4 MAY 15, 2011
Smoke Signals
E&siroiniQdly tiestiiifiTies before CoDDgjiress
Tribal chairwoman
keys in on improved
health care funding
By Dean Rhodes
Smoke Signal editor
Tribal Chairwoman Cheryle A.
Kennedy was among 18 Native
American representatives who
testified on Wednesday, May 4,
before the House Appropriations
Committee's Subcommittee on In
terior, Environment and Related
Agencies.
Testimony focused on the need to
retain adequate funding for Ameri
can Indian programs throughout
Indian Country in the fiscal year
2012 federal budget.
Kennedy's comments are below:
"My name is Cheryle Kennedy
and I am the Chairwoman of the
Confederated Tribes of the Grand
Ronde Community of Oregon. Mr.
Simpson, I had the pleasure of
working with all of Idaho's Tribes
during my tenure as executive di
rector of the Northwest Portland
Area Indian Health Board, which
represents health care issues of the
43 federally recognized Tribes in
Washington, Oregon and Idaho.
"I also have the honor of serving
on Secretary Sebelius' Secretary's
Tribal Advisory Committee (STAC),
the first Tribal advisory committee
established to advise the secretary
in the history of the Department of
Health and Human Services.
"First, I want to thank the Sub
committee for its leadership in
addressing the many issues facing
Indian Country. My testimony to
day is shaped in part by a 30-year
career as a health administrator
working to improve the access and
quality of health care to Native
people and, more importantly, as
someone who personally experi
enced the immediate injustices of
federal Termination of her Tribe
and has lived long enough to wit
ness and chronicle its long-term
consequences.
"I would like to focus my testi
mony today on a topic of great im
portance to me, my Tribe and other
Contract Health Dependent Area
Tribes. Specifically, changing the
2001 CHS Allocation Workgroup
formula. This formula is used to
allocate increases in Contract
Health Service (CHS) funding to
Tribes. However, it does not fairly
account for the unique situation of
CHS Dependent Tribes like Grand
Ronde.
"Health care to eligible beneficia
ries is provided at the Grand Ronde
Health and Wellness Center, a
health care facility built, financed
and owned by the Tribe on the
Grand Ronde Reservation. Like
most Tribes, we have struggled to
achieve and maintain a high level
of health care service, given chronic
under-funding, especially of CHS
funds.
"The CHS budget is the most im
portant budget item for the Grand
Ronde Health and Wellness Center.
The Portland area has no IHS hos
pitals or specialty care facilities.
This is significant because these
facilities can provide inpatient
and specialty care services that
outpatient clinics cannot. Unlike
hospital-based areas, which can
provide these services directly,
Grand Ronde and other Portland
area Tribes must purchase all spe
cialty and inpatient care services
with CHS resources.
"Moreover, hospital-based Areas
can bill Medicare, Medicaid and
other third-party payers thereby
preserving critical CHS funds. CHS
Dependent Areas cannot generate
third party reimbursements at the
same level as hospital-based areas,
thus their need for CHS funds is
higher.
"Yet neither the annual distribu
tion of CHS funds nor the 2001 CHS
Allocation Workgroup formula give
sufficient weight to this fundamen
tal difference. The funding disparity
impacts the ability of Tribes such as
Grand Ronde to offer services such
. as radiology, specialty diagnostics,
laboratory and pharmacy services
which tend to be associated with
hospital-based facilities.
"Due to the lack of facilities to
deliver services, Grand Ronde has
no choice but to purchase specialty
and inpatient care from the pri
vate sector using CHS funds. It is
important to understand that the
CHS program does not function as
an insurance program with a guar
anteed benefit
package. When fg,
CHS funding is
depleted, CHS
payments are
not authorized.
"As the for
mer executive
director of the
Northwest
Portland Area
Indian Health
Board, I am
keenly aware
of the impact the 2001 CHS Work
group formula has had on the
ability of Tribes to provide quality
health care to their members. The
formula is simply not fair.
"I appreciate Dr. Roubideaux's
outreach to Indian Country to
solicit recommendations on how
best to improve the efficiency and
effectiveness of the CHS program
and acknowledge that changes to
the CHS distribution formula may
be warranted. The Portland Area
has been working for many years
to address the inadequacies the
distribution methodology used by
IHS to allocate CHS resources has
had on CHS Dependent Areas.
"Last year, the Northwest Port
land Area Indian Health Board
held a listening session with Dr.
