hawaiian Community has not yet reorganized a2859central government, Congress' thoughtful inclusion of Native Hawaiians2860in legislation like NAGPRA and NHPA demonstrates that Native Hawaiians2861can be effectively included in the consultation process. However,2862Native Hawaiians are still largely omitted from consultation policies2863and processes across many federal agencies. While it is important for2864all agencies to develop consultation policies, we want to highlight the2865importance of meaningful dialogue with the Department of Defense.2866    The U.S. military is a prominent part of Hawaiian history and daily2867life. Approximately 46,500 acres of land across the State of Hawai`i is2868being used by the U.S. military, including Army, Navy, and Air Force2869bases and installations, with the largest being the 23,000 acres of2870Pohakuloa Training Area on Hawai`i Island. Numerous events have made2871the Native Hawaiian Community dubious of the U.S. military's role as2872caretakers and stewards of the land they occupy. In recent memory, the28732004 Kaho`olawe UXO Clearance Project left 25 percent of the island2874with unexploded ordinances and unescorted access to these areas remains2875unsafe; the U.S. Navy Red Hill Bulk Fuel Tanks stored up to 250 million2876gallons of fuel and documented multiple leaks in O`ahu's major aquifer;2877and U.S. Space Force announced an estimated 700 gallons of diesel fuel2878spilled at the summit of Haleakala. Multiple military land leases will2879be expiring this decade, providing the opportunity to renegotiate and2880improve the relationship between the Native Hawaiian Community and the2881U.S. Military. Given the significant historical and ongoing presence of2882military operations and activities in Hawai`i, we urge this Committee2883to support meaningful consultation between the Native Hawaiian2884Community and the U.S. military for any proposed undertakings that2885would impact the land or the people. This includes but is not limited2886to further study and remediation, oversight authority to ensure2887accountability and consultation, and increased funding to support2888clean-up efforts.2889    Finally, we would like to emphasize the importance of broad2890inclusion for the Native Hawaiian Community. Native Hawaiian migration2891to the continental United States has been happening for over two2892hundred years. Some Native Hawaiians were documented in the Pacific2893Northwest as early as 1787. \25\ Another group of Native Hawaiians2894settled in a community near Salt Lake City in the 1880s called Iosepa.2895\26\ The federal trust responsibility extends throughout the country.2896Given the increasing Native Hawaiian population throughout the United2897States, it is important that neither consultation policies nor2898definitions of Native Hawaiian Community are geographically bound to2899Hawai`i. We urge the Committee to support consultation policies2900inclusive of all Native Hawaiians.2901---------------------------------------------------------------------------2902    \25\ Jean Barman and Bruce McIntyre Watson, Leaving Paradise:2903Indigenous Hawaiians in the Pacific Northwest, 1787-1898 (December29042021).2905    \26\ Benjamin C. Pykles, ``Iosepa: Utah's Pacific Islander2906Pioneers'' Utah Historical Society. https://history.utah.gov/iosepa-2907utahs-pacific-islander-pioneers/.2908---------------------------------------------------------------------------2909    The Council for Native Hawaiian Advancement appreciates the2910opportunity to present priorities for the Native Hawaiian Community for2911the 119th Congress to the Senate Committee on Indian Affairs. We look2912forward to working with the Committee and its members during this2913session to advance the interests of the Native peoples in accordance2914with the federal trust responsibility.29152916    The Chairman. Mahalo, Mr. Lewis, thank you. And thank you2917all for your comments this afternoon.2918    We will now turn to questions from the respective members2919of the Committee. You have all reminded us of the trust2920responsibility that the Federal Government owes to our Native2921peoples. Regardless of where you live, that trust2922responsibility is something that we hold. And it is with regard2923to economic opportunity, education, health care, housing, as we2924have heard here today.2925    So when we think about the priorities going into this new2926Congress and areas that we can focus, I think you have given us2927a lot to consider.2928    I want to start my questions here this afternoon directed2929to you, Chief Bill, on the health aspects of this2930responsibility. You have mentioned in your comments the2931alarmingly high maternal mortality rates that we see for2932indigenous women. I find the statistics just really shocking.2933Pregnancy-related deaths at a rate more than three times that2934of white women, American Indian and Alaska Native infants born2935prematurely, underweight, twice as likely to die before the age2936of one.2937    We know that some of these statistics are related to access2938to health care and to socio-economic challenges. But you2939suggested in your comments that there are some recommendations2940that have been outlined in a couple of different reports, one2941of which is the Native Children's Commission. This Committee is2942going to be working to build that out.2943    Can you expand a little bit more on any specific2944recommendations that you would like to see the Committee2945address when it comes to maternal mortality and infant health?2946    Mr. Smith. Thank you for the question. I have five of them2947here, it says protect tribal sovereignty and self-2948determination, emphasize the importance of tribal nation's2949right to self-govern as a function of our health equity. We2950know how to take care of our own. We proved that in Alaska with2951COVID, we took care of the whole village instead of just taking2952care of specific people.2953    Invest in equity resources and funding, advocate for2954significant investment in tribal communities to improve2955outcomes for the children and prenatal to age three. The other2956part of that program was address trauma and strengthen2957connections to culture. Focus on the healing from trauma and2958building resiliency through culture connections.2959    As you know, there is all kinds of trauma starting with the2960boarding schools and even in isolated areas, our lower villages2961over there. It is far away from all kinds of supermarkets,2962playgrounds, and everything else that is needed to make sure2963that the kids can have a place to grow up after they do turn2964three.2965    So, enhance access to quality health services, ensure that2966Alaska Native and American Indian families have access to2967competent, high quality health services. I put this to, when I2968was born in Alaska and went to the Indian Health Service's2969hospital on Fourth Avenue, Fourth and Third, I was scared to2970death to go there.2971    This new hospital we have in Anchorage, the Medical Center,2972welcomes you and everything else. But it was like a death2973sentence to go into that other one, and for the dental work, as2974you were growing up as a kid. So I can just imagine, I never2975recognized the one through three, because I don't remember that2976part. But Mom does.2977    [Laughter.]2978    Mr. Smith. Support also an intergenerational approach,2979promote policies and consider the [indiscernible] and2980intergenerational needs from Alaska Natives and American2981Indians.2982    All these recommendations aim to create a path forward2983toward a healthy outcome for American Indians and Alaska Native2984infants, the toddlers, and for their mothers.2985    The Chairman. I think what we want to do here on the2986Committee is look at the various reports that are out there. It2987is one thing to task a commission and have them put together a2988great report. It is another thing to actually have us implement2989on that. I think we want to do that.2990    I want to direct a couple of questions to you, Mr. Butler,2991with NAFOA. I appreciate that you have given us some concrete2992suggestions here to look at from the financing perspective, New2993Market Tax Credits, tribal low income tax credits, focusing on2994the Indian Loan Guarantee Program, some real specifics here.2995    You have also mentioned priority of making Treasury's2996Office of Tribal and Native Affairs permanent and continuing2997the Tribal Treasury Advisory Committee. That is good to hear,2998because oftentimes, we don't hear good reports coming out of2999some of these tribal liaisons that we have established within3000agencies. What you are telling me is that this is one where we3001are seeing good outcomes and it is working and it needs to be3002continued. Is that a fair summation?3003    Mr. Butler. Absolutely. Absolutely, Chair. And selfishly,3004one of the many hats I wear is actually as a member of the3005Treasury Tribal Advisory Committee as well. So I saw first-hand3006in a very short period of time how the impact of having tribal3007leaders engaging directly with leadership in a specific3008department, in this case Treasury, leads to great results.3009    The rulings that were put out on GWE and all these wholly3010tribally chartered corporations is monumental. For the tribally3011chartered corporations, that ruling was 30 years in the making.3012Having the Office of Native Affairs there as well as the TTAC3013there allowed us to progress that, and constantly be in the ear3014of Treasury and IRS, working hand in hand collaboratively to3015solve those issues that tribes have been waiting on for3016decades, quite frankly.3017    So it is a great example of success in the Department of3018Treasury, and