Friendship House Celebrates Investment in Healing-Centered Housing in San Francisco

/in /by

On January 16, 2026, Friendship House Association of American Indians welcomed California Governor Gavin Newsom and state officials to celebrate a landmark $31.4 million state investment in The Village SF, a Native-led approach to housing and healing in San Francisco.

The Village SF will serve as a comprehensive model by integrating recovery housing, behavioral health services, workforce pathways, and cultural programming in one location. This model reflects Friendship House’s more than 60 years of service to Native people through culturally grounded, trauma-informed care. Once fully operational, The Village SF is projected to serve over 7,000 community members annually.

NCUIH celebrates Friendship House’s leadership in demonstrating how Urban Indian Organizations can deliver community-driven solutions that strengthen health, stability, and connection for future generations.

NCUIH January Policy Update: Increase for Urban Indian Health, Federal Agency, and Advocacy Developments

/in /by

In this Edition:

  • 💰 $5 Million Increase for Urban Indian Health in Fiscal Year 2027
  • 📄 2025 Policy Assessment Released
  • 🏥 Indian Health Service Realignment: Comments Due February 9
  • ⚖ Court Grants Injunction on Health Resources and Services Administration 340B Rebate Pilot Program
  • 💬 Medicare and Medicaid Billing Challenges Request for Information
  • 💡 California Urban Indian Organization Social Determinants of Health Survey
  • 📅 Upcoming Events and Key Dates

Fiscal Year 2026 Appropriations Enacted with Increase for Urban Indian Health

Congress enacted Fiscal Year 2026 appropriations, including increased investments across Indian Health Service and Tribal health programs.

  • $95.42 million for Urban Indian Health, a $5 million increase over Fiscal Year 2025
  • $5.31 billion in advance appropriations for Fiscal Year 2027
  • Senate report language directing the Indian Health Service to explore an interagency working group to support Urban Indian Organizations

Additional provisions include:

  • $5 million for generators at Indian Health Service, Tribal, and Urban Indian facilities
  • $7 million for the Produce Prescription Pilot Program
  • $39.43 million for Tribal Epidemiology Centers

2025 NCUIH Policy Assessment Released

The National Council of Urban Indian Health released its 2025 Policy Assessment, which will inform the development of the organization’s 2026 policy priorities.

Key focus areas include:

  • Advance appropriations for the Indian Health Service
  • Impacts of federal policy changes on Urban Indian Organization funding
  • Executive orders affecting diversity, equity, inclusion, and accessibility programs
  • Achieving full Medicaid parity for Urban Indian Organizations
  • Strengthening the Urban Indian health workforce
  • Food is Medicine initiatives addressing food insecurity and health

→ Go Deeper: Access the Policy Assessment via the NCUIH Policy Resource Center.

Rural Health Transformation Funding Update

Rural Health Transformation Funding Awards in States

Several states have received Rural Health Transformation funding and included Tribes or Tribal organizations as partners, subrecipients, or priority populations in their state plans.

  • State awards range from approximately $160 million to $280 million
  • Multiple states explicitly list Tribes or Tribal organizations as subrecipients, including Michigan, Montana, Nebraska, and Oregon
  • Some states reference Tribal workforce development, training pipelines, and long-term retention strategies
  • New Mexico’s plan allows Tribes to apply directly for a competitive grant program funded through the state’s allocation

Why it matters: These state plans may present opportunities for Urban Indian Organizations to engage in implementation, partnerships, and future funding discussions.

Federal Agency Updates

Indian Health Service Realignment: Comments Due February 9

The Indian Health Service is seeking Tribal and Urban Indian Organization input on its proposed agency realignment.

  • Urban confer held January 15
  • NCUIH hosted a preparation session for Urban Indian Organizations on January 14
  • Written comments are due February 9, 2026 
  • NCUIH will provide a comment template for Urban Indian Organizations

Federal Court Update

Court Grants Injunction on Health Resources and Services Administration 340B Rebate Pilot Program

A federal court granted an injunction halting implementation of the Health Resources and Services Administration’s proposed 340B Rebate Pilot Program.

Why it matters: 

  • Prevents financial strain from paying full drug prices upfront
  • Avoids administrative disruptions to reimbursement and claims processing
  • Aligns with requests from the Secretary’s Tribal Advisory Committee and the Tribal Technical Advisory Group

NCUIH continues to advocate for exemptions for Indian health care providers.

