NCUIH Urges the Indian Health Service to Protect the Urban Health Line Item During the Agency’s Strategic Realignment

On August 28, 2025, the National Council of Urban Indian Health (NCUIH) submitted written comments to the Indian Health Service (IHS) Acting Director, P. Benjamin Smith, regarding IHS’ June 13, 2025, Dear Tribal Leader and Urban Indian Organization (UIO) Leader letter (DTLL/DULL) and the July 28, 2025, virtual Urban Confer on the IHS Strategic Realignment. NCUIH recommended IHS protect the Urban Health line item and maintain a dedicated focus on urban Indian health.

Background on IHS Strategic Realignment

On June 13, 2025, IHS published a DTLL/DULL announcing IHS was initiating Tribal Consultation and Urban Confer to receive comments and recommendations regarding IHS’ Strategic Realignment.​ IHS described the goal of the Strategic Realignment as creating a “more accountable, efficient, and responsive IHS that maximizes resources and improves outcomes while simultaneously strengthening intergovernmental relationships for better service coordination and funding access.” ​​During the Urban Confer session on the Strategic Realignment, IHS shared the agency is still in the development phase. As part of the development phase, IHS was seeking feedback from relevant stakeholders, including Tribes and UIOs.

NCUIH’s Requests

Following the Urban Confer, NCUIH submitted the following requests and recommendations to IHS:

• IHS should consider the following as part of the realignment:
  • Protect the Urban Health line item
  • Maintain a dedicated focus on urban Indian health
    • Maintain a dedicated branch of IHS for urban Indian health
    • Clarify the role of the 2023-2027 Office of Urban Indian Health Programs Strategic Plan
    • Strengthen funding streams for UIOs by advocating for 100% Federal Medical Assistance Percentage (FMAP) for UIOs
  • Ensure meaningful engagement with UIOs during the realignment process through additional Urban Confer sessions
  • Engage with the U.S. Department of Health and Human Services (HHS) to develop a Department Urban Confer policy
• When evaluating what is working well and making adjustments that might be helpful, consider adjustments that benefit patient care:
  • Strengthening Area Offices’ relationships with Indian Health System facilities
  • Filling vacancies within IHS
• Preserve IHS’ Tribal advisory groups

NCUIH will continue to closely follow the development and implementation of IHS’ Strategic Realignment.