one that should be replicated in other3019departments as well.3020    The Chairman. Good. I appreciate that.3021    Let's go to the Vice Chair.3022    Senator Schatz. Thank you, Chair, thank all of you for your3023testimony.3024    Mr. Lewis, thank you for your work. Can you help me to3025understand, help the Committee to understand what are the3026barriers to success? Any needed changes or improved3027flexibilities that could help the Council for Native Hawaiian3028Advancement to access more Federal dollars?3029    Mr. Lewis. Aloha, Senator, and thanks for the question.3030    I think the immediate challenge is the uncertainty that3031currently exists. We have active grants and awards from the3032Federal Government, some which we can't even draw down on. And3033what that does is it creates a lot of instability in our3034organization, not knowing the future of some of the programs3035that are actively implementing.3036    So that is a current challenge for us, there is a lot of3037uncertainty. Also our ability to plan going forward and how we3038can address some of the long-term needs of our people that we3039have been working toward for a while. I would say we of course3040are looking at how we can diversify ourselves. But the Federal3041Government has been an important part in how we develop3042programs and work collaboratively with the government to3043support the needs of our people.3044    Senator Schatz. Thank you.3045    Just one thought for everybody watching. I understand the3046principle here that when you are dealing with Native peoples3047you are dealing in treaty and trust and statutory3048responsibilities, and that you are not dealing with particular3049ethnic groups. So this sort of dragnet of calling everything3050DEI should not apply. I get that. I agree with that.3051    But we need a little solidarity too, all of us together, to3052say that if what someone is talking about when they say DEI is3053the consultant coming in and showing a PowerPoint and dividing3054up the workplace by race and developing quotas and refereeing3055the kinds of words that people are trying to use, that is one3056thing.3057    But understand that when they say DEI, they are rolling3058back basic protections for women, for Native people, for Black3059people, for Asians, for Latinos, for immigrants. So when they3060go, when these kids, frankly, go into agencies and literally3061CTRL-F to find words like ``gender'' or ``climate'' or3062``equity'' or ``inclusion,'' they are sweeping up recruitment3063for the Navy, they are sweeping up recruitment for FBI3064officers. They are disallowing NIH research into pregnant3065women.3066    So I understand the need, if you are in charge of an3067organization, if you represent a tribal community, the need to3068just survive this moment. But we need to understand, what is3069happening right now is unlawful. And it is not our job in a3070democracy to petition the king for mercy. It is our job in a3071democracy to stand up and say, this is impermissible under the3072law, not, I know this is impermissible, but would you please3073make an exception for me? That was not a question.3074    [Applause.]3075    Senator Schatz. Mr. Bird, tell me about the impact that the3076executive order on school choice for BIE and tribally3077controlled BIE schools is impacting the work that you do and3078the organization that you oversee?3079    Mr. Bird. Sure. School choice, tribal nations believe in3080school choice and local control of their schools. However,3081tribally controlled schools are our choice, and we feel that3082school students learn best when the tribe has control of those3083schools, and are determining what is being taught. Our3084curriculum includes tribal values from the community. They3085include curriculum that is related to that particular tribe as3086well as Natives in other tribal communities.3087    We are concerned about the possibility that a school choice3088model that relates to schools being under BIA control, that3089would take away funding from BIE controlled schools. So any3090school choice model for Native students must be made with3091tribal nations at the table helping to assist in making those3092determinations.3093    I know looking at my father's tribe, the Sisseton Wahpeton3094Oyate, they have a tribally controlled school, Tiospa Zina. It3095is located in an area very close to the heart of the tribe, it3096is close to senior centers, close to tribal administration,3097close to the pow-wow grounds. So it has all those components3098that make it more of a success, because it is so centered in3099that community, and it has the parents' involvement, it has the3100seniors' involvement, it has language providers in that school.3101    So the curriculum is very much focused on the needs of the3102students in that school system. They wouldn't have that same3103opportunity at the public high school in Sisseton, where there3104are no or very limited Indian teachers in that community, in3105that school system. It wouldn't have the same types of3106encouragement or pride as being an Indian student in that3107community.3108    So the school choice being a tribally controlled school is3109so important because of what it brings to the student and to3110the tribal member and the involvement of those within the3111community.3112    Senator Schatz. Thank you.3113    The Chairman. Senator Smith?3114    Senator Smith. Thank you so much, Chair Murkowski, and3115thanks to all of you for being here.3116    I want to just say that Vice Chair Schatz, I appreciate3117your comments. I am thinking about how earlier today I was3118addressing an issue with the Catholic University in Minneapolis3119that had a grant to train special education teachers frozen,3120because it was all caught up in this DEI nonsense.3121    So that is going to hurt the ability of my State to respond3122to the deep shortage of special education teachers. It is going3123to hurt kids, it is going to hurt Black kids, it is going to3124hurt Brown kids, it is going to hurt White kids. It hurts3125everybody. So I appreciate your comments.3126    I want to touch on first something that I know is really3127important and certainly in the tribal nations in Minnesota and3128I believe around the Country, which is the impact of this3129devastating opioid and fentanyl crisis. Certainly, it is an3130issue all over the Country.3131    But I think it has a particularly devastating impact on3132many tribal nations, because of the ways in which tribal3133members are targeted for these crimes. I see this as both a3134public health crisis and also as a public safety crisis.3135    President Macarro, I am going to ask you first about this.3136Last year, Senator Daines and I partnered to introduce a bill3137called the PROTECT Act, which would basically expand the3138special tribal criminal jurisdiction which has been so3139successful with issues around trafficking, expand that special3140criminal jurisdiction to include drug crimes and gun crimes3141that are committed as part of drug crimes. This would get at3142the challenge that so many tribes have in addressing when non-3143Native people come onto tribal land and commit drug and gun3144crimes.3145    President Maccaro, would you talk about this a bit and give3146me your perspective on whether something like this would3147address some of those jurisdictional challenges you were3148talking about in your testimony?3149    Mr. Macarro. Thank you for the question. I appreciate the3150softball. Yes, it is something, tribes need jurisdiction back.3151The ability to not only arrest, detain, but to prosecute those3152who commit crimes on our reservation lands and our reservation3153communities is going to be important going forward, to be able3154not only to stem the flow of drugs but to create safe3155communities. The status quo right now is really unacceptable is3156a circumstance where drug dealers, they know what the laws are,3157they know they can't be prosecuted, they know they will get3158away with the crime.3159    Senator Smith. It creates a revolving door.3160    Mr. Macarro. It is a revolving door. There is a3161circumstance where, if they will come on, maybe the tribe is3162lucky enough to have a police force that they will get arrested3163and they might even be detained for 72 hours. But then they3164have to be released at 72 hours and one minute. They take them3165to the county line and if the tribal police are lucky, there3166will be county police or county sheriffs to accept the3167criminals, but maybe not, and they just go away and come back3168within hours sometimes, sometimes within a day, and do it all3169over again. And it doesn't end.3170    It is a scourge. The solution is ultimately the full fix3171for Oliphant. But I know we are taking baby steps, incremental3172steps toward that, getting to that goal. But the sooner we get3173there, I think the better things will be in the long term.3174    Let me add this, though. If you were to wave a wand right3175now and Congress would, in a bipartisan fashion, create that3176kind of a jurisdictional fix, the condition of not having3177enough funding, creating a fix without the funding is also not3178going to help.3179    Senator Smith. Right.3180    Mr. Macarro. So both parts need to happen.3181    Senator Smith. I appreciate that. I think that is a really3182great point. It is a tool that if you don't have the funding to3183use the tool, then the tool is not going to be that valuable.3184    As I said, and I think all of us do see, this is both a3185public health crisis as well as a public safety crisis. So3186Chair Smith, I want to ask you, in your testimony, you talked3187about the Special Diabetes Program as a model for bringing both3188funding and autonomy