President’s FY 2021 Budget Proposal Includes $50 Million for Urban Indian Health

The Request for FY 2021 is an Increase of $1 Million from FY 2020 Request, $8 Million Below FY 2020 Enacted

President Trump delivered a fiscally conservative budget proposal for FY2021. Although Congress and the President will negotiate new funding levels once the caps expire in September 2021, the President and congressional leaders had previously settled on new funding caps for the fiscal year ahead. The total Health and Human Services (HHS) budget is set at $96.4 billion which represents a nearly 10 percent cut to its most recent budget and includes $6.2 billion in Indian Health Service (IHS) funds.

Urban Indian Line Item

  • The spending proposal recommends a funding level for the urban Indian line at $49,636,000. This is an $8 million decrease from the enacted budget for FY 2020, but it is a $1 million increase from the President’s FY 2020 budget request for the line item. Meanwhile, IHS received an overall increase of $185 million.

Special Diabetes Program for Indians (SDPI)

  • President Trump’s budget also includes continued funding for the Special Diabetes Program for Indians (SDPI) at the current funding levels of $150 million through FY 2021.

Federal Tort Claims Act

  • The budget expands the Federal Tort Claims Act to Urban Indian Organizations (UIOs), which would protect UIO employees from malpractice lawsuits, saving each UIO an estimated $100,000 annually in malpractice insurance.

105(l) Leases

  • The FY 2021 budget adds $101 million for 105(l) leases. IHS was forced to reallocate $72 million in FY 2019 to pay $101 million for leases under section 105(l) of The Indian Self-Determination and Education Assistance Act (ISDEAA). Approximately $782,000 of which came from urban medical inflation funds.

Centers for Disease Control and Prevention and National Institutes of Health

  • The budget request would trim funding for the Centers for Disease Control and Prevention by almost 16 percent.  Funding loss that would affect the HHS core mission of preventing and controlling emerging public health issues such as opioid abuse.  The President proposes to give the National Institutes of Health a $38 billion budget for FY2021 – about $3 billion less than the current funding level. This cut would affect priorities to include research on the opioid epidemic and stimulants such as methamphetamine, issues that are at critical levels in Indian Country.

National Health Service Corps

  • The National Health Service Corps loan repayment program is reauthorized with $15 million – UIOs employees of UIOs are eligible for participation in the loan repayment program.


  • New programs include a focus on HIV/AIDS with $302 million allocated to Health Resources and Service Administration (HRSA) for HIV prevention diagnosis services expansion at health centers and treatment through the Ryan White HIV/AIDS program.

Quick Glance

  • $6,232,568,000 – IHS budget authority total
  • $4,507,113,000 – IHS services budget
  • $49,636,000 million – Urban Indian Health
  • $150,000,000 million – Special Diabetes Program for Indians
  • $101,000,000 million – Section 105(l) ISDEAA
  • $15,000,000 million – The National Health Service Corps loan repayment program
  • $302,000,000 million – HRSA for HIV prevention

A more in-depth analysis of the White House’s FY 2021 Budget is forthcoming.

NCUIH Contact: Carla Lott (, Director of Congressional Relations

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