Policy Blog Archives

IHS Employee Layoffs Halted After Urgent Advocacy Efforts

February 19, 2025/in Policy Blog/by NCUIH

On February 14,2025, the National Council of Urban Indian Health (NCUIH) issued an urgent action alert calling on advocates to contact Congress and demand and immediate stop to the layoffs of probationary Indian Health Service (IHS) employees. That same day, NCUIH joined several national Native organizations in a letter to the Office of Personnel Management (OPM), urging federal leadership to protect IHS employees serving Indian Country. With IHS facing a 30% vacancy rate, further reductions in staffing would severely impact healthcare access for American Indians and Alaska Native people.

Following these advocacy efforts, a February 17 report confirmed that HHS Secretary Kennedy rescinded the layoffs of 950 IHS employees. NCUIH will continue to monitor these developments and we remain committed to ensuring the federal government upholds its trust responsibility.

ACTION ALERT: URGENT—Federal Layoffs Devastating Tribal Programs Are Happening TODAY, According to ICT News

February 14, 2025/in Policy Blog/by Meredith Raimondi

FOR IMMEDIATE RELEASE

Dear Advocates,

We need your immediate action—federal layoffs targeting essential tribal programs have begun TODAY, and the impacts will be catastrophic for Indian Country. According to ICT News, thousands of workers could be affected in health, education and other programs across Indian Country. The news reports that Trump administration has started laying off thousands of federal employees, threatening vital healthcare, education, law enforcement, and social services across tribal communities.

What’s Happening Right Now?

Mass Layoffs Underway: According to ICT News, the Trump administration has started laying off thousands of federal workers, including over 850 Indian Health Service (IHS) employees—doctors, nurses, pharmacists, and more.

Critical Services at Risk: Tribal healthcare facilities, schools, and public safety programs are losing essential staff. Communities that rely on these services will face immediate disruptions.

Trust Obligations:These layoffs will severely impact the federal government’s ability to fulfill the trust responsibility to Tribes and Native people.

According to ICT, the layoffs, targeted at probationary workers hired within the last year or two, are expected to impact programs at the Indian Health Service, Bureau of Indian Affairs, Bureau of Indian Education, and more. If no action is taken immediately, tribal communities will lose life-saving healthcare, childcare services, emergency response capabilities, educational support, and justice services.

Why This Is an Emergency

According to ICT, the layoffs are happening NOW. Without swift intervention from Congress, these cuts will send shockwaves through Indian Country.

How You Can Help—Act Now!

Contact Congress Immediately: Call or email your representatives TODAY to demand they stop these layoffs and protect tribal programs.
Spread the Word: Share this alert widely on social media to raise awareness about this urgent issue.

Sample Email to Your Representative:

Dear Representative [NAME],

I am writing with urgency as federal layoffs devastating tribal programs have already begun today. These cuts threaten the health and safety of Indian Country by targeting critical services such as healthcare, education, law enforcement, and social services.

According to ICT, over 850 Indian Health Service employees—including doctors and nurses—are being terminated right now, leaving tribal communities without access to essential care. These layoffs violate the U.S. government’s trust and treaty responsibilities to Tribal Nations and put lives at risk.

I urge you to take immediate action to stop these harmful layoffs and ensure that tribal programs are protected from further cuts. Please act now to uphold the federal government’s legal obligations to Indian Country.

Thank you for your swift attention to this urgent matter.

Additional information: https://ictnews.org/news/abrupt-federal-layoffs-expected-to-hit-tribal-programs

Sincerely,

[Your Name]

Time Is Running Out—Contact Congress Now!

These layoffs are happening as we speak—your voice can make a difference in protecting tribal communities from devastating harm. Let’s stand together to demand action before it’s too late!

