▶ 0:18:54>> noon. Calling this oversight hearing to order. We are here this afternoon to examine critical programs within the U.S. department of health and human services that are also essential to upholding the federal government's trust response ability for the health and well-being of native communities that are not under the indian service.
▶ 0:19:24We have -- are just as in as those under the ihs. These programs often provide the only consistent access to basic supports for the most vulnerable members in native communities. What programs are we talking about? Tribal head start helps children grow healthy. It ensures tribal elders have heat in the winter and air conditioning in the summer. These aren't just federal services.
▶ 0:19:53They are critical components of the social safety net and my view is that these programs support family stability, child development, and basic dignity. Today, we are going to hear about hhs programs -- the family violence prevention and services act, the primary federal funding stream supporting vital crisis services and shelters for those experiencing family violence and we will hear about how tribes are reducing the cost -- the risk of costly intervention and foster care removals through
▶ 0:20:24Child welfare services. These programs help break intergenerational cycles of trauma, support safe housing and equip native families with the tools to thrive. Many trans built these effective programs of generations from investing their own resources, training their own workforce is they better align with their community needs. These are models of local innovation and sovereignty and they deserve protection and sustained support.
▶ 0:20:49Given the scope and critical nature of these hhs programs, we are hearing growing concerns from tribes and native communities about the executive orders on optimizing the workforce across the federal government and the hhs announcements about reorganization. I hear regularly from constituents that are asking how do these proposals affect me and the delivery of essential services? I want to thank senator kennedy for recognizing the importance of ihs very early on.
▶ 0:21:19He made clear that they were not going to be subject to those. We are now asking for the same understanding for other programs at hhs and that starts with tribal consultation at hhs on these programs. I think it has to occur early, be consistent, and be meaningful. When tribes are truly engaged in shaping the policies and programs that serve their citizens, outcomes improve, trust deepens, and federal resources are more effectively aligned with local priorities.
▶ 0:21:48These programs work best when they reflect the voices of the people they are meant to serve. Forms like this hearing are also important. This is your opportunity to make your case for these programs to the legislative branch but we also know hhs will take notice, too. I was in a hearing that began at 1:30 and secretary kennedy was there.
▶ 0:22:13I have alerted him that we were having this oversight and he said if he was not in that hearing, he would be here as well which I appreciate. And I think perhaps some of his team, if they are not in the room, they might be watching or listening. So I think what we learn today is not just going to be confined to this room, this audience, but broader.
▶ 0:22:39I want to thank all of you for traveling with us to be here today or if you are here in D.C., your journey is a little bit easier but I know your time and expertise are invaluable. The insights you share will help inform our continued work to uphold the promises made to native communities so I am looking forward to your testimonies. I now turn to the vice chair for his comments. I want to extend a special warm aloha.
▶ 0:23:10It is the sole entity responsible for coordinating native hawaiian healthcare services and is a leading voice for health care across the state of hawaii. The hollow for your continued leadership on behalf of native hawaiian people. Providing health care is one of the federal government's most fundamental trust and treaty responsibilities to american indians, native hawaiians, and alaska natives and delivering on that promise depends on over a dozen hhs agencies, not just the indian health service.
▶ 0:23:39For native hawaiians in particular, the trust and responsibility extends but despite a promises from the secretary about strengthening native health and addressing long-standing issues, we have seen that this administration is engaging in staff layoffs, office closures, funding freezers, and proposed budget cuts that will undermine the quality of care and overwhelm a health care system that is frankly already on the brink.
▶ 0:24:10Excuse me. Native people are among the most vulnerable in health terms in the country, falling behind on almost every metric. They experienced some of the highest rates of cancer, heart disease, respiratory illness, diabetes, overdose, and suicide, and the life expectancy is the lowest of any racial group in the united states and nearly 10 years below the national average so the status quo was insufficient to begin with and then came the sweeping cuts at
▶ 0:24:40Cdc, acf, and other offices and programs. Ac/dc team supporting overdose prevention was reduced from seven staffers to a single human who is now responsible for managing millions of dollars in funding. The healthy tribes program which is focused on preventing certain chronic diseases was gutted.
▶ 0:25:06Five hhs regional offices which serve 400 61 tribes in 22 states terminated staff and were abruptly closed in march and all of this means that native communities have less support for job training, childcare, domestic violence victim services, suicide and substance abuse prevention, and much more. These cuts are being carried out without any tribal consultation whatsoever in plain violation of our treaty responsibilities.
▶ 0:25:34This is not just a moral question of what we owe native people. It's also a question of the law. Let's be clear clear, the status quo is already insufficient. The administration's repose cuts of nearly $1 billion to native health care will make matters worse. There is bipartisan agreement on this committee that these communities need more help. Now is the time to stand together to protect native health care. I want to thank our witnesses and I look forward to the hearing.
▶ 0:26:05>> thank you, senator. We will now turn to the witnesses and I am going to turn to our colleague from south cota to do the first introduction. >> thank you, madam chair. And vice chair. I want to thank you to our witnesses as well for taking the time to attend today's hearing and share your perspectives. Today, I'm proud to introduce my friend, chairwoman janet of the standing rock sioux tribe. After retiring as a staff sergeant in the U.S.
▶ 0:26:33Air force, the chairwoman returned home to serve the standing right sioux tribe. During this time, she oversaw the daily operation. In 20 21, janet became the first woman ever elected by the people as chairwoman of the tribe.
▶ 0:26:56The chairwoman provides an important voice on several key tribal issues including health care, public safety, and economic development. In recognition of her leadership and advocacy, the chairwoman was named one of usa today's women of the year in 2025. Not bad. Congratulations. As a matter of fact, congratulations.
▶ 0:27:23She continues to advocate for her people as a board member of the national indian health board. I want to again thank the chairwoman and all of the other witnesses for attending today's hearing. Thank you, madam chair. >> thank you. I will make full introductions of everyone and then we will begin with individual statements. Following the chairman, we have the honorable lonnie, vice chair of jamestown -- say it again.
▶ 0:28:00The tribal council from washington and we also have from fairbanks, alaska, melissa charlie. Melissa is currently the executive director of fairbanks native association. She is a tribal citizen and has been involved in many leadership capacities in her region.
▶ 0:28:28She is focused and committed to early childhood development and community wellness and I really appreciate the fact that you traveled so far to be with us. Following melissa, we have lucy simpson, the executive director for the national indigenous women's resource center from laimbeer, montana, as well as Dr. sherry and daniels, the who the vice chairman has already introduced. I'm going to just try to say it.
▶ 0:28:59As the chief executive officer -- I have -- ok. From honolulu. It is good for us to be working through the names and doing them correctly to show that respect. I want to remind everyone that we do have your full testimony that each member has. We would ask you to try to keep your comments to five minutes so that we can have questions following your statements.
▶ 0:29:30So chairman, you may begin with your testimony. >> good afternoon chairwoman, ranking member, and distinguished members of the committee. On behalf of the national indian health board and the 574 sovereign, federally recognized nations's reserve, thank you for this opportunity to provide testimony today.
▶ 0:29:56My name is janet and I serve as the chairwoman of the standing right sioux tribe standing rock sioux tribe and the great plains are presented for the national indian board. A descendant of the lakota leaders who signed the 1868 for their army treaty. I am a beneficiary of the treaty trust obligations enshrined in that agreement which continue to shape the rights of our people in indian country.
▶ 0:30:24The department of health and human services delivers vital programs to tribal nations and citizens and form a part of the federal government's trust and treaty obligations. These services, many beyond the indian health service, are essential to the health and well-being of our citizens. As tribal leaders, we are deeply concerned about the ongoing hhs reorganization and its far-reaching consequences for serving tribal nations and their citizens.
