Senate Advances FY 2026 Interior Bill with Increases for IHS and Advance Appropriations for FY 2027

On July 25, 2025, the Senate Appropriations Full Committee passed the Fiscal Year (FY) 2025 appropriations bill for Interior, Environment, and Related Agencies. The bill provides $8.1 billion for IHS, including $5.3 billion in advance appropriations for FY 2027, despite the President’s budget not requesting advance appropriations. The Committee’s total funding for IHS is the same as the President’s IHS budget authority request. The bill authorizes $90.4 million for urban Indian health – the same funding as the FY25 enacted amount. The report states that “[t]he Committee is committed to improving the health and well-being of AI/AN living in urban Indian communities.”

Background

On July 22, 2025, the House Appropriations Full Committee passed the FY 2026 appropriations bill for Interior, Environment, and Related Agencies. The House bill provides $8.41 billion for IHS, including $6.05 billion in advance appropriations for FY 2027, despite the President’s budget not requesting advance appropriations. The House Committee’s total funding for IHS is approximately $500 million higher than the President’s IHS budget authority request. The House bill authorizes $105.99 million for urban Indian health – an increase of $15 million over the FY25 enacted amount.

The National Council of Urban Indian Health (NCUIH) is a longstanding advocate for full funding for IHS and urban Indian health and supports the recommendations of the Tribal Budget Formation Workgroup. On February 27, 2025, NCUIH board president-elect and Oklahoma City Indian Clinic CEO Robyn Sunday-Allen (Cherokee) testified before the House Appropriations Subcommittee on Interior, Environment, and Related Agencies, urging full funding for urban Indian health and the Indian Health System.

NCUIH is also grateful for the support of Senators working to support the health of Indian Country. On May 19, 2025, 19 Senators joined Senator Tina Smith (D-MN) in a letter to Chairman Murkowski (R-AK) and Ranking Member Merkley (D-OR) of the Senate Interior Appropriations Committee requesting support for Urban Indian Health, maintaining advance appropriations for IHS, and protecting IHS from sequestration. The letter emphasized 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.

Next Steps

The Senate will now need to schedule a floor vote on the Interior, Environment, and Related Agencies spending bill. The legislation is not expected to become law in its current form. Senate leadership will need to work with House Leadership to negotiate a final bill text for passage in both chambers.

FY25 funding is set to end on September 30, 2025. If Congress cannot come to a funding agreement by that deadline, they will need to pass a Continuing Resolution to keep the funding levels at the FY25 level until they can reach an agreement. Should political disagreements lead to a government shutdown, UIOs and parts of IHS will be protected by Advance Appropriations.

Bill Highlights

Line Item FY 25 Enacted FY 26 Tribal Request FY 26 President’s Budget FY 26 House Proposed FY 26 Senate Proposed
Urban Indian Health $90.42 million $770.5 million $90.4 million $ 105.99 million $90.4 million
Indian Health Service $6.96 billion $63 billion $8.1 billion $8.41 billion $8.1 billion
Advance Appropriations $5.19 billion ___________ Did not include $6.05 billion $5.3 billion
Hospital and Clinics $2.5 billion $13.8 billion $2.65 billion $2.85 billion $2.65 billion
Tribal Epidemiology Centers $34.4 million ___________ $34.4 million $ 44.43 million ___________
Mental Health $127.1 million $4.76 billion $131 million $144.95 million $131.3 million

Additional Key Provisions:

UIO Interagency Workgroup

Bill Report, Pg. 133: Despite the excellent efforts of Urban Indian Organizations, AI/AN populations continue to be left out of many Federal initiatives. Therefore, the Committee reminds the IHS of the directive to explore the formation of an interagency working group to identify existing Federal funding supporting Urban Indian Organizations [UIOs] and determine where increases are needed, or what programs should be amended to allow for greater access by UIOs; to develop a Federal funding strategy to build out and coordinate the infrastructure necessary to pilot and scale innovative programs that address the needs and aspirations of urban AI/ANs in a holistic manner; develop a wellness centered framework to inform health services; and meet quarterly with UIOs to address other relevant issues. In addition to the Indian Health Service, the working group should consist of the U.S. Department of Health and Human Services, U.S. Department of Housing and Urban Development, U.S. Department of Agriculture, U.S. Department of Justice, U.S. Department of Education, U.S. Department of Veteran Affairs, U.S. Department of Labor, the Small Business Administration, the Economic Development Agency, FEMA, the U.S. Conference of Mayors, and others as identified by UIOs.

