IHS Finalizes Reorganization Office of the Director, Creates the Office of Tribal and Urban Affairs and the Division of Urban Indian Affairs

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On January 8, 2025, the Indian Health Service (IHS) published a final notice in the Federal Register amending Part G of the Statement of Organization, Functions, and Delegations of Authority of the Department of Health and Human Services (HHS) to reflect the IHS reorganization. IHS wrote that “[t]he purpose of this reorganization is to revise the current approved structure for the IHS, Office of the Director, Intergovernmental Affairs functions.” Importantly, this includes the establishment of the previously proposed Office of Tribal and Urban Affairs and Division of Urban Indian Affairs. This final notice does not include a request for feedback.

Background

In an October 10, 2024, letter to Tribal leaders and Urban Indian Organization (UIO) leaders (DTLL/DULL), IHS announced a proposed reorganization of IHS Headquarters Office of the Director (hereinafter “proposed reorganization”), which would then have impacts on how offices under the Deputy Director for Intergovernmental Affairs (DDIGA) are structured. IHS stated “[t]here are five primary objectives of the proposed reorganization, which adopts a One IHS model that:

  1. 1) Strengthens [IHS’] relationship with Indian Tribes and UIOs by streamlining operations and enhancing communications;
  2. 2) Enhances the business relationships with Indian Tribes through self-determination and self-governance;
  3. 3) Amplifies the work of the Agency with all partners by cultivating intergovernmental partnerships and furthering external relationships;
  4. 4) Modernizes the way the Agency supports Tribes pursuing [Indian Self-Determination and Education Assistance Act (ISDEAA)] opportunities by supporting ISDEAA negotiation teams across the Agency working under a One ISDEAA model; and
  5. 5) Fosters education and training throughout the entire IHS system on how ISDEAA interfaces with our everyday work.”

IHS also announced a November 13, 2024, Urban Confer and November 14, 2024, Tribal Consultation on the proposed reorganization. Enclosed with the DTLL/DULL, IHS included the draft IHS Headquarters Office of the Director Organizational Chart (hereinafter “draft organizational chart”). The draft organization chart for the proposed reorganization indicated that IHS planned to eliminate the Office of Urban Indian Health Programs (OUIHP) and create the Division of Urban Indian Affairs under the Office of Tribal and Urban Affairs. During the November 13, 2024, Urban Confer IHS stated that IHS envisions the Division of Urban Indian Affairs will be led by a director-like leader.

NCUIH’s Role

On December 16, 2024, the National Council of Urban Indian Health (NCUIH) submitted written comments to the IHS Director, Roslyn Tso, regarding IHS’ October 10, 2024, DTLL/DULL and November 13, 2024, Urban Confer on IHS’ proposed. In its comments following the Urban Confer, NCUIH submitted the following requests and recommendations to IHS:

  • Maintain a dedicated focus on urban Indian health
    • Clarify the role of the IHS OUIHP Strategic Plan
    • Clarify the role of the proposed Division of Urban Indian Affairs leader
  • Protect the Urban Indian Health line item
  • Ensure meaningful engagement with UIOs through Urban Confer throughout the reorganization process by hosting additional Urban Confers
    • Extend the written comment deadline
  • Clarify a timeline and next steps for the reorganization

NCUIH will continue to closely follow the reorganization.

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