Find Your Members of Congress

Use this link to find your members: https://www.congress.gov/members/find-your-member

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

FINAL REPORT: Urban Indian Health at Risk – Federal Funding Disruptions Threaten Critical Services

February 12, 2025/in Policy Blog/by Meredith Raimondi

REPORT: Impact of Federal Funding Pauses on Urban Indian Organizations

Today, February 12, 2025, we are providing an update on the National Council of Urban Indian Health (NCUIH) report regarding the potential impact of federal funding disruptions on Urban Indian Organizations (UIOs) funded by the Indian Health Service (IHS). The final report, released on February 11, 2025, builds upon the preliminary findings from February 3, 2025, offering a more comprehensive view of the challenges facing UIOs.

Background

Urban Indian Organizations were established in response to severe health, education, employment, and housing problems caused by federal forced relocation policies. Congress formally incorporated UIOs into the Indian Health System in 1976 with the passage of the Indian Health Care Improvement Act (IHCIA). Today, 41 UIOs operate over 85 facilities in 38 urban areas, serving patients from more than 500 federally recognized Tribes. These organizations provide crucial primary care, behavioral health, traditional medicine, and social services to American Indians and Alaska Natives living in urban areas.

Key Changes from February 3 to February 11 Report

Survey Participation

The final report reflects increased participation from UIOs. While the preliminary report on February 3 included responses from thirteen (13) of the forty-one (41) UIOs, the February 11 report incorporates data from twenty (20) UIOs.

Workforce Instability

The data on potential staff reductions has been refined:

February 3 report: 23.1% of UIOs definitely will need to furlough or lay off staff.
February 11 report: 25% of UIOs definitely will need to furlough or lay off staff.

Additionally, the percentage of UIOs indicating potential for staff reductions increased:

February 3 report: 38.5% indicate potential for staff reductions.
February 11 report: 45% indicate potential for staff reductions.

These changes suggest a slightly more severe outlook for workforce stability among UIOs.

Consistent Findings

Several key findings remain consistent between the two reports:

Operational Sustainability: Over half of UIOs would not be able to sustain operations beyond six months without federal funding.
Service Discontinuation: Over half of UIOs anticipate discontinuing critical services if federal funding disruptions persist. The potentially affected services remain the same, including primary care, behavioral health services, substance abuse treatment, community wellness initiatives, health programs, and cultural and youth programming.
Immediate Impact: Some UIOs can only sustain operations for 30 days or less without federal funds.

Implications and Call to Action

The final report reinforces the critical nature of federal funding for UIOs and the potential far-reaching consequences of funding disruptions on urban American Indian and Alaska Native populations. The increased survey participation provides a more comprehensive picture of the challenges facing UIOs, while the slight increase in potential workforce instability underscores the urgency of addressing these funding concerns.

As we release this updated information based on the final NCUIH report, we continue to urge policymakers, healthcare leaders, and advocates to recognize the vital role of UIOs in the Indian health system and take immediate action to ensure their continued operation and funding stability. The health and well-being of urban Native communities depend on the uninterrupted services provided by these organizations.

Additional Information

February 3, 2025 – REPORT: Urban Indian Health at Risk – Federal Funding Disruptions Threaten Critical Services

February 4, 2025 – Action Alert: Contact Congress to Protect Indian Health System Funding

Tribal Leaders Recommend Increased Urban Indian Health Funding in Fiscal Year 2027 Area Reports

February 12, 2025/in Policy Blog/by Alex Sampson

On January 22-23, 2025, the Indian Health Service (IHS) held their Area Report Presentations Webinar for Fiscal Year (FY) 2027 where Tribal leaders from all 12 IHS Areas and leaders from Native organizations, including the National Council of Urban Indian Health (NCUIH), presented on their budget requests. Tribal leaders spoke about the need to increase urban Indian health funding. For example, Oneida Division Director, Debra Danforth, said that Urban Indian Organizations (UIOs) need critical funding increases to serve large American Indian and Alaska Native populations in urban settings in the Bemidji Area.

Some common themes among Area reports were the need for funding for mental health, purchased/referred care, dental services, and alcohol/substance abuse.

