IHS Chief of Staff Clayton Fulton Assumes Acting Director Role During Leadership Transition

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On December 2, 2025, the Indian Health Service (IHS) announced that Clayton Fulton, Chief of Staff for IHS, will assume all delegable authorities, duties, and functions of the IHS director as the agency in the absence of confirmed director. This delegation was made by the U.S. Department of Health and Human Services (HHS) HHS Secretary Robert F. Kennedy, Jr and will remain in place while the IHS director position continues to be vacant. At this time, the Administration has not submitted a nominee for the director position.

It was also announced that as part of the leadership shift, Benjamin Smith will return to his role as deputy director, and Darrell LaRoche will resume his position as deputy director for management operations. Additionally, Dr. Rose Weahkee concludes her service in an acting leadership capacity. Fulton expressed sincere gratitude for the dedication and leadership demonstrated by each of these individuals, especially during a time marked by significant responsibility. He also extended appreciation for their steadfast commitment to the agency and Tribal Nations.

Fulton emphasized that the mission of the Indian Health Service remains strong and unchanged. “We remain fully committed to upholding the government-to-government relationship and ensuring continuity of services and operations across the Indian health system. The work of raising the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level continues to guide every decision we make,” Fulton stated.

A citizen of the Cherokee Nation, Fulton holds a Juris Doctor from the University of Michigan Law School and an MBA from Northeastern State University. He reaffirmed his dedication to maintaining transparency, partnership, and open communication throughout the transition. “You have my commitment that IHS will maintain transparency, partnership, and open communication throughout this period. I look forward to continuing our work together to advance tribal health priorities and to support the delivery of high-quality, culturally grounded care across all our service areas,” he said.

Read more: https://www.ihs.gov/newsroom/pressreleases/2025-press-releases/ihs-chief-of-staff-clayton-fulton-assumes-delegable-duties-of-agency-director/

Indian Health Service Announces Next Phase of Agency Realignment, Invites Tribal and Urban Leader Feedback

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Four In-Person Consultations and One Virtual Session Scheduled Across the Country

On November 13, 2025, Acting Director Ben Smith of the Indian Health Service (IHS) sent a letter to Tribal Leaders and Urban Indian Organization Leaders announcing the next phase in the Agency’s proposed realignment. This initiative, first introduced in the summer of 2025, is stated with an intent “to transform the IHS into a more patient-centered, self-determination-driven, operationally efficient, and fiscally sustainable health care system”.

Director Smith’s letter emphasized the Agency’s commitment to high-quality, culturally responsive care and thanked Tribal and Urban Leaders for their active engagement and thoughtful input during the initial round of Tribal Consultation and Urban Confer. He noted that feedback received made it clear that a second round of consultation would be valuable as more details about the realignment structure become available.

NCUIH submitted comments in response to the first round of confer on August 28, 2025, and recommended additional confers to provide more opportunities for feedback.

According to IHS, the realignment seeks to modernize the Agency, enhance accountability, and better align leadership functions with its contemporary mission. Smith highlighted the importance of clarifying roles, reducing administrative burdens, and allowing leaders at both headquarters and in the field to focus on policy, oversight, and partnership. The letter states that approximately 62 percent of the IHS budget is managed by Tribes and Tribal organizations through Title I contracts and Title V compacts under the Indian Self-Determination and Education Assistance Act (ISDEAA), while the remaining 38 percent supports federally operated IHS hospitals, health centers, and programs. These statistics are provided as reasoning for the need to modernize the Agency.

“This modernization will strengthen patient care within IHS-operated facilities and elevate the Agency’s inherent Federal functions—ensuring that we are an effective partner and support system for self-determination, no matter how each Tribe chooses to exercise that right,” Smith wrote.

IHS will hold four in-person Tribal Consultation sessions and one virtual Urban Confer session.

Feedback from the sessions and written comments must be submitted by February 9, 2026. Comments for the Tribal Consultation should be emailed to consultation@ihs.gov, and Urban Confer comments to urbanconfer@ihs.gov, with the subject line “IHS Proposed Realignment.”

After the comment period, IHS will begin an internal deliberation phase to review all feedback before moving forward with the finalization and implementation of the realignment plan.

