President’s Budget Proposes Increase for Indian Health Service, Stable Funding for Urban Indian Health for FY 2026

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On May 30, the President released the full Fiscal Year (FY) 2026 Department of Health and Human Services Budget In Brief. The budget “prioritizes funding for IHS,” proposing $8.1 billion for the Indian Health Service, and level funding for urban Indian health. Notably, the Secretary emphasizes the trust obligation for American Indian and Alaska Native people: “HHS has a unique responsibility to provide healthcare for tribes on remote reservations and other vulnerable communities in Indian Country.” The proposal also includes $80 million for a new Native American Behavioral Health and Substance Use Disorder program, and reauthorizes the Special Diabetes Program for Indians (SDPI) at its current funding.

“The budget prioritizes funding for IHS, providing $7.9 billion to fulfill our promises to tribal nations. In particular, the budget prioritizes funding for direct health services as well as funding for staffing and operational costs of new facilities opening in FY 2026. This investment will ensure access to care in remote and underserved communities. Within AHA, the budget includes $80 million for a newly funded Native American Behavioral Health and Substance Use Disorder program. It will provide funding directly to tribes to support culturally tailored mental health, prevention, and treatment efforts for behavioral health issues in Indian Country.”

– FY2026 Budget in Brief (May 30, 2025)

Next Steps

The FY 2026 proposal serves as a statement of the Administration’s policy and funding priorities. The budget acts primarily as a symbolic blueprint of the President’s vision for the size and scope of the federal government. The final appropriations will be determined through the Congressional budget process. The House and Senate Appropriations Committees are currently crafting their respective FY 2026 funding bills.

IHS Acting Director Ben Smith and Finance Director Jillian Curtis will testify before the House Appropriations Committee on Thursday, June 5.

NCUIH has stood alongside Tribes, Urban Indian Organizations and the community to advocate for stable and secure resources for the Indian Health System. NCUIH will continue to engage with lawmakers to ensure the Indian Health System and all Tribal programs receive the resources they need.

A more detailed NCUIH analysis of the budget will be released next week.

Related News

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

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May Policy Update: NCUIH Releases Priorities, Tracks Lawsuits, and Defends Medicaid

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In this Edition:

📸 NCUIH Policy Priorities: NCUIH Released its 2025 Policy Priorities.

🚨 NCAI, Indian Gaming Association, and National Organizations host a Legislative Summit –NCUIH presented on an Appropriations panel and joined Capitol Hill meetings to share UIO issues alongside Tribal leaders.

⚖ Lawsuits & Court Cases Updates – Current court cases and legal action impacting American Indian and Alaska Native (AI/AN) health care and policy.

🚨 Budget Reconciliation – House Committee Advances Budget Reconciliation Text with Exemptions for AI/AN People.

📜 FY 2026 Appropriations – President Releases FY 2026 Budget, Congress Requests Protection of IHS Funding.

Protecting AI/AN People on Medicaid – NCUIH Submits Comments Supporting Exemption of AI/AN People from Work Requirements in State Medicaid Programs.

📬 Federal Agency Actions – Department of Health and Human Services (HHS) New DEI Rules in Grant Policy Statement and HHS Recission of Four Guidance Documents.

In Case You Missed It (ICYMI) – IHS Tribal Consultation and Urban Confer on Health IT Modernization, Recent Dear Tribal and Urban Leader Letters.

📆 Upcoming Events – NCAI Mid-Year Conference in Mashantucket, CT.

New Resource: 2025 Policy Priorities Released

NCUIH is pleased to announce the release of its 2025 Policy Priorities document, which outlines a summary of urban Indian organization (UIO) priorities for the Executive and Legislative branches of the government for 2025, as well as talking points and recommendations for each priority.

Read the full priorities.

These priorities were informed by NCUIH’s 2024 Policy Assessment.

NCAI, Indian Gaming Association, and National Organizations Host Legislative Summit

NCUIH thanked Sen. Murkowski, Rep. Tom Cole, Rep. Sharice Davids and Rep. McCollum for supporting UIOs.

On May 13-14, the National Congress of American Indians, Indian Gaming Association (IGA), and other National organizations hosted a Legislative Summit in Washington D.C. regarding recent administration developments and Budget Reconciliation.

Speakers included national Native organizations, Administration officials, and Members of Congress to address key legislative and budgetary issues affecting Native communities. The event featured policy briefings, Capitol Hill visits, and opportunities for direct advocacy and engagement with Members of Congress.

NCUIH presented on an Appropriations panel and joined Capitol Hill meetings to share UIO issues alongside Tribal leaders.

Monitoring The Bench: Lawsuits Filed Against Recent Executive Orders and Presidential Actions

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.

  • Status: Preliminary Injunction (PI) was granted on 2/25/2025 – nationwide injunction that prevents the federal government from rescinding or freezing funds that have been appropriated by Congress. Defendants filed an Appeal with the DC Circuit on 4/24/2025, regarding the decision to grant the Preliminary Injunction. Case Stayed on 5/12/2025 while the appeal is heard in the DC Circuit.
  • Why this matters for UIOs: Funding at issue in the case is related to the rescinded OMB Memo (M-25-13) that directed federal agencies to pause disbursement of funds that could be implicated by Executive Orders. This includes funding related to DEI, which could implicate funding for AI/AN communities.

American Federation of Government Employees, AFL-CIO v. Trump​ – Lawsuit filed in the District Court of Northern California by a coalition of unions, nonprofits, and local governments over reorganization of the executive branch that would result in mass terminations.

  • Status: Temporary Restraining Order (TRO) Granted on 5/9/2025, preventing the Department of Government Efficiency (DOGE) from carrying out the directive to reduce the government workforce.

“The President has neither constitutional nor, at this time, statutory authority to reorganize the executive branch.”

  • Why this matters for UIOs: Reorganization of the Executive Branch includes various agencies, including HHS, which will impact AI/AN communities who receive programs and services that may be at risk of being eliminated. Could impact IHS and cause restructuring that also eliminates essential programs and services.

State of New York v. Kennedy – Lawsuit filed in the District Court of Rhode Island by 19 states and D.C. over restructuring of HHS that has resulted in mass terminations and cuts to programs.

  • Status: Motion for PI was filed on 5/9/2025. Still awaiting a hearing and ruling.
  • Why this matters for UIOs: Plaintiffs include 12 states where UIOs are located: AZ, CA, CO, IL, MD, MN, NJ, NM, NY, OR, WA, and WI. Restructuring of HHS has led to mass terminations and elimination of programs within the CDC, FDA, SAMHSA, ACF, and ACL.

State of Colorado v. U.S. Department of Health and Human Services – Lawsuit filed in the District Court of Rhode Island by 23 states and D.C. over termination of $11 billion in public health funding that was authorized in response to the COVID-19 pandemic but intended to be used beyond the pandemic itself.

  • Status: TRO Granted 4/3/2025, requiring Defendants to cease withholding funds and to make funds available.
  • Why this matters for UIOs: Plaintiffs include 15 states where UIOs are located: AZ, CA, CO, IL, MD, MA, MI, MN, NV, NM, NY, OR, PA, WA, and WI. Funding includes SAMHSA programs and CDC grants with state health departments.

Over 300 lawsuits have been filed against recent executive orders and presidential actions, covering issues like agency data access, federal employee terminations, and elimination of diversity, equity, and inclusion (DEI) initiatives. NCUIH continues tracking these cases to identify any rulings that may impact UIOs.

House Advances Reconciliation Bill with Exemptions for American Indian and Alaska Native People from Community Engagement Requirements

On May 22, the House of Representatives voted 215-214-1 to pass a major reconciliation bill that would deliver the major elements of President Trump’s legislative agenda, including tax cuts, Medicaid reforms, and lifting the debt ceiling. The bill contains a health title, which includes Medicaid reform provisions, such as cost-sharing and provider tax changes.