to tribes so that tribal knowledge and3189medicine and healing can be brought together to solve issues3190around diabetes. The same model, I believe, could also be used3191really effectively to address behavioral health issues.3192    I am wondering if you could comment on that. I am really3193grateful to NIHB for your assistance in moving my Native3194Behavioral Health Access Improvement Act, that is a mouthful,3195but what it would do is take that learning from the Special3196Diabetes Program and apply it to behavioral health.3197    Mr. Smith. Thank you for that question. My answer would be3198to you, education of our health workers so we can help the3199person that is stuck on these drugs to get them off and get3200them in a safe place. But that is not going to solve it until3201they do get tougher on the crimes and put the perpetrators3202away. You might not like this, but I think they should take3203their own medicine.3204    I know when I was growing up in Alaska, in the old days, we3205had what you called blue chip. When you wanted to blue chip3206somebody that was being not correct in your community, you sent3207them to Seattle, which means you put them back on the boat. And3208that just puts the problems in Seattle.3209    The problem is the courts just let them get away with it.3210We need to stop that.3211    But on the health part of that, and that is the part that3212the National Indian Health Board can help with, with education3213and how to recover from a fentanyl overdose. Because a lot of3214them don't. Once the brain gets scrambled, sometimes you just3215can't unscramble it. Preventive maintenance, education,3216everything else is what the health part of it is.3217    The other part of it is like working with the National3218Congress of American Indians where we can stress to be tougher3219on the criminals, quit giving them the revolving door, quit3220letting them in and out, and knowing that they can get away3221with it. Even in my State of Alaska, they are really happy they3222found a bunch of fentanyl coming into Alaska. How much didn't3223they find? How much came in that they didn't? Because it is3224coming in every which way. We just need to figure out how to3225stop it, enforcement.3226    The education part is trying to educate the young ones to3227just stay away and the ones that are hooked how to get off. One3228thing is teaching grandmas and grandpas and parents how to save3229that person with Narcan or whatever it takes.3230    Senator Smith. Thank you. I know I am way over time. Thank3231you very much, Chair Murkowski. Thank you so much to all of you3232for your testimony.3233    The Chairman. Thank you, Senator Smith.32343235           STATEMENT OF HON. CATHERINE CORTEZ MASTO,3236                    U.S. SENATOR FROM NEVADA32373238    Senator Cortez Masto. Thank you, Madam Chair. And thank you3239all for being here and for the continued work on all of these3240issues that we are constantly trying to address here. It almost3241feels like Groundhog Day, because we are back saying the same3242things.3243    But let me just say this. Because of, and I hope you take3244this away, because of your work and advocacy, there is3245legislation and there is bipartisan legislation. This is going3246to be a priority for us in this Congress to get it passed, as3247you all know. And we are going to continue to need your3248advocacy.3249    So I appreciate your being here, because there are many of3250us working together to get it done.3251    And let me start with this, the BADGES Act. My colleague,3252Senator Hoeven, and I have reintroduced that again. It is so3253important for the very reasons, President Macarro, and everyone3254else that I am hearing from about the law enforcement piece and3255the underfunding of law enforcement in Indian Country.3256    I also know that for our BIA officers in Indian Country, it3257is hard to not only recruit them but retain them. As part of3258the challenge that we have in the BADGES Act, we will work to3259address that. So it is good to see you again, President3260Macarro, and thank you for your work on the BADGES Act.3261    I do want to touch on one thing, because we always talk3262about BIA officers, we talk about law enforcement. We forget3263tribal courts. Tribal courts are just as important. And there3264are challenges in our tribal courts right now. Let me just give3265you an example, and this is what I hear in my State.3266    Tribal courts and communities are often denied access to3267funding and law enforcement tools that their non-tribal3268counterparts regularly use. For example, I have introduced the3269Tribal Access to Electronic Evidence Act. This would give our3270tribal courts the same access as their non-tribal counterparts3271to electronic evidence for criminal investigations.3272    It sounds so simple, but it is important for us to make3273sure that our tribal courts have access to all the information3274that our non-tribal courts do if we are going to hold these3275predators and people in our communities accountable.3276    So President Macarro, let me ask you this. Can you talk a3277little bit about the importance of tribal courts in Indian3278Country? But also as you talk about it, can you address the3279lack of resources for tribal courts and the impact on public3280safety that provides if we don't have resources for tribal3281courts?3282    Mr. Macarro. I wish we had enough time to go into depth on3283that question. Can you focus it just a bit? It is broad-3284ranging.3285    Senator Cortez Masto. Let me ask you this. Because at the3286end of the day, for our tribal courts, there are a lot of3287challenges there. But if we were to forget the jurisdictional3288issues, because we need a challenge, we need to address those3289jurisdictional issues, but if we were to give tribal courts3290access to the same information, electronic information, access3291to maybe national Federal data bases that non-tribal courts3292have, how would that improve public safety?3293    Mr. Macarro. It would improve it tremendously. There isn't3294necessarily a problem or an issue with tribal courts having3295capacity or competence or things like that. We know that from3296the daily work that tribal courts do throughout Indian Country.3297    There are problems, I think, with outside courts and3298entities having, I think the term is comity, accepting as valid3299the work that tribal courts do. That attitude, I know, is still3300there. I know it is still there in Indian child welfare work3301and also other subject matter arenas.3302    It feels like that would be helpful in moving the ball3303considerably. In the way that, with law enforcement, having3304access to data bases, for tribal law enforcement agencies to3305have access to NCIC for officers in the field and other data3306bases like that, so that the quality of the work going on, for3307the people doing the actual work, meets those standards, and3308there is no question about it.3309    Senator Cortez Masto. I appreciate that. Let me just3310highlight this, because this is just one piece of it, right?3311You are always having to come to us to try and figure out even3312what crimes tribal courts can go after and hold people3313accountable for. This is crazy in the sense that if we are3314going to recognize that sovereignty and give tribal courts the3315authority that they need to go after and hold individuals3316accountable, we shouldn't hamstring them. It is not just a lack3317of resources; it is actually some areas where you need access3318to information that you are not getting that other courts are3319getting that are non-tribal.3320    Mr. Macarro. Absolutely. Can I just add one more element to3321this? One of the reasons why I said this goes a lot deeper, I3322think there is a missing infrastructure piece to the question3323you are asking. The infrastructure that is needed within the3324Department of Justice, there is no bona fide tribal desk, there3325is no place of a clearinghouse of all tribal issues and there3326should be and there needs to be.3327    This is not to discount the tremendous work that those who3328are doing Native American work in the Department of Justice are3329doing. But there aren't enough, for instance, there aren't3330enough attorneys to handle tribal work within the Department of3331Justice. So I think there needs to be ultimately some3332restructuring so there can be a focus on this. Then all things3333tribal, all things Indian Country could flow through that desk.3334For a long time, it just has seemed to be more ad hoc than3335truly structural and grounded. In all things, tribal3336sovereignty.3337    Senator Cortez Masto. Thank you. I know I am over my time.3338    I want to thank you all again for your comments. President3339Butler, thank you for highlighting the Tax Parity Act, the3340importance of it. That act and that legislation, again, was3341driven by all of you. What I was hearing, what we were hearing,3342the chairwoman is working with me on that as well. She3343understands the issues that are important. I think this is3344another opportunity for us to move the ball forward here and3345get something done.3346    Thank you again for all of your advocacy.3347    The Chairman. Thank you, Senator Cortez Masto.3348    A lot of good discussion here about everything from housing3349to how we can move out on economic development. Obviously,3350education, health care, drugs, public safety, all very key.3351    When we think about tribal self-determination and what that3352really means, there are so many opportunities for us,3353particularly within 638, with compacting. There is a big3354efficiency effort going on by some folks outside this building,3355you may have noticed it. I can't think