HHS Secretary Kennedy Visits Second Urban Indian Organization in Oklahoma City

Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. along with Senior Advisor Mark Cruz (Klamath) visited the Oklahoma City Indian Clinic (OKCIC

On June 26th, 2025, the Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. along with Senior Advisor Mark Cruz (Klamath) visited the Oklahoma City Indian Clinic (OKCIC) to learn more about their work as an Urban Indian Organization within the Indian Health System. Secretary Kennedy spent time in the clinic’s food resource center, discussing the links between nutrition, chronic disease prevention, and the persistent food insecurity faced by many Native families living in cities. Secretary Kennedy was joined on his visit by Tribal leaders and the Oklahoma IHS Area Director.  

OKCIC Chief Executive Officer, Robyn Sunday Allen (Cherokee), walked the Secretary through the clinic’s integrated care model—combining primary care, behavioral health, pharmacy, and culturally grounded wellness programs under one roof. Kennedy praised OKCIC’s community-centered approach as a practical roadmap for addressing social drivers of health and pledged continued collaboration with Urban Indian Organizations to ensure that Native people in urban settings receive equitable, high-quality care. This visit is Secretary Kennedy’s second visit to an Urban Indian Organization since his confirmation in February, his first visit was to Native Health in Arizona on April 8.  

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National Tribal Budget Formulation Workgroup Releases Recommendations for Fiscal Year 2027, Recommends Full Funding for Indian Health Service and Urban Indian Health

In April 2025, the National Tribal Budget Formulation Workgroup (NTBFW) released their fiscal year (FY) 2027 Tribal Budget Recommendations, The Federal Trust Responsibility to Tribal Nations: A Strategy to Advance Indian Health Care, as part of the Indian Health Service (IHS) Budget Formulation process. The NTBFW recommends $1.09 billion for the Urban Indian Health line item and $73 billion for IHS. The NTBFW also recommends that IHS retain and expand eligibility for Urban Indian Organizations (UIOs) to participate in grant programs and ensure that UIOs are included in exemptions for Medicaid reform, including work requirements.

Read the full recommendations here.

Background on IHS Budget Formulation

As part of the trust responsibility to provide health care to all American Indian and Alaska Native people, Tribal leaders present their funding needs each year to the Secretary of the U.S. Department of Health and Human Services (HHS) and the Director of the Office of Management and Budget (OMB). The recommendations are formed through the Tribal Budget Formulation Workgroup and serve as a framework for the Administration in setting budget amounts for their annual requests to Congress. This process ensures the federal government has the resources to provide health care to all American Indian and Alaska Native people in fulfillment of the trust responsibility.

The National Council of Urban Indian Health (NCUIH) assists UIOs in advocating for their needs during the IHS Area level consultation sessions and presents information on UIOs’ priorities and needs during the February Area Report Webinar. NCUIH supports full funding for the IHS, Tribal, and UIOs (I/T/U) system.  NCUIH endorses a budget in which IHS, Tribal Facilities, and UIOs are all fully funded to improve health outcomes for all Native people no matter where they live.

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NCUIH Congratulates Mark Cruz on Appointment as HHS Senior Advisor, Reaffirming Secretary Kennedy’s Commitment to Indian Country

On Thursday, June 20th, 2025, Mark Cruz, a citizen of the Klamath Tribes, was sworn in by Secretary of Health and Human Services Robert F. Kennedy Jr. as Senior Advisor to the Secretary. Mr. Cruz’s appointment demonstrates the Secretary’s commitment to fulfilling the promise he made during his confirmation hearing to ensure that Native voices have a seat at the highest levels of the Department.

During the ceremony Secretary Kennedy said, “Indian Country is not just a concern of mine—it is a top priority. We cannot Make America Healthy Again without making Native health a central focus… it is very important to me to have a Native American in my direct inner circle so that every decision we make at HHS takes into consideration the impacts and the potential opportunities for Native Americans.”

The National Council of Urban Indian Health commends Mr. Cruz on this important appointment, and looks forward to working with Mr. Cruz and the HHS team to elevate urban Native health and uphold the trust responsibility to all Native communities, no matter where they live.