Community Engagement Requirements for Certain Medicaid Beneficiaries – First Ever Inclusion of “Urban Indians” in Exemption:

  • What it does: States would be required to implement community engagement requirements for able-bodied adults without dependents. Compliance may be achieved through:- Working, volunteering, or participating in a work program for at least 80 hours/month; or
    – Enrolling in educational programs totaling 80 hours/month.
  • Impact on Indian Country –The bill exempts American Indian and Alaska Native beneficiaries from these requirements. Specifically, it states that “specified excluded individuals” include:- Indians and Urban Indians as defined in the Indian Health Care Improvement Act (IHCIA);
    – California Indians as described in Section 809(a) of the IHCIA;
    – Individuals determined eligible as an Indian for the Indian Health Service under regulations promulgated by the Secretary.
  • The work requirements go into effect on December 31, 2026.

Other Key Provisions:

  • Modifying Cost Sharing Requirements for Certain Expansion Individuals Under the Medicaid Program – AI/AN beneficiaries are already exempted
  • Moratorium on New or Increased Provider Taxes – UIOs are already exempted due to their tax status
  • Reduction in Expansion FMAP for States Covering Undocumented Immigrants – Seven stated with UIOs provide such coverage (California, Washington, Oregon, Minnesota, Illinois, New York, and Colorado).

Read more on these provisions here. 

Next Steps: Budget reconciliation package will need to proceed to the House floor for a vote. Once passed, the Senate will take up the package and provide their edits.

Recent NCUIH Efforts: On May 8, NCUIH joined the Partnership for Medicaid—which is a nonpartisan, nationwide coalition of organizations representing clinicians, health care providers, safety-net health plans, and counties with the goal to preserve and improve the Medicaid program— in a statement of concern regarding coverage losses and benefits and provider payment reductions outlined by the recent Congressional Budget Office report on Medicaid policy options being considered by Congress as part of reconciliation. NCUIH also joined the Partnership in a reconciliation letter to House Energy and Commerce to protect Medicaid on May 9.

NCUIH has worked with UIO leaders and national partners, including the National Indian Health Board (NIHB) and the Medicaid Medicare Policy Committee (MMPC), to ensure that American Indian and Alaska Native Medicaid beneficiaries are protected from harmful policy changes. NCUIH participated in over 60 Capitol Hill meetings to emphasize the importance of Medicaid’s role in AI/AN communities, and to spotlight the unique needs of UIOs.

  • Why it Matters: In 2023, approximately 2.7 million AI/AN people were enrolled in Medicaid across the United States, according to American Community Service data. Medicaid is a major source of health care funding, particularly for UIOs, which provide essential healthcare services to AI/AN people living in urban areas. The proposed Medicaid cuts would threaten the ability of UIOs to sustain necessary service offerings, potentially reducing access to essential health care services for urban AI/AN people.
  • Read NCUIH’s comprehensive overview highlighting the crucial role Medicaid plays in providing health care to AI/AN communities.

President Releases FY 2026 Budget, Congress Requests Protection of IHS Funding

On May 2, the President released the FY 2026 budget proposal, which acts primarily as a symbolic blueprint of the President’s vision for the size and scope of the federal government.

By the numbers: The proposal for HHS outlines a 26.2% reduction to the overall HHS budget, amounting to $33.3 billion in cuts.

The President’s funding request overview states that the Administration will “Maintain Support for Tribal Nations”, stating, “the Budget preserves Federal funding for the Indian Health Service and supports core programs at the Bureau of Indian Affairs and Bureau of Indian Education, sustaining the Federal Government’s support for core programs that benefit tribal communities.” It also indicates plans to “streamline other programs for tribal communities, to reduce inefficiencies and eliminate funding for programs and activities found to be ineffective.”

Next Steps: The administration is expected to release its full Budget in Brief in the coming weeks. In the meantime, the House and Senate Appropriations Committees will craft their respective FY 2026 funding bills. NCUIH will continue to engage with lawmakers to ensure the Indian Health System and all Tribal programs receive the resources they need.

Congressional Advocacy for Indian Health:

Senate Indian Affairs Committee (SCIA) Oversight Hearing 

On May 14, 2025, SCIA held an oversight hearing to examine delivering essential public health and social services to Native Americans. Hearing focused on federal programs serving Native Americans across the operating divisions at the HHS. Chairwoman Janet Alkire was NIHB and NCUIH’s shared witness and incorporated UIOs into her testimony.

NCUIH also worked with Senator Cortez Masto who shared story shared by Nevada Urban Indians and Native Connections: “I am so concerned about the cuts to mental health services that we fought for in our communities. There is a program called Native Connections, and I know about it because in my state, I have talked with so many of my Native community members. There’s a nine-year-old girl at Nevada Urban Indians who was struggling with her mental health, and she did not, could not get care from a school or a pediatrician. But it was Native Connections program that, according to her father, got his daughter back. It’s a Native Connections program, and so I don’t know if any of you are familiar with it, if we could talk about it, but please stress the importance of why funding for programs, particularly in this mental health and Native Connections, is so important.”

Congressional Leaders Letter Requesting Protection of IHS Funding and Increased Resources for Urban Indian Health 

NCUIH supported House and Senate Dear Colleague Letters requesting that the Interior Appropriations Committees retain advance appropriations for IHS in FY27, protect IHS from sequestration, and provide robust funding for urban Indian health in the final FY 2026 appropriations bill.

Senators Urge HHS Secretary Kennedy to Address IHS Staffing Shortages

On May 6, Senators Jeff Merkley (D-OR), Brian Schatz (D-HI), and Lisa Murkowski (R-AK), sent a letter to HHS Secretary Kennedy:

  • Demanding urgent action from HHS Secretary Robert F. Kennedy, Jr. to ensure the IHS has the necessary resources and staffing to fully deliver health care services for AI/AN people, as required by federal law.
  • Calling for the IHS to immediately halt any further actions affecting Tribal health care delivery without first engaging in meaningful Tribal consultation.

NCUIH has worked closely with these offices to inform them of impacts of IHS workforce changes impacting UIOs.

Read more on NCUIH’s blog. 

NCUIH Submits Comments Supporting Exemption of AI/AN People from Work Requirements in State Medicaid Programs

Earlier this month, NCUIH submitted comments to CMS and state Medicaid programs supporting the exemption of AI/AN people from work requirements for Arizona, Arkansas, Iowa, and Utah.

HHS Updates: New DEI Rules in Grant Policy Statement and Recission of Four Guidance Documents

New DEI Rules in HHS’ Updated Grants Policy Statement

HHS recently released an updated HHS Grants Policy Statement (GPS), which is effective April 16, 2025, and “replaces all prior versions.”

  • This version of the GPS includes rules on prohibiting DEI.
  • The DEI rule is consistent with recent EOs on DEI.
  • Impact on IHS/Tribes/UIOs: Based on the February 25, 2025, Advisory Opinion from the HHS General Counsel, the GPS DEI rule will not impact the I/T/U’s ability to serve AI/AN people because the EOs do not impact the government-to-government relationship between the United States and Tribes and do not impact the United States’ obligations to Tribes and their citizens, including healthcare obligations. Instead, restrictions on UIO will be on operations, such as hiring.

We recommend your UIO discusses how potential “DEI programming” may affect your particular program with compliance and/or legal advisors.  

Notification of HHS Documents Identified for Rescission

On May 14, 2025, HHS published a Rule in the Federal Register announcing documents identified for recission:

  • Extension of Designation of Scarce Materials or Threatened Materials Subject to COVID-19 Hoarding Prevention Measures; Extension of Effective Date With Modifications, 86 FR 35810 (July 7, 2021).
  • Opioid Drugs in Maintenance and Detoxification Treatment of Opiate Addiction; Repeal of Current Regulations and Issuance of New Regulations: Delay of Effective Date and Resultant Amendments to the Final Rule, 66 FR 15347 (Mar. 19, 2001).
  • Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder, 86 FR 22439 (Apr. 28, 2021).
  • Notification of Interpretation and Enforcement of Section 1557 of the Affordable Care Act and Title IX of the Education Amendments of 1972, 86 FR 27984 (May 25, 2021).

NCUIH is still analyzing this notice and impacts.

ICYMI: IHS Tribal Consultation and Urban Confer on Health IT Modernization, Recent Dear Tribal and Urban Leader Letters

IHS Tribal Consultation and Urban Confer on Health IT Modernization

On May 15, IHS held a Tribal Consultation and Urban Confer (TC/UC) regarding Health Information Technology (HIT) Modernization: Four Directions Warehouse. Key updates:

  • The expected go-live date for the pilot (Lawton and the three service units) will being Spring 2026. IHS is preparing for pilot go-life between now and then.
  • IHS anticipates beginning PATH EHR go-lives for cohorts which will include Tribal, Urban, and federal partners.
  • Written comments and recommendation are due Saturday, June 14, 2025. Email to either consultation@ihs.gov or urbanconfer@ihs.gov.

