In this Edition:

• Questions for UIOs: Request for Input and Feedback
• Senate Confirms Mark Cruz as Indian Health Service Director
• Federal Leaders Visit Arizona UIOs
• Federal Medical Assistance Percentage (FMAP) Updates
• New NCUIH Medicaid Resources
• Fiscal Year 2027 Appropriations Status and Updates
• NCUIH Speaks at Congressional Briefing Launching the Native Children’s Commission Implementation Act
• NCUIH Endorses Bill to Improve Public Health Emergency Preparedness for Indian Health Care Providers
• Submitted Federal Comments (H.R. 1 Implementation and Special Diabetes Program for Indians Funding) and Upcoming Comment Opportunities
• Upcoming Events, Policy Dates, and Funding Opportunities

Questions for UIOs: Request for Input and Feedback

• Rural Health Transformation Program (RHTP): NCUIH is gathering UIO experiences with RHTP and requests that Urban Indian Organizations let NCUIH know if their organization receives funding and how you are engaging with your state. More information on the Rural Health Transformation Fund is available on the NCUIH Policy Resource Center Webpage.
• Special Diabetes Program for Indians (SDPI) 25% Supplemental Funding:IHS announced that 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. Have any UIO SDPI grantees received their supplemental funding?
• UIO Listening Session with the Indian Health Service (IHS) Division of Behavioral Health (DBH): NCUIH is facilitating a virtual UIO listening session with IHS DBH on September 17, 2026, at 1:00 PM ET. Register at ncuih.org/events. Please let us know any questions you have for DBH, behavioral health challenges and successes at your UIO, and topics you want covered during the session.

Responses can be sent to policy@ncuih.org.

Senate Confirms Mark Cruz as Indian Health Service Director

On August 7, 2026, the Senate confirmed Mark Cruz, a citizen of the Klamath Tribes, as Director of the Indian Health Service (IHS). NCUIH submitted questions for the record ahead of his June 24 nomination hearing, including on IHS’s role in supporting Urban Indian Organizations (UIOs) and efforts to secure 100% Federal Medical Assistance Percentage (FMAP) for UIOs.

NCUIH will continue to engage with Director Cruz and IHS on priorities including full and stable funding for IHS including urban Indian health, Medicaid parity for UIOs, and investments in Native behavioral health programs.

[Read the full Blog Post]

Federal Leaders Visit Arizona UIOs

Dr. Caprice Knapp (CMS), Erin Tawney (HHS), and other agency representatives visited the NATIVE HEALTH Phoenix clinic alongside Native American Connections and NCUIH. The visit highlighted how UIOs are transforming Medicaid and Children’s Health Insurance Program (CHIP) coverage into improved health outcomes for Native communities.

NCUIH also joined the HHS Administration for Native Americans (ANA) and Pew Charitable Trusts in a visit to Native American Connections to see firsthand how UIOs provide culturally responsive care to American Indian and Alaska Native people in urban settings.

We thank CMS, HHS, and Pew for joining us in showcasing the important role of Urban Indian Organizations in the Indian Health System.

Federal Medical Assistance Percentage (FMAP) Updates

• Current legislation:The bipartisan Urban Indian Health Parity Act (H.R. 4722) would provide 100% federal medical assistance percentage (FMAP) for services provided to Medicaid beneficiaries at UIOs.

NCUIH Joined the Centers for Medicare & Medicaid Services Tribal Technical Advisory Group in Hill Meetings on AI/AN Medicare and Medicaid Priorities, including 100% FMAP for UIOs.

• On July 27, NCUIH joined the CMS Tribal Technical Advisory Group (TTAG) Hill Day to provide education on TTAG Medicare and Medicaid priorities, including 100% FMAP for UIOs.
• Offices visited: Sens. Baldwin (D-WI), Smith (D-MN), Cassidy (R-LA, HELP Chair), Johnson (R-WI), Slotkin (D-MI), Peters (D-MI), Murkowski (R-AK), and Merkley (D-OR).