Roubideaux to discuss recommend
ed programmatic and CHS distri
bution formula changes specific to
CHS Dependent Area Tribes. It is
the position of the Portland Tribes
that the proposed formula devel
oped by the 2001 CHS Workgroup
has not been officially adopted by
the IHS and that the agency should
continue to consult with Tribes over
its continued use.
"It was also recommended that
Dr. Roubideaux convene a new
CHS Workgroup to revisit the
The CHS budget
is the most impor
tant budget item for
the Grand Ronde
Health and Well
ness Center."
Cheryle A. Kennedy
Tribal Chairwoman
Charyla A. Kennedy
2001 formula and consider the fol
lowing: "(1) Alternate resources (Medic
aid, Medicare, private insurance
and changes under health reform)
when making CHS distributions;
"(2) CHS Dependency;
"(3) Use of actual medical infla
tion when allocating CHS fund
ing; "(4) The unique circumstances
of CHS Dependent Areas must be
addressed by IHS and Congress in
national and internal health re
form, otherwise these systems will
continue to be plagued with chronic
underfunding and may not be able
to capitalize on health care cover
age expansions
that will come
with health re
form; "And (5) to
address the
lack of access
to the Cata
strophic Health
Emergency
Fund (CHEF),
Congress
should consid
er establishing
an intermediate risk pool for CHS
Dependent Areas.
"In sum, the 2001 Workgroup
formula does not meet the test of
fairness in the way it was developed
or the results it produces. Grand
Ronde, along with the Northwest
Portland Area Indian Health Board,
is ready, willing and able to work
on a new formula that will meet the
needs of all Tribes.
"In addition to the recommended
changes in the 2001 CHS Allocation
Formula, I strongly support the
IHS Budget Formulation Work
group requests for a $118 million
increase to be provided for Contract
Health Services. Considering the
estimated CHS program needs
exceeds $1 billion, the requested
increase would greatly assist the
many Indian people without access
to key medical services.
"I support the Workgroup's re
quest for an increase of $145 mil
lion to fully fund Contract Support
Costs (CSC) in FY2012. The Tribal
self-determination and self-governance
initiatives have been widely
recognized as the single greatest
contributor to improved health care
in American Indian and Alaska Na
tive communities. Successful opera
tion of Tribal health care systems
depends on CSC funding being
available to cover fixed costs.
"When Grand Ronde took over
the delivery of health care services,
our goal was simple: to provide the
best possible health care to our
people. We wanted to provide a
continuum of care to our patients
that would include as many pos
sible health services in one loca
tion as possible so that the care
provided by physicians who are
providers could be integrated and
coordinated.
"The challenge Grand Ronde has
faced in providing health services
to its members is an illustration of
the impact that CHS underfunding,
IHS under-funding and the lack of
fairness of the distribution formula
has on Tribal health programs and
Tribal sovereignty.
"Before I conclude my testimony,
I would like to add my voice to
those advocating for increased
funding to address the law enforce
ment, infrastructure and education
needs of Indian Country. There are
huge gaps between Tribes' abilities
to fund law enforcement and their
law enforcement needs. Grand
Ronde is responding to community
demands for police services by tak
ing steps to establish its own Police
Department. Department start-up
cost are high, but so is the cost of
fear for Tribal members living in
rural areas poorly served by county
sheriffs, even where Tribal-county
agreements for sheriff patrols in
Tribal communities are in place.
"Funding needs are especially
acute for restored Tribes such as
Grand Ronde. During the 1960s
and 1970s, the federal government
provided Tribes more training,
involvement and influence in the
process of managing federal funds
through, for example, Tribal Prior
ity Allocations for law enforcement,
social services, adult vocational
training and natural resources
management. As Grand Ronde
was not restored until 1983, the
Tribe was unable to participate in
this federal investment in Indian
Country.
"The Tribe is playing catch-up
from the years its community was
neglected following Termination in
1954. Serious efforts must be made
to provide restored Tribes with
direct funding to assist them in de
veloping fundamental public safety
resources and infrastructure in
their communities. Federal funds
intended for Tribes are often sent
first to the states, which may then
distribute these funds to Tribal gov
ernments. This is inefficient. Funds
for Tribal governments should go
directly to them.
"As a mother and grandmother,
as well as the Tribal Chairwoman,
I implore Congress to continue
funding for education programs
serving Native students, including
funding for the Chemawa Indian
School. Education is a fundamen
tal component of the federal trust
responsibility. The education we
provide our children must keep
pace with the rapid pace of techno
logical change.
"Your attentions to the outlined
concerns and requests are greatly
appreciated." D