On March 4, 2014, President Obama submitted to Congress his proposed FY 2015 budget for federal agencies. In this Memorandum we report on proposed FY 2015 appropriations for the Indian Health Service (IHS). The detailed IHS budget justification became available several days after March 4 but not all federal agency detailed budget justifications are yet available, notably that for the Bureau of Indian Affairs/Bureau of Indian Education.
FUNDING OVERVIEW
Increases. The Administration proposes $4.63 billion for the IHS which is $200 million over the FY 2014 enacted level. This increase consists of: $63 million for medical inflation; $2.6 million for pay cost increases at the IHS and tribal service delivery level; $70.8 million for staffing of new facilities; $8 million to partially fund five newly recognized tribes; an $18 million program increase for Purchased/Referred Care (PRC); $29.8 million increase to fund the estimated full funding amount for Contract Support Costs (CSC); and $10 million to restore funding taken from the following programs in FY 2014 in order to accommodate needed CSC costs: $5 million for Indian Health Profession; $1 million for Tribal Management; $1 million for Self-Governance; and $3 million for the Director’s Emergency Fund.
The two IHS accounts which are proposed for program increases are Purchased/Referred Care and Contract Support Costs.
Staffing of New Facilities. The proposed budget (Services and Facilities accounts combined) includes $70.8 million for staffing and operations costs for the following new facilities: San Carlos Health Center ($28.4 million); Southern California Youth Treatment Center ($3.2 million); Choctaw (MS) Alternative Rural Health Care Center ($10.9 million); and Kayenta Alternative Rural Healthcare Center ($28.3 million).
Partial Funding for Built-in Costs. The Administration’s proposal would provide $63 million for medical inflation, but no funding for non-medical inflation or population growth. Also requested was $2.6 million for pay raises (1 percent) at the IHS and tribal levels (the funding is in the Hospitals and Clinics line item only). In FY 2014 the Administration proposed $6 million for a one percent pay increase for federal and tribal employees, and apparently tribes and IHS would have to absorb part of the pay increase cost as well as non-medical inflation.
The IHS increasingly emphasizes, in its budget book and in testimony, the opportunity for tribes to receive third party collections, even though they are not to be considered an offset for IHS budgets that fall short of need.
LEGISLATIVE PROVISIONS
Legislative Initiatives. The Administration proposes three legislative initiatives in its budget justification. These would likely not be part of an appropriations bill but rather would be enacted separately.
• The Administration proposes a three-year extension of the Special Diabetes Program for Indians at the current level of $150 million annually.
• The Administration proposes that tribes, the IHS, and urban Indian organizations utilizing the Purchased/Referred Care program be charged Medicare-like rates for non-hospital services, thus stretching the funding for Purchased/Referred Care. Medicare-like rates are currently required for hospital services. A 2013 Government Accountability Office report concluded that IHS and tribal facilities would save millions of dollars and be able to increase care if the Medicare-like rate cap was imposed on non-hospital providers and suppliers through the Purchased/Referred Care program. This proposal is deemed to be revenue-neutral.
• The Administration proposes, as in past years, to make tax-exempt the IHS Health Professions Scholarship Program and Loan Repayment Program, thus freeing up funding now used to pay taxes on these benefits for the loan repayment program.
Contract Support Costs. As mentioned above, the budget would fully fund Contract Support Costs. The proposed budget, consistent with the Interior appropriations acts for FYs 1999-2014, attempts to limit the ability of the IHS and BIA to fund past-year shortfalls in Contract Support funding from remaining unobligated balances for those fiscal years (section 406). This provision has been included in the appropriations act for many years and has not precluded recovery on past-year CSC claims.