The next joint IHS TC/UC session on HIT Modernization will be on PATH EHR Scope and Capabilities and held virtually via Zoom on August 7, 2025, 1:30-3:00 PM Eastern. Register here.

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

April 22 DTLL – The HRSA Administrator writes to Tribal leaders to share updates on HRSA regional office structure and reaffirm his commitment to ensuring that no programs, services, or communications are interrupted.

Regional Offices are now closed in the following regions:

  • Region 1 – Boston: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont
  • Region 2 – New York: New York, New Jersey, the U.S. Virgin Islands, and Puerto Rico
  • Region 5 – Chicago: Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin
  • Region 9 – San Francisco: Arizona, California, Hawaii, Nevada and the Pacific Islands (American Samoa, Federated States of Micronesia, Guam, Marshall Islands, Northern Mariana Islands and Palau)
  • Region 10 – Seattle: Alaska, Idaho, Oregon, and Washington

May 20 DTLL – CDC writes to Tribal leaders to provide information about a webinar CDC is hosting entitled “Partnering with Tribal Nations to Prevent and Respond to New World Screwworm.”

  • Webinar: Wednesday, June 4, 2025, 3-4 PM Eastern. Register here.
  • Tribal nations, tribal communities, tribal serving organizations, and healthcare providers, veterinarians, and livestock ranchers and farmers living and working on tribal lands are welcome to attend.
  • The webinar will provide an overview on: The New World Screwworm (NWS) and the current situation in Central America and Mexico, how the NWS is a threat to Tribal nations and Tribal communities, and how to identify and treat infestations.

Upcoming Events

  • June 8-11 – NCAI Mid-Year Conference in Mashantucket, CT. Register here.
  • June 10 – CMS All Tribes Call
  • June 18 – Next NCUIH Monthly Policy Workgroup (virtual)
  • June 17-18 – Virtual Tribal Leaders Diabetes Committee (detailed forthcoming)

One more thing: Coalition for Tribal Sovereignty

The Coalition for Tribal Sovereignty (CTS) is a collaborative alliance that serves as a powerful unifying voice of regional and national inter-tribal policy-oriented, non-profit organizations to engage with federal policymakers on critical issues affecting the sovereign interests, rights, and authorities of Tribal Nations, tribal citizens, and community members across the United States.

The Coalition:

  • Creates joint messages to share with policy makers
  • Sends letters to key administration officials
  • Develops advocacy strategies

Learn more at www.coalitionfortribalsovereignty.org

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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House Advances Reconciliation Bill with Exemptions for American Indian and Alaska Native People from Community Engagement Requirements

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On May 22, 2025, the House of Representatives voted 215-214-1 to pass a major reconciliation bill that would deliver the major elements of President Trump’s legislative agenda, including tax cuts, Medicaid reforms, and lifting the debt ceiling. The bill contains a health title, which includes Medicaid reform provisions, such as cost-sharing and provider tax changes. Importantly, the bill exempts American Indian and Alaska Native beneficiaries from the Medicaid community engagement requirements.

NCUIH Action

The National Council of Urban Indian Health (NCUIH) has worked with Urban Indian Organization (UIO) leaders and national partners, including the National Indian Health Board (NIHB) and the Medicaid Medicare Policy Committee (MMPC), to ensure that American Indian and Alaska Native Medicaid beneficiaries are protected from harmful policy changes. NCUIH participated in over 60 meetings with congressional offices.

Next Steps

The reconciliation package now goes to the Senate for consideration.

Analysis

Community Engagement Requirements for Certain Medicaid Beneficiaries

What it Does: States would be required to implement community engagement requirements for able-bodied adults without dependents. Compliance may be achieved through:

  • Working, volunteering, or participating in a work program for at least 80 hours/month; or
  • Enrolling in educational programs totaling 80 hours/month.

Impact on Indian Country: The bill exempts American Indian and Alaska Native beneficiaries from these requirements. Specifically, it states that “specified excluded individuals” include:

  • Indians and Urban Indians as defined in the Indian Health Care Improvement Act (IHCIA);
  • California Indians as described in Section 809(a) of the IHCIA;
  • Individuals determined eligible as an Indian for the Indian Health Service under regulations promulgated by the Secretary.

The work requirements go into effect on December 31, 2026.

Modifying Cost Sharing Requirements for Certain Expansion Individuals Under the Medicaid Program

What it Does: Requires states to impose cost sharing on Medicaid Expansion adults with incomes over 100 percent of the federal poverty level (FPL). This cost-sharing is capped at:

  • $35 per service.
  • May not exceed five percent of the individual’s income.

Impact on Indian Country: American Indian and Alaska Native beneficiaries are already exempted from cost-sharing provisions for those who receive a “service directly by the Indian Health Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization or through referral under contract health services for which payment may be made under this subchapter.” This exemption will remain in place.

Moratorium on New or Increased Provider Taxes

What it Does: Prohibits states from implementing new provider taxes or increasing existing ones beyond their levels on the date of enactment.

Potential Impact on Urban Indian Organizations: UIOs are exempt from provider taxes due to their tax status and will not be affected by this provision.

Reduction in Expansion FMAP for States Covering Undocumented Immigrants

What it Does: Reduces by 10% the Federal Medical Assistance Percentage (FMAP) for Medicaid Expansion States who use their Medicaid infrastructure to provide health care coverage for undocumented immigrants under Medicaid or another state-based program.

Impact on States with Urban Indian Organizations: Seven states currently provide such coverage: California, Washington, Oregon, Minnesota, Illinois, New York, and Colorado, all of which have UIOs. States will have to individually decide on how and if they will adapt their programs to adjust to the potential decrease in federal funding,

Resource

Coalition for Tribal Sovereignty Reconciliation Letter (February 20, 2025)

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

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20 Senators Request Protected Funding for IHS and Increased Resources for Urban Indian Health in FY 2026

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On May 21, 2025, 19 Senators joined Senator Tina Smith (D-MN) in her letter to Chair Lisa Murkowski (R-AK) and Ranking Member Jeff Merkley (D-OR) of the Senate Interior Appropriations Committee requesting funding for urban Indian health at the highest level possible—up to the Tribal Formulation Workgroup’s request of $770.5 million—and retaining advance appropriations for the Indian Health Service (IHS) in the final fiscal year (FY) 2026 Interior, Environment, and Related Agencies Appropriations Act.

The 20 Senators requested full funding for urban Indian health as part of the Tribal Formulation Workgroup’s topline request of $63.04 billion for IHS in FY 2026, and that such an increase not be paid for by diminishing funding for already hard-pressed IHS and Tribal providers. The letter also requests the Appropriations Committee maintain advance appropriations for IHS for FY 2027.

The letter emphasizes the critical role that Urban Indian Organizations (UIOs) play in the health care delivery to American Indian and Alaska Native patients and the importance of providing UIOs with the necessary funding to continue to provide quality, culturally competent care to their communities. On May 15, 2024, a group of 61 Representatives sent a letter to the House Interior Appropriations Committee with the same requests.

The letter also notes that chronic underfunding of IHS and urban Indian health has contributed to the health disparities among American Indian and Alaska Native people living in urban areas that suffer greater rates of chronic disease, infant mortality, and suicide compared to other populations.

This letter sends a clear and powerful message to Chair Murkowski and Ranking Member Merkley and the members of the Senate that funding for urban Indian health must be significantly increased to fulfill the federal government’s trust responsibility to provide quality healthcare to all American Indian and Alaska Native people.