of a greater3356demonstration of empowerment of our tribes, of the people on3357the ground, than how we are able to build things out or3358facilitate efforts through compacting; 638 holds such promise3359for us.3360    We have a measure that I have talked a lot about when it3361comes to forest management. When you think about those who are3362closest to the land, those who we have a real appreciation of3363understanding when you have low rains and low snow pack, you3364are going to have a greater propensity for fire.3365    How do we handle this, how do we address it? Those who are3366literally on the ground who are the stewards of these areas3367know better than anyone else. So how can we really work to do3368more in this area is something that I am going to challenge us3369as a Committee to work on.3370    Mr. Bird, I know that USDA soliciting feedback from tribes3371right now regarding the child nutrition programs, the tribal3372pilot projects. I understand that there either was or is a3373listening session later today at the NIEA conference to allow3374tribe and tribal organizations to administer nutrition3375programs, whether it is the school lunch program, the school3376breakfast program, summer food services, the child and adult3377care food program.3378    Can you share with me how that is coming? Have we3379identified barriers to standing up some of these programs? I3380think about specifically like the summer food programs, where3381you don't have the kids in the school necessarily, and they are3382just going to disperse over.3383    But how we can implement in a more efficient, a more3384effective way that gives the value, if you will, to the3385children in terms of nutritious opportunities for food during3386the summer or during the school year, we can do more on this.3387Have we identified the barriers? What do we need to do?3388    Mr. Bird. It is not so much identifying the barriers, well,3389it is about giving the tribes control of the whole institution.3390They already have control of the school itself, but not the3391lunch component that is the mid-day of the students' existence3392there at school.3393    I was talking to a tribal member back in Sisseton, and he3394said that one of the things they have is a bison herd. Their3395goal is, or they are planning to process the meat. So they have3396a meat processing plant that they have implemented, that they3397have purchased. Their goal is to purchase the meat from their3398bison herd through the meat processing and then use that to3399feed the kids at their school.3400    It becomes basically a whole tribal involvement in the3401school as well as with the students. They are going back to3402eating traditional foods. That is what control of the lunch3403program will give those tribes the ability to do, so they can3404incorporate more traditional foods, whether it is bison or3405blueberries or other things that are grown in the community.3406Basically, the whole process of taking back some of the3407traditional ways of the tribal community and then teaching that3408to the kids in their student lives and their daily existence.3409    I think also with the school lunch program during the3410summer, these kids often go without meals. The daily meals that3411they would get during school time, they miss those during the3412summer. I have been back to Sisseton, I know what my cousins3413eat. They rely on snacks and non-nutritious foods, potato chips3414and other things that they get.3415    So having a food program that actually puts together a food3416bag or a food lunch program for the kids, for the kids to come3417to an after school program or summer school program where they3418actually get food that is a balanced meal, nutritious meal for3419those kids.3420    So it is a mix of things where during the school year, they3421are actually fed more traditional foods. But during the summer,3422when they can do bag lunches for the kids to take or come to a3423summer program, they can get those foods as well, I think are3424the benefits to having tribal involvement with the USDA program3425that provides for that community.3426    The Chairman. It all comes back to health. We can provide3427our kids with nutritious food, and again, food that they will3428eat, whether it is bison or in Alaska it might be salmon. It is3429important to make sure that we have those healthy food options3430there.3431    I am actually going to be meeting in just about an hour3432here with the nominee to be Secretary of Agriculture. I want to3433talk to her about programs like FDIPR and what more we can be3434doing again to making sure that we are getting some of our3435traditional foods into these menus again. So they are healthy3436and the kids will eat them.3437    I am going to give everybody a little bit of a homework3438assignment, only because I can. And it is not just for those of3439you who are part of our panel today. Mr. Lewis, we haven't3440forgotten you there in Hawaii.3441    I mentioned the Alyce Spotted Bear and Walter Soboleff3442Commission on the Native Children. Chief Smith mentioned it as3443well. It is something that, again, as a committee we are going3444to be looking at this report. The report has identified some of3445the systematic challenges that face our Native children. What3446we want to do is now take some of the recommendations that are3447in the report. I would like you to take a look at it. It is not3448that long, it is 80.3449    [Laughter.]3450    The Chairman. There is a lot of index to it.3451    [Laughter.]3452    The Chairman. There is a summary. But I want you to go3453beyond the summary. I would like you to take a look at that.3454Then within your portfolios, whether it is education or finance3455or health care or housing or public safety, kind of provide us,3456if you will, some of the recommendations that you would like to3457see implemented from this to again, it is focusing on our3458Native children, but when our children do well, we all do well.3459    So I welcome your input as we develop this broader package3460of initiatives focused on healthy Native children. For those3461who are part of our listening audience, don't think that,3462again, we only want to hear from those who we have invited to3463testify today.3464    There has been much discussion about the impact of the3465recent actions as the administration has been stood up. The3466freeze on many of these programs, again, we have tried to make3467sure that it is clear that it should not impact our Federal,3468our Indian and our tribal programs. But in fact we know that3469there are all holdups, there are areas that we are seeing a3470spillover that should not be happening.3471    So we need to hear from you on that. I hear what my Vice3472Chair says. I take it to heart, because I too believe that you3473don't have to petition the king. This is our responsibility3474here in the Legislative Branch to make sure that we are3475representing those who we serve. When something is not within3476process, it is not within the rule or the law, we need to be3477there to speak for you as well.3478    So the more that we can receive from you in terms of, this3479portal is not opening, this funding source is not coming3480through, please let us know. We have an in-box on our website3481that welcomes these very specific initiatives. So let us try to3482make this a little bit easier. I know it has been hard.3483    The last point that I will make on this is that even though3484we may be able to release funds that have been delayed or3485halted, and we get those moving, we are seeing very clearly3486what is happening with the push for a reduction in employees3487throughout Federal service. Those are your programs. Those are3488programs that impact you.3489    So we can help you get the money released. But if there is3490nobody then to help execute these through the programs because3491they were either asked to leave or just decided that this was3492not the environment for them, then we are no further ahead.3493    So know that I take very, very carefully this as an issue,3494that it is not just about the funding for the programs. It is3495also about the ability to execute under the programs. We need3496to have these people in place. And for far too long within our3497tribal programs, we have had workforce shortages. We see it3498within our schools, we see it within health care, we see it in3499all aspects. Certainly public safety, we hear over and over and3500over again.3501    So this is yet another challenge for us. Know that we take3502this up. We are here to listen, to learn, and to act.3503    So thank you for working with us, and with this Committee.3504    With that, I thank everyone for your time this afternoon.3505The Committee stands adjourned.3506    [Whereupon, at 3:40 p.m., the hearing was adjourned.]35073508                            A P P E N D I X35093510 Prepared Statement of Francys Crevier, CEO, National Council of Urban3511                         Indian Health (NCUIH)3512    My name is Francys Crevier, I am Algonquin and the Chief Executive3513Officer of the National Council of Urban Indian Health (NCUIH), a3514national representative advocating for the 41 Urban Indian3515Organizations (UIOs) contracting with the Indian Health Service (IHS)3516under the Indian Health Care Improvement Act (IHCIA) and the American3517Indians and Alaska Native patients they serve. On behalf of NCUIH and3518these 41 UIOs, I would like to thank Chairman Murkowski, Vice Chairman3519Schatz, and Members of the Committee for your leadership to improve3520health outcomes for urban Indians and for the opportunity to provide3521testimony. We respectfully request the following:35223523   Protect Funding for the Indian Health