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NCUIH Commends MacArthur Foundation’s Native Self-Determination Program and Urges Philanthropy to Invest Boldly in Indian Country

FOR IMMEDIATE RELEASE

WASHINGTON, D.C. (June 22, 2025) – The National Council of Urban Indian Health (NCUIH) proudly applauds the MacArthur Foundation’s launch of its Native Self-Determination Program—a transformational commitment to Indigenous leadership and community-driven solutions. This announcement comes at a critical moment for Native communities, who are continuing to face compounding public health, economic, and political crises.

“The MacArthur Foundation is setting a powerful precedent for what trust-based, community-led philanthropy should be,” said Francys Crevier (Algonquin), CEO of the National Council of Urban Indian Health. “At a time when Native communities are enduring unprecedented public health underinvestment and ongoing federal divestment, we need courageous, values-driven action from philanthropy. We call on all funders to follow MacArthur’s lead—now is the time to invest in Indian Country like never before. Vast wealth has been built on our lands; now is the moment to reinvest in our people. While the average American life expectancy exceeds 70 years, some of our relatives are still fighting to reach 50. Less than 1% of philanthropic dollars goes to Native organizations. Philanthropy must step up to close this gap in this critical moment—because our lives depend on it.”

The MacArthur Foundation’s program builds upon $109 million in past investments and aims to deepen Indigenous influence across philanthropic practices.

NCUIH has advocated for serious investments in Indian Country as the federal government divests from significant programs. As the premier national organization representing the health needs of over American Indian and Alaska Native people living in urban areas, NCUIH stands ready to partner with MacArthur and other funders interested in advancing Indigenous priorities.

During NCUIH’s Public Health Emergency webinar hosted by Grantmakers In Health (watch here) in November 2024, they emphasized the urgent need for sustained and strategic investment to prevent the unraveling of decades of progress in Native health. “This is not just a crisis—this is an emergency,” Crevier said during the webinar. “Lives are on the line, and philanthropy must act urgently.”

A Call to Action

Philanthropy has a critical role in protecting Native health, restoring community wellness, and sustaining self-determination in the face of historic and ongoing disinvestment. NCUIH urges all funders to match MacArthur’s commitment—to listen, to trust, and to invest deeply in Native communities now. NCUIH stands ready to support all philanthropy in developing solutions that work for Indian Country.

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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NCUIH June Update: Budget Numbers, Appropriations Timeline, Calls to Act

In this Edition:

📊 FY 2026 Budget: The President’s request funds IHS at $8.1 billion and Urban Indian Health at $90.4 million while omitting advance appropriations.

🏛 House Appropriations: At the Interior Subcommittee hearing, Reps. Simpson, Pingree, and Cole pledged to retain advance appropriations, with mark-ups set for June 23 and 26.

✉️ Native Caucus Letter: Members have until June 23 to sign the Native American Caucus letter urging protection of Tribal and Urban Indian programs.

⚖️ Reconciliation: Senate drafts keep the AI/AN Medicaid work-requirement exemption, but the SNAP exemption is absent and may be revived on the floor.

📝 NCUIH Advocacy: NCUIH submitted testimony to appropriators and circulated comment letters on SNAP and CMS waivers that defend AI/AN health protections.

🏥 IHS Consultations: Comments are open on EHR modernization and regional realignment, with an Urban Confer on July 28 and final comments due August 28.

🤝 NCAI Mid-Year: NCUIH President Walter Murillo co-chaired the Health Subcommittee as resolutions advanced priorities on Medicaid, IHS funding, and nutrition programs.

💡 Medicaid Guidance: HHS issued a memo directing states to align Medicaid payments with Medicare rates, trimming oversized state-directed payments.

📆 Save the Dates: OUIHP Executive Call (June 26), Monthly Policy Workgroup (July 16), IHS Virtual Urban Confer on IHS Proposed Realignment (July 28), and TTAG Quarterly Meeting (July 29-30).

Fiscal Year 2026 Budget Request and Appropriations

President’s Proposal: New Investments, No Advance Appropriations

The President proposes $8.1 billion dollars for the Indian Health Service and $90.4 million dollars for Urban Indian Health, with new investments in diabetes care, behavioral health, and disease-prevention initiatives, but without advance appropriations.