NCUIH is grateful for the support of the following Senators:

  1. Tina Smith (D-MN)
  2. Maria Cantwell (D-WA)
  3. Kirsten Gillibrand (D-NY)
  4. Richard Blumenthal (D-CT)
  5. Ben Ray Luján (D-NM)
  6. Andy Kim (D-NJ)
  7. Michael Bennet (D-CO)
  8. Elissa Slotkin (D-MI)
  9. Alex Padilla (D-CA)
  10. Elizabeth Warren (D-MA)
  11. Catherine Cortez Masto (D-NV)
  12. Ron Wyden (D-OR)
  13. Tammy Duckworth (D-IL)
  14. Edward Markey (D-MA)
  15. Amy Klobuchar (D-MN)
  16. Tammy Baldwin (D-WI)
  17. Jacky Rosen (D-NV)
  18. Chris Van Hollen (D-MD)
  19. Mark Kelly (D-AZ)
  20. Richard Durbin (D-IL)

Full Letter Text

Dear Chair Murkowski and Ranking Member Merkley,

We write to thank you for your proven commitment to the Indian health system, including Urban Indian Organizations (UIOs), and to request you continue your support by funding urban Indian health at the highest level possible, up to the demonstrated need of $770,528,000,[1] and retaining advanced appropriations for the Indian Health Service (IHS) in the Fiscal Year (FY) 2026 Interior, Environment, and Related Agencies Appropriations Act.

These requests reflect the full need for urban Indian health determined by the Tribal Budget Formulation Workgroup, which is comprised of Tribal leaders representing all twelve IHS service areas. The Workgroup recommended this funding amount for urban Indian health as a part of a $63.04 billion topline recommendation for the Indian Health Service. UIOs are an important part of the IHS, which oversees a three-prong system for the provision of health care: Indian Health Service, Tribal Programs, and Urban Indian Organizations (I/T/U).

UIOs are on the front lines in working to provide for the health and well-being of American Indians and Alaska Natives living outside of Tribal jurisdictions. They serve patients from over 500 federally-recognized Tribal Nations in 38 urban areas across the country. UIOs are not eligible for other federal line items that IHS and Tribal facilities are, like hospitals and health clinics money, purchase and referred care dollars, or IHS dental services dollars. Therefore, this funding request is essential to providing quality, culturally-competent health care to AI/AN people living in urban areas.

Chronic underfunding of IHS and urban Indian health has contributed to the health disparities among AI/AN people. Additionally, AI/AN people living in urban areas suffer greater rates of chronic disease, infant mortality, and suicide compared to all other populations. Urban Native populations are less likely to receive preventive care and are less likely to have health insurance. Additional funding is critical to addressing this disparity.

In order to fulfill the federal government’s trust responsibility to all AI/AN people to provide quality healthcare, funding for urban Indian health must be significantly increased. It is also imperative that such an increase not be paid for by diminishing funding for already hard-pressed IHS and Tribal providers. The solution to address the unmet needs of urban Native and all AI/AN people is an increase in the overall IHS budget.

Thank you for your continued support of urban Indian health and your consideration of this important request.

[1] https://legacy.nihb.org/resources/NIHB-FY26-Budget.pdf

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Maximizing SDPI Impact: Effective Strategies and Data-Driven Solutions for UIOs

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Background

Urban Indian Organizations (UIOs) play a vital role in addressing diabetes disparities within urban American Indian and Alaska Native (AI/AN) communities through the Indian Health Service’s (IHS) Special Diabetes Program for Indians (SDPI). Established by Congress in 1997, SDPI has been a cornerstone in diabetes prevention and treatment efforts, providing UIOs with critical funding to support culturally tailored health interventions. Over the years, SDPI has contributed to significant reductions in diabetes-related complications and has improved overall health outcomes within AI/AN communities (IHS SDPI Overview and Outcomes).

Through SDPI, UIOs have developed comprehensive programs integrating traditional healing practices with modern medical care, fostering a holistic approach to diabetes prevention and management. These efforts reduce the prevalence of diabetes-related complications and empower AI/AN individuals to take control of their health through education, early screening, and lifestyle support. Despite significant progress, UIOs continue to face challenges such as resource limitations, workforce shortages, and evolving patient needs. By refining strategies, leveraging data-driven solutions, and building supportive partnerships, UIOs can build upon their SDPI successes and drive even greater impact in urban AI/AN communities.

Comprehensive SDPI Services at UIOs

To better understand how UIOs are leveraging SDPI resources, NCUIH analyzed 2025 program profiles to identify the most commonly offered services across urban Indian health settings.

Figure 1. Commonality of SDPI Services Offered by UIOs (n=32)

Source: NCUIH Program Profiles, 2025. Data reflect the number of Urban Indian Organizations reporting each SDPI-related service.

SDPI-funded programs at UIOs offer a robust and holistic suite of services designed to meet the diverse needs of AI/AN communities. Among the most frequently provided offerings are diabetes-related education programs and blood glucose monitoring through onsite lab services, underscoring the importance of early detection and proactive treatment. Additionally, services such as access to a nutritionist or dietician, nutritional counseling, and prevention programs are critical components of both diabetes prevention and long-term disease management. UIOs also provide fitness programming and culturally relevant education initiatives that empower individuals to make informed health choices.

The success of these services highlights the commitment of UIOs to patient-centered care, where both traditional knowledge and evidence-based medicine work in tandem. Expanding access to specialized offerings, such as medication monitoring and long-term follow-ups, can further enhance health outcomes and ensure continued progress in diabetes prevention and management.

Enhancing Diabetes Program Performance

Performance metrics, guided by the Government Performance and Results Act (GPRA), highlight SDPI’s impact. Between 2018 and 2019, UIOs demonstrated improvements in blood pressure control rates, with the average rate increasing from 62.8% in 2018 to a peak of 64.2% in 2019[1]. Although external factors like the COVID-19 pandemic disrupted recent trends, UIOs quickly adapted by incorporating innovative solutions, including telehealth and at-home monitoring tools.

Success Story: Expanding Diabetes Care with Telehealth

At NATIVE HEALTH in Phoenix, a UIO-supported SDPI program successfully expanded its diabetes care services by integrating telehealth and remote patient monitoring. By distributing wireless glucose monitors and offering virtual diabetes education sessions, NATIVE HEALTH significantly improved patient engagement and glycemic control among its urban AI/AN population. This approach has since been adopted by other UIOs, demonstrating the effectiveness of digital tools in chronic disease management. Programs that consistently achieve high performance often incorporate robust case management and proactive outreach strategies, which can serve as models for other UIOs.

Strategies for Strengthening SDPI Services

To build on current successes and address identified challenges, UIOs can implement the following five strategic approaches:

  1. Expand Specialized Diabetes Care
    • Increase access to medication monitoring, individualized dietary counseling, and comprehensive follow-up care.
    • Leverage telehealth services to improve patient access to specialized diabetes care (IHS Telehealth Resources).
  2. Standardize Data Reporting
    • Implement a universal service taxonomy to improve reporting accuracy and transparency.
    • Utilize comprehensive electronic tracking systems to ensure consistent data collection and analysis through patient electronic health management systems.
  3. Staff Training and Development
    • Conduct regular training to enhance accurate, standardized reporting practices (NCUIH Technical Assistance and Training).
    • Designate dedicated data leads at each UIO to oversee reporting and ensure data integrity.
  4. Continuous Quality Improvement
    • Perform routine data audits to identify strengths and opportunities for growth.
    • Establish peer learning networks to facilitate knowledge-sharing and best practice adoption, such as participation in NCUIH Learning Collaboratives.
  5. Align Services with Performance Metrics
    • Ensure service offerings align with GPRA performance metrics to maximize program impact.
    • Use data visualization dashboards to track service provision and patient outcomes more effectively (IHS Quality Metrics).

Collaborative Partnerships

Collaboration is key to maximizing SDPI’s impact. UIOs are encouraged to actively engage with NCUIH, IHS, other UIOs, and SDPI technical assistance teams to enhance service delivery, improve data collection methods, and share successful strategies. Strengthening partnerships with local health care providers and community organizations can also support program sustainability and expand patient access to diabetes care services (NCUIH Partnership Resources).

Conclusion

Through SDPI support, UIOs continue to make meaningful progress in combating diabetes in urban AI/AN communities. By implementing evidence-based strategies and leveraging data-driven insights, UIOs can further enhance diabetes care, reduce disparities, and improve overall health outcomes. Continued collaboration and strategic investment are essential to sustaining these advancements and ensuring healthier futures for AI/AN populations in urban settings.

Need tailored data insights for your SDPI program? Contact our research team for support. Submit a Request for Data Support (Research – NCUIH).

