House Appropriations Committee Advances Labor Health and Human Services Spending Bill, Protects Key Indian Country Programs

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On June 9, 2026, the House Appropriations Full Committee passed the Fiscal Year (FY) 2027 appropriations bill for Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). The bill includes $110.767 billion for the Department of Health and Human Services (HHS), which is $4.03 billion below FY 2026 enacted and $12.16 billion above the President’s request. The committee notably did not fund the Administration for a Healthy America (AHA), President Trump’s proposed new agency that would consolidate programming across SAMHSA, HRSA, and other agencies as part of its HHS reorganization.

The committee also provided increased funding for key Indian Country provisions including the Improving Native American Cancer Outcomes program, Good Health and Wellness in Indian Country program, and Tribal Behavioral Grants (Native Connections).

Background

NCUIH worked closely with Appropriators to advocate for increased funding for Indian Country. In written testimony, NCUIH advocated for $10 million for the Improving Native American Cancer Outcomes program, $30 million for the Good Health and Wellness in Indian Country program and protecting Tribal set asides.

Next Steps

House Leadership will now work with Senate Leadership to develop the final LHHS appropriations spending bill. The Senate has not yet released their Labor-HHS appropriations bill. As a final appropriations bill is produced, NCUIH will continue to work to protect funding for Indian Country and maintain maximum funding levels.

Bill Highlights

Line Item FY 2026 Enacted FY 2026 President’s Budget Request FY 2027 Committee Passed
Health Resources and Services Administration $9.2 billion Fold into Administration for a Healthy America (AHA) $8.35 billion
Substance Abuse and Mental Health Services Administration $7.4 billion Fold into AHA $7.29 billion
National Institutes of Health $48.72 billion $42.97 billion $48.82 billion
Centers for Disease Control $9.2 billion Fold into AHA (Partially) $8.16 billion
Good Health and Wellness in Indian Country $27 million — $30 million
Improving Native American Cancer Outcomes $9 million — $15 million
Ryan White HIV/AIDS Program $2.57 billion $2.50 billion $2.35 billion
Minority HIV/AIDS Fund $56 million Eliminated $20 million
Minority HIV/AIDS Fund – Tribal Set Aside No less than $6 million — $6 million
Tribal Behavioral Grants (Native Connections) $26.25 million Eliminated. Created a new behavioral health program under AHA $30 million

Additional Key Provisions:

Health Resources and Services Administration

Innovation for Maternal Health: $20.3 million (10% Tribal set-aside)
Bill report pg. 52: The Committee includes $20,300,000 for the Innovation for Maternal Health program. The Innovation for Maternal Health program supports the establishment or continuation of a program to identify, develop, or disseminate best practices to improve maternal health care quality and outcomes, improve maternal and infant health, and eliminate preventable maternal mortality and severe maternal morbidity, among other activities. This funding supports capacity building, technical assistance, and continued implementation of the Alliance for Innovation on Maternal Health Program’s patient safety bundles to all States, territories, and tribal organizations. Patient safety bundles are a set of targeted and evidence-informed best practices that, when implemented, improve patient outcomes and reduce maternal mortality and severe maternal morbidity.

  • (NEW) Tribal Set-Aside: The Committee directs HRSA to reserve at least 10 percent of available funding for Tribes and Tribal organizations.

Federal Office of Rural Health Policy: $575.77 million

Native Hawaiian Health Care Program: $27 million
Bill report pg. 38: The Committee continues $27,000,000 for the Native Hawaiian Health Care Program. Of the total amount appropriated for the Native Hawaiian Health Care Program, not less than $10,000,000 shall be provided to Papa Ola Lokahi for administrative purposes authorized under 42 U.S.C. 11706, including expanded research and surveillance related to the health status of Native Hawaiians and strengthening the capacity of the Native Hawaiian Health Care Systems.

National Health Service Corps: $133.1 million (15% Tribal set-aside)
Bill report pg. 40: The Committee includes $133,100,000 for the National Health Service Corps (NHSC) to support competitive awards to health care providers dedicated to working in rural, Tribal, and underserved areas.

