Native American Veterans Falling through Cracks Between VA, IHS Healthcare Services

by U.S. Medicine

July 12, 2012

By Sandra Basu

WASHINGTON — The VA and IHS need to better coordinate services for American Indian and Alaska Native veterans, federal officials acknowledged at a recent Senate Indian Affairs Committee hearing.

“For some AI/ANs, navigating the two healthcare systems may prevent optimal use of health services for which they are eligible. VA and IHS will continue to work together to address the input we receive from tribes and to improve services for American Indians and Alaska Natives. And, we are making progress,” Indian Health Service Deputy Director Randy Grinnell told the committee.

Grinnell and Stephanie Elaine Birdwell, director of VA’s Office of Tribal Government Relations, were among panelists testifying before the Senate Committee on Indian Affairs on programs serving AI/AN veterans.

Members of the National American Indians Veterans group pose for a photo on Memorial Day 2010 at Arlington National Cemetery. U.S. Army Photo by Command Sergeant Major (Ret) Anthony Walker

AI/ANs participate in the military more than any other ethnic group as a percentage of the population, according to IHS. Both VA and IHS provide care to these veterans, but at issue has been whether these veterans are falling between the cracks. At a 2009 Senate Veterans’ Affairs Committee hearing, Sen. Daniel Akaka (D-HI) said, despite dual-eligibility for VA and IHS healthcare, “American Indian and Alaska Native veterans report unmet healthcare needs at four times the rate of other veterans.”

At the recent hearing, Akaka, who also chairs the Senate Committee on Indian Affairs, noted it is important that the nation meet its “dual responsibility to [American Indian and Alaska Natives] as veterans and as indigenous people.”

AI/AN Veterans

Grinnell told the committee that American Indian and Alaska Native veterans have said they want better coordination of services between VA and the IHS. He pointed out some of the challenges these veterans face.

“IHS is primarily a rural health system; therefore, in some locations, our facilities may be a significant distance from VA facilities. In addition, the eligibility rules for IHS and VA healthcare services differ, which may cause confusion about coverage of services,” he said.

IHS and VA are committed to improving access to services, Grinnell added, pointing out that in 2010 the agencies renewed a memorandum of understanding (MOU) to establish coordination, collaboration and resource-sharing between the two departments and to improve care for these veterans.

Birdwell told the committee during her testimony that VA is embarking on a robust outreach and consultation effort with tribes. She said her office was established by the VA last year to develop partnerships with American Indians and Alaska Natives to “enhance access to services and benefits” for native veterans. She said the VA continues to work on earning the trust of Native American veterans.

“I know it will take time, but I believe it is a goal VA will achieve,” she told the Senate Indian Affairs Committee.

Native American Veterans Falling through Cracks Between VA, IHS Healthcare Services

Improving Care

Akaka wanted to know whether the 45,000 veterans receiving care through IHS are aware of the services for which they are eligible at both VA and IHS.

“One of the things we are doing in collaboration with the VA is that we are training our business office staff,” Grinnell responded. “The VA also has a program specifically of tribal veterans’ representatives that helps to further provide outreach and education. Recently we had a number of trainings with them, webinar trainings and so forth.”

Sen. Al Franken (D-MN) asked why trust is an issue with AI/ANs veterans.

“What is the source of distrust in your opinion?” he asked. “To what extent [are] the memorandum of understanding and these kind of actions mitigating that trust?”

Birdwell responded that, during the past five years, the VA has made an aggressive effort to reach veterans in rural areas, but in the past the VA had a harder time connecting with tribes in rural locations.

“I think it would be fairly accurate to say that maybe the VA did not historically reach out to rural locations because they were hard to get to, and specifically the tribal communities because they were hard to get to, and the agency didn’t speak the language, in terms of understanding some of the unique cultural issues,” she said.      

Birdwell further explained that, if a native veteran had a bad experience with the VA because of “lack of understanding, lack of engagement and also maybe [the veteran] not consistently showing up,” that this built up “mistrust” over time.        

Grinnell said a lot of the feedback IHS received from veterans is that “they feel like they are being shuffled back and forth between the two systems.”

She said she hoped the MOU between VA and HIS “will help us to move closer to our mutual goal in trying to really address the true needs of our veterans.”

A step forward in the collaboration between the agencies is “significant” progress in developing a draft agreement to facilitate VA reimbursement for direct-care services provided to eligible AI/AN veterans at IHS and participating tribal facilities, Birdwell and Grinnell told the committee.

Still, not enough is being done, said Wayne Burke, tribal chairman of the Pyramid Lake Paiute Tribe of Nevada. Burke told the committee that, as native veterans return home, he sees the need for advocacy and support for them.

“The VA must understand and know the population they serve,” he said. “Tribes from the North, South, East and West all have distinct traditions and beliefs. The VA is a complex system, which is intimidating and frustrating for veterans to navigate.”

He also spoke of the need for resources to provide mental-health services for AI/AN veterans who require them.

“Many of our reservations are found in extreme rural areas of the country where ambulatory and mental-health services are only available on a limited schedule,” Burke said.

Back to July Articles

Related Articles

Suicide Rates Jump Up for Younger Veterans in Recent Years

Rates of suicide among younger veterans (ages 18-34) “increased substantially in recent years,” climbing from 40.4 suicide deaths per 100,000 population in 2015 to 45 suicide deaths per 100,000 population in 2016, according to a new report.

Two-Thirds of VAMCs Improved Quality, Efficiency in Recent Assessment

More than half of 15 VAMCs classified as “high risk” in the October 2017 Strategic Analytics for Improvement and Learning report moved out of that category in the most recent update. But one, the DCVAMC in Washington declined and is now considered “critical.”

U.S. Medicine Recommends

More From department of veterans affairs

Department of Veterans Affairs (VA)

VHA Makes Progress in Improving Safety of Opioid Prescribing

VHA medical facilities should ensure that its providers are following three key opioid risk mitigation strategies, including conducting urine drug screening, a recent report recommended.

Department of Veterans Affairs (VA)

VA faces healthcare staffing shortages, barriers to hiring facility leaders

A facility-specific survey found that 138 of 140 VA facilities reported shortages of medical officers, with psychiatry and primary care positions being the most frequently listed.

Department of Veterans Affairs (VA)

Veteran nephrologist labors to improve ESRD treatment at VA

When Terrence O’Neil, MD, retired as chief of nephrology at the James H. Quillen VAMC in Johnson City in December 2016, he left in his wake decades of work treating kidney disease—nearly 35 years in the Air Force and DoD, plus 11 more at VA.

Department of Veterans Affairs (VA)

Committee approves bill to provide agent orange benefits to ‘blue water’ vets

A long sought-after bill that would make it easier for Blue Water Navy veterans to receive Agent Orange benefits has been passed by a key House of Representatives committee.

Department of Veterans Affairs (VA)

Bill to Streamline, Expand VA’s Choice Program Signed Into Law

Legislation that would streamline VA’s community care programs into one program and expand VA’s caregiver program to veterans of all eras was signed into law earlier this month..

Facebook Comment

Subscribe to U.S. Medicine Print Magazine

U.S. Medicine is mailed free each month to physicians, pharmacists, nurse practitioners, physician assistants and administrators working for Veterans Affairs, Department of Defense and U.S. Public Health Service.

Subscribe Now

Receive Our Email Newsletter

Stay informed about federal medical news, clinical updates and reports on government topics for the federal healthcare professional.

Sign Up