Advocacy Highlights and Requests for Information

Medicare and Medicaid Billing and Claims Processing Challenges 

The National Indian Health Board’s Medicare, Medicaid, and Health Reform Policy Committee is collecting information on denied billing and claims processing challenges affecting Indian Health Service, Tribal, and Urban Indian providers.

  • Goal: Identify consistent issues across Indian Health Service Areas
  • Deadline: February 9, 2026 
  • Submissions will be de-identified and elevated to the Centers for Medicare and Medicaid Services Tribal Technical Advisory Group

Indian Health Service Loan Scholarship Program Recipients at Urban Indian Organizations 

NCUIH is seeking input from Urban Indian Organizations on participation in the Indian Health Service Loan Scholarship Program.

  • Does your organization currently employ any recipients of the Indian Health Service Loan Scholarship Program?
  • If your organization previously employed recipients, did they remain at your Urban Indian Organization after completing their service obligation?

How to Respond: Please share your responses by emailing policy@ncuih.org.

New NCUIH Research Opportunity (California Urban Indian Organizations)

Earn $750+ for Your Organization

The National Council of Urban Indian Health launched a survey to collect insights from California Urban Indian Organizations on key Social Determinants of Health affecting urban American Indian and Alaska Native communities.

  • Eligible organizations: California-based Urban Indian Organizations only
  • Stipend: $750+ per completed response
  • Limit: One response per Urban Indian Organization
  • Survey closes: January 31, 2026 

Go Deeper: Access the survey via the National Council of Urban Indian Health website.
Contact: Sophie Chishty, NCUIH Research Associate, at schishty@ncuih.org.

Federal Budget Process

Fiscal Year 2028 Indian Health Service Budget Formulation

  • Tribal request: $29.8 billion in full mandatory funding
  • Indian Health Service Area budget consultations held October–December
  • January 21–22: Area report presentation webinars
  • January 22: NCUIH presents Urban Indian Health priorities
  • February 10–11: National Tribal Budget Formulation Work Session

Upcoming Events and Important Dates

  • February 9: State of Indian Nations Address (Washington, District of Columbia)
  • February 10–12: National Congress of American Indians Executive Council Winter Session and Hill Day
  • February 12: Indian Health Service Tribal Summit (70th Anniversary)
  • February 18: National Council of Urban Indian Health Monthly Policy Workgroup (virtual)
  • February 19: Department of Urban Indian Affairs Executive Directors and Chief Executive Officers Call

2026 NCUIH Annual Conference

2026 NCUIH Annual Conference Registration Open

Join us for our 2026 Annual Conference on April 27–30, 2026, at The Westin Downtown in Washington, D.C. The conference will bring together Urban Indian Organizations, health leaders, policymakers, and partners to share strategies, strengthen systems, and advance urban Indian health nationwide. Programming includes UIO board training, two full days of conference sessions, and a Hill Day for Urban Indian Organizations. Registration and hotel room block are open!

NCUIH Annual Conference 2026 Website

 

Recent NCUIH Policy Blogs

NCUIH Policy Blog

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.

CMS Announces Rural Health Transformation Program Awards in All 50 States, Including Tribal Set-Asides and Initiatives in Several States

/in /by

On December 29, 2025, the Centers for Medicare and Medicaid Services (CMS) announced all 50 states will receive awards under the Rural Health Transformation Program (RHTP), which was created in the One Big Beautiful Bill Act (OBBBA). In 2026, states will receive first-year awards from CMS averaging $200 million with awards ranging from $147 million to $281 million. Importantly, many states included Tribal-specific components within their RHTP application abstracts.

