Quarterly Newsletter – 2025 Edition 1 – January
January 23, 2025 | Newsletter
Upcoming Delegates Meeting – February 5, 2025
Hosted at the Office of Tribal Public Health & Relations, Office of Policy, Planning and Evaluation, Washington State Department of Health. See invite sent from info@aihc-wa.com for more details on how to get there and parking.
Join us in welcoming three new staff members!
- Laura Kluever, Enhanced Tribal Assister
- Liam King, Communications Specialist
- Marci Halverson, Administrative Assistant
Upcoming Events
- Tribal Assisters Training – April 24-25 at Yakama Legends
- Next Delegates meeting – May 14 at The NATIVE Project
- Washington State Tribal Opioid and Fentanyl Task Force Summit – May 20-22 at ilani
- Regional Public Health Response Meeting – Tulalip, Spring 2025
- Stay up to date on all upcoming events – Check out the calendar on our new website for upcoming meetings and events: https://aihc-wa.com/calendar
From the Executive Director, Vicki Lowe
We are reinstating our newsletter with our updated branding. This newsletter will be issued quarterly prior to quarterly delegates meetings as an update on the work completed between meetings.
We are in a time of change – not only is a new governor coming in, with new staff, but the leadership at all of the state agencies we work with is changing. The Health Care Authority has brought the former Medicaid director, MaryAnne Lindeblad, back to serve as interim director while the Governor works to find a new director. The Department of Health has chief of staff, Jessica Todorovich, acting as Secretary.
I have attended two health transition committee meetings and had several conversations with (former Senator) David Frockt, Governor Ferguson’s Deputy Policy Director Healthcare, Housing, Public Safety. David joined our December 3rd GIHAC meeting. Caitlin Safford has been hired to support healthcare, public health, and behavioral health policy, taking the place of Molly Voris, Amber Leaders and Samantha Pskowski. Caitlin has worked for DOH, several MCOs, and Washington State Hospital Association. Caitlin was very involved in the Accountable Communities of Health (ACH) work during Medicaid Transformation 1.0. AIHC will continue to meet biweekly with Governor’s office staff to make sure they are up to speed on issues with between Tribes, Indian Health Care Providers, and the State Agencies.
Tribal Public Health
Work supporting and advocating for Tribal public health over the last several months includes:
- Working with the Governor’s Indian Health Advisory Council’s Tribal Data Sovereignty Committee (GIHAC TDSC) on data sovereignty principles which were approved by GIHAC in December 2024.
- Worked with DOH to make changes to the previous version of the model data sharing agreement based on GIHAC feedback. Consultation on this model was held on 1/9/25.
- Preparing for legislative session and priorities that relate to public health including:
- Decision Package asking for more FPHS funding in an effort to get Tribes up to 10% of the total Foundational Public Health Services (FPHS) funding
- A public records act exemption for Tribes
- Continued support of FPHS through serving on Steering Committee, the FPHS project management team, advocating for Tribal representation on local boards of health, drafting model public health codes, coordinating with Kauffman and Associates (the Tribal FPHS reporting contractor), and collaborating within the system to work towards a single FPHS system report.
- Model public health code development is continuing, with a focus on finishing the food safety and sovereignty code.
Emergency Response
For emergency preparedness the last several months have been focused on:
- Keeping Tribes up-to-date on highly pathogenic avian influenza at the bi-weekly Current Issues in Public Health and Emergency Preparedness meetings.
- The public health emergency activation for the Benton-Frankling highly pathogenic avian influenza outbreak which occurred at a commercial egg farm. Jessica McKee was activated as Tribal Liaison and provided updates to Tribal Emergency Managers during response and at demobilization.
- Participating in the highly pathogenic avian influenza readiness group.
- Hosting a FEMA Continuity of Operations training.
- Working to set up a Region 1 and 6 emergency preparedness meeting for Spring 2025.
Government to Government
Since the Tribal and State Leaders Health Summit in November and Annual Delegates meeting in December, AIHC held a continuing legal education (CLE) with Office of the insurance Commissioner (OIC) Staff on the “Requirements for Health Insurance Issuers” document developed through collaboration between AIHC and OIC. The Public News Service article on this document can be found here: https://www.publicnewsservice.org/2024-12-09/native-american-indigenous/wa-insurance-commissioner-helps-tribal-members-access-heath-care/a93793-1
We have been working with the Department of Health and utilized the GIHAC Tribal Data Sharing checklist to prepare for consultation on the DOH Tribal Umbrella Data Sharing Agreement. AIHC has been working on this agreement with DOH for three-and-a-half years. The DOH Press Release on their work with the Tulalip Tribes can be found here: https://doh.wa.gov/newsroom/doh-and-tulalip-tribe-sign-historic-tribal-specific-data-sharing-agreement?fbclid=IwY2xjawH8_-VleHRuA2FlbQIxMQABHb60kfrJ3ESgeQQrznAHq9lNQUzb4SCtsv6Mds9v87trNoDa-hZOJ5oVdg_aem_UgvjnK1nHsMwuY9AW7MCVA
State budget freezes for programs funded with general state funds were announced during our December 4th delegates meeting. AIHC Chair, Steve Kutz, sent letters to Sec. Umair Shah, DOH, and Director Sue Birch, HCA, requesting the Tribal work not be subject to the freeze.
HCA Response:
At the Health Care Authority (HCA), we fully recognize the funding for programs serving Tribes is not discretionary, and how they are essential for providing critical client services. We understand the current budget constraints are causing real concern. Programs and services which have already been funded are protected, but our charge is to limit any new program and policy changes that would increase expenditures to the budget.
