REPORT: Urban Indian Health at Risk – Federal Funding Disruptions Threaten Critical Services

Today, February 3, 2025, the National Council of Urban Indian Health (NCUIH) releases a critical report on the potential impact of federal funding disruptions on Urban Indian Organizations (UIOs). This timely survey highlights the importance of these vital healthcare providers serving American Indians and Alaska Natives in urban areas across the United States.

Key Findings

  • Operational Sustainability: Over half of the surveyed UIOs report they would be unable to sustain operations beyond six months without federal funding. Alarmingly, some organizations can only maintain services for 30 days or less, underscoring the immediate threat to these essential healthcare providers.
  • Workforce Instability: More than 60% of UIOs face potential staff reductions, with 23.1% definitely needing to furlough or lay off staff if federal funding is disrupted. This threatens not only the livelihoods of dedicated healthcare professionals but also the continuity of care for urban Native communities.
  • Service Discontinuation: A significant number of UIOs anticipate discontinuing critical services if federal funding is disrupted.
    • These at-risk services include:
      • Primary care
      • Behavioral health services
      • Substance abuse treatment
      • Community wellness initiatives
      • Health programs (vaccinations, testing, education)
      • Cultural and youth programming

Implications

The potential disruption of UIO services could have far-reaching consequences for urban American Indian and Alaska Native populations. UIOs serve patients from over 500 federally recognized Tribes, providing crucial primary care, behavioral health, traditional medicine, and social services. Any interruption in these services could exacerbate existing health disparities and undermine decades of progress in urban Native healthcare.

As we release this report, we call on policymakers, healthcare leaders, and advocates to recognize the critical role of UIOs in the Indian health system and take immediate action to ensure their continued operation and funding stability. The health and well-being of urban Native communities depend on the uninterrupted services provided by these organizations.

Report

IMPACT OF FEDERAL FUNDING PAUSES ON URBAN INDIAN ORGANIZATIONS

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PRESS RELEASE: Tribal Organizations Urge Administration to Respect Tribal Sovereignty and Uphold Trust and Treaty Obligations Amid Executive Actions

FOR IMMEDIATE RELEASE

WASHINGTON, D.C. (February 3, 2025)– A coalition of Tribal organizations, representing Tribal Nations and their citizens and communities, is calling on the Administration to ensure that recent executive actions do not undermine the unique sovereign political status of Tribal Nations as sovereign nations with which the federal government has trust and treaty obligations, or disrupt federal funding that flows from those relationships for essential Tribal programs.

Following the issuance of multiple executive orders and Office of Management and Budget (OMB) directives, concerns arose over freezes on federal funding that Tribal Nations and Tribal organizations, including urban Indian organizations, rely on to provide critical healthcare, economic development, education, and social services to Tribal communities. While OMB has since rescinded the initial memorandum, questions remain about how federal agencies will interpret and implement the Administration’s executive orders and policies moving forward.

Tribal Nations are not special interest groups—they are sovereign governments with a unique legal and political relationship with the United States and with their own Tribal communities. The trust and treaty obligations of the federal government are political and debt-based in nature.  Tribal Nations’ sovereignty and the federal government’s delivery on its trust and treaty obligations must not become collateral damage in broader policy shifts.

The coalition emphasizes that federal funding for Tribal programs is not discretionary, but rather a legal mandate owed under the United States’ trust and treaty obligations and the many statutes that carry them out. The organizations urge the Administration to explicitly recognize Tribal sovereignty and trust and treaty obligations in the implementation of all executive orders and priorities and to ensure that federal agencies provide clear guidance that protects Tribal programs from unnecessary disruption.

As the Administration advances its priorities, it must do so in a way that respects Tribal sovereignty, strengthens self-determination, and delivers on trust and treaty obligations. We stand ready to work with federal partners to ensure that all policies and decisions uphold the government-to-government relationship beteen the U.S. and Tribal Nations.

The coalition will continue to advocate for Tribal sovereignty and fulfillment of the trust and treaty obligations and ensure that the voices of Indian Country are heard in Washington. A full copy of the sign-on letter can be found here: https://qrco.de/letter2225.

List of National Tribal Organizations

American Indian Higher Education Consortium
Association on American Indian Affairs
Affiliated Tribes of Northwest Indians
California Tribal Chairpersons Association
Great Lakes Inter-Tribal Council
Great Plains Tribal Chairmans Association
Indian Gaming Association
Inter-Tribal Association of Arizona
Midwest Alliance of Sovereign Tribes
Native American Finance Officers Association
National American Indian Court Judges Association
Native American Rights Fund
National Association of Tribal Historic Preservation Officers
Native Forward Scholars Fund
National Congress of American Indians
National Council of Urban Indian Health
National Indian Child Welfare Association
National Indian Education Association
National Indian Health Board
Northern California Tribal Chairperson’s Association
Rocky Mountain Tribal Leaders Council
Self-Governance Communication & Education Tribal Consortium
Southern California Tribal Chairmen’s Association
United South and Eastern Tribes

January 31, 2025 – National Council of Urban Indian Health Calls for Protection of Indian Health System Funding

About NCUIH

The National Council of Urban Indian Health (NCUIH) is a national representative for the 41 Urban Indian Organizations contracting with the Indian Health Service under the Indian Health Care Improvement Act. NCUIH is devoted to the support and development of high quality and accessible health and public health services for American Indian and Alaska Native people living in urban areas.

NCUIH respects and supports Tribal sovereignty and the unique government-to-government relationship between our Tribal Nations and the United States. NCUIH works to support those federal laws, policies, and procedures that respect and uplift Tribal sovereignty and the government-to-government relationship. NCUIH does not support any federal law, policy, or procedure that infringes upon or in any way diminishes Tribal sovereignty or the government-to-government relationship.

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NCUIH Contact: Meredith Raimondi, Vice President of Policy and Communications, mraimondi@ncuih.org

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