February Policy Updates: Federal Funding Threats, IHS Budget Advocacy & Key Tribal Actions

On February 12, NCUIH released a final report on the potential impact of federal funding disruptions on urban Indian Organizations (UIOs).​

• Read the final report here.

Key Findings:

• Operational Sustainability: Over half of UIOs would not be able to sustain operations beyond six months without federal funding.
• Service Discontinuation: Over half of UIOs anticipate discontinuing critical services if federal funding disruptions were to persist.
• Immediate Impact: Some UIOs can only sustain operations for 30 days or less without federal funds.

The potential disruption of UIO services could have far-reaching consequences for urban American Indian and Alaska Native (AI/AN) populations. The 41 UIOs collectively 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 American Indian and Alaska 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 AI/AN communities depend on the uninterrupted services provided by these organizations.

Background on OMB Federal Funding Freeze 

On January 27, the Office of Management and Budget (OMB) issued a memorandum to Agencies that requires Agency leadership “to the extent permissible under applicable law…temporarily pause all activities related to obligation or disbursement of all Federal financial assistance.”

The OMB memo freezing financial assistance was rescinded on January 29, 2025, and there are current federal court orders blocking the enforcement of various Executive Orders (EOs) that disrupt federal funding. However, concerns remain about the potential for future freezes and their detrimental effects on the Indian health system.

In response, NCUIH…

• prepared a template email for UIO leaders to use in reaching out to their Members of Congress, urging their support to exempt the Indian health system from any future funding freezes or restrictions.
• submitted a letter to OMB requesting exemption for the Indian Health System from any future funding restrictions or pauses (January 31).
• submitted a letter HHS requesting exemption for the Indian Health System from any future funding restrictions or pauses (January 31).
• joined the National Indian Health Board (NIHB) in sending a joint letter to Congressional leadership highlighting the need for exemptions on any future funding freezes (January 31).

Take Action! 

• Tell Congress to protect Indian health system funding: While the recent OMB memorandum freezing financial assistance has been rescinded, NCUIH remains concerned about potential future impacts on the Indian health system. Let Congress know that it is critical that Indian health system funding is protected from any future disruptions, using this language for your representative.

On January 20, President Trump issued a memorandum ordering a hiring freeze for federal civilian positions.

In response, NCUIH…

• joined NIHB, National Congress of American Indians (NCAI), and Self-Governance Communication and Education Tribal Consortium in sending a letter to HHS regarding the memorandum issued by President Donald Trump instituting a federal civilian employee hiring freeze (January 31).
• The letter requests an exemption for the IHS from any plans, policies, or incentives that seek to decrease its workforce because IHS is the principal health care provider for American Indian and Alaska Native people and is essential in fulfilling the United States legal and trust obligation to provide health care to American Indian and Alaska Native people.
• The letter also states that exempting IHS from the federal civilian position hiring freeze is critically necessary to protect public safety.
• Read our blog

HHS and DOI Confirm DEI EO Do Not Apply to American Indian and Alaska Native People

A January 30 Department of Interior (DOI) Secretary’s Order “Ending DEI Programs and Gender Ideology Extremism” states that nothing in the order shall affect activities that implement legal requirements independent of the rescinded equity-related EOs, including activities the statutory authorities, treaty, and/or trust obligations of DOI and its Bureaus/Offices to Tribal Nations.

In a February 6th memo, HHS Acting General Counsel Sean Keveney responded to Senator Murkowski’s (R-AK) inquiry regarding the applicability of the EO on DEI to IHS programs serving AI/AN people. Acting General Counsel Keveney clarified that the Executive Order “does not apply to programs or activities of the Department of Health and Human Services that affect or serve AI/ANs.”

NOTE: We urge UIOs to discuss any questions you may have about the potential impact HHS’s note and DOI’s Secretary’s Order may have on your communications, funding, or programming with your General Counsel.

HHS Advisory Opinion on Application of DEI Executive Orders to the Department’s Legal Obligation to Indian Tribes and Their Citizens

On February 25the HHS Office of General Counsel issued an Advisory Opinion which reaffirms that recent Executive Orders do not alter the federal government’s trust responsibility to provide healthcare for AI/AN people. This opinion clarifies that recent Executive Orders do not alter the federal government’s distinct legal obligations to Indian Tribes and their citizens, as established by treaties, statutes, and the U.S. Constitution. It also notes that IHS facilities must comply with these Executive Orders in the operation of policy-based programming.