Key Indian Country Provisions

  • IHS: $8.1 Billion – Minor increase but largely flat.
  • Urban Indian Health: $90.4 million – flat funded
  • Advance appropriations not included, despite the inclusion for FY 2026 in the FY 2025 continuing resolution.
  • Reauthorization for the Special Diabetes Program for Indians (SDPI) – $159 million.
  • NEW: Native American Behavioral Health and Substance Use Disorder program – $80 million
  • NEW: Prevention Innovation Program- $19 million set aside for Tribes, tribal organizations, UIOs, and health service providers to Tribes serving rural communities experiencing poor chronic disease and maternal health outcomes.

House Interior Appropriations Subcommittee IHS FY 2026 Budget Hearing Highlights

Acting Director Ben Smith testified and highlighted Secretary Kennedy’s visit to NATIVE HEALTH.

Committee Chairman Cole reaffirmed commitment to stable funding for IHS: “One thing I can assure you, we didn’t get here to give it up. I can just tell you now, we will be retaining advanced appropriations.”

Subcommittee Chair Simpson and Ranking Member Pingree expressed disappointment in advance appropriations not being included in the President’s request.

Rep. Celeste Maloy (R-UT-02) applauded the work of Urban Indian Center of Salt Lake, stating “Utah has only one Urban Indian Organization—the Urban Indian Center of Salt Lake—and they’re doing terrific work. What more can Congress do to make sure centers like this get the resources they need?” In response, Acting IHS Director, Ben Smith, cited stronger consultation and issue tracking that includes UIO feedback.

Native American Caucus Dear Colleague Letter to Protect Tribal Programs in FY 2026 Closes June 23rd

Reach out to your Member of Congress to sign on by June 23rd, 2025

Requests to House Appropriations Committee:

  • Safeguard and support all federal funding flowing to Indian Country to ensure successful delivery of services.
  • Support funding necessary to maintain federal employee positions that service Tribal nations and the federal offices that provide these services.

ICYMI:

On June 17th, 2025, Adrianne Maddux (Hopi), Executive Director of Denver Indian Health and Family Services and NCUIH Board Treasurer, attended the Tribal Leaders Diabetes Committee Meeting meeting representing Urban Indian Organizations. The next meeting is set for September 16th, 2025.

On June 12th, 2025, NCUIH submitted Written Testimony to the Senate Interior Appropriations Committee. Requests included:

  1. Protect Funding for the IHS and fund Urban Indian Health at $100 million for FY26
  2. Maintain Advance Appropriations for the IHS, until mandatory funding is achieved, and protect IHS from sequestration.
  3. Appropriate $80 million for the Native Behavioral Health Resources program
  4. Ensure Federal Policies Uphold Trust Obligations to American Indian and Alaska Native Communities

On June 12th, 2025, NCUIH submitted Written Testimony to the Senate LHHS Appropriations Committee. Requests included:

  1. Protect Funding for the Indian Health Service and fund Urban Indian Health
  2. Ensure Federal Policies Uphold Trust Obligations to American Indian and Alaska Native Communities
  3. Fund the Initiative for Improving Native American Cancer Outcomes at $10 million for FY26
  4. Fund the Good Health and Wellness in Indian Country (GHWIC) Program at $30 Million for FY26
  5. Appropriate $80 million for the Native Behavioral Health Resources program
  6. Protect Funding for HIV/AIDS Prevention and Treatment

Budget Reconciliation and Policy Development

Senate Finance Text

On June 16th, 2025, the Senate Finance Committee released their reconciliation text.

  • NCUIH worked with the Committee to maintain the AI/AN exemption for Medicaid work requirements.
  • NCUIH worked with the Committee to provide an AI/AN Exemption from new 6-month redetermination requirement for the Medicaid expansion population.

Senate Agriculture Text

On June 16th, 2025, the Senate Ag Committee also released their reconciliation text.

  • The text does not currently have an AI/AN work requirement exemption for SNAP.
  • However, the exemption could still be brought as a floor amendment.

