Arizona delegation looks for changes to Native aid in next relief package

Arizona's Native American tribes are among the worst-hit jurisdictions in the world by COVID-19.

As Congress pursues another federal aid package — it's fourth since the pandemic upended American life — members of the state's congressional delegation want to change federal policies they say are making the situation more difficult for Native communities.

In particular, they are seeking changes to the cost-share formula the Federal Emergency Management Agency (FEMA) uses to reimburse tribes, states and territories for emergency expenses. They also want to extend the deadline to spend federal relief money, which expires at the end of the year, and want to provide urban health clinics with malpractice coverage.

Native people account for 21.2% of deaths from COVID-19, according to the U.S. Centers for Disease Control and Prevention. But the group makes up less than 6% of the state's population.

In early June, the White Mountain Apache Tribe and the Navajo Nation had worse case rates than any individual state, according to data compiled by the University of California, Los Angeles. The White Mountain Apache — a tribe of about 15,500 people in eastern Arizona — had 1,024 COVID-19 cases through June 5, a higher case rate than any other tribe or state and more than three times higher than New York, the worst-hit state.

The spread has since slowed. But the tribe has recorded a total of more than 2,000 cases. Its hospital has routinely been more than 80% full since mid-May, with several patients requiring transfer to other hospitals either because they needed a higher level of care or because the tribal hospital lacked capacity.

The economic disaster compounded the large caseload. Arizona tribes depend on revenue from tribally-owned enterprises like casinos to fund their operations. With casinos, restaurants and other businesses closed, tribes have struggled to pay for needed supplies and services.

Jerry Gloshay Jr., chief of staff to White Mountain Apache Chairwoman Gwendena Lee-Gatewood, said federal funding in legislation Congress passed in March was crucial, though it took a long time to arrive.

"It was dangerously slow when we were in dire need," he said.

To help make up for lost revenue, the Navajo Nation requested in April that FEMA pay for all of the Navajo Nation's emergency costs. During a federal disaster, FEMA typically reimburses tribes, states and territories for 75% of eligible emergency costs, including medical care, medical supplies and transportation of people and supplies. The tribe, state or territory is required to pay for the remaining 25%.

The agency has not denied the request, but it hasn't approved it either. There is no timeline for a decision, said Ricardo Zuniga, a spokesman for FEMA's Region IX, which includes the Navajo Nation.

Arizona Sen. Martha McSally, a Republican, asked Fema's administrator for the region, Robert J. Fenton Jr., about the request at a July 1 hearing of the U.S. Senate Indian Affairs Committee. McSally said the requirement was "burdensome and seems to unwisely divert funding away from where it's needed."

Fenton said the agency could still waive the requirement, and suggested Congress could alter the rules without FEMA's approval.

U.S. Sen. Kyrsten Sinema and U.S. Rep. Tom O'Halleran, both Democrats, have said they would support a legislative change. Sinema told leaders of both parties in a May letter that Congress should waive the cost-share requirement in its next relief bill.

O'Halleran, whose district includes the Navajo Nation and the Hopi reservation, said FEMA should approve the request before then.

"FEMA has to do what's right," he said.

FEMA has not approved such a request from any tribe, state or territory.

Arizona tribes can use their portion of the $8 billion set aside for Native Americans under the CARES Act to pay for their share of emergency costs, Fenton said. The U.S. Treasury Department split the money into two different allocations, with the first 60% decided by population and the remaining amount decided by other factors. The department said in a June 17 update it had released all of the money except some slated for Alaska.

The federal government has not reported what share each tribe received. The Harvard Project on American Indian Economic Development estimated that 21 Arizona tribes received a total of about $902 million in the first round of COVID-19 funding.

The delay in funding has caused another problem for tribes because the law requires funds to be spent by the end of the year. O'Halleran introduced a bill last week that would extend that deadline to the end of 2022. Two other members of Arizona's congressional delegation, Reps. Ruben Gallego, a Democrat, and David Schweikert, a Republican, are cosponsors.

Urban Clinics

Arizona delegation members are also behind an effort they say would give additional resources to health clinics serving Native people outside of reservations.

About 70% of American Indians and Alaska Natives live outside of reservations. The Indian Health Service (IHS), a U.S. Department of Health and Human Services agency focused on Native communities, funds facilities on tribal lands and in urban areas. But federal law that provides malpractice insurance for IHS facilities on tribal land doesn't apply to health clinics serving Native people outside of reservations.

Gallego, whose district includes much of Phoenix, sponsored a bill that would treat clinics serving Native people living outside reservations the same as those on tribal lands. O'Halleran and U.S. Rep. Greg Stanton, a Democrat whose district is within Maricopa County, are cosponsors. McSally and Sinema have cosponsored a companion bill in the Senate.

The bill was important to urban providers before the pandemic, and is even more so now, Gallego said.

"It actually can be very helpful for COVID because it'll loosen up funds that these organizations are paying for protection and instead now they'll use that money for whatever they want," he said. "And right now, because of COVID, they are very severely underfunded."

Native Health, a community health center in the Phoenix area, pays about $21,000 a year in malpractice insurance coverage, spokeswoman Susan Levy said. But the cost would be three to four times higher without a grant that provides coverage, she said.

Walter Murillo, the organization's CEO, called the process of obtaining coverage a burden.

"It slows us down," he said. "It takes away from the hiring of a doctor or a nurse."