[1]FY 2018 Urban GPRA Report_FINAL.pub.pdf; FY 2019 Urban GPRA Report_FINAL.pdf

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NCUIH 2025 Policy Priorities Released

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NCUIH 2025 Policy Priorities

The National Council of Urban Indian Health (NCUIH) is pleased to announce the release of its 2025 Policy Priorities document, which outlines a summary of urban Indian organization (UIO) priorities for the Executive and Legislative branches of the government for 2025. These priorities were informed by NCUIH’s 2024 Policy Assessment.

NCUIH hosted five focus groups to identify UIO policy priorities for 2025, as they relate to Indian Health Service (IHS)- designated facility types (full ambulatory, limited ambulatory, outreach and referral, and outpatient and residential). NCUIH worked with UIOs to identify policy priorities in 2025 under eight themes:

  • Funding for Native Health Initiatives
  • Elevating Native Voices and Fostering Dialogue
  • Strengthening Health Outcomes: Addressing Social Determinants of Health
  • Honoring Promises to Native Veterans
  • Revitalizing Native Health: Embracing Traditional Healing and Behavioral Wellness
  • “Not One More’: Healing Generational Trauma and Protecting Native Lives
  • Addressing Workforce Recruitment and Retention Challenges
  • Improving the Indian Health Service
Read the 2025 Policy Priorities

2025 Policy Priorities:

FUNDING FOR NATIVE HEALTH INITIATIVES
Increasing Funding for Indian Health Service (IHS) and Urban Indian Health
  • Appropriate the Maximum Amount Possible for IHS and Fund Urban Indian Health at $100 million.
  • Support Participation and Continued Inclusion of Urban Indian Organizations in the IHS Budget Formulation Process.
Protecting Funding for Native Health from Political Disagreements
  • Maintain Advance Appropriations for IHS to Insulate the Indian Health System from Government Shutdowns
  • and to Protect Patient Lives.
  • Transition IHS from Discretionary to Mandatory Appropriations.
  • Transition Contract Support Costs and 105 (l) Leases to Mandatory Appropriations.
Meeting the Trust Obligation for IHS-Medicaid Beneficiaries Receiving at Urban Indian Organizations (UIOs)
  • Pass the Urban Indian Health Parity Act to Ensure Permanent Full (100%) Federal Medical Assistance
  • Percentage (FMAP) for Services Provided at UIOs (100% FMAP for UIOs).
  • Ensure that All American Indian and Alaska Native People are Exempt from Medicaid Work Requirements.
  • Allow for Audio-Only Telehealth Services for Medicare Beneficiaries at UIOs through the Telehealth for Tribal Communities Act.
Transforming Health Care Resources in Indian Country and Beyond
  • Decrease Competition and Reduce Barriers to Access to Ensure Equitable Distribution of Grant Funding.
ELEVATING NATIVE VOICES AND FOSTERING DIALOUGE
Inclusion of Urban Native Communities in Resource Allocation
  • Ensure Critical Resource and Funding Opportunities are Inclusive of Urban Native Communities and the Urban Indian Organizations that Help Serve Them.
STRENGTHENING HEALTH OUTCOMES: ADDRESSING SOCIAL DETERMINANTS OF HEALTH
Improving Native Maternal and Infant Health
  • Strengthen the Ability of the Advisory Committee on Infant and Maternal Mortality to Address Native Maternal and Infant Health.
  • Improve Funding Access for Urban Indian Organizations to expand Housing Services.
Improving Food Security for Urban American Indian and Alaska Native People
  • Increase Access to U.S. Department of Agriculture (USDA) Resources and Funding Opportunities for Urban American Indian and Alaska Native Communities and the Urban Indian Organizations that Serve Them.
  • Increase Urban Indian Organization Access to Fresh and Traditional Foods Through Increased Funding for the IHS Produce Prescription Pilot Program.
  • Permanently Reauthorize and Increase Funding for the Special Diabetes Program for Indians (SDPI) at a Minimum of $250 Million Annually
Including Urban American Indian and Alaska Native People in Preparing and Protecting Their Communities
  • Increase Emergency Preparedness through the Passage of the CDC Tribal Public Health Security and Preparedness Act.
HONORING THE PROMISES TO NATIVE VETERANS
Improving American Indian and Alaska Native Veteran Health Outcomes
  • Engage with Urban Indian Organizations to Successfully Implement the Interagency Initiative to Address Homelessness for Urban American Indians and Alaska Native Veterans.
REVITALIZING NATIVE HEALTH: EMBRACING TRADITIONAL HEALING AND BEHAVIORAL WELLNESS
Improving Behavioral Health for All American Indian and Alaska Native People
  • Increase Funding for Behavioral Health and Substance Use Disorder Resources for American Indian and Alaska Native People.
  • Respond to the Significant Increase in Overdose Deaths in Indian Country.
  • Pass the Comprehensive Addiction Resources Emergency (CARE) Act.
Improving Health Outcomes Through Traditional Healing and Culturally Based Practices
  • Improve Funding Access for Urban Indian Organizations to Expand Traditional Healing and Culturally Based Practices.
“NOT ONE MORE”: HEALING GENERATIONAL TRAUMA AND PROTECTING NATIVE LIVES
Healing from Federal Boarding Schools
  • Support Federal Initiatives to Allow the Indian Health Service to Support Healing from Boarding School Policies.
Ending the Epidemic of Missing or Murdered Indigenous Peoples (MMIP)
  • Pass the Bridging Agency Data Gaps and Ensuring Safety (BADGES) for Native Communities Act.
  • Honor Executive Order 14053: Improving Public Safety and Criminal Justice for Native Americans and
  • Addressing the Crisis of Missing or Murdered Indigenous People by Including Urban Indian Organizations in Prevention and Intervention Efforts.
ADDRESSING WORKFORCE RECRUITMENT AND RETENTION CHALLENGES
Improving the Indian Health Workforce
  • Include Urban Indian Organizations in the national Community Health Aide Program (CHAP).
  • Improve the Indian Health Workforce through the Placement of Residents at Urban Indian Organizations through the Department of Veterans Affairs Pilot Program on Graduate Medical Education and Residency Program (PPGMER).
  • Enable Urban Indian Organizations to Fill Critical Workforce Needs through University Partnerships by Passing the Medical Student Education Authorization Act.
  • Extend Federal Health Benefits to Urban Indian Organizations.
  • Improve Recruitment and Retention of Physicians at Urban Indian Organizations by Reintroducing the IHS Workforce Parity Act.
  • Increase Tax Fairness for Loan Repayment for Urban Indian Organization Staff by Reintroducing the Indian Health Service Health Professions Tax Fairness Act.
  • Permit U.S. Public Health Service Commissioned Officers to be Detailed to Urban Indian Organizations.
  • Improve Community Health Worker Coverage at Urban Indian Organizations through the Introduction of the Community Health Workers Access Act.
Accurately Account for Provider Shortages
  • Engage with the Health Resources and Services Administration (HRSA) so that Urban Indian Organizations receive Health Professional Shortage Area (HPSA) Scores that Accurately Reflect the Level of Provider Shortage for Urban Indian Organization Service Areas.
IMPROVING THE INDIAN HEALTH SERVICE
Bridging the Gap: Enhancing Patient Care by Advancing Health Information Technology
  • Improve Health Information Technology, Including Electronic Health Records Systems.
Elevate the Health Care Needs of American Indian and Alaska Native People Within the Federal Government
  • Pass the Stronger Engagement for Indian Health Needs Act to elevate the IHS Director to Assistant Secretary for Indian Health.
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Bipartisan Group of 61 Congressional Leaders Request Protection of IHS Funding and Increased Resources for Urban Indian Health

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On May 15, 2025, 60 Congressional leaders joined Representative Leger Fernandez in her letter to Chairman Simpson and Ranking Member Pingree of the House Interior Appropriations Committee requesting a minimum of $100 million for Urban Indian Health, maintaining advance appropriations for the Indian Health Service (IHS), and protecting IHS from sequestration in the final fiscal year (FY) 2026 Interior, Environment, and Related Agencies Appropriations Act. The letter emphasizes that the federal government has a trust responsibility to provide federal health services to maintain and improve the health of American Indian and Alaska Native people.