On June 11th, 2025, NCUIH provided a letter template to UIOs to send to Senate Agriculture Chair Boozman in support of the proposal exempting Native people from work requirements and promoting Tribal administration of SNAP.

Indian Health Service Reorganization and Admin Announcements

IHS Reorganization

Announced by IHS Acting Director Ben Smith: IHS is dividing the hospital system into two regions, north and south, and the hospitals will report to Loretta Christensen. All of the IHS Area Directors will report to Dr. Beverly Cotton. IHS published a DTLL/DULL on the proposed realignment with dates for the in-person Tribal Consultation sessions and virtual Urban Confer. The virtual Urban Confer is scheduled for July 28th. Comments are due August 28th.

Admin Announcements

Picture 1819830372, Picture

June 6th Memo – Eliminating Waste, Fraud, and Abuse in Medicaid

Directs HHS to take appropriate action to ensure Medicaid payments rates are not higher than Medicare, to the extent permitted by applicable law.

Previous Trump Administration policy allows states to make State Directed Payments (SDPs) up to the average commercial rate.

NCUIH Co-Chairs and Presents at NCAI Mid-Year Convention Health Subcommittee

On June 9th, 2025, NCUIH Board President, and CEO of Native Health, Walter Murillo (Choctaw), co-chaired the Health Subcommittee at the National Congress of American Indians Mid-Year Convention, advancing resolutions on Medicaid, Indian Health Service funding, behavioral health, and nutrition. Topics for resolutions passed included:  Medicaid exemptions for AI/AN, FY26 Indian Health Service budget support, Native Connections grant support, Promoting the Director of Indian Health Service to Assistant Secretary, and SNAP work requirement exemption.

NCUIH Actions

June 14th – NCUIH Submitted Comments to IHS on the IHS Health Information Technology (HIT) Modernization: Four Directions Warehouse

NCUIH requested IHS provide clarification to UIOs on the 4DW about access for all UIOs; support IHS, Tribal, and UIO (I/T/U) facilities for data migration and transition to PATH EHR; and communicate regularly with facilities about the HIT Modernization project.

NCUIH provided a comment template to UIOs.

The next joint IHS TC/UC session on HIT Modernization will be held virtually via Zoom on August 7th, 2025, 1:30-3 PM Eastern.

Over the last month, NCUIH Submitted Comments Supporting Exempting AI/AN People from Work Requirements in Proposed Amendments to State Medicaid programs:

  • May 28th – South Carolina Palmetto Pathways to Independence
  • May 28th – CMS Georgia Pathways to Coverage Program
  • June 12th – Kentucky
  • June 18th – South Dakota

Key Upcoming Dates

Several forums this summer invite Urban participation: 

  • Office of Urban Indian Health Programs Executive Directors call – June 26th.
  • Monthly Policy Workgroup – July 16th.
  • IHS Virtual Urban Confer on IHS Proposed Realignment- July 28th.
  • Tribal Technical Advisory Group quarterly meeting – July 29–30th.
  • IHS Virtual TC/UC session on HIT Modernization- August 7th.
  • IHS Division of Behavioral Health Virtual UIO Listening Session – August (date TBD)

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 Submits Written Testimony Urging Senate to Protect Funding of Indian Health Service & Funding for Key Indian Health Programs in FY 2026

On June 12, 2025, the National Council of Urban Indian Health (NCUIH) submitted outside written testimony to the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies (LHHS) and the Senate Appropriations Committee on Interior, Environment, and Related Agencies regarding Fiscal Year (FY) 2026 funding for Urban Indian Health. NCUIH called for protecting funding for the Indian Health Service (IHS) and urban Indian Health and increased resources for American Indian and Alaska Native health programs.

In the testimonies, NCUIH requested the following:

  • Protect Funding for IHS and fund Urban Indian Health
  • Maintain Advance Appropriations for the IHS, until mandatory funding is achieved, and protect IHS from sequestration.
  • Ensure Federal Policies Uphold Trust Obligations to American Indian and Alaska Native Communities
  • Appropriate $80 million for the Native Behavioral Health Resources program
  • Fund the Initiative for Improving Native American Cancer Outcomes at $10 million for FY26
  • Fund the Good Health and Wellness in Indian Country (GHWIC) Program at $30 Million for FY26
  • Protect Funding for HIV/AIDS Prevention and Treatment

Next Steps:

This testimony will be considered by the Senate Committees and used in the development of the Committee’s priorities. NCUIH will continue to support these requests in the 119th Congress and work closely with Committee members and staff.