Produce Prescription Pilot Program: $3 million

Bill Report, Pg. 130: The bill maintains funding at fiscal year 2025 enacted levels for the Produce Prescription Pilot program.

Contract Support Costs: $1.8 billion and Tribal 105(l) Leases: $366 million

Bill Report, Pg. 134: The Committee has continued language from fiscal year 2021 establishing an indefinite appropriation for contract support costs estimated to be $1,819,000,000 in fiscal year 2026. By retaining an indefinite appropriation for this account, additional funds may be provided by the Agency if its budget estimate proves to be lower than necessary to meet the legal obligation to pay the full amount due to Tribes. The Committee believes that fully funding these costs will ensure Tribes have the resources they need to deliver program services efficiently and effectively.

Bill Report, Pg.  134: The recommendation includes an indefinite appropriation of an estimated $366,000,000 for the compensation of operating costs associated with facilities leased or owned by Tribes and Tribal organizations for carrying out health programs under Indian Self-Determination and Education Assistance Act (ISDEAA) contracts and compacts as required by 25 U.S.C. 5324(l).

Purchased and Referred Care: $996.75 million

Bill Report, Pg. 132: The recommendation includes $996,755,000 for purchased/referred care.

Indian Health Professions: $80.56 million

Bill Report, Pg. 133: The recommendation includes $80,568,000 for the Indian Health Professions program.

Sanitation Facilities Construction: $106.6 million

Bill Report, Pg. 134: The recommendation includes $106,627,000 for Sanitation Facilities Construction activities, equal to the enacted level.

Health Care Facilities Construction: $182.7 million

Bill Report, Pg. 135: The recommendation includes $182,679,000 for Health Care Facilities Construction, equal to the enacted level.

Dental Health: $259.5 million

Bill Report, Pg. 131: The recommendation includes $259,501,000 for dental health, an increase of $5,384,000 to the fiscal year 2025 enacted level.

Alzheimer’s Disease: FY 2025 Funding

Bill Report, Pg. 130: The bill maintains funding at fiscal year 2025 enacted levels for the Alzheimer’s program.

Maternal Health: $1 million

Bill Report, Pg. 131: The Committee recommendation supports funding for maternal health initiatives and provides an additional $1,000,000 for these efforts.

Alcohol and Substance Abuse: $267 million

Bill Report, Pg. 131: The recommendation includes $267,404,000 for alcohol and substance abuse programs, an increase of $633,000 to the fiscal year 2025 enacted level.

Bureau of Indian Affairs, Missing and Murdered Indigenous Women Initiative: $250 thousand

Bill Report, Pg. 68: The Committee recommends an additional $250,000 with an emphasis on addressing the crisis of missing, trafficked, and murdered Indigenous people, especially women, as part of the Bureau of Indian Affairs (BIA) Law Enforcement Special Initiatives.

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

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Press Release: NCUIH Commends Bipartisan Effort to Improve Health Outcomes for Urban Native Communities

FOR IMMEDIATE RELEASE

WASHINGTON, D.C. (July 23, 2025)– On July 23, 2025, Congressman Dr. Raul Ruiz (CA-25) and Congressman Don Bacon (NE-02) reintroduced the bipartisan Urban Indian Health Parity Act. This vital provision will help expand access to necessary health services for American Indian and Alaska Native families and children and ensure the federal government better fulfills its trust responsibility.

“We are grateful that Representatives Ruiz and Bacon are once again championing this bipartisan effort. Fulfilling the federal trust responsibility means ensuring all Native people have access to critical resources. With strong support across Indian Country, we urge Congress to act swiftly to pass this important legislation and improve health outcomes for Native communities,” stated Francys Crevier, JD (Algonquin), CEO, National Council of Urban Indian Health

“American Indian and Alaska Native communities deserve more than promises, they deserve action,” said Congressman Dr. Raul Ruiz (CA-25). “While there is broad, bipartisan recognition of the need to improve tribal health care—including statements of support from Secretary Kennedy—we have yet to see a detailed, actionable plan to make that a reality. The Urban Indian Parity Act is a practical, bipartisan step they can take right now to close health care gaps, strengthen the Indian Health Service, and protect Native patients—regardless of where they live.”

“I am pleased to join Dr. Ruiz on this bipartisan legislation to ensure Native Americans living in urban areas have access to quality healthcare,” remarked Congressman Don Bacon (NE-02). “Nebraska is home to approximately 16,000 American Indian and Alaska Natives and this legislation will strengthen our healthcare system by providing Urban Indian Organizations with the resources they need to serve their communities effectively.”

