the Homeland Security, 10:20 - 10:40

Vincent Toya, Pueblo of Jemez
Rosalind Taveapont, Vice Chair, Northern Ute Tribe

Mr. Vincent Toya, from the Pueblo of Jemez, greeted the meeting from the great Southwest. He said that due to the tragic events of September 11th, homeland security and related health issues have become an emerging national priority across the country. It is important to focus on it within the competing priorities that we face. The most visible action has been the formation of the new Office of Homeland Security and the appointment of a Director to head up that office. Numerous agencies have been enhanced, restructured, and in some cases given new powers over the last six months. Many new laws have been passed. These include PL 107-38, the emergency appropriations act to compensate the victims, and PL-107-117. This latter bill appropriated funds for public defense, including substantial funds to the Department of Justice to address counter-terrorism and border threats, and an increase for the Department of Health and Human Services to counter bioterrorism and related public health threats.

This issue is critical to Indian communities for a variety of reasons. Since the anthrax assault that followed the terrorist attacks of September 11th, the public health system has become as important to homeland defense as the military is to international defense. These terrorist attacks have focused attention on the long-neglected public health infrastructure. The anthrax situation that occurred last fall has emphasized how biological agents can be used as weapons. These weapons have the potential for massive silent attacks.

Smallpox is another virus known from past centuries. It can cause a person-to-person chain of infection if ever released as a weapon. Also, the supply of vaccine is limited and only palliative and supportive care is available as a medical response. Further, it is a particularly silent attacker, often misdiagnosed, and may go undetected for days.

After someone is first infected, they could end up far from where the infection began, like in a small rural Indian community. Indians were very hard hit by this virus back when America was first being settled by Europeans. At the time of Columbus, it is estimated there were fourteen million Indians in America. Over ninety percent of those people were killed by this virus and other infections, including botulism and plague, to name a few.

Local response depends on the national leadership, resources, and coordination. The responsibility for responding to medical emergencies falls first, and most heavily, on local communities such as our tribal clinics, I/T/U hospitals, and so on. State and local governments need to take part in planning, consulting, and capacity-building efforts to create better information and coordination channels for antiterrorism and bioterrorism prevention activities. Tribes need to be involved in this process just like the states.

We need to ask ourselves important questions:

• Are we prepared to function effectively in the aftermath of a disaster?
  
  
• How will we manage an emergency?

Terrorism threatens all Americans regardless of race, creed, or nationality. We have witnessed the physical and psychological trauma resulting in terror attacks like the World Trade Center and the bombing of the Alfred P. Murrah building in Oklahoma City. Additionally, we are faced with weapons of mass destruction, and the unknown.

This past weekend, HBO showed a very moving documentary on the September 11th events. It was another moment to think about those sad events. As a tribal leader, last year I was requested to take a medicine society into Ground Zero to help with the healing process. That was the saddest thing to experience, right there. But with hopes of the medicine, the healing and the strengthening process began from that moment on. We prayed for the entire world, every nationality, so that people can heal and live on, so that terrorists will not strike again. Those are some of the activities that we performed for the nation last year.

So, to prepare for this kind of disaster, there must be a preparedness program, including funding to provide education, services, and equipment directed towards vulnerable areas. Our goals should be to increase biological and chemical preparedness, focus to upgrade the capacity of hospitals in the I/T/Us, and the development of outpatient facilities to care for the victims of bioterrorism.

Indian communities are no different from other communities. However, we lack the fully developed infrastructure that many communities are starting from. And although billions have been allocated to this program, the tribes have not been included. We urge your department to work to understand what is needed so we can work together. This is a government-to-government matter, which is something that some of the state and local governments in Indian country don't understand. We need your help to further that kind of national level coordination and cooperation.

Ms. Rosalind Taveapont, Vice-Chair of the Northern Ute Tribe, spoke next on Homeland Security. She pointed out that many tribal lands lie near military facilities, nuclear plants, national labs, and international borders. Areas with some of these high-risk facilities include Aberdeen OK; Four Corners NM; Alaska, Billings MT; Albuquerque NM and more. According to BIA, there are some thirty-five tribes whose jurisdiction and lands extend across the U.S. borders with Mexico and Canada, and over waters.

Many tribes also have dams, oil and gas facilities, wastewater treatment facilities as well as private sector factories. There are also hydroelectric and other energy infrastructure facilities. To date, no specific funding has been dedicated to the tribes. The recent bioterrorism bill introduced funding that is ALL sent through the states. The I/T/U's need access to this funding for many purposes. You may not be aware of this, but at this point, only four states have worked with the tribes on bioterrorism.

She asked Robin Carufel to share with the group his experience with the State of Wisconsin, which is one of those four states. Mr. Carufel said that his governor sent out a letter reminding that the Indian Health Service and its healthcare system should be involved in the homeland security planning process. Wisconsin's responsiveness to the needs of the tribes has not been limited to reminders; 72 counties in Wisconsin receive local dollars, and 11 Indian centers do as well - they are awarded the same status as a local health department. So the devolution of this responsibility down to state and local levels does not have to shut out Indian communities.

It can take involvement from the top levels of government, however, to ensure that it happens effectively. The Governor of Wisconsin had received a letter of reminder from Secretary Thompson that suggested the state involve the tribes and the Indian Health Service in their planning work. Sometimes, as in Wisconsin, the Secretary's letter is effective, but sometimes the states don't listen. We hope you will think about this.

Ms. Taveapont continued. In many rural areas, she said, I/T/U's are the sole providers of health care services for all citizens. They must be trained and enhanced to handle health crises in any type of emergency, on very short notice. There is an urgent need for communication and information sharing between Federal, state, and tribal authorities. Further, there is a critical need to share the most advanced technologies and tools. The war on terrorism is being fought on many fronts, including our tribal areas.

I have a good feeling about coming before you. As Indian people, we are very proud. We have a rich culture and tradition that we carry. This land means a lot to us.

(Ms. Taveapont spoke in the Ute language.)

You guys have a very important decision to make that affects our people. We as Indian leaders and delegates come to you, not because we want to, but because our people say. You need to go back and make a really strong point to the President and your higher people, to understand us and to let them know that we have walked this land for years and years. Our ancestors were here. My grandparents once told me "there's a great man at Washington D.C., has a big white house. One of these days, you may come before them and ask for things for your people, but remember one thing - never give up, keep trying, because that's the only way we will accomplish anything."

And with your hand, and our hand together, this is one time we will bring some reality to our people so they will know that we don't stand up here and come here and go back with nothing. This is one thing I would like to know and understand. Hopefully, this will be our first year of understanding and getting together - we will open the doors for our people for better living and for each one of us also.

Jackie Johnson thanked both Rosalind and Vincent for their remarks. She underscored one point that had been made by both -- that devolution of funding down to the state level does NOT work for tribes. Tribes are governments, just like any other, and they should be named in the funds so that they will get direct funding. Even with incentives, as with welfare, we may still not get all the states to work with the tribes. There are states - Alaska and South Dakota are examples - which may never develop relationships and work with tribes. But it is critical to name us when you propose legislation.

HHS Response, Questions and Discussion

Janet Hale said that the example given about the state of Wisconsin had answered many of her questions. She said she knows that Julie, over at CDC, and Steve and the the folks at HRSA have all spent time working to understand the problems with government-to-government language and to find out how to improve those applications and regulations. We DO have the opportunity to go back and say to specific governors and ask "what have and haven't you done?"

There is NO better time to be here than right now because these applications are being reviewed right now.

Julie Gerberding from CDC commented that right now as they are reviewing applications from the states, they are documenting any lack of attention to the involvement of tribes in state homeland security planning. They are clearly marking this as a weakness in those applications for available money.

Ms. Hale followed up, saying that they sat down with Dr. Trujillo and the Indian Health Service several times, and discussed this issue among others. That is what led to that letter reiterating the request for participation. Specific problems of this nature are important to raise right now.

A tribal leader said that in New Mexico there are three major national laboratories located just next to tribal lands. It has been very difficult even to pursue the question of what hazardous materials or infectious agents those tribes have already been exposed to. We have no idea what group or groups may be targeting those locations, or what biological threats may emerge if those facilities are attacked. We are very concerned. We have managed to establish a relationship but it is not an easy problem and the infrastructure problems make the concern even stronger. We need a champion - IHIS is doing what it can, but we don't have the resources to build up the systems that are needed.

Jackie Johnson added that border towns are a particular danger, because Indian lands are easy-access and frequently lack law enforcement resources to repel or deter anyone entering those areas with a bomb or a biological toxin. We are an easy target for many problems.

Ms. Hale replied that those DHHS officials in the room, as well as Secretaries Thompson and Allen, will continue to attend council meetings with Director Ridge, and will bring some of these points up. These points are terribly important, and she thanked people for making them.

She asked if preparedness training has begun in the field - participation in the CDC training and outreach programs, and so on? Are there ways to communicate at least the….stuff that we know? ("Stuff that we know" is my technical term, she added.)

Yvette Joseph-Fox replied that they have seen some of the CDC videotapes, and know there is access to videos about how to prepare for some of the emergencies that are anticipated, particularly bioterrorism. And there are some videoconferencing mechanisms available through some of our area health boards through ANA grants to disperse some of that training. We can set up opportunities for that.

