IHS Seeking Written Feedback from UIOs on the Use of $70 Million in Special Diabetes Program for Indians Funding

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On July 13, 2026, IHS released a Dear Tribal Leader and Urban Indian Organization Leader to initiate Tribal Consultation and Urban Confer to request feedback and recommendations regarding the use of approximately $70 million in Special Diabetes Program for Indians (SDPI) funding ($50 million associated with the Fiscal Year (FY) 2026 SDPI funding increase and $20 million in one-time unobligated SDPI funding).

This follows the agency’s May 21 announcement of administrative grant supplements for all current grantees and a commitment to Tribal Consultation and Urban Confer on additional funding.

IHS is seeking written responses to the following questions:

  1. Current SDPI grant recipients will receive a Calendar Year 2026 administrative grant supplement totaling 25% of their annual SDPI grant award using one-time, unobligated funding.
    1. What IHS flexibilities do you suggest to help current grantees fully spend the additional supplemental SDPI funds within the grant period?
    2. What educational resources or technical assistance would your SDPI program request to fully spend supplemental SDPI funds by December 31, 2027?
    3. What is the best way to distribute the additional SDPI funds to improve current efforts in treatment, prevention, and care coordination within existing SDPI scopes of work?
  2. How should the IHS prioritize the use of $70 million to achieve the greatest impact?
  3. What are the most significant diabetes risk factors affecting your community that could be addressed through a prevention-focused SDPI initiative?
  4. What recommendations do you have for structuring a prevention and wellness program that supports Tribal sovereignty, cultural practices, local decision-making, and community-defined health priorities?
  5. How can the IHS best support prevention efforts that focus on children, youth, and families to improve long-term health outcomes and prevent type 2 diabetes and related chronic diseases?
  6. What are your recommendations for the future direction of SDPI, including opportunities to strengthen the program’s impact, flexibility, sustainability, and responsiveness to Tribal and Urban Indian community needs?

Comments due to IHS by August 12, 2026. Email Urban Confer comments to: urbanconfer@ihs.gov (SUBJECT LINE: SDPI Funding)

According to the letter, the IHS Tribal Leaders Diabetes Committee (TLDC) will review the input received through Tribal Consultation and Urban Confer and provide IHS with final national recommendations.

Background on SDPI

The Consolidated Appropriations Act, 2026 (P.L. 119-75), signed into law in February 2026, reauthorized SDPI at $200 million per year, a $41 million increase above the prior funding level and the highest authorization in program history. The law also provided $50 million for the first three months of FY 2027, extending authorization through December 31, 2026. Thirty-one Urban Indian Organizations (UIOs) are among the 310 current SDPI grant recipients.

IHS Tribal Leaders Diabetes Committee

The IHS TLDC is charged under IHS Circular 25-11 with making recommendations to the IHS Director on the distribution of SDPI funds and broad-based policy and advocacy priorities related to diabetes in American Indian and Alaska Native (AI/AN) communities. The TLDC has been actively engaged with IHS on SDPI funding administration. NCUIH serves as a technical advisor to the TLDC, representing the needs of urban AI/AN communities and the UIOs that serve them.

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Senators Murkowski and Schatz Introduce Native Children’s Commission Implementation Act, Key Inclusions for Urban Indian Organizations Across Health, Research, and Data Initiatives

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On July 14, 2026, U.S. Senators Lisa Murkowski (R-AK) and Brian Schatz (D-HI) introduced the Native Children’s Commission Implementation Act, comprehensive legislation to improve health, housing, nutrition, workforce, and justice outcomes for Native children, youth, and families. The bill spans nine titles covering health, research and data, environmental health, nutrition, homelessness, workforce, and justice for Native children and families.

Key Highlights for Urban Indian Organizations

Title IV of the bill, which focuses on the physical and behavioral health of Native children, contains key inclusions of UIOs in bill:

  • Tribal Perinatal Workforce Demonstration Grants (Sec. 403):The section establishes a grant program for eligible entities to recruit, train, and retain maternity care providers, behavioral health providers, dietitians, doulas, and other perinatal health workers. Urban Indian organizations are named as eligible entities for the program.
  • HRSA Tribal Advisory Committee (Sec. 401):This new committee, composed of at least 12 members, would be appointed from nominations submitted by Indian Tribes, Tribal organizations, and urban Indian organizations.
  • SAMHSA Tribal Technical Advisory Committee (Sec. 404):Of at least 14 members, two seats are reserved for representatives of “national Tribal organizations or urban Indian organizations” with national expertise in behavioral health.

