In this Edition:

💰 FY 2026 Labor HHS: House bill released; Indian Country program levels increase in several lines.
🤝 Coalition Advocacy: CTS letter to OMB on Executive Order 14332 and Trust/Treaty obligations.
⚖️ Parity & Stability: Urban Indian Health Parity Act reintroduced; bipartisan Advance Appropriations bill returns.
🏥 OBBBA RHTF: CMS opens state NOFO; UIO eligibility clarified; AZ consultation proposes 10% set-aside.
📑 AI/AN Medicaid Exemptions: CMS one-pager affirms protections and state implementation support.
💉 Vaccines: CDC ACIP meets Sept. 18–19 (COVID-19, RSV, HepB, MMRV).
🧠 Behavioral Health: Native Connections grant sustainability concerns from UIOs.
💛 Diabetes Leadership: UIO representation at IHS Tribal Leaders Diabetes Committee.
🔄 IHS Engagement: NCUIH comments on IHS strategic realignment and PATH EHR scope.
📊 FY 2028 Budget Formulation: Area consultations anticipated to begin in November.
📆 Save the Dates: UIO Focus Groups (Oct. 7–9), UIO Caucus (Oct. 20), IHS–UIO Federal Summit (Oct. 21–23), STAC/DSTAC (Sept. 22–26), NCUIH Policy Workgroup (Oct. 15).

National Tribal Health Conference 2025

National Indian Health Board Hosts NTHC
(Sept. 8–12, Phoenix, AZ)

NCUIH actively represented Urban Indian Organizations throughout the NIHB National Tribal Health Conference in Phoenix, Arizona, with multiple sessions, activities, and opportunities to spotlight UIO leadership.

Exhibit Hall Booth: Shared resources with attendees, including our Pew Behavioral Health toolkit, Hope for Life Day information, NCUIH 2026 Annual Conference Save the Dates, while engaging leaders and Tribal partners.

Federal Engagement: Met with Dr. Hartwig, the new Senior Advisor at the Indian Health Service, alongside Self-Governance Communication and Education Tribal Consortium and the National Indian Health Board.

Meredith Raimondi, Vice President of Policy and Communications, joined a panel on advocacy and messaging strategies, sharing NCUIH’s approach to advancing policy priorities and amplifying UIO perspectives in federal conversations.

Thank you to the National Indian Health Board (NIHB) for convening this year’s National Tribal Health Conference and to the Gila River Indian Community for hosting. Your partnership created a productive space for Tribal and Urban Indian Organization leaders and federal partners to advance shared priorities in Native health – in a good way.

Appropriations and Fiscal Policy Updates

Labor–Health and Human Services (LHHS) Bill – House Action

► FY 2026 HHS: $108B – $7B below FY25, $22B above President’s request, $8B below Senate proposal.
○ Does not fund the Administration for a Healthy America.
○ Make America Healthy Again Initiative: $100M (10% set-aside for Tribes, Tribal organizations, UIOs, and health service providers to Tribes serving rural communities).

This is a new funding line item that would allow the Secretary to invest in prevention innovation programs for rural communities and telehealth resources for chronic care and nutrition services. The Committee encourages the Secretary to support opportunities for advancing telemedicine tools and remote monitoring technologies at universities. This research should support studies on the efficacy of virtual care for managing chronic illnesses, development of AI-assisted telehealth platforms, and training programs for healthcare providers on integrating remote solutions into standard practice.

► Indian Country Programs:
○ Good Health and Wellness in Indian Country: $30M (+$6M)
○ Improving Native American Cancer Outcomes: $14M (+$8M)
○ Minority HIV/AIDS Fund – Tribal Set Aside: $6M
○ Tribal Behavioral Health Grants (Native Connections): $30M (+$6.3M)

Next Steps: House and Senate leadership to reconcile final bill.

The House released their text for a Continuing Resolution

Timeframe: The CR will go from September 30 to November 21.
SDPI: Reauthorizes SDPI for the CR period and provides $22.7 million in funding.

Next steps: The House passed the bill on September 19. However, the Senate was unable to pass the bill. The Senate will need to come to an agreement by September 30 to prevent a government shutdown.

Federal Advocacy and Policy Updates

► One Big Beautiful Bill Act Implementation

CMS confirmed AI/AN exemptions from cost sharing, work requirements, and frequent eligibility redeterminations, and will provide guidance and TA to ensure proper implementation.
Sept. 15: CMS released a Notice of Funding Opportunity (NOFO) for States to apply for Rural Health Transformation Fund (RHTF).
UIOs considered CMS FQHCs (CMS definition differs from HRSA’s); UIO eligibility affirmed.
Aug. 19: NCUIH sent template letters to UIOs for state submissions to CMS.
Tribal Consultation in Arizona held Sept. 11; proposals included a 10% state set-aside for Indian Country.

Action: 1. Encourage your state to hold Tribal consultation and urban confer.

2. Engage in Urban Confer/Tribal Consultation with your state on RHTF plans.

► Indian Programs Advance Appropriations Act

Reintroduced by Rep. Betty McCollum (D-MN), Rep. Tom Cole (R-OK), Sen. Mullin (R-OK), and Sen. Luján (D-NM).
Legislation would authorize advance appropriations to the Indian Health Service, Bureau of Indian Affairs, and Bureau of Indian Education to avoid funding lapses due to delays in enacting annual federal spending bills.