Annual Allocations and Tribal Mentions for States with UIOs

State Total Annual Allocation Tribal Set Aside or Tribal Initiative1
Arizona $166,988,956
California $233,639,308
Colorado $200,105,604
Illinois $193,418,216
Kansas $221,898,008
Maryland $168,180,838
Massachusetts $162,005,238
Michigan $173,128,201 List Tribes or Tribal organizations as subrecipients of the state’s funding allocation.
Minnesota $193,090,618 Minnesota states that rural Tribal Nations are a potential subgrantee of its funding allocation.
Missouri $216,276,818
Montana $233,509,359 List Tribes or Tribal organizations as subrecipients of the state’s funding allocation.
Nebraska $218,529,075 List Tribes or Tribal organizations as subrecipients of the state’s funding allocation.
Nevada $179,931,608
New Mexico $211,484,741 Includes an initiative to “build and sustain a rural and Tribal health workforce by expanding local career pathways, strengthening clinical training pipelines and educational opportunities, and supporting long-term retention through housing, mentorship, and community-based incentives.” Also includes an initiative to “launch a competitive grant program that empowers rural, frontier, and Tribal communities in New Mexico to design and lead locally tailored health initiatives addressing unique challenges such as preventive care, behavioral health, non-medical drivers of health, and provider facility needs.”
New York $212,058,208 Includes information about partnering with Tribal Nations to implement their plans in the most effective way possible.
Oklahoma $223,476,949 Includes information about partnering with Tribal Nations to implement their plans in the most effective way possible.
Oregon $197,271,578 Oregon has a dedicated set-aside for the nine federally recognized Tribes in the state.
South Dakota $189,477,607
Texas $281,319,361
Utah $195,743,566 Includes information about partnering with Tribal Nations to implement their plans in the most effective way possible.
Washington $181,257,515 Washington states its initiatives will support, among other things, “increasing training capacity for Tribal providers, nurses and long-term care workers.”
Wisconsin $203,670,005 Includes information about partnering with Tribal Nations to implement their plans in the most effective way possible.

Background on the RHTP

The RHTP’s $50 billion in funds will be allocated to approved states over five years, with $10 billion available each year from 2026 through 2030. As directed by the OBBBA:

  • 50% of the funding is distributed equally among all approved states; and
  • 50% is allocated based on factors as described in the Notice of Funding Opportunity.

NCUIH will continue to monitor how the allocations under the RHTP will be distributed.

1Hobbs, Straus, Dean & Walker, LLP., General Memorandum 26-001, (2026, January 6), https://hobbsstraus.com/general_memo/general-memorandum-26-001/.

Fresno American Indian Health Project Marks the Opening of Renewed Native Wellness and Youth Services Spaces

/in /by

Fresno American Indian Health Project recently gathered community members, staff, and partners to mark the opening of its newly renovated Native Wellness and Youth Services spaces. The moment reflects continued investment in care that is shaped by community, culture, and trust. 

The renewed spaces were designed to better support Native youth and families accessing wellness and behavioral health services in Fresno. Community members and partners recognized the importance of environments that feel welcoming, grounded, and reflective of the people they serve. 

FAIHP continues to show how intentional spaces can strengthen care, connection, and long-term wellness for urban Native communities across California. 

Congressional Leaders Release Three Bill Minibus for FY 2026 with Increases for Urban Indian Health and Advance Appropriations for Indian Health Service

/in /by

On January 5, 2026, the House and Senate Appropriations Full Committee released a three bill appropriations minibus for fiscal year (FY) 2026 entitled the Commerce, Justice, Science; Energy and Water Development; and Interior and Environment Appropriations Act, 2026. The bill provides a total of $8.05 billion for the Indian Health Service (IHS), and $5.31 billion in advance appropriations for the agency for FY 2027. The bill also authorizes $95.42 million for urban Indian health– an increase of $5 million over the FY 2025 enacted amount. The bill also reaffirms the Senate report language directing IHS to explore the formation of an interagency working group aimed at supporting urban Indian organizations (UIOs).

Other key provisions include:

  • $5 million for generators at IHS/Tribal Health Programs/UIOs
  • $7 million, a $4 million increase, for the Produce Prescription Pilot Program for Tribes and UIOs to increase access to produce and other traditional foods
  • $39.43 million, a $5 million increase, for Tribal Epidemiology Centers (TECs).

Next Steps

The minibus is expected to receive a vote by the House on January 8, 2026. Once it passes, the bill will head to the Senate for a vote. The bill is expected to pass both chambers.

Background

The National Council of Urban Indian Health (NCUIH) is a longstanding advocate for full funding for IHS and urban Indian health and supports the recommendations of the Tribal Budget Formation Workgroup. On February 27, 2025, NCUIH board president-elect and Oklahoma City Indian Clinic CEO Robyn Sunday-Allen (Cherokee) testified before the House Appropriations Subcommittee on Interior, Environment, and Related Agencies, urging full funding for urban Indian health and the Indian Health System.

NCUIH is also grateful for the support of the Senators and Representatives working to support the health of Indian Country. On May 15, 2025, 60 Congressional leaders joined Representative Leger Fernandez in a bipartisan letter to Chairman Simpson and Ranking Member Pingree of the House Interior Appropriations Committee requesting support for Urban Indian Health, maintaining advance appropriations for IHS, and protecting IHS from sequestration. The letter emphasized that the federal government has a trust responsibility to provide federal health services to maintain and improve the health of American Indian and Alaska Native people. On May 21, 2025, 19 Senators joined Senator Tina Smith in a similar letter to Chair Lisa Murkowski (R-AK) and Ranking Member Jeff Merkley (D-OR) of the Senate Interior Appropriations Committee.

