On January 8, 2025, the Indian Health Service (IHS) published a final notice in the Federal Register amending Part G of the Statement of Organization, Functions, and Delegations of Authority of the Department of Health and Human Services (HHS) to reflect the IHS reorganization. IHS wrote that “[t]he purpose of this reorganization is to revise the current approved structure for the IHS, Office of the Director, Intergovernmental Affairs functions.” Importantly, this includes the establishment of the previously proposed Office of Tribal and Urban Affairs and Division of Urban Indian Affairs. This final notice does not include a request for feedback.

Background

In an October 10, 2024, letter to Tribal leaders and Urban Indian Organization (UIO) leaders (DTLL/DULL), IHS announced a proposed reorganization of IHS Headquarters Office of the Director (hereinafter “proposed reorganization”), which would then have impacts on how offices under the Deputy Director for Intergovernmental Affairs (DDIGA) are structured. IHS stated “[t]here are five primary objectives of the proposed reorganization, which adopts a One IHS model that:

1. 1) Strengthens [IHS’] relationship with Indian Tribes and UIOs by streamlining operations and enhancing communications;
2. 2) Enhances the business relationships with Indian Tribes through self-determination and self-governance;
3. 3) Amplifies the work of the Agency with all partners by cultivating intergovernmental partnerships and furthering external relationships;
4. 4) Modernizes the way the Agency supports Tribes pursuing [Indian Self-Determination and Education Assistance Act (ISDEAA)] opportunities by supporting ISDEAA negotiation teams across the Agency working under a One ISDEAA model; and
5. 5) Fosters education and training throughout the entire IHS system on how ISDEAA interfaces with our everyday work.”

IHS also announced a November 13, 2024, Urban Confer and November 14, 2024, Tribal Consultation on the proposed reorganization. Enclosed with the DTLL/DULL, IHS included the draft IHS Headquarters Office of the Director Organizational Chart (hereinafter “draft organizational chart”). The draft organization chart for the proposed reorganization indicated that IHS planned to eliminate the Office of Urban Indian Health Programs (OUIHP) and create the Division of Urban Indian Affairs under the Office of Tribal and Urban Affairs. During the November 13, 2024, Urban Confer IHS stated that IHS envisions the Division of Urban Indian Affairs will be led by a director-like leader.

NCUIH’s Role

On December 16, 2024, the National Council of Urban Indian Health (NCUIH) submitted written comments to the IHS Director, Roslyn Tso, regarding IHS’ October 10, 2024, DTLL/DULL and November 13, 2024, Urban Confer on IHS’ proposed. In its comments following the Urban Confer, NCUIH submitted the following requests and recommendations to IHS:

• Maintain a dedicated focus on urban Indian health
  • Clarify the role of the IHS OUIHP Strategic Plan
  • Clarify the role of the proposed Division of Urban Indian Affairs leader
• Protect the Urban Indian Health line item
• Ensure meaningful engagement with UIOs through Urban Confer throughout the reorganization process by hosting additional Urban Confers
  • Extend the written comment deadline
• Clarify a timeline and next steps for the reorganization

NCUIH will continue to closely follow the reorganization.

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Dear Advocates,

We need your help contacting Congress today! 

Last week, the Office of Management and Budget (OMB) released a memorandum that temporarily froze resources critical to the operation of Tribal health care and Urban Indian Organization (UIO) facilities. While the recent OMB memorandum has been rescinded, NCUIH remains concerned about potential future impacts on the Indian health system. This is why we need your help to letting Congress know that it is critical that Indian health system funding is protected from any future disruptions.

Why is this important?

1. The U.S. Government has a legal obligation to provide health services to Native people, as established by the Indian Health Care Improvement Act.
2. Recent funding uncertainties forced UIOs to consider staffing cuts, service suspensions, and even facility closures.
3. Past experience shows any disruption in funding can have grave consequences on the Indian health system. During the 2019 government shutdown, funding disruptions led to reduced services and facility closures, resulting in tragic consequences including fatal opioid overdoses in some communities.
4. Specific Exemption Request: NCUIH is calling for a specific exemption for the entire Indian Health System, including the Tribal organizations, and UIOs, from any future funding restrictions.

You can use the text below as a template to call and/or email your Representative. If you can please, both call and email your representative. You can find your representative here.

Sincerely,
The National Council of Urban Indian Health

Ways to Advocate

Contact Congress | Post on Facebook

Contact Congress!

Step 1: Copy the email below.
Step 2: Find your representative here.
Step 3: Go to their website and click contact.
Step 4: Paste the email into the form and send. Please contact Meredith Raimondi (policy@ncuih.org) with questions.

Email to Your Representative!

Dear Representative [NAME],

As an urban Indian health advocate, I am writing to request your support in protecting Indian health system funding and ensuring that any funding restrictions or pauses explicitly exempt Tribal health programs and Urban Indian Organizations (UIOs) to prevent unintended disruptions in care, and to remain consistent with federal law and policy.

The Indian Health Care Improvement Act (IHCIA) established that “Federal health services to maintain and improve the health of the Indians are consonant with and required by the Federal Government’s historical and unique legal relationship with, and resulting responsibility to, the American Indian people.” Because these are legal obligations, programming that serves the interests of Tribes and Tribal citizens should not be included in any funding restriction or pause. This includes UIOs, which are health care Native-led nonprofit organizations that contract with the Indian Health Service to support the federal government’s legal obligation to provide health care services to Tribal citizens living in urban areas. In fact, the IHCIA directs the Secretary to “enter into contracts with, or make grants to, [UIOs] for the provision of health care and referral services for urban Indians resident in urban centers in which such organizations are situated.”

Any funding restrictions or pauses affecting the Indian health system would not only contradict these legal obligations but could also have devastating consequences, jeopardizing our ability to provide care to your constituents, meet payroll for providers and staff, and maintain essential services—ultimately putting the health and well-being of Tribal citizens at serious risk. For example, during the 2019 government shutdown, several UIOs had to reduce services or close their doors entirely, forcing them to leave their patients without adequate care. One UIO had multiple opioid overdoses in their community after they were forced to close their doors, several of which were fatal. Therefore, even a temporary halt in funding could immediately deprive people and communities of their life-saving services.

Your support is vital to ensuring that we continue to deliver essential healthcare services to our community uninterrupted. I look forward to your response on this critical issue.

Sincerely,
[NAME]

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

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