This action reflects responsiveness to calls from Tribal leaders and AI/AN organizations urging the administration to uphold its trust obligations. NCUIH has consistently advocated for the protection of the Indian health system, including UIOs, which provide health services for AI/AN people.

Read NCUIH’s statement.

Executive Order on Reducing the Federal Civil Workforce

On February 11, 2025, the Administration issued an EO entitled “Implementing the President’s “Department of Government Efficiency” Workforce Optimization Initiative.”

 The EO aims to reform the workforce in several ways: 

• Instituting a hiring ratio where “each agency hire no more than one employee for every four employees that depart.”
• Instructing agencies to develop a plan the ensure career appointment hires are in highest-need areas.
• Initiating reductions in the workforce, exempting functions related to public safety, immigration enforcement, or law enforcement.

According to news reports, officials in the Office of Personnel Management (OPM) met with agency leaders and advised them to dismiss probationary employees.

In response, NCUIH…

• released  an action alert urging advocates to contact Congress to demand they stop these layoffs and protect tribal programs (February 14).
• joined other national Native organizations and the Navajo Nation in a letter to OPM advocating on behalf of federal employees who serve Indian Country (February 14).

Recission of IHS Employee Termination 

• A February 17 news report noted HHS Secretary Kennedy rescinded the layoffs of 950 IHS employees.
• With IHS facing a 30% vacancy rate, further reductions in staffing would severely impact healthcare access for AI/AN people.
• NCUIH will continue to monitor these developments, and we remain committed to ensuring the federal government upholds its trust responsibility.

Protecting Indian Country Amid Executive Actions

Letter to Admin

• On February 2, NCUIH and Tribal organizations sent a letter to the President, Members of Congress, and the Department of Interior Secretary 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.

Letter to OMB

• On February 14, NCUIH and Tribal organizations sent a letter to OMB Director Russell Vought to congratulate him on being confirmed to lead OMB and request a meeting with him as soon as possible to discuss implementing President Trump’s priorities in a manner that recognizes the sovereign governmental status of Tribal Nations and the United States’ longstanding trust and treaty obligations.

Monitoring the Bench

State of New York v. Trump 

• Lawsuit brought in the District Court of Rhode Island by 22 states to stop the federal funding freeze.
• Temporary Restraining Order Granted on 1/31 – still in effect as of February 28, 2025. 
• Defendants argued the OMB memo was rescinded and the case was moot, but Plaintiffs provided evidence from the Administration that there was still intent to implement the freeze.
• Motion for Preliminary Injunction filed by Plaintiffs on 2/7 with a Hearing held on 2/21. The Motion was taken under advisement, and a decision has not been issued yet. In the meantime, the Temporary Restraining Order is still in effect.
• Defendants appealed the Temporary Restraining Order to the 1st Circuit.
• This was ordered to be voluntarily dismissed on 2/13.
• Defendants filed an Emergency Motion for Permission to withhold FEMA and other funding – this was Denied on 2/12.
• “Neither the TRO nor the Court’s subsequent Order require the Defendants to seek “preclearance” from the Court before acting to terminate funding when that decision is based on actual authority in the applicable statutory, regulatory, or grant terms.”

National Council of Nonprofits v. Office of Management and Budget (OMB) 

• Lawsuit brought in the District Court of the District of Columbia by nonprofits to stop the federal funding freeze.
• Temporary Restraining Order Granted on 2/3.
• Plaintiffs filed their Motion for Preliminary Injunction on 2/11 with a Hearing held on 2/20.
• A Preliminary Injunction was issued on 2/25, preventing the Trump administration from implementing the funding freeze before a final decision is made.
• Judge AliKhan barred the federal government from “implementing, giving effect to or reinstating under a different name” the OMB directive to pause federal financial assistance.

NCUIH is monitoring litigation surrounding Executive Orders that directly or indirectly affect UIOs and/or urban AI/AN health.

IHS National Tribal Budget Formulation Workgroup Areas Recommend an Average Increase of $73 Billion for IHS and $998 Million for Urban Indian Health for FY 2027

NCUIH Board Member Todd Wilson (Crow), NCUIH President Walter Murillo (Choctaw), NCUIH CEO Francys Crevier (Algonquin), and Executive Director of the Montana Consortium for Urban Indian Health Jason Smith.