New NCUIH Medicaid Resources

• Updated Resource: Overview of the Impact of Medicaid on Health Care for American Indian and Alaska Native People— refreshed data on American Indian and Alaska Native (AI/AN) Medicaid enrollment and the role of UIOs as providers for AI/AN Medicaid beneficiaries. [Link]
• New Resource: Medicaid is Changing — Medicaid Work Requirements and the AI/AN Exemption — outlines the work, renewal, and cost-sharing changes taking effect in 2027 and what the AI/AN exemption protects. [Link]

Fiscal Year 2027 Appropriations Status and Updates

On August 8, the Senate passed a continuing resolution (CR)by a vote of 90-6 that would fund the government through December 11. The CR:

• Prevents implementation of the Office of Management and Budget’s (OMB) proposed grants rule through the duration of the CR; and
• Extends authorizations of important health, veterans, infrastructure, and other programs for the duration of the CR.

Next Steps: The House returns from recess on August 31 and must act on the Senate’s version before the September 30 funding deadline. NCUIH will continue to work to protect funding for Indian Country.

NCUIH Joins Tribal Leaders and Senate Champions to Celebrate Introduction of the Native Children’s Commission Implementation Act

On July 23, NCUIH’s Board President Robyn Sunday-Allen (Cherokee Nation), who also serves as Chief Executive Officer of the Oklahoma City Indian Clinic (OKCIC), spoke at the congressional briefing launching the Native Children’s Commission Implementation Act, introduced July 14 by Sens. Lisa Murkowski (R-AK) and Brian Schatz (D-HI).

[Read NCUIH’s press release on the event.]

This bi-partisan legislation would address longstanding challenges facing Native children and families across child welfare, education, health care, juvenile justice, housing, workforce development, nutrition, and data systems, and represents one of the most significant investments in Native children and families in a generation.

UIO inclusions in the 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.
• 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.

[Read NCUIH’s analysis on the bill.]

NCUIH Endorses Bill to Improve Public Health Emergency Preparedness (PHEP) for Indian Health Care Providers

Introduced July 21 by Sen. Warren (D-MA), Sen. Heinrich (D-NM), Rep. Stansbury (D-NM-01), and Rep. Leger Fernández (D-NM-03), the CDC Tribal Public Health Security and Preparedness Act would allow Tribes to apply directly to CDC for Public Health Emergency Preparedness (PHEP) program funds.

• Authorizes$750 millionfor each fiscal year, 2026 through 2028, for the PHEP program, 5% Tribal set-aside.
• UIOs are included in several consultation provisions that would ensure they are included in crafting public health plans.

[Read NCUIH’s analysis on the bill.]

NCUIH Submits Comments to CMS on Interim Final Rule on H.R. 1 Implementation

On July 31, NCUIH submitted comments on the CMS interim final rule on H.R. 1 implementation. In its comments, NCUIH encouraged CMS to provide clear guidance and support for implementation of the American Indian and Alaska Native Medicaid provisions, promote collaboration with UIOs, Tribes, and Tribal Organizations, strengthen oversight and data collection efforts, and ensure meaningful engagement with UIOs.

NCUIH Submits Comments to IHS on Additional Special Diabetes Program for Indians Funding

IHS requested feedback on $70 million in additional Special Diabetes Program for Indians (SDPI) funding — $50 million from the Fiscal Year 2026 funding increase and $20 million in one-time unobligated SDPI funding. In its comments, NCUIH encouraged IHS to provide flexibility in the use of funding, promote local decision-making, engage with Tribes and UIOs, and allow sufficient time for feedback.

Comment Opportunity — Due September 5: IHS Health Information Technology Modernization: Roadmap to Cohorts

On August 6, IHS held a Tribal Consultation and Urban Confer session on Health Information Technology (HIT) Modernization: Roadmap to Cohorts. Formation of Cohort 1 for implementing the Patients at the Heart (PATH) electronic health record (EHR) is dependent on funding, but IHS is envisioning two federal sites and one Tribal site.

IHS is seeking responses to: 

1. What additional information or content would be helpful to determine readiness at your site?
2. What questions do you have about requirements or level commitment needed to support PATH EHR implementation?
3. What questions or recommendations do you have regarding the cohort identification process?

Comments are due to IHS by September 5, 2026. 

