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.

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