▶ 0:30:54Despite chronic underfunding, tribal nations and tribal organizations and urban indian organizations rely on hhs resources to deliver life-saving care. Tribes have long supported efforts to streamline federal programs, reduce reporting burdens, and direct funding to the indian health system. Any reorganization must honor treaty and trust obligations including meaningful consultation.
▶ 0:31:21We have urged hhs to hold consultations to ensure programs that serve tribal nations and citizens are protected. To date, the -- the reorganization has reduced staff by 24%, disrupting grant access, tribal advisory committees, and causing staff to leave. This has already resulted in the cancellation of over 6 million dollars in grants, jeopardizing critical infrastructure for the indian health system.
▶ 0:31:50The great plains is experiencing a syphilis epidemic with rates among native people rising to 1865% from 2020 to 2022. 10 times the national average. The cdc played a key role in the response but the recent restructuring cut nearly 20% of its staff including those staff supporting our tribal epidemiology center.
▶ 0:32:16The office of infectious disease, hiv-aids policy also lost staff, ending a program that awarded 16 million dollars to 18 indian organizations, improved hiv outcomes by over 90% at the phoenix medical center.
▶ 0:32:33This leaves us without essential federal sti response support and additionally, majority of the staff operating healthy tribes program under cdc which oversees several grants including good health, wellness in indian country, grantees are receiving conflicting information about their grants and their programs are in limbo. One tribal grantee has already received notice of the termination.
▶ 0:32:59They have reported losing communication with their project officer and grants manager, leaving a critical gap in their program. Cdc's division of reproductive health is a huge component for tracking maternal health outcomes nationwide including native moms.
▶ 0:33:17These staff were also placed on administrative leave and updates to the pregnancy risk assessment monitoring system, one of the few national data sources that tracks native maternal and infant health disparities has been paused. Because of this, we are losing vital tools for identifying risk , interventions, and saving lives. The center for mental health services has seen major staff cuts.
▶ 0:33:43Key tribal behavioral health grants have been terminated or left in limbo even when funding has been removed. Temporary disruptions in funding can destabilize programs. The tribal leaders are connecting with our youth program which applies traditional lakota values to reduce youth suicide through mentorship and culturally grounded education is at risk. This program reduced native youth suicides in our area by 78% from 2019 to 2024.
▶ 0:34:14Successful outcomes like this shows what's at stake. In conclusion, programs serving tribal nations and their citizens have a minimal fiscal impact but are foundational to improving chronic health conditions in indian country. Tribes share in vision for a healthy america but tribes must be consulted in the first instance. They want to work with hhs and appreciate with the secretary has done so far to protect our health.
▶ 0:34:41We want efficiency to provide direct funding to tribes instead of a reliance on state block grants which expand tribal self-governance outside ihs. We must avoid barriers which increase burdens and withhold funding from programs serving tribal tribes and their citizens. We can be the solution to a more efficient hhs.
▶ 0:35:08I thank the committee for this opportunity to provide this testimony. >> chairman. The next one will go to the vice chair. Jamestown. >> thank you so much. On the latest, chair, thank you so much for the opportunity and other members of the community that I know are here, I'm grateful for the time as well.
▶ 0:35:38I want to acknowledge the opening comments you said earlier. He will be hearing me repeat probably many of the things both of you have said already and for the vice chair, one of the things I said is I hate being the first place and everything like that. Chronic disease, all of these negative impacts, I hate being in first place and I want to fix that so that is one of the reasons why I am here testifying before you today so thank you for this opportunity.
▶ 0:36:05I have family in the great state of alaska so I get to visit often and it's beautiful there. So I am the current vice chair. We are located in washington, the great state of washington and I serve currently as the text chair so I am intimate with the programs and how those programs are being implemented on the ground especially within my region, state, and community.
▶ 0:36:30The jamestown tribe has a few acf programs so I get to see what those things are doing to my families in the most positive way possible. My service to my community comes honestly. I have seven generations worth of tribal leadership in my blood , all going from educational services to child where -- child welfare.
▶ 0:36:49For me to be a social services director is one of my passions and I currently serve as the chair of a few different tables in washington state as an indian policy advisory chair, serving the only chess social services in a traditional sense but department of corrections and health care authority as well so I am glad to be able to speak before you today.
▶ 0:37:10In ancient times, we had our own systems, such as speak, of how we addressed the community level needs than the family level needs and then the individual needs and most of that was addressed in our ancient times through communal living and spirituality because we believe mental health and emotional health, that was made whole through the spirituality so as the relationship between tribal governments and the united states was growing and came to be, it has evolved over decades and decades and decades, right?
▶ 0:37:43We have been learning how to evolve our systems. What does it mean to blend western systems with our indigenous perspective and being able to serve people with federal services? So this is why we are here and testifying as we are here to figure out how do we blend that altogether? That is essential to us figuring out how do we blend these systems together and make these programs work for us? How do we make these programs for our cultural needs and translate them into federal speak so we can access federal funds?
▶ 0:38:14The huge concern of the rifts at hhs as well as the proposed funding cuts, those are the things that are threatening our ability to be able to do that. These rift happen without consultation. The budget proposals happening without consultation. I have lost connections to my staff and reach at acf. That means my regional administrator, gone.
▶ 0:38:39Everybody is gone and this was all done without consultation and very little warning not only to the tribes but also to the staff and that also meant that we did not have any transition planning. There was nobody to tell us here is your next contact. For example, regions have been consolidated -- they have been eliminated and now, they are being consolidated into the rest of the five areas my new regional office is in denver, colorado and when you eliminate all of region 10, that is all of
▶ 0:39:10Alaska is more than 200 tribes. Washington's 29, idaho's five, oregon nine and that's 250 plus tribes that denver is absorbing into their portfolio. They don't know who we are. They don't know our lands. We need to be able to have people on the ground who know our land and our intimate cultural and political nuances and that is what these hhs staff members have been for us. They help translate our language into your language.
▶ 0:39:37So we can access funds that are obligated to us through treaty and trust responsibility. As I conclude with my remarks, one of the things that we want to see is just consultation. Consultation, consultation, consultation.
▶ 0:39:52We need hhs to understand the impact that have already happened because of not having consultation but we know there are regulation decisions to come, deregulation decisions to come in we need to make sure tribal voices are at the forefront, that we have our voices and impacts hurt so we can minimize impacts and maybe find some different creative solution that meets the federal goal but maintains treaty responsibility for our tribes.
▶ 0:40:19In conclusion, I want to acknowledge that secretary kennedy seems to want to work with tribes and I am glad for that. He advocated for head start for us and we saw that in the president's latest drafted budget so we are thankful to that. It is still being chatted about as well but we want to see more. You mentioned this earlier.
▶ 0:40:40Into chess programs as a whole, even if the word tribe, native american, or indian is not in the grant name, it still serves tribes and we want to be able to make our communities healthy so we continue to blend those systems together. Hopefully, get us out of first place so we can be healthy again. Thank you for the opportunity to speak for you today. Thank you. >> while said. Welcome to the committee.
▶ 0:41:07>> good afternoon, chair and vice chair and members of the committee. Thank you for this opportunity to testify today. My name is melissa and I serve as the executive director of fairbanks native association , a native nonprofit organization serving the alaska native community since 1967.
▶ 0:41:32I am here today not only on behalf of fna but to uplift the critical importance of tribal hester and other U.S. department of health and human services programs that serve native communities nationwide. Our tribal head start program is the foundation of our investment in early childhood development, cultural identity, and family stability.
▶ 0:41:55Our program offers not only education but nourishment, cultural grounding, health and intervention, while offering a healthy foundation for families who needed the most. Our classrooms honor native identity and anguish, installing pride in our community while preparing children for academic success.
▶ 0:42:13For many families, it is the first point of connection for our broader network of services that addresses wellness and family support. Our program integrates traditional knowledge, language, and values into every classroom. We know tribal hester and childcare programs across the country integrate various programs and grants to stretch every dollar and create a system of comprehensive community-based services.