On February 11-12, NCUIH joined the FY 2027 IHS National Tribal Budget Work Session where all 12 of the IHS Areas’ budget recommendations are consolidated into a comprehensive set of national health priorities and budget recommendations. NCUIH President Walter Murillo presented urban Indian health priorities, such as full funding for IHS and the Urban Indian line item, establishing permanent 100% FMAP for services provided to Medicaid beneficiaries at UIOs, exempting urban AI/AN Medicaid beneficiaries from Medicaid reform work requirements, and SDPI reauthorization.

• Tribes drive the budget formulation process to ensure the IHS budget reflects the evolving health needs of AI/AN people and communities.
• NCUIH always supports the Tribal Budget Formulation Workgroup budget request and advocates for full mandatory funding for IHS.
• NCUIH is grateful for the Tribal Budget Formulation Workgroup’s advocacy for a fully funded Indian health care system, including UIOs.
• The bottom line: Average Tribal recommendation increase for IHS for FY2027: $73 billion.
• The bottom line: Average Tribal recommendation for Urban Indian Health for FY 2027: $998.1 million.

One more thing: During the FY 2027 IHS National Tribal Budget Formulation Work Session, IHS clarified that they are not anticipating delays in UIO contracts and are moving forward with contracts as normal at this time, in the midst of recent Executive Orders.

NCUIH Requests Full Funding for the Indian Health System for FY 2026

NCUIH Testimony at House Interior Appropriations Subcommittee American Indian and Alaska Native Public Witness Hearing

On February 27, Robyn Sunday-Allen (Cherokee), CEO of the Oklahoma City Indian Clinic and NCUIH Board President-Elect, was NCUIH’s witness for the FY 2026 House Appropriations Committee’s AI/AN Witness Day.

• Go deeper: Testimony advocated for:
• Protecting Funding from cuts and freezes for IHS and fund Urban Indian Health at $100 million for FY 2026.
• Maintaining Advance Appropriations for IHS, until mandatory funding is achieved, and protect IHS from sequestration.
• Ensuring Federal Policies Uphold Trust Obligations to AI/AN Communities.

FY 2025 Appropriations and Budget Resolution

Continuing Resolution and FY25 Funding: 

The current Continuing Resolution (CR), which temporarily funds the government, is set to expire on March 14.

• What’s Next?: If Congress fails to reach an agreement on either a full-year funding bill or a year-long CR by this deadline, the government will face a shutdown. With the tight timeline and ongoing negotiations, Congressional leaders are now leaning toward passing a year-long CR to avoid a shutdown and maintain government operations.

Budget Resolution:

• On February 21, the Senate passed a budget resolution following an 11-hour Vote-a-rama. No Tribal Amendments were included.
• This sets up the Senate Committees with jurisdiction to develop budgets based on the guidelines outlined in the resolution. The Senate will then go through another round of Vote-a-rama to pass the final bill.
• On February 25, the House of Representatives passed their version of a budget resolution.
• This plan will set up Congress to pass President Trump’s legislative agenda in one bill, instead of two. President Trump has stated support for the House’s budget resolution over the Senate’s bill.
• Next Steps: The Senate will now take up the House budget resolution and provide their suggested changes to match their priorities. Both Chambers need to adopt the same Budget Resolution in order to move forward.

NCUIH Supports the Partnership for Medicaid’s Call to Protect Medicaid amid Budget Resolution 

On February 6, NCUIH joined the Partnership for Medicaid in releasing a statement that calls on Congress to reject cuts to Medicaid during the budget reconciliation process.

The National Council of Urban Indian Health (NCUIH) joined the Partnership for Medicaid (P4M) in calling on Congress to protect Medicaid, while expressing a commitment to work with policymakers to identify more sustainable strategies to strengthen Medicaid and improve on its promise of providing high quality coverage and access to care for populations in need. On February 6, P4M issued a statement urging Congress to reject cuts to Medicaid during the budget reconciliation process, and on February 24, P4M released a statement urging Congress to vote “no” on the budget resolution which includes $880 billion in cuts for the Energy and Commerce Committee, which would likely significantly impact Medicaid.

• Did you know?: NCUIH is a member of the Partnership for Medicaid, which is a nonpartisan, nationwide coalition of organizations representing clinicians, health care providers, safety-net health plans, and counties. The goal of the coalition is to preserve and improve the Medicaid program.