Bill Highlights

Line Item FY 25 Enacted FY 26 Tribal Request FY 26 Senate Proposed FY 26 House Proposed FY 26 Enacted
Urban Indian Health $90.42 million $770.5 million $90.4 million $105.99 million $95.42 million
Indian Health Service $8.22 billion $63 billion $8.1 billion $8.41 billion $8.05 billion
Advance Appropriations $5.19 billion ______________ $5.3 billion $6.05 billion $5.3 billion
Hospital and Clinics $2.5 billion $13.8 billion $2.65 billion $2.85 billion $2.63 billion
Tribal Epidemiology Centers $34.4 million ______________ ______________ $44.43 million $39.4 million
Mental Health $127.1 million $4.76 billion $131.3 million $144.95 million $133.69 million

Additional Key Provisions:

Produce Prescription Pilot Program: $7 million

Bill Report, Pg. 60: The recommendation includes $7,000,000 for IHS to expand, in coordination with Tribes and Urban Indian Organizations (UIOs), the Produce Prescription Pilot to implement a produce prescription model to increase access to produce and other traditional foods among its service population.

  • This represents a $4 million increase.
Contract Support Costs – $ 1,819 billion and Tribal 105(l) leases – $366 million

Bill Report, Pg. 60: The bill provides an indefinite appropriation to fully fund contract support costs, which are estimated to be $ 1,819,000,000 in fiscal year 2026.

  • This represents a $217 million decrease.

Bill Report, Pg. 60: The bill provides an indefinite appropriation to fully fund payments for Tribal leases. which are estimated to be $366,000,000 in fiscal year 2026.

  • This represents a $34 million decrease.
Purchased and Referred Care – $997 million
  • This is level funding for the line item.
Indian Health Professions: $84.57 million
  • This represents a $4 million increase.
Sanitation Facilities Construction: $107.94 million

Bill Report, Pg. 62: The agreement provides $107,943,000 for Sanitation Facilities Construction.

  • This represents a $1.3 million increase.
Health Care Facilities Construction: $184.68 million

Bill Report, Pg. 62: The agreement includes $184,679,000. including $13,000,000 for staff quarters for staff housing across the IHS health care delivery to support the recruitment and retention of quality healthcare professionals across Indian country.

  • This represents a $2 million increase.
Equipment – Generators: $5 million
Dental Health: $260.36 million

Bill Report, Pg. 60: The recommendation includes $260,360,000 for Dental Health, including $6,500,000 for Dental Support Centers and continues funding for Electronic Dental Health Records.

  • This Represents a $6.24 million increase.
Alzheimer’s Disease: $6 million

Bill Report, Pg. 60: The agreement provides $6,000,000 to continue Alzheimer’s and related dementia activities.

Maternal Health: $8 million

Bill Report, Pg. 60: The agreement provides $8,000,000 for Improving Maternal Health.

Alcohol and Substance Abuse: $267.08 million
  • This represents a $309,000 increase.
Bureau of Indian Affairs, Missing and Murdered Indigenous Women Initiative: $18. 5 million

Bill Report, Pg. 32: The recommendation includes $27.094,000 for Law Enforcement Special Initiatives, including $ 18,500,000 for the Missing and Murdered Indigenous Women Initiative.

  • This represents a $2 million increase.

Partnership for Medicaid Urges CMS Guidance for AI/AN Medicaid Exemptions Under the One Big Beautiful Bill Act

/in /by

On November 25, 2025, NCUIH joined the Partnership for Medicaid in a letter to the Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz sharing requests and recommendations regarding the implementation of the One Big Beautiful Bill Act (OBBBA) (H.R. 1). NCUIH worked with the Partnership to urge CMS to reiterate the exemption of American Indian and Alaska Native (AI/AN) beneficiaries from the new Medicaid requirements in its guidance to states.

Read the full letter here.

Background on OBBBA and AI/AN Medicaid Exemptions

On July 4, 2025, the President signed the OBBBA into law. The OBBBA is a major bill that delivers many elements of President Trump’s legislative agenda, including new requirements for access to Medicaid and Supplemental Nutrition Assistance Program (SNAP). Indians, Urban Indians, California Indians, and individuals determined eligible as an Indian for the Indian Health Service under regulations promulgated by the Secretary are exempted from the Medicaid requirements in the OBBBA and included in exemptions for the SNAP work requirements.