► Urban Indian Health Parity Act (H.R. 4722)

Reintroduced by Reps. Ruiz (CA-25) and Bacon (NE-02).
NCUIH is working to secure Republican co-sponsors.
Request for UIOs: Email Republican offices to sign on.

► American Indian and Alaska Native (AI/AN) Medicaid Exemptions

CMS confirms AI/AN exemptions from cost sharing, work requirements, and frequent eligibility redeterminations.
CMS will provide guidance and TA to ensure proper implementation.

Health & Behavioral Health Updates

► Vaccines

Sept. 18–19: Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) meeting — topics include COVID-19, respiratory syncytial virus (RSV), influenza, hepatitis B, and measles-mumps-rubella-varicella (MMRV).
AHIP (America’s Health Insurance Plans) reaffirmed that health plans will continue covering all ACIP-recommended immunizations as of September 1, 2025 — including updated COVID-19 and influenza vaccines — with no cost-sharing for patients through the end of 2026.
Questions for Urban Indian Organizations (UIOs): Are you administering COVID-19, RSV, and/or influenza vaccines? Which remain uncertain?

► SAMHSA Native Connections Grant

Several UIOs report grant funding ending, raising sustainability concerns.
NCUIH has engaged with HHS for clarity. The administration has directly requested the information below. Your responses are critical to protecting the program.
Questions for UIOs: Can you share measurable results and positive outcomes from this grant?

► Tribal Leaders Diabetes Committee Update

Sept. 16–17: NCUIH represented UIOs at IHS Tribal Leaders Diabetes Committee.
Adrianne Maddux [picture above alongside Chairman Rep.Jeff Hurd, CO-03] represented UIOs as the NCUIH representative.

Key Updates:

TLDC recommendation to IHS on Realignment: Conduct Tribal Consultation/Urban Confer once they have a finalized plan.
SDPI grantees can request supplemental funding for SDPI if their area has unobligated balances. Grantees can make one request per year only if the Tribe/UIO has spent down all of their funds. Grantees can with their area office on their request.

IHS Engagement & Consultations

► IHS Strategic Realignment – NCUIH Comments (Aug. 28)

Protect Urban Health line item.
Maintain dedicated IHS branch for urban Indian health.
Clarify role of 2023–2027 OUIHP Strategic Plan.
Advocate for 100% FMAP.
Hold additional Urban Confer sessions and develop HHS-wide Urban Confer policy.
Strengthen Area Office collaboration with IHS facilities.
Fill vacancies and preserve IHS Tribal advisory groups.

► PATH EHR Modernization – NCUIH Comments (Sept. 6)

Clarify mobile app capabilities.
Provide training periods before go-live to account for staff/time constraints.
Ensure PATH EHR capabilities include the ability to document social services provided at UIOs, including Traditional Healing and Medicine services

► FY 2028 Budget Formulation

Area budget formulation meetings for Fiscal Year 2028 are anticipated to begin in November.
UIO participation in Area Consultations is essential to secure urban line-item funding. NCUIH will share information on the Area Budget Formulation meetings and assist UIOs in preparing for their Area Consultations in October.
Action: Share consultation details with NCUIH at Policy@NCUIH.org.

Upcoming Summits and Meetings

► NCUIH UIO Caucus and Tacos

Oct. 20 | Indian Gaming Association, Washington, DC.
Please RSVP by October 14

► IHS UIO and Partner Federal Agencies Summit

Oct. 21–23 | HHS Humphrey Building (Room 800), Washington, DC.
Objectives: Introduce federal partners, share priorities, and explore collaboration.

► NCUIH UIO Focus Groups

Oct. 7 | Full Ambulatory (1–2 p.m. ET), Outpatient/Residential (3–4 p.m. ET).
Oct. 8 | Limited Ambulatory (1–2 p.m. ET), Outreach/Referral (3–4 p.m. ET).
Oct. 9 | Make-Up Session (1–2 p.m. ET).
Topics: 2026 Policy Priorities, 2025 accomplishments/challenges, candid feedback.

► Other Key Dates

September 18: Department of Urban Indian Affairs (DUIA) (Formerly OUIHP)-Urban Program Executive Directors/Chief Executive Officers Monthly Conference Call
Sept. 22–26: HHS Secretary’s Tribal Advisory Committee (STAC) and IHS Direct Service Tribes Advisory Committee (DSTAC) meetings (Martha’s Vineyard, MA)
September 30: Department of Justice (DOJ) Office of Violence Against Women (OVW) Task Force on Research on Violence Against American Indian and Alaska Native Women Meeting
Oct. 15: NCUIH Monthly Policy Workgroup (Virtual).

Federal Engagement Highlights

► Coalition for Tribal Sovereignty (CTS)

Aug. 28: Letter to OMB urging that implementation of EO 14332 (Improving Oversight of Federal Grantmaking) not undermine federal trust and treaty obligations.
CTS continues as a unifying voice of inter-tribal, policy-oriented organizations.
[Resource: www.coalitionfortribalsovereignty.org]

About CTS: The Coalition for Tribal Sovereignty (CTS) is a collaborative alliance that serves as a powerful unifying voice of regional and national inter-tribal policy-oriented, non-profit organizations to engage with federal policymakers on critical issues affecting the sovereign interests, rights, and authorities of Tribal Nations, tribal citizens, and community members across the United States.

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.

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