Background on President’s FY 2026 Budget Proposal: Increased for IHS, Stable Funding for Urban Indian Health, Advance Appropriations for IHS Not Included

The President’s FY 2026 proposed budget includes a $90.4 million for Urban Indian Health. This amount is flat with the FY 2025 enacted amount. The President’s proposal also requests $8.1 billion for IHS which includes reauthorization for the Special Diabetes Program for Indians (SDPI) for $159 million. HHS also proposes $80 million for the newly funded Native American Behavioral Health and Substance Use Disorder program to be administered through the Administration for Healthy America (AHA). HHS’ Budget in Brief and IHS Congressional Justification do not include advance appropriations for IHS, despite the inclusion of advance appropriations for FY2026 in the March 14 Continuing Resolution, which funded the government through the end of FY2025.

Read our full analysis of the President’s proposed FY 2026 budget.

NCUIH Work on FY 2026 Funding

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Contact Congress to Protect Funding for Tribal Programs TODAY

Dear Friends,

NCUIH worked with the Coalition for Tribal Sovereignty to support the Congressional Native American Caucus in leading a letter to support and protect funding for Tribal Programs and Urban Indian Organizations in the FY26 budget. The letter highlights that funding flowing to Indian Country is a furtherance of trust and treaty obligations and therefore must be safeguarded from harmful cuts and changes.

It is crucial to notify Congress of your support for Tribal Programs and Urban Indian Organizations and request that they sign on to the Native American Caucus letter.

For your convenience, we have provided the text below as a template to call and/or email your Representative. If you can, we recommend you call and email your Representative. You can find your Representative here.

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 Facebook
CONTACT CONGRESS

Step 1: Copy the email below.

Step 2:Find your representative here.

Step 3: Go to their website and click contact.

Step 4: Paste the email into the form and send. Please contact 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 bipartisan Congressional Native American Caucus letter to the House Committee on Appropriations in support of funding for Tribal programs, including Urban Indian Organizations in the FY26 budget.

These programs deliver on the United States’ trust and treaty obligations to Tribal Nations and Tribal citizens. As such, funding for these programs must be safeguarded to ensure successful delivery of services to Tribal citizens and Tribal Nations.

Tribal programs are unique because they are delivered in recognition of Tribal Nations’ and Native people’s unique political status under the U.S. Constitution, as recognized by the U.S. Supreme Court. I respectfully ask that you help honor the federal trust obligation to provide health services to Native people, no matter where they live, by signing on to this letter.

Sign on to the letter by reaching out to Vittoria Casey (vittoria.casey@mail.house.gov). The deadline to sign on to the letter is June 23, 2025.

Thank you for your leadership and your commitment to Indian Country.

Sincerely,

[contact information]

POST ON SOCIAL MEDIA

Example post: 

We need your help to support American Indian and Alaska Native communities! Tribal programs and Urban Indian Organizations are essential to delivering on the United States’ trust and treaty obligations, and funding for these programs must be protected. Call on your Representative TODAY and urge them to sign on to the Native American Caucus Tribal Programs support letter.

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.

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

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House Appropriations Subcommittee examines IHS Fiscal Year 2026 Budget, Bipartisan Lawmakers Defend Stable Funding for IHS

On June 5, the House Appropriations Subcommittee on Interior, Environment, and Related Agencies held a hearing where Acting Indian Health Service (IHS) Director Benjamin Smith and Chief Financial Officer Jillian Curtis testified on the President’s Fiscal Year 2026 budget request for IHS, which notably does not include advance appropriations. Members from both sides of the aisle expressed commitment to retain advanced appropriations for IHS. Questions covered support for deepened urban consultation, staffing needed for the June 2026 electronic health record launch, and continued investment in the Special Diabetes Program for Indians and related food-as-medicine pilots.