▶ 0:42:39Many of these include utilizing headstart or connecting programs with language work at the administration for native americans. Indian country is the most dynamic investment the federal government can make. Our funding is no different.
▶ 0:42:55In addition to headstart, they offer critical programs under hhs including a youth and adult behavioral health treatment program which provides services that integrate minted culture values and practices with evidence based approach funding.
▶ 0:43:13Child welfare community-based family prevention, emergency use shelter services, and family in domestic violence prevention and services under acf and we utilize funding under -- administration on aging teva six funding which fosters a healthy and connected elder community by providing nutrition, support services, and caregiver services. Yet despite decades of success, tribal headstart and other programs remain under resourced compared to other nontribal counterparts.
▶ 0:43:42We face challenges retaining qualified staff. We need updated facilities, modern learning materials, and a more robust professional development which requires an increase of stable federal investment in partnership with travel organizations. Now is not the time to divest these programs. Now is the time to invest in indian country. The same way the federal government hopes to reinvest in states.
▶ 0:44:07These programs work to form a safety net for tribal families who too often exist in a gap where they remain underserved by state and local communities. Travel programs like these are a direct impact for fulfilling trust and treaty organizations -- obligations to tribes.
▶ 0:44:27They have done so through native organizations had whether it tribal nation or native organization, we are in the best position to deliver these services because we understand our communities histories, our strengths, our need. Tcc is our sister organization providing a large array of prevention and clinical services across interior alaska appeared either in complement of the services or in collaboration, tcc relies on federal funding
▶ 0:44:58Guaranteed under the federal government's trust obligation to alaskan natives and american indians which requires the united ways to protect tribal lands, assets, resources and treaty rights and to provide certain services such as health care, education, and housing. The federal trust obligation is not one that can simply be transferred to a state government. It is the legal and moral obligation of the federal government alone.
▶ 0:45:21There's many tribes and many tribes across the country, these programs are not simply support services. They are a nation to nation partnership upholding the federal reserve -- federal trust responsibility to families and communities.
▶ 0:45:40Today, I urge congress to maintain the tribal headstart program and other childcare funding and support such a childcare development fund, ensuring these go directly to tribes work native organizations and that they are not rerouted through the states.
▶ 0:45:56To protect funding for acf programs including by protecting administration for native americans through streamlined funding which is provided to tribes and native organizations to support infrastructure investments so tribal providers can modernize facilities and expand reach. We stand ready to work with the administration and congress to streamline and strengthen these programs with quality investments. Thank you for holding this important hearing and for your continued focus on the health and well-being of native communities.
▶ 0:46:25I look forward to your questions. We turn to lucy simpson. Welcome. >> terry gou. Thank you, members of the committee, for the opportunity to testify today on the critical role of hhs programs serving indian country.
▶ 0:46:53My name is lucy and I am the executive director of the national indigenous women's resource center. We are a native led nonprofit dedicated to restoring safety from native women and families. We serve as a national indian research center addressing the mystic violence and safety for indian women and the tribal safe housing capacity building enter under the family violence protection act.
▶ 0:47:18I want to ground this testimony in the grounding principal of the federal government's work, trust and treaty responsibility to tribal nations. This responsibility is not abstract. It is a legal and moral obligation. Hhs plays a crucial role in fulfilling this obligation not only by providing public health services through the indian health service but also providing services that address the public health crisis that is violence against native people.
▶ 0:47:45Congress reaffirmed this obligation and the -- in the reauthorization of 2005, stating that indian tribes require additional films service resources to respond to violent assaults against women and the unique legal relationship of the united states to indian tribes creates a federal trust responsibility to assist tribal governments in safeguarding the lives of indian women.
▶ 0:48:09By investing in tribal nations and native led organizations as they design and implement community driven culturally grounded services, hhs programs become instruments of tribal self-determination. Such programs include those funded by phipps -- fipsa.
▶ 0:48:30It remains the only federal funding source specifically dedicated to emergency shelter and related services for victims and their children and is especially important for tribal nations and american indian, alaskan native, and hawaiian victims of violence. More than four in five making indian and alaskan women have expanse violence in their lifetime and more than half have experienced sexual violence and intimate partner violence.
▶ 0:48:59It reflects a complex public health and safety per crisis which involves jurisdictional confusion, a lack of law enforcement presence, geographic isolation, historical trauma, interest -- distrust of systems yet despite the pervasive levels of violence, many tribal communities still lack access to the most basic safety services with fewer than 60 natives -- native centered domestic violence shelters across all of indian country.
▶ 0:49:28It provides counseling services, tribal domestic violence programs, strong hearts native helpline, and resource centers like ours, all of which ensure that culturally appropriate services are available where they are most needed. But recent and abrupt changes within hhs, specifically the removal of experienced staff and leadership from agencies and programs that serve indian country threatened to destabilize the progress made.
▶ 0:49:53Sudden changes in leadership, staffing, and structure, especially without tribal consultation, can disrupt the continuity of services, erode trust, and delay funding for life-saving programs. At a time when native women face the highest rates of murder, rape, and abuse in the country, preserving institutional knowledge in maintaining stable, informed, and responsive leadership is not just a matter of continuity. It is a matter of life and death.
▶ 0:50:20Every day, we hear from front-line advocate who was limited resources are saving lives by creating safe homes, traditional healing circles, and language-based advocacy services that allows survivors to heal in ways that reflect their values and culture. When winvest in native nations -- when we invest in native women, we invest in the future of tribal nations.
▶ 0:50:43We respectfully urge congress and hhs to fulfill your trust and treaty obligations by prioritizing, strengthening, and expanding all programs that impact the health and safety and native peoples and for hhs to engage in meaningful government to government consultation with tribal nations before making changes to program structure, leadership, or funding. Thank you. >> thank you. Finally, Dr. daniels, welcome.
▶ 0:51:11>> aloha, chairwoman, and vice chairman, thank you for the introduction. And members of the committee. Thank you for inviting me today to provide remarks on behalf of of the native hawaiian health board. We appreciate the committee's legacy of strong bipartisanship in honoring the federal trust responsibility and I am honored to hear and to learn from other native american leaders and communities on this panel because whose comments, stories, and challenges that they shared are what we face as well.
▶ 0:51:45It was congressionally and statutorily created in 1988 to improve the health status of native hawaiians and the named entity in the native health care improvement act. We are statutorily named and created to support and uplift the health of native hawaiians. And as the named entity, we have the statutory responsibility for the coordination, implementation, and updating of a comprehensive health master plan.
▶ 0:52:14The identification and research of diseases, establishment of a network of health resources, services, and infrastructure through our five island community-based health organizations as well as administer a scholarship for health care professionals. On the topic of this oversight hearing today, it is in our written testimony, we highlight the following key messages. Federal trust responsibility to native hawaiians are based on our unique political status, not on our race.
▶ 0:52:44So let me say that again. There is a trust responsibility to native hawaiians. And that is through policy, funding, and consultative practices which we often do not get.
▶ 0:52:59Our unique political status is recognized in other congressional acts, not just the native hawaiian health care improvement act and this is with a population that has grown 29% since between 2010 and the 2020 census. That is huge. For almost 40 decades, we continue fulfilling our statutory responsibility including era native hawaiian health systems.
▶ 0:53:25We do this through funding with hhs. We talk about ihs and you are correct that we do not get any funding through ihs so the bulk of our funding comes from hhs and that fulfillment of the federal trust responsibility for native hawaiians are in the ways of programming and funding and primarily -- and the other hhs areas including samsara, we
▶ 0:53:55Would be impacted through mental health and substance abuse and we all know what those statistics are. In addition to that, we also currently are supporting the lahaina wildfires impacted families. Over the last two years, over 12,000 families, 30 4000 people, 3700 professionals, boots on the ground, and over 140 organizations had a role in that and continue to have a role in that.