What we see as the main problem, she added, is that when we contacted the ten states with the largest Indian populations, we found that only two of those states were doing anything to fulfill Secretary Thompson's request. The others, representing probably over a million Native Americans, have offered little or no cooperation. We have been working through Senators Inouye and Kennedy, as well as several members of the House to get provisions to write tribes into the allocation plans for the supplemental appropriation that was coming up with additional funds for bioterrorism.

Unfortunately, we really hit against the lobby for the counties and the cities - they were pressing for language that would benefit their jurisdictions and leave ours out. We haven't heard exactly where the National Governors Association stands on this issue. We have tribes who would like to participate, but we badly need resources to get the training out to the tribes and their health centers. For example, in Ship Rock New Mexico there is a tertiary care hospital that will probably be the one place where both Indians and non-Indians will go to if there is an emergency. The same goes for frontier areas like South Dakota, Alaska, and Montana. All these facilities have the capacity to provide this training, but we need resources to get it there. We will continue to work through Congress, but we also need the department to continue to press for more coordination with State and local governments.

Jackie Johnson added that when requests go out to States to consult with tribes, they often pay little attention. The Community Development Block Grant has provisions that require them to bring in all sectors to be included in the public hearing process - this might be a better model.

Ms. Hale said that the guidance DHHS is giving back to applicants for homeland security/bioterrorism funding will be loud and clear in numerous of these areas. It will be important to stay in very close contact as we work through these issues, but she wanted to make sure the tribes knew that their message had been heard.

James Knapp asked if scenario-style "what if?" planning was going on, and if so, whether tribes were being included as part of these scenarios?

Ms. Hale responded that part of DHHS's Office of Preparedness work has included some scenario planning, and they have invited the Indian Health Service to participate. She said she thinks there will be more of that.

Julie Gerberding from CDC said part of the money in the grant is for regional and local and state scenario planning, so they are looking at ways to develop contracting mechanisms - technical support workshops and so on - to enhance scenario building. As a result, she said, this is a great opportunity for them to reach out and make sure tribes are involved.

Dr. Trujillo commented that as of this time, the efforts around education and training have not really reached out into Indian country as much as they could have. He said they had done some through the Indian Health Service and some of the health boards have done a little of the education, but the available dollars have not really funneled out through states to the local programs appropriately.

Also, as has been mentioned, the inclusion of tribal governments in the initial appropriation language would be very critical and important for Indian tribes across the nation with regard to homeland security and preparedness. He said there are also some "high-risk" states that have not worked with tribes traditionally and in the past. As we evaluate those programs coming into the department, we ought to pull those and make sure they are working more closely.

Jackie Johnson closed the question part of this session with two suggestions:

• It would be good to have a roundtable discussion around the homeland security issue.
• FEMA has used a model at both the local level and at the national level that has worked very well, and DHHS might want to consider it as a way to better coordinate its efforts among state, local, and tribal governments to enhance emergency preparedness in this context.

State/Tribal Relations for HHS Programs and Economic Development/Social Service Needs, 11:00 - 11:20

Tim Martin, USET

Jackie Johnson then introduced Mr. Tim Martin, who is Executive Director of the United South and Eastern Tribes. Mr. Martin complimented the group on its telepathic skills - he said he hadn't realized how good they were until he was sitting reviewing his notes just before the break, and realized what a good discussion they were already having on tribal relations. He thanked everyone kindly.

Tribal relations, however, represent an extremely key area and he said that he had to say that frankly, you are not doing a very good job. He explained that he serves on the DOI Trust Reform Task Force. Recently he was in the Minneapolis area, and visited one of the gaming facilities there. (He explained that he likes to go to the different structures and see how they're built….) As he was studying the area, he was talking to some folks there. A lady asked him where he was from, and he said he was from L.A. - not Los Angeles, but Lower Alabama, otherwise known as the Redneck Riviera.

He said that he comes from the Poarch Band of Creek indians - Buford Rolin is Tribal Administrator of that tribe. He said it is a very poor rural area, and that is fairly typical for indian tribes in this country. He painted a verbal portrait of Indian country:

• 25.9% of American Indians/Alaskan Natives live in poverty.
  
  
• Of those fortunate enough to have a job, that income, based on the US Census, is only 75% of that of the non-Indian population.
  
  
• Out of the 26 counties with a majority population of American Indians/Alaskan Natives, 25% of those counties have a high poverty level - twice the average of the non-Indian communities.
  
  
• The typical Indian tribe lives in an isolated rural area, with few or no opportunities for economic development.
  
  
• The commute from the reservation to some place where people can earn a livelihood averages one to two hours each way.
  
  

Devolution goes counter to our basic philosophy, he said. He pointed out that his tribe's government-to-government relationship is not with the State of Alabama. It is with the U.S. Government. For a long time, the State of Alabama thought that they had done a good job by moving all the Indians in the state to places West of the Mississippi River. It took their tribe twenty years of going through the Federal recognition process to tell the government of Alabama that they had not taken care of their tribe, because they STAYED in Alabama. Because the tribe actually stayed in their own historical tribal region instead of taking part in the dispersion, the only entity they really have that relationship with is the Federal government.

USET combines 24 Federally recognized tribes and falls under the Nashville regional office of the Indian Health Service. The tribes that are a part of USET live in 12 different states and cover six of the ten regional offices, so Mr. Martin said he has experience working with the regional offices and working with numerous state governments.

An example of state/tribe/federal interaction has been the CHIPS program, under the CMS agency. One state in which a USET tribe is located sent in its CHIPS program application saying, in part, that it had zero American Indians and no tribal governments, so tribes would not need to participate in collaboration talks. In reality, the state had a tribe in it with several hundred members, but the plan went forward and was approved despite that error.

Indian votes in some states represent significant swing votes, which has given Indians in those states an opportunity to improve and maximize relationships, but so far, it has not enabled them to make things work well. Overall, there are conflictual relationships with states. They try to send our members to the Indian Health Service, saying that they need the state money for non-Indians, and therefore Indians do not deserve services. He said that both healthcare providers and state officials hold other stereotypes about Indians that hurt Indian people's chances to receive the services they deserve from state-funded programs:

• They believe that since some tribes have casinos, all Indians must be rich;
• They believe that Indians are poorly educated;
• They believe all Indians are sorry, fit only to stay on those reservations where they live.
• They believe that Indians are all "somebody else's problem."

As devolution goes forward, it is forcing Indian tribes to deal increasingly with state governments, and the tribes are doing that reluctantly, because of the history of problems. Still, they keep trying because they know the underlying foundation of what they are doing requires them to do the maximum that they can to offer effective health care delivery systems.

But Indian tribes need the help of DHHS. This is one of the largest agencies that is putting money out there at the local level in a whole array of programs. You will find that the local Indian communities are marrying all the different HHS programs. Tribal people are wearing several Federal hats to manage those programs, because they are taking care of the total spectrum of Indian health care, social services, law enforcement, court adjudication, and other functions at those local levels.

You officials at DHHS have a tremendous amount of resources to the point where you have to divide it in order to manage it. At the local level, we don't have that luxury - we have to put programs together in order to scrape up the money.

Some tribe s are doing very well, and have been able to invest in a grant writer in order to go out and politic the bureaucracy of the government to get the discretionary funding that each of the Federal officials in this room has authority over.

Example: Right now under the American Indian Welfare Reform Act, there is a capacity-building component proposed. That proposal would put $50 million into the Administration for Native Americans to go towards capacity building in American Indian and Native Alaskan villages. The money would help each of them invest in the capacity to apply more effectively for Federal money and build up a useful infrastructure in order to succeed on their own.

He said that when he talks to his tribes, he speaks to them about getting to "critical mass." Once you are able to get a tribe to a level where they have a stable tribal government, planners, and grant writers, then they can succeed. When you study tribes you will see that the ones that put those structures into place experience a kind of spike - they begin to do well and to be able to provide services to others.

The sad case is that the overwhelming majority of Indian tribes are not there yet. They are very small, isolated, they have no natural resources to generate income - their total existence is dictated by the amount of resources they can get through the core Indian programs of BIA, HUD, IHIS. But that only lets them carry on basic day-to-day lifesaving activities. They have no way to get to the CDC money, the NIH money, and so on - they have no specialty programs and they can't make a difference to their people in critical areas.

He said that he was struck by Ms. Hale's question - How do we prioritize and make the judgment call when we have too few resources to do the jobs we want to be able to do.

His answer, he said, is to have the flexibility to use the dwindling resources that we are given so we can utilize them to the total extent possible. Especially, let the resource decisions be made at the lowest possible level, because what works for Navajo may not work for Poarch Creek, or for Seminole, or for Alaskan villages. There are commonalities - mainly that all of us are motivated to provide the best level of health care that we can to our people.

Earlier there was a question about access. If Indian Country can't become the 51st state, then Indians need access to DHHS programs and they need DHHS officials to champion them at the state level - to mandate our inclusion by the States. Devolution has many positive benefits, but if tribal governments don't have the same access to resources that the states do, then what is needed is not "encouragement," but a suggestion with teeth.

