IHS Clarifies Additional $800,696 in Funding Allocated in the Consolidated Appropriations Act, 2022 Not Intended for UIO Infrastructure Study Activities

On February 13, 2023, the Indian Health Service (IHS) sent a  Dear Urban Indian Organization Leader letter (DULL) clarifying use of funds requirements from the Fiscal Year (FY) 2022 Urban Indian Organization (UIO) Infrastructure Study as a follow-up to the virtual Urban Confer convened by the IHS on June 23, 2022. In the letter, IHS emphasized that “…the joint explanatory statement accompanying the Consolidated Appropriations Act, 2022 (CAA, 2022) does not mean Congress intends to allocate additional funding for UIO Infrastructure Activities. Instead, Congress intends to ensure that the additional funding provided remains in the Direct Operations accounts of IHS management use.” IHS notes that this aligns with UIO Confer recommendations to avoid using the funding for any additional UIO Infrastructure Study activities.


In 2021, Congress allocated $1 million in funds for IHS to conduct an Urban Indian Infrastructure study through the Consolidated Appropriations Act, 2021. The purpose of the Infrastructure Study aims to better understand the most critical deficiencies facing UIOs. On March 15, 2022, Congress provided $800,666 in additional funding to IHS for the Infrastructure Study through the CAA, 2022. On June 16, 2022, IHS requested input from UIO leaders regarding the additional funding from the CAA, 2022 on how these funds can be utilized by IHS. On June 23, 2022, UIO Leaders and NCUIH attended an Urban Confer where IHS explained that the Infrastructure Study will be completed by December 31, 2022, with results scheduled for release in January 2023. Results have not been released as of February 2023.

NCUIH’s Recommendations to IHS

On August 23, 2022, NCUIH submitted comments to IHS in response to the June 16, 2022 DULL regarding the use of funding available for the Urban Indian Infrastructure Study.  NCUIH made the following recommendations regarding the Infrastructure Study:

  • Provide UIOs with the findings from the first Infrastructure Study prior to making any decisions regarding use of the additional funds
    • It is crucial that UIOs are aware of the scope, results, and usefulness of the Infrastructure Study before they make any recommendations regarding the use of the further funding.
    • Given the timeline presented during the Urban Confer, there was an 8-month window in which UIOs and IHS will be able to review the Infrastructure Study results following their scheduled release in January 2023 and decide as to the best use of the additional funding
  • OUIHP should provide a timeline of the Planning Process to UIOs
    • NCUIH requested a timeline be released to UIOs delineating when the initial Infrastructure Study will be released, the contracting process necessary to use the additional funding, and the deadline for the obligation of the additional funding.
    • The requested timeline will provide clarity to UIOs. With a clearer picture in mind, the planning process and use of the additional FY22 funds for the Infrastructure Study becomes more cooperative between UIOs and IHS.
  • IHS should host an additional Urban Confer after releasing the results of the Infrastructure Study.
    • NCUIH notes that informed feedback from UIOs creates a scenario where the additional funding can be best used to support the needs of UIOs.

NCUIH continues to advocate for transparency in the process of the Infrastructure Study and greater support to address the critical infrastructure needs at UIOs. NCUIH will continue to keep UIOs informed as more information is made available from IHS. 

NCUIH Requests the Administration of Children and Families Host Urban Confer with UIOs Regarding the Tribal Maternal, Infant, and Early Childhood Home Visiting Program

On January 27, 2023, the National Council of Urban Indian Health submitted comments to the Administration for Children and Families (ACF) in response to their December 20, 2022 request for comment on review of the Tribal Maternal, Infant, and Early Childhood Home Visiting Program (Tribal MIECHV) Guidance for Submitting Reports to the Secretary of the Office of Management and Budget (OMB). The Tribal MIECHV Program provides grants to tribal organizations and urban Indian organizations (UIOs) to develop, implement, and evaluate home visiting programs in American Indian and Alaska Native (AI/AN) communities.


NCUIH made the following recommendations to ACF in response to the request for comments:

  • NCUIH requested that ACF host an Urban Confer with UIO leaders to discuss the Tribal MIECHV program.
  • NCUIH recommended that ACF work with its colleagues at IHS to host and facilitate an Urban Confer on the annual reporting requirements for Tribal MIECHV grantees.
    • Given the substantial increase in the set-aside for the Tribal NCUIH further recommends that ACF consider broadening the scope of this Urban Confer to engage with UIOs on the Tribal MIECHV program generally.
    • This will provide ACF a forum in which to work with UIOs to ensure that they are participating in this program to the greatest extent possible and that urban Native communities are being served as Congress intended.