4. Email Urban Confer comments to: urbanconfer@ihs.gov

Upcoming Events and Policy Dates

September 1-3: NCUIH UIO Focus Groups — Setting Policy Priorities for 2027 (ncuih.org/events)

• September 1: Full Ambulatory | 1:00-2:00 p.m. ET; Outpatient and Residential | 3:00-4:00 p.m. ET
• September 2: Limited Ambulatory | 1:00-2:00 p.m. ET; Outreach and Referral | 3:00-4:00 p.m. ET
• September 3: Make-Up Session | 1:00-2:00 p.m. ET

September 15-16: IHS Tribal Leaders Diabetes Committee (TLDC) Quarterly Meeting (virtual)

September 15-17: National Congress of American Indians (NCAI) Tribal Impact Days (Washington, D.C.)

September 16: NCUIH Monthly Policy Workgroup and IHS DBH Prep Session for UIOs (virtual)

September 17: NCUIH and IHS DBH Listening Session (virtual – register at ncuih.org/events) | 1:00-2:00 p.m. ET

Current Funding Opportunities

Visit the NCUIH Website to apply and explore the Full List of Opportunities.

HHS Administration for Native Americans (ANA): AI3 Action Institute — Artificial Intelligence for American Indians (AI3) 

• Urban Indian Organizations are eligible.
• The award is $3,500,000 total (single award).
• The application deadline is August 27, 2026.

HHS ANA: National Center for Native Training and Technical Assistance Cooperative Agreement 

• Urban Indian Organizations are eligible.
• The award is $3,100,000 total (single award) over a 3-year project period.
• The application deadline is August 27, 2026.

HHS ANA: Economic Advancement Grants for Local Empowerment (EAGLE) 

• Urban Indian Organizations are eligible.
• The award is up to $900,000 per project over a 3-year project period.
• The application deadline is August 27, 2026.

Indian Health Service Addressing Dementia in Tribal and Urban Indian Communities: CAReS Program 

• Urban Indian Organizations are eligible.
• Option A offers up to $750,000 per year for five years to one national awardee to expand dementia care through mini-projects, training, and technical assistance.
• Option B offers up to $300,000 per year for five years to one national awardee to develop a caregiver support and training center.
• The application deadline is September 4, 2026.

Indian Health Service Fiscal Year 2026 Urban Emergency Fund (UEF) 

• The purpose of this fund is to help Urban Indian Organizations address costs associated with one-time, non-recurring emergencies and disaster relief efforts.
• The award is a limited discretionary fund, with up to $250,000 available.
• The application deadline is as soon as reasonably practicable after the emergency occurs.

 

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.

Washington, DC, August 14, 2026 — The National Council of Urban Indian Health (NCUIH) has released a new resource, Medicaid is Changing, outlining upcoming changes to Medicaid under the One Big Beautiful Bill Act (OBBBA) and the protections in place for American Indian, Alaska Native, and Urban Indian beneficiaries. 

Starting in 2027, most Medicaid enrollees will face new work requirements, more frequent eligibility redeterminations, and new cost-sharing charges for some expansion adults. Indians, Urban Indians, California Indians, and individuals otherwise determined eligible for the Indian Health Service are exempt from these changes.

As of August 2026, some states have already begun implementing these changes ahead of the national deadline. UIOs and patients should confirm their state’s specific timeline with their state Medicaid agency.

What Is the AI/AN and Urban Indian Medicaid Exemption?

Indians, Urban Indians, California Indians, and individuals otherwise determined eligible for the Indian Health Service are exempt from the OBBBA’s new Medicaid work requirements, six-month redetermination cycle, and cost-sharing changes. This exemption is written into the statute itself.

What the Exemption Protects

• No Work Requirement: No work, school, or volunteer hour requirement to keep Medicaid. (OBBBA § 71119(a))
• 12-Month Renewal: The current 12-month renewal cadence is retained, rather than the new 6-month redetermination cycle. (OBBBA § 71107)
• Cost-Sharing Protection: No new cost sharing for services at an Indian health care provider or through qualifying referred care. (ARRA § 5006, 42 U.S.C. § 1396o(j))
  • Note: This protection applies specifically to care received at an Indian health care provider or through a qualifying referral from one. It does not extend to cost sharing for Medicaid services received elsewhere.