The bipartisan group of 61 Congressional leaders reiterated their support for the House Appropriations Committee’s inclusion of advance appropriations for IHS for FY 2026 in the recent Continuing Resolution. Previously, IHS was the only federal health care provider funded through annual appropriations. Without advance appropriations, IHS is subject to the negative impacts of government shutdowns and continuing resolutions that can lead to serious disruptions in urban Indian organizations ability to provide critical patient services. The continued inclusion of advance appropriations is a crucial step toward ensuring long-term stable funding for IHS. 

This letter sends a powerful message to Chairman Simpson and Ranking Member Pingree, and Members of Congress that in order to fulfill the federal government’s trust responsibility to all Native people to provide safe and quality healthcare, funding for IHS must be significantly increased.

NCUIH is grateful for the support of the following Representatives:

  • Teresa Leger Fernandez (D-NM-3)
  • Jeff Hurd (R-CO-3)
  • Don Bacon (R-NE-2)
  • Dusty Johnson (R-SD-At Large)
  • Jared Huffman (D-CA-2)
  • Raul Ruiz (D-CA-25)
  • Kim Schrier (D-WA-8)
  • Gwen Moore (D-WI-4)
  • Seth Moulton (D-MA-6)
  • Stephen Lynch (D-MA-8)
  • Mark Takano (D-CA-39)
  • Kristen McDonald Rivet (D-MI-8)
  • Ilhan Omar (D-MN-5)
  • Haley Stevens (D-MI-11)
  • Jimmy Panetta (D-CA-19)
  • Ro Khanna (D-CA-17)
  • Shontel Brown (D-OH-11)
  • Greg Stanton (D-AZ-4)
  • Pramila Jayapal (D-WA-7)
  • Julie Johnson (D-TX-32)
  • Juila Brownley (D-CA-26)
  • Steve Cohen (D-TN-9)
  • Doris Matsui (D-CA-7)
  • Timothy Kennedy (D-NY-26)
  • Yassamin Ansari (D-AZ-3)
  • Diana DeGette (D-CO-1)
  • Melanie Stansbury (D-NM-1)
  • Gabe Vasquez (D-NM-2)
  • Salud Carabajal (D-CA-24)
  • Sharice Davids (D-KS-3)
  • Brittany Pettersen (D-CO-7)
  • Chris Deluzio (D-PA-17)
  • Jared Golden (D-ME-2)
  • Raja Krishnamoorthi (D-IL-8)
  • Chuy Garcia (D-IL-4)
  • Nanette Diaz Barragan (D-CA-44)
  • Jahana Hayes (D-CT-5)
  • Gilbert Ray Cisneros, Jr. (D-CA-31)
  • Juan Vargas (D-CA-52)
  • Shomari Figures (D-AL-2)
  • Adam Smith (D-WA-9)
  • Sara Jacobs (D-CA-51)
  • Jared Moskowitz (D-FL-23)
  • William R. Keating (D-MA-9)
  • Greg Casar (D-TX-35)
  • Janelle S. Bynum (D-OR-5)
  • Maxine Dexter (D-OR-5)
  • Robin Kelly (D-IL-2)
  • Val Hoyle (D-OR-4)
  • Joe Neguse (D-CO-2)
  • Jim Costa (D-CA-21)
  • Zoe Lofgren (D-CA-18)
  • Scott Peters (D-CA-50)
  • Darren Soto (D-FL-9)
  • Kevin Mullin (D-CA-15
  • Luz Rivas (D-CA-29)
  • Rick Larsen (D-WA-2)
  • Sam Liccardo (D-CA-16)
  • Hillary Scholten (D-MI-3)
  • Steven Horsford (D-NV-4)
  • Linda Sanchez (D-CA-38)

Full Letter Text

Dear Chairman Simpson and Ranking Member Pingree:

We write to thank you for your proven commitment to the Indian healthcare system, including Urban Indian Organizations (UIOs), and to request your continued support by funding Urban Indian Health at the highest possible level, with a minimum of $100 million, which is in line with the House proposed amount for FY 2025. Additionally, we would like to request that you retain advance appropriations for the Indian Health Service (IHS) in FY 2027 and protect IHS from sequestration in the final FY 2026 Interior, Environment, and Related Agencies Appropriations Act.

The federal government has a trust responsibility to provide federal health services to maintain and improve the health of American Indian and Alaska Native people.  According to the Tribal Budget Formulation Workgroup (TBFWG), a workgroup comprised of Tribal leaders representing all twelve IHS service areas and serving all 574 federally recognized Tribes, “only a significant increase to the Urban Indian Health line item will allow UIOs to increase and expand services to address the needs of their Native patients, support the hiring and retention of culturally competent staff, and open new facilities to address the growing demand for UIO services.” American Indians and Alaska Natives experience major health disparities compared to the general U.S. population, including lower life expectancy, higher rates of infant and maternal mortality, and psychological or behavioral health issues. This is true regardless of where an American Indian or Alaska Native person lives. A lack of sufficient federal funding for the Indian Health Service budget plays a significant role in these continuing devastating health disparities, as the Indian health system simply does not have the necessary financial resources and support to address these inequities.

The lack of federal funding is deeply impactful for UIOs who are on the front lines in working to provide for the health and well-being of American Indian and Alaska Native people living outside of Tribal jurisdictions. UIOs are an integral part of the Indian health system, comprised of the Indian Health Service, Tribes, and UIOs (collectively I/T/U), and provide essential healthcare services, including primary care, behavioral health, and social and community services, to patients from over 500 Tribes in 38 urban areas across the United States. Unfortunately, despite being an integral part of the I/T/U system UIOs are chronically underfunded. The urban Indian health line item historically makes up only one percent (1 percent) of IHS’ annual appropriation and UIOs often only receive direct funding from the urban Indian health line item. UIOs generally do not receive direct funds from any other distinct IHS accounts, including the Hospital and Health Clinics, Indian Health Care Improvement Fund, Health Education, Indian Health Professions, or any of the line items under the IHS Facilities account.

Without a significant increase to the Urban Indian Health line item, UIOs will continue to be forced to operate on limited and inflexible budgets that limit their ability to fully address the needs of their patients. Current funding levels pose challenges for UIOs in offering competitive salaries to attract and retain qualified staff who are essential for delivering quality care to their communities. Additionally, UIOs need resources to expand their services and programs, including addressing pressing issues such as food insecurity, behavioral health challenges, and rising facilities costs. By providing UIOs with the necessary resources, we can ensure that American Indian and Alaska Native people receive the comprehensive and culturally competent healthcare services they deserve.

We appreciate the inclusion of advanced appropriations for IHS for FY 2026 in the recent Continuing Resolution. Because of this inclusion, the I/T/U system has been able to operate normally and without fear of funding lapses during the FY 2026 appropriations negotiation process. We emphasize that advanced appropriations are a crucial step towards ensuring long-term, stable funding for IHS and, therefore, it is imperative that you include advance appropriations for IHS FY 2027 in the final FY 2026 Interior, Environment, and Related Agencies Appropriations Act. Further, for the reasons discussed above, we request that you protect IHS from any sequestration measures taken in this Act, as IHS, and the urban Indian line item, cannot afford any funding reduction.

Thank you for your consideration of our request.

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Coalition of Health Organizations Request Congress Increase Funding for Key IHS Resources in FY 2026 to Address Native American Health Needs

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On April 29, 2025, the American Indian/Alaska Native (AI/AN) Health Partners, a coalition of health organizations dedicated to improving health care for AI/AN people, sent letters to House and Senate Interior, Environment, and Related Agencies Subcommittee leadership regarding the fiscal year (FY) 2026 appropriations. The coalition emphasized that without sustained investment in the Indian Health Service (IHS), persistent health disparities facing AI/AN communities will continue to worsen.

Letter Highlights

In the letter, the coalition outlined three critical areas for increased investment:

Loan repayment and scholarships: The coalition requested an $18 million increase to the IHS Loan Repayment and Scholarship Programs to help close the 30% provider vacancy rate identified by IHS. The funding would support hiring approximately 400 additional providers.

Staff Quarters: The coalition requested $11 million for new and replacement staff quarters. The letter underscored the urgent need for new and renovated staff housing, especially in rural and remote IHS service areas. Many existing staff quarters are over 40 years old and in disrepair.