Back to the example he had given about the CHIPS program - that state's proposal claiming they had no Indians wasn't denied, it was approved. It went into effect. It was only because the affected tribe went kicking and screaming to every Federal official they could find that the decision was reviewed and reversed until the tribe could be given access to that program. To their credit, the state did work with the tribe, but many tribes are not able to advocate for this kind of inclusion on their own. The norm is that Indians get ignored and left behind. In most agencies, Indian people, because they are such a small part of the population, never even show up on the radar screen.

We are asking you not to look at us as just "Another Minority." For the secession of our lands our tribes have given up, and the treaties we have signed, you have an obligation to consider us in every decision you make.

He said he is a tri-citizen - of a tribe, of a state, and of the U.S. Some Indians are even quad-citizens, with dual citizenship with Canada or Mexico. It is tragic to be treated last in every one of those citizenship situations where others get treated first.

As the tribes struggle to succeed and our people in the cities face serious problems in survival, they are increasingly coming back to the reservations and adding to the burden of service provision faced by the already limited resources there.

We would like you to advocate for a seamless, almost invisible distinction between state programs and tribal programs. We have done one of the best jobs anywhere in the country of providing services for very little money, but the health disparity data shows that that little is still nowhere near enough.

HHS Response, Questions and Discussion

Mr. Chris McCabe said that one of the partners of the Office of Intergovernmental Affairs is the National Governors Association (NGA), which represents states. What kind of dialogue have you had historically with the NGA as representatives of governors? Has it been of any value, or is it just not worth pursuing?

Mr. Martin said that it has been hit and miss, and in recent years quite negative, especially where the Governors' Councils and the Attorney Generals' Councils have been at odds with tribes over gaming issues. He added that where the DHHS could be of assistance in helping to champion the concerns of tribes would be to turn the focus away from gaming and hunting rights and related land issues and move them to health issues. It seems as if DHHS could remind the governors that real collaboration and progress are not about trivial issues, but about trying to raise the issue of healthcare for all citizens and elevate the level of discussion.

Jackie Johnson added that NCAI has dialogue with NGA on a regular basis. NCAI has given presentations at their national meetings and worked to educate them on Indian issues, but the thing that has made the biggest difference in the relationship has been welfare reform. It has been a good model for collaboration - we've had meetings about legislation that we all needed in this area, with tribal representatives meeting with state representatives at all levels, including council members. This has represented our first real alliance with NGA.

LUNCH BREAK

Afternoon Session

Afternoon Moderator, 1:00 - 3:40
Julia Davis, Chairperson, National Indian Health Board and Council Member, Nez Perce Tribe

Julia Davis welcomed the assembled group back from the lunch break, and introduced the first afternoon panel. She noted for the record that we still don't have Tex Hall at the meeting yet, but that he is on his way and is expected before the end of the afternoon. Jackie Johnson is here to stand in for him until he gets here, so Jackie is 'Miss NCAI.'

Head Start, Child Care, Indian Child Welfare and Children's Mental Health, 1:00 - 1:20

William Jones, Sr., Councilman, Lummi Nation

The first speaker, Mr. Willie Jones, told this story: I used to be a DSHS advisor for the governor in the state of Washington, for the North West Indian Child Welfare Board, when the Indian Child Welfare regional office was forming. That is how I got started. When I finished my term up advising the governor, they asked me to be on the Board, so I was on that Board for several years.

But the real story I wanted to tell was about a young man by the name of Kina James, who was an Indian child, adopted out when he was very small. He grew up in Seattle and they had changed his name to Charles Myer, but told him what his Indian name had been. One summer he was at a summer camp in Yakima, and his Indian name came up. He told them he knew he was an Indian but he didn't know any more than that.

An Indian girl at the camp said that she had played baseball up in Lummi, and that in Lummi, there was a Kwina Road. When he got home from the camp, he got his caseworker to help him find the town and the family he'd been adopted out of, and that is how I met him - he was coming off a bus. He asked for Kwina Road and said he was looking for the James family. We talked, and I came to find out that in fact he was my cousin. That was how I first got interested in Indian child welfare.

After I first got interested, I began talking to people about the adopting out issue, and found out how bad the situation really was after looking into other families and other tribes.

Mr. Jones continued: I haven't been directly involved for quite some time now, but I agreed to help present these issues on behalf of David Simmons and Harry Cross, who aren't here now. I thought I was coming up here to give them some support, but I guess I'm up here with James Knapp and Julie Quaid to talk to you about the subject myself.

They sent me 29 pages of talking points, which I won't read, since they have been distributed and are on the table outside the room here; also, many of these points have been touched on already by others in today's discussion. Instead, I will touch on the legislation and report on each of the major recommendations being made in these areas by the National Indian Child Welfare Association. They do an excellent job as a national organization in research and putting information together and making recommendations. Many of the points in here have been touched on earlier in the day by some of the other tribal leaders. It all comes out here in specific recommendations to make things better for our greatest resource, our children. These are the main recommendations:

1. Title IV-E   Foster Care and Adoption Assistance
   Support current legislation (S.550, HR. 2335 and S.2484) authorizing tribal governments to be eligible for direct reimbursement for these services to eligible Indian children, and support a revenue offset to support this change.
   
   
2. Title IV-B, Subpart 1   Child Welfare Services
   Amend the regulations to create a base level of funding of no less than $20,000 per fiscal year for all tribes. The amounts received currently are too small to create adequate programming or staffing.
   
   
3. Title IV-B, Subpart 2   Promoting Safe and Stable Families
   Support the authorization of a 3 percent tribal allocation from this program, rather than the one percent included in the mandatory funding portion of the Act. Last year, only 63 tribes were able to access this program because of funding scarcity.
   
   
4. Title XX - Social Services Block Grant
   Amend the authorizing legislation to make tribal governments eligible to receive direct grants and reserve 3 percent of the total appropriation to be distributed to eligible tribal governments. To fund this without impacting states, we also recommend increasing the base level funding by an equivalent 3 percent overall.
   
   
5. Children's Mental Health Services (IHIS)
   Increase the IHIS mental health and social services funding to at least $100 million to allow hiring of adequately trained clinical staff and development of tribal programs. In addition, require the IHIS to provide data detailing the level of funding in child mental health and social services to provide an accurate picture of need.
   
   
6. Mental Health Block Grant (SAMHSA)
   Amend the authorizing statute to provide tribal governments direct access to these funds, and reserve 3 percent of the total allocation for tribal governments. To fund this without impacting the states, we also recommend the increase of the total appropriations by 3 percent. Specific allocations of funds to the tribes could be done with a base amount per tribe, plus a percent based on the tribe's population.
   
   
7. "Circles of Care" Tribal Grantees (SAMHSA)
   Continue the Circles of Care program at the current funding level to support planning for community mental health service delivery.
   
   
8. Children's Mental Health Services Grant Program
   Continue this tribal service site funding, reserve 10% of the total program allocation for tribal applicants, and exempt Indian tribes and organizations from population limits used in grant allocation.
   
   

Mr. Jones urged everyone to read their presentation and the details. The contact person and the number for each recommendation is in the printed materials. He thanked every one for their attention. He said they had heard some key points today, and one of the main ones is that Indian tribes would like to be recognized as a government with the status of a state. We would like to be treated like a state in a way that will actually solve some problems and benefit our children.

Ms. Julie Quaid then spoke. Ms. Quaid is President of the National Indian Child Care Association and is the Essential Education Director of the Confederated Tribes of the Warm Springs. She thanked DHHS for carving out some time for her to speak today. She said that she came here to Washington from Warm Springs in Oregon where there is a confederation of three tribes. Her mother is Nez Perce and her father is from a mix of tribes, so she is a product of a boarding school romance. She said she has worked in the field of child welfare for over twenty-two years - Head Start, Child Care, K-12, infant care, school age care, and even higher education for her tribe. Currently she is also the Chair of the National Indian Child Care Association. They have developed a lengthy agenda that they've been sharing on the Hill. They began this lobbying before the current national initiatives and efforts on welfare reform really got started.

Budget Recommendations:

1. Child Care Development Block Grant. This has been around through the first PERORA in 1994 and the Welfare Reform Reauthorization. When that funding first came out, there were 206 grantees awarded funds the first year; currently the number is up to 262. If the levels of funding for this program stay the same, it will mean that everyone will be getting less each year. Tribes cannot provide quality child care on this amount of money. Without an increase, it will not be possible to achieve the many child-related goals of Healthy People 2010. So we are urging you to increase that money.

   Another point related to this is that if the definition of work expands to 40 hours, then our families are going to need child care longer. So if our families need child care longer and we have no increase in funding, how are we going to do that? We simply won't be able to probide quality child care, which we all know promotes healthy child development for children. A huge majority of children now spend time in out-of-home child care because their parents have to work. We need to be able to maintain a quality setting for those children and also increase their school readiness.

   So the key recommendation is to please give us more money. The pressures on us to provide quality in these programs are legitimate, and we need support to do this. Also to continue to keep the training and technical assistance networks strong - outcomes, research, and so on. When we began to look at the ways we are able to promote health families, and support fatherhood, and the way we do child outcomes - these need to include Indian children and families, and it takes money to do that. Under level funding, we are basically being handed a lot of unfunded mandates.
   