Read more about these exemptions in NCUIH’s overview of the OBBBA resource.

About the Partnership for Medicaid

NCUIH is a member of the Partnership for Medicaid, which is a nonpartisan, nationwide coalition of organizations representing clinicians, health care providers, safety-net health plans, and counties. The goal of the coalition is to preserve and improve the Medicaid program.

NCUIH Releases 2025 Annual Policy Assessment

/in /by

The Policy Assessment informs Urban Indian Organizations policy priorities for 2026, identifies barriers to closing funding gaps, opportunities to strengthen the workforce, and building community resources for Urban Native communities.

The National Council of Urban Indian Health (NCUIH) is pleased to announce the release of its 2025 Policy Assessment. This assessment was developed based on the 5 focus groups by UIO facility type (full ambulatory, limited ambulatory, outreach and referral, and outpatient and residential) between October 7-9, 2025, as well as a written survey sent out via email to all 41 UIO leaders. The focus groups and survey provided an invaluable opportunity to reflect on the achievements and challenges of 2025, fostering a deeper understanding of the progress made and the areas that require further attention.

Together these focus groups allow NCUIH to work with UIOs to identify policy priorities in 2026 and identify barriers that impact delivery of care to Native patients and their communities. Of the 41 UIOs, 20 attended the focus groups and/or participated in a survey. This is the sixth year that NCUIH has conducted the assessment via focus groups sessions.

Read the 2025 Policy Assessment

Overview of the Policy Assessment

During the focus group sessions, UIO leaders had the opportunity to share their opinions on the successes and challenges they experienced in 2025. UIO leaders also provided input on the policy areas they would like to see the greatest policy support from NCUIH. Some of the key policy priority areas identified included increasing funding for IHS and urban Indian health line items, the importance of advance appropriations, securing 100% Federal Medical Assistance Percentage (FMAP) for UIOs, and implementing food is medicine programs.

Key Findings from the Policy Assessment are as follows:

  • Advance Appropriations for the Indian Health Service Prove Critical to Maintaining Services in the Shutdown
  • Impacts of Federal Policy Changes on Urban Indian Organization Funding
  • Impact of DEIA Executive Orders on Urban Indian Organizations
  • Achieving Parity: Extending 100% Federal Medicaid Assistance Percentage to Urban Indian Organizations
  • Strengthening the Workforce to Support Urban Indian Organizations
  • Food is Medicine: Addressing Food Insecurity and Health

Next Steps

NCUIH will use this assessment to develop a comprehensive document of the 2026 Policy Priorities.

Past Assessments and Priorities

NCUIH December Policy Update: Legislative, Agency, and IHS Developments

/in /by

In this Edition:

  • 📊 Government Shutdown Ended & FY 2025 Funding Extended
  • 🤝 NCUIH at the 2025 NCAI Annual Convention & Marketplace
  • 💻 NCUIH Comment Submission on IHS Health IT Modernization
  • 🏷 NCUIH Requests UIO Exemption from HRSA’s 340B Rebate Model Pilot Program
  • 🗓 IHS Tribal Consultation & Urban Confer on Agency Realignment
  •  🩺 Updates from the IHS Tribal Leaders Diabetes Committee (TLDC)
  •  💬 CMS Tribal Technical Advisory Group (TTAG) Meeting Highlights
  •  📘 CMS Guidance on AI/AN Exemptions in OBBBA Medicaid Work Requirements
  •  📝 CMS Informational Bulletin on OBBBA Medicaid & CHIP Provisions
  •  👥 Federal Hiring Freeze Lifted & IHS Staffing Updates
  •  🎗 IHS Request for Urban Cancer Care Services Data for Mapping Initiative
  •  📈 IHS FY 2028 Budget Formulation Updates

NEW: Strategy Guide Release — Strategy 1: Strengthening Health Care Access for Urban American Indian and Alaska Native People

This month, NCUIH released Strategy 1 of our new multi-part Strategy Guide series designed to support Urban Indian Organizations in delivering high-quality, culturally grounded health care. Building on our Investing in Wellness: Financing Strategies for Behavioral Health in Indian Country work, Strategy 1 outlines practical ways to strengthen Medicaid reimbursement for behavioral health services and expand sustainable financing options that support prevention, treatment, and recovery efforts at UIOs

Explore Strategy One Material and Resources for UIOs: Visit the NCUIH Website

Government Shutdown Ended, Government Funded through End of January

On November 12, Congress passed a spending package keeping FY 2025 funding through January 30, 2026.
• SDPI funded at $53.15 million through January.
• Enhanced ACA subsidies were not extended.
• The Continuing Resolution (CR) reversed all Reduction In Force (RIF) actions taken since October 1 and prevents further RIFs during the CR period.
→ Go Deeper: Link to NCUIH analysis.