This bill would amend the Social Security Act to set the federal medical assistance percentage (FMAP) at 100% for services provided to Medicaid beneficiaries at urban Indian organizations (100% FMAP for UIOs). States have received 100% FMAP for services provided to IHS/Medicaid beneficiaries at Indian Health Service and Tribal facilities for decades. Congress has been working toward parity through legislation since 1999. Extending 100% FMAP to UIOs will require the federal government to bear the cost of Medicaid services provided to American Indian and Alaska Native patients no matter which facet of the Indian health system they utilize, as is required by the trust responsibility. Parity for UIOs is essential to enable them to collaborate effectively with states to strengthen the Medicaid program for the 46% of Native patients they serve who are Medicaid beneficiaries.

NCUIH released a report and one pager highlighting the importance of 100% FMAP, which includes case studies of two states, Washington and Montana, that successfully utilized the American Rescue Plan Act’s (ARPA) temporary authorization of 100% FMAP for UIOs to increase funding support for their UIOs. It also provides an extensive history of 100% FMAP in the Indian health care system.

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.

###

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

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House Advances FY 2026 Interior Bill with Increases for IHS and Advance Appropriations for FY 2027

On July 22, 2025, the House Appropriations Full Committee passed the Fiscal Year (FY) 2025 appropriations bill for Interior, Environment, and Related Agencies, which was previously approved by the House Subcommittee on July 15, 2025. At the Subcommittee Hearing, Chairman Cole (R-OK-04), affirmed the Committee’s continued recognition and commitment to protecting the Indian Health Service (IHS) stating the bill “advances the federal commitment to honor our trust and treaty responsibilities to American Indians and Alaska Natives through Indian Affairs and the Indian Health Service. I’m proud that the legislation prioritizes funding across Tribal accounts—ensuring the delivery of critical services in Indian Country.”

The bill provides $8.41 billion for IHS, including $6.05 billion in advance appropriations for FY 2027, despite the President’s budget not requesting advance appropriations. The Committee’s total funding for IHS is approximately $500 million higher than the President’s IHS budget authority request. The bill authorizes $105.99 million for urban Indian health – an increase of $15 million over the FY25 enacted amount. The report states that “the Committee recognizes the Federal trust responsibility to provide health care services to American Indian and Alaska Native citizens and acknowledges that approximately seventy-one percent live in urban areas.”

Other key provisions include:

  • $8 million for generators at IHS/Tribal Health Programs/Urban Indian Organizations (UIOs).
  • $7 million, a $4 million increase, for the Produce Prescription Pilot Program for Tribes and UIOs to increase access to produce and other traditional foods.
  • $44.43 million, a $10 million increase, for Tribal Epidemiology Centers (TECs).

Background

The National Council of Urban Indian Health (NCUIH) is a longstanding advocate for full funding for IHS and urban Indian health and supports the recommendations of the Tribal Budget Formation Workgroup. On February 27, 2025, NCUIH board president-elect and Oklahoma City Indian Clinic CEO Robyn Sunday-Allen (Cherokee) testified before the House Appropriations Subcommittee on Interior, Environment, and Related Agencies, urging full funding for urban Indian health and the Indian Health System.

NCUIH is also grateful for the support of Representatives working to support the health of Indian Country. On May 15, 2025, 60 Congressional leaders joined Representative Leger Fernandez in a bipartisan letter to Chairman Simpson and Ranking Member Pingree of the House Interior Appropriations Committee requesting support for Urban Indian Health, maintaining advance appropriations for IHS, and protecting IHS from sequestration. The letter emphasized 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.

Next Steps

The House will now need to schedule a floor vote on the Interior, Environment, and Related Agencies spending bill. The legislation is not expected to become law in its current form. House leadership will need to work with Senate Leadership to negotiate a final bill text for passage in both chambers. The Senate Appropriations Committee is scheduled to mark up the Senate Interior bill on July 24.

FY25 funding is set to end on September 30, 2025. If Congress cannot come to a funding agreement by that deadline, they will need to pass a Continuing Resolution to keep the funding levels at the FY25 level until they can reach an agreement. Should political disagreements lead to a government shutdown, UIOs and parts of IHS will be protected by Advance Appropriations.