▶ 0:54:24We need to continue to focus on the most vulnerable of populations, programs that address the self-sufficiency of native hawaiian families and that is ems. Our native hawaiian population in hawaii is 21% yet for families, 33% of them are native hawaiian. For victims of child abuse and neglect, 39.7%. Those are large numbers, greater than our population.
▶ 0:54:58The total hawaiian population currently receiving medicaid equals almost 77,000. That is a lot. 34% of them are children. That is not acceptable. If we talk about our cultural values and where we put our youngest as well as our oldest, that is culture. When we remove those things, we create at the impacts and other concerns down the line.
▶ 0:55:28Cdc, the prevention services, tobacco, chronic conditions, we all know diabetes. Diabetes does not discriminate. It is no longer just a native issue. Cutting those services has huge impacts. We want to make sure we continue to advance the missing and murdered hawaiian women and girls initiatives with our travel partners. We know that a quarter of the missing girls are native hawaiian.
▶ 0:56:00We also want to recognize communities and the impact it has on health, that health policy should aim to reduce differences between rule and city areas. It is especially important because our native communities, for many of us, tribes, everyone, our people live in rural areas often with limited access to services. And finally, we need to continue to strengthen our networks.
▶ 0:56:28In our written testimony, we highlight the native collaborators across our eight major islands. It is not just us. We recognize it is our native hawaiian health systems, federally qualified health hospitals, and especially our community-based organizations. We are doing it with everyone, linking arms.
▶ 0:56:51I think that is important to recognize and these are just some of the highlighted examples of the impact that hhs and reduction in the things that are happening could happen in our communities. I look forward to answering any question from the committee. >> appreciate your testimony and what you bring to the conversation here today.
▶ 0:57:15I want to start with tribal -- by the chairwoman and lonnie as well. I think all of you reference it and again, we are seeing changes that are going on.
▶ 0:57:32I believe it was you, chairwoman, that indicated that a letter had been sent urging tribal consultation in light of the reductions in staffing and the cut.
▶ 0:57:52I am assuming that if there has been a response to that that initial consultations have yet not in maid. Can you clarify for me where we are in that? >> yes. I think I just want to say thank you to the ladies here also. We come here to make these statements. Thank you, committee, for hearing what we have to say.
▶ 0:58:23But we know what we have to say has to come from our heart. Our people have always struggled with the fact of consultation and I think, you know, we send these letters but we have not heard anything yet and I think that is the issue that I think all of america is dealing with, with all these issues that we have. These are saving lives.
▶ 0:58:51The consultation for tribal leaders and those involved with these grants, that are receiving these grants and implementing these programs in the real communities, that -- that's the voices that need to be told how important these programs saved lives for our people.
▶ 0:59:09>> that is why we are having this conversation with you, representing the many voices from your tribes, tribal communities, your regions. As I mentioned, secretary kennedy was before the health committee today and it is important for him to be presenting the budget as we know it at this point in time.
▶ 0:59:40But this feedback is so necessary. We have talked about seeing what is happening with the proposals for consolidation. The administration for healthy america will consolidate the office.
▶ 1:00:03In so many of these agencies that are really very critical to the services that are provided to our tribal communities feared what I am hearing is they are acting first, you are responding, saying we need to know what is going on and true consultation is not a responsive action.
▶ 1:00:28It is being there at the beginning so that some of this input, the imperative of travel has started, the imperative of fipsa, that that is factored in before the decisions are being made. I just want to mention that for the record, we are hearing from you as leaders in your respective areas is that that outreach has yet to be had.
▶ 1:01:00Is that correct? I see everybody nodding their heads. Vice chair, I want to ask because you have great detailed insight into the travel advisory committee, emmanuel -- given your role there.
▶ 1:01:19Given the reduction of tribal engagement staff that we are seeing that acf going from five to now just two and the loss of the regional tribal program leads, what is this meaning on the ground for you? You mentioned the consolidation within the region so alaska, washington, and some of the other impacted areas are now reporting into denver.
▶ 1:01:47Just quickly, what is the impact of all of this? What do you think is needed to restore effective tribal advisory functions during this were organization? Because we have got a reorganization going on and it is pretty public here. Tribal advisory role is pretty key. How do we make this more effective? Corkscrew questions.
▶ 1:02:16So the effect of what we are seeing now with the wrists -- >> great question. They were helping leadership be able to understand tribal nuances. What does it take for us to participate in grants? It was also helpful in the constitution setting where we could help form agendas together, make it a collaborative process rather than a one-sided federal process. Consultation is both a us coming together, right?
▶ 1:02:49Walking out the door is tribal nuanced knowledge, institutional knowledge and intimacy with the tribes so all of the advisory is walking out the door, unfortunately. We are left behind with staff who may be have minimal knowledge or no knowledge and they are learning it as they go and it takes a long time to understand tribes so that is one of the areas I have a huge concern about. What can it take in the meantime? If we could get those staff back my don't know what process that would take if we could get this particular staff back, that would be wonderful.
▶ 1:03:21Having the consultation process with tribes, if you brazil tribes. Each branch of hhs with tribes so we can dig into those particular programs and those nuances and that is meant to be mosul because we have lost this advisory staff.
▶ 1:03:37>> this is a question that my colleagues would agree is worth drilling down on because the secretary has said to individuals within hhs that have been terminated that if they so desire, they can move over within the ihs sphere.
▶ 1:04:02Does that make sense or are you talking about levels of expertise where a body just isn't a body? Corkscrew question. I would be concerned that ihs becomes all things indian for ahs because it is strictly about health. When hhs programs and tribes, it is all into hs offices so I need expertise in each branch of hhs. >> very good. Thank you. Vice chair. >> thank you.
▶ 1:04:29It occurs to me, obviously, you are the chair and you can tell us how to work together on a bipartisan basis but it seems to me this hearing is calling for some follow-up and is using their keen meaning authority because nobody is talking to anybody and I think it should start -- we could suppose how things might work better and we might have some pretty good ideas but it sort of starts with you knowing who to call and that person having any authority or knowledge at all so you know, I
▶ 1:05:01Am not a believer of just getting everybody into a room and it will work out but I do think that is probably a necessary condition for success that we start to have a dialogue and know who our points of contact are and kind of what the path forward is. I commit to you, chair, that I do my fair share of partisan fighting.
▶ 1:05:23This is not the place for that and I will try to make sure that we keep it on the substance of the matters so thank you for your leadership. . Dr., welcome. We are authorized to coordinate health care programs and services for native hawaiians, some with community health organizations. Are there any other entities authorized to do this work under the statute? Thank you. >> sorry. No other entities.
▶ 1:05:54>> the only entity across the state, what is your service population and what happens if funding gets cut? Once our service population is targeting native hawaiians. Because we get federal dollars, we cannot limit access so it is community.
▶ 1:06:15Just in our five systems, we are serving over 70,000 individuals touch points. That is clinical, nonclinical, or. We know in our communities, face-to-face, going out to where they are at, that is what we know we have to do. Traditional practices. All of those things roll up into those numbers and that does not include our network runners so it's not just the five systems. We contract with other sq hc's.
▶ 1:06:50We realize we cannot be the do all nba. In our community does not only see one type of provider so reaching out to our community health centers, our hospital and institutions, we are creating bridges and partnering with them but also, our community-based organizations across the state. So adding those numbers and, those touch points, comes -- it grows.
▶ 1:07:16We know that that is how our community gets help and accesses care. And to adjust that to already be fearful about cuts in funding, people are scared and nervous and having the reach out to allow us to keep a pulse on what is happening with our community so we can report that but also so we can get the stories which we did provide in our written testimony from communities in
▶ 1:07:46All different areas. >> thank you. Everyone is tracking that there is a house bill that will cut medicaid by $700 billion. There are carveouts for alaska native and indian tribes.