Read the Letter

Resource: Overview of the One Big Beautiful Bill Act Exemptions for American Indian and Alaska Native People 

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Download One-Pager

On July 4, 2025, the President signed the One Big Beautiful Bill Act (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 SNAP. Fortunately, 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 Supplemental Nutrition Assistance Program (SNAP) work requirements. 

Community Engagement Requirements for Certain Medicaid Beneficiaries 

What it Does: States are required to implement community engagement and work requirements for able-bodied adults without dependents beginning after December 31, 2026. Compliance may be achieved through working, volunteering, or participating in a work program for at least 80 hours/month; or enrolling in an educational program at least half-time. 

AI/AN People Exempted: The bill exempts American Indian and Alaska Native beneficiaries from these requirements.

Medicaid Redetermination Period 

What it does: State are required to conduct eligibility redeterminations at least every 6 months for Medicaid expansion adults beginning after December 31, 2026.  

AI/AN People Exempted: The bill exempts American Indian and Alaska Native beneficiaries from these requirements and maintains the 12-month Medicaid eligibility redetermination cadence.   

Modifications to SNAP Work Requirements for Able-Bodied Adults 

What it does: The provision institutes exemptions to the SNAP work requirements for able-bodied adults. 

AI/AN People Exempted: The bill exempts American Indian and Alaska Native beneficiaries from work requirements as part of SNAP eligibility.

Cost Sharing Requirements Under the Medicaid Program 

What it Does: States are required to impose cost sharing on Medicaid Expansion adults with incomes 100 – 138 percent of the federal poverty level (FPL). This cost-sharing is capped at $35 per service and may not exceed five percent of the individual’s income. 

Impact on Indian Country: The American Recovery and Reinvestment Act of 2009 mandates “no cost sharing for items or services furnished to Indians through Indian health programs.” This will remain in place. 

Download One Pager

NCUIH November Policy Update: Shut Down Ends, Federal Funding Developments, Advocacy Priorities, and New Resources for UIOs

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In this Edition:

  • 📡 Senate Hearing on Shutdown Impacts in Native Communities
  • 🏛️ Federal Funding Continued Through a New Continuing Resolution
  • 🎤 Congressional Briefing on Preventing Substance Use Disorder and Overdose
  • 📘 New Resources: AARP Family Caregiving Guide and Overview of the One Big Beautiful Bill Act (OBBBA)
  • 🏥 Updates on Affordable Care Act Premium Tax Credits for American Indian and Alaska Native People
  • 📝 Indian Health Service Fiscal Year 2028 Budget Formulation and Updated Information
  • 🤝 Tribal Government-to-Government Roundtable on Strengthening Tribal Sovereignty
  • 👥 Staffing Updates at the Department of Health and Human Services and the Indian Health Service
  • ⚖️ Office of Management and Budget Deregulatory Memo and New Supplemental Nutrition Assistance Program Provisions
  • 💊 Health Resources and Services Administration Updates on the 340B Rebate Pilot and the Ryan White Program
  • 📊 Data Standards Committee Updates on Medicaid Enrollment, Health Information Technology Modernization, and NCUIH’s New Substance Use Disorder Fact Sheet

Appropriations and Shutdown Updates

Senate Committee on Indian Affairs Oversight Hearing

On October 29, 2025 the Senate Committee on Indian Affairs (SCIA) held an Oversight hearing addressed shutdown impacts on Native communities.

Vice Chairman Senator Schatz stated:

  • “Native programs are not Diversity, Equity, and Inclusion spending or charity—they are the law.”
  • “Attempting to cancel funds for Native programs, RIFing more that 42,000 federal employees, and eliminating tribal consultation policies – that’s not the Unites States government meeting its trust and legal obligations.”

Continuing Resolution / Federal Funding

On November 12, 2025, Congress reached an agreement on a Continuing Resolution (CR) to maintain FY 2025 funding through January 30, 2026.

  • Prevents further shutdown disruptions that heavily impact Indian Country and Urban Indian Organizations.

The CR included language that reversed the RIF actions taken since October 1, as well as protections against future RIFs for the duration of the CR.

The CR also extended several key policy riders important to Indian country through January 30, 2026: 

  • Funding for the Special Diabetes Program for Indians (SDPI) at $159 million annualized.
  • Extension of the Medicare telehealth flexibilities, which allows IHS, Tribal, and Urban Indian programs to resume billing Medicare for tele-visits.
  • Extension of Community Health Center and National Health Service Corps funding.