Bill Highlights

Line Item FY 25 Enacted FY 26 Tribal Request FY 26 President’s Budget FY 26 House Proposed
Urban Indian Health $90.42 million $770.5 million $90.4 million $ 105.99 million
Indian Health Service $6.96 billion $63 billion $8.1 billion $8.41 billion
Advance Appropriations $5.19 billion ______________ Did not include $6.05 billion
Hospital and Clinics $2.5 billion $13.8 billion $2.65 billion $2.85 billion
Tribal Epidemiology Centers $34.4 million ______________ $34.4 million $ 44.43 million
Mental Health $127.1 million $4.76 billion $131 million $144.95 million

Additional Key Provisions:

Produce Prescription Pilot Program: $7 million

Bill Report, Pg. 83: The recommendation includes $7,000,000 for IHS to expand, in coordination with Tribes and Urban Indian Organizations (UIOs), the Produce Prescription Pilot to implement a produce prescription model to increase access to produce and other traditional foods among its service population. The Committee encourages IHS to provide a briefing to the Committee not later than 90 days following the enactment of this Act on the distribution of funds and implementation efforts.

  • This is a proposed $4 million increase.
Contract Support Costs – $ 1,819 billion and Tribal 105(l) leases – $366 million

Bill Report, Pg. 85: The Committee recommends an indefinite appropriation estimated to be $1,819,000,000 for contract support costs incurred by the agency as required by law. The bill continues language making available such sums as are necessary to meet the Federal Government’s full legal obligation and prohibiting the transfer of funds to any other account for any other purpose. In addition, the bill includes language specifying carryover funds may be applied to subsequent years’ contract support costs.

Bill Report, Pg. 86: The Committee recommends an indefinite appropriation estimated to be $366,000,000 for Payments for Tribal Leases incurred by the agency as required by law. The bill includes language making available such sums as necessary to meet the Federal Government’s full legal obligation and prohibits the transfer of funds to any other account for any other purpose.

Purchased and Referred Care – $1.05 billion

Bill Report, Pg. 84: The recommendation includes $1,054,066,000 for Purchase and Referred Care (PRC). The Committee is aware that some IHS areas are considered Purchased and Referred Care Dependent and Tribes in PRC-dependent areas must rely solely on PRC for emergency, hospital, and special health care services. The Committee recognizes the importance of these funds for PRC-dependent areas and directs IHS to provide a report not later than 90 days following the enactment of this Act on the funding distribution methodology and how PRC dependent areas, including those in California, are receiving the necessary PRC funds needed to purchase lifesaving care for Tribal members.

Indian Health Professions: $95,252,000

Bill Report, Pg. 85: The recommendation includes $95,252,000 for Indian Health Professions programs. The Committee continues to support Indian Health Professions programs and expects IHS to allocate the funding provided across all programs, including the Scholarship Program, Loan Repayment Program, Indians Into Medicine Program (INMED), American Indians into Nursing (RAIN) Program, and the American Indians into Psychology Programs.

Sanitation Facilities Construction: $130,968,000

Bill Report, Pg. 86: The recommendation includes $130,968,000 for Sanitation Facilities Construction.

Health Care Facilities Construction: $188,702,000

Bill Report, Pg. 86: The recommendation includes $188,702,000 for Health Care Facilities Construction. The recommendation includes $14,000,000 for Staff Quarters for staff housing across the IHS health care delivery system to support the recruitment and retention of quality healthcare professionals across Indian country.

Equipment – Generators:  $8 million

Bill Report, Pg. 86: To increase the resilience of these facilities, the recommendation includes $8,000,000 to purchase generators, including for IHS, Tribal Health Programs, and Urban Indian Organizations located in areas impacted by de-energization events.

Dental Health: $287 million

Bill Report, Pg. 83: The recommendation includes $287,085,000 for Dental Health services.

  • Also includes $8,000,000 to expand Dental Support Centers to all 12 service areas and $6,500,000 to install an electronic Dental Records System.
Alzheimer’s Disease: $6 million

Bill Report, Pg. 83: The recommendation includes $6,000,000 to continue Alzheimer’s and related dementia activities. These funds will enable awardees to continue to implement locally developed models of culturally appropriate screening, diagnostics, and management of people living with Alzheimer’s and other related dementia. This funding also supports the Dementia ECHO program, designed to support clinicians and caregivers to strengthen their knowledge and care around dementia for Tribal patients.

Maternal Health: $3 million

Bill Report, Pg. 83: The recommendation also includes $3,000,000 for Improving Maternal Health. The Committee also recognizes the importance of in vitro diagnostics tools for the detection of diseases, infections, and other medical conditions. These tools provide valuable information to aid providers in accurate diagnostics, treatment planning, and monitoring of patient health. The Committee encourages the use of in vitro diagnostics in IHS health clinics and medical facilities.

Alcohol and Substance Abuse: $286 million

Bill Report, Pg. 84: The recommendation includes $286,389,000 for Alcohol and Substance Abuse programs.

