Indian Health Service Report Finds that Urban Indian Organization Staff Must Increase by 136% to Meet Patient Demand by 2032

On April 23, 2024, the Indian Health Service (IHS) Office of Urban Indian Health Programs (OUIHP) released the Urban Indian Organization (UIO) Infrastructure Study Report to Congress Fiscal Year 2023 (“UIO Infrastructure Study”). The report establishes future facility needs for the majority of the 41 UIOs and estimates the operational resources needed to serve each UIO Service Area’s future urban American Indian and Alaska Native population.

Key Findings

Some key findings address UIOs’ future services, staffing needs, operational budget, and facility requirements.

Regarding future services provided at UIOs, the UIO Infrastructure Study stated that “the majority of UIOs emphasize primary medical care services and aspire to be the culturally appropriate medical home for their patient population and community.” UIOs that offer primary care and provided data plan to have staff and resource capacity to support approximately 1,376,000 primary care visits in 2032, an increase from the current rate of approximately 463,000 provider visits per year. “Most UIOs see themselves offering a broader spectrum of outpatient services in the future to provide their patients with a one-stop shop of services.”

To reach the UIOs’ 2032 goals, the 39 UIOs that provided staffing data would need to grow from 3,420 Full-Time Equivalents (FTEs) to 6,275 FTEs, which is a 78% increase. “For overall patient service demand, the number of FTEs would need to grow to 8,083.” To fund the 2032 vision, IHS “contract and grant funding provided annually would need to increase by $1.37 billion for the Urban Indian population portion and overall would need to increase by $1.81 billion.” Lastly, UIOs need an additional 2.75 million building gross spare feet (BGSF) which would require $2.95 billion for facility design and construction and $4.4 billion to replace the entire inventory of UIOs’ space.


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 is to further understand the most critical deficiencies facing UIOs. IHS contracted with The Innova Group, a healthcare consultancy entity, to conduct the Infrastructure Study. On March 15, 2022, Congress provided $800,969 in additional funding to IHS for the Infrastructure Study through the Consolidated Appropriations Act, 2022.

NCUIH’s Advocacy

On August 23, 2022, NCUIH submitted comments to IHS in response to the June 16, 2022, Dear Urban Indian Organization Leader letter regarding the use of funding available for the Urban Indian Infrastructure Study.

NCUIH continues to advocate for transparency in the process of the UIO 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.