Hearing Highlights

The discussion covered core operational challenges and featured direct reference to an Urban Indian Organization (UIO) in Utah. Below are the main points raised by members and witnesses.

  • Advanced Appropriations for IHS: Bipartisan support for advance appropriations was clear. Members from both parties emphasized that advance appropriations remain essential for keeping IHS hospitals and clinics open during funding lapses like government shutdowns. House Appropriations Chairman Tom Cole (Chickasaw, R-OK-04) reiterated his support, saying, “One thing I can assure you, we didn’t get here to give it up; Congress will keep advance appropriations in place,” despite its omission from the FY 2026 request. 
  •  Urban Indian Organization Services: Rep. Celeste Maloy (R-UT-02) praised the Urban Indian Center of Salt Lake and asked how Congress can bolster urban Native health; Director Smith cited stronger consultation and issue-tracking, including UIO feedback.
  • Electronic Health Record modernization: Chair Simpson (R-ID-02) asked whether the new Oracle-Cerner platform will turn on in June 2026; Director Smith confirmed the schedule and acknowledged that “about fifty specialized positions remain open” and that IHS staffing is “still hovering near thirty percent vacant.” If vacancies persist, Ranking Member Chellie Pingree (D-ME-01) pressed for contingency plans. 
  • Special Diabetes Program for Indians (SDPI): Rep. Betty McCollum (D-MN-04) highlighted the fact that eighty percent of SDPI grants now target youth prevention, calling the program “a model the rest of public health should copy.” Members from both parties applauded complementary “food-as-medicine” pilots such as Produce Prescription.
  • Workforce Pipeline: Ranking Member Chellie Pingree (D-ME-01) urged IHS to widen its scholarship and loan-repayment programs by co-funding new rural residency rotations with the Veterans Health Administration and HRSA. Smith said the inter-agency task force is “standing up the first joint primary-care rotations for 2026 graduates” and will report back on early recruitment data.

What’s Next

House Interior Appropriations will propose their budget on the June 23 subcommittee markup and the June 26 full committee markup.

Background

Read our full analysis of the proposed budget: ANALYSIS: President Trump Proposes Increase for Indian Health Service, Stable Funding for Urban Indian Health for FY 2026

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Lawmakers and Tribal Leaders Emphasize Importance of HHS Programs for Native Healthcare in Senate Committee on Indian Affairs Oversight Hearing

On May 14, 2025, the United States Senate Committee on Indian Affairs held an Oversight Hearing on “Delivering Essential Public Health and Social Services to Native Americans – Examining Federal Programs serving Native Americans across the Operating Divisions at the U.S. Department of Health and Human Services.” The purpose of this hearing was to examine programs within the Department of Health and Human Services (HHS), specifically non-Indian Health Service (IHS) programs, that are essential to upholding the federal government’s trust responsibility. The trust responsibility requires the federal government to provide healthcare services to American Indian and Alaska Native people.

Watch the hearing here.

Senators and Tribal Leaders Emphasize Importance of HHS Resources and Highlight UIO Stories

In her opening, Senator Lisa Murkowski (R-AK) emphasized the importance of HHS programs for American Indian and Alaska Native communities: “As we look broadly at the programs within HHS, we have to remember that for many Native communities, non-IHS programs are just as important as those under the IHS. From public health initiatives to social services, these programs often provide the only consistent access to basic supports for the most vulnerable members of Native communities.” Senator Brian Schatz (D-HI) added to this by stating that there is a bipartisan agreement within the Committee that American Indian and Alaska Native communities need more help, and that “now is the time to stand together and protect Native healthcare.”

Chairwoman Janet Alkire, Standing Rock Sioux Tribe, testified that “despite chronic underfunding, Tribal Nations, Tribal Organizations, and Urban Indian Organizations rely on HHS resources to deliver life-saving care.” She also shared a story from an urban Indian organization (UIO) who lost communication with their Project Officer and Grants Manager for the Centers for Disease Control and Prevention (CDC) Healthy Tribes Program. This led to a gap in their program and ability to provide services to their patients.