Title III (Research and Data) also includes meaningful UIO inclusion:

  • NIH Tribal Health Research Office and Tribal Advisory Committee (Sec. 301):The bill establishes a new Tribal Health Research Office within the Office of the Director of NIH, along with a Tribal Advisory Committee of at least 17 members. Notably, two of those seats are specifically reserved for representatives of urban Indian organizations.
  • Native Infant and Maternal Health Data (Sec. 302):The bill directs CDC to enter into cooperative agreements with Indian Tribes, Tribal organizations, Tribal Epidemiology Centers, Papa Ola Lokahi, and urban Indian organizations to address misclassification and under sampling of Native infant and maternal health data.
What Else Is in the Bill

Beyond health, the Native Children’s Commission Implementation Act touches several other areas important to Indian Country:

  • Title VII (Homelessness)would create new Tribal and Native Hawaiian homeless housing assistance grant programs and a Tribal Continuum of Care Participation Grant Program — though eligibility is currently limited to Indian Tribes and tribally designated housing entities.
  • Title IX (Workforce)strengthens the 477 Initiative to give Tribes more flexibility to integrate federal workforce and self-sufficiency funding streams and creates a new Early Childhood Native American Advisory Committee with a dedicated seat for “a national urban Indian organization.”
  • Title VI (Nutrition)establishes new Tribal pilot programs for SNAP and child nutrition program administration.
  • Title V (Environmental Health)creates a new Native Children’s Environmental Health Protection Task Force at the Council on Environmental Quality.
  • Title II (Justice)creates an Advisory Committee on Tribal Juvenile Justice with a dedicated urban Indian organization seat, along with a new Alaska Native Victim Services Fund and expanded Tribal domestic violence resources.
Background 

This bill grows directly out of the work of the Alyce Spotted Bear and Walter Soboleff Commission on Native Children.

The Commission was founded by the Alyce Spotted Bear and Walter Soboleff Commission on Native Children Act, which was introduced by Senators Lisa Murkowski (R-AK) and Heidi Heitkamp (D-ND) and signed into law in 2016. The 11-member Commission was charged with conducting a comprehensive study of federal, Tribal, state, and local programs, grants, and supports available to American Indian, Alaska Native, and Native Hawaiian children and youth from birth through age 24, and with recommending how that system could be strengthened, improved, and, where needed, transformed. The Commission held regional hearings, virtual hearings, and listening sessions around the country, taking testimony directly from Tribal leaders, youth, elders, service providers, and scholars.

In February 2024, the Commission transmitted its final report, The Way Forward: Report of the Alyce Spotted Bear & Walter Soboleff Commission on Native Children, to the President and Congress. The report laid out a roadmap of recommendations spanning child welfare, physical and behavioral health, education, juvenile justice, early childhood development, nutrition, and data sovereignty. The report’s recommendations created the foundation for the Native Children’s Commission Implementation Act.

Next Steps

The bill has been referred to the Senate Committee on Indian Affairs. NCUIH will continue to monitor the bill’s progress.

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Senate Committee on Indian Affairs Holds Hearing on Mark Cruz Nomination for IHS Director; Key Discussions on Staffing, Advance Appropriations, and Tribal Consultation

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On June 24, 2026, The Senate Committee on Indian Affairs (SCIA) held a hearing on the nomination of Mark Cruz (Klamath Tribes) to serve as Director of the Indian Health Service (IHS). SCIA will need to vote to advance Cruz’s nomination to the full Senate for confirmation.

Watch the full hearing here.

During the hearing, Cruz expressed commitment to Tribal Consultation, stressing that it is “a process, not an event.” He also expressed support for the President’s budget request, including the continuation of advance appropriations for IHS, which helps provide funding stability for IHS, Tribal, and urban Indian health programs.

Senator Lisa Murkowski (R-AK), Chair of the Senate Committee on Indian Affairs, said she intends to support his nomination and questioned how Cruz would balance his dual role as IHS Director, as he would also continue serving as Senior Advisor to Secretary of Health and Human Services (HHS) Robert F. Kennedy Jr. Cruz noted that he would continue working with experienced political appointees within IHS and assume a management role if confirmed, and hold an office at both IHS headquarters and HHS.

