Advocates for the funding of two diabetes-related programs that benefit Native Americans have once again come up short in the federal budget process.

The Special Diabetes Program for Indians (SDPI) and the Special Diabetes Program (SDP) were given five-month extensions in Congress’ recently passed 2020 budget.

However, the National Indian Health Board and at least 19 other Native American advocacy organizations have been intensely lobbying for months to secure five years of funding.

The latest short-term fix is not the first one, either. There have been at least two others in the past two years. The current funding lasts through May 22.

“NIHB continues to stress to lawmakers the undue challenges and problems with short-term extensions and will continue to strongly advocate for long-term reauthorization of SDPI,” the group said in a statement.

There had appeared to be an agreement on SDPI funding at $150 million for four years in a House version and for five years in a Senate bill. Tribes had asked for $200 million.

But despite bipartisan support during the summer months, many lawmakers expressed concerns with part of the packages that would have established a “median in-network reimbursement rate for all out-of-network providers.”

“Multiple lawmakers and many external stakeholders would prefer that disputes be settled through a ‘baseball-style’ arbitration approach, which several state governments have opted to use to address surprise billing,” the NIHB said.

In addition, external stakeholders such as hospital and provider associations were hoping to see more widespread use of arbitration, as opposed to a more narrow scope proposed in the package.

Nevertheless, SDPI is considered one of the most successful public health programs in Indian Country and nationwide.

Over the life of the program, the incidence of end-stage renal disease among Native Americans has dropped 54% – the largest decline for any demographic in the U.S.

Cost savings highlighted in a 2019 report from the Department of Health and Human Services estimates that SDPI saves Medicare up to $52 million each year.

“The data suggests that SDPI funding the Seminole Tribe of Florida receives is having an impact on the prevalence, severity and early detection of diabetes in Tribal members,” Dr. Paul Isaacs, the executive director of the Tribe’s Health and Human Services Department, said.

SDPI typically funds prevention and treatment related to type-II diabetes, while SDP funds type-1.

“Whether the Tribe is fortunate enough to have their own self-funded health insurance, we should never lose sight of the trust obligation the U.S. government has to provide health care to Native Americans,” Isaacs said.