   

2. Facility Development & Construction/Renovation. We need to bring Head Start and Child Care together into the same facilities. In the old days, Head Start used to have buildings, and child care was housed in a trailer or a church basement. Today, it's the reverse. In the Child Care Development Block Grant and CCDF, we have the opportunity for construction and renovation, although we do have an agreement for Head Start and Child Care to work collaboratively. We need to support that collaboration in construction as well. The bottom line is that we need to ensure the health and safety of children in quality facilities, and we need to work on that together.
   
   
3. Compacting HHS programs (like BIA/IHIS). As far as this is concerned, we would like to see some pilot projects so we can take a more holistic approach to evaluating how well this works or doesn't work. If HHS programs could do compacting, there might be an opportunity for more collaborative efforts across other programs - across Head Start, child care, child support enforcement, child welfare, et cetera. It would be nice to be able to work together instead of with a lot of broken pieces. Pilot projects would be able to demonstrate how well that might work.
   
   
4. Infrastructure. We urge you to assist tribes to provide a stable infrastructure. What we're faced with today at the local level is to deliver services to children in a very complicated funding picture. We all have multiple resource streams. In my program, we get funding from several state programs, Federal grants, tribal dollars, and also from the County. With all the different rules and formats, it is very hard to deliver a seamless program. We need to invest money into being able to build strong systems within tribal government so we can access and use and account for all these multiple funding streams that we use now to deliver good services to our families.
   
   
5. Access to Rural Transportation. An issue that comes up a lot in our programs and probably throughout Indian country. It is one of the biggest barriers to employment, to accessing social service, to parent involvement - to almost anything. This is the number one problem for people living in many areas. Rural transit is really needed out in Indian country. We are in a recession - in Indian reservations, it seems like we've always been in a recession, and the rest of the country has just found out about it. But the bottom line is that you can't access services unless you can get to them.

Ms. Quaid said she also had a few positive comments. She said she had experienced a wonderful working relationship with the Indian Health Service. IHIS staff members had met Indian child welfare workers more than halfway in supporting immunizations, physicals, and visual screenings, medical screenings, and providing services for disabled children. They have really stepped up to the plate and done their job there. It is a great achievement for our children and has improved the quality of their lives.

Also, she said, the DHHS training and technical assistance network has been extremely helpful. They send out bulletins, written material, training videos, walls of stuff -- and they actually come out to help. This is a big strength, and she said she wanted headquarters staff to know how responsive they are, and that there is real gratitude for their services.

Mr. James Knapp, from the National Indian Child Welfare Association (NICWA) spoke next. He said he is new to the board, but not new to the issues of child welfare. He himself was adopted out as a child and raised outside of the Indian community. He is a Seneca Indian and has had the opportunity as an adult to go out and advocate for his people. His own history has given him familiarity with the identity issues and all the decisions that are made by professionals which are determining the destinies of children. He also said he is one of the few who made it through the system resilient and strong, a leader and committed to this issue. He said he will go to his grave making sure that he is doing his best to never let these issues disappear off the horizon in terms of the need, because it hasn't gone away.

Mr. Knapp said he was there to talk in more detail about Title IV-E, speaking from the same briefing paper that Willie Jones spoke from. Title IV-E relates to Indian Foster Care and Adoption Assistance. The problems with Title IV-E represent an oversight that happened back in 1980 and Indian advocates at NICWA have been working for over twenty years since that time to get it rectified. The authorization for tribal governments to be directly reimbursed in this matter was left out by staff in Congressman Miller's office, and it wasn't caught until too late.

This money needs to get to tribes to enable children to have their own sovereign governments help make the legal determinations they need. The bottom line is that we want to find responsible foster and adoptive parents and to find ways to keep children connected with their tribes.

He said that he is living proof that it's possible to be raised outside of your community and eventually to become a responsible contributing citizen of the United States and walk in two worlds. But in his experience, it is a very small percentage of people who end up with that. Most succumb to alcoholism, to domestic violence, or become locked into the very cycles that brought them into foster care to begin with.

What is needed is a partnership. HHS assistance is very much needed here, working with tribal governments as partners. Budget recommendations really aren't the purview at NICWA. He described NICWA as a policy and advocacy group that works with tribal governments and that regards the government-to-government issue as critical. To be in communication with officials like those in DHHS, helping out as a middle person between those officials and tribes, is the way NICWA works, and he appreciates being here to speak, and being welcomed to the table.

He said that when he was working in Buffalo New York, he often had to invite himself into rooms in order to get his organization involved. It wasn't that it was intentional - people had just not thought the issues all the way through. He said that Indians can often be the invisible community, and sometimes by choice - sometimes we like it like that. But there are people out there who are trying to bridge the gaps and organizations and tribal governments that are very competent and astute and capable of handling these difficult issues. He requested that the meeting attendees read the handout for more information.

Julia Davis said there would be a few minutes for a couple of questions or comments.

HHS Response, Questions and Discussion

Assistant Secretary Janet Hale commented that in the Mental Health world, the Federal government has a very small proportion of the total mental health dollars. Some come from States, other from private sources. She asked where else the resources are in this area that tribes might be drawing on? If no one in the room was aware of the answer to this, she would appreciate someone getting back to her. She said this issue is terribly important. Right now they are spending a lot of time looking at mental health as it relates looking back to September 11th. We saw it happen after Oklahoma City, across the whole country, and right now we are trying to understand the impact in many areas.

William Jones answered said that many tribes are getting more into natural healing. He said he didn't know if this was for financial reasons only, or for other reasons. Dr. Trujillo said that many people are dependant on the Indian Health Service providing these services. James Knapp added that there is some information on page 16 of the NICWA handout. There is a lot of foundation money, but that so far his association had been unable to access any of it because they don't have the data needed to demonstrate their eligibility for it. Several different kinds of HHS programs are all lumped together in terms of recordkeeping, so DHHS help is needed in order to sort out the programs and demonstrate this need.

Julia Davis said that we could probably send answers to Ms. Hale's question directly, and that could help with collaboration.

At this point, Tex Hall arrived from his long airport odyssey. Julia welcomed him and pointed out that he had timed this just right.

Child Support Enforcement, TANF, Native Employment Works (NEW), and Faith and Community-Based Initiative, 1:30 - 1:40

Tex Hall, NCAI

Julia Davis introduced Tex Hall, who is the President of the National Congress of American Indians and Chairman of the Mandan, Hidatsa, Arikara Nation.

Mr. Hall thanked her, the tribal leaders, DHHS officials, and Dr. Trujillo. He apologized for arriving late to the meeting, but explained that he is chairman of the three affiliate tribes on the Fort Berthille [sp?] Indian reservation in rural west central North Dakota, which is close to Montana, on the way to from Minnesota and not too far south of Canada - a part of the country where you have to get up at 4 a.m. to get here, and even then, you can't always be sure you will get here.

He said he wants to commend every one for this very important issue that affects all of Indian country. It all reflects back into our culture.

He said Indian culture regards children and older people as sacred. The older people in the reflection of their life, and they are constantly teaching us, telling us to look out for each other. That may mean only a small group of closely related tribe members, but it can also mean the entire population of Indian country - some 569 tribes and close to four million people. This is really a tremendous growth.

He said the Indian tribes in North Dakota and in many rural parts of the country are in a strange situation. First of all, there's really an out-migration problem - the whole region is losing population. They are largely agricultural, or their business entities are oil and gas - they just don't have a diversified economy and they don't have the market, so there is a huge out-migration movement. The whole of the northern plains region - North and South Dakota, Montana… all have lost a tremendous amount of population.

At the same time, many Indian tribes are having a "homecoming" problem as the homecomings of both younger and older people are increased by economic pressures. We're not only experiencing a great growth of population but also of educational achievement. Many tribes are recognizing that for us to compete, we really have to focus on the training and education of our young people. I'm happy to report that there are record numbers of young Native American students that are graduating.

One vehicle for supporting kids is the community college program. Many of them are located right at home. A lot of our people want to live within our culture and a way to be there for the tribe so we have an expanding resource in those kids. We're looking at a pool. We're looking to make the tide that lifts all boats.

For welfare reform to be successful you can't just take people off the welfare rolls and reduce your caseloads, you need meaningful jobs, and that's what we're doing. We're all engaged, we're all in that mode. We're the only race of people in this country with this kind of internal responsibility for every aspect of our people's lives. But we're working on developing partnerships to help us do those things right. We've expanded beyond the Department of Interior, the Bureau of Indian Affairs and the Indian Health Service. It's agencies such as DHHS and other federal agencies and with private, corporate America. Access to capital is a big gap - it is our main challenge. There's a less than 50% chance that someone in my tribe can qualify for a home loan, and my tribe is typical of most tribes. With the issue of employment, and the statistic of 50% unemployment, the challenge is clearly the economy. We feel that a lot of the work the government is doing today can be outsourced to Indian tribes, and that's what we're working towards.

He added that NCAI is developing a website for a partnership summit in Bismarck including private America and later roll this out for a national summit in Phoenix Arizona on September 16 through 19. We're going to showcase tribes who are doing well to let the other tribes know what models are working. Indian tribes are doing a lot and it all relies on creating jobs.

You may wonder why I'm talking about economics under this topic heading, but it is the basis for success. To focus successfully on TANF and healthcare and reauthorization, we have to have those jobs to make it successful. By the year 2008, he said, our goal is to create 100,000 jobs. This may not seem realistic, but after 200 years, we kind of figure we have to be a little aggressive.