  • Tribal Set-Aside.—Within the total provided for the NHSC, the Committee includes a set aside of not less than 15 percent to support awards to participating individuals that provide health services in Indian Health Service facilities, Tribally-operated health programs, and Urban Indian Health programs.
Centers for Disease Control and Prevention

Good Health and Wellness in Indian Country: $30 million
Bill report pg. 73.

Office of the Secretary – General Departmental Management

Minority HIV/AIDS Fund: $20 million ($6 million Tribal set-aside)
Bill report pg. 252: The Committee includes $20,000,000 for the Secretary’s Minority HIV/AIDS Fund (MHAF).

  • Tribal Set-Aside.—The Committee notes that according to the CDC, HIV-positive status among Native Americans is increasing and nearly one-in-five HIV-positive Native Americans is unaware of their status. In addition, only three-in-five receive care and less than half are virally suppressed. To increase access to HIV/AIDS testing, prevention, and treatment, the Committee reserves not less than $6,000,000 as a Tribal set-aside within the total provided for MHAF.
Substance Abuse and Mental Health Services Administration

National Center of Excellence for Eating Disorders: $4 million
Bill report pg. 162: The Committee provides $4,000,000, an increase of $2,000,000 above the fiscal year 2026 enacted level, for the National Center of Excellence for Eating Disorders. Funding will support increased engagement with primary care providers, including pediatricians, to provide specialized advice and consultation on screening and treatment for eating disorders. The Committee supports work on pediatric training models for prevention, early intervention, treatment, and ongoing support protocols for youth with, or at-risk of developing, an eating disorder. The Committee directs SAMHSA to devote sufficient resources to a competitive grant process to support the National Center of Excellence, as authorized in section 1131 of Public Law 117–328. The Committee further directs SAMHSA to provide an update in the fiscal year 2028 congressional justification detailing actions taken to support the Center of Excellence in advancing education, training, and awareness of eating disorders.

Substance Abuse Prevention Services: $204 million

Tribal Behavioral Grants (Native Connections): $30 million
Bill report pg. 161: The Committee provides $30,000,000, an increase of $3,750,000 above the fiscal year 2026 enacted level, to prevent and reduce suicidal behavior and substance use, reduce the impact of trauma, and promote mental health among AI/AN youth, through age 24.

Zero Suicide: $23.8 million
Bill report pg. 159: The Committee includes $23,800,000 for the Zero Suicide program, which is the same as the fiscal year 2026 enacted level. Zero Suicide grants support suicide prevention efforts in health systems, including screening adults for suicide risks, providing referral services, implementing evidence based practices to provide services to adults at-risk, and raising awareness of such risks.

American Indian and Alaska Native Set Aside:$4.4 million
Bill Report pg. 159: Within the amount provided, $4,400,000 is included for Zero Suicide grants to American Indian and Alaska Native health systems, which is the same as the fiscal year 2026 enacted level.

Mental Health Services Block Grant: $1.05 billion
Bill report pg. 154: The Committee provides $1,047,571,000 for the MHBG, an increase of $35,000,000 above the fiscal year 2026 enacted level. Of the funds provided, $21,039,000 shall be derived from evaluation set aside funds available under section 241 of the PHS Act.

988 Suicide & Crisis Lifeline: $544.62 million
Bill report pg. 159: The Committee provides $544,618,000 for the 988 Suicide & Crisis Lifeline, an increase of $10,000,000 above the fiscal year 2026 enacted level, to support the national suicide hotline to continue to support State and local suicide prevention call centers as well as a national network of backup call centers and the national coordination of such centers.

  • 988 Tribal Capacity Building.—Tribal Nations continue to face unique challenges with fully adopting 988 services, including access to technology and crisis support services, intergovernmental coordination, and culturally responsive mental health services. The Committee instructs SAMHSA to complete the briefing directive included under this heading in the House Report 119–271.

Substance Use Prevention, Treatment, and Recovery Services Block Grant: $2.03 billion
Bill report pg. 163: The Committee includes $2,039,079,000 for the Substance Use Prevention, Treatment, and Recovery Services (SUPTRS) Block Grant, which is a $26,000,000 increase above the fiscal year 2026 enacted level.