Sec. 406. Notwithstanding any other provision of law, amounts appropriated to or otherwise designated in committee reports for the Bureau of Indian Affairs and the Indian Health Service by Public Laws 103-138, 103-332, 104-134, 104-208, 105-83, 105-277, 106-113, 106-291, 107-63, 108-7, 108-108, 108-447, 109-54, 109-289, division B and Continuing Appropriations Resolution, 2007 (division B of Public Law 109-289, as amended by Public Law 110-5 and 110-28), Public Laws 110-92, 110-116, 110-137, 110-149, 110-161, 110-329, 111-6, 111-8 and 111-88, 112-10, 112-74 and 113-6 for payments for contract support costs associated with self-determination or self-governance contracts, grants, compacts, or annual funding agreements with the Bureau of Indian Affairs or the Indian Health Service as funded by such Acts, are the total amounts available for fiscal years 1994 through 2013 for such purposes, except that for the Bureau of Indian Affairs, tribes and tribal organizations may use their tribal priority allocations for unmet contract support costs of ongoing contracts, grants, self-governance compacts or annual funding agreements.
The above language is section 404 of the Fiscal Year 2015 Appendix, Budget of the U.S. Government.
In addition, the Administration proposes bill language to ensure that FYs 2014 and 2015 CSC cannot be used to pay prior year Contract Support Costs nor to repay the Judgment Fund for payment on prior year funds. The budget justification does not explain why this language was included.
The proposed language, which would apply to both the IHS and the BIA which would be applicable to FY 2014 (section 405 of the Fiscal Year 2015 Appendix, Budget of the U.S. Government) is:
Sec. XXX Amounts provided under the headings “Department of the Interior, Bureau of Indian Affairs and Bureau of Indian Education, Operation of Indian Programs” and “Department of Health and Human Services, Indian Health Service, Indian Health Services” in the Consolidated Appropriations Act, 2014 (P.L. 113–76) are the only amounts available for contract support costs arising out of self-determination or self-governance contracts, grants, compacts, or annual funding agreements with the Bureau of Indian Affairs or the Indian Health Service for activities funded by the FY 2014 appropriation: Provided, That such amounts provided by that Act are not available for payment of claims for contract support costs for prior years, or for repayments of payments for settlements or judgments awarding contract support costs for prior years.
And for FY 2015 (section 406 of the Fiscal Year 2015 Appendix, Budget of the U.S. Government):
Sec. XXX Amounts provided by this Act for fiscal year 2015 under the headings “Department of Health and Human Services, Indian Health Service, Indian Health Services” and “Department of the Interior, Bureau of Indian Affairs and Bureau of Indian Education, Operation of Indian ” are the only amounts available for contract support costs arising out of self-determination or self-governance contracts, grants, compacts, or annual funding agreements for fiscal year 2015 with the Bureau of Indian Affairs or the Indian Health Service: Provided, That such amounts provided by this Act are not available for payment of claims for contract support costs for prior years, or for repayments of payments for settlements or judgments awarding contract support costs for prior years.
Restriction of IHS Funds in Alaska to Regional Native Organizations Extended to 2018. The Consolidated Appropriations Act, 2014 (PL 113-76) extended to October 1, 2018, the provision that provides that IHS funds for Alaska be made available only to regional Alaska Native health organizations (with some exceptions). Thus the FY 2015 budget justification is silent on this matter. We repeat here the language from the FY 2014 Appropriations Act:
Sec. 424. (a) Notwithstanding any other provision of law and until October 1, 2018, the Indian Health Service may not disburse funds for the provision of health care services pursuant to Public Law 93-638 (25 U.S.C. 450 et seq.) to any Alaska Native village or Alaska Native village corporation that is located within the area served by an Alaska Native regional health entity.
(b) Nothing in this section shall be construed to prohibit the disbursal of funds to any Alaska Native village or Alaska Native village corporation under any contract or compact entered into prior to May 1, 2006, or to prohibit the renewal of any such agreement.
(c) For the purpose of this section, Eastern Aleutian Tribes, Inc., the Council of Athabascan Tribal Governments, and the Native Village Eyak shall be treated as Alaska Native regional health entities to which funds may be disbursed under this section.
