CMS/ITU Outreach & Education Event Friday, May 11, 2018 – Chicago, IL

VA ~ Office of Tribal Government Relations OTGR was created in 2011 in response to President Clinton’s Executive Order 13175 (November 2000) and President Obama’s Memorandum on Tribal Consultation (November 2009) President Clinton's 2000 Executive Order 13175 reaffirmed the U.S. Government's responsibility for continued collaboration and consultation with Tribal Governments in the development of Federal policies that have tribal implications, to strengthen the United States government-to-government relationships with Indian tribes, and reduce the imposition of un-funded mandates upon Indian tribes.  President Obama’s (2009) Memorandum on Tribal Consultation took it a step further – he directed each agency head to create a detailed plan of actions the agency will take to implement the policies and directives of Clinton’s Executive Order 13175. – 1 day short of 9 years after Clinton’s Order. http://www.va.gov/tribalgovernment/ 2

VA ~ Office of Tribal Government Relations www.va.gov/tribalgovernment

VA ~ Office of Tribal Government Relations Stephanie Birdwell StephanieElaine.Birdwell@va.gov 202-461-4585 Terry Bentley Terry.Bentley@va.gov 541-440-1271 Mary Culley Mary.Culley@va.gov 405-456-3876 Clay Ward David.Ward@va.gov 202-461-7445 Homana Pawiki LoRae.Pawiki@va.gov 928-445-4860 x5306 Peter Vicaire Peter.Vicaire@va.gov 651-405-5676 4

VA ~ Office of Tribal Government Relations (VHA) Veterans Health Administration (health; mental health; substance abuse) (VBA) Veterans Benefits Administration (compensation; pension; education; insurance; home loan guarantees; vocational rehabilitation) Second largest agency (after DoD) with a budget of 180 billion for FY17. 186.5 Billion requested for FY18. Employs about 345,000 (NCA) National Cemetery Administration (national cemeteries; burials; plots; tombstones) 5

VA ~ Office of Tribal Government Relations 6

VA OTGR NATIONAL UPDATE VA/IHS/THP Reimbursement Program VA OTGR NATIONAL UPDATE Signed Reimbursement Agreements: 77 IHS sites 108 Tribal Health Program (THP) 44 THPs In Progress with Tribal.Agreements@va.gov Total Disbursed (January 2018) $68.5 Million (approximately 8,994 Veterans) Extended at least until June 30th, 2019.

VA/IHS/THP Tribal Relations Milestones 8

VA ~ Office of Tribal Government Relations Veterans Benefits Administration (VBA) – Districts https://benefits.va.gov/benefits/offices.asp - 58 Regional Benefit Offices 9

Veterans Benefits Administration (VBA) VA ~ Office of Tribal Government Relations Veterans Benefits Administration (VBA) Disability Compensation: tax-free monetary benefit paid to veterans with disabilities resulting from disease or injury incurred or aggravated during active military service. Pension/Fiduciary Service: provides supplemental income through Veterans Pension, Death Pension, and Dependency and Indemnity Compensation. Fiduciary: Protects the benefits paid to vulnerable beneficiaries due to disease, injury, or infirmities of advanced age. Education Service: provide education and training benefits to eligible active duty, National Guard, and reserve servicemembers, veterans, and dependents. Loan Guaranty Service: guarantees home loans in varying amounts and ensures veteran's rights are protected when purchasing a home. SAH: specially adapted housing grants for severely disabled veterans so they can adapt or acquire suitable housing. NADL Vocational Rehabilitation & Employment (VR&E): Assists veterans with service-connected disabilities to prepare for, obtain, and maintain suitable education, employment; start their own business; or receive independent-living services. http://www.va.gov/health/aboutVHA.asp 10

National Cemetery Administration (NCA) VA ~ Office of Tribal Government Relations National Cemetery Administration (NCA) Burial in a VA national cemetery is open to all members of the armed forces and veterans discharged under conditions other than dishonorable. A veteran's spouse, widow, and minor children may also be eligible for burial. Since 2011, VA has provided funding to establish, expand, improve and maintain tribal veterans cemeteries. $36.1 million to 11 tribes: Rosebud Sioux; Yurok; Pascua Yaqui; Oglala Sioux; Seminole (OK); Ponca (OK); Crow; Big Sandy; San Carlos Apache; Sisseton; Maliseet 2 Tribes with cemeteries under construction: Leech Lake and Standing Rock George.Eisenbach@va.gov (Director, Veterans Cemetery Grant Program) 11