Service and fund Urban3524        Indian Health at $100 million for FY2635253526   Maintain Advance Appropriations for the Indian Health3527        Service, until mandatory funding is achieved, and protect IHS3528        from sequestration.35293530   Ensure Federal Policies Uphold Trust Obligations to American3531        Indian and Alaska Native Communities.35323533   Reauthorize the Special Diabetes Program for Indians at $2503534        million.35353536   Appropriate $80 million for Behavioral Health and Substance3537        Use Disorder Resources for Native Americans.35383539   Protect Medicaid and Authorize Permanent 100 percent Federal3540        Medical Assistance Percentage for services provided at UIOs.35413542   Allow U.S. Public Health Service Commissioned Officers3543        detailed directly to UIOs35443545   Fund the Initiative for Improving Native American Cancer3546        Outcomes at $10 million for FY26.35473548A Brief History on Urban Indian Organizations3549    As a preliminary issue, ``urban Indian'' refers to any American3550Indian or Alaska Native (AI/AN) person who is living in an urban area,3551either permanently or temporarily. UIOs were created by urban AI/AN3552people with the support of Tribes, starting in the 1950s in response to3553severe problems with health, education, employment, and housing. \1\3554Congress formally incorporated UIOs into the Indian Health System in35551976 with the passage of the Indian Health Care Improvement Act3556(IHCIA). Today, over 70 percent of AI/AN people live in urban areas.3557UIOs are an integral part of the Indian health system, comprised of the3558Indian Health Service, Tribes, and UIOs (collectively I/T/U), and3559provide essential healthcare services, including primary care,3560behavioral health, and social and community services, to patients from3561over 500 Tribes in 38 urban areas across the United States. UIOs also3562work closely with Tribal and law enforcement partners to address the3563Missing and Murdered Indigenous People's (MMIP) crisis.3564---------------------------------------------------------------------------3565    \1\ Relocation, National Council for Urban Indian Health, 2018.35662018_0519_Relocation.pdf3567---------------------------------------------------------------------------3568Request: Protect Funding for the Indian Health Service and fund Urban3569        Indian Health at $100 million for FY263570    The federal government owes a trust obligation to provide3571healthcare services to AI/AN people no matter where they live. In fact3572it is the national policy of the United States ``to ensure the highest3573possible health status for Indians and urban Indians and to provide all3574resources necessary to effect that policy.'' \2\ This requires that3575funding for Indian health be significantly increased if the federal3576government is to finally fulfill its trust responsibility. At a3577minimum, funding must be maintained and protected as budget-cutting3578measures are being considered.3579---------------------------------------------------------------------------3580    \2\ 25 U.S.C.  1601(1)3581---------------------------------------------------------------------------3582    Without an increase to the urban Indian health line item, UIOs will3583continue to be forced to operate on limited and inflexible budgets,3584that limit their ability to fully address the needs of their patients.3585A lack of federal funding is deeply impactful for UIOs who are on the3586front lines in working to provide for the health and well-being of3587American Indians and Alaska Natives living outside of Tribal3588jurisdictions. While UIOs historically only receive 1 percent of the3589IHS budget, they have been excellent stewards of the funds allocated by3590Congress and are effective at ensuring that increases in appropriations3591correlate with improved care for their communities.3592    We thus request Congress honor its trust obligation by3593appropriating the maximum amount possible for IHS and appropriating at3594least $100 million for Urban Indian Health, which is in line with the3595House proposed amount for FY25. As the Tribal Budget Formulation3596Workgroup (TBFWG) report states, ``Only a significant increase to the3597Urban Indian Health line item will allow UIOs to increase and expand3598services to address the needs of their American Indian and Alaska3599Native patients, support the hiring and retention of culturally3600competent staff, and open new facilities to address the growing demand3601for UIO services.'' Increased investments in Urban Indian Health will3602continue to result in the expansion of health care services, increased3603jobs, and improvement of the overall health in urban American Indian3604and Alaska Native communities.3605Request: Maintain Advance Appropriations for the Indian Health Service3606        until Mandatory Funding is Enacted and Protect Against3607        Sequestration3608    The inclusion of advance appropriations in the FY24 Omnibus and3609maintaining advance appropriations for FY25, is a crucial step towards3610ensuring long-term, stable funding for IHS. Previously, the I/T/U3611system was the only major federal health care provider funded through3612annual appropriations. It is imperative that Congress maintain advance3613appropriations for the IHS in the final spending bill for FY26 and3614beyond. It is also imperative to protect IHS from sequestration.3615    Advance appropriations improve accountability and increase staff3616recruitment and retention at IHS. When IHS distributes their funding on3617time, our UIOs can consistently pay their doctors and providers.3618    It is also imperative to shield and protect the IHS from cuts or3619funding freezes that force Indian health-providers to make difficult3620decisions about the scope of healthcare services they can offer to3621American Indian and Alaska Native patients. For example, the3622sequestration of $220 million in IHS' budget authority for FY 20133623resulted in an estimated reduction of 3,000 inpatient admissions and3624804,000 outpatient visits for American Indian and Alaska Native3625patients. \3\ A recent survey from the National Council of Urban Indian3626Health, over half of surveyed UIOs report they would be unable to3627sustain operations beyond six months without federal funding. \4\ UIOs3628provide essential healthcare services to their patients, including3629primary care, urgent care, and behavioral health services, and are on3630the front lines in working to provide for the health and well-being of3631American Indian and Alaska Native people living in urban areas, many of3632whom lack access to the health care services that it is the federal3633government's trust responsibility to provide. Any reduction or pause in3634funding would reduce UIOs' ability to provide these essential services3635to their patients and communities, delaying care and reducing UIO3636capacity to take on additional patients.3637---------------------------------------------------------------------------3638    \3\ Contract Support Costs and Sequestration: Fiscal Crisis in3639Indian Country: Hearings before the Senate Committee on Indian3640Affairs.(2013) (Testimony of The Honorable Yvette Roubideaux)3641    \4\ Impact of Federal Funding Pauses on Urban Indian Organizations.3642National Council of Urban Indian Health. 2025. https://ncuih.org/wp-3643content/uploads/Fed-Funding-Pause_NCUIH-D562_F3.pdf3644---------------------------------------------------------------------------3645    Therefore, we request that you exempt IHS from sequestration in an3646amendment to Sec. 255 of the Balanced Budget and Emergency Deficit3647Control Act. We also request that IHS funding be protected from3648impoundment and other budget-cutting measures as is required by the3649trust responsibility.3650    Finally, while advance appropriations are a step in the right3651direction to avoid disruptions during government shutdowns and CRs,3652mandatory funding is the only way to assure fairness in funding and3653fulfillment of the trust responsibility. Until authorizers act to move3654IHS to mandatory funding, we request that Congress continue to provide3655advance appropriations to the Indian health system to improve certainty3656and stability.3657Request: Ensure Federal Policies Uphold Trust Obligations to American3658        Indian and Alaska Native Communities3659    We acknowledge and appreciate the recent steps taken by the3660Departments of Health and Human Services (HHS), Interior, and the3661Office of Personnel Management (OPM) to clarify that actions should not3662interfere with the United States' commitment to fulfilling its trust3663obligations to American Indian and Alaska Native communities. However,3664we remain concerned that potential future actions may fail to3665adequately consider this unique relationship.3666    Therefore, we respectfully request that the Congress take necessary3667steps to ensure these directives are implemented in a manner consistent3668with the unique political status of American Indian and Alaska Native3669people under U.S. law, as well as the federal government's legal3670obligation to uphold its trust responsibilities. Specifically, we3671request that Congress pass legislative text that explicitly exempts IHS3672from similar policies being applied across the federal government to3673safeguard the delivery of critical services to American Indian and3674Alaska Native people.3675Request: Appropriate $80 Million for Behavioral Health and Substance3676        Use Disorder Resources for Native Americans3677    In response to these chronic health disparities, Congress3678authorized $80 million to be appropriated for the Behavioral Health and3679Substance Use Disorder