If you look at the 1999 BIA labor force statistics submitted to Congress, it shows 50% unemployment in most parts of Indian country. In my part of the country, The Oglala Sioux tribe and the Shine River tribe are averaging between 80% and 85% unemployment. That is stark reality. NCAI took this report and looked at the whole country, and found there are nearly 400,000 eligible Native Americans with high school diplomas or 2-year or 4-year degrees without jobs. That is a tremendous amount of strain and pressure on the tribes and on agencies like your own to help support these people who have no options for support, so we are obviously looking on how to solve this problem, with your help.

One of our leaders, Sitting Bull, was a very noted intellectual and a historian and a medicine man and a chief of his time. He was a member of the tribe at the time they were forced onto the reservation in 1876. He said we needed to put our heads together and see what we can do for ourselves and for seven generations to come.

Well, Mr. Hall said, this is the 7th generation since Sitting Bull's, and we are at a crossroads here. We may sound like perennial optimists, but we can't help being optimists, because we can't fail. We are obligated to work on behalf of our people. He said that as a manager himself, with a master's degree in management - he said he knows you have to submit numbers. But, in our culture, we are not numbers, we are human beings. But the scarce resources, of healthcare and jobs and other resources, and the young people coming home, we know we have real changes to make.

So our first goal is to create jobs, and the second NCAI goal is to make every tribe self-sufficient by the year 2020. We may not reach those goals but we can strive to do so. We may not reach that mark, but we will be able to say we hired this many, and saved this many lives - most importantly, we started focusing on that formula of health distribution, so it's not focused on the population, but on the disease and doing something to help it. Right now In North Dakota, cancer and diabetes and heart disease are increasing, even among our young people, so we have to consider it. When diabetes is starting to affect our youth, it tells us clearly that we're not hitting the bulls eye. We need to look to the long term strategy and start making that difference, sending the numbers the other way.

On TANF, many tribes want to take over but haven't been able to because they don't have the funding, since they can't meet the eligibility requirements. Tribes want to do so, but they don't have the support to document what they need to document. They are using somebody else's statistics, and they don't match Indian reality. Mr. John Steel, President of the Oglala Nation, said in a meeting at the BIA last week in Phoenix, that in the last census, his tribe was estimated at 14,000 people, whereas he knew for a fact that there were more like 43,000. Indian tribes are consistently undercounted when it comes to national census data, and that data forms the basis for these eligibility determinations. With TANF, you get to put forth your own reality-based numbers, which makes a huge difference.

He said he had had a similar experience in his own tribe with the welfare reform initiative, where you have a five-year clock ticking on your unemployment figures. The state showed 50% unemployment, whereas all the tribal data showed they had reached 47% unemployment, but the welfare reform people insisted that they were accepting the state's data, no matter where it came from and how much it differed from our own records.

So the bottom line is that we want to administer our own TANF programs.

Other programs are critical. The CHIPS program is very important for Indian young people, but we still need to do a better job of informing our tribal constituents that this program exists. I keep getting back to the government-to-government issue and how important it is, but I can't stress it enough. Our constituents elect us. They elect us to come to Washington and to work government-to-government to come up with the best strategy for our people.

This consultation is ongoing, it's under executive order, and it needs to be continuous. So that is my message to you as part of this consultation - please help us find ways to get the CHIPS program information out to our people. It's really a key thing for us. And this reauthorization that is coming up - we hope it will pass. The new TANF and welfare reform bill passes. We at NCAI will be talking about it more at Bismarck when our executive council meets. There are some things you can do in this 107th Congress, and I think that's one of the things we can do -- but we know there are some things we can't. I'm probably preaching to the choir here, but we in Indian country are going to focus on what we can do.

The second thing we are going to focus on is passage of the Indian Health Care Improvement Act - we want it to pass, and we're going to do everything we can to do what it takes.

The third thing is the funding. In my neck of the woods, Senator Conrad and Senators Daschle and Johnson supported the $1 billion increase. Speaking of the tide that lifts all boats, that would help tremendously in Indian country. If we can get that $1 billion increase - well, it is just very critical - just need to get it done. We will be talking about it in Bismarck and talking with Julia and the National Indian Health Board about it.

We're not just up here talking and wasting the airplane ticket out here and getting up at 4:00 in the morning and trying to make it here -- We're here to make a difference, and we want to make the difference with you. Maybe this billion dollars is too much, but you know, they always find money for other things - the farm bill was looking at 70 and they ended up with $190 billion. Just think of what we could do with that one billion dollars. This is so important. I think of the disease factors, and the priority one status and the lack of referrals because of the lack of funds. If we do the economics, some of the rest will follow. The economic tide can lift all boats.

Mr. Hall continued, saying that at NCAI, we are committed to working with the process here - one tribe, one state, just can't do it all by itself. Even government officials with with authority and power - Mr. Thompson, Mr. Bush, Dr. Trujillo - none of these men can do it all himself. We need to work in partnership and get money to those who need it most. The President has got a tremendous saying in his education bill: "Leave no child behind." Now, there will be some children left behind, unless we put our heads together in a partnership and come up with a strategy to get some funding and get some equity in that formula so that we can get the money where it's needed most, because those boats are sinking. They're not holding any water any more. We need to help those people who need it most, first. If we can do it, those people can maintain that boat and they can turn and help lift somebody else's boat as well as their own. Pretty soon we will all have a boat and we can look forward to the future.

Remember, we're committed to the process. We're committed to getting some pieces of legislation passed. We're committed to the welfare reform reauthorization and the Indian Health Care Improvement Act and we're committed to getting a substantial piece of funding. We'll keep coming back and keep coming back and working with you. That's our commitment to you and to all of us in Indian Country.

HHS Response, Questions, and Discussion

Julia Davis said that now the folks at HHS can see why the tribes of the United States elected Tex Hall as President of NCAI. He stepped right in, got off the plane, didn't get any briefing, caught up to us, just knew exactly where we were coming from and what we had said, so Tex, we are very proud of you. She apologized for the thinning out on the tribal side of the room because of the departure of several of the Indian tribal leaders. She said that some of their people had to leave to catch their return flights.

Chris McCabe asked about the Economic Summit - Earlier today, a number of people had made the point that because of the lack of jobs, the welfare rolls in the Indian community are higher because unemployment is higher. And I understand from your comments that there is some kind of strategy involving more than one federal agency in partnership with you all. So I'm just wondering what kind of progress has been made in establishing partnerships for this conference with other federal agencies, and if you have an interest in HHS participating, whether there was anything formal Mr. Hall could share with us.

Mr. Hall responded that on June 4th a 10:00 planning meeting concerning partnerships had been scheduled at the FCC. Jackie Johnson will forward Mr. McCabe the details, and they would welcome attendance by DHHS - they would find representatives from Interior, Defense, Commerce, Agriculture, FCC and other agencies there. (USDA is heavily involved in telemedicine, and our Senator Conrad has a formal committee on Tele-Health. Senators Inouye and Stevens are also on that committee.

He said that they hadn't made any arrangements with a representative from DHHS, but you are obviously a critical piece of this whole pie. There will be regular NCAI meetings on the topic as well. The mid-year session of NCAI is on building capacity. Tribal leaders will be developing an economic development tribal leaders statement to share with the administration. The purpose of the September Congress is for the administration and Congress to respond to the Tribal Leaders statement and to see if we can't create a long-term partnership bringing private sector into it. We're thinking a real triangle - private sector, the administration, and the tribal leaders

Julia Davis said that we would look forward to having DHHS on our agenda in September. She added that there would be a White House meeting on the Faith-based and Community-based Initiative the following day. Several tribal leaders would be attending the meeting, and Chris McCabe asked those folks to stick around at the end of the meeting so they could get some background from the DHHS folks and coordinate their plans to attend.

Darlene Ross from the Office for Human Research Protections said that they were at Haskell Indian Nations University in Lawrence, Kansas during the latter part of April sponsoring a workshop with the Indian Health Service and the Food and Drug Administration. Over the last decade, they have sponsored ten educational workshops to bring the tribes up to speed in that area so they can negotiate a federal-wide assurance and then go for grants. We also did it in conjunction with AHA.

Patrick Johannason, from the Office of Minority Health, said that he serves as the liaison from HHS to tribal colleges and universities. Among the top seven priorities identified by tribes during the HHS 2001 consultation report, the need for healthcare providers in Indian communities was listed as a priority. He asked how the DHHS can support the T/C/U's to train more healthcare providers?

Darlene recommended they contact Dr. Karen Swisher out at Haskell Indian Nations University. I think she would be a good resource to put you in contact with other people.

Dr. Trujillo said that the department has had initiatives regarding black colleges. The department also took that same type of initiative to work with tribal colleges, with funding and other kinds of technical assistance and expertise in evaluation. That's another mechanism that's already formalized already with tribal colleges.

Robin Carufel recommended contacting the American Indian College Fund - Richard Williams.

