In this Edition:

🏛 FY 2026 Appropriations: House and Senate advance LHHS and Interior bills with UIO/IHS gains.

🤝 Coalition Advocacy: CTS continues inter-Tribal engagement on sovereignty and appropriations.
⚖️ FMAP Push: Bipartisan bill reintroduced; NCUIH presses CMS on 100% FMAP.

📝 Hiring Freeze Extended: NCUIH urges HHS to exempt IHS workforce.

🔄 IHS Realignment: UIO leaders provide feedback; comments due Aug. 28.

💻 PATH EHR: Tribal Consultation and Urban Confer held Aug. 7; next session Sept. 6.

🏥 Behavioral Health: UIOs highlight funding gaps, workforce challenges, and Traditional Healing needs.

📊 Tribal Budget Formulation: FY 2027–28 discussions continue.

📆 Save the Dates: VA ACTIA, TLDC, NCUIH UIO Focus Groups, October IHS–UIO Federal Summit.

⚖️ Grantmaking Oversight: New White House EO impacts federal awards.

Federal Engagement Highlights

Coalition for Tribal Sovereignty

About the Coalition for Tribal Sovereignty: The Coalition for Tribal Sovereignty is a collaborative alliance that unifies regional and national inter-tribal policy-oriented, nonprofit organizations to engage with federal policymakers on issues affecting Tribal sovereignty, rights, and community well-being.

The Coalition recently met with staff from the Senate Minority Interior Appropriations Committee, House Majority and Minority Interior Appropriations Committee, and House Natural Resources Committee, to discuss critical issues facing Indian Country.

Resources: www.coalitionfortribalsovereignty.org

Appropriations and Fiscal Policy Updates

Labor–Health and Human Services Appropriations – Senate Action

• The Senate Appropriations Committee advanced the Fiscal Year 2026 Labor–Health and Human Services bill on July 31.

Department of Health and Human Services: $116.6 billion, $446 million above Fiscal Year 2025 levels, $22 billion above the President’s request.

– Does not fund the Administration for a Healthy America proposal.

Level funding for Indian Country provisions, including:

• Improving Native American Cancer Outcomes: $6 million
• Good Health and Wellness in Indian Country: $24 million
• Tribal Behavioral Health Grants (Native Connections): $23.67 million
• Minority HIV/AIDS Fund – Tribal Set-Aside: $5 million

The House bill is expected to be introduced in September.

Interior Appropriations – House and Senate Action

House Appropriations Committee advanced the Fiscal Year 2026 Interior bill on July 22:

• Urban Indian Health: $105.99 million, a $15 million increase over Fiscal Year 2025
• Indian Health Service: $8.41 billion, a $168 million increase over Fiscal Year 2025
• Advance Appropriations: $6.05 billion

Senate Appropriations Committee advanced its bill on July 25:

• Urban Indian Health: $90.4 million
• Indian Health Service: $8.1 billion
• Advance Appropriations: $5.3 billion

Hospital and Clinics:

• Fiscal Year 2025 Enacted: $2.5 billion
• Fiscal Year 2026 President’s Budget: $2.65 billion
• House Proposed: $2.85 billion
• Senate Proposed: $2.65 billion

Tribal Epidemiology Centers:

• Fiscal Year 2025 Enacted: $34.4 million
• Fiscal Year 2026 President’s Budget: $34.4 million
• House Proposed: $44.43 million

Mental Health:

• Fiscal Year 2025 Enacted: $127.1 million
• Fiscal Year 2026 President’s Budget: $131 million
• House Proposed: $144.95 million
• Senate Proposed: $131.3 million

Federal Oversight

Issued August 7, 2025, by the White House:

• Covers cooperative agreements, discretionary grants, and similar awards.

New requirements:
– Prohibition on recipients directly drawing down general funds for specific projects without agency authorization
– Requirement for written justification for each request

• Office of Management and Budget will revise federal guidance, permitting “termination for convenience.”

NCUIH will continue monitoring and tracking related federal actions.

Federal Advocacy and Policy Updates

Urban Indian Health Parity Act and Federal Medical Assistance Percentage

On July 23, Representatives Raul Ruiz (CA-25) and Don Bacon (NE-02) reintroduced the bipartisan Urban Indian Health Parity Act (H.R. 4722).

• Representatives Ruiz and Bacon also sent a letter to Secretary Kennedy urging support for Federal Medical Assistance Percentage for Urban Indian Organizations.
• Take Action: Contact your Representatives to sign on to H.R. 4722.
• At the July Tribal Technical Advisory Group meeting, NCUIH Board President, Walter Murillo, pressed for 100 percent Federal Medical Assistance Percentage for Urban Indian Organizations.
• CMS Advisor Mark Cruz attended the NCUIH Board Meeting to discuss Federal Medical Assistance Percentage opportunities.

NCUIH is exploring budget strategies to advance Federal Medical Assistance Percentage.

Indian Country Org Letter on Preserving Maternal and Child Health Programs in FY26

NCUIH joined National Indian Health Board and other Indian Country organizations in a letter to House and Senate leadership, expressing concern with the proposed elimination of $274 million across multiple maternal and child health programs that AI/AN communities rely on within HHS.

Several successful programs are slated for elimination:
– ACF Low-Income Home Energy Assistance Program
– CDC Maternal and Infant branch
– HRSA’s Healthy Start

Federal Hiring Freeze

New: The Administration extended the federal hiring freeze until October 15, 2025.

• On August 13, NCUIH sent a letter to the Department of Health and Human Services requesting:
• Additional exemptions for all Indian Health Service positions (administrative, support, and specialty)
• Appointment of a permanent Indian Health Service Director.

Indian Health Service Strategic Realignment

On July 23 and July 28, NCUIH and Urban Indian Organizations participated in Tribal Consultation and Urban Confer sessions regarding the proposed realignment.

Urban Indian Organizations and NCUIH provided feedback on:

• Relationship between the realignment and the reorganization of the Indian Health Service Office of the Director
• Maintaining the Indian Health Service/Tribal/Urban Indian Organization system
• Need for inclusion of Urban Indian Organizations in Indian Health Service planning
• Ensuring cross–Department of Health and Human Services collaboration
• Concern that Indian Health Service slides did not mention Urban Indian Organizations
• Extending the timeline to allow Tribal and Urban Indian Organization input
• Prioritizing local control and patient service needs
• Implementing 100 percent Federal Medical Assistance Percentage and an All-Inclusive Rate for Urban Indian Organizations

Written comments are due August 28, 2025 to urbanconfer@ihs.gov. NCUIH will submit comments and provide templates for Urban Indian Organizations.

Next Steps: The Indian Health Service will host additional opportunities for engagement between September and December 2025.

CMS Tribal Technical Advisory Group and OBBBA Implementation

July 30–31: NCUIH represented Urban Indian Organizations at the CMS Tribal Technical Advisory Group meeting. NCUIH’s CEO and President were able to meet Dr. Mehmet Oz currently serves as the Administrator of the Centers for Medicare & Medicaid Services (CMS).

Medicaid Work Requirement Waivers

NCUIH submitted Urban Indian-inclusive comments on Medicaid work requirement waivers:

• August 9 – Kentucky
• August 9 – South Carolina
• August 15 – Utah
• August 18 – Montana

Department of Health and Human Services Reorganization

On July 18, NCUIH submitted comments urging the Department of Health and Human Services to safeguard Urban Indian Organization and Tribal health programs, maintain SAMHSA grants, and preserve American Indian and Alaska Native funding.

Federal Comments and Listening Sessions

PATH Electronic Health Record Modernization – Comments Due: September 6

• On August 7, Indian Health Service hosted a Tribal Consultation and Urban Confer on the PATH Electronic Health Record scope and capabilities.
• A follow-up Tribal Consultation and Urban Confer will be held on September 6, 2025.
• Questions for Urban Indian Organizations:
  -What clarification do you need on PATH Electronic Health Record capabilities?
  -What potential challenges do you foresee for staff or patients in implementing PATH Electronic Health Record?
  -What capabilities and features are most important to your organization?

Division of Behavioral Health Listening Session – August 4

• NCUIH hosted a listening session with Indian Health Service Division of Behavioral Health and Urban Indian Organizations.
• Dr. Glorinda Segay participated on behalf of the Division of Behavioral Health.
• Dr. Segay welcomed invitations to Urban Indian Organization events.

National Tribal Budget Formulation

Fiscal Year 2027–2028 Planning and Evaluation

• On August 11, Indian Health Service held a Tribal Budget Formulation Workgroup session.
• Discussions focused on whether Fiscal Year 2028 funding should be mandatory, discretionary, or a combination.
• Leaders expressed desire to take this discussion back to their Areas.
• Guidance expected in September.

Upcoming Summits and Meetings

IHS Urban Indian Organization and Partner Federal Agencies Summit

• October 21–23: Indian Health Service will host a meeting with Urban Indian Organizations and federal partners at the Department of Health and Human Services Humphrey Building, Room 800, Washington, DC.

Objectives:

• Introduce federal partners and share current priorities
• Learn about organizational initiatives and challenges
• Explore alignment and collaboration opportunities

NCUIH UIO Caucus

• October 20: NCUIH will host a UIO Caucus ahead of the Summit.
• Location: Indian Gaming Association
  224 2nd Street SE, Washington, DC  20003

Please RSVP by 10/14.

Call for Nominations – Department of Veteran Affairs

NCUIH is seeking nominations for the Urban Representative on the Department of Veterans Affairs Advisory Committee on Tribal and Indian Affairs.

Requirement:

• At least one member must represent Urban Indian Organizations nominated by a national Urban Indian Organization.
• Deadline: August 25, 2025
• Nominations may be sent to policy@ncuih.org

NCUIH 2025 UIO Focus Groups

• October 7: Full Ambulatory (1:00–2:00 p.m. ET) and
  Outpatient/Residential (3:00–4:00 p.m. ET)
• October 8: Limited Ambulatory (1:00–2:00 p.m. ET) and
  Outreach/Referral (3:00–4:00 p.m. ET)
• October 9: Make-Up Session (1:00–2:00 p.m. ET)
• Focus groups will review 2025 accomplishments, 2026 priorities, and provide candid feedback.

Other Upcoming Events and Dates

• September 3–5 – Department of Veterans Affairs Advisory Committee on Tribal and Indian Affairs Meeting (Honolulu, HI)
• September 7–12 – National Indian Health Board Tribal Health Conference (Phoenix, AZ)
• September 16–17 – Tribal Leaders Diabetes Committee Meeting (Hybrid – Arlington, VA)
• September 17 – NCUIH Monthly Policy Workgroup (Virtual)
• September 22–26 – Department of Health and Human Services Secretary’s Tribal Advisory Committee and Indian Health Service Direct Service Tribes Advisory Committee Meetings (Martha’s Vineyard, MA)
• October 7–9 – NCUIH 2025 Urban Indian Organization Focus Groups (Virtual)
• October 20 – NCUIH Urban Indian Organization Caucus (Indian Gaming Association, Washington, DC)
• October 21–23 – Indian Health Service Urban Indian Organization and Federal Agencies Summit (Department of Health and Human Services Humphrey Building, Washington, DC)

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.