IDEA Data Collection Language. The Administration would continue to authorize the BIA to collect data from the IHS and tribes regarding disabled children in order to assist with the implementation of the Individuals with Disabilities Education Act (IDEA):
Provided further, That the Bureau of Indian Affairs may collect from the Indian Health Service and tribes and tribal organizations operating health facilities pursuant to Public Law 93-638 such individually identifiable health information relating to disabled children as may be necessary for the purpose of carrying out its functions under the Individuals with Disabilities Education Act. (20 U.S.C. 1400, et. seq.)
Prohibition on Implementing Eligibility Regulations. The prohibition on the implementation of the eligibility regulations, published on September 16, 1987, would be continued.
Services for non-Indians. The provision that allows the IHS and tribal facilities to extend health care services to non-Indians, subject to charges, would be continued. The provision states:
Provided, In accordance with the provisions of the Indian Health Care Improvement Act, non-Indian patients may be extended health care at all tribally administered or Indian Health Service facilities, subject to charges, and the proceeds along with funds recovered under the Federal Medical Care Recovery Act (42 U.S.C. 2651-2653) shall be credited to the account of the facility providing the service and shall be available without fiscal year limitation.
Assessments by DHHS. The Administration would continue the provision that has been in Interior appropriations acts for a number of years which provides that no IHS funds may be used for any assessments or charges by the Department of Health and Human Services “unless identified in the budget justification and provided in this Act, or approved by the House and Senate Committees on Appropriations through the reprogramming process.”
Limitation on No-Bid Contracts. The Administration would continue the provision regarding the use of no-bid contracts. The provision specifically exempts Indian Self-Determination agreements and reads:
Sec. 411. None of the funds appropriated or otherwise made available by this Act to executive branch agencies may be used to enter into any Federal contract unless such contract is entered into in accordance with the requirements of the Chapter 33 of title 41 United States or chapter 137 of title 10, United States Code, and the Federal Acquisition Regulations, unless:
(1) Federal law specifically authorizes a contract to be entered into without regard for these requirements, including formula grants for States, or federally recognized Indian tribes; or
(2) such contract is authorized by the Indian Self-Determination and Education and Assistance Act (Public Law 93-638, 25 U.S.C. 450 et seq., as amended) or by any other Federal laws that specifically authorize a contract within an Indian tribe as defined in section 4(e) of that Act (25 U.S.C. 450b(e)); or
(3) Such contract was awarded prior to the date of enactment of this Act.
FUNDING FOR INDIAN HEALTH SERVICES
FY 2013 Enacted $3,914,599,000
FY 2013 Post-Sequester $3,712,278,000
FY 2014 Enacted $3,982,842,000
FY 2015 Admin. Request $4,172,182,000
SPECIAL DIABETES PROGRAM FOR INDIANS
While the entitlement funding for the Special Diabetes Program for Indians (SDPI) is not part of the IHS appropriations process, those funds are administered through the IHS. The SDPI is currently funded through FY 2014 at $150 million, minus a two percent reduction ($3 million) due to the sequestration of non-exempt mandatory programs. (PL 112-240).
HOSPITALS AND CLINICS
FY 2013 Enacted $1,844,397,000
FY 2013 Post-Sequester $1,749,072,000
FY 2014 Enacted $1,790,904,000
FY 2015 Admin. Request $1,862,501,000
Included in the total is $20.8 million for medical inflation;, $2.57 million for pay cost increase; $41.6 million for staffing of new facilities; $3.6 million for newly-recognized tribes; $3 million restoration to the Director’s Emergency Fund; $4.7 million for epidemiology centers; $172 million for Health Information Technology; and recurring funding of $8.9 million for the domestic violence prevention initiative.