Senator Catherine Cortez Masto (D-Nevada) asked witnesses to provide details about the importance of mental health programs at HHS, specifically Native Connections, by sharing a story about a patient at a UIO in Nevada: “There’s a nine-year old girl in Nevada Urban Indians who was struggling with mental health. And she did not – could not get the care from a school or pediatrician, but it was Native Connections’ program that, according to her father, got his daughter back.”

Senator Murkowski closed the hearing by stating, “The message I would like to leave with, with all of you, is amidst this uncertainty, know that we’ve got all got to link arms and get through this together.”

Background

NCUIH worked with the National Indian Health Board in preparation of the oral testimony of Chairman Alkire. NCUIH will also be submitting written testimony to the Committee.

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ANALYSIS: President Trump Proposes Increase for Indian Health Service, Stable Funding for Urban Indian Health for FY 2026

On May 30, 2025, the Department of Health and Human Services (HHS) published their Fiscal Year (FY) 2026 Budget in Brief and the Indian Health Service (IHS) published the IHS Justification for Estimates for Appropriations Committees for FY 2026 (hereinafter Congressional Justification).

Proposed Funding for the Urban Indian Health Line Item and the Indian Health Service

The President’s Budget includes a $90.4 million for Urban Indian Health. This amount is flat with the FY 2025 enacted amount. The President’s proposal also requests $8.1 billion for IHS which includes reauthorization for the Special Diabetes Program for Indians (SDPI) for $159 million. HHS also proposes $80 million for the newly funded Native American Behavioral Health and Substance Use Disorder program to be administered through the Administration for Healthy America (AHA).

Advance Appropriations

HHS’ Budget in Brief and IHS Congressional Justification do not include advance appropriations for IHS, despite the inclusion of advance appropriations for FY2026 in the March 14 Continuing Resolution, which funded the government through the end of FY2025. Advance Appropriations are essential to provide stability and insulate to Indian health care providers from the effects of budgetary disagreements. Congress first included Advance Appropriations for IHS in the FY 2023 Omnibus and included Advance Appropriations in budgetary legislation for FY 2024 and FY 2025. Maintaining Advanced appropriations is a top priority for Indian Country, as they ensure that funding remains stable for Indian health care providers even in the event of a government shut down.

Mandatory Funding

The HHS Budget in Brief and IHS Congressional Justification do not include a request to shift the IHS budget from discretionary to mandatory appropriations either in whole or in part. The shift from discretionary to mandatory funding for the IHS budget has been a long-term request from Indian Country to ensure stable and predictable funding for the Indian health system. The budget also does not include a request to shift CSC and Section 105(l) lease funding from discretionary to mandatory, which has become a high priority issue in Indian Country this past year due to the recent Supreme Court decision in San Carlos Apache v. Becerra.

FY 2026 President’s Budget Highlights for IHS

Line Item FY 23 Enacted FY 25 Enacted FY 26 Tribal Request FY 26 President’s Budget
Urban Indian Health $90.42 million

 

$90.4 million $770.5 million $90.4 million
Indian Health Service $6.96 billion $7.1 billion $63 billion $8.1 billion
Hospital and Clinics $2.5 billion $2.58 billion $13.8 billion $2.65 billion
Tribal Epidemiology Centers $34.4 million $34.4 million _______________ $34.4 million
Electronic Health Record System $218 million $190.56 million $659.4 million $190.5 million
Community Health Representatives $65.21 million $65.2 million $1.58 billion $65 million
Mental Health $127.1 million $130.1 million $4.76 billion $131 million

Note: While previous years’ budgets included proposals for advance appropriations and funding for the IHS Cancer Moonshot Initiative and resources for HIV, hepatitis and syphilis prevention and treatment, this year’s Budget in Brief and IHS Congressional Justification do not include these items. IHS continues to list targeting HIV, hepatitis and syphilis as services IHS offers in the IHS Congressional Justification.