Under the ACF, the MIECHV Program supports pregnant people and parents with young children who live in communities that face greater risks and barriers to achieving positive maternal and child health outcomes. The Tribal MIECHV program is funded by a six percent set-aside from the larger MIECHV program. The Tribal MIECHV program aims to support the development of happy, healthy, and successful AI/AN children and families through a coordinated home visiting strategy that addresses critical maternal and child health, development, early learning, family support, and child abuse and neglect prevention needs. It also implements high-quality, culturally relevant, evidence-based home visiting programs in AI/AN communities and expands the evidence base around home visiting interventions with Native populations.

Urban Native Maternal and Child Health Disparities

Native people have endured a tragic history of forced removal from their homelands throughout eras of colonization and US expansion. Formally dating back to the 1800s, forced removal included the loss of ancestral homelands,  children taken from their parents and placed into government boarding schools, and policy aimed at integrating Native people into US cities, each resulting in traditional and cultural deprivation. This migration into cities has resulted in urban Indians experiencing more unemployment and homelessness compared to the general population, lower levels of educational achievement, higher rates of morbidity and mortality and a loss of traditional and cultural connection. Urban Indian women have considerably lower rates of prenatal care and higher rates of infant mortality than their reservation counterparts within the same state. While UIOs provide critical health and social services, the safety net available to those living on reservations is often not matched in urban environments. Recognizing the health disparities experienced by urban Indians, MIECHV legislation allows Tribal MIECHV funds to be awarded to UIOs to further support the health and social needs of Native people living in urban areas.

NCUIH’s Role

NCUIH has engaged in extensive policy work, including attending Congressional meetings and joining sign-on letters with coalition partners, in support of reauthorizing the MIECHV program and doubling the Tribal set-aside. NCUIH was pleased that Congress reauthorized the Tribal MIECHV program and increased the funding level. The Tribal MIECHV program helps improve the lives of AI/AN children and families and NCUIH looks forward to more UIOs becoming grantees and working with ACF to support the development of happy, healthy, and successful Native children and families no matter where they live.

NCUIH Releases “2022 Annual Policy Assessment”

The Policy assessment informs urban Indian organization policy priorities in 2023, identifies traditional healing barriers, and addresses mental and behavioral health needs.

2022 Policy Assessment thumbnailThe National Council of Urban Indian Health (NCUIH) is pleased to announce the release of its 2022 Annual Policy Assessment. NCUIH hosted five focus groups to identify Urban Indian Organization (UIO) policy priorities for 2023, as they relate to the Indian Health Service (IHS) designated facility types (full ambulatory, limited ambulatory, outreach and referral, and outpatient and residential). The focus groups were held on October 18, 21, and 24, 2022. Additional information was also collected from the UIOs via a questionnaire sent out on November 15, 2022.

Together these tools allow NCUIH to work with UIOs to identify policy priorities in 2023 and identify barriers that impact delivery of care to Native patients and their communities.  Of 41 UIOs, 26 attended the focus groups and/or participated in the questionnaire. This is the third year that NCUIH has conducted the assessment via focus groups and follow up questionnaire. This is also the highest response from UIOs NCUIH has seen since following this process.

Overview of Policy Assessment

2022 Policy Assessment chartAfter the height of the COVID-19 pandemic, newfound priorities were identified for 2023, including workforce development and retention, increased funding for traditional healing, and expanded access to care and telehealth services. Existing priorities also remain a key focus across UIOs, especially increasing funding amounts for the urban Indian health line item and IHS, maintaining advance appropriations for IHS, establishing permanent 100% Federal Medical Assistance Percentage (FMAP) for UIOs, reauthorizing the Special Diabetes Program for Indians (SDPI), and increasing behavioral health funding.


Key findings from the discussions are as follows:

  • Funding Flexibility is Key to Expanding Services
  • Need for Funding Security Remains a Priority
  • Advance Appropriations Mitigates Funding Insecurities Generated by Government Shutdowns and Continuing Resolutions
  • Facility Funding Directly Impacting UIOs
  • Permanent 100% FMAP Increases Available Financial Resources to UIOs
  • Workforce Concerns Amidst Inflation and Market Changes
  • Traditional Healing Crucial to Advance Comprehensive Native Healthcare
  • Addressing Access and Quality of Native Veteran Care
  • Health Information Technology and Electronic Health Record Modernization
  • New Barriers Limit UIO Distribution of Vaccines
  • HIV, Behavioral Health, and Substance Abuse Report
  • Reauthorizing the Special Diabetes Program for Indians
  • UIOs Find Current NCUIH Services Beneficial

Next Steps

NCUIH will release a comprehensive document of the 2023 Policy Priorities in the coming weeks.

Past Resources: