Indian Health Service Announces Next Phase of Agency Realignment, Invites Tribal and Urban Leader Feedback

Four In-Person Consultations and One Virtual Session Scheduled Across the Country

On November 13, 2025, Acting Director Ben Smith of the Indian Health Service (IHS) sent a letter to Tribal Leaders and Urban Indian Organization Leaders announcing the next phase in the Agency’s proposed realignment. This initiative, first introduced in the summer of 2025, is stated with an intent “to transform the IHS into a more patient-centered, self-determination-driven, operationally efficient, and fiscally sustainable health care system”.

Director Smith’s letter emphasized the Agency’s commitment to high-quality, culturally responsive care and thanked Tribal and Urban Leaders for their active engagement and thoughtful input during the initial round of Tribal Consultation and Urban Confer. He noted that feedback received made it clear that a second round of consultation would be valuable as more details about the realignment structure become available.

NCUIH submitted comments in response to the first round of confer on August 28, 2025, and recommended additional confers to provide more opportunities for feedback.

According to IHS, the realignment seeks to modernize the Agency, enhance accountability, and better align leadership functions with its contemporary mission. Smith highlighted the importance of clarifying roles, reducing administrative burdens, and allowing leaders at both headquarters and in the field to focus on policy, oversight, and partnership. The letter states that approximately 62 percent of the IHS budget is managed by Tribes and Tribal organizations through Title I contracts and Title V compacts under the Indian Self-Determination and Education Assistance Act (ISDEAA), while the remaining 38 percent supports federally operated IHS hospitals, health centers, and programs. These statistics are provided as reasoning for the need to modernize the Agency.

“This modernization will strengthen patient care within IHS-operated facilities and elevate the Agency’s inherent Federal functions—ensuring that we are an effective partner and support system for self-determination, no matter how each Tribe chooses to exercise that right,” Smith wrote.

IHS will hold four in-person Tribal Consultation sessions and one virtual Urban Confer session.

Feedback from the sessions and written comments must be submitted by February 9, 2026. Comments for the Tribal Consultation should be emailed to consultation@ihs.gov, and Urban Confer comments to urbanconfer@ihs.gov, with the subject line “IHS Proposed Realignment.”

After the comment period, IHS will begin an internal deliberation phase to review all feedback before moving forward with the finalization and implementation of the realignment plan.