State Opioid Response Grants: $1.6 billion (4.5% Tribal set aside)
Bill report pg. 163: The Committee includes $1,600,000,000 for State Opioid Response (SOR) grants, an increase of $5,000,000 above the fiscal year 2026 enacted level. The Committee supports efforts from SAMHSA through SOR grants to expand access to substance use disorder treatments in rural and underserved communities, including through funding and technical assistance. Within the amount provided, the Committee includes a set-aside of not less than 4.5 percent for Indian Tribes and Tribal organizations.

National Institute on Minority Health and Health Disparities

Improving Native American Cancer Outcomes: $15 million
Bill report pg. 131: The Committee remains deeply concerned that Native Americans experience overall cancer incidence and mortality rates significantly higher than those of non-Native populations. The Committee includes $15,000,000, an increase of $6,000,000 from the fiscal year 2026 enacted level, to continue and expand support for existing grantees under the Initiative for Improving Native American Cancer Outcomes. This initiative supports research, education, outreach, and clinical access related to cancer in Native American communities. The Committee further directs NIMHD to continue to work with NCI to maintain support for current grantees.

Native Hawaiian/Pacific Islander Health Research Office: $7.5 million
Bill report pg. 132: The Committee provides $7,500,000, which is an increase of $2,500,000 above the fiscal year 2026 enacted level, for the Native Hawaiian/ Pacific Islander Health Research Office (NHPIHRO) with a focus on both addressing Native Hawaiian and Pacific Islander (NHPI) health disparities, as well as supporting the pathway and research of NHPI investigators. The Committee encourages NHPIHRO to develop partnerships with academic institutions with a proven track record of working closely with NHPI communities and NHPI serving organizations located in States with significant NHPI populations to support the development of future researchers from these same communities.

Important Behavioral and Mental Health Provisions

Medication-Assisted Treatment for Prescription Drug and Opioid Addiction Tribal Set Aside: $20 million

Infant and Early Childhood Mental Health Program: $16 million
Bill report pg. 158: The Committee provides $16,000,000 for the Infant and Early Childhood Mental Health program, an increase of $1,000,000 above fiscal year 2026 enacted level, to support human service agencies and nonprofit organizations that provide age-appropriate mental health promotion and early intervention or treatment for children with significant risk of developing mental illness including through direct services, assessments, and trainings for clinicians and education providers. Increased funding is included to expand funding to additional communities, working to build the infrastructure and systems needed to deliver early childhood mental health services.

Administration for Community Living

Native American Caregiver Support Program: $16 million
Bill report pg. 211: The Committee provides $16,000,000 for the Native American Caregivers Support program. This program provides formula grants to Tribes for the support of American Indian, Alaskan Native, and Native Hawaiian families caring for older relatives with chronic illness or disabilities.

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

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Urban Indian Health Hill Day 2026: Urban Indian Leaders Make Their Voices Heard

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On April 30, 2026, NCUIH and Urban Indian Organizations (UIOs) leaders from across the country gathered in Washington, D.C. for a Capitol Hill Day. UIO leaders, staff, and members of the community participated in NCUIH’s in-person Training ahead of Hill Day, arriving prepared and equipped to increase awareness of urban Indian health needs and carried those messages directly to Capitol Hill.

This year’s Hill Day came at a critical moment. Budget conversations are actively underway in Congress, making the timing of these meetings essential to ensuring that the health needs of American Indian and Alaska Native people living in urban areas are not overlooked in policy discussions. As Congress moves forward with the appropriations process, NCUIH will build on the momentum of Hill Day by continuing to educate policymakers and raise awareness about urban Indian health needs.

Read the Full Hill Day 2026 Recap Booklet
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House Advances FY 2027 Interior Bill with Increases for IHS and Advance Appropriations for FY 2028

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On June 3, 2026, the House Appropriations Full Committee passed the Fiscal Year (FY) 2027 appropriations bill for Interior, Environment, and Related Agencies, which was previously approved by the House Subcommittee on May 25, 2026. 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 “reflects our commitment to honoring and upholding our sacred trust and treaty oaths to protect Native American communities. I’m proud that the legislation prioritizes funding for the accounts that deliver critical services to Indian country.”