DENTAL SERVICES
FY 2013 Enacted $165,191,000
FY2013 Post-Sequester $156,653,000
FY 2014 Enacted $165,290,000
FY 2015 Admin. Request $175,654,000
Included in the total is $1.67 million for medical inflation, $8.2 million for staffing of new facilities, and $468,000 for newly-recognized tribes.
MENTAL HEALTH
FY 2013 Enacted $78,171,000
FY 2013 Post-Sequester $74,131,000
FY 2014 Enacted $77,980,000
FY 2015 Admin. Request $82,025,000
Included in the total is $880,000 for medical inflation, $2.8 million for staffing of new facilities, and $319,000 for newly-recognized tribes.
ALCOHOL AND SUBSTANCE ABUSE
FY 2013 Enacted $195,245,000
FY 2013 Post-Sequester $185,145,000
FY 2014 Enacted $186,378,000
FY 2015 Admin. Request $193,824,000
Included in the total is $2.8 million for medical inflation, $4.3 million for staffing of new facilities, and $289,000 for newly-recognized tribes.
Recurring funding $15.5 million for the Meth/Suicide Prevention and Treatment Initiative is included.
PURCHASED/REFERRED CARE
(Formerly Contract Health Services)
FY 2013 Enacted $844,927,000
FY 2013 Post-Sequester $801,258,000
FY 2014 Enacted $878,575,000
FY 2015 Admin. Request $929,041,000
Included in the funding is $51.5 million for the Catastrophic Health Emergency Fund, the same as FY 2014. Also included is $32.5 million for medical inflation,
$2.6 million for newly-recognized tribes and a program increase of $15.4 million. IHS estimates the program increase will purchase an additional 800 inpatient admissions, 23,800 outpatient visits, and 900 one-way patient travel trips.
PUBLIC HEALTH NURSING
FY 2013 Enacted $69,894,000
FY 2013 Post-Sequester $66,282,000
FY 2014 Enacted $70,909,000
FY 2015 Admin. Request $76,353,000
Included in the funding is $713,000 for medical inflation, $4.5 million for staffing of new facilities, and $257,000 for newly-recognized tribes.
HEALTH EDUCATION
FY 2013 Enacted $17,454,000
FY 2013 Post-Sequester $16,552,000
FY 2014 Enacted $17,001,000
FY 2015 Admin. Request $18,263,000
Included in the funding is $237,000 for medical inflation, $861,000 for staffing of new facilities, and $164,000 for newly-recognized tribes.
COMMUNITY HEALTH REPRESENTATIVES
FY 2013 Enacted $61,482,000
FY 2013 Post-Sequester $58,304,000
FY 2014 Enacted $58,345,000
FY 2015 Admin. Request $59,386,000
Included in the funding is $917,000 for medical inflation and $124,000 for newly-recognized tribes.
HEPATITIS B and HAEMOPHILUS
IMMUNIZATION (Hib) PROGRAMS IN ALASKA
FY 2013 Enacted $1,925,000
FY 2013 Post-Sequester $1,826,000
FY 2014 Enacted $1,826,000
FY 2015 Admin. Request $1,855,000
Included in the funding is $29,000 for medical inflation.
The Budget Justification notes a need for data sharing agreements with tribal partners in order to access screening test results:
In 2013, at least 58 percent of AI/ANs with chronic hepatitis B or C infection were screened for liver cancer and for liver aminotransferase levels (58 percent and 61 percent of the population, respectively). Although the program maintains its practice of encouraging hepatitis patients to have regular, bi-annual screening, this percentage has dropped from previous years as several regional clinics are no longer sending specimens to the ANTHC laboratory for screening tests. This decline is correlated with the implementation of electronic health records in the regions and it will be proposed that data sharing agreements be established with Tribal partners which will provide the program with access to screening test results. (CJ-111-112)
URBAN INDIAN HEALTH
FY 2013 Enacted $42,949,000
FY 2013 Post-Sequester $40,729,000
FY 2014 Enacted $40,729,000
FY 2015 Admin. Request $41,375,000
Included in the funding is $646,000 for medical inflation.