NCUIH in Action

NCAI 2025 Annual Convention & Marketplace

NCUIH President Walter Murillo co-chaired the Health Subcommittee.
Health resolutions that passed included:

  • UIO inclusion in Medicaid 1115 waivers
  • 15% HHS Tribal set-aside
  • Protecting IHS in Medicaid reforms
  • Extending FEHB to Tribal retirees
  • Safeguarding AI/ANs in OBBBA
  • Codifying HHS Tribal advisory committees
  • Preserving Medicaid reimbursement rates
  • Supporting Native youth leadership in substance-abuse prevention
Resolutions

NCUIH also participated in:

  • December 4 – Pharmaceutical Research and Manufacturers of America Annual Holiday Partner Celebration  – Connecting with health sector partners and stakeholders.

  • December 9- Partnership for Medicaid End-of-Year Meeting – Strengthening collaboration with coalition members and contributing to shared Medica55id policy priorities affecting Urban Indian Organizations.

  • December 11 – NCUIH with Rep. Adelita Grijalva (AZ-07) at the House Natural Resources Subcommittee on Indian and Insular Affairs hearing on Modernizing the Implementation of 638 Contracting at the Indian Health Service.

NCUIH Comment Submission on Indian Health Service Health Information Technology Modernization

NCUIH Comment Submission on Indian Health Service Health Information Technology Modernization

  • Background: NCUIH submitted comments requesting clarity on 24-hour technical support, functionalities of the Patients at the Heart electronic health record, documentation pathways for Traditional Healing, and continued engagement with Urban Indian Organizations.
  • NCUIH recommended: Ongoing consultation and transparent implementation planning.

NCUIH Request for Urban Indian Organization Exemption from 340B Rebate Pilot

  • Background: NCUIH submitted a formal letter requesting the Health Resources and Services Administration to exempt Urban Indian Organizations and Indian Health Care Providers from the proposed 340B Rebate Model Pilot due to financial and administrative burdens.
  •  NCUIH recommended: Full exemption for the Indian Health Service, Tribal, and Urban Indian health system.

Indian Health Service Agency Realignment Tribal Consultation and Urban Confer

February 9, 2026 — Indian Health Service Agency Realignment Tribal Consultation and Urban Confer 

  • Background: The Indian Health Service is gathering Tribal and Urban Indian Organization feedback on its proposed organizational realignment.
  • What’s Next: Written comments are due February 9, 2026, and may be submitted through the Indian Health Service consultation portal or emailed to urbanconfer@ihs.gov.

UIO Important Dates:

  • Urban Confer (virtual only): Thursday, January 15, 2026, 1:00 – 4:00 PM ET (rescheduled from Jan. 8)
  • NCUIH will be holding a virtual prep session for UIOs on January 14, 2026, at 1pm ET.

Tribal Consultations  

UIOs are invited to the Tribal Consultations in-person to listen. 

  • December 15, 2025, 1:00 – 4:00 PM CT (Durant, OK)
  • December 16, 2025, 1:00 – 4:00 PM MT (Denver, CO)
  • December 17, 2025, 1:00 – 4:00 PM PT (San Diego, CA)
  • December 22, 2025, 2:00 – 5:00 PM ET (Virtual)
  • January 5, 2026, 1:00 – 4:00 PM MST (Flagstaff, AZ)
  • January 6, 2026, 1:00 – 4:00 PM PT (Seattle, WA)
  • January 7, 2026, 1:00 – 4:00 PM MST (Billings, MT)
  • January 8, 2026, 1:00 – 4:00 PM CST (Green Bay, WI)

Upcoming Events and Important Dates

IHS & Federal Agency Updates

IHS Tribal Leaders Diabetes Committee (TLDC) — Dec. 2 

  • SDPI FY 2026 funding: 6-month awards (Jan–June); remainder to be issued when Congress fully authorizes SDPI.