Legislative Updates

Federal Medical Assistance Percentage (FMAP) Update

Bipartisan Urban Indian Health Parity Act (H.R. 4722): Ongoing advocacy for extending the Federal Medical Assistance Percentage increase for Urban Indian Organizations.

  • Reintroduced by Reps. Ruiz (CA-25) and Bacon (NE-02)
  • NCUIH is working to secure republican co-sponsors.
  • Request for Urban Indian Organizations: Email Republican offices to sign on to the House bill.

Special Diabetes Program for Indians (SDPI) 

Legislation supporting funding and reauthorization of SDPI has been introduced in the House and the Senate.

H.R.5488 – Bipartisan Special Diabetes Program for Indians Reauthorization Act of 2025

  • $160 million for FY 2026-2030

S.2211 – Bipartisan Special Diabetes Program Reauthorization Act of 2025

  • $160 million for FY 2026-2027

NCUIH Hosted Congressional Briefing

NCUIH hosted a congressional briefing on policy solutions to prevent Substance Use Disorder (SUD) and overdose in Native communities.

  • Kerry Hawk-Lessard of Native American LifeLines presented on local initiatives and community-based efforts.
  • NCUIH called on Congress to fund behavioral health programs that serve Native communities, especially in urban areas.

Highlights emphasized:

  • The urgent need for culturally grounded prevention and treatment.
  • The role of Urban Indian Organizations (UIOs) as essential access points.

New Resources Highlight

Overview of the One Big Beautiful Bill Act (OBBBA)

NCUIH has developed a one pager on key provisions and exemptions impacting American Indian and Alaska Native people in the OBBBA.

AARP Family Caregiving Guide

  • The AARP Family Caregiving Guides support people navigating all stages of caregiving.

The guides include resources to:

  • Find help assessing needs.
  • Start important conversations.
  • Evaluate your loved one’s needs.
  • Develop or update a caregiving plan.
  • Coordinate help while maintaining caretaker well-being.
  • Manage grief and plan for life after caregiving.

Access here: https://www.aarp.org/caregiving/prepare-to-care-planning-guide/

Substance Use Disorder Fact Sheet​​

NCUIH Policy and Data Teams developed a new two-page fact sheet addressing:

  • Disparities in overdose deaths among American Indian and Alaska Native people.
  • The essential role of Urban Indian Organizations.
  • Policy recommendations and needed federal actions.
  • Fact sheet available for download on the NCUIH website.

NCUIH Advocacy for Premium Tax Credits

The letter highlights new analysis illustrating the impact on American Indian and Alaska Native families if enhanced premium tax credits expire. The Urban Institute estimates show:

  • A significant portion of American Indian and Alaska Native people (318,000) rely on Marketplace plans with premium tax credits.
  • Without enhanced tax credits, many (126,000) would lose coverage—representing an estimated 40 percent reduction for American Indian and Alaska Native enrollees.

NCUIH continues advocating for restored and enhanced Affordable Care Act premium tax credits for American Indian and Alaska Native families.

Indian Health Service Fiscal Year 2028 Budget Formulation

Indian Health Service has begun Fiscal Year 2028 budget formulation consultations.

Urban Indian Organization participation remains important for:

  • Identifying priority service needs.
  • Ensuring representation in federal budget recommendations.

NCUIH Technical Assistance: 

  • NCUIH held a prep session for UIOs on October 15.
  • NCUIH sent out slide templates and talking points to UIOs by Area.
  • If your UIO would like to schedule a one-on-one session with NCUIH to prepare for your respective Area budget consultation, please don’t hesitate to reach out to policy@ncuih.org.

Upcoming scheduled consultations:  

  • Phoenix: December 2-3, 9am-5pm AZ time (Hybrid)
  • Alaska: December 9-11
  • California: December 10
  • Great Plains: December 10, 9am-3pm CST (virtual)

Updated Information Overall Funding Target  

  • The total funding amount to meet for fiscal year 2028 is $29.8 billion.
  • This recommendation is $43.2 billion less than the previous year’s recommendation.
  • Due to the drastic decrease in recommended funding, the total recommendation for the Urban Health line item will likely be considerably less than previous years.
  • NCUIH sent out updated resources with updated numbers.

Tribal Government-to-Government Roundtable Series

Third convening focused on preserving, protecting, and strengthening Tribal sovereignty.