Overview of HHS Budget

Indian Health Service

The Budget in Brief and IHS Congressional Justification propose funding IHS for $8.1 billion in FY 2026. The proposed funding amount includes $90.4 million for Urban Indian Health and reauthorization of SDPI for one year for $159 million. This represents an increase for IHS, flat funding for Urban Indian Health compared to FY 2025, and a decrease of $363,000 for SDPI. IHS also estimates funding Contract Support Costs (CSCs) and Section 105(l) leases through an indefinite discretionary appropriation of $1.7 billion and $413 million, respectively. This represents a proposed 47% increase for CSCs and a proposed 93% increase for Section 105(l) leases. IHS proposes a significant decrease in Sanitation Facilities Construction from $106.6 million enacted in FY 2025 to $13.49 million proposed in the IHS Congressional Justification, a $93.13 million decrease, and an increase to Clinical Service to account for $6 million to support the delivery of healthcare services for the Lumbee Tribe. The increases for CSCs and Section 105(l) leases account for the proposed funding increase for IHS, leaving the majority of the IHS’ line items flat funded.

IHS also included grants and other programming for which UIOs are eligible in the IHS Congressional Justification:

Dementia Models of Care Grant: For FY 2026, IHS is planning a new five-year Dementia Models of Care notice of funding opportunity and a five-year multi-service national clinical champions cooperative agreement.

Indian Health Professions: IHS also proposes flat funding of $80.56 million for Indian Health Professions. This offers additional IHS Scholarship and Loan Repayment awards, bolstering recruitment and retention efforts through these two high demand programs.

Other Agencies within HHS

Several agencies have received significant cuts within the Budget in Brief: National Institutes of Health ($17 billion); Administration for Children, Families, and Communities ($7 billion); and the Administration for a Healthy America ($6 billion).

Programs previously funded through SAMHSA have now been consolidated into the AHA. These include Mental Health ($1.5 billion), Substance Abuse Prevention ($89 million), and Substance Abuse Treatment ($20 million). The proposed funding for these programs is at a decrease compared to the FY2025 amounts. The budget also proposes to consolidate three block grants into the Behavioral Health Innovation Block Grant ($4 billion). These block grants, previously funded through SAMHSA, are the Community Mental Health Services Block Grant; Substance Use Prevention, Treatment and Recovery Support Services Block Grant; and State Opioid Response. Other agencies proposed to be consolidated into the AHA are the Health Resources and Services Administration (HRSA), Office of the Assistant Secretary for Health (OASH), National Institute for Environmental Health Sciences (NIEHS), and some programs previously funded through the Centers for Disease Control and Prevention (CDC).

Due to consolidation of programs, SAMHSA’s Tribal Behavioral Health and Opioid Response Grant is facing cuts. However, the budget does include proposed funding for the Native American Behavioral Health and Substance Use Disorder program ($80 million), which will be within AHA. This program was first authorized in 2022 and is intended to support tribes in providing culturally tailored services in addressing mental health and substance use. Additionally, within the AHA is another new program, the American Indian and Alaska Native Suicide Prevention Initiative ($4 million).

Within the budget there is a proposal to consolidate programs within the Administration for Children and Families (ACF) and the Administration for Community Living (ACL) and create a new Administration for Children, Families, and Communities (ACFC). It proposes to continue funding Native American Programs, previously funded through ACF, at $61 million. Other programs consolidated into ACFC from ACL are the Native American Nutrition and Supportive Services ($38 million) and Native American Caregiver Support Services ($12) million. In the CDC section of the Budget in Brief, there is no mention of the Healthy Tribes Program as that funding has been proposed to be cut.

In their Congressional Justification, CMS has requested $3 million to continue its American Indian and Alaska Native outreach efforts through Tribal Outreach and Education. The purpose of this program is to remove barriers for rural communities that cause disparities in health care. Funding for HHS Tribal Affairs was requested in the HHS Congressional Justification, at $730,000. This funding is used to support the Secretary’s Tribal Advisory Committee (STAC). Additionally, the Congressional Justification and Budget in Brief also highlight that HHS will make an effort to support Tribal healthcare data sovereignty and Tribal public health infrastructure.

Next Steps

The Appropriations Committees will review the President’s Budget for consideration as they craft their bills for FY 2026. NCUIH will submit testimony and send letters to House and Senate Appropriators to request full funding for FY2026. NCUIH will continue to work with the Trump Administration and Congress to push for full funding of Urban Indian Health in FY 2026.

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