Montana lawmakers urge state health department to reinstate tribal relations position

Yahoo

02-04-2025

Kaiden Forman-WebsterMTFP + ICT
Those who have fought to restore the tribal relations manager position in the state health department saw a positive step last week when the committee tasked with helping craft the state budget introduced an amendment indicating support for reestablishing the role.
The state health department eliminated the position in late 2023 when longtime employee Lesa Evers retired. As tribal relations manager, Evers traveled to tribal communities across Montana to communicate changes in state health policy and served as the point of contact for tribal leaders with questions or concerns. When the job was cut and in legislative hearings this year, tribal leaders, health officials, community members and others urged the state health department to reinstate the role, saying it's critical in improving health outcomes in Indian Country.
The state health department, meanwhile, has said that the duties and responsibilities of the tribal relations manager have been absorbed by the American Indian health director in the department. Tribal advocates, however, say the work is too much to be done by one person.
Rep. Mike Fox, D-Hays, Gros Ventre and Assiniboine, sponsored the amendment. He said the legislative intent of the change is to establish the tribal relations manager position once again and make clear 'it will be held by some person that will have the same level of communication [as the previous person in the tribal relations manager position], stationed in Helena, and prioritize tribal consultation above all else.'
The amendment does not include funding for the role. Rep. Donavon Hawk, D-Butte, Crow, Crow Creek Sioux introduced the amendment on behalf of Fox to the House Appropriations Committee and told lawmakers that it's meant to prod the department.
'This is not binding. The governor's office and the health department should be taking the tribal relations position more seriously,' Hawk said.
Though there's not money tied to the amendment, Rep. Mary Caferro, D-Helena, said the wording is strong.
'Here is what I know, you can even use it [legislative intent] in court,' Caferro said in a late-March interview with Montana Free Press and ICT.
Rep. Bill Mercer, R-Billings, was one of the two no votes on the amendment. Mercer said he opposed it because Charlie Brereton, the director of the Department of Public Health and Human Services, told Mercer and others that he does not believe tribal consultation has been diminished. The amendment passed 21-2.
The state health department has argued that the tribal relations position was often duplicative with the American Indian health director. In an email sent March 25, a spokesperson for the department said it 'reorganized to improve coordination, continuity and consistency with how the Department serves tribal and urban leaders.'
Democratic Gov. Steve Bullock in 2015 established the Office of American Indian Health, within the state health department, after a report revealed that Native Americans died 20 years earlier than their white counterparts in Montana. The office was established to address those health disparities.
The office would also advance the work of the state health department's tribal relations manager. Evers, the tribal relations manager at the time, reported to the director of the state health department and upheld government-to-government consultation between tribal governments, the state and the federal government.
The tribal relations manager was an independent position within the state health department. The Office of American Indian Health, run by the American Indian health director, is also its own entity within the department. In a March 25 statement, a spokesperson for the department said 'this arrangement was inefficient and redundant.'
In an interview in January with Ted Russette III, vice chairman of the Chippewa Cree Tribal Business Committee, Russette reflected on how Evers operated to ensure tribes were kept updated on state and federal health policy.
'She would have went to every one of our reservations. That's what she used to do. Since she left, nothing. It is a big drop off,' Russette said of Evers, echoing comments by other tribal leaders and tribal health department employees.
Evers in a recent interview reflected on her time at DPHHS, saying that she would take trips to every tribe in Montana twice a year and sometimes more than that, often bringing department leaders with her to introduce them to tribal leaders across the state to build relationships.
A 2016 Montana Healthcare Foundation report detailed that 'Many people specifically noted that Lesa Evers (DPHHS tribal relations manager) is doing a great job and has helped tribes tremendously in their work with DPHHS, and noted that the Office of American Indian Health should not subsume or replace her or her position.'
However, when the health department quietly eliminated the tribal relations position, it moved those duties to the American Indian health director.
'The removal of the position was done without their consultation,' Evers said, referencing tribal leaders.
In a Jan. 21 letter to health department Director Brereton, state Sen. Susan Webber, D-Browning, Blackfeet, wrote that the Legislature's interim State-Tribal Relations Committee traveled to all seven reservations in Montana in 2024 and heard frustrations from around the state about the loss of the position.
'It became apparent that the tribal leaders were concerned about the DPHHS ignoring their voices since the retirement of the tribal health manager position this past year,' Webber wrote. 'This position built trust between them and the department.'
This elimination of the position became a point of contention after a budget subcommittee hearing earlier this session when tribal leaders from around the state called for the Legislature and the department to reinstate the position.
On Feb. 26, Webber brought a bill that would have created a tribal relations management team in the department, effectively reviving the tribal relations manager position.
But at a hearing for the bill, Webber immediately asked the Senate Public Health, Welfare, and Safety Committee to table the legislation, effectively killing it. Webber said that was because the bill had served its purpose by establishing communication with the health department regarding the issue.