NCUIH connected with:

  • Rep. Begich (R-AK), Vice Chair of the Native American Caucus
  • HHS Secretary Robert Kennedy Jr.
  • HHS Senior Advisor Mark Cruz
  • HHS Senior Advisor for Medicaid, Charles Chapman
  • White House Office of Intergovernmental Affairs
  • Tribal leaders

Federal Staffing Updates: IHS Announces New Chief of Staff

Indian Health Service

The Indian Health Service announced a new Chief of Staff, Clayton Fulton (Citizen of the Cherokee Nation)

  • Responsible for overseeing the coordination of key agency activities and supporting the Office of the Director in a broad range of duties related to the development and implementation of IHS initiatives and priorities.
  • NCUIH met with Clayton on Nov. 4 to discuss urban Indian health priorities.

NCUIH Leadership Meeting with Mark Cruz

  • The NCUIH Board met with Senior Advisor to the HHS Secretary, Mark Cruz, on October 21 to discuss federal priorities.

Reduction in Force (RIFs)  

  • IHS was not included in RIFs; HHS also extended that to tribal programs in other operating divisions.
  • There is ongoing litigation regarding the RIFs.

HHS Grants  

  • Cruz warned that funding may be cut across HHS authorizing divisions.
  • Please let NCUIH know if you have any issues with your grant funding.

HHS Key Staffing Updates  

  • IHS Director still has not been appointed. Acting Director Smith can serve until mid-November.
  • Dr. Kim Hartwood started at IHS as Chief of Strategic Initiatives.
  • The Senior Advisor who worked with Secretary Kennedy on SAMHSA matters, Chris Jones, resigned last Friday. Mark Cruz has been asked to caretake SAMHSA.
  • Administration for Children and Families has a new Assistant Secretary – Alex Adams. Has experience working with Idaho Tribes.

Regulatory Updates: Office of Management and Budget and U.S. Department of Agriculture

Office of Management and Budget Deregulatory Memo

The memo is on streamlining the administration’s deregulatory efforts.

  • Lays out guidance to agencies on how it should conduct Tribal consultation during a deregulation review process.
  • Discussed that most deregulatory efforts should not trigger Tribal consultation, and that if there is a need for Tribal consultation, that general notice and comment period for stakeholders is considered sufficient consultation.
  • Issues guidance on how political appointees can repeal regulations without a formal notice or comment period if the official deems the regulation unlawful.

U.S. Department of Agriculture Memo: Supplemental Nutrition Assistance Program (SNAP) Provisions in OBBBA 

OBBBA modifies exemptions to the Able-Bodied Adults Without Dependents (ABAWD) time limit rule of receiving SNAP for only 3 months in a 3-year period if they do not meet certain work requirements by:

  • Expanding the age range to 18-64 (previously 18-54)
  • Limits the exception for a parent with responsibility for a dependent child to children under 14 years of age (previously 18 years of age)
  • Eliminating certain exemptions (homeless individuals, veterans, and foster youth).

New Exceptions for AI/AN people are not subject to the time limit:

  • “An Indian” as defined in paragraph (13) of section 4 of the IHCIA;
  • “An Urban Indian” as defined in paragraph (28) of Section 4 of the IHCIA; and
  • “A California Indian” as described in section 809(a) of the IHCIA.

Health Resources and Services Administration (HRSA) Updates

340B Rebate Pilot Program

Background:

  • Under the Program, covered entities continue to make purchases through their 340B wholesaler account and request rebates on specific drugs dispensed to 340B eligible patients after the purchase is made.
  • All covered outpatient drugs, without a rebate model approved by HRSA, are subject to upfront discounted 340B prices.
  • The Office of Pharmacy Affairs (OPA) has approved eight manufacturers’ plans for participation in the 340B Rebate Model Pilot Program for the January 1, 2026, start date.
  • Ryan White HIV/AIDS Program

Background:

  • HRSA is proposing to implement a funding methodology that calculates Ryan White HIV/AIDS Program (RWHAP) Part A and B formula awards based on living HIV and AIDS case data. This methodology would use the most recent address, rather than residence at diagnosis.
  • The methodology for determining RWHAP Part A and B eligibility would remain unchanged.