Resources for Native Americans Program for3680fiscal years 2023 to 2027. Despite authorizing $80 million for the3681Program, Congress has failed to appropriate funds for this program.3682    We request that the authorized $80 million be appropriated to the3683Behavioral Health and Substance Use Disorder Resources for Native3684Americans Program for FY25 and each of the remaining authorized years.3685Until Congress appropriates funding for this program, critical3686healthcare programs and services cannot operate to their full3687capability, putting American Indian and Alaska Native lives at-risk.3688This is an essential step to ensure our communities have access to the3689care they need.3690Request: Reauthorize the Special Diabetes Program for Indians at $2503691        Million.3692    SDPI's integrated approach to diabetes healthcare and prevention3693programs in Indian country has become a resounding success and is one3694of the most successful public health programs ever implemented. SDPI3695has demonstrated success with a 50 percent reduction in diabetic eye3696disease rates, drops in diabetic kidney failure, and 50 percent decline3697in End State Renal Disease. \5\ Additionally, the reduction in end3698stage renal disease between 2006 and 2015 led to an estimated $439.53699million dollars in accumulated savings to the Medicare program, 403700percent of which, of $174 million, can be attributed to SDPI. \6\3701---------------------------------------------------------------------------3702    \5\ 2020 SDPI Report to Congress, Indian Health Service, 2020, 20203703SDPI Report to Congress (IHS.gov)3704    \6\ The Special Diabetes Program for Indians: Estimates of Medicare3705Savings, DHHS ASPE Issue Brief (May 10, 2019). Available at:3706SDPI_Paper_Final.pdf (HHS.gov)3707---------------------------------------------------------------------------3708    Currently 31 UIOs are in this program and are at the forefront of3709diabetes care. Facilities use these funds to offer a wide range of3710diabetes treatment and prevention services, including but not limited3711to exercise programs and physical activity, nutrition services,3712community gardens, culinary education, physical education, health and3713wellness fairs, group exercise activities, green spaces, and youth and3714elder-focused activities.3715    The incredibly successful Special Diabetes Program for Indians3716(SDPI) has repeatedly been reauthorized in Continuing Resolutions and3717is now set to expire on March 14, 2025. We request that the committee3718work with authorizers to permanently reauthorize SDPI at a minimum of3719$250 million with automatic annual funding increases tied to the rate3720of medical inflation, to continue the success of preventing diabetes-3721related illnesses for all of Indian Country.3722Request: Protect Medicaid and Authorize Permanent 100 percent Federal3723        Medical Assistance Percentage for services provided at UIOs.3724    The Medicaid program plays a vital role in providing essential3725healthcare services to American Indian and Alaska Native communities,3726serving as a critical lifeline for those who rely on it. In fact,3727Medicaid is the largest source of funding for Urban Indian3728Organizations (UIOs) outside of the Indian Health Service (IHS). In37292021 alone, UIOs received over $137 million in Medicaid reimbursements3730for services delivered to Medicaid beneficiaries, underscoring the3731program's significance in sustaining healthcare access for American3732Indian and Alaska Native populations.3733    NCUIH Board Vice President Angel Galvez recently emphasized the3734profound impact of Medicaid, stating, ``The services we provide are3735services [our patients] can't afford otherwise. . . What you're doing3736is saving someone's life.'' \7\ This sentiment highlights the life-3737saving role Medicaid plays in ensuring that vulnerable populations3738receive the care they need.3739---------------------------------------------------------------------------3740    \7\ Catie Edmonson, Medicaid Cuts Pose Budget Conundrum for Valadao3741and Republicans Nationwide, N.Y. Times, Feb. 21, 2025. https://3742www.nytimes.com/2025/02/21/us/politics/medicaid-republicans-3743budget.html?unlocked_article_code=1.zk4.bCdx.cjxuKW_H25do&smid=nytcore-3744ios-share&referringSource=articleShare3745---------------------------------------------------------------------------3746    Protecting and strengthening the Medicaid program is essential to3747maintaining support for UIOs and the 59 percent of American Indian and3748Alaska Native patients they serve who depend on Medicaid for their3749healthcare. Safeguarding this program ensures that UIOs can continue to3750deliver critical services, ultimately improving health outcomes and3751quality of life for American Indian and Alaska Native communities.3752    A top Medicaid legislative priority for UIOs is providing 1003753percent federal medical assistance percentage (FMAP) for services3754provided at UIOs. The FMAP refers to the percentage of Medicaid costs3755covered by the federal government and reimbursed to states. States have3756received 100 percent FMAP for services provided to IHS/Medicaid3757beneficiaries at Indian Health Service and Tribal facilities for3758decades, and UIOs have advocated for parity through legislation since37591999. Extending 100 percent FMAP to UIOs will require the federal3760government, not states, to bear the cost of Medicaid services provided3761to AI/AN people no matter which facet of the Indian health system they3762utilize, as is required by the trust responsibility.3763    Ultimately, permanent 100 percent FMAP will bring fairness to the3764I/T/U system and increase available financial resources to UIOs and3765support them in addressing critical health needs of urban American3766Indian and Alaska Native patients.3767Request: Allow U.S. Public Health Service Commissioned Officers3768        detailed directly to UIOs3769    Due to chronic underfunding, many UIOs continue to grapple with3770hiring and retaining skilled health service providers. Detailing Public3771Health Service Commissioned Officers (PHSCOs) to UIOs would help3772address workforce shortages and increase collaboration across the3773federal healthcare system.3774    Section 215 of the Public Health Service Act (PHSA) authorizes the3775Secretary of Health and Human Services (HHS) to detail officers to3776federal agencies and state health or mental health authorities. While3777UIOs have requested that officers be detailed to them to fill many3778roles related to the functions of the Public Health Service, subsection3779(c) of Section 215 (42 U.S.C. 215(c)) prevents UIOs from receiving3780detailed officers because they do not fall within the requirement that3781non-profits eligible for detailing be educational or research non-3782profits, or non-profits ``engaged in health activities for special3783studies and dissemination of information''.3784    With this being said, subsection (b) has been interpreted to allow3785HHS to detail an officer to a state health authority, which may then3786designate the UIO as the officer's duty station. The officer is3787authorized to perform work at a UIO that is related to the functions of3788the Service, including health care services and support functions. This3789process is completely dependent on the availability of a State or local3790health authority that is capable and willing to enter into such an3791arrangement. The process can be burdensome and time-consuming for all3792involved, leaving many State health authorities reluctant to3793participate.3794    Amending the law would provide IHS with the discretionary authority3795to detail officers directly to a UIO to perform work related to the3796functions of the Service. Therefore, we request full support for this3797proposal to allow UIOs to continue engaging in critical health care3798services for urban American Indian and Alaska Native communities.3799Request: Fund the Initiative for Improving Native American Cancer3800        Outcomes at $10 million for FY263801    Rising cancer rates has become an increasingly alarming issue in3802Indian Country. In fact, cancer is the leading cause of death among3803American Indian and Alaska Native women and the second leading cause of3804death among American Indian and Alaska Native men. \8\ The rising3805cancer rates has been described by some UIO leaders as the ``new3806diabetes'' in Indian Country, with one clinic alone diagnosing 15-203807cases a month.3808---------------------------------------------------------------------------3809    \8\ Elizabeth Arias, Kenneth Kochanek, & Farida B Ahmad,3810Provisional Life Expectancy Estimates for 2021, Vital Statistics Rapid3811Release, Report 23, August 2022. Vital Statistics Rapid Release, Number3812023 (August 2022) (CDC.gov)3813---------------------------------------------------------------------------3814    This is why specific funding for cancer in Indian Country is3815critical. The FY24 LHHS spending bill appropriated $6 million in few3816funding to address American Indian and Alaska Native cancer outcomes,3817by creating the Initiative for Improving Native American Cancer3818Outcomes, the Initiative will support efforts including research,3819education, outreach, and clinical access to improve the screening,3820diagnosis, and treatment of cancers among American Indian and Alaska3821Native people. The purpose of this Initiative is to ultimately improve3822screening, diagnosis and treatment of cancer for American Indian and3823Alaska Native patients.3824    This initiative will be critical to addressing cancer-related3825health disparities in Indian Country. We request that the Committee3826continue to support the appropriation of funds