National Council of Urban Indian Health

Good afternoon, everyone. Francys [Crevier, CEO], thanks for the invitation to join you on this tribal land, the ancestral homeland of the Nacotchtank and Piscataway people.

All this country's tribal land. So let me first recognize the tribal leaders, tribal elders, and Native Vets. And no Vet deserves more recognition-and thanks-than your president, my friend, Airborne Army Sergeant Sonya Tetnowski. Sonya, thanks for your continued service chairing VA's Tribal Advisory Committee, the TAC, work that's invaluable to me, to VA, and critical to the American Indian, Alaska Native, and Native Hawai'ian Vets we're privileged to serve.

President-Elect Murillo and members of the board, good afternoon. And, good afternoon, everyone. It's good to be back with you to continue our work caring for this country's heroic Native American and Alaska Native Veterans. As President Biden often says, our nation's most sacred obligation is preparing and equipping the troops this country sends into harm's way, and caring for them and their families when they return home.

The second part of that sacred obligation, that's our mission at VA. But it is our whole nation's obligation. And the fact is that alone, working individually, we can never meet it. When we work together, and do that well, then we can really change Vets' lives, for the better. Veteran Patricia Tavella is just one example.

Patricia grew up in Phoenix, a member of the Tohono O'Odham Nation. And when we talk about the Native American tradition of serving this country at the highest rates, Patricia's family is a perfect example. Patricia's son, Army Veteran. Her older brother, Marine Vet. Older sister, Marine Vet. Another older brother, Air Force Vet. And when it was Patricia's turn, she joined the Air Force, followed that tradition, because, she said, she just wanted to serve this nation.

Well, years after serving and a career in the medical field, Patricia's life started falling apart-mental health challenges, struggles with sobriety, housing instability and, ultimately, homelessness. Fortunately, a friend was there for her in her moment of greatest need, told her about Tribal HUD-VASH, gave her the number [877-424-3838], and got her connected. A Tribal HUD-VASH Case Manager contracted with the Tohono O'Odham Ki:Ki Association came to her. He listened to her story, and he helped her enroll with VA.

Patricia chose VA Phoenix for the mental health care she needed, along with inpatient rehab services. There, she joined a women's group, participated in talking circles, smudging ceremonies, and learned she's not alone in her recovery. Today, Patricia has the stable housing she needs so she can focus on her mental health. She's made great progress in her sobriety. And she's accomplishing her list of personal goals-gardening, cooking, drawing, finding a job. And her Indian health provider and VA provider are working together so Patricia's getting the right care, for her, at the right places.

Now, let me acknowledge right there and let you know how much I appreciate that ending homelessness among American Indian and Alaska Native Vets remains a top policy priority of yours. And we're all in, along with HHS, HUD, the White House Council on Native American Affairs Health Committee, and you. We're committed to continuing to build more and more collaborative and effective relationships with IHS, with CDC, this Council, and the UIOs you represent, bringing to bear a real whole-of-government approach.

Same for another one of your 2024 policy priorities, and our top clinical priority: addressing in a more effective way-which is to say, in a culturally competent way-the disproportionally high rates of suicide among Native Vets, the disproportionally high rates of suicide among Native Vets living in urban areas where they're more disconnected from their tribes and traditions. With your help and the TAC's advice, we're crafting an enhanced model of community-based suicide prevention to better support our Native Vets. In fact, Alexandra Payan helped craft the concept of this path forward in Oklahoma last year. Thank you, Alexandra. And Alexandra and Chandos Culleen worked to connect us to tribal communities for listening sessions. Alexandra, please, pass on my thanks to Chandos.

And, Sonya, it was because of your advice at the TAC in February that we're now including reps from Tribal Epidemiology Centers in those listening sessions, and we'll see them at our gathering in August to help inform any data helping drive our direction.

All that's good, so good.

But let me go back to Patricia's story for a minute-here's what's not so good about her experience. Until that friend pointed her to VA-and thank heaven for friends-Patricia said she just didn't know that VA was there for her. And we have to wonder-had she known, could she have been spared suffering, avoided getting to crisis before getting to help? And, by extension, we have to wonder-among the 144,000-plus American Indian and Alaska Native Vets living today, both urban and rural-how many more people like Patricia are out there, Native Vets who just don't know that we're there for them?

And that's why I'm here. That's why we're all here, to do everything we can, together, to make sure every Vet's needs are met, and to make sure every Vet knows we're here for them, and knows what's available to them.

And, with that in mind, let me revisit some of the things we talked about last spring-the co-pay exemption, our reimbursement agreements with UIOs, and the PACT Act. And I want to quickly bring you up to date on some of that work, ask for some help, and touch on a few other points.

Co-Payment Exemptions. It was right around this time last year that we started exempting co-payments for American Indian and Alaska Native Vets, Vets like Patricia who are getting some VA care. Since then, nearly 6,000 have applied for the waiver. Over 5,000 have been approved. And nearly 180,000 co-payments have been exempted or reimbursed, right at $3.2 million for Native Vets. Now, as Dr. Prairie Chicken briefed the Tribal Advisory Committee last February in Oklahoma, some Vets weren't approved because their applications were simply illegible. And some weren't approved because Vets didn't submit tribal affiliation documentation necessary for eligibility.

But here are two things that concern me. First concern-about 65,000 Native Vets are enrolled in VA health care. Not every one of them may be eligible. Still, we want them to apply so we can help determine eligibility. So, we have a long way to go getting applications from about 59,000 more American Indian and Alaska Native Vets.