Legislative Updates

House Hearing on the Stronger Engagement for Indian Health Needs Act of 2025 (H.R. 741)

On February 5, the House Subcommittee on Indian and Insular Affairs hearing on the bill, which NCUIH has worked on with Rep. Stanton (D-AZ-4) and has endorsed it since its first introduction.

• What is it?: This bill would elevate the IHS Director to Assistant Secretary for Indian health within HHS, increasing their authority within the federal government on the health care needs of the AI/AN population.
• What’s Next?: The bill will have to be voted on in the Subcommittee in order to be considered by the full House for a vote.

SCIA Hearing on 119th Congress Priorities for Indian Country 

On Feb. 12, 2025, the Senate Committee on Indian Affairs (SCIA) held a hearing to cover AI/AN priorities in the 119^th Congress.

• NIHB, the Council for Native Hawaiian Advancement, the National Indian Education Association Board, and Native American Financial Officers Association testified at the hearing on AI/AN priorities such as IHS workforce cuts, Native Behavioral Health Access Improvement Act, and nutritious food for AI/AN children.

ICYMI: Recent Dear Tribal and Urban Leader Letters (DTLL/DULL)

Jan. 15 – IHS Headquarters Office of the Director Reorganization Completion

• The IHS Director wrote to Tribal leaders and UIO leaders in a follow-up to Tribal Consultation and Urban Confer on the IHS Headquarters reorganization of the offices that comprise the Deputy Director for Intergovernmental Affairs.
• Following the publication of their Federal Register Notice on January 8, 2025, IHS announced the completion of this reorganization.

Jan. 16 – IHS Appointment of Deputy Director for Field Operations

• The IHS Director wrote to Tribal leaders and UIO leaders to announce the appointment of Dr. Beverly Cotton (Mississippi Band of Choctaw Indians) as the Deputy Director for Field Operations at IHS.
• As IHS DDFO, Dr. Cotton provides management oversight and resource allocation for four IHS Area Offices: Albuquerque, Navajo, Oklahoma City, and Tucson.

 Jan. 16 – IHS Interactive Web Map for Cancer Screening, Diagnosis, and Treatment

• The IHS Director wrote to Tribal leaders and UIO leaders to share a vital resource developed by the IHS to help patients overcome barriers when accessing cancer care services in our communities.
• IHS is building an interactive web map that provides IHS patients with a search tool to locate cancer services near home, and health care providers can use the map to plan appointments and referrals.
• IHS Tribal and Urban health care cancer subject matter experts will populate the web map with the locations of cancer services, based on their discretion.

 Jan. 17 – HHS 27th Annual Tribal Budget Consultation

• HHS wrote to Tribal leaders to invite them to the 27th HHS Annual Tribal Budget Consultation (ATBC). The ATBC will provide a forum for tribes to collectively share their views and priorities with HHS officials on national health and human services funding priorities and make recommendations for the Department’s FY 2027 budget request.
• The ATBC will take place in-person on April 22 – 23, 2025, at the Hubert H. Humphrey Building at 200 Independence Avenue, SW, Washington, DC. Register to attend here.
• The ATBC written comment period ends Monday, April 21, 2025, at 5:00pm ET and can be emailed to consultation@hhs.gov with subject line “HHS Annual Tribal Budget Consultation.”
• Tribes are once again invited to register for one-on-one consultations in conjunction with the ATBC.

NCUIH in Action

Earlier this month, NCUIH attended the 2025 State of Indian Nations Address hosted by the NCAI.

On February 13th, NCUIH worked with NCAI & NIHB to facilitate and staff dozens of Congressional meetings for Tribal Leaders and provided talking points on provided talking points on Medicaid, IHS Appropriations, and the Special Diabetes Program for Indians (SDPI). NCUIH Visited 10 offices.

On February 12, NCUIH VP of Policy and Communications Meredith Raimondi moderated a panel with NCUIH CEO Francys Crevier and NIHB Interim CEO A.C. Locklear on health care priorities during NCAI’s 2025 ECWS. The panel discussed federal funding and hiring freezes, protecting IHS funding, Medicaid in AI/AN communities, SDPI, and data collection as a tool for advocacy.