Medical and Diagnostic Equipment: Outdated or obsolete medical devices continue to hinder the quality of care across the IHS/Tribal/Urban Indian (I/T/U) system. The coalition urged Congress to fund the Indian Health Facilities equipment account at no less than $42.8 million—the amount approved by the House in FY 2024—to help modernize diagnostic and treatment tools.

The AI/AN Health Partners also reminded Congress of the broader implications of underfunding IHS, highlighting health disparities for AI/AN people due to poor access to health care. Only with sufficient resources will IHS be able to fulfill the federal government’s trust responsibility to provide quality healthcare services to AI/AN people no matter where they live. resources to meet its mission to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.”

About the AI/AN Health Partners

The AI/AN Health Partners is a coalition of health organizations dedicated to improving health care for AI/ANs. Members of this coalition, all of whom signed the letters to the House and Senate appropriators, include:

  • Academy of Nutrition and Dietetics
  • American Academy of Pediatrics
  • American Association of Colleges of Nursing
  • American College of Obstetricians and Gynecologists
  • American Dental Association
  • American Dental Education Association
  • American Medical Association
  • American Psychological Association Services
  • Association of Diabetes Care & Education Specialists
  • Commissioned Officers Association of the USPHS
  • National Kidney Foundation 

Full Letter Text

The full text of the AI/AN Health Partners letter to Senate appropriators can be found below:

Dear Chairman Simpson and Ranking Member Pingree:

The AI/AN Health Partners is a coalition of health organizations dedicated to improving health care for American Indians and Alaska Natives (AI/ANs). AI/ANs face substantially poorer health outcomes, and higher mortality and morbidity rates than the general population. The Indian Health Service (IHS) is critical to how they access health care. However, the IHS must have sufficient resources to meet its mission to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.

We appreciate the continued support the Committee has given to the Indian Health Service.   We know that you have listened to testimony from tribes and tribal organizations stressing the importance of maintaining the best possible health care system for AI/ANs.   We ask that you continue that support for the FY 2026 Indian Health Service appropriation.

Over the years, our mutual goals have not deviated.  Instead, they have only become more urgent.  To provide health care for AI/ANs at a level equivalent to the rest of the nation there must be strong support for increasing and maintaining a robust health care system.  We believe that there are three initial steps to accomplish this:

  • Loan repayment and scholarships: Increase funding for Health Professions Loan Repayment and Scholarships.  For FY 2025, we requested an $18,000,000 increase in this account.   Recently, Health and Human Services Secretary Robert F. Kennedy, Jr, cited the 30 percent health care provider vacancy rate for the Service.   It has been estimated that it would take approximately $18,000,000 to close this gap and allow the IHS to hire about 400 more providers.
  • Staff quarters: Identify specific funding to address the need to provide decent staff quarters at existing healthcare facilities.  Many of the 2,700 staff quarters in the IHS health delivery system are more than 40 years old and in need of major renovation or total replacement. Additionally, in several locations, the number of housing units is insufficient. Decent and adequate staff quarters, especially in remote areas, is necessary for attracting and keeping health care providers in Indian Country.  We endorsed the Administration’s request for $11 million for new and replacement staff quarters for FY 2025.  We continue to support this request for FY 2026.
  • Medical and diagnostic equipment: Health care professionals need modern equipment to make accurate clinical diagnoses and prescribe effective medical and dental treatments. The IHS/Tribal/Urban Indian (I/T/U) health programs manage approximately 90,000 devices consisting of laboratory, imaging, patient monitoring, pharmacy, and other biomedical, diagnostic, and patient equipment. However, many of these facilities use outdated equipment like analog mammography machines. In some cases, they are using equipment that is no longer manufactured. Today’s medical devices/systems have an average life expectancy of approximately six to eight years. The IHS has calculated for several years that to replace the equipment at the end of its six to eight-year life would require approximately $100 million per year. For three fiscal years, this account has been frozen at $32,598,000. We urge the Committee for FY 2026 to fund the Indian Health Facilities equipment account at the House-approved FY 2024 amount of at least $42,862,000. 

In closing we are reminded of inspiring and guiding words from Native Americans: 

“Let us put our minds together and see what kind of life we can make for our children.”  Sitting Bear

“Look and listen for the welfare of the whole people, and have always in view not only the present, but also coming generations – the unborn of the future nation.”  Constitution of the Iroquois Confederation

Thank you for considering our IHS funding requests for FY 2026.  We look forward to working with you to ensure the best possible health care for American Indians and Alaska Natives.

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Senators Send Bipartisan Letter Urging HHS Secretary Kennedy to Address IHS Staffing Shortages

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On May 6, 2025, Senators Jeff Merkley (D-OR), Brian Schatz (D-HI), and Lisa Murkowski (R-AK), sent a letter to HHS Secretary Kennedy, demanding action to provide IHS with the resources and staff required to deliver health care services to American Indian and Alaska Native people. Additionally, they request that any actions impacting Tribal health care delivery be stopped until Tribal Consultation can occur.

In the letter, the Senators emphasized that IHS’ ability to provide health care has been impeded by recent federal actions, which does not align with the federal trust responsibility. While IHS received an exemption from probationary employee staffing reductions and a limited exemption from the hiring freeze, they note other positions should be exempt from the hiring freeze due to the important role they play in the delivery of wrap around health care services. Emphasis was also made on how IHS facilities being understaffed can impact accreditation and further harm the ability to provide life-saving care for American Indian and Alaska Native communities and threaten their ability to receive Medicaid and Medicare reimbursement. Lastly, the Senators raised concern over changes to IHS being implemented without consultation with Tribes, explaining that these actions have harmed the federal-Tribal relationship. They advise HHS to seek Tribal input on federal actions that have an impact on American Indian and Alaska Native communities.

The letter concludes by requesting that Secretary Kennedy meet with the Senate Appropriations Committee and Senate Committee on Indian Affairs to address the concerns outlined in the letter. NCUIH will monitor for any response.

Full Letter Text

Dear Secretary Kennedy:

We write to express our deep concerns regarding the Indian Health Service’s (IHS) ability to meet its health care obligation amid recent federal actions that diminish the quality of and access to health care and erode the federal government’s trust responsibility by failing to meaningfully consult with Tribal governments. We urge you to take immediate action to ensure that the IHS programs serving Native communities have the resources and staffing necessary to fulfill their missions and halt any further actions affecting Tribal health care delivery without first engaging in meaningful Tribal consultation.

The IHS provides health care services to approximately 2.8 million American Indians and Alaska Natives, an obligation enshrined in federal law, treaties and through the trust responsibility. As trustee, you must know that the IHS service population is among the most vulnerable in our nation, falling behind in nearly every health metric. American Indians and Alaska Natives experience disproportionate rates of mortality from most major health issues, including chronic liver disease and cirrhosis, diabetes, unintentional injuries, assault and homicide, and suicide, and currently have an average life expectancy equal to that of the general U.S. population living in 1944.[1] Accordingly, the National Indian Health Board recently passed a resolution emphasizing the need for continued and increased staff at IHS, urging the federal government to exempt the IHS and other Indian health programs from any staffing cuts and to instead commit to prioritizing hiring for Tribal health programs, including the IHS.[2] So while we appreciate that you have exempted IHS from probationary employee staffing reductions and exempted a limited number of IHS employees from the hiring freeze to date, it is critical that other Native-serving agencies within your Department be treated similarly.[3]

The impacts of the hiring freeze for other positions playing crucial roles administering services at IHS continues to exacerbate existing clinical staffing issues. IHS cannot deliver quality health care without sufficient personnel – not just physicians, nurses, dentists, and mental health professionals, but also laboratory technicians who perform tests and process and collect specimens, and administrative personnel who perform essential tasks, including billing, appointment scheduling, and ensuring IHS facilities maintain their accreditation. Additionally, the civilian staff reductions at the U.S. Public Health Service (USPHS) headquarters threatens support functions for approximately 1,200 USPHS officers serving at IHS and Tribal facilities. The loss of administrative infrastructure for payroll, assignments, and special pays will disrupt healthcare delivery in remote Tribal communities. In short, all these positions are imperative to delivery of wrap around health care services to American Indian and Alaska Natives, and staffing cuts, hiring freezes, and staff buyouts are exacerbating the already chronic problem of understaffing at IHS.[4]

Such cuts also put IHS facility accreditation in danger, as understaffed facilities have little chance of meeting accreditation standards. Losing accreditation would further erode trust in the system and limit access to life-saving care for Native communities. Additionally, staffing issues can negatively impact the ability of a facility to meet the CMS Medicare Conditions of Participation and Coverage (COPs) or Conditions for Coverage (CFC) requirements. Several high-profile instances where IHS hospitals were found to be in severe condition previously led inspectors from the Centers for Medicare and Medicaid Services (CMS) to threaten the loss of Medicare and Medicaid reimbursement and participation in third-party insurance networks.[5] The all too frequent occurrence of incidents that put IHS facility accreditation in jeopardy are precisely why Congress provides $58 million annually for accreditation emergencies: to help IHS make emergency hires to maintain accreditation — and ultimately save lives.