Bureau of Indian Affairs, Missing and Murdered Indigenous Women Initiative: $31 million

Bill Report, Pg. 43: The recommendation includes $31,000,000 for the Missing and Murdered Indigenous Women Initiative to address the crisis of missing and murdered indigenous women, including for criminal investigators, software platforms, and evidence recovery equipment. The Committee directs BIA to work with Tribal and Federal law enforcement agencies to facilitate sharing law enforcement and public records data and other technological tools to assist those agencies in finding missing individuals.

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

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NCUIH July Update: Congressional Budget Updates, Medicaid Exemptions, and Secretary Kennedy’s UIO Tour

In this Edition:

📍 Secretary Visit: Kennedy spotlights OKC Indian Clinic on second UIO tour since confirmation.

🤝 Federal Briefing: NCUIH and partners meet with new HHS Senior Advisor Mark Cruz.

🏛 FY 2026 Bill: House advances Interior bill with $8.41B for IHS and $6.05B in advance appropriations.

⚖️ Reconciliation Law: Medicaid and SNAP exemptions secured for AI/AN people, including urban Natives.

📊Budget Request: Tribal Workgroup urges $1.09B for Urban Indian Health in FY 2027.

📝 Medicaid Waivers: NCUIH comments on Iowa work-requirement exemption; more due in August.

🏥 IHS Realignment: Urban Confer on July 28; written comments due August 28.

📆Save the Dates: Upcoming webinars, meetings, and the October IHS–UIO Federal-Partner Summit.

Federal Engagement Highlights

HHS Secretary Kennedy Visits Second Urban Indian Organization in Oklahoma City

What’s new: On June 26, HHS Secretary Kennedy and Senior Advisor Mark Cruz visited the Oklahoma City Indian Clinic (OKCIC).

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.

NCUIH Meets with Newly Appointed Senior Advisor to HHS Secretary, Mark Cruz


On Thursday, June 20th, Mark Cruz, a citizen of the Klamath Tribes, was sworn in as Senior Advisor to the HHS Secretary.

On July 10, NCUIH joined the Coalition for Tribal Sovereignty in a meeting with Mark Cruz. Self-Governance, the role of UIOs, and opportunities to collaborate with the new admin were discussed.

Coalition for Tribal Sovereignty Updates


On July 17, NCUIH joined the Coalition for Tribal Sovereignty for an important discussion with the staff of Native American Caucus Co-Chair Nicholas J. Begich III (R-AK-At Large).

On June 25, NCUIH joined the Coalition for Tribal Sovereignty in a letter regarding the One, Big Beautiful Bill Act and Upholding Obligations to Indian Country.

About the Coalition for Tribal Sovereignty: The Coalition for Tribal Sovereignty 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.

Appropriations and Fiscal Policy Updates

Fiscal Year 2026 Updates

NCUIH worked with the Coalition for Tribal Sovereignty to support the Congressional Native American Caucus in leading a letter to Chairman Cole and Ranking Member DeLauro of the House Appropriations Committee requesting the Committee support and protect funding for Tribal Programs and UIOs in the FY26 budget. The letter closed on June 23, with 17 signees.

FY 2026 House Interior Appropriations Budget Markups on President’s Budget

By the numbers: On July 15, the House Interior Appropriations Subcommittee passed the FY2026 appropriations bill out of committee. The bill includes:

  • IHS: $8.41 billion, $168 million increase above FY 2025
  • IHS Advance Appropriations for FY27: $6.05 billion

Budget Reconciliation Signed into Law

The big picture: On July 4, 2025, the President signed the One Big Beautiful Bill Act (OBBB) into law. The OBBB is a major bill that delivers many elements of President Trump’s legislative agenda, including tax cuts, Medicaid reforms, and lifting the debt ceiling.

Go deeper: The bill contains a health title, which includes the following notable provisions:

Community Engagement Requirements for Certain Medicaid Beneficiaries:

  • AI/AN Exempt, including specific exemption for Urban Indians

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

  • AI/AN already exempted

Moratorium on New or Increased Provider Taxes:

  • UIOs already exempted

Reduction in Expansion FMAP for States Covering Undocumented Immigrants:

  • Seven states with UIOs may be affected (California, Washington, Oregon, Minnesota, Illinois, New York, and Colorado).

Modifications to SNAP Work Requirements for Able-Bodied Adults:

  • AI/AN Exempt, including specific exemption for Urban Indians

More Frequent Medicaid Redetermination Period:

  • AI/AN Exempt, including specific exemption for Urban Indians

NCUIH, along with partner organizations, worked to ensure AI/AN exemptions were included in the final bill.

