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Medical and Diagnostic Equipment: Outdated or obsolete medical devices continue to hinder the quality of care across the IHS/Tribal/Urban Indian (I/T/U) system.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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Action Alert: Contact Congress to Protect Funding for Indian Health TODAY

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Dear Advocates,

We need your help contacting Congress to support access to health care for Native communities!

Representative Teresa Leger Fernández is leading a letter to support funding for Urban Indian Health in the FY26 budget. The letter also includes a request to retain advance appropriations for the Indian Health Service (IHS) in FY27 and protect IHS from sequestration.

While the President’s budget says IHS funding will be preserved, it is crucial to notify Congress of your support for IHS and Urban Indian Health. We encourage you to contact your Member of Congress and request that they sign on to the Leger Fernández Urban Indian Health letter.

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

Thank you for your leadership. Your outreach on this is invaluable to providing greater access to health care for American Indian and Alaska Native people.

Sincerely,

The National Council of Urban Indian Health

 

Ways to Advocate

Contact Congress | Post on Social Media

 

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 Jeremy Grabiner (policy@ncuih.org) with questions.

Email to Your Representative

Dear Representative [NAME],

As an urban Indian health advocate, I respectfully request that you sign on to the Leger Fernández letter to the House Committee on Appropriations in support of funding for the Urban Indian Health line item for FY26.

Indian Health Service (IHS) funded Urban Indian Organizations (UIOs) provide essential healthcare services to patients from over 500 Tribes in 38 urban areas across the United States. As an integral part of the Indian health care delivery system, IHS UIOs are innovative stewards who use scarce federal resources to provide services to American Indian and Alaska Native patients. The Urban Indian Health line item historically makes up only one percent (1%) of IHS’ annual appropriation, and UIOs often only receive direct funding from the Urban Indian Health line item.

The letter requests funding for Urban Indian Health, IHS advance appropriations for FY27, and to protect IHS from sequestration. I respectfully ask that you help honor the federal trust obligation to provide health service to American Indian and Alaska Natives, no matter where they live by signing on to this letter.

Sign on to the letter by reaching out to Sofia Mingote (sofia.mingote@mail.house.gov) with any questions.

Thank you for your leadership and your commitment to urban Indian health.

Sincerely,

[contact information]

POST ON SOCIAL MEDIA

Example post:

We need your help to support urban American Indian and Alaska Native communities! Indian Health Service funded Urban Indian Organizations provide essential healthcare services to American Indian and Alaska Native patients from over 500 Tribes in 38 urban areas across the United States. Call on your Representative TODAY and urge them to sign on to the Leger Fernández Urban Indian Health funding letter.

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

NCUIH Supports Tribal Sovereignty

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

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NCUIH Urges Administration and Congress to Honor Trust Responsibility in FY26 Budget

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FOR IMMEDIATE RELEASE

WASHINGTON, D.C. (May 5, 2025)– On May 2, the President released the Fiscal Year (FY) 2026 budget proposal. 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 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.” The proposal for the Department of Health and Human Services (HHS) outlines a 26.2% reduction to the overall HHS budget, amounting to $33.3 billion in cuts.

Note: Detailed agency-level budget requests are expected in the coming weeks. As such, the Indian Health Service (IHS) and Urban Indian Health line items have not yet been released. It is unclear if any programs in the Indian Health Services are proposed for elimination due to “inefficiencies”.

The CEO of NCUIH, Francys Crevier, J.D. (Algonquin), stated, “The trust responsibility for Native people extends beyond the Indian Health Service. We call on the Administration to honor its commitment to Native people and reconsider all cuts to programs serving Native communities. We further urge the administration to engage in Tribal consultation in recognition of the legal Nation-to-Nation relationship before undergoing any changes impacting Native people. Congress has long demonstrated bipartisan support for Tribal Nations and Native people, and we call upon our Congressional champions to ensure that the Indian Health Service and programs serving Native people receive the necessary resources to fulfill the trust responsibility.”

NCUIH has also joined the Coalition for Tribal Sovereignty to ensure that the administration and Congress honor the legal trust responsibility for health care for Native people. We stand with Tribal Nations in protecting all trust responsibilities and the Nation-to-Nation relationship. NCUIH opposes any cuts to programs serving Native communities.

NCUIH’s Engagement on FY26

  • On February 28, 2025, NCUIH Board President-Elect, Robyn Sunday-Allen, testified at the House Appropriations Subcommittee on Interior, Environment, and Related Agencies, urging full funding for urban Indian health and the Indian Health System. In her testimony, Robyn Sunday-Allen said, “Historically, disruptions in funding to the Indian health system have resulted in loss of life… Our care is too critical to be paused or reduced.” Ensuring mandatory and full funding for the entire Indian Health System—Tribal facilities, IHS, and UIOs—is essential for saving lives.
  • NCUIH joined the Coalition for Tribal Sovereignty in a letter to Secretary Kennedy requesting that he appeal the OMB proposed cuts to critical Tribal programming.
  • Rep. Leger Fernandez is currently circulating a Dear Colleague letter to the leadership of the House Appropriations Subcommittee on Interior, Environment, and Related Agencies, requesting robust funding for Urban Indian Health. The deadline for Congressional members to sign on is May 15.

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.

Resources

About NCUIH

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

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

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

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