Data Standards Committee Updates

Centers for Medicare & Medicaid Services Tribal Technical Advisory Group (TTAG) Data Subcommittee

Updates from July and August meetings:

  • National Indian Health Board presentation on Indian Health Service registrants enrolled in Medicaid from 2019–2023.
  • Some states with Medicaid expansion saw significant increases in enrollment.
  • In 2023, approximately 57.1 percent of Indian Health Service registrants were enrolled in Medicaid.
  • Wide variation in accuracy between Indian Health Service registrant data and the American Community Survey population across states.

No September or October updates due to the government shutdown.

Upcoming Tribal Consultations and Events

Consultation/Confer Dates:

  • Urban Confer (virtual only): Thursday, January 8, 2026, 1:00 – 4:00 PM ET
  • NCUIH will be holding a virtual prep session on January 7, 2025, at 1pm ET

Tribal Consultations (in person only):  

  • Monday, December 15, 2025, 1:00 – 4:00 PM CT (Durant, OK)
  • Tuesday, December 16, 2025, 1:00 – 4:00 PM MT (Denver, CO)
  • Wednesday, December 17, 2025, 1:00 – 4:00 PM PT (San Diego, CA)
  • Tuesday, January 6, 2026, 1:00 – 4:00 PM PT (Seattle, WA)

Comments:

  • Comment submissions close on February 9th, 2025.

Other Upcoming Events:

  • December 17: NCUIH Monthly Policy Workgroup (virtual)

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 Celebrates 25 Years of Native American LifeLines’ Service to Urban Native Communities

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Native American LifeLines (NAL) is celebrating 25 years of serving Native people in Baltimore and Boston. For a generation, NAL has worked to strengthen wellness and belonging for urban Native communities in both the Mid-Atlantic and Northeast regions through culturally grounded care and community connection.

Founded with a mission to promote health and social resiliency within urban Native communities, NAL applies principles of trauma informed care to provide culturally centered behavioral health, dental, outreach and referral services. Across both sites, NAL has fostered a place where Native people can gather, learn, access care, and remain connected to their identities.

NCUIH honors this milestone and recognizes the leaders, staff, and community members whose dedication continues to guide NAL’s impact.

Learn more about Native American LifeLines at nativeamericanlifelines.org

The Indian Health Service Establishes New Office for Indian Veterans Support

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The Indian Health Service (IHS) has announced the creation of a new Office for Indian Veterans Support to strengthen federal coordination and improve services for American Indian and Alaska Native veterans.

The office will be led by Capt. Carmen “Skip” Clelland, a citizen of the Cheyenne and Arapaho Tribes of Oklahoma. As Director, Capt. Clelland will guide efforts that support Native veterans’ health and well-being, serve as the primary liaison among IHS, the United States Department of Veterans Affairs, Tribes, Tribal organizations, and Urban Indian Organizations, and ensure that Native veterans’ needs are represented across federal systems. NCUIH will continue to follow this development and share updates relevant to Urban Indian Organizations and the veterans they serve.

NCUIH Calls for Protecting the Federal Programs and Workforce That Serve Indian Country

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On November 10, 2025, the National Council of Urban Indian Health (NCUIH) submitted written testimony to the Senate Committee on Indian Affairs (SCIA) in response to their October 29 oversight hearing entitled “Impacts of Government Shutdowns and Agency Reductions in Force on Native Communities.”

In the testimony, NCUIH requested the following:

  • Extending Advance Appropriations to All Indian Country Serving Programs
  • Reduction in Force (RIFs) Exemptions for All Federal Employees Serving Indian Country

Continuing Resolution Includes Protection from RIFs

On November 12, 2025, Congress passed a Continuing Resolution (CR) to fund the government through January 30, 2026. Included in the CR was language that reversed the federal workforce RIF actions taken since October 1, as well as protections against future RIFs for the duration of the CR.