Finally, we must remind you that meaningful Tribal consultation should be at the forefront of any discussions regarding potential changes at HHS, including the IHS. This foundational tenet of the federal government’s trust relationship empowers Tribes to be a part of policymaking on a government-to-government basis. We are concerned about reports that senior officials from HHS agencies are being reassigned to IHS positions in Alaska, Montana, and Oklahoma without consideration of Tribal needs, Indian Preference requirements, or IHS service priorities. It appears that HHS has failed to meaningfully consult with Tribes on recent actions, which has negatively impacted the federal-Tribal relationship, and we urge you to seek Tribal input and consult on any future federal action impacting their interests.

Native communities deserve reliable access to quality health care, and we urge you to reevaluate all actions that jeopardize delivery of any health care services for American Indians and Alaska Natives. We look forward to your prompt response and request a bipartisan meeting with you and the Senate Appropriations Committee and the Senate Committee on Indian Affairs staff to address our concerns set forth above.

Resources on NCUIH Advocacy:

[1] FY2025 Indian Country Budget Hearing – Testimony provided by the Indian Health Service (May 15, 2024) https://www.appropriations.senate.gov/imo/media/doc/download_testimony75.pdf. American Indian and Alaska Natives also face higher rates of colorectal, kidney, liver, lung, and stomach cancers than non-Hispanic White people.

[2] National Indian Health Board, Resolution 2025-24 (Mar. 11, 2025), available at https://www.nihb.org/wpcontent/uploads/2025/03/25-04-Resolution-on-IHS-Exemption-from-RIF-in-EO-14210.pdf

[3] For example, recent staffing cuts at the Centers for Disease Control’s (CDC) Healthy Tribes Program threaten to rollback chronic disease prevention advancements particular to Native communities. And with the recent HHS announcement that CDC will decrease its workforce by 2,400 employees, National Institutes of Health by 1,200, and Centers for Medicare and Medicaid Services (CMS) by 300, with additional cuts pending in future reductions in force, impacts to non-IHS Native-serving agencies within HHS is concerning. See https://www.hhs.gov/pressroom/hhs-restructuring-doge.html.

[4] Last year, IHS experienced nearly 2,000 vacancies, and a 2018 GAO report found that IHS had an overall health care provider vacancy rate of 25 percent across service areas. See IHS Workforce Parity Act and Tribal Access to Clean Water Act of 2023: Hearing on S. 4022 and S. 2385 Before the S. Comm. on Indian Affs., 118th Cong. 1 (2024); S. GOV’T ACCOUNTABILITY OFF., GAO-18-580, INDIAN HEALTH SERVICE: AGENCY FACES ONGOING CHALLENGES FILLING PROVIDER VACANCIES 9-10 (Aug. 2018) (statement of Melanie Anne Egorin, Assistant Sec’y for Legis., U.S. Dep’t of Health & Human Res.).

[5] For example, between 2015 and 2017, CMS inspectors found that a baby was born in a bathroom at the Rosebud IHS hospital and, in another instance, a heart attack victim did not receive care for 90 minutes (in fact, the emergency room had been closed for six months). CMS officials also witnessed repeated deficiencies in the emergency room at the IHS hospital in Pine Ridge. At that facility, officials reported that a diabetic man who said he had gone days without insulin was forced to wait two hours before receiving care, at which point his glucose levels were severe enough to cause organ damage. He ultimately died the next day after he needed surgery to treat a severely damaged small intestine. See Roll Call – The Never Ending Crisis at the Indian Health Service (2018) https://rollcall.com/2018/03/05/the-never-ending-crisis-at-the-indian-health-service/

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Tribal Leaders Highlight the Importance of Medicaid at Hearing

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On April 4, 2025, the House Natural Resources Subcommittee on Indian and Insular Affairs held a hearing on “Examining 50 Years of the Indian Self-Determination and Education Assistance Act in Indian Country” in Oklahoma City, Oklahoma. The Subcommittee on Indian and Insular Affairs members asked Tribal leaders about the impacts of self-determination contracts. In the hearing, Tribal leaders expressed the successes of self-governance agreements in areas of agriculture, healthcare, and Department of Justice programs, as well as the need for additional funding and support for these contracts. In terms of healthcare, it was highlighted that Medicaid is an essential funding source that funds healthcare related self-governance agreements, and that any cuts to Medicaid would impact Tribes’ ability to manage their health systems.

During the hearing, Rep. Leger Fernandez (D-NM-3), Ranking Member of the Subcommittee on Indian and Insular Affairs, noted the connection between Medicaid and self-determination, “I am very concerned about the Medicaid cuts because we know that Indian self-determination does not exist in a vacuum, that when I was helping set up those clinics and when you were setting up your own clinics, you were relying on third party funding. Everybody’s shaking their head because it’s simply true, you’re relying on those Medicaid dollars to come in so that you could increase services because, sadly, we underfund IHS. We’ve had hearings on that and it breaks my heart every time we read the numbers of how every other agency for their healthcare gets paid so much more.

If you cut Medicaid funding, tribes might have to cut services, they might have to cut staff. And this is a — is a major problem. So a $880 billion cut to Medicaid doesn’t just hurt other communities, it hurts this amazing goal and promise of Indian self-determination.”

In response to questions regarding the implications of cuts to Medicaid, Martin Harvier, President of Salt River Pima-Maricopa Indian Community, shared, “We face a stark reality, residents in our community, on average, die more than 30 years younger than residents of Scottsdale, only a few miles away. It will be a challenge to meet our five-and-five goal. if there are significant cuts to Medicaid. IHS only funds about 65 percent of our operational budgets so we, like other tribes, rely on third party revenue to supplement our programing.

And the vast majority comes from Medicaid. Any cut to Medicaid would, significantly, reduce the budget of our health system. And without an equal increase in IHS funds, we would have limited capacity to expand programs and facilities that are needed. A cut to Medicaid would make it nearly impossible to keep up with the demand for service.”

Medicaid’s Importance for AI/AN Communities and UIOs

In 2023, approximately 2.7 million American Indian and Alaska Native (AI/AN) people were enrolled in Medicaid across the United States, according to American Community Service data. Medicaid is a major source of health care funding, particularly for Urban Indian Organizations (UIOs), which provide essential healthcare services to AI/AN people living in urban areas. The proposed Medicaid cuts would threaten the ability of UIOs to sustain necessary service offerings, potentially reducing access to essential health care services for urban AI/AN people.

Read NCUIH’s comprehensive overview highlighting the crucial role Medicaid plays in providing health care to AI/AN communities.

Budget Reconciliation and Medicaid

On April 5, 2025, the Senate passed their budget resolution. The resolution will allow Congressional Republicans craft their budget reconciliation aimed at extending the 2017 Trump tax cuts and instituting new spending cuts. The resolution also allows for $1.5 trillion in new tax cuts over a decade and $5 trillion increase to the federal borrowing limit to avoid hitting the debt ceiling. The House version passed on February 25, 2025, allows $4.5 trillion in tax breaks and $2 trillion in spending cuts, including $880 billion from the Energy and Commerce Committee which has jurisdiction over the Medicare and Medicaid programs. An analysis by the nonpartisan Congressional Budget Office (CBO) shows that budget goals outlined in the House plan cannot be reached without reducing spending on Medicaid

Resources

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