INDIAN HEALTH PROFESSIONS
FY 2013 Enacted $40,563,000
FY 2013 Post-Sequester $38,467,000
FY 2014 Enacted $33,466,000
FY 2015 Admin. Request $38,466,000
The Administration proposes to restore the $5 million taken from the program in FY 2014 in order to meet CSC needs.
Programs funded under Indian Health Professions and their estimated FY 2015 amounts are: Health Professions Preparatory and Pre-Graduate Scholarships ($3.68 million); Health Professions Scholarships ($10 million); Extern Program ($1.11 million); Loan Repayment Program ($20.1 million); Quentin N. Burdick American Indians Into Nursing Program ($1.66 million – 4 grants); Indians Into Medicine Program ($1.09 million – 3 grants); and American Indians into Psychology ($717,078 – 3 grants).
The Act allows for up to $36 million to be utilized for the Loan Repayment Program – IHS Area Offices and Service Units are authorized to provide supplemental funds. In FY 2013 the Loan Repayment Program received $4.9 million from the Hospitals and Clinics program.
The Administration would continue the provision that allows funds collected on defaults from the Loan Repayment and Health Professions Scholarship programs to be used to recruit health professionals for Indian communities:
Provided further, That the amounts collected by the Federal Government as authorized by sections 104 and 108 of the Indian Health Care Improvement Act (25 U.S.C. 1613a and 1616a) during the preceding fiscal year for breach of contracts shall be deposited to the Fund authorized by section 108A of the Act (25 U.S.C. 1616a-1) and shall remain available until expended and, notwithstanding section 108A(c) of the Act (25 U.S.C. 1616a-1(c)), funds shall be available to make new awards under the loan repayment and scholarship programs under sections 104 and 108 of the Act (25 U.S.C. 1613a and 1616a)
TRIBAL MANAGEMENT
FY 2013 Enacted $2,575,000
FY 2013 Post-Sequester $2,442,000
FY 2014 Enacted $1,442,000
FY 2015 Admin. Request $2,442,000
The Administration proposes to restore the $1 million taken from the program in FY 2014 in order to meet CSC needs.
Funding would be for new and continuation grants for the purpose of evaluating the feasibility of contracting the IHS programs, developing tribal management capabilities, and evaluating health services. Funding priorities are, in order, 1) tribes that have received federal recognition or restoration within the past five years; 2) tribes/tribal organizations that are addressing audit material weaknesses; and 3) all other tribes/tribal organizations.
DIRECT OPERATIONS
FY 2013 Enacted $71,594,000
FY 2013 Post-Sequester $67,894,000
FY 2014 Enacted $67,894,000
FY 2015 Admin. Request $68,065,000
Included is $171,000 for newly-recognized tribes.
The IHS states in its budget submission that 56.5 percent of the Direct Operations budget would go to Headquarters and 43.5 percent to the twelve Area Offices. Tribal Shares funding for Title I contracts and Title V compacts are also included.
SELF-GOVERNANCE
FY 2013 Enacted $6,039,000
FY 2013 Post-Sequester $5,727,000
FY 2014 Enacted $4,727,000
FY 2015 Admin. Request $5,727,000
The Administration proposes to restore the $1 million taken from the program in FY 2014 in order to meet CSC needs.
The Self-Governance budget supports implementation of the IHS Tribal Self-Governance Program including funding required for Tribal Shares; oversight of the IHS Director’s Agency Lead negotiators; technical assistance on tribal consultation activities; analysis of Indian Health Care Improvement Act new authorities; and funding to support the activities of the IHS Director’s Tribal Self-Governance Advisory Committee.
The IHS estimates that in FY 2015 $1.6 billion will be transferred to tribes to support 89 ISDEAA Title V compacts and 114 funding agreements. IHS estimates that an additional 5 tribes will enter into Title V compacts and funding agreements.