I must clarify while we are committed to supporting the Tribes, we are unable to authorize a blanket exemption for every expenditure, contract, or purchase related to Tribes, UIHOs, and Tribal organizations. We do evaluate specific expenditures based on their impact on essential services, including travel, hiring, and contracts/procurement. Should there be any concerns or requests regarding these areas, we will work closely with you to address them on a case-by-case basis.
DOH Response:
We remain committed to doing everything we can to support our newly created Office of Tribal Public Health & Relations (OTPHR) which as you know, focuses both on [T]ribal public health as well as government to government [T]ribal relations. While the reality of the funding forecast is stark and thereby concerning, we will do everything we can to continue to focus on our agency’s tribal health work.
While I am supportive of this and given all of the changes as part of the upcoming transition (both at the federal and state levels) in addition to the above funding concerns, we will note your concerns and advocacy for this key issue and will do our best to incorporate in our decision-making. Kristin and Candice will follow up further on this, as necessary.
Access to Healthcare Revenue
At the Tribal and State Leaders Health Summits, a request was made to hold an all-day in person meeting with HCA Staff on the Native Hub. As part of Medicaid Transformation 2.0, community information exchanges (CIEs) or Hubs will support services that connect health related social needs (HRSN) to health services. Hubs are meant to ensure patients are able to follow through on referrals outside the healthcare system. On January 7, 2025, the Native Hub Work Session was held at HCA. Ten Tribal staff members attended. AIHC and HCA Staff were in attendance in person, others attended online. Three actions to move the work forward were determined:
- The work to establish the Native Hub will happen through Governor’s Indian Health Advisory Council
- A meeting with CHPW to discuss their support of a Tribal TPA
- Understand funding available – Infrastructure, 2025 funding to Tribes/UIHOs, Electronic Health Records (EHR) funding through CMS.
A follow-up meeting was tentatively set for Jan 23 but had to be rescheduled. New date soon.
With new provider types enrolling to provide Medicaid services, the Health Care Authority has been working on how to implement payments methods and has been discussing which providers and services are eligible for the IHS All-Inclusive Rate (AIR). This conversation should not be done without the Tribes and Indian Health Care Providers. Tribal consultation has been called. There are two work sessions: January 24, 2025, from 2:00 to 3:30 pm and February 14, 2025, 2:00 to 3:30 pm, and a consultation on March 10, 2025, from 9:00 to 11:00 am. Tribal Caucus will be held between the two work sessions, date to be determined soon.
AIHC is working with Rep. Lekanoff on the Traditional Indian Medicine Waiver for CMS. Together, we have submitted a bill to direct the Health Care Authority to work with Tribes and UIHOs to develop an 1115 waiver to honor Traditional Indian Medicine Practitioners in the Washington State Medicaid program.
Legislation
Welcome to the 2025 Legislative Session:
Governor Jay Inslee performed his final official duties on Tuesday January 14th after 12 years in office. Governor-elect Bob Ferguson took his oath of office Wednesday afternoon.
Monday January 13, 2025, was the first day of the 2025 Legislative Session. This will be a long session, 105 days, with sine die, the last day of session, scheduled for April 27, 2025.
During this year’s opening session, two important Tribal allies we elected to leadership positions: Representative Laurie Jinkins (Tacoma) was re-elected Speaker of the House and Senator Chris Sterns (Seattle) was elected Speaker Pro-Tempore. Ken Choke, Nisqually Tribal Council Chair, welcomed the Legislative members to the land of the Nisqually people and gave a prayer. Antonette Squally, Vice Chair – Nisqually Council, offered a blessing song and prayer. In her first comments, Speaker Jinkins stated her continued support and commitment to Tribal collaboration and acknowledged the Government-to-Government relations with the Nisqually Tribe and all 29 Tribes in our state.
Representative Debra Lekanoff was selected as the Vice Chair of the House Health Care & Wellness Committee. This committee is important to the AIHC work. Senator Claudia Kaufman was selected as the Leadership Liaison to Tribal Nations in the Senate.
This year’s crop of state representatives makes up the most diverse House in Washington history. AIHC is planning to educate new and existing members during the first few weeks of this session with a variety of efforts.
On January 22, 2025, AIHC held our 6th in-person Legislative Day. Tribal delegates, members, and elders joined us to meet with their Legislative representatives to discuss AIHC Legislative priorities. At the end of our Legislative Day, we met with 60+ legislators, including an open invite lunch time session for anyone in the House, and their staff, to join. This lunch time session will also include Tribal Elders and Tribal leadership from Jamestown, Puyallup, and Tulalip.
Prior to our Legislative Day, AIHC hosted a virtual training session on the legislative process, including a How to Meet with your Legislator video.
Our legislative priorities that we will be speaking on are:
- Tribal Public Health Funding – Increase state funding available to Tribes for providing Tribal Foundational Public Health Services to 10%.
- Solution: Legislators need to approve the DOH Decision Package that includes an increase of funding to Tribes to equal 10% of all FPHS funds.
- Traditional Indian Medicine – Providing Medicaid reimbursement for Traditional Indian Medicine Practitioners
- Solution: require HCA, through state legislation, to submit an 1115 Waiver for Traditional Indian Medicine services.
- HB1583 was submitted by Representative Lekanoff: https://app.leg.wa.gov/BillSummary/?BillNumber=1583&Year=2025&Initiative=false
- Indigenous Data Protection – Protect Indigenous data held in certain state agency data systems from public disclosure.
- Solution: Amend the Public Records Act to exempt from public disclosure information pertaining to American Indians and Alaska Natives or Indian Tribes retained by certain state agencies.
Additionally, we’ve asked legislators for their support on the following priorities that are not AIHC bills:
- 10% Tribal Set Aside for Housing Trust Funding
- Removing flavors from tobacco products – HB1203; SB5183
- Expanding Governor’s Health Disparities Council to include a Tribal representation – HB 1262; SB5228