National Tribal Budget Formulation Workgroup Releases Recommendations for FY 2027

By the numbers: FY 2027 Tribal Budget Recommendations

  • $1.09 billion for the Urban Indian Health line item
  • $73 billion for IHS

IHS retains and expands eligibility for UIOs to participate in grant programs and ensures that UIOs are included in exemptions for Medicaid reform, including work requirements.

Federal Comments Submitted

On June 14, NCUIH submitted comments to IHS regarding the January 13, 2025, Dear Tribal Leader and UIO Leader letter and May 15, 2025, joint Tribal Consultation and Urban Confer session on Health Information Technology (HIT) Modernization: Four Directions Warehouse (4DW) NCUIH made the following comments, requests and recommendations:

  • Provide clarification to UIOs on the 4DW about access for all UIOs, including those who are not using the Resource and Patient Management System (RPMS) or Patients at the Heart (PATH) electronic health record (EHR), or who do not have access to the D1 network because they are non-domain members
  • Support IHS, Tribal, and UIO (I/T/U) facilities for data migration and transition to PATH EHR by doing the following:
  • Develop materials to prepare I/T/U facilities for data migration and the PATH EHR transition
  • Ensure site selection for the implementation cohort includes all I/T/U facility types
  • Communicate regularly with facilities- virtually and in person- about the HIT Modernization project by doing the following:
  • Share information on the HIT Modernization project in an in-person format in addition to the quarterly joint TC/UC sessions
  • Reschedule the cancelled February 2025 open dialogue

NCUIH created a comment template and distributed it to UIOs prior to the submission deadline.

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

CMS Medicaid Work Requirement Waivers

The Big Picture: Medicaid waivers allow states to propose changes to how they administer their Medicaid programs, including adding work requirements. These requirements can affect access to care for American Indian and Alaska Native (AI/AN) people. NCUIH supports exemptions that reflect the federal trust responsibility and protect coverage. Comments were submitted on Iowa’s waiver, with Kentucky and South Carolina waivers under review. Since the passage of the One Big Beautiful Bill (OBBB), states will have to implement the required changes, including work requirements and the corresponding exceptions for AI/AN people. NCUIH is continuing to monitor state actions to impose work requirements to ensure alignment with the OBBB requirements.

Comments to CMS supporting the exemption of AI/AN people from work requirements in state Medicaid programs:

  • June 25 – Iowa

Upcoming comment opportunities being analyzed by NCUIH:

  • August 9 – Kentucky
  • August 9 – South Carolina

Key Upcoming Dates

Upcoming highlight:

IHS UIO and Partner Federal Agencies Summit October 21-23:

On July 1, 2025, IHS invited UIOs to join an in person meeting with IHS partner federal agencies.

  • Proposed Dates: Tuesday, October 21 – Thursday, October 23, 2025
  • Location: HHS – Humphrey Building, Room 800, Washington, DC
  • More details regarding federal agencies, draft agenda, and sponsored travel and lodging will be forthcoming.

Meeting Objectives: 

  • Introduce federal partners and share current priorities
  • Learn about your organization’s initiatives and challenges
  • Discuss potential areas of alignment and collaboration

What to Watch: Additional Upcoming Events and Important Dates

  • July 23: NCUIH Webinar: Navigating Behavioral Health Financing for Urban Indian Organizations
  • July 24: OUIHP-Urban Program Executive Directors/Chief Executive Officers Monthly Conference Call (Virtual)
  • July 28: IHS Urban Confer on IHS Proposed Realignment (Virtual)
  • July 29: NIHB Medicare, Medicaid and Health Reform Policy Committee (MMPC) Face-to-Face meeting (Washington D.C.)
  • July 30-31: CMS Quarterly Tribal Technical Advisory Group (TTAG) Face-to-Face Meeting (Washington D.C.)
  • August 7: IHS Health Information Technology (HIT) Modernization Tribal Consultation and Urban Confer: PATH EHR Scope and Capabilities (Virtual)
  • Aug 11: FY 2027-2028 National Tribal Budget Formulation Planning and Evaluation Meeting (Hybrid, Washington D.C.)
  • August 20: NCUIH Monthly Policy Workgroup (Virtual)
  • Date TBD (August): IHS Division of Behavioral Health (DBH) Listening Session for UIOs – Hosted by NCUIH
    – Do UIOs have any topics/questions they would like to bring up during the listening session?
  • September 3-5: VA Advisory Committee on Tribal and Indian Affairs (ACTIA) Meeting (Honolulu, HI)

Urban Confer: Indian Health Service Strategic Realignment

On June 13, 2025, IHS released a Dear Tribal Leader Letter/ Dear Urban Leader Letter initiating consultation and confer and requesting comments and recommendations regarding the proposed realignment of the Indian Health Service (IHS). IHS will hold a virtual Urban Confer on Monday, July 28th, 2025, from 1:00 PM – 3:00 PM EST.