Vice Chair Brian Schatz (D-HI) emphasized the urgency of addressing persistent staffing shortages across the IHS system and sought Cruz’s commitment to tackling workforce challenges that continue to impact access to care for Native communities.

The National Council of Urban Indian Health (NCUIH) submitted questions for the record ahead of the hearing focused on Cruz’s vision for IHS, the agency’s role in supporting Urban Indian Organizations (UIOs), and efforts to secure 100% Federal Medical Assistance Percentage (FMAP) for services provided through UIOs. IHS has operated without a permanent director for over a year, and NCUIH has previously stressed the importance of appointing a permanent IHS Director and called for the elevation of the role to Assistant Secretary.

Next Steps: SCIA will need to vote to advance Cruz’s nomination to the full Senate for confirmation.

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National Tribal Budget Formulation Workgroup Releases Recommendations for Fiscal Year 2028, Recommends Full Funding for the Indian Health Service and Urban Indian Health

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In April 2026, the National Tribal Budget Formulation Workgroup (NTBFW) released their fiscal year (FY) 2028 Tribal budget recommendations, Aligning with the Federal Trust Responsibility Through Full Funding to Make American Indians and Alaska Natives Healthy Again, as part of the Indian Health Service (IHS) Budget Formulation process. The NTBFW recommends $1.64 billion for the Urban Indian Health line item and $76.1 billion for IHS overall. The NTBFW also recommends that IHS retain and expand eligibility for Urban Indian Organizations (UIOs) to participate in grant programs and ensure that urban Indians are included in the implementation of the exclusions for American Indian and Alaska Native people in the Medicaid requirements in H.R. 1.

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 NTBFW 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 Urges CMS to Approve CalAIM Renewal to Continue Access to Traditional Health Care Practices

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On June 25, 2026, the National Council of Urban Indian Health (NCUIH) submitted comments to the Centers for Medicare & Medicaid Services (CMS) in response to CMS’s request for public comment on California’s Advancing and Innovating Medi-Cal (CalAIM) Renewal Demonstration. NCUIH also provided Urban Indian Organization (UIO) leaders with a comment template to support UIO engagement on the renewal.

The CalAIM Renewal includes continued coverage of traditional health care practices, also known as Traditional Healing services, for substance use disorder treatment for American Indian and Alaska Native people. NCUIH urged CMS to approve the renewal, including the provision providing access to traditional health care practices for American Indian and Alaska Native people in California.

This decision matters because the CalAIM Renewal will determine whether Indian Health Care Providers in California, including UIOs, can continue providing traditional health care practices for substance use disorder treatment. NCUIH emphasized that continued access to these services is consistent with the federal trust responsibility to provide health services to American Indian and Alaska Native people, including those living in urban areas.

NCUIH also noted that the United States owes this trust obligation to American Indian and Alaska Native people no matter where they live and contracts with the 41 UIOs to help fulfill this obligation for Native people living in urban areas. Traditional health care practices are provided through the Indian health system to eligible American Indian and Alaska Native people under the Indian Health Care Improvement Act. This framework is grounded in the political relationship between the United States and Tribal Nations.

NCUIH highlighted the continued need for access to traditional health care practices for substance use disorder treatment. Substance use disorder remains a serious health concern among the American Indian and Alaska Native people served through the Indian health system, and traditional health care practices are an established part of the care the United States provides to meet its trust obligation.

Approving the CalAIM Renewal would allow Indian Health Care Providers in California, including UIOs, to continue providing traditional health care practices to treat substance use disorder and better serve American Indian and Alaska Native communities. NCUIH further noted that these services were recently recognized by the U.S. Department of Health and Human Services Secretary during the April 2026 meeting of the Secretary’s Tribal Advisory Committee.

CMS is now reviewing public comments on the CalAIM Renewal. NCUIH will continue to monitor the demonstration renewal and engage as needed to support continued access to traditional health care practices through Indian Health Care Providers in California, including UIOs. CMS approval is needed before the current demonstration authority expires so these services can continue without interruption.

As CMS considers the CalAIM Renewal, NCUIH continues to urge approval of the provision supporting access to traditional health care practices for American Indian and Alaska Native people in California. Continuing this coverage is necessary to preserve access to care through the Indian health system and uphold the federal trust responsibility to Native people, including those living in urban areas.

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