Urban Indian Issues, 1:50 - 2:10
Loren Sekayumptewa, UIHP

Mr. Loren Sekayumptewa addressed the group. He is here representing the Urban Indian Health Programs (UIHP) and currently serves as President of the National Urban Indian Health Council, which is the only nationally based Indian organization advocating for Urban Indian populations residing in urban areas of the United States. Mr. Sekayumptewa said that his Indian name is a proud name, even though everyone finds it hard to pronounce. He got it from his grandfather, whose clan is the coyote clan. His name means "yellow underside of the coyote." He said that it is an honor to speak to this audience. He thanked the DHHS folks for sticking around and listening to us. He said that he is serving a year here in Washington D.C. and that he wants to make a positive impact.

He said he was proud to hear our chairman from the NCAI but he was also thinking about his traditions and his culture. In the Hopi language, he said, what we are doing here is "Ba vu si ya," which means prayerful planning - speaking words of truth and wisdom in a sacred circle. It means we support each other in that brotherhood circle, not only for today, or tomorrow, but for years to come.

As you contemplate what you do here, he said, think about the impact you can have for yourselves, and for your children, and for eternity -- what you are doing for the future. When I look at the constellations, I always think and I say that there are many people who are still coming yet. There's many people who have come before us, but many more to follow.

He explained that he was once a sheepherder for his grandfather. They herded over 300 sheep, and those sheep were all different colors. If you were a sheepherder, you knew every one of your sheep by its name and character, and the differences in color didn't matter. That is what it is like being in this room and communicating together - you may be of a different tribe or color, but you are all my children and I think of you in that way.

My grandfather used to teach us some additional terms in Hopi that relate to this: "Sun mi una ya" which means working together, and "Na mi una ya," which means working in union. Both terms are about working to bring about positive outcomes.

It's going to take us all as a community - Indian people and agency people - to work together as a family to bring about positive change for our people.

Mr. Sekayumptewa said he prepared a slide presentation but would not go through it thoroughly in order to save time. NCUIH - is the national association, and the only one that represents and serves urban Indian people. I wanted to recognize some people who are here at this meeting:

• James Cozzens - Urban Indian Program for IHIS
• Karen Boyles - James' right hand person
• Phyllis Proctor - my right hand person

He thanked these people for attending and said that for the DHHS folks, these are the people you'll work with here more locally to make sure urban Indians are not left behind and left out. An issue he is concerned with is the fact that in comparison to other Indian Health Service Programs, Urban Indian programs only get 1% of the IHIS funding, even though they represent 57% of all Indians in the country.

There are are currently 36 Urban Indian Health Programs housed in 41 sites located throughout urban centers of the nation, currently serving only 332,000 out of an estimated 500-700,000 American Indians and Alaskan Natives who live in urban areas. This is only a fraction of the total numbers. The map I have up on a slide here shows where the urban sites are located. We are diverse and spread out across the whole country, but as you look to the east, you see very few. For example, here in the DC area there are approximately 113,000 Native Americans but the state of Maryland has no urban clinics.

He said that one of his major goals in Washington this year is to pursue 330 funding and faith-based funding for Urban Indian people. This will let us participate in the President's initiative to increase the 2000 community health centers within certain timelines. If he gave us one percent of that money and made it specific for Native Americans, that would mean 20 clinics for us in Urban centers. That's not asking for too much.

We've been asking for new startups to address Native American needs, particularly in places where we have no clinics at all.

Major Issues:

• Accessing services from DHHS is a major obstacle confronting urban Indians.
• Regulations governing DHHS eligibility are limited to the reservations
• Population is overlooked, labeled ineligible by both Federal government and tribes
• The majority are underserved, uninsured, and under qualified for good jobs

This combination means that a lot of those people don't have the capacity to make a living in urban centers - they have no money for healthcare services, so the families go without health care and the children are suffering. These are concerns not only to you but to tribal leaders. These children within urban centers are the children of the tribes as well, even if they are not living in the tribal reservations or centers.

Recommendations:

• Continue to include urban Indians in the language and within eligibility regulation definitions so that urban Indians can qualify for services to participate equally in programs available to Indian people.
  
  
• Encourage Federal and State agencies to coordinate services with urban programs.
  
  
• Encourage HRSA to basically provide us our own designation for Native Americans so we can participate in 330 funding. I'm a member of the Arizona Association for Community Health Centers, and on their Board of Directors. They've given us a $10,000 grant to help my center in Phoenix to participate in 330 funding. It's a laborious, detailed study that has to be done. We don't have that technical expertise in our urban centers to get up to the capacity to do them.
  
  
• Consider waiving some of these requirements until the capacity is built.
  
  
• Educate Federal and State agencies about the distinct differences between minorities, American Indians, and tribal governments, and about Indian health in general. Education is a two-way street - we need to understand your information, and you need our information as well.
  
  

We have been running around for a long time to prepare information for you here today. Some of us were up until midnight trying to give you the best information possible so you can make good decisions on behalf of our Indian people.

In conclusion, I wanted to say the word for life in Hopi is "gotzi." Life is precious, and our children's lives are precious. Among the Hopi, when we have children, we never let go of that child -- we embrace them forever. So in that closing image, I want to encourage you to not let go of the hands of the people for whom you have responsibility - which is us, and for your children as well.

HHS Response, Questions, and Discussion

Stephen Smith said that as the representative from HRSA, we will be happy to try to work with you to work through all those requests that you have for consideration. We'd be glad to do that.

Julia Davis thanked Loren for his remarks. She said she thinks he is doing a very good job representing the Urban Indian Association. She attended the meeting he spoke of in Arlington, and it was a very good meeting.

Elderly and Aging Issues, 2:20 - 2:40
Gary Kodasett, National Indian Council on Aging

Mr. Gary Kodasett, from NICA, told the group that he was a DHHS retiree, who had left the Administration on Aging in 1996. Now he serves as a member of the Board for the National Indian Council on Aging. He commented that the folks who had drawn up the program had put the elders last, but that is part of the circle of life.

He said that his organization has a 13-member board representing the 12 regions, and the National Title VI Directors' Association sits on the board as well.

The biggest need for elders is training dollars for aging programs. A few years back, Congress decided that training dollars could be cut, and one of the things that was cut was funding for the aging programs. This is a very critical blow to Indian aging programs. We have a 45% turnover among our directors, and so there is a burning need to train the new directors. We do a lot with USDA, who help to train new directors, but it's a constant thing.

HHS' Administration on Aging has been very good in that they developed a manual for our directors, but they sent no trainers. So this is something we need desperately. We've gone to Congress and to the Administration on Aging - not requesting a lot of money, but just enough for a grant. Our last request was for $600,000 to run training programs for directors.

Our main area of concern is Title VI of the Older Americans Act. There are other titles in there that affect Indian elders. One is the Family Caregiver program - a recent program that started last year, when 110 applied for $15 million. This year, 177 have applied for the same amount of money. As it has been said by many people here today, that means a pie that is staying the same size, with more people getting smaller and smaller slices.

Another area of focus is the overall funding levels for the Older Americans Act - original appropriation was supposed to be $30 million but we haven't seen that yet. Right now it's only gotten up to $26.4 million total funding, and some of that goes to the Native Hawaiians. This helps fund 236 Federally recognized Indian tribal programs.

Indian elders need information on many topics. For example, only 66% of Indians participate in Social Security programs as compared to 88% for the general public because they don't understand it. They don't know they're eligible, and there is no one to explain it to them. I was brought up to work here in DC and know these problems, but when I go back home even I have problems understanding these programs. Do I apply for both Medicare Part A and Part B? Do I need supplemental Insurance? There is no one to tell me that. And it's coming to all of you - one day you're 64 and the next day you get your Medicare card. Be expecting it. It's a little like the AARP, which magically knows when you turn 50. You were probably shocked when you got that card in the mail - how do they KNOW?

Another area is CMS - we need training on Medicaid, Medicare, and I think it's your discretionary grants program. When I worked in the Dallas region, I tried to learn all I could about government programs and share that information with the tribes. There were 50 different tribes in Region 6 - the Dallas region. We would try to have annual training for our Tribes, including their directors and staff of the programs, but this was just kind of our own regional initiative. Not all the other regions were doing this. This is an approach that would benefit all the regions. I would encourage the Secretary to reach out to the regional offices to ask that they help do this. If you train your staff members, they can train the Indian people.

We get a lot of help from IHIS on training elders on health topics like diabetes - which is not just an elder problem, either. Grade school, elementary school kids are being diagnosed with diabetes now, and it's not just the Indian people, either. Mr. Kodasett observed that when he was young, we didn't have any fat Indian kids - we were all skinny. My mother used to say I looked like a P.O.W. from Germany or someplace. But we didn't have television and DVDs and so on - we played outside and we were healthy. We need to educate parents and get those kids away from the TV and from Big Macs and so on, and educate the elders about other topics that affect all our Indian families.

He said their group had sent up a 20-page report to the agency and so the DHHS officials will probably get copies of that.

HHS Response, Questions, and Discussion

Chris McCabe pointed out that recently HHS released Caregiver Grants. He asked how those will be utilized by the individual recipients?

The answer was they're being mostly used for respite care. These grants are small, and the pie is the same size, while the number of slices is increasing. There's not a lot you can do with those dwindling amounts of money.