for the Initiative in3827FY26 and increase funding to $10 million.3828Conclusion3829    These requests are essential to ensure that urban Indians are3830appropriately cared for, in the present and in future generations. The3831federal government must continue to work towards its trust and treaty3832obligation to maintain and improve the health of American Indians and3833Alaska Natives. We urge Congress to take this obligation seriously and3834provide the I/T/U system with all the resources necessary to protect3835the lives of the entirety of the American Indian and Alaska Native3836population, regardless of where they live.3837                                 ______38383839   Prepared Statement of Aaron Hines, Chair, Northwest Portland Area3840                          Indian Health Board3841    Chair Murkowski, Vice Chair Schatz and members of the Senate3842Committee on Indian Affairs (Committee): My name is Aaron Hines and I3843serve as the Chief Executive Officer at the Yellowhawk Tribal Health3844Center, the Tribal clinic of the Confederated Tribes of the Umatilla3845Indian Reservation. Today, I provide my testimony in my role as Chair3846of the Northwest Portland Area Indian Health Board (NPAIHB or Board). I3847thank Committee for the opportunity to provide this testimony on Native3848Communities Priorities for the 119th Congress.3849    NPAIHB was established in 1972 and is a Tribal organization under3850the Indian Self-Determination and Education Assistance Act (ISDEAA),3851P.L. 93-638. NPAIHB provides support to the 43 Federally-recognized3852Indian Tribes in Idaho, Oregon, and Washington (Portland Area Tribes or3853Portland Area) on specific health care issues. The Board's mission is3854to eliminate health disparities and improve the quality of life for3855American Indians and Alaska Natives (AI/ANs) by supporting Portland3856Area Tribes in the delivery of high-quality health care. ``Wellness for3857the seventh generation'' is the Board's vision. This Committee is3858critical to making this a reality.3859    I write today to urge the Committee to consider the below-listed3860priorities for the 119th Congress, and to utilize the lens of Tribal3861Sovereignty, the Trust Responsibility and Treaty Obligations, and3862Tribal Self-Determination and Tribal Self-Governance in all its3863legislative activities in the 119th Congress.3864Respect for Tribal Sovereignty3865    The sovereignty of Tribal Nations predates the formation of the3866United States \1\ and the Constitution. This Committee has always3867acknowledged this history and has upheld Tribal sovereignty in3868legislation impacting Tribal Nations. As recognized by the Supreme3869Court, Tribal Nations are distinct political bodies with the inherent3870right to regulate their internal affairs according to their laws and3871customs, which includes addressing the health and well-being of our3872people. The Supreme Court upholds Indian-specific legislation,3873recognizing the political status of Tribes rather than a racial3874classification. \2\3875---------------------------------------------------------------------------3876    \1\ Worcester v. Georgia, 31 U.S. 515, 581 (1832).3877    \2\ Morton v. Mancari, 417 U.S. 535, 555 (1974); see also Moe v.3878Confederated Salish & Kootenai Tribes of Flathead Reservation, 425 U.S.3879463, 479-80 (1976); Washington v. Washington State Commercial Passenger3880Fishing Vessel Ass'n, 443 U.S. 658, 673 n.20 (1979); United States v.3881Antelope, 430 U.S. 641, 645-47 (1977); Am. Fed'n of Gov't Employees,3882AFL-CIO v. United States, 330 F.3d 513, 520-21 (D.C. Cir. 2003).3883---------------------------------------------------------------------------3884    Portland Area Tribes, and Tribal Nations across the Nation, rely on3885this Committee to ensure that Congress and the Administration protect3886Tribal interests and the government-to-government relationship.3887Honor Federal Trust and Treaty Obligations3888    The Trust responsibility has been defined in numerous Supreme Court3889cases, Executive Orders, Statutes, Regulations and other policies.3890According to this doctrine, the United States has legal, moral and3891ethical obligations to Tribal Nations. Treaty obligations are contracts3892between the United States and Tribal Nations that mandate the United3893States to provide healthcare to American Indians/Alaska Natives, among3894other agreements. We look to this Committee to support, promote, and3895include legislative language that recognizes and honors Federal trust3896and treaty obligations during the 119th Congress.3897Preserve and Expand Tribal Self-Determination and Tribal Self-3898        Governance3899    Portland Area Tribes support Tribal self-determination and Tribal3900self-governance through the ISDEAA. ISDEAA provides Tribes with the3901flexibility to tailor health care services to meet the needs of their3902people and communities. Since ISDEAA was enacted, numerous Tribes have3903entered compacts and contracts with the Indian Health Service (IHS). In3904the Portland Area, 38 of 43 Tribes have signed Title 1 (contracts) or3905Title V (compacts) agreements with IHS and administer their own3906programs, functions, services and activities.3907    We request that this Committee support Tribal Nations long-standing3908requests that all divisions of the Department of Health and Human3909Services (HHS) provide funding to Tribal Nations through ISDEAA3910compacts or contracts. In the interim, Portland Area Tribes request3911that Tribal Nations be given an option to receive grant funding through3912compacts or contracts. Such grants include the Special Diabetes Program3913for Indians, IHS Behavioral Health Initiatives, SAMSHA Tribal Opioid3914Response funding, etc. Moving this funding to a Tribe's compact or3915contract reduces Agency level expense, allows more funding to flow to3916direct services, and provides a Tribe with flexibility to maximize3917limited resources while reducing the Administrative burden of grant3918requirements.3919Ensure Direct Service Tribes Nations are Protected from Harm3920    While many Tribal Nations have moved to ISDEAA compacts or contract3921to operate programs, functions, services and activities, the Portland3922Area still has five Direct Service facilities that continue to rely on3923IHS to provide health care to their people. With a 30 percent vacancy3924rate at IHSoperated facilities, it is difficult to comprehend how the3925Federal government can meet its Trust and Treaty obligation to provide3926health care to American Indians/Alaska Natives. Recent Administrative3927actions compound long-standing vacancy rates and are destabilizing the3928Indian Health system. Because of the hiring freeze, one Tribe in the3929Portland Area has been unable to hire staff to maintain and clean their3930IHS facility. This is unconscionable. While the layoffs of IHS3931employees were rescinded on February 15 by the new Department of Health3932and Human Services Secretary, other Administrative Actions (past or3933future ones) related to the Federal workforce reductions must exempt3934IHS.3935Fully Fund the Indian Health Service3936    The IHS has always been significantly underfunded. This resource3937gap leads to poor health and significant health disparities among3938American Indian/Alaska Native people. The FY 2024 level of need for the3939Indian Health Service was identified as $51.4 billion while the enacted3940funding for FY 2024 was only $6.9 billion. For IHS annual3941appropriations, the rising costs of Contract Support Costs and 105(l)3942lease costs have continued to diminish program increases to IHS. We3943still do not what the impact will be on IHS and Tribally-operated3944facilities for FY 2025. For FY 2026, we request that the Committee3945support full funding for the IHS at $63.0 billion.3946Provide Mandatory Funding for IHS3947    Portland Area Tribes are experiencing annual program decreases due3948to the rising cost of 105(l) leases and Contract Support Costs (CSCs).3949While we appreciate securing an indefinite appropriation for 105(l)3950leases and CSC, we request movement of 105(l) leases and CSC to3951mandatory appropriations accounts to ensure that these appropriations3952are funded year after year without impacting programmatic increases to3953IHS-operated facilities and Tribally-operated facilities.3954Expand Advance Appropriations to All IHS Accounts3955    We appreciate this Committee's support for Advance Appropriations.3956We also request that Advance Appropriations for the IHS continue and be3957expended to every account in the IHS budget. There must also be3958increases to adjust for medical inflation, population growth and3959program increases.3960Create 10 percent HHS Tribal Set Asides3961    Lastly, we request that this Committee support 10 percent set3962asides across all Department of Health and Human Service (HHS)3963divisions and agencies. Changes to funding opportunities by the current3964Administration will impact grant opportunities that have been more3965broadly available to other populations, not Tribal specific. We also3966request that HHS and its operating divisions and agencies transfer3967Tribal set-asides and grant funding to IHS through interagency3968agreements for distribution to Tribes through ISDEAA compacts and3969contracts.3970Protect American Indians/Alaska Native People from Medicaid Program3971        Changes3972    American Indians/Alaska Natives access to Medicaid is rooted in the3973Indian Health Care Improvement Act (IHCIA) (P.L. 94-437, U.S.C.  1601)3974which acknowledges the importance of raising the health status of3975American Indians/Alaska Natives as a national goal, and documents the3976impact unmet health needs have on the health and well-being of