▶ 1:08:12There are no carveouts for native hawaiian health and I'm wondering if you can speak to the impact of medicaid cut for native hawaiians. >> good question, senator. I want to say this because I think one comment -- because I think there is an exclusion of native hawaiians which is unacceptable. That should stir something in all of us.
▶ 1:08:38We talk about being native communities yet we exclude and that is not acceptable. So just at the offshoot, the exclusion of native hawaiians in that house carve out, it perpetuates the belief that within the -- within departments and agencies, we do not exist. Some of our other tribal communities might fill that way. These moments of not existing and we cannot perpetuate that.
▶ 1:09:08But I think the biggest piece is in imposing these new hurdles. That is when I am going to call them. It is just that. They are hurdles that impact eligibility, slow access to identification of needs. They slow access to services. We don't need any more slowdowns.
▶ 1:09:32And specifically if you talk about the work requirements, employment is one of the social determinants of health. And if we are talking these things, saying these things, all of this adds to our community and the people we work with. I think already -- I'm sorry. Native hawaiian employment rates are amongst the lowest in our state and you couple that with the highest health disparities and it doesn't look good. It doesn't fit.
▶ 1:10:05Basically, health plus employment are seen as separate issues and they are not. Employment equals health and health equals employment. >> thank you. There are a lot of very valid complaints about the health care system. I have never met a single soul who has asked for more paperwork and that is a lot of what the house bill does.
▶ 1:10:30>> so, the senator was here first but he just kind of walked in if you want to catch your breath and let senator smith go. [applause] -- [laughter] >> thank you for this hearing today and thank you so much to all of you for being here and for providing your testimony.
▶ 1:10:54I think that now is a very good time to be talking about hhs programs and how they should be benefiting native people as part of our trust and treaty responsibilities and to acknowledge what the trump administration is doing, what secretary kennedy is doing and getting and reorganizing, the department is directly hurting.
▶ 1:11:16-- communities, native communities in this process and I think it is so ironic because during his confirmation process, the secretary attempt a lot about being a champion for native people. He worked hard to build his reputation for being a leader who was going to keep native people in his mind for yet in his role so far, I think the reality has been very different.
▶ 1:11:45I am struck by the stunning lack of consultation you all have described in your testimony. That travel consultation is not -- it is part of our trust and treaty responsibilities, recognizing your sovereign nation status to do that.
▶ 1:12:08Whether come to suicide prevention, all of these are vital to the health and well-being of native communities and god knows, ihs needs reform and improvement and more funding but to be clear, that is not all that we are talking about here and so I am grateful for this hearing and the opportunity to talk about this because I think in many cases, I know from the nations that I represent in minnesota, that these are issues
▶ 1:12:38Of life or death and I have such direct consequences on what happens to people in their lives. I appreciated very much the question that the chair snuck in at the end that I want to follow up on.
▶ 1:13:00There has been this information about how senior career officials who are tobacco regulators, research scientists, and others, as those jobs are being eliminated have been offered jobs in far-flung locations in ihs and I mean, as I was reading this, I found this offensive.
▶ 1:13:31To have individuals -- these are clinical jobs for the most part and these jobs would be offered to be filled where we already have such a great shortage of staff and people with folks that don't have clinical experience so I want to ask any witness if you could comment on this, what impact you see this has and how you -- how do you view this? I can open that up to anybody. Sure. Yes. Would you like to take this?
▶ 1:14:02What's yes. In preparation for coming here, you know, all of us ladies here, we all have an area but one of the things in my regard was to talk to our ceo at our ihs facility and talk about the impact it has had in regards to staffing and the loss of providers and I am glad secretary kennedy -- letting up on the hiring freeze but it is not -- it needs to be across the
▶ 1:14:35Board, especially especially for those types of providers that we need, and to provide that health care. The staffing is so important for these facilities. If we can't even hire a maintenance janitor, that means the safe. These kind of basic things. So I think all the ladies could agree on that.
▶ 1:15:08There is huge need.
▶ 1:15:09Sen. Smith: I'm sorry, and sending a research scientist who specializes in tobacco cessation research to an ihs facility when what's needed is not research but clinical care does not really solve any problem.
▶ 1:15:31Chair Greninger: May I? The other thing we need to keep in mind, with tribal research, this is a historical issue of concern where research has been a used against tribes and implemented in the communities. If we will be eliminating positions of research with tribal knowledge, it's a double whammy.
▶ 1:15:57Chair Greninger: In the last budget consultation with hhs, I was wondering how if I make a better connection between nih and acf programs because data is huge? Child welfare, especially in the state systems and our own systems. To hear that those positions were also eliminated just because I'm not in nih intimately does not mean I'm not concerned and I don't see those issues in my tribal community.
▶ 1:16:25Sen. Smith: Thank. Chair murkowski.
▶ 1:16:30Chair Murkowski: Thank you, madam chairwoman. Can I jump back --
▶ 1:16:40Sen. Cortez Masto: I want to jump back to a few hc's. Medical funding is in trouble and if they don't get funding, they close their doors. In nevada we had -- have 28 federally recognized communities. Not everyone has a health center. So they rely on a few agencies. Sometimes they are a two hour drive.
▶ 1:17:09Sen. Cortez Masto: So we are not -- a carveout is not enough. It is really important that we provide a system of health care for our tribal communities that they cannot only access, that is reliable, affordable. Can you talk about the medicaid cuts?
▶ 1:17:32Sen. Cortez Masto: It's not just the impact of the communities themselves but surrounding communities whether the system of health care that could be devastated particularly in rural communities.
▶ 1:17:49Dr. Daniels: Absolutely. You brought up a good point that is not just the medicaid. Fqhc's are impacted. It includes the retention and recruitment of staff. For then we have several fqhc's in high rural areas that they supplement housing for those providers.
▶ 1:18:09Dr. Daniels: We have one island that access to it is on little planes and cats impacted. Where do the community go? Off island? We already have health deserts. Not the same way as south dakota but similar.
▶ 1:18:34Dr. Daniels: We have water between the islands, but when pregnant women cannot give birth on the islands, we are already eliminating another access point. That is a challenge. The one thing we recognize is the network. I think often times fqhc's and other health entities are siloed. We do what we do our community and that's it. We recognize that we no longer can do that. Resources go down.
▶ 1:19:03Dr. Daniels: We will need each other and to support and pool our resources so we can continue to serve our community. But when those keep getting pinged off, it is hard to do that. The communities grow and providers don't grow. They are still only a handful but the number that's coming grows. I think it is all of these domino effects.
▶ 1:19:35Dr. Daniels: It might seem medical -- minimal that we take off medicaid but we might not see it today or tomorrow, but we will see it as people start having to close. Not even just closed doors but close servicers. Maybe we are not doing five types of services, maybe it's only two. That becomes a problem. For us, we look at if that service is not provided on their island, where do they go?
▶ 1:20:01Dr. Daniels: Do they have access to pay for a $200 ticket to fly to the next island?
▶ 1:20:09Sen. Cortez Masto: It is the same in rural communities as well. In nevada, sometimes you have to drive for hours just to get access to health care. That's if you have a car. It is a system that will shut down that is essential for providing health care that quite honestly you have worked so hard to put together because of a lack of resources and providers, and a lack of geography that brings everybody together like you have in urban areas.
▶ 1:20:40Sen. Cortez Masto: My time is running out. Mental health. I cannot stress this enough. I'm so concerned about the cuts to mental health services we fought for in the communities. There's a program called native connections and I know about it because in my state I have talked with so many of my native community members.