'Now that I got the bill and now that it's being heard, they [DPHHS] finally speak up about the progress they are going to make,' Webber said during her bill hearing. 'I hope this keeps their feet to the fire.'
Even though Webber made it clear that she wanted her bill tabled, Sen. Dennis Lenz, R-Billings and chair of the committee, gave people that attended the hearing time to testify.
American Indian Health Director Stephanie Iron Shooter spoke on behalf of the state health department. Iron Shooter told lawmakers and other attendees that her office, along with the new structure created after the removal of the tribal relations manager position, is maintaining and working to strengthen tribal relations. It's unclear if DPHHS would have supported Webber's bill; the department did not comment when asked.
'The Office of American Indian Health team within the department works very hard to oversee all aspects of tribal relations,' Iron Shooter said. 'Our new structure is working and we wish to maintain and continue strengthening it.'
Kelsen Young, representing the Montana Coalition Against Domestic and Sexual Violence, testified that she was disappointed with the tabling of the bill.
'We were able to witness firsthand how important that was, as we [the Montana Coalition Against Domestic and Sexual Violence] served on various task force councils, etc., within DPHHS,' Young said. 'I guess what I was most excited about for this bill is the fact that it would be enshrined in code so that it would be an ongoing, committed position, regardless of the whims of the director or the governor.'
During the weekly Montana American Indian Caucus meeting March 19, Iron Shooter, speaking on behalf of DPHHS, told lawmakers that her office covers a vast spectrum of responsibilities including tribal consultation.
'We're also here to provide a platform for tribal governments and tribal members, and we're talking about the constituents as well, to provide us with candid insights into the divisions and offices and programs [and] facilities and feeding those needs into our system at the department,' Iron Shooter said.
Iron Shooter told the caucus that an internal assessment in DPHHS after she was hired in 2022 showed her position and the tribal relations manager were 'duplicative government-to-government efforts.'
'For the future, what we wanted to really come to an agreement with after the retirement of the tribal relations manager, was to really provide for a real, single point of contact,' Iron Shooter said. 'Streamline communication and relationships for American Indian leaders, tribal governments, urban Indian organizations, between them and the department, divisions and staff … across the board, with the department [providing] more resources for implementation without increasing funding.'
As director of the office, Iron Shooter said her responsibilities include research and development, incorporating Indian health equity into policies and programs, tribal relations and providing technical assistance.
In recent months the Office of American Indian Health has seen expansion with the hiring of two new employees, including an American Indian health program officer and an American Indian child and family program specialist.
Iron Shooter said her office is working to build relationships with tribes statewide.
'Now, we are not there yet. We are slowly building on providing the information,' Iron Shooter said. 'It's going to take some time to build these processes, and it's not going to happen overnight. And I feel like the department is being super patient and kind with our process that we've developed.'
In her remarks to the caucus, Iron Shooter emphasised the office's focus on consultation.
'We are tribal members. We grew up here in Montana,' Iron Shooter said. 'And while I don't report directly to the department director, I am in the director's office, and there is always an open-door policy with the director and myself to communicate. And I do report to him once a month, and it's on demand.'
Iron Shooter is a citizen of the Sicangu Oyate from the Rosebud Sioux of South Dakota and of the Aaniih Anin from the Fort Belknap Indian Community of Montana.
Several American Indian Caucus members have alleged that Iron Shooter works remotely rather than in Helena at the DPHHS office. The state database that tracks employee pay shows Iron Shooter as located in Billings as of 2024.
When asked if Iron Shooter is a remote worker, the health department replied that the question would have to go through a public information request portal. That yielded a direction to use the state's pay transparency website. The department responded similarly when MTFP requested a tour of the Helena office; that was denied.
Fox told MTFP and ICT that Iron Shooter is not stationed in Helena. 'She told me herself, she works from an office in Billings,' Fox said.
Evers, who worked out of the DPHHS office in Helena, said being located in the capital city was crucial to her role.
'I was a part of leadership and reported directly to the director [of DPHHS]. This built the relationship internally with all staff,' Evers said.
Iron Shooter is a level below Evers' former post and reports to the Public Health and Community Affairs Executive Director Dave Gerard, according to organizational charts.
By being located in Helena, Evers said she was involved in impromptu meetings and she believes that department leaders thought to involve her in discussions that could potentially affect Indian Country because they saw her in the building every day.
'I understand that the department wants to be effective, but there has been ample time now to see that the newer process is not working, which was expressed by legislators and tribal leaders," Evers said
Webber said if the position is not reinstated by this Legislature, 'we will bring this bill back next session.'
Webber also suggested that during the interim before the 2027 legislative session, the interim State-Tribal Relations Committee could consider recommending the creation of a new state department, what she called 'the Department of Legislative Tribal Consultation.'
Fox said he thinks there's a '50-50 chance' the amendment made in the budget committee last week has the desired effect, adding if it doesn't happen this session it will continue to be a priority going forward.
This story is co-published by Montana Free Press and ICT, a news partnership that covers the Montana American Indian Caucus during the state's 2025 legislative session