American3977Indians/Alaska Natives in the United States. This legislation3978authorizes Indian Health Care Providers (IHCPs) to bill Medicare,3979Medicaid and private insurance, and amends section 1905(b) of the3980Social Security Act providing 100 percent Federal Medical Assistance3981Payment (FMAP) to American Indians/Alaska Native people for services3982received through IHS and Tribally-operated programs.3983    Portland Area Tribes request protection of 100 percent FMAP for3984services to American Indian/Alaska Native people received through IHS3985and Tribally-operated programs. Retaining 100 percent FMAP honors the3986Trust responsibility and Treaty obligations with the Federal3987government, and the intent and purpose of ICHIA.3988Exempt AI/AN from State Reductions in Services, Per Capita Caps and3989        Block Grants3990    The provision of health care service to eligible American Indian/3991Alaska Native people is a Federal Trust responsibility which is met3992through IHS, Medicaid/Medicare, and other HHS programs and supports.3993Reducing Medicaid funding will reduce available Medicaid services to3994American Indians/Alaska Natives and reduce Medicaid reimbursements to3995IHS and Triballyoperated facilities. It will also disproportionately3996burden State coffers; and is contrary to the legislative intent of the3997IHCIA.3998    An exemption is needed to protect Americans/Alaska Natives from any3999changes to Medicaid. Two 2017 bills, although not enacted, provide4000examples of exemptions for IHS eligible individuals from the definition4001of enrollees used to calculate per capita caps. The first bill is the4002American Health Care Act (AHCA), and the second is the Better Care4003Reconciliation Act (BRCA). Therefore, we request that this Committee4004support an exemption for American Indians/Alaska Natives from4005reductions in Medicaid services, state block grants, and state-based4006per capita spending caps.4007Exempt AI/AN from Work Requirements4008    Medicaid work requirements dishonor the Federal Trust4009responsibility, weakens the IHCIA, and threatens to reduce the capacity4010of Indian Health Care Providers to provide health care services to4011American Indian/Alaska Native people because revenue from the Medicaid4012program to Indian Health Care Providers is used to bridge the current4013funding gaps at the IHS. During the first Trump Administration, several4014Section 1115 Demonstration Waivers provided an exemption from work4015requirements for American Indians/Alaska Natives, including Arizona,4016Indiana, South Carolina, and Utah. These exemptions align with the4017Federal Trust and Treaty obligations and recognize the chronic4018underfunding of the Indian health system.4019    Thank you for this opportunity to provide written testimony on4020Portland Area Tribes priorities for the 119th Congress.4021                                 ______40224023                                            Julie A. Malone40244025Dear Chairwoman Lisa Murkowski,40264027    Thank you for the opportunity to comment on the priorities of4028Native communities for the 119th Congress to consider.4029    My name is Julie Malone, and I am a member of the Osage Nation in4030Pawhuska, Oklahoma. I also own a headright share in the Osage Mineral4031Estate which is 1.5 million acres of underground minerals belonging to4032the Osage Tribe of Indians. My grandfather was an original allottee in40331906, and I inherited my interest when my mother passed away in 2017.4034    Since 2014 our oil & gas producers have stopped drilling in the4035Osage Minerals Estate due to the long period of time it took to begin4036drilling. Our BIA Superintendent, Adam Trumbly, was trying to4037streamline the process for approving drilling permits and leases. The4038producers were starting to return. Many Osages who rely on their4039royalty checks each month were excited about increased business.4040    On February 13, 2025 the Federal mandate that all Federal employees4041who were probationary removed. Our Osage Agency BIA Superintendent,4042Adam Trumbly was fired after one year and three months.4043    The U. S. Department of the Interior is our Trustee, and as such is4044supposed to be acting in our best interest. That is not the case in4045this circumstance. Is there a way to exempt Native communities from4046these suddenly-mandated changes? This is harmful to many Osage4047Shareholders, or Headright Owners and the future of our oil & gas4048production.4049    Thank you for your time and consideration.40504051        Sincerely,4052Julie A. Malone, Osage Nation Member and Shareholder in the4053                                       Osage Mineral Estate4054                                 ______40554056                        Defense Credit Union Council (DCUC)4057                                                  February 11, 202540584059Subject: The Need for Increased Access to Credit Unions and4060                   Financial Services in Native Communities40614062Dear Chairwoman Murkowski and Ranking Member Schatz,40634064    On behalf of the Defense Credit Union Council (DCUC) and our member4065credit unions, I appreciate the opportunity to submit this letter for4066the record regarding the Committee's oversight hearing on ``Native4067Communities' Priorities for the 119th Congress.'' DCUC represents4068credit unions stateside and overseas serving military and veteran4069communities as well as their families, encompassing over 40 million4070members and having over $525 billion in assets.4071    One of the most pressing issues facing Native American communities4072today is the lack of access to affordable financial services. Many4073Native American reservations and communities exist in banking deserts,4074where access to traditional financial institutions is either limited or4075nonexistent. This absence of mainstream financial services leaves4076Native Americans vulnerable to predatory lenders, check-cashing4077services, and other exploitative financial practices that trap families4078in cycles of debt and economic instability.4079    Credit unions provide a powerful solution to these challenges by4080offering safe, responsible, and community-driven financial services.4081Unlike for-profit banks, credit unions are not-for-profit, member-owned4082financial cooperatives that reinvest in their communities. This4083structure allows credit unions to provide lower interest rates on4084loans, higher returns on savings, and financial education programs that4085help individuals and families build financial security.4086    For Native communities, the benefits of establishing and expanding4087credit union services are clear:40884089   Ending Financial Exclusion: Credit unions can provide low-4090        cost checking and savings accounts, small business loans, home4091        mortgages, and emergency credit options-critical services that4092        are often unavailable in these areas.40934094   Fighting Predatory Practices: Without access to credit4095        unions, many Native Americans must turn to payday lenders and4096        other high-cost financial services that charge exorbitant fees4097        and interest rates, deepening financial hardship.40984099   Encouraging Community Investment: Credit unions reinvest in4100        their communities, supporting small business growth,4101        homeownership, and economic development.41024103   Promoting Financial Education: Many credit unions offer4104        financial literacy programs that help individuals make informed4105        decisions, build credit, and achieve financial stability.41064107    However, despite the clear need and benefits, regulatory barriers4108and financial constraints often make it difficult to establish and4109expand credit union services in Native American communities. DCUC urges4110Congress to consider policies that will:41114112         1. Encourage and Support the Establishment of Credit Unions on4113        Reservations--Provide incentives and regulatory flexibility for4114        credit unions seeking to serve Native communities.41154116         2. Expand Access to Capital for Native-Owned Credit Unions--4117        Increase funding and grant opportunities to help credit unions4118        establish branches and digital banking services in underserved4119        areas.41204121         3. Strengthen Consumer Protections Against Predatory Lenders--4122        Ensure that Native Americans are not disproportionately4123        targeted by high-cost lending practices.41244125         4. Enhance Financial Readiness Programs--Support initiatives4126        that promote financial education and literacy tailored to the4127        unique needs of Native American communities.41284129    As an organization dedicated to serving military and defense-4130affiliated communities, DCUC understands the unique financial4131challenges faced by underserved populations, including Native American4132service members and veterans. By expanding access to credit unions, we4133can provide Native communities with the tools and resources necessary4134to build financial independence, strengthen local economies, and break4135cycles of financial hardship.4136    We appreciate the Committee's attention to this critical issue and4137stand ready to support efforts to increase financial access and4138economic opportunity for Native communities. Thank you for your4139leadership, and we look forward to working together to ensure financial4140security for all Native Americans.4141    Should you or your team have any questions or desire additional4142information, please do not hesitate to contact me.41434144        Sincerely,4145                      Jason Stverak, Chief Advocacy Officer41464147                                  [all]