▶ 1:21:01Sen. Cortez Masto: There is a nine-year-old girl with -- in nevada urban indians struggling with mental health and she could not get care from a school or pediatrician but it was native connections program that according to her father got his daughter back. It is a native connections program. And so I don't know if any of you are familiar or talking about it but please, stressed the importance of life funding for programs?
▶ 1:21:34Sen. Cortez Masto: Talk about why this is so important.
▶ 1:21:39Chair Alkire: Thank you. I am so glad you brought that up. It is clear to me that programs like native connections save lives. Thank you for that. For my tribal community, last week, two suicide ideation's happened with a fifth and sixth grader. These programs are so important to save lives.
▶ 1:22:09Chair Alkire: Suicide rates for native youth are four times higher than any other racial or ethnic group. Native connections allows awardees to tailor culturally appropriate programming to reduce suicide, substance use and impact of trauma and in the communities. Native connections and strengthens community ties and providing culturally responsive support.
▶ 1:22:38Chair Alkire: Through this program, youth engage in models that promote through protective factors like personal wellness and positive self image and a strong sense of cultural identity. Without this funding, intervention and support services for native youth will become even more limited.
▶ 1:23:02Chair Alkire: This puts native youth, many of whom experienced discrimination, trauma, and loss of loved ones at greater risk for resources available for them to heal. So I think it is so important, it is life-saving. So thank you for that question.
▶ 1:23:22Chair Murkowski: Thank you madam chairwoman. >> thank you madam chair and vice chair schatz and each of our distinguished witnesses, thank you for taking time to be here away from other responsibilities and away from home. I know this is not easy.
▶ 1:23:48Chair Murkowski: Before I begin, being aware that secretary kennedy would have liked to be here and that his staff may be here or may be watching, I want to point out what a disappointment I believe this administration has been to the indian health service there's.
▶ 1:24:05Chair Murkowski: Recently when secretary kennedy was in arizona and gallup, new mexico, he was minutes away from one of the oldest ihs centers in gallup, new mexico. If he would have gone there, he would have seen this. What it says is do not drink the water. Do not use the water for consumption. Failure to follow this advisory could result in illness.
▶ 1:24:36Chair Murkowski: Do not use the ice made from tap water. For drinking and patient care, do not use it for baby formula, for brushing teeth, making ice, until further notice. The way I was raised as you make time for what's important. And he didn't make time.
▶ 1:25:00Chair Murkowski: The other thing I would share with secretary kennedy is it has been over 60 days members of the united states senate sent you a letter about the measles outbreak in america. Many of our consists rents are not just sick but some of them died -- constituents are not just sick, but some of them died. Keep your word. When you are sent a letter signed by members of the united states senate, you took an oath and said yes. Keep your word. I'm very disappointed.
▶ 1:25:31Chair Murkowski: Ms. charlie, as an alum of head start, I'm one of only two in the united states senate that went to headstart. I often joke, I thought everybody went to headstart. I did not know you have to be poor enough to go. I believe in early childhood education. I believe the united states senate, this is a place where headstart can get you in addition to other responsibilities around the world.
▶ 1:25:59Chair Murkowski: Research has demonstrated high-quality early childhood education programs increase childhood educational achievement later in life and reduce the likelihood of adult poverty. Right now there's conversations taking place about going after one program or another. Their statement on social media that are later redacted. What can you share with us about the importance of early childhood education and programs like head start to the livelihoods of kids and others you are honored to represent and speak for?
▶ 1:26:42Ms. Charlie: Headstart is critical to who we serve. We provide innovations, with a special education department. We do 45 and 90 day dental health screenings. We were provided referrals with health care for other specialists needed. We provide early intervention for kids so when they got into school, they are not delayed. The school doesn't have the capacity to do what we do.
▶ 1:27:10Ms. Charlie: They don't even screen for iep's until third grade. They don't have the capacity to provide the services we do at headstart. It is critical. It provides a structure for them , develops routines for them so they are ready when they get into school. Not only that, it supports the whole family.
▶ 1:27:35Ms. Charlie: Our program supports grandparents who volunteer. We are culturally based. We do culturally relevant activities. We are working on an additional app to get access to anybody who wanted it. So it is important that the school just doesn't have the capacity or resources to do what we do.
▶ 1:28:02Sen. Lujan: I appreciate that testimony. I appreciate all of us on this dais, we all care greatly for native american mothers and for babies, which is why I'm outraged by the fact that 90% of native american women who die from pregnancy-related deaths are considered preventable. Let that sit for a second. The cdc has seen a 20% reduction in staffing, leaving more vulnerabilities out there.
▶ 1:28:33Sen. Lujan: This could be all preventable. Can you speak to how a reduction in force at I hhs and pregnancy programs will affect people going forward, namely mothers and babies?
▶ 1:28:57Sen. Lujan: In the area of maternal health, with moms and especially with babies, looking at 92% of those we lose, it is preventable. There are conversations around the pregnancy risk assessment monitoring system getting support or not. Some of the layoffs at hhs. Do you have any thoughts about taking those programs away or making it harder, what impact would have on moms and babies?
▶ 1:29:27Chair Alkire: Yes, actually, there are several. We provided lot of this in the testimony because this is such an important issue for us. The investments, this is one of the conversations I had with the ceo in regards to young moms where I come from.
▶ 1:29:56Chair Alkire: She said the issue is that a lot of them, these programs fill the gaps because ihs does provide services, but these programs that hhs provide, they fill the gaps for a lot of our tribes with grants. One of them is to help young moms get some prenatal care, get some education.
▶ 1:30:23Chair Alkire: The issue I think with such scary statistics we have is that a lot of these are young moms and they don't come to the hospital until they are like going to have the baby so a lot of them need this education. They need these programs, they need grants that are out there to provide the connection for them to learn what is coming. That way even to see the baby's growth.
▶ 1:30:51Chair Alkire: That way it provides more of a connection for the mom to see how important it is to take care of themselves and take care of the baby. That's with the grants provide. So the investment and healthy start saves lives, by supporting tribally tailored programs. It helps reduce infant mortality and address adverse conditions in american indian and alaska native populations.
▶ 1:31:21Chair Alkire: Healthy start is a vital lifeline for rural and remote communities. It provides essential services like health screenings. Nurse visits, and support through tribal home visiting programs, which I think is so important right there. To ensure new and inspecting -- expecting mothers receive the care they need. Programs like this help bring knowledgeable staff into our communities.
▶ 1:31:49Chair Alkire: So expecting mothers and new moms do not have to drive three or four hours a to get support for pre-and postnatal care. Without the funding, the tribal maternal and health safety net is at risk. Losing these dedicated resources would weaken critical support for native families at a time when these services are essential more than ever.
▶ 1:32:20Chair Alkire: Many young mothers as I said do not show up until they are ready to have their baby, so perinatal care is often not even sought. This program puts babies on the radar's home visits can be conducted. It helps connect them. These programs are successful of collaboration and also culturally appropriate programs. I think it just helps with identity issues for the mother and the baby, and the family.
▶ 1:32:51Chair Alkire: Super important.
▶ 1:32:56Sen. Lujan: Madam chair, just in closing, thank you for putting a face on the people across the country we are working so hard to represent and fighting for them. More of that is what we need. I just want to say thank you to you and priced chair schatz -- vice chair schatz.
▶ 1:33:13Chair Murkowski: Thank you senator lujan. Significant issues, maternal mortality, how we are able to ensure that programs that are so important again, so many that are so vulnerable. We talk about mental health. I want to talk about domestic violence for a moment. This was a matter I raised with the secretary of the hearing at 1:30.
▶ 1:33:41Chair Murkowski: I mentioned the primary federal funding source for domestic violence shelters and support services and tribal communities. Obviously essential for emergency shelter crisis intervention. We understand all too well up north why these are priorities. I received a letter back.
▶ 1:34:08Chair Murkowski: It was stated april 2 from the alaska native women's resource center about the impacts of the layoffs at the office. The concerns about what it means to have the director of that office placed on administrative leave.