The bill provides $8.69 billion for IHS, including $6.06 billion in advance appropriations for FY 2028. The bill also expands advance appropriations to include Indian Health Facilities Sanitation Facilities Construction and Health Care Facilities Construction accounts. The bill authorizes $105.992 million for urban Indian health – an increase of $10.57 million over the FY26 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:

  • $7 million for the Produce Prescription Pilot Program for Tribes and UIOs to increase access to produce and other traditional foods
  • $45 million, a $5.57 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 March 17, 2026, NCUIH CEO Francys Crevier 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 March 20, 2026, 59 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.

FY26 funding is set to end on September 30, 2026. 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 FY26 level until they 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 26 Enacted FY 27 Tribal Request FY 27 President’s Budget FY 27 House Proposed
Urban Indian Health $95.42 million $1.09 billion $95 million $105.992 million
Indian Health Service $8.05 billion $73 billion $9.1 billion $8.69 billion
Hospital and Clinics $2.63 billion $18.5 billion $2.84 billion $2.87 billion
Tribal Epidemiology Centers $39.4 million ____________ $39.4 million $45 million
Mental Health $133.69 million $5.41 billion $139 million $144.95 million

Additional Key Provisions:

Clinical Decision Support for Diabetes Management (NEW)
Bill Report, Pg. 92,93: The Committee directs IHS to evaluate and, where clinically appropriate, implement evidence-based, artificial intelligence-enabled digital tools to improve insulin management, patient safety, and clinical outcomes in IHS facilities.

Rural Health Care Access (NEW)
Bill Report, Pg. 93: The Committee remains concerned about the ongoing difficulties rural and remote Tribal communities face in accessing timely health services. To reduce geographic barriers and improve care continuity, the Committee directs the IHS to procure integrated rural health care delivery models that leverage mobile medical units, telehealth-enabled clinical services, and clinical staff augmentation to address persistent workforce gaps.

IHS Hiring Initiative Follow Up (NEW)
Bill Report, Pg. 90: The Committee commends IHS on the launch of its fiscal year 2026 hiring initiative. As it works to streamline and expedite hiring processes, the Committee expects IHS to maintain the integrity and thoroughness of the background check process, and to consider ways to collaborate with and consult Tribes on hiring system improvements and decisions affecting healthcare services. The Committee encourages IHS to provide a report not later than 90 days following the enactment of this Act on its success in addressing the high staffing vacancy rate and implementing targeted recruitment and retention strategies in underserved areas.

Current Services: $264,752,000
Bill Report, Pg. 90: The Committee acknowledges that fixed costs continue to rise and flat funding results in a cut to programmatic dollars. The recommendation provides $264,752,000 for the Agency’s requested Current Services, which covers fixed costs for fiscal year 2027, for key health services to ensure increases go directly to programs. The Committee directs IHS to provide a detailed spend plan for fixed costs not later than 60 days following the enactment of this Act, including a timeline for when the funds will be distributed.

Produce Prescription Pilot Program: $7 million
Bill Report, Pg. 90: The recommendation includes $7,000,000 for IHS to expand, in coordination with Tribes and Urban Indian Organizations, 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 not later than 90 days following the enactment of this Act on the distribution of funds and implementation efforts.

Contract Support Costs – $ 1.731 billion and Tribal 105(l) leases – $720 million
Bill Report, Pg. 93: The Committee recommends an indefinite appropriation estimated to be $1,731,000,000 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. 93: The Committee recommends an indefinite appropriation estimated to be $720,000,000 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 – $1.06 billion
Bill Report, Pg. 91: The recommendation includes $1,055,713,000 for Purchased and Referred Care (PRC). The amount provided reflects the fiscal year 2026 enacted base of $996,755,000, full funding for fiscal year 2027 current services requirements estimated at $45,958,000, and $13,000,000 for the purposes described below.