CONTRACT SUPPORT COSTS
FY 2013 Enacted $472,191,000
FY 2013 Post-Sequester $477,788,000
FY 2014 Enacted $587,376,000
FY 2015 Admin. Request $617,205,000
The proposed $617 million is estimated to meet the full need for Contract Support Costs. Congress has called on the Administration to work with them and with tribes on a long-term solution to meet the legal obligation of paying CSC. A work plan and announcement of consultation with tribes is to be completed within 120 days of enactment (May 17, 2014). The IHS and the BIA began consultation on this matter on March 11, 2014, at the National Congress of American Indians Winter Session in
Washington, DC. The IHS notes:
The FY 2015 budget request for Contract Support Costs (CSC) of $617,205,000 is $29,829,000 above the FY 2014 Enacted funding level. The request reflects the estimated amount needed to fully fund CSC associated with this budget request, based on information available as of this budget submission. This budget request responds to the Supreme Court’s decision in Salazar v. Ramah Navajo Chapter, No. 11-551 (June 18, 2012). Since the number of Tribes assuming new or expanded contracts in FY 2015 is unknown at this time, this request includes an estimated amount. In addition, the actual need for CSC is calculated after the appropriation year and upon receipt of updated information that impacts the calculation of CSC such as updates to provisional rates and corrections will be made as needed. In the explanatory statement of the Consolidated Appropriations Act of 2014, Congress remanded the issue of determining CSC amounts back to the agency and required a workplan to consult with Tribes on a more long term solution. The IHS will provide updated information as it becomes available as a result of this consultation, any decisions on the long term solution requested by Congress, and any updates on the amount of CSC associated with new and expanded contracts or updated information. (CJ- 137)
FUNDING FOR INDIAN HEALTH FACILITIES
FY 2013 Enacted $441,605,000
FY 2013 Post-Sequester $428,569,000
FY 2014 Enacted $451,673,000
FY 2015 Admin. Request $461,995,000
MAINTENANCE AND IMPROVEMENT
FY 2013 Enacted $53,721,000
FY 2013 Post-Sequester $50,919,000
FY 2014 Enacted $53,614,000
FY 2015 Admin. Request $53,614,000
Maintenance and Improvement (M&I) funds are provided to Area Offices for distribution to projects in their regions. Funding is for the following purposes: 1) routine maintenance; 2) M&I Projects to reduce the backlog of maintenance; 3) environmental compliance; and 4) demolition of vacant or obsolete health care facilities. Of the total funding requested, $50.1 million would be allocated to sustain the condition of federal and tribal healthcare facilities buildings, $3 million for environmental compliance projects, and $500,000 for demolition projects.
IHS notes the lack of resources to maintain and recapitalize buildings on a routine basis and states that “Federal and Tribal Healthcare administrators may be required to redirect other funding sources (e.g., Medicare/Medicaid, third-party insurance, etc.) normally planned for healthcare services to fund building repairs and improvements in order to continue to meet mission requirements.” (CJ-147) The IHS estimates that as of October 2013, the Backlog of Essential Maintenance, Alteration and Repair (BEMAR) for all IHS and reporting tribal healthcare facilities is $465 million.
FACILITIES AND ENVIRONMENTAL HEALTH SUPPORT
FY 2013 Enacted $204,231,000
FY 2013 Post-Sequester $193,578,000
FY 2014 Enacted $211,051,000
FY 2015 Admin. Request $220,585,000
Included in the funding is $973,000 for medical inflation, $8.5 million for staffing of new facilities, and $67,000 for newly-recognized tribes.
MEDICAL EQUIPMENT
FY 2013 Enacted $22,582,000
FY 2013 Post-Sequester $21,404,000
FY 2014 Enacted $22,537,000
FY 2015 Admin. Request $23,325,000
Included in the funding is $788,000 for inflation. The IHS expects to distribute the FY 2015 requested funds as follows: $17.3 million for new and routine replacement medical equipment at over 1,500 federally- and tribally-operated health care facilities;
$5 million for new medical equipment in tribally-constructed health care facilities; and $500,000 each for the TRANSAM and ambulance programs.