▶ 1:34:37Chair Murkowski: I'm going to enter this into the record as well as an attached letter that was directed to secretary kennedy about the same subject. When I mentioned this to the secretary, he indicated his clear support for making sure that when it comes to domestic violence, shelters for women and the most vulnerable, that it is not his intention to be cutting
▶ 1:35:10Chair Murkowski: Programs. I don't recall his words specifically but it was something along the lines of, he didn't think that they had cut programs. But I also recognize that in budgets that are proposed, that's one thing. But sometimes you can effectively eliminate the effectiveness of the program if you don't have people there.
▶ 1:35:36Chair Murkowski: If there's nobody there to process the grant application, if there's nobody there to answer the phone or respond to your email about what the status of your grant is. Let me direct this one to you, Ms. simpson.
▶ 1:35:52Chair Murkowski: Can you describe how the office of family violence and prevention has been key in implementing fipsa in tribal communities? And let's say the program is still there but you don't have the folks to implement it?
▶ 1:36:21Ms. Simpson: Thank you for the question. The office has been instrumental for recognizing the need for culturally grounded domestic violence programs. The four milligrams allowed them to provide emergency shelter.
▶ 1:36:48Ms. Simpson: With native led organizations like an iw or seed, provide assistance and resources to build the capacity of tribal organizations so the community has access to long-term and specialized care that meets the unique needs. In this way, ofips helps carry out the trust in the organization.
▶ 1:37:12Ms. Simpson: When director dawson was abruptly placed on administrative leave, not only did that impact the office ability to move forward but that was felt all the way down to the individual tribe -- tribal grantees there. Was a gap, communication and silence between program officers and tribal programs in terms of what the -- this was going to mean for ongoing funding.
▶ 1:37:41Ms. Simpson: There's a lot of uncertainty from grantees because none of the new solicitations have gone out. None of the continuation applications that normally are released in march I have been released yet. Programs are unsure what the funding is going to be. It's good to hear that secretary kennedy has assured that programs will maintain funding but that has not been expressed in the programs yet. There's a lot of questions about what is now allowable and what is not.
▶ 1:38:13Ms. Simpson: That information that we have not gotten guidance, travel programs have not gotten guidance yet so there's a need to hold services because they are worried they might do something wrong and get grants terminated. So it creates a lot of uncertainty and stress and fear within these tribal programs. The substantial reductions in force, if they are more, it will interrupt the functions.
▶ 1:38:46Ms. Simpson: These riffs threaten decades of improvements in the public health response. Travel programs rely on staff who have cultivated trusted relationships with the tribal nations and this can take years to build. The institutional knowledge is immense. This long-term relationship building has led to many ofips staff developing significant cultural competence.
▶ 1:39:12Ms. Simpson: The deep understanding of the complex realities that face native communities, so when we lose those staff and the communication with those staff, we are resulting in gaps of silence and tribes unable to move forward with domestic violence programming. It is pretty significant. Also I think the loss of leadership is a direct result of that, the funding delays that tribes have experienced.
▶ 1:39:44Ms. Simpson: It results in many programs where the possibility of being forced to shut down or lay off staff, we know they are having programs to lay off staff because of the gap in receiving funding through drawdowns as well as the uncertainty to maintain funding into the future.
▶ 1:40:04Chair Murkowski: We've heard some of that where the uncertainty with the funding, let's say it's been put on a pause or a freeze. And so many of these programs, if you've got a shelter that you're trying to run, usually you don't have a lot of cushion.
▶ 1:40:25Chair Murkowski: You're able to pay your staff and salaries that month and maybe the following month you are able to get the food that supplies for maybe that month and the following, but there's not a lot of cushion in the event that these funds don't come through. And if you can't provide the services, you can't open the doors and you can't provide the safety that is sought. Ms.
▶ 1:40:52Chair Murkowski: Charlie, I know that at f and a, you utilize the fipsa funding to help those you serve in doing everything from temporary housing and safety for survivors. So I'm going to ask you a question that kind of ties into fipsa but goes a little bit more.
▶ 1:41:19Chair Murkowski: I mentioned the issue of the low income heating and energy assistance. This is a program that has been zeroed out for us in alaska and it makes a difference. You need to stay warm in the winter. I would imagine that in some of the areas that you represent, it's about air conditioning in the summer in order for your elders to be safe in their own homes.
▶ 1:41:49Chair Murkowski: One of the things that we have heard is that the assumption with this proposed budget was that the greatest focus on energy production, it would lower the costs of energy to people's homes and so thus the assistance would not be necessary.
▶ 1:42:19Chair Murkowski: That may be true in the future, I don't know that we have an easy button on this to reduce energy costs around the country, much less in a place as expensive as alaska or hawaii.
▶ 1:42:35Chair Murkowski: But if you can just share for the committee record the expense that a family basically faces staying warm in a place like fairbanks, alaska, and what it would mean if you were not able to access this .
▶ 1:43:12Ms. Charlie: Like you said, the cost of living in fairbanks in alaska is extremely high. There are places in alaska that one gallon of heating fuel can run from five dollars, to anywhere over $10 a gallon. That is for heating fuel. We do have an elders program. We do a lot of case management. We do deal with a lot of elders who not only have food insecurity, but can't pay their energy bill. They can't pay their rent.
▶ 1:43:41Ms. Charlie: So this is the case management we provided and also do it with the fsbo funds for emergency shelter. As women leave a domestic violence situation with just the clothes on their back, they cannot afford temporary housing. Not in fairbanks or in remote alaska. It's really critical.
▶ 1:44:05Ms. Charlie: For the energy assistance, it's a huge impact on the families we serve, not just elders but the head start. The cost of living in fairbanks is extremely high and the surrounding area is much higher. It would be devastating to everybody we serve across all of our programs.
▶ 1:44:28Chair Murkowski: I'm just going to keep going here for a few more minutes. I think one of the things we share as members of the committee, when we think about the many challenges across indian country and the barriers to economic opportunities and a
▶ 1:44:58Chair Murkowski: Strong education, is the issue of mental health and behavioral health and the lack of services made available. We had a little conversation about some of these statistics related to suicide and I agree with you, vice chair greninger, we are tired of being number one in so many of these awful statistics.
▶ 1:45:24Chair Murkowski: So the center for mental health services has faced pretty significant riffs and with this proposed elimination overall, I would like to hear from you about the impacts on the delivery of culturally responsive programs to tribal communities. Either one of you. Go ahead. It is an important issue.
▶ 1:45:56Chair Greninger: Thank you for the question. This is an important issue. When you look at these programs compared to mental health programs for ihs, ihs is focused on adult mental health and stamps that has children and family mental health. We need the dollars to specifically tailor mental health to children and young families. I would highlight circles of care is one of those programs.
▶ 1:46:23Chair Greninger: The other great thing is tribes don't have to compete for them. In other programs we have to. Which is really sad for us, we hate competing against our brother and sister nation spirit those are the biggest things. Focus on youth and non-competitiveness.
▶ 1:46:44Chair Greninger: The ability to have even culturally relevant services and that flexibility is what allows us to get to that spirituality peace I talked about in my comments where we can bring in the songs and the language and we are filling in that emotional and spiritual piece of the holes in our hearts that medical care from the western perspective cannot touch here that is why we are going after those dollars bringing in drum making kits, regalia, teaching her kids language and bringing in
▶ 1:47:15Chair Greninger: Language teachers. That is part of mental health as well as traditional forms of treatment like counseling. That's all essential. But bringing spiritual healers to bring us songs and heal our hearts as well, those dollars can help us in those ways as well.
▶ 1:47:28Chair Murkowski: An important point about not having to compete which is significant. Dr. daniels.