Full Testimony Text

My name is Francys Crevier, I am Algonquin and the Chief Executive Officer of the National Council of Urban Indian Health (NCUIH), a national representative advocating for the 41 Urban Indian Organizations (UIOs) contracting with the Indian Health Service (IHS) under the Indian Health Care Improvement Act (IHCIA) and the American Indians and Alaska Native patients they serve. On behalf of NCUIH and these 41 UIOs, I would like to thank Chairman Murkowski, Vice Chairman Schatz, and Members of the Committee for your leadership to improve health outcomes for urban Indians and for the opportunity to provide testimony on the current impacts of the government shutdown. We respectfully request the following:

  • Extend Advance Appropriations to All Indian Country Serving Programs
  • Request Reduction in Force Exemptions for All Federal Employees Serving Indian Country

A Brief History on Urban Indian Organizations:

As a preliminary issue, “urban Indian” refers to any American Indian or Alaska Native (AI/AN) person who is living in an urban area, either permanently or temporarily. UIOs were created by urban AI/AN people with the support of Tribes, starting in the 1950s in response to severe problems with health, education, employment, and housing. Congress formally incorporated UIOs into the Indian Health System in 1976 with the passage of the Indian Health Care Improvement Act (IHCIA). Today, over 70% of AI/AN people live in urban areas. UIOs are an integral part of the Indian health system, comprised of the Indian Health Service, Tribes, and UIOs (collectively I/T/U), and provide essential healthcare services, including primary care, behavioral health, and social and community services, to patients from over 500 Tribes in 38 urban areas across the United States.

Advance Appropriations for the Indian Health Service Critical to Maintaining Services in the Shutdown

The historic inclusion of advance appropriations for IHS in the FY23 appropriations bill and its subsequent continuation in following FY spending packages has proved to be critical during the current government shutdown. Previously, the I/T/U system was the only major federal health care provider funded through annual appropriations. As such, in previous shutdowns, clinic staff had to go without pay, some UIOs reduced services, while others had to shutdown completely. These impacts were severe and long lasting in our communities.

With IHS currently receiving advance appropriations, funding has been able to flow to UIOs without delay during the current shutdown, ensuring that services are maintained for the community. As one UIO leader said, “The last government shutdown impacted our ability to provide full services, which resulted in 10 members of our community losing their lives. Advance Appropriations has allowed us to stay open and continue serving our people, and that stability has truly saved lives.” Advance appropriations has been a crucial step towards ensuring long-term, stable funding for IHS, which improves accountability and increases staff recruitment and retention at IHS.

Unfortunately, not all line items within the IHS budget are protected under advance appropriations, notably, Sanitation Facilities Construction, the Indian Health Care Improvement Act Fund, Facilities Construction, Contract Support Costs (CSC), Section 105(l) lease payments, and Electronic Health Records. These accounts account for more than $1.3 billion in the IHS budget.

Additionally, the Bureau of Indian Affairs (BIA) and the Bureau of Indian Education (BIE) do not receive any advance appropriations. While not related to health, these departments have a significant importance to the many functions in Indian Country. One Montana UIO has informed us that they have completed and submitted their application for the BIA’s loan guarantee for their $21 million capital project. However, the shutdown has stalled communication with federal staff, making it impossible to confirm if or when the loan guarantee will be approved. As a result, their ability to move forward with vital renovations and begin construction has been delayed, placing both the project and its anticipated benefits to their community at risk. This situation highlights how the disruption to federal processes is threatening essential infrastructure and jeopardizing much-needed investment in Indian Country.

The success of advance appropriations for IHS demonstrates that now more than ever Congress should pass S.2771, the Indian Programs Advance Appropriations Act of 2025, which would extend advance appropriations to BIA and BIE. 

Proposed Reduction in Force Threatens Trust Obligations

The current Office of Management and Budget (OMB) proposed Reduction in Force (RIFs) represent a serious threat to programs and staff within the Department of Health and Human Services (HHS) that serve Indian country. While portions of the process have been temporarily paused following a Temporary Restraining Order (TRO) issued in response to legal challenges, the threat of these RIFs has created significant fear about the potential instability that would arise from these actions.

The federal government owes a trust obligation to provide adequate healthcare to American Indian and Alaska Native people. It is the policy of the United States “to ensure the highest possible health status for Indians and urban Indians and to provide all resources necessary to effect that policy.” This trust obligation is fulfilled, in part, through direct delivery of programs and services and through the provision of federal funding to Tribal programs and UIOs. Using the government shutdown as pretext to RIF federal employees, with no exemption for federal employees serving Indian Country, decimates the ability of the United States to carry out its sacred obligations to American Indian and Alaska Native communities.

We request that the Committee request that OMB issue guidance to exempt Indian Country programs and federal employees serving Indian Country from RIFs in order to uphold United States’ delivery on trust and treaty obligations.