TLDC recommended: 
– 25% administrative supplements to all SDPI recipients (2026–27)
– Sharing area-level unobligated balances
– SDPI data impact analysis

Centers for Medicare & Medicaid Services Informational Bulletin Update

CMS TTAG Meeting — Dec. 8

  • Tribal guidance on OBBBA coming this winter.
  • CMS DTA pursuing Tribal exemption for HRSA’s 340B Model Rebate Pilot.
  • Ongoing vacancies: IHS Director and CMS DTA Director positions.
  • CMS encourages Tribal–state engagement for RHTP implementation.

On November 18, the Centers for Medicare & Medicaid Services issued an informational bulletin clarifying how Medicaid and Children’s Health Insurance Program provisions in the One Big Beautiful Bill Act apply to American Indians and Alaska Natives. The bulletin confirms that eligibility redeterminations, Medicaid community engagement requirements, and modified cost-sharing provisions do not apply to eligible American Indian and Alaska Native individuals, including Urban Indians. Additional guidance issued on December 8 reiterates that American Indians and Alaska Natives are excluded from Medicaid work requirements.

Federal Hiring Freeze Ended — Oct. 15 

  • IHS is preparing staffing plans under the Continued Accountability in the Federal Government’s Employment Executive Order.
  • Vacancies will begin to be filled once the plan approved.

IHS Staffing Updates 

  1. Clayton Fulton now carries out duties of Acting IHS Director.
  2. Benjamin Smith returns to Deputy Director.
  3. Darrell LaRoche resumes Deputy Director for Management.
  4. Dr. Rose Weahkee returns to Associate Deputy Director for Management Operations.

IHS Health IT Modernization — NCUIH Comments Submitted 
NCUIH requested:
• Clarification on 24-hour national helpdesk function
• Details on PATH EHR capabilities
• Support for Traditional Healing documentation
• Continuous engagement with UIOs throughout modernization

IHS Request for Urban Cancer Care Services Data 

IHS FY 2028 Budget Formulation 
• Tribal request: $29.8 billion mandatory funding for IHS
• January 21–22, 2026: Area report presentations
• February 10–11, 2026: National Budget Formulation Work Session

BADGES for Native Communities Act Update 

  • On December 12, 2025, the Bridging Agency Data Gaps and Ensuring Safety for Native Communities Act unanimously passed the United States Senate and now advances to the House of Representatives.
  • The bipartisan legislation strengthens Tribal public safety, improves reporting on Missing or Murdered Indigenous Peoples, and establishes a grant program to support coordinated response efforts.
  • Urban Indian Organizations are eligible entities under the grant program.

Reminder: One Big Beautiful Bill Act Resource for Urban Indian Organizations

NCUIH has developed a resource to help Urban Indian Organizations understand Medicaid and Children’s Health Insurance Program provisions under the One Big Beautiful Bill Act. The resource outlines which provisions apply to Urban Indian Organizations and clarifies protections and exemptions for American Indian and Alaska Native patients during state-level implementation.

UIO Input Request

NCUIH is continuing to engage with federal partners on several policy developments that may affect Urban Indian Organizations, including Indian Health Service (IHS) Realignment efforts and broader discussions related to care delivery and program administration.

To strengthen NCUIH’s advocacy and ensure UIO perspectives are accurately reflected,we invite UIOs to share feedback and experiences related to the following: 

  • IHS Realignment Participation: Are you planning to attend any upcoming in-person consultations related to IHS Realignment?
  • Realignment Concerns: Do you have concerns or considerations regarding the proposed IHS Realignment, particularly as it relates to UIO operations or service delivery?
  • Contract Centralization: How might the proposed centralization of contracts at IHS Headquarters, rather than through Area Offices, impact your organization? Are there specific concerns you would like NCUIH to elevate?
  • Food is Medicine Programs: Do any UIOs currently operate or plan to develop Food is Medicine programs specifically designed to support cancer patients?

Feedback shared will help inform NCUIH’s ongoing policy engagement, written comments, and participation in consultations and advisory discussions.

How to respond: UIOs are encouraged to share feedback by emailing policy@ncuih.org.

Save the Date: 2026 NCUIH Annual Conference

Join us for our 2026 Annual Conference on April 27–30, 2026, at The Westin Downtown in Washington, D.C. The conference will bring together Urban Indian Organizations, health leaders, policymakers, and partners to share strategies, strengthen systems, and advance urban Indian health nationwide. Programming includes UIO board training, two full days of conference sessions, and a Hill Day for Urban Indian Organizations. NCUIH is also accepting session and poster proposals, with submissions due January 15, 2026.