CONSTRUCTION
Construction of Sanitation Facilities
FY 2013 Enacted $79,582,000
FY 2013 Post-Sequester $75,431,000
FY 2014 Enacted $79,423,000
FY 2015 Admin. Request $79,423,000
Four types of sanitation facilities projects are funded by the IHS: 1) projects to serve new or like-new housing; 2) projects to serve existing homes; 3) special projects such as studies, training, or other needs related to sanitation facilities construction; and
4) emergency projects. The IHS sanitation facilities construction funds cannot be used to provide sanitation facilities in HUD-built homes.
The IHS proposes to distribute up to $48 million to the Area Offices for prioritized projects to serve existing homes; up to $5 million for projects to clean up and replace open dumps on Indian lands; and $2 million would be reserved at IHS Headquarters ($1 million for special projects and emergency needs; $500,000 to collect homeowner data and demographic information in three IHS Areas; and $500,000 for improving data collection systems to help fund a Water Resource Center to develop teaching materials and techniques for homeowners and communities to support usage in a way that promotes health). The Water Resource Center is in partnership with the Alaska Native Tribal Health Consortium whose funding stream began in FY 2012 with $250,000 and is expected to be funded for five years through FY 2016.
Remaining funding will be for new and like-new homes, including for sanitation facilities for homes of the disabled or sick with a physician referral, with priority for BIA Housing Improvement Projects.
Construction of Health Care Facilities
FY 2013 Enacted $81,489,000
FY 2013 Post Sequester $77,238,000
FY 2014 Enacted $85,048,000
FY 2015 Admin. Request $85,048,000
The FY 2015 IHS health facility construction is for:
• Kayenta Health Center in Kayenta, AZ – $18,869,000 to complete construction of the health care facility and staff quarters
• Northern California Regional Youth Treatment Center in Davis, CA – $17,161,000 for site preparation and to begin and complete construction of the treatment center
• Fort Yuma Health Center in Winterhaven, CA- $46,292,000 to begin and complete construction of the replacement health center which received design funding in 2008
• Gila River Southeast Health Center in Chandler, AZ – $2,726,000, to continue construction of the health center which received design funding in 2008 and initial construction funds in 2009
Opportunity, Growth, and Security Initiative. The Administration’s overall budget proposal adheres to the FY 2015 budget cap set by Congress, but it contains an additional proposal (entitled the Opportunity, Growth and Security Initiative) which would be contingent upon Congress raising the budget cap and/or enacting various revenue and spending changes to provide an additional $56 billion to be divided equally between defense and non-defense spending. The Administration is proposing as part of the Initiative $200 million in FY 2015 for construction of health care facilities on the IHS priority list. At this point Appropriations Committee chairs have said they intend to propose bills that stay within the already set FY 2015 spending caps, thus making dim the prospects for enactment of the Initiative.
The $85 million for construction listed above is separate from the Initiative proposal.
OTHER
TRANSAM Equipment, Ambulances, Demolition Fund. The Administration proposes to continue bill language that would provide up to $500,000 to purchase TRANSAM equipment from the Department of Defense, $500,000 to be deposited in a Demolition Fund to be used for the demolition of vacant and obsolete federal buildings, and up to $2.7 million for the purchase of ambulances.
THIRD PARY COLLECTIONS
The IHS estimates a total IHS and tribal Medicare, Medicaid and private insurance collections of $1,196,961,000 in FY 2015.
Medicare $153 million federal; $64 million tribal
Medicaid $679 million federal; $172 million tribal
Private Insurance $90 million
Veterans Administration $39 million
If we may provide additional information or assistance regarding FY 2015 Indian Health Service appropriations, please contact us at the information below.