Tex Hall commented that another issue that relates to elders is prescription drugs. The problems with the rising cost of prescription drugs are getting worse and worse. We just had a water summit at home yesterday on our reservation. We don't have very much water on our land, and most of the population, including the elderly population, still have to haul their water, because we don't have any access to a rural water distribution system. So an elder on a fixed income is in a fix.

An elder who receives social security in the State of South Dakota may get $850 a month. (That is the average in North Dakota.) For a tribal member, it's just under half of that -- $420 on the average. The elder has to make a choice between paying for water hauling, or food, or propane, or medicine - it's not possible to afford all of them. So because of the discrepancy in social security, we really need to create some initiatives to deal with drugs and we need to highlight and flag that issue.

Gary Kodasett seconded that suggestion. He said that AARP is working on that issue. He has family members who quit taking drugs, even when the doctor tells them they need it. It's either the medicine or the rent, and they choose to keep a roof over their heads.

Janet Hale said that Congress and the President and all of us here at HHS are very committed to getting a prescription drug benefit. But the politics may or may not get worked out. Right now CMS is clearly trying now to educate and do the outreach, and I think that probably we ought to go look and make sure we are doing enough outreach on the Indian reservations to get the information out. We have now started additional outreach modes, including advertising. If you have any suggestions to CMS we'd appreciate them.

Robin Carufel offered a suggestion. He said that HCFA used to provide specific outreach dollars for both training and transport to mothers, helping them learn where to go and how to get there. That outreach worker in the tribal health clinics was critical to providing services to young mothers. A similar kind of outreach worker for seniors is needed - additional dollars for outreach, with some of the money tailored for seniors. For example, we did some work for outreach with elders - found someone who can help them with QMB and SLMB [??]- state benefits that will help them. Under that kind of program, if an eligible elderly tribal member gets, say, $53.00 deducted for their Medicare Part B benefit, that money can be devoted to paying that propane or water bill. As Mr. Kodasett said, AARP knows how to find you when you turn 50. If AARP and Medicare can find you, it ought to be possible for outreach workers to do so too.

Mr. Kodasett said he had forgotten to specifically mention Long Term Care Services in Indian Country. A few years ago the AoA did a study by Dr. Jackson. At that time, there were only 31 Indian-run nursing homes in the country. There are probably less than that now, because several of them went under. But a lot of Indian elders don't want to leave their homes. We need to work with CMS to have Indian-specific caregivers to work at home with the elder to maintain them where they want to be. Tribes want to strengthen their in-home services but the money isn't available under Medicaid. CMS has the authority to approve requests for Medicaid waivers, and we would like to see Indian tribes made eligible for such waivers just as states are.

Dr. Trujillo commented that IHIS and NICOAH [?] are working with CMS and AoA in regards to some of these long-term care issues and having those individuals remain functional. That's one of the major issues of concern to that organization, and certainly to our program.

Also, disabled elders are particularly hindered and at risk. Access to care and availability of services are extremely poor in rural areas. With regards to training programs, we've had some pilot programs through NICOAH's aging program. We've done this in combination with CMS, Social Security, and now VA to get outreach into the intertribal programs or the Indian Health Center programs. We're looking for knowledgeable trainers on SS, Medicare, Medicaid and VA benefits - those combination of services in the field and rural areas are extremely important. When it has been done in the field it has been extremely effective. The pilots have been run out of Albuquerque and the Denver Regional Office.

Janet Hale commented that this relates to the One-HHS program. Secretary Thompson has been very explicit on ensuring the component agencies of the Department to work together. I am glad to hear about programs where CMS and AoA and IHS work together - we just need to be sure there's a lot more of it and that we put the limited resources there.

Mr. Kodasett said in closing that he wanted to invite everyone to Albuquerque on September 4, 5 and 6 for the World Conference on Elder Health. He said they need speakers so if you are willing to be a speaker, he invited them to contact Julia, who is a contact person for the conference.

Tribal Wrap Up, 3:00 - 3:20

Julia Davis said that she was sorry to realize that the elders were placed last on the program. They had hoped to begin the program with them, but they changed some of the order of speakers in order to accommodate to Claude Allen's schedule. She said it is part of Indian culture to honor our elders and we don't want to forget that.

She thanked all of the speakers and said they had done an excellent job of summarizing our points.

HHS Summation, 3:20 - 3:40

Janet Hale said that she can't thank the tribal representatives enough for the time and information and willingness to help us. She said this meeting couldn't have come at a better time. The Department will be starting the FY2004 budget process next week, and that it is very helpful to have this information early in that process.

She said that she and Mr. McCabe and Mr. Allen were all extremely impressed. Dr. Trujillo and the agencies frequently bring up the concerns of Indian country, but it's extremely valuable to hear it directly from tribal leaders.

She said she wanted to be perfectly honest - the $1 billion will be tough. As everyone knows, OMB looks over our shoulder. The appropriations process has many steps and although we are tremendously excited about the $1 billion in the appropriations package, we will have to stay in close touch with Dr. Trujillo as we watch that. We always have to be good soldiers and stay on our reservation as we say, with OMB, but I think we'll also be talking very closely with the IHS appropriators up on the Hill as that process for FY03 goes forward.

One of the most important things for us and I asked about this several times during the day, is process. Getting the information from you about your needs and issues, topics like the chronic diseases we're facing all across the country and obviously on Indian reservations; preventive care that we want to all give; the issues of the aging; community health centers - we want to work on all of these with you. What I hope is that today is not the only time we talk about these issues. It is terribly important to have the tribal consultations like this today but I also hope that we will follow up throughout the year.

That is why one of the questions I asked today had to do with the budget times, to be sure that Dr. Trujillo and I can arrange a call during the heat of those OMB passbacks, because that could also be important. I know you will be in contact with IHS folks, but it will be even more useful to hear it directly. Sometimes it will be delivery of bad news, but it will be much better to do it with you rather than sort of from afar.

Nick went scrambling around this morning trying to find the report that several of you brought up. We've actually located it, which is very important, because as Claude said, he knew he signed off on it. And it looks like there is one lingering issue that you have raised. Today's meeting has caused us to have a meeting tomorrow to try and resolve that.

So when you find that stuff is late and not getting out, pick up the phone and call us, and I'll offer Chris' good offices to let us know when there's concern so that we can move those things forward. We'll try to resolve that as quickly as we can and move that up to Congress to let them take the next step on that process of moving it forward.

I also heard in my process questions today a terribly important issue - on the consultation. You brought up the Departmental Management Initiatives that got put in the process and that we need to consult with you. I know you've been talking to Dr. Trujillo but if it is appropriate I think that probably myself and some of my colleagues with the Assistant for Legislation and Public Affairs can sit down and talk to you as well. I think that is important and we did not intentionally NOT do that - I think as you all know, in the passback time some issues come flying over the transom that you get to deal with within a very short period of time. Even though we may be late, we would like to sit down and talk to you all about that and we will turn to whoever to set that up.

On the issues of Homeland Security that were brought up: I know Julie was asking for information before she left today to be sure that before they go through the final stages of the CDC review, and Steve was going to go back to HRSA and look to be sure about the consultation and be sure that it does get our funding - not directly, because I think that will be hard to change at this stage of the process - but to be sure that the consultation and that there is funding and collaboration out across the country in rural America in the Indian reservations, so I know that we want to follow up on that as well.

There are so many issues, and I think it is terribly important that this become not just a one-a-year but that we continue that dialogue and I would look forward to working with any and all of you as we move forward on that. I am thinking this is the first step in the consultation for the Fy04 budget for the Indian Health Service and the rest of the Department's programs that serve your-all's communities.

She then asked if she can answer any questions - everyone was so nice to answer any and all of hers today - how about questions on how we make those crazy decisions down here?

Tex Hall thanked Ms. Hale for the comments. He said it was encouraging to hear the Department's willingness to work in a constructive, proactive manner towards government-to-government on the issues that the tribes are presenting to the Department today.

He said he agrees with her and wanted to carry her point further about the involvement of tribes in the entire budget process so it just doesn't end today and then we go home and the issues don't get taken up. He asked what was planned for the role of Indian tribes as part of the budget process? The Bureau of Indian Affairs handled this with a Joint Budget Council, members of which met with the BIA head, the Secretary of Interior, and a representative from OMB. In that council there were two Indian tribal leaders from each region, so it is a very effective way to proceed with all the key people. This group meets quarterly including up to the time when it's to OMB in the pass back. He said it was done so that the bean counters don't rule the roost. Because their priorities might be completely different. It goes back to what are our priorities collectively, and how do we carry them over the goal line?

This is just an idea for you and Chris to think about - a way of making it a formal process, so it's systematic and ongoing and not a one-shot deal so that in 2004 we're not back to…. 'Well, what are we going to do this year?'

Janet Hale laughed, and said that she is a former OMB bean counter, but now she better understood different roles and positions. It all depends on where you sit. She said this is her fourteenth Federal budget year. It is always hard, and there is always a balance between what you DO discuss and what you DON'T discuss, but this is a unique relationship that we need to figure out a way to do that. I heard today about the EPA relationship and what they've done and how they've done it over at OMB. During the break I went down to my office and asked my budget officer to call over to OMB and see what we could work out too, to be sure that we've got a relationship not just with us, but that in fact we are also talking and including you where appropriate. Obviously, that will involve some internal battles downtown. I think it's important, and I think we should not let today go by without trying to figure out when the next time we'll meet, and how we'll do it, and not have another year go by before we start this process again. Each OMB division works slightly differently so we'll have to walk that with our division which is slightly different than BIA's or EPA's, but I think that's a good process to follow up on.

