NCUIH Requests the Indian Health Service Strengthen Relationships with Area Offices Under the Proposed Realignment
On February 27, 2026, the National Council of Urban Indian Health (NCUIH) submitted written comments to the Indian Health Service (IHS) Chief of Staff, Clayton Fulton, regarding IHS’ November 13, 2025, and December 5, 2025, Dear Tribal Leader and Urban Indian Organization (UIO) Leader letters (DTLLs/DULLs) and January 15, 2026, virtual Urban Confer on the IHS Proposed Realignment.
In the written comments, NCUIH recommended IHS strengthen UIOs’ relationships with Area Offices as part of the Proposed Realignment, and emphasized the importance of protecting UIO contracts, addressing IHS staffing needs, and ensuring continued engagement with UIOs, while also highlighting the importance of 100% Federal Medical Assistance Percentage (FMAP) for UIOs.
NCUIH will continue to closely follow the development and implementation of IHS’ Proposed Realignment.
Background on the IHS Proposed 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’ Proposed Realignment. IHS described the goal of the Proposed 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 Proposed 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.
On November 13, 2025, IHS’ then-Acting Director, Ben Smith, published a DTLL/DULL announcing the next phase in the Agency’s proposed realignment which would include four in-person Tribal Consultation sessions and one virtual Urban Confer session. On December 5, 2025, the IHS Chief of Staff released a DTLL/DULL in response to requests for additional opportunities and added more in-person sessions and a virtual Tribal Consultation. IHS also released a realignment narrative, a draft re-organization chart, and a frequently asked questions document. During the second Urban Confer on the Proposed Realignment, IHS reiterated that no decisions had been made by IHS regarding the Proposed Realignment.
IHS also created a webpage on IHS’ website on the Proposed Realignment.
Next Steps
While the path forward is subject to change, IHS shared the Agency plans to have a Federal Register comment period (30 days) followed by a Federal Register notice with a “Transition to Future State” occurring between May and June of 2026. IHS stated that the Agency plans to continue to use Tribal Consultation and Urban Confer to keep Tribes and UIOs up to date on the Proposed Realignment.
