PRESS RELEASE: President Proposes $49.6 Million in FY 2021 Budget for Urban Indian Health

Contact: Meredith Raimondi

Request for FY 2021 is $8 Million below FY 2020 Enacted

WASHINGTON, DC (February 11, 2020) – On February 10, 2020, the President released the annual budget proposal for Fiscal Year (FY) 2021. The proposal includes a total of $96.2 billion for the Department of Health and Human Services (HHS), which represents a nearly 10 percent cut to current enacted budget. Under the request, the Indian Health Service (IHS) would receive approximately $6.4 billion in FY 2021.  NCUIH, in conjunction with the Tribal Budget Formulation Workgroup (TBFWG), had encouraged the Administration to fund IHS at $9.1 billion with an urban Indian health line item of $105.9 million for FY 2021. This is an increase of $48.2 million for urban Indian health over the enacted FY 2020 budget. The proposed IHS budget falls nearly $3 billion short of TBFWG’s overall IHS recommendation, and the proposed urban Indian health funding amount constitutes $56.3 million less than the TBFWG recommendation.

“NCUIH looks forward to working with the Administration and Congress to fully fund IHS and the urban Indian health care line item. NCUIH was encouraged by the enacted FY 2020 IHS budget of approximately $6.0 billion, an increase of 4% above the enacted FY 2019 level. The FY 2020 Enacted appropriation funded urban Indian health at approximately $57 million and provided over $115,000 in increases for 39 of the 41 Urban Indian Organizations. For FY 2021, NCUIH encourages Congress to meet the TBFWG recommendation of approximately $106 million for the urban Indian Health line item, which is $56.3 million above the President’s FY 2021 request,” said Francys Crevier, Executive Director of NCUIH.

Congress will consider the President’s request as it begins to draft appropriations bills for FY 2021. Please find below a summary of some of the proposed funding amounts that would impact urban Indian health.  A more in-depth analysis of the White House’s FY 2021 Budget is forthcoming.

Urban Indian Line Item

  • The spending proposal recommends a funding level for the urban Indian line item at $49,636,000. This is an approximately $8 million decrease from the FY 2020 Enacted amount, but it is $865,000 increase from the President’s FY 2020 budget request.

Special Diabetes Program for Indians (SDPI)

  • The President’s budget also includes continued funding for the SDPI at the current funding levels of $150 million through FY 2021. It includes expected spending for the program over a 10-year period if Congress extends funding only through FY 2021 and does not include a long-term re-authorization.

Federal Tort Claims Act

  • The budget proposes to expand medical malpractice coverage under the Federal Tort Claims Act to Urban Indian Organizations (UIOs), which would protect UIO employees from malpractice lawsuits, saving some UIOs upwards of $250,000 annually in malpractice insurance costs. It also proposes an expansion of malpractice coverage for IHS volunteers.

105(l) Leases

  • The FY 2021 budget adds $101 million for 105(l) leases. In FY 2019, IHS was forced to reallocate $72 million in FY 2019 to pay for $101 million in leases under section 105(l) of the Indian Self-Determination and Education Assistance Act. In FYs 2018 and 2019, IHS reprogrammed approximately $782,000 each year from urban Indian health inflation funds to pay for 105(l) leases. The $101 million in 105(l) lease costs in FY 2019 represented a nearly fourfold increase to the amount requested in FY 2018 – if this trend continues, there is concern $101 million will be insufficient and IHS will again reprogram other 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. This is a funding loss that would affect the HHS core mission of preventing and controlling emerging public health issues, such as opioid and substance use disorders.
  • The proposal includes an approximately $38 billion budget for the National Institutes of Health in FY 2021, which is – 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 to address in Indian Country.

National Health Service Corps

  • The proposal seeks to reauthorize the National Health Service Corps loan repayment program with $15 million. UIOs’ employees are eligible for participation in the loan repayment program.


  • New programs proposed include a focus on HIV/AIDS with $302 million allocated to the Health Resources and Services Administration (HRSA) for HIV prevention providing the funding for diagnosis services expansion at Health Centers and expanded 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 – Urban Indian Health
  • $150,000,000 – Special Diabetes Program for Indians
  • $101,000,000 – Section 105(l) ISDEAA
  • $15,000,000 – The National Health Service Corps loan repayment program
  • $302,000,000 – HRSA for HIV prevention


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