NCUIH Annual Conference 2026 Website

One Last Thing — Check Out This Upcoming Funding Opportunity

Urban Indian Organizations can now apply for funding to support culturally grounded overdose prevention projects.

Applications are due January 16, 2026, with awards of up to $45,000.

Our partners at Seven Directions and the National Network of Public Health Institutes are sharing materials to help spread the word—please repost or use the linked graphics to share this opportunity with your community.

Apply Here

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.

PRESS RELEASE: New Government Prescription Program Threatens Native Health Access, Exemption Needed for Indian Health Care Providers

/in , /by

FOR IMMEDIATE RELEASE

WASHINGTON, D.C. (December 17, 2025) – On December 8, 2025, the NCUIH sent a letter to HRSA Administrator, Thomas J. Engels, to request an exemption for UIOs and Indian Health Care Providers from the 340B Rebate Model Pilot Program. This request is consistent with a Tribal request that has been made by both the HHS Secretary’s Tribal Advisory Committee (STAC) and the Centers for Medicaid and Medicare Services (CMS) Tribal Technical Advisory Group (TTAG).

The National Council of Urban Indian Health (NCUIH) calls on the Health Resources and Services Administration (HRSA) to exempt Urban Indian Organizations (UIOs) and Indian Health Care Providers from HRSA’s 340B Rebate Model Pilot Program. This urgent request is to prevent the administrative and financial burden on UIOs and Indian Health Care Providers, and barriers to access to vital medications for American Indian and Alaska Native patients.

The Impact

Under the HRSA 340B Rebate Model Pilot Program, scheduled to begin January 1, 2026, covered entities will no longer receive 340B discounts at the point of purchase. Instead, entities must pay full Wholesale Acquisition Cost (WAC) upfront for 10 select drugs and later submit claims to receive manufacturer rebates. Medications used to treat diabetes, cardiovascular disease, and autoimmune conditions will increase substantially in cost for UIOs, which do not have the reserves to cover these costs while awaiting uncertain rebate payments.

25 out of the 41 UIOs across the country currently participate in the 340B program. UIOs that participate in the 340B program often have limited cash reserves and narrow operating margins, relying on 340B savings to support pharmacy services and access to vital medications for their American Indian and Alaska Native patients. For UIOs and Indian Health Care Providers, this model creates an immediate risk that threatens patient access to care.

Stats

The rebate model shifts financial risk from manufacturers to health care providers, creating new financial and operational challenges for UIOs:

  • Preliminary UIO feedback indicates that upfront drug purchasing costs range from $340,000 to $2.4 million annually for some UIOs that participate in the 340B program. Even temporary delays in rebate payments may significantly strain UIO operating budgets.
  • The pilot introduces new requirements for rebate claim submission, tracking, and reporting. These changes may require additional staffing, IT system capacity, and administrative resources.
  • Increased financial and operational pressures may affect the sustainability of UIO pharmacy operations and limit the ability to stock or dispense high-cost medications, jeopardizing access to medications for American Indian and Alaska Native patients.

Resources

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.

###

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

NCUIH Sends Letter to HRSA Seeking Exemption for UIOs and Indian Health Care Providers from the 340B Rebate Model Pilot Program

/in /by

On December 8, 2025, the National Council of Urban Indian Health (NCUIH) sent a letter to the Health Resources and Services Administration (HRSA) Administrator, Thomas J. Engels, to request an exemption for Urban Indian Organizations (UIOs) and Indian Health Care Providers from HRSA’s 340B Rebate Model Pilot Program. NCUIH made this urgent request to prevent the administrative and financial burden of the Program on UIOs and Indian Health Care Providers. This request is consistent with a Tribal request that has been made by both U.S. Department of Health and Human Services’ (HHS) Secretary’s Tribal Advisory Committee (STAC) and the Centers for Medicaid and Medicare Services (CMS) Tribal Technical Advisory Group (TTAG).

Read the full letter here.

Background on the 340B Rebate Model Pilot Program

On July 31, 2025, HRSA announced the voluntary 340B Rebate Model Pilot Program for drugs on the Centers for Medicare and Medicaid Services’ (CMS) Medicare Drug Price Negotiation Selected Drug List for year 2026 from qualifying manufacturers meeting specific criteria. Under the Program, covered entities continue to make purchases through their 340B wholesaler account and request rebates on select drugs after the purchase is made. Read here for more information on the Program.