VA Tribal Consultations VA ~ Office of Tribal Government Relations VA Tribal Consultations Accreditation of Tribal Veterans Service Officers - Proposed rule amending CFR Title 38, Part 14, recognizing tribal organizations as being able to assist American Indian and Alaska Native claimants with their VA benefits. 17 written comments submitted. The rule became effective on 3/21/2017 Care in the Community - Input on proposed consolidating health care provided to veterans through non-VA health facilities into a standard system, including IHS and THPs. All responding tribes and organizations uniformly expressed that they do not support transitioning to a standardized agreement for reimbursement. Washington D.C. - September 28, 2016. Input from 30 tribes and 9 national/regional organizations. Extended to June 30, 2019. Top 3-5 Priorities – Identifying needs tribal governments face when serving veterans, especially those unique to Indian Country. Spokane, WA – June 29, 2016 (NCAI). Input from 30 tribes, 20 individuals, 13 Native organizations and 2 urban Indian health organizations. 12

Tribes’ Top Priorities for Serving Veterans in Indian Country In 2016, VA asked Tribes to identify their top 3 to 5 priorities for serving veterans in Indian Country: Access to Medical Care Addressing Housing and Homelessness Treatment for PTSD and Mental Health Understanding Benefits, including benefits for families Transportation Other Priorities for Veterans Substance abuse treatment Care in the community Including Urban Indians and Urban Indian Organizations Veteran Status Tribal Veteran Cemeteries A tribal Veterans advisory health care committee Who Responded: 30 Tribal governments 20 Individuals (Veterans and advocates) 13 Tribal organizations 2 Urban Indian Health Organizations 13

Tribal HUD-VASH Pilot Program 26 Tribes selected by HUD for the pilot program for a total of $5.8 million dollars, total of 515 units to be funded. As of February 26, 2018 – 350 AI/AN veterans in HUD/VASH case management and 253 veterans housed through the Tribal HUD-VASH Housing Voucher Program 14

Examples of How Tribes are Working with VA Oklahoma, IHS and Tribal Health staff working with VA, State, and local agencies on Homeless Stand Down Programs OTGR and Tribes conducted 27 Veterans Training Summits (2012 to 2017), nationwide - 3,200 participants Chinle and Tuba City Health Care (Navajo Reservation) and VA collaborated to build a mini VA clinic within the Chinle IHS and Tuba City Clinics VA Telehealth in THPs: Mississippi Band of Choctaw Indians; Crow; Northern Cheyenne; Flathead; Blackfeet; Fort Belknap; Pawnee; Fort Peck; Rocky Boy Asheville VAMC Home Based Primary Care housed in EBCI facility and allows for sharing of medical records Cherokee Tribe, NC, and the Asheville VAMC, share 50% salary costs each for a position to service Indian veterans out of the Cherokee Indian Hospital Oneida Nation recently signed a reimbursement agreement contract with VA for serving elderly veterans in its nursing home. OKC VAMC & several THP and IHS collaborated to reconfigure OKC VAMC referral process, making access easier for tribal veterans. VA has an enrollment rep office at the Northern Cheyenne IHS facility 15

Presumptive Conditions Campaign in Indian Country “Your Service Presumptive Conditions Campaign in Indian Country “Your Service. Our Mission: Bringing Benefits Home” Throughout 2018, VA is launching a nationwide campaign to roll out veteran disability enrollment claim events collaboratively with 20 tribes. It kicks off March 21 in Navajo Nation and tribal communities in eleven states have already confirmed their participation. Focus on identifying and assisting Veterans for disability and pension claims Letters were mailed to all 567 tribal communities nationwide - 20 responded with interest. 20 tribes scheduled for claim clinics in 2018 are: Copper River Native Association (AK); Native Village of White Mountain (AK); Tule River Tribe (CA); Walker River Paiute Tribe (NV); Siletz Tribe (OR); Nooksack Indian Tribe (WA); Bay Mills Indian Community (MI); White Earth Nation (MN); Red Cliff Band of Lake Superior Chippewa Indians (WI); Osage Nation (OK); Seminole Nation of Oklahoma (OK); Eastern Shawnee Tribe (OK); Choctaw Nation of Oklahoma (OK); Kewa Pueblo (NM); Pascua Yaqui Tribe (AZ); Tohono O'odham Nation (AZ); San Carlos Apache (AZ); Navajo Nation (AZ); Pueblo of Pojoaque (NM); and Taos Pueblo (NM). 16

Rural Interdisciplinary Team Training 17

Miscellany Illegal state taxation of reservation-domiciled veterans OTGR Newsletter 18

Central and Eastern Region Contact Department of Veterans Affairs Office of Tribal Government Relations Peter.Vicaire@va.gov 651-405-5676 612-558-7744 (cell) www.va.gov/tribalgovernment - Main website Tribal.agreements@va.gov – VA-IHS-THP Reimbursement Agreements Tribal.Consultation@va.gov – email for tribal leaders to submit inquiries directly to VA 19