The Committee is aware that delayed reimbursements can cause financial strain on the Tribal member patient and the provider. This can sometimes result in the patient being incorrectly held liable for costs and cause medical debt to appear on the patient’s credit report. Therefore, within 90 days of the enactment of this Act, the Committee directs the Indian Health Service to report on ways to improve the speed at which reimbursement payments are paid to meet the 30-day requirement. The Committee also provides $13,000,000 for additional staff and resources needed to improve reimbursement timelines.

The Committee is interested in IHS findings on the Purchased and Referred Care 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. 92: 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.

The Committee appreciates the opportunities made available through Indian Health Professions programs like the Loan Repayment Program (LRP). The recommendation includes $53,000,000 for LRP to help offset student loan costs in exchange for two years of service at an Indian health program. The Committee remains concerned about the tax assessments associated with this grant program and the impact tax liabilities have on this valuable program. The Committee looks forward to the report from IHS and other applicable Bureaus and Agencies with respect to tax implications, as directed in House Report 119–215.

Sanitation Facilities Construction: $130,968,000
Bill Report, Pg. 94: The recommendation includes $130,968,000 for Sanitation Facilities Construction.

Health Care Facilities Construction: $190,508,000
Bill Report, Pg. 94: The recommendation includes $190,508,000 for Health Care Facilities Construction.

Equipment – Generators:  $2.5 million in addition to FY26 amounts ($5 million)
Bill Report, Pg. 94: $2,500,000, in addition to amounts provided in fiscal year 2026, to purchase generators, including for IHS, Tribal Health Programs, and Urban Indian Organizations facilities located in areas impacted by de-energization events to increase the resilience of these facilities.

Dental Health: $287 million
Bill Report, Pg. 91: The recommendation includes $287,085,000 for Dental Health services.

  • Also includes $1,500,000 to expand Dental Support Centers to all 12 service areas and $2,500,000 to install an electronic Dental Records System.

Alzheimer’s Disease: $6 million
Bill Report, Pg. 90: 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.

Improving Maternal Health: $3 million
Bill Report, Pg. 91: 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. 91: The recommendation includes $286,389,000 for Alcohol and Substance Abuse programs.

Behavioral Health Pilot Program
Bill Report, Pg. 91: The Committee looks forward to the report on the status and outcomes of the new behavioral health pilot program that was enacted in fiscal year 2026 that supports grants to Indian Tribes, Tribal organizations, or consortia of Indian Tribes to operate and implement special behavioral health programs authorized by the Indian Health Care Improvement Act (25 U.S.C. 1665 et seq.) on or near an Indian Reservation.

Bureau of Indian Affairs, Missing and Murdered Indigenous Women Initiative: $33 million
Bill Report, Pg. 46: The recommendation includes $33,000,000 for the Missing and Murdered Indigenous Women Initiative to address the s 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 technology.

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

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Trump Submits Nomination of Mark Cruz for Director of the Indian Health Service

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On June 1, 2026, President Trump submitted the appointment of Mark Cruz, a citizen of the Klamath Tribes, as the Director of the Indian Health Service (IHS). Cruz currently serves as Senior Advisor to Secretary of Health and Human Services Robert F. Kennedy Jr., as one of the highest-ranking Native officials within HHS. Cruz holds a Bachelor of Arts in Political Science from Pepperdine University and a Master of Arts in Urban Education Policy from Brown University.

The position of IHS Director has been vacant since the resignation of former Director Roselyn Tso. On December 2,2025, IHS Chief of Staff Clayton Fulton assumed the acting director role during the leadership transition. As the IHS Director, Cruz will be responsible for administering a nationwide program that is responsible for providing comprehensive health care services to American Indians and Alaska Natives through the Indian Health Service, Tribes, Tribal organizations, and urban Indian organizations.

The National Council of Urban Indian Health has previously stressed the importance of appointing a permanent IHS Director and called for the elevation of the role to Assistant Secretary.

Next Steps

The nomination will now be referred to the Senate Committee on Indian Affairs, which will schedule a confirmation hearing before a full Senate floor vote.

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

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