Tribal Leaders Recommend Increased Urban Indian Health Funding in Fiscal Year 2026 Area Reports

On January 24-25, 2024, the Indian Health Service (IHS) held their Area Report Presentations Webinar for Fiscal Year (FY) 2026 where Tribal leaders from all 12 IHS Areas and leaders from Native organizations, including the National Council of Urban Indian Health (NCUIH), presented on their budget requests. Tribal leaders spoke about the need to increase urban Indian health funding.  Phoenix Area representative and Chairwoman of the Fallon Paiute-Shoshone tribe, Cathi Willams-Tuni, even noted that urban health line item has “…remained static for way, way too long.”

Common themes among Area reports were the need for increased funding for mental and behavioral health, electronic health records (EHR), permanent authorization of the Special Diabetes Program for Indians (SDPI), and permanent exemption from sequestration.

NCUIH always supports the Workgroup’s recommendation for the IHS budget and is grateful for Tribal Leaders’ support for increased funding in the urban health line item.

Area Report Highlights

Several Areas featured the work of UIOs in their presentations and advocated for increased allocation of funding and resources for urban Indian health.

The Bemidji Area stressed that UIOs are forced to use grants that are restrictive in nature leaving highly accessed urban sites financially unstable. They recommended an increase of $914 million above the FY2023 planning base for the Urban Indian Health line item for FY2026 and noted that increased funding would support authorized new programs and services for UIOs.

The Billings Area included urban Indian health as a top priority and recommended an increase of $1.3 billion over the FY2023 planning base for the Urban Indian Health line item for FY 2026.

The Oklahoma Area included a request to increase funding for the urban Indian health line item by $467.5 million above the FY 2023 recommendation as a priority for FY2026 in their Area report.

The Phoenix Area included urban Indian health funding as a top priority and recommended an increase of $103.7 million above the FY2023 planning base for FY2026. The Phoenix Area also noted that UIOs have many unmet construction, maintenance and improvement needs.

The Portland Area recommended a 2% increase over the FY 2023 planning base to the urban Indian health line item for FY 2026. The Area representative also noted that when UIOs are not sufficiently funded, tribal members will come to tribal clinics and get denied Purchase Referred Care (PRC) because they live in urban areas.

The Tucson Area highlighted the need for increased funding for the Urban Health line item and recommended $1.4 billion over the FY 2023 planning base for FY2026. The Tucson Area also included the need for 100% Federal Medical Assistance Percentage (FMAP) for Medicaid services at UIOs in their Area report. They also presented on the Tucson Indian Center’s successes such as celebrating 60 years of serving the Tucson American Indian community and launching primary care and behavioral health services in January 2024.

NCUIH Presents Priorities at Area Presentations Webinar

Meredith Raimondi, NCUIH’s Vice President of Public Policy and Communications, presented the top priorities for urban Indian health FY 2026 during the Area Report Webinar. NCUIH supports full funding for the IHS, Tribal, and urban Indian organization (UIO) (I/T/U) system.  We endorse a budget in which IHS, Tribal Facilities, and UIOs are all fully funded to improve health outcomes for all Native people no matter where they live.

1. Maintaining the Tribal Budget Workgroup’s most recent request for Urban Indian health, with no cuts for sequestration.
   1. This funding is necessary to address health priorities for Native in urban areas, including:
      1. 1. Ensuring Urban Indian Health funding keeps pace with population growth.
         2. Providing funding for UIO facilities and infrastructure.
         3. Expanding service offerings to Native patients in urban areas.
2. Establishing Permanent 100% Federal Medical Assistance Percentages (FMAP) for services provided to Medicaid beneficiaries at UIOs
3. Recruitment and Retention of Workforce
4. SDPI reauthorization
5. Increased funding and resources for Traditional Healing services, food and housing insecurity

Background on Area Budget Formulation

As part of the trust responsibility to provide health care to all American Indians and Alaska Natives, Tribal Leaders present their funding needs each year to the Secretary of HHS and the Director of the Office of Management and Budget. The recommendations are formed through the Tribal Budget Formulation Work Group and serve as a framework for the Administration in setting budget amounts for their annual requests to Congress. This process ensures the federal government has the resources to provide health care to all American Indians and Alaska Natives in fulfillment of the trust responsibility.

Next Steps

On February 13-14, 2024, IHS will host the FY 2026 National Tribal Budget Formulation Work Session.  This is a 2-day annual meeting where the two tribal representatives from each Area come together to review and consolidate all the Area’s Budget recommendations into a comprehensive set of national health priorities and budget recommendations. Work session activities include:

• Tribal Caucus occurs where the tribal workgroup co-chairs are selected
• Tribal representatives from each Area give a brief Area report presentation to the group
• Discussion on determining priorities and budget recommendations
  • Discussions are made by consensus from workgroup members. Only the two tribal representatives that are part of the workgroup are allowed to partake in voting.
• The workgroup will meet with the IHS Director and other IHS leadership to discuss health priorities and budget recommendations.
• At least one tribal representative from each Area along with technical team members will coordinate to complete follow-up work on the budget recommendation and testimony that will be presented.