On February 5, NCUIH and Georgetown CCF co-hosted a webinar on Medicaid in AI/AN Communities. Speakers included Winn Davis, NIHB and Lisa James, Montana Consortium of Urban Indian Health. Watch the webinar here.

On February 3, NCUIH represented UIOs and presented policy updates at the American Academy of Pediatrics (AAP) Committee on Native American Child Health (CONACH) Spring Business Meeting.

NCUIH 2025 Annual Conference (April 22 – April 25) Award Nominations

Call for Nominations! NCUIH’s 2025 Annual Conference Awards

Submit a nomination here by Friday, March 21, 2025

The National Council of Urban Indian Health (NCUIH) invites you to submit award nominations for our Annual Conference, on April 23 – April 24, 2025, in Washington, D.C.

As part of our commitment to uplifting excellence in health care, we are seeking nominations for individuals and organizations who have made remarkable contributions to the field of urban Indian health. We invite you to nominate candidates for the following prestigious awards:

1. Urban Indian Organization Staff Member of the Year Award: This award recognizes a staff member of an Indian Health Service funded Urban Indian Organization (UIO) who exemplifies dedication and leadership in serving urban AI/AN populations through innovative initiatives and unwavering commitment.
2. Urban Indian Organization Visionary Award: The Urban Indian Organization Visionary Award celebrates an individual within an Urban Indian Organization who has demonstrated visionary leadership and innovation in addressing challenges and opportunities within urban AI/AN communities. Nominees should have a track record of developing and implementing innovative programs, initiatives, or strategies that have significantly contributed to the advancement of urban Indian health and well-being.
3. Urban Indian Legacy Award: The Urban Indian Legacy Award honors an individual who has made enduring and significant contributions to the urban Indian health movement over the years. This award recognizes individuals who have dedicated their careers to advocating for urban AI/AN health, preserving cultural heritage, and fostering community empowerment. Nominees should have a demonstrated legacy of leadership, service, and impact within the urban AI/AN health community.
4. Tribal Leader Impact Award: The Tribal Leader Impact Award acknowledges a tribal leader who has demonstrated exceptional leadership, dedication, and impact in addressing health disparities and improving the well-being of AI/AN populations inclusive of urban communities. Nominees should have a proven track record of advocating for policies, programs, or initiatives that have positively influenced health outcomes, cultural preservation, and community resilience within their tribal communities and beyond.

Please submit your nominations via the form below which includes detailed instructions on the nomination process and criteria for each award. The deadline for submissions is Friday, March 21, 2025.

Upcoming Events and Important Dates

• March 4- NIHB 2025 Tribal Health Equity Data Symposium. Register for the livestream here.
• March 5- HHS Annual Tribal Budget Consultation Planning Session. Register here.
• March 19-20 IHS Tribal Self-Governance Advisory Committee meeting in Arlington, Virginia. More information here.

One last thing, check out these upcoming funding opportunities:

 The Health Resources and Services Administration (HRSA) is accepting applications for its Behavioral Health Workforce Development (BHWD) Technical Assistance Program.

• This program provides support to HRSA’s BHWD recipients to expand the number of highly trained behavioral health providers nationwide. Eligible programs include the Behavioral Health Workforce Education and Training Program for Professionals, Behavioral Health Workforce Education and Training Program for Paraprofessionals, and the Graduate Psychology Education program. Funding is expected to be multi-year, with an estimated award date of September 1, 2025.
• Application Deadline Date: March 3, 2025 (Apply).

The Substance Abuse and Mental Health Administration is accepting applications for its Circles of Care for American Indian/Alaska Natives Program.

• The purpose of this program is to provide AI/AN organizations with the resources to plan and design a family-driven, community-based, and culturally and linguistically competent system of care. Grant recipients are expected to organize a spectrum of community-based services and supports for AI/AN children who are experiencing or are at risk of mental health challenges.
• Application Deadline Date: March 17, 2025 (Apply).

HRSA is accepting applications for its Behavioral Health Workforce Education and Training (BHWET) Program for Paraprofessionals

• The purpose of the BHWET Program for Paraprofessionals is to develop and expand community-based experiential training such as field placements and internships to increase the skills, knowledge and capacity of students preparing to become mental health workers, peer support specialists, and other behavioral health paraprofessionals.
• Application Deadline Date: March 18, 2025 (Apply).

For more funding opportunities, visit the NCUIH website.