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

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.