▶ 1:47:37Dr. Daniels: You mentioned the center of excellence and I think we all have part of that. We actually are a pass-through with the state for the center of excellence. Ours is called the ohana center of excellence.
▶ 1:47:56Dr. Daniels: What has been happening is with the riffs and the changes, that program has been asked to scrub the information that they put on for communities to access. So things around webinars or culturally appropriate programming that goes on to those websites are at risk. So our communities cannot access it. It is not just those communities.
▶ 1:48:26Dr. Daniels: It is the professionals working with communities that it is a type of opportunity for them. That center of excellence is at risk. Also the emergency surge, the wildfire disaster moneys, same thing that those kinds of opportunities to get creative and really focus in on communities are being kind of shifted off.
▶ 1:48:57Dr. Daniels: So I agree with that understanding and how they support the communities.
▶ 1:49:13Chair Murkowski: I think part of what we were hoping to accomplish today is to remind not only those in the administration but to remind all of us that of the many many programs available that are critically important to native people, whether in hawaii, alaska or elsewhere around the country, but are outside of the ihs system. We talked about young people, early head start. We have not had that much of a discussion about elders.
▶ 1:49:43Chair Murkowski: Clearly the older americans act, it doesn't say anything about natives in the title, but clearly those programs, the services, whether it is caregiver support, these are vitally important. I know melissa, probably fna probably does an amount.
▶ 1:50:13Chair Murkowski: The tribal program within the older americans act, do you want to speak to how important these programs are for the elders? >> yes so at fna we have a community services and we have title vi funding. We provide 800 meals a month monday through friday and assist with food boxes. They have a garden for food insecurity.
▶ 1:50:45Chair Murkowski: And we serve over 300 elders in the program. We do a lot of case management if they can't pay the rent, if they can't pay the fuel bill. What I love about elders program is they are really integrated. They are at the school tanning loose hide, they are at the head store -- head start program teaching them how to cook fried bread and make berries.
▶ 1:51:15Chair Murkowski: They are their grandparents for certain classrooms and they are teaching them songs and dance. They are really involved in everything we do at fna. I really love that program. It's important we take care of our elders. We will all be elders one day. It is a really amazing program.
▶ 1:51:41Chair Murkowski: They left their program, they love to come together and congregate and eat and just be together. Otherwise, they would be home alone. So every time we invite them to talk at our annual meeting, they are speaking. They own their program. They develop agendas and meetings and topics they want to do. It's amazing for program and really builds and makes them happy to come together.
▶ 1:52:16Chair Murkowski: I love the fact that they are there with the kids as well. I want to ask a question about efficiency. We are operating in an administration that has taken a very keen eye towards efficiency. We all know we can and should do more when it comes to more efficient operations. So I think we have something when it comes to the 477 program. I look at that as a model.
▶ 1:52:47Chair Murkowski: It demonstrates how tribes can exercise its sovereign authority. It is the integration of employment, training, human services into one efficient streamlined plan.
▶ 1:53:04Chair Murkowski: I think this is probably directed to you, vice chair grin injured -- greninger, the progress we've made in expanding hhs participation in tribal 477 plans and how important you think it could be in this administration, one that is keenly focused on how we can do
▶ 1:53:36Chair Murkowski: A better job in reducing inefficiencies and eliminating the overlap and overlay. If we got multiple programs here , consolidation is good. That's make sure we are consulting on it all. Let's make sure it makes sense. Talk a little bit for the committee here about the value of the tribal 477 program.
▶ 1:54:07Chair Greninger: Absolutely. Thank you for the question. We are all mobile -- wearing multiple hats, smaller governments and trying to stretch the dollar as far as possible. 477 is critical to tribes because it allows us the flexibility to self govern. We can take these funds from the federal government, and issued them into the community and the ways we see fit. The other part of that is we talk about efficiency is the reporting structures. Data reporting is much more streamlined.
▶ 1:54:37Chair Greninger: It is a reduced burden for us, especially the smaller tribes like jamestown. We are not 477 but we would advocate for it. When we talk about hhs programs in particular, we have been working with acf specifically to increase those programs.
▶ 1:54:57Chair Greninger: What we would love to see is if all programs could be in 477 because of the streamlining tractor and gives us the self governments -- governance benefit. I think we are up to about five programs at 477. I would like to highlight for this committee that there are going to have to be conversations to talk about the barriers with regulations and the statutory pieces of this.
▶ 1:55:27Chair Greninger: With head start, we fight concerns. With headstart, it was not able to be put into 477 but there were discussions on, are we meeting statutory requirements? Data burdens, health and safety burdens, things like that. If there are statutory requirements, we need to look and evaluate those and I think those conversations should be happening. We are hoping hhs would remain open to adding more programs.
▶ 1:56:01Chair Murkowski: So let me ask, maybe it's too early to know whether somebody within hhs that is dedicated I guess to be able to support tribes in integrating hhs programs into the 477 plans.
▶ 1:56:26Chair Greninger: I would need to follow-up up with you. I want to say that acf has two or three staff dedicated to 477 right now but I can follow up.
▶ 1:56:38Chair Murkowski: The reason I ask, and I think the vice chair noted this at the beginning of his questions or may be the end of them, that this input we are getting from you today is really important that it be an iterative process, not just a conversation today but that we build on this.
▶ 1:57:04Chair Murkowski: As you are bringing information to us, we are able to feed that up and let them know you have someone in your department tasked to these things, and further that that individual that has been named, you will know who is on point there. We can be the intermediary.
▶ 1:57:34Chair Murkowski: It should not be more than the fact of getting a name and being able to pass that on. I think it is going to be important again that we are working with the folks at hhs, the folks in the secretary's office in recognizing and acknowledging the many many programs within hhs that have implications for our tribal
▶ 1:58:05Chair Murkowski: Citizens and native people. How we do this going forward, we will rely on those of you, the money you represent -- many you represent, there is still much going on with this reorganization that we are all just learning about, and the fact that we don't get have a full president's budget. We just have a skinny budget.
▶ 1:58:36Chair Murkowski: We are operating off of a continuing resolution, and we are hoping the departments will be following their operational plan, and if not that there free programming. There is so much that is uncertain.
▶ 1:58:53Chair Murkowski: I think the message I would like to leave with all of you is amidst this uncertainty, know that we've all got to link arms and get through this together. Even though the frustration at times may be really hard to deal with because you can't seemingly get answers.
▶ 1:59:21Chair Murkowski: I know we want to try to give benefit of the doubt as administrations are getting stood up. We are very, very slow in moving these nominations through the floor. It is a process. It could be made easier but we are where we are.
▶ 1:59:43Chair Murkowski: You may be the secretary that is accountable but you might not have the full teams in place to do the execution and do the kind of consultation that I think we are talking about that you need and demand. So not making excuses for the administration, they've got to answer on their own. But I do know that the secretary has indicated to me that these matters are priorities to him.
▶ 2:00:15Chair Murkowski: We want to take him at his word for that and that he will assign teams that work with us to better the lives of our native peoples wherever they may be. So I'm really appreciative for what you've brought here today.
▶ 2:00:46Chair Murkowski: If there are additional matters the committee needs, I know there are questions for the record to continue to come in and we would ask you to try to help us out with that. I started off my morning with the administrator of the epa and we were asking him about various grants that have been paused or frozen or still under review. I told him that we would like a list.
▶ 2:01:17Chair Murkowski: We want to know from your perspective where things are because if something has been terminated, that's one thing. If something is still under review, that's another thing. Maybe you hold on and keep your focus on at your shelter for another month. If you know they're still all likelihood the funding will come through, but if it's been terminated, then decisions are being made for you.
▶ 2:01:45Chair Murkowski: So if you have specifics you want to share with us that we can elevate and know that we can perform that role as well. Thank you to each of you for making the trip and thank you for the leadership that you provide respectively. And with that, the committee stands adjourned.