She added that this group had left very lasting memories with us. There is no finer test than being sure that we walk away with a message. I think that quote about the average life expectancy of a man on an Indian reservation compared to a man in Bangla Desh will be one that I'll remember for a long time. So again, thank you for your caring, your time, and ability to come and share with us your needs. So thank you.

Julia Davis commented that as chair of the NIHB, it's taken many years to get to this point. We have gotten past the point of the doom and gloom, and just saying "Oh, us poor Indians." We have gotten past that. As advocates for our people back home who can't speak, now we are talking partnerships and we're looking for some kind of working relationship with the DHHS. IHS has been outstanding and should be a model for working with tribal leaders. We have always been included in all the discussions that impact our people when it comes to funding. All we're asking for as tribal leaders is to have that same opportunity to make that argument with any of the other agencies under HHS. I understand that there are a few elite work groups already in place that have expressed unwillingness to consult with us. I need to express my concern as a tribal leader - we need to speak with all of you.

Remember, we've taken an oath to take care of our people. That will mean being very assertive. We have to be at the table whenever there is any discussion on funding. So my challenge to you, as chair of NIHB, is to please consider your consultation process that has been lined out, and please keep in mind the President's message and promise about having us present in budget discussions. We have people that can sit at the table and make those decisions for us.

We appreciate this meeting - we tried for a long time to have this meeting. And we have pressed long and hard to meet with Secretary Thompson and we hope, Janet, that when you and Gena Tyner-Dawson sit down and meet with him you will press that for us. We appreciate you and know that you are part of his administration, but we still need to have that tribal leaders meeting with us. He met very briefly with us last year, but we need to meet with him again. Too many things have happened over the last year. We as tribal leaders have to go home, go to funerals, see our old people and our young people leave us - it's very hard to sit here at these meetings and know that we have to rush home to a funeral. I hope you will consider the concerns that we have, and especially the remarks, which have come heartfelt from our members here. I don't mean to get emotional here, but when I think of our people at home, it's just so real. It's just right there in front of us, so I do appreciate you taking the time to be with us today, and now I'll turn it over to Tex.

Tex Hall thanked Julia. He said that in our way, in our culture, when someone is speaking from the heart, we don't let their words hit the ground. So I won't let your words hit the ground.

Back at our reservation we celebrated this last Memorial Day and a couple of things really came to my mind. We have many Indian veterans and now we are in another kind of war. September 11 changed everything really in terms of our security and how innocent civilians by terrorists driving an airplane right into a world trade center. It happened then and it could happen any time in the future.

So I looked up in the Memorial Day address and I saw the large number of Native American veterans. No other racial group in the U.S. has a higher proportion of veterans and - in World War I, World War II, Viet Nam and Desert Storm -- they don't wait to get drafted - they are enlistees and always among the first into combat. I am going to put together a booklet and show the people in Congress the commitment that American Indians have given to our country. I've had an opportunity to travel overseas, and people in other countries wonder how we can do this after our history. After smallpox, germ warfare, cavalry, genocide - they almost wiped us out.

Some estimates of the number of Indians in America at the time of Columbus' arrival are as high as 20 million people. In 1925, when we were finally allowed citizenship, there were only 200,000 or so left.

There is a movie coming out this month called "Code Talkers." We might not have won in World War II if it wasn't for the Code Talkers. People don't get that. I'm going to say it here so that everybody gets it, I'm not trying to be disrespectful here, but what we know now America will be able to see in a film. We will finally see a public acknowledgement of how critical was our contribution to World War II.

The other thing that affected me on Memorial Day was the number of crosses on the highways. We have a traffic safety director, and he puts crosses up and down the road where people died. We all lose family members due to traffic fatalities. I lost a brother ten years ago in 1992. My brother went off the road. We don't have any ambulances, and he was thirty miles from the nearest clinic, and nobody seen him. It was very cold and distances were very long - he survived until a school bus found him the next morning. It was just over freezing - they air-evacuated him but it was too late. They didn't get to him in time.

But there are over 250 crosses on our roadways in Fort Berthel. As I was putting flowers on the graves in that cemetery, like many of you did over the weekend probably, I saw far too many young people doing the same thing. There was no way they should have been in that cemetery. They should have been living. They should have been producing a family, producing their income, helping their tribe and helping their community.

But for many of the reasons I talked about, for inadequate healthcare and for not having the ambulatory services we need, there's far too many of them.

In summary, we are totally committed to this process, and Native Americans will continue to contribute to this country no matter how this country treats us in the sense of living up to those trust responsibilities. Someone once said we're only at $1300 per average expenditure per Indian. This country spends three times that amount per year for each Federal prisoner. So what's that message? You'll have better health care if you go to jail than you'll get on an Indian reservation. That's a bad message for our young people. We have to change it. And it's also a message that this country, no matter how much we contribute, does not want to live up to those obligations.

So that's why we're working to pull ourselves up by our bootstraps and saying that we need to put our heads together. And one of these days this country will get it. It's not a partisan issue, it's a bipartisan issue - it's helping lift all boats.

Tribes were skeptical of any administration coming inbut maybe it'll be this administration that will really break the backs of poverty and really put a dent into the disease and change the way we do business, and really work collectively so we can make a difference..

So finally, Janet, Chris, members here - it's back to our priorities. What can we do here, in this 107th session? What are our priorities? What can we get done under Secretary Tommy Thompson's administration? What can we get done under President Bush's administration? We're almost halfway and that means we need to set some goals. We maybe set some foolish goals in economic development - the 100,000 jobs by 2008 and the goal to make all 569 boats self-sufficient by 2020 - but we had to do something. I would offer that maybe we should do something with setting some goals for the remainder of time that we have, with the priorities that we're looking at, so we can lift all the boats in Indian Country. And I think everybody wins then.

Once again, he said, we're committed to the process. The NCAI midyear conference will take place from June 16th to 19th and we are happy to use that and share that platform. Julia Davis is the contact for getting consultation to all the tribes. It's a great opportunity - there'll be probably a thousand to 1500 tribal leaders, Dr. Trujillo, that we could utilize that vehicle. And of course we have our annual meeting at the end of October in San Diego. Mr. Hall closed by thanking DHHS for this opportunity and this meeting.

Chris McCabe thanked the tribal leaders once more for their participation. He said that this had been a very meaningful session for him personally and for all of us here. He also thanked his immediate office staff for working to put this meeting on, as well as all the different agency liaisons involved in representing their particular groups. Several individuals are here who haven't spoken, but who have been listening very carefully. One of them has a particularly important role in many aspects of what we've been talking about. Mr. McCabe then introduced Charlie Currie, the new director of SAMHSA.

Mr. Currie said that SAMHSA is committed to developing a relevant response. He said that he had two staff members here to make sure that there was a SAMHSA representative at all times.The data is clear that we need to respond in areas of mental health and substance abuse. These are priorities for all the tribes and SAMHSA is committed to sitting down and ensuring that we are developing a relevant response. We have to go beyond listening at this point to true action because the data are very clear. We need to make sure that mental health and substance abuse are cornerstones of public health - that we're there with the understanding that we need to address them foundationally if we are truly going to go forth having healthy communities. I know there have been issues around how we do funding through the States, but I look forward to finding ways to handling a direct relationship and doing some specific follow up with you.

Mr. McCabe also thanked the tribal presenters today and said that the information in this meeting will be captured to get it out to everyone. It will be made available publically, to each of the presenters, as well as to the IGA website and to HHS decision makers.

It came across to me loud and clear that:

• You want to be recognized as a government by a government. As a former elected official, I appreciate the passion and commitment that you are giving here as a representative of your people to the HHS.
• You want to continue consultation and improve it. As someone who isn't always consulted even by my colleagues whose offices are just around the corner from mine, I understand that wish. It is an unfortunate part of the process, but we are dedicated to improving it. Today is my 14th wedding anniversary, and my wife and I don't always talk on a timely basis, but we are committed to doing that.
• There is a need to have some of our key people present at your conferences to continue learning and listening to your concerns and needs, as well as keeping you and your people current on what we are doing in our programs that have an impact on your constituents back at home.

On behalf of HHS, he said, I look forward to using this information and being responsive to your concerns and making a meaningful difference to you.

Final Blessing, 3:40
Hilda Moss, Councilwoman, Northern Cheyenne Tribe

Hilda Moss said that it was an honor to be asked to have this closing prayer for this group. She said that she is a spiritual person herself, and she hopes that today when we leave the meeting hopefully that all of our efforts will go forward and in the days to come there will be a better relationship between tribal officials and the government agencies. Washington DC has powerful people, and this room has so much energy today that God is probably just waiting for my prayer and I hope he can answer it. One of the things that I'll ask him is for better communication skills - we have telephone and email and there's no reason for anybody to be home in the dark today. I will take home a positive report to my people in Billings. I would like to thank Dr. Trujillo and his staff in the Indian Health Service for making my trip possible. I will pray in my native tongue and hope you will say your prayers to our Creator.

That concluded the meeting.

Last revised: November 10, 2003

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