Conclusion

While the inclusion of advance appropriations for IHS has been a lifesaving step forward, the current shutdown and threat of RIFs underscore the urgent need for further Congressional and Administrative action. Extending advance appropriations to all Indian Country–serving programs and protecting the federal workforce that upholds the trust and treaty responsibilities of the United States are essential to ensuring continuity of care and stability in our communities. We thank the Committee for its steadfast leadership and urge continued bipartisan collaboration to safeguard the health and well-being of all American Indian and Alaska Native people, no matter where they live.

Oklahoma City Indian Clinic Wellness Center Earns National Certification for Advancing Native Health and Wellness

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The Oklahoma City Indian Clinic Wellness Center has made history as the first American Indian and first Oklahoma facility to be certified by the Medical Fitness Association. This national certification represents the highest standard for medical fitness centers, recognizing organizations that meet rigorous criteria in safety, professional oversight, and evidence-based wellness programming. Certified facilities must demonstrate active medical supervision, individualized health screenings, and programs that prevent disease and promote therapeutic lifestyles. For the Oklahoma City Indian Clinic, this certification affirms a long-standing commitment to helping Native patients build healthier, stronger lives through integrative care that blends clinical medicine, behavioral health, and culturally grounded fitness initiatives like Med Fit. 

This recognition comes as the Clinic continues to draw national attention for its leadership in urban Native health. In June 2025, Secretary of Health and Human Services Robert F. Kennedy Jr. visited the Oklahoma City Indian Clinic to learn more about its innovative programs addressing food insecurity, chronic disease prevention, and the social drivers of health. During the visit, Chief Executive Officer Robyn Sunday Allen (Cherokee) highlighted how the Clinic’s integrated model—combining medical, behavioral, pharmacy, and wellness services under one roof—serves as a roadmap for improving Native health outcomes in urban settings. 

The Oklahoma City Indian Clinic’s recent achievements reflect the transformative potential of Native-led health programs when given the flexibility and resources to innovate. By achieving Medical Fitness Facility Certification, the Clinic has demonstrated not only operational excellence but also a deep commitment to culturally informed care that empowers Native communities to thrive. The National Council of Urban Indian Health proudly recognizes this milestone as a defining moment in the ongoing story of urban Native health leadership, wellness, and resilience in Indian Country.  

NCUIH Resource Highlights Substance Use Disorder and Opioid Crisis in Native Communities, Proposes Policy Solutions

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The National Council of Urban Indian Health (NCUIH) has released a new resource on Substance Use Disorder and Overdose in American Indian and Alaska Native Communities. This resource highlights the urgent need for increased support and funding to address the disproportionate impact of substance use disorder (SUD) and overdose among American Indian and Alaska Native (AI/AN) people.

ACCESS THE RESOURCE
The Crisis:


AI/AN communities continue to face the highest overdose death rates in the nation. Urban Indian Organizations (UIOs) are essential providers of culturally grounded prevention, treatment, and recovery services. However, they face persistent challenges, including limited resources, data access, and sustainable funding. The new resource provides key data, outlines barriers to care, and recommends policy solutions to strengthen UIOs’ ability to respond to this public health crisis.

Policy Solutions:

Fund the Behavioral Health and Substance Use Disorder Resources for Native Americans (BHSUDRNA) Program

Congress authorized the Behavioral Health and Substance Use Disorder Resources for Native Americans (BHSUDRNA) Program in the Consolidated Appropriations Act, 2023, to provide services for the prevention of, treatment of, and recovery from mental health and substance use disorders among American Indians, Alaska Natives, and Native Hawaiians.

  • Authorized Funding: $80 million for each of Fiscal Years (FY) 2023-2027.
  • Problem: No funds have been appropriated.
    • The President’s FY 2026 budget requested that $80 million be appropriated for this program. The House and Senate did not include this program in their FY 2026 appropriations bills.

Continuing Support for Tribal Behavioral Health Grants (Native Connections)

Native Connections is a five-year grant program that helps AI/AN communities identify and address the behavioral health needs of Native youth. The Native Connections grant program supports grantees in: reducing suicidal behavior and substance use among Native youth up to age 24; easing the impacts of substance use, mental illness, and trauma in tribal communities; and supporting youth as they transition into adulthood.

The Tribal Behavioral Health Grants line item in the Labor, Health and Human Services, Education, and Related Agencies appropriations bill funds the Native Connections program. Currently there are 12 UIOs who are active recipients.