Call to Action

Primary Ask: Ensure Proper Implementation of the AI/AN and Urban Indian Medicaid Work Requirement Exemption

States may not yet have sufficient information to reliably identify everyone who qualifies for the AI/AN exemption before outreach occurs, creating a risk of misidentification or confusing notices. HHS and CMS should issue binding guidance so states apply the AI/AN exemption automatically, ensuring implementation does not create new barriers for AI/AN and Urban Indian people.

Ongoing Priority: Preserve and Maintain All Existing Medicaid Resources for the Indian Health System

Cuts to Medicaid place a heavier burden on states and can force Indian health care providers to reduce essential services. Preserving Medicaid resources is critical to ensuring AI/AN and Urban Indian beneficiaries can access necessary care and to fulfilling the trust responsibility.

Frequently Asked Questions

Do American Indian and Alaska Native people have to comply with the new Medicaid work requirements?

No. AI/AN and Urban Indian Medicaid beneficiaries are statutorily exempt from the OBBBA’s community engagement and work requirements.

Will AI/AN Medicaid beneficiaries have their eligibility checked every six months?

No. The exemption preserves the current 12-month Medicaid renewal cycle for AI/AN and Urban Indian beneficiaries. 

Will AI/AN people face new Medicaid cost-sharing charges?

No. Federal law already prohibits cost sharing for services furnished to Indians through Indian health programs, and this protection remains in place under the OBBBA.

When do the OBBBA Medicaid changes take effect?

As of August 2026, the new work requirements and six-month redeterminations are already in effect in Nebraska and Montana, with Arkansas notifying enrollees ahead of a January 1, 2027 compliance start and Iowa following in December 2026. All other states must comply by January 1, 2027.

Who is covered by the AI/AN and Urban Indian Medicaid exemption?

Indians, Urban Indians, California Indians, and individuals otherwise determined eligible for services from the Indian Health Service.

FOR IMMEDIATE RELEASE

WASHINGTON, D.C. (August 7, 2026)– The National Council of Urban Indian Health (NCUIH) applauds the U.S. Senate’s confirmation of Mark Cruz (Klamath Tribes) as Director of the Indian Health Service (IHS). The Senate confirmed Mr. Cruz today, following a favorable vote by the Senate Committee on Indian Affairs (SCIA) on July 22, 2026, and a nomination hearing before SCIA on June 24, 2026.

Director Cruz’s confirmation ends more than a year without a Senate-confirmed IHS Director, which began when former Director Roselyn Tso (Navajo) resigned at the start of the current administration. NCUIH previously stressed the importance of appointing a permanent IHS Director and called for the elevation of the role to Assistant Secretary. IHS Chief of Staff Clayton Fulton has served in an acting capacity since December 2025.

As IHS Director, Director Cruz will oversee a nationwide health care delivery system serving approximately 2.8 million American Indians and Alaska Natives through the Indian health system. Mr. Cruz will continue to jointly serve as Senior Advisor to HHS Secretary Robert F. Kennedy Jr., where he is one of the highest-ranking Native officials within the Department.

During his confirmation hearing, Director Cruz pledged his commitment to the work ahead, stating: “Tribal leaders and Congress can count on me to engage early, listen carefully, and be transparent. I am realistic about the challenges but optimistic about what we can achieve together. With strong federal, Tribal, and urban Indian health partners, outcomes will continue to improve.”

Director Cruz’s confirmation drew broad support from Indian Country. The National Congress of American Indians (NCAI) applauded the nomination and called for the Senate’s swift confirmation, citing Cruz’s advocacy for historic increases in IHS appropriations, his work mobilizing more than 70 Public Health Service officers to IHS facilities, and his efforts to reduce barriers for Tribal Nations developing culturally grounded health responses. The committee received more than 40 letters from Tribes and Tribal organizations in support of his confirmation.

NCUIH will continue to engage with Director Cruz and IHS on priorities including full and stable funding for IHS including urban Indian health, Medicaid parity for UIOs, and investments in Native behavioral health programs.

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