  • NCUIH held a prep session for the Urban Confer on July 16th.
  • Written comments are due on August 28th, 2025.

More information can be found on the NCUIH Policy Blog post on this consultation and confer.

Registration Link: https://ihs-gov.zoomgov.com/meeting/register/q6joL7ncQgS1z5tf0xl9vw

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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Congressional Native American Caucus Leaders Lead Letter to Safeguard FY 2026 Tribal Program Funding

On June 23, 2025, 15 Congressional leaders joined the Native American Caucus co-chair Sharice Davids (D-KS-03) and vice-chair Nick Begich (R-AK) in their Dear Colleague letter to House Appropriations Chair Tom Cole (R‑OK‑04) and Ranking Member Rosa DeLauro (D‑CT‑03) requesting the FY 2026 spending bills fully protect funding for Tribal programs. The letter emphasizes that programs such as Indian Health Service (IHS), Bureau of Indian Affairs, Bureau of Indian Education, and related Department of Justice initiatives are not discretionary benefits but an expression of, as the letter states, “… the United States’ trust and treaty obligations to Tribal Nations and Tribal citizens and communities.” 

The letter calls for safeguarding every federal dollar that reaches Indian Country—including direct Tribal line items, set‑asides, and broader accounts leveraged by Tribes—while expanding self‑determination, self‑governance, and more stable funding mechanisms.

NCUIH is grateful for the support of the following Representatives:

  • Sharice L. Davids (D-KS-03)
  • Nicholas J. Begich III (R-AK-At Large)
  • Greg Stanton (D-AZ-04)
  • Melanie Stansbury (D-NM-01)
  • Dusty Johnson (R-SD-At Large)
  • Timothy M. Kennedy (D-NY-26)
  • Joe Neguse (D-CO-02) 
  • Raul Ruiz, M.D. (D-CA-25)
  • Gabe Vasquez (D-NM-02)
  • Angie Craig (D-MN-02)
  • Jared Huffman (D-CA-02)
  • Brian Babin, D.D.S. (R-TX-36)
  • Marilyn Strickland (D-WA-10)
  • Kelly Morrison (D-MN-03)
  • Emily Randall (D-WA-06)
  • Salud Carbajal (D-CA-24)
  • Cleo Fields (D-LA-06)

Background 

NCUIH has worked tirelessly with Congressional leaders and partners to protect funding for IHS and other key programs in the upcoming FY 2026 appropriations bills. NCUIH worked with the Coalition for Tribal Sovereignty to help secure signees for this Native American Caucus Dear Colleague letter. Additionally, NCUIH has provided oral and written testimony to the committee and support for a Congressional Dear Colleague letter in support of Urban Indian Health. 

Full Letter Text:

Dear Chairman Cole and Ranking Member DeLauro,

We are contacting you on behalf of the undersigned members of the Congressional Native American Caucus to urge you to protect and support funding for Tribal programs for Fiscal Year (FY) 2026.

As you both know very well, Tribal programs are different from other federal programs. Tribal programs deliver on the United States’ trust and treaty obligations to Tribal Nations and Tribal citizens and communities. Examples of essential services provided under these obligations include healthcare through the Indian Health Service, land management, law enforcement, and public safety through the Bureau of Indian Affairs, education through the Bureau of Indian Education, criminal prosecution by the Department of Justice, and other important services. Tribal programs are also 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.

All federal funding that flows to Indian Country should be considered delivered in furtherance of trust and treaty obligations—despite the varied delivery methods. This includes funding specific to Tribal programs, Tribal set-asides, and more widely available funding that Indian Country has accessed to fill gaps in funding deficits. It also includes funding used to provide direct services and funding Tribal Nations have accepted through self-determination contracts, self-governance compacts, or otherwise to deliver governmental services to their own communities. Any improvements to these programs should focus on increasing the efficiency of federal dollars by expanding self-determination and self-governance models and creating more stable funding mechanisms.

We respectfully ask that you safeguard and support all federal funding flowing to Indian Country to ensure successful delivery of services. We also ask that you support funding necessary to maintain federal employee positions that service Tribal nations and the federal offices that provide these services.