Second concern-among those who haven't applied, how many just don't know this benefit's there, for them? I think we've got the waiver right. I don't think we've got the communications piece right, yet. So, help us spread the word. Encourage Vets UIOs are serving to apply … maybe put a message and link on your websites to VA's application site, and reach out to Dr. Prairie Chicken about providing outreach in your area.

Sonya, I'd appreciate your help with that, and whatever you, the Council, and the TAC think can help spread the word. Native Vets-just like all Vets-deserve to have access to high quality care when they need it, where they need it, no matter where they call home, and whether they receive that care at VA, a UIO, a tribal health facility, or IHS. That's what our co-pay exemptions are about. That's what our VA-UIO reimbursement agreements are about, as I said here last year.

So, reimbursement agreements, let's turn to them for a moment. Right now, we have reimbursement agreements with six UIOs. We're working with seven more. Frankly, I was hoping to see more uptake and relationship building between the local VA and UIOs. My sense was that they'd really catch fire. Yet, even among the six, we haven't paid any reimbursements.

Tomorrow, VA's Office of Integrated Veteran Care has an Urban Confer with you on this topic. They'll dive into it in detail, present the updated agreement we're working on. That updated agreement has some administrative changes-like expanding the timeframe facilities can submit claims to 36 months. And it includes reimbursement for more direct care services, durable medical equipment like eyeglasses and wheelchairs, and long-term care. Basically, we want to cover anything a Vet's eligible for at VA. And we're considering dropping the expiration-date entirely so we're not endlessly renewing agreements unless there need to be changes. Bottom line-we've got to get this right for our Vets, and I look forward to hearing about your recommendations after the Confer.

I deeply appreciate your help on that.

And I'll appreciate your help on the PACT Act benefits for American Indian and Alaska Native Vets. All American Indian and Alaska Native Vets should know about, and apply for, their toxic exposure benefits, their PACT Act benefits. We owe them that, yes? Remember, these are new service-connection presumptions for more than 20 health conditions related to toxic exposures-Agent Orange, burn pits, and a lot more.

So far, 14,000 Native Vets have filed claims. Nearly 8,000 have been granted. And that's meant over $48 million in earned benefits for Vets and their families. But, again, I'm concerned. That 14,000 represents just 30% of those we estimate are eligible. And, again, that question-how many just don't know?

In March, we made three new groups of Vets eligible for VA health care under the PACT Act. Vets who served in Vietnam, the Gulf War, Iraq, or Afghanistan can enroll. Vets who deployed to any combat zone after 9/11 can enroll. Vets who deployed in support of the Global War on Terrorism can enroll. And Vets can enroll who never deployed, but who were exposed to toxins or hazards while training or serving on active duty here at home-working with chemicals, pesticides, lead, asbestos, certain paints, nuclear weapons, x-rays, and more.

Vets don't need to wait to be sick to enroll. They shouldn't wait. All they have to do is show they served in one of those locations, or operations, or participated in one of those activities that could have exposed them to toxins or hazards. It's critical for Vets, to be sure. But it's also an opportunity for us, at VA, to build trust among American Indian and Alaska Native Vets, their families, caregivers, and survivors of these wars where we don't have trust. And it's an opportunity for us at VA to restore trust, trust we've broken because we failed them in the past, failed to provide the culturally competent care we owe them.

A quick example. Vietnam Vet Robert Wilson of the Cheyenne Tribe of Oklahoma came home from Vietnam. Like so many Vietnam Vets, he was met with hate. And VA wasn't a lot better. "After Vietnam," Robert said, "the VA wasn't much help to old timers like me, and we had bad experiences."

Trust, broken.

Well, when VA Oklahoma partnered with the Cheyenne and Arapaho Tribes Veterans Department and brought VA benefits to those tribal lands, Robert gave VA another try. He filed for his PACT Act benefits, was given 100% disability, and he enrolled in VA health care. "Let's just say VA isn't what it used to be in the 70's," Robert said. "It's come a long way, and in a positive direction."

Trust restored.

And we need to build that trust, long before crisis, so we can do everything possible, together, to help them avoid crisis. Vets may not need the care the PACT Act affords them today. But they might need it tomorrow, or the next day, or 30 years from now.

All they have to do is enroll, and they have access for life. We just want them to know that. So, again, Sonya, everyone, help us make sure every Vet in your community knows about the PACT Act, and how to apply-even if it's just a short message on your web page and a hot-link to our PACT Act site.

Here's my point, and I'm finishing up. We cannot forget that in all the top-tier work we're doing, the only thing that finally matters are the effects at the local level, the day-to-day delivery on tribal lands, in urban communities, the positive outcomes for the Vets. That's what matters-good outcomes.

And that's why our partnership, our collaboration is so critical, on so many of our shared initiatives. And that collaboration, it makes a difference. Patricia Tavella will tell you that "it's meant the world" to her. "Fifteen, 20 years ago," she said, "there was no such thing as collaboration like this, this coming together."

That what we're all about-this collaboration, this coming together, and doing it so well-like you always do-to fulfill that sacred obligation, to change the lives of all the Robert Wilsons and Patricia Tavellas for the better. No matter where Native American and Alaska Native Vets choose to get their care, we want them getting the excellent, culturally competent care they need, that they've earned, that they deserve-care that resonates with their spirit, that gives them the opportunity not just to survive, but to really thrive.

God bless all of you, and the Vets that-together-we're devoted to serving as well as they have served all of us.

Thank you.

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