  • Appropriations Status: Congress has maintained funding for this program in the proposed FY 2026 appropriations bills in each chamber. The Senate has proposed maintaining funding at the current level of $23.67 million. The House has proposed increasing funding to $30 million.

NCUIH Joins Families USA and 153 Partner Organizations in Urging Congress to Permanently Extend Enhanced Premium Tax Credits

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On October 16, 2025, NCUIH joined Families USA and 153 partner organizations in signing a letter to Majority Leader Thune, Minority Leader Schumer, Speaker Johnson, and Minority Leader Jeffries calling on Congress to permanently extend enhanced premium tax credits (ePTCs) that help make health coverage more affordable for millions of Americans.

The letter emphasizes that allowing the enhanced credits to expire would cause more than 20 million people, including small business owners, older adults, and families with children, to face rising health costs or lose coverage altogether. If not extended, an estimated 4 million people could lose insurance, and 11 million people with incomes between 100 and 150 percent of the Federal Poverty Level would lose access to zero-dollar premium plans.

The loss of the ePTCs will also have a significant impact on American Indian and Alaska Native (AI/AN) people. The Urban Institute estimates that 318,000 American Indian and Alaska Native (AI/AN) people are enrolled in the Marketplace in 2025 under tax credits and 126,000 AI/AN people will lose their Marketplace coverage without ePTCs, representing a 40 percent reduction for AI/ANs currently covered. Increasing premiums, even modestly, creates barriers for people with limited incomes, forcing many to choose between paying for health care and basic necessities.

Read the Full Letter Text

Dear Majority Leader Thune, Minority Leader Schumer, Speaker Johnson, and Minority Leader Jeffries:  

As millions of families across the country struggle to pay for the high and rising cost of health care, the more than 150 undersigned organizations representing patients, workers, small businesses, health care providers, public health professionals and other health care stakeholders strongly urge Congress to permanently extend the enhancements to the premium tax credit without delay and without any changes that could place health coverage out of reach for millions of vulnerable Americans. 

Without a timely extension of the enhanced premium tax credits, more than 20 million people – including about 5 million small business owners and self-employed people, along with 6 million older adults – will see their health care costs skyrocket. Roughly 4 million people are projected to lose their coverage altogether due to the higher cost. Further, if the enhancements expire, the 11 million people with Marketplace coverage who have incomes between 100 and 150 percent of the federal poverty level ($15,650 to $23,475 for an individual in 2025) would lose access to a silver plan with zero-dollar premiums. Data shows that the availability of such plans ensured that more people, and on average healthier people, are enrolled in coverage — a significant driver of recent record low numbers of Americans who are uninsured. 

Increasing the monthly cost of health care coverage, even by relatively modest amounts, for people with limited income would create significant barriers for them to maintain coverage, putting them at risk of dropping out of coverage altogether due to added confusion and red tape. Lowering income eligibility would particularly harm older adults, people in rural areas, and families with children by exposing them to skyrocketing costs. Those who could somehow manage to maintain their coverage might be forced to forgo other basic needs in order to pay for it. This reality further threatens people’s ability to treat ongoing health conditions like diabetes, heart disease, and cancer, as well as respond to new threats to their health.  

Changes made earlier this year in H.R.1 only compound the negative impact that losing enhanced premium tax credits will have by making vulnerable families unable to re-enroll in coverage if they fail to pay even a minimal premium. In that event, they would be ineligible for coverage for an entire year until the next Open Enrollment period – leaving millions vulnerable to even higher medical bills and greater uncompensated care costs for hospitals and health care providers already on the brink.  

The harms from eliminating these specific tax credits would be felt most acutely by people in states that have failed to expand Medicaid eligibility, including Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. Collectively, over six million people in those states who do not have access to Medicaid coverage with annual incomes below $21,597 are eligible for health care tax credits and a plan with zero-dollar premiums because of the enhancements. Texas, Florida, Georgia, and South Carolina in particular are among the top states in the country in terms of having the largest number of residents utilizing enhanced premium tax credits to get coverage. 

Raising health costs for people living paycheck to paycheck will endanger people’s health while making their financial predicament even more dire. To avoid this outcome, Congress must quickly extend the health care tax credits across all currently eligible income levels, including access to a zero-dollar premium plan for the most vulnerable families. We urge you and your colleagues to act without delay.  

Read the full letter here.