Congress’s full and stable delivery of federal funding obligated to Indian Country will directly result in enhanced economic development and capacity building that benefits Tribal communities and their surrounding states and localities. Full, sustained, and advanced funding will strengthen local communities and provide the federal government a valuable return on investment.

If you have any questions, please feel free to contact Co-Chair Davids’ office at (202) 225-2865 or Vice Chair Begich’s office at (202) 225-5765. Thank you for considering our views when negotiating the final FY26 appropriations bills.

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Coalition for Tribal Sovereignty Action Alert: Call on Congress to Support Tribal Programs in FY2026 Appropriations

Contact your member of Congress today to ensure support for Tribal Programs in FY 2026 Appropriations!

As the House and Senate consider Fiscal Year (FY) 2026 appropriations, we recommend that our network submit a written letter and contact your Senators and Representatives to ask them to urge members of the Senate and House Appropriations Committees to protect and hold harmless all Tribal programs and programs that benefit Tribal Nations and citizens from FY 2026 appropriations reductions. This is especially important, given the deep reductions to Tribal programs proposed by the Administration through the President’s Budget Request.

Template Letter to Congress

Template Script

Hello,
On behalf of [YOUR ORGANIZATION or TRIBE], we urge Representative/Senator [NAME] to protect and hold harmless all Tribal programs and programs that benefit Tribal Nations and citizens during the FY 2026 appropriations process by expressing your support for Tribal programs to the leadership of the [HOUSE/SENATE] Appropriations Committee.

Resources

To find the contact information for your Representative, please click here, and to find the contact information for your Senator, please click here.

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Senate Passes Reconciliation Bill with Exemptions for American Indian and Alaska Native People from Community Engagement Requirements for SNAP and Medicaid

On July 1, 2025, the Senate passed their budget reconciliation bill. The Senate’s One Big Beautiful Bill Act is a major bill that would deliver the significant 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. The Senate bill has notable provisions impacting American Indian and Alaska Native healthcare compared to the House-passed bill: exempts American Indian and Alaska Native beneficiaries, including “Urban Indians”, from the Medicaid and Supplemental Nutrition Assistance Program (SNAP) community engagement requirements and exempts American Indian and Alaska Native beneficiaries from more frequent eligibility redetermination 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, and the National Congress of American Indians, and the Coalition for Tribal Sovereignty to ensure that American Indian and Alaska Native Medicaid and SNAP beneficiaries are protected from harmful policy changes.

Next Steps

The bill will return to the House to be voted on, and its passage remains unclear. There is a stated deadline of July 4.

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 100 – 138 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: Reduces the safe harbor limit for states that have adopted the Affordable Care Act (ACA) expansion by 0.5% annually starting in fiscal year 2028 until the safe harbor limit reaches 3.5% in FY 2032.

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. Several states, including California, Minnesota, and Illinois, have announced plans to freeze or cut these programs.

Modifications to SNAP Work Requirements for Able-Bodied Adults

What it does: Instituting exceptions to the SNAP work requirements for able-bodied adults.

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.
Medicaid Redetermination Period

What it does: Requires states to conduct eligibility redeterminations at least every 6 months for Medicaid expansion adults beginning after December 31, 2026. It also requires the Secretary of Health and Human Services to issue guidance within 180 days of enactment.

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.
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IHS Seeks Feedback on Strategic Realignment; Virtual Urban Confer Set for July 28

Released on June 13, 2025, the IHS Dear Tribal Leader/Urban Leader Letter invites comment on a proposed Strategic Realignment designed to make the Agency more patient-centered, operationally efficient, and supportive of Tribal self-governance. Feedback is requested on three focus areas—Delivery of Direct Patient Care, Enterprise/Operational Management, and Supporting Tribal Self-Determination. Engagement opportunities include four in-person Tribal Consultations (Seattle 7/8, Phoenix 7/10, Minneapolis 7/15, Washington D.C. 7/23) and a virtual Urban Confer on Monday, July 28th, 2025, from 1:00 PM – 3:00 PM EST.  Written comments for both tracks are due August 28, 2025, sent to consultation@ihs.gov (Tribal leaders) or urbanconfer@ihs.gov (UIO leaders) with “IHS Strategic Realignment” in the subject line. NCUIH is monitoring for any further details or other information from IHS about what the proposed realignment will entail and how it will affect the Indian health system.  

Registration Link: https://ihs-gov.zoomgov.com/meeting/register/q6joL7ncQgS1z5tf0xl9vw

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