NCUIH always supports the National Tribal Budget Formulation Workgroup’s recommendation for the IHS budget and is grateful for Tribal leaders’ support for increased funding in the Urban Health line item.

Area Report Highlights

Several Areas featured the work of UIOs in their presentations and advocated for increased allocation of funding and resources for urban Indian health.

The Bemidji Area stressed the need for an increase in funding to support authorized programs for UIOs. They recommended an increase of $303 million for the Urban Health line item above the fiscal year (FY) 2023 enacted of $90.4 million base.

The Billings Area listed Urban Health as priority 9 and recommended an increase of $2.6 billion increase above the FY 2023 enacted base.

The California Area recommended a $1.6 billion increase above the FY 2023 enacted base and kept Urban Health at priority 11.

The Navajo Area recommended a $3 billion increase above the FY 2023 enacted base.

The Oklahoma City Area kept Urban Health at priority 4 and included 100% Federal Medical Assistance Percentages (FMAP) at UIOs as hot issue 12. They recommended a $559 million increase above the FY 2023 enacted base.

The Phoenix Area kept Urban Health at priority 6 and recommended a $874 million increase above the FY 23 enacted base.

The Portland Area kept Urban Health at priority 5 and recommended a $1.1 billion increase above the FY 23 enacted base.

The Tucson Area included 100% FMAP for Medicaid services provided at UIOs as hot topic 7 and recommended a $1.6 billion increase above the FY 23 enacted base.

NCUIH Presents Priorities at Areas Presentations Webinar

Alexandra Payan, NCUIH’s Interim Director of Federal Relations, presented the top priorities for urban Indian health for FY 2027 during the Area Report Webinar. NCUIH supports full funding for the IHS, Tribal, and UIOs (I/T/U) system. NCUIH endorses a budget in which IHS, Tribal Facilities, and UIOs are all fully funded to improve health outcomes for all Native people no matter where they live.

Full funding for IHS and the Urban Indian line item
1. This funding is necessary to address health priorities for Native in urban areas, including:
  1. Ensuring Urban Indian Health funding keeps pace with population growth.
  2. Providing funding for UIO facilities and infrastructure.
  3. Expanding service offerings to Native patients in urban areas.
Establishing Permanent 100% FMAP for services provided to Medicaid beneficiaries at UIOs
Recruitment and Retention of Workforce
Special Diabetes Program for Indians (SDPI) reauthorization
Increased funding and resources for Traditional Healing services, food and housing insecurity

Background on Area Budget Formulation

As part of the trust responsibility to provide health care to all American Indian and Alaska Native people, Tribal leaders present their funding needs each year to the Secretary of the U.S. Department of Health and Human Services and the Director of the Office of Management and Budget. The recommendations are formed through the Tribal Budget Formulation Workgroup and serve as a framework for the Administration in setting budget amounts for their annual requests to Congress. This process ensures the federal government has the resources to provide health care to all American Indian and Alaska Native people in fulfillment of the trust responsibility.

Next Steps

On February 11-12, 2024, IHS will host the FY 2027 National Tribal Budget Formulation Work Session. This is a 2-day annual meeting where the two Tribal representatives from each Area come together to review and consolidate all the Areas’ budget recommendations into a comprehensive set of national health priorities and budget recommendations. Work session activities include:

Tribal Caucus occurs where the Tribal workgroup co-chairs are selected
Tribal representatives from each Area give a brief Area report presentation to the group
Discussion on determining priorities and budget recommendations
- Discussions are made by consensus from workgroup members. Only the two Tribal representatives that are part of the workgroup are allowed to partake in voting.
The workgroup will meet with the IHS Director and other IHS leadership to discuss health priorities and budget recommendations.
At least one tribal representative from each Area along with technical team members will coordinate to complete follow-up work on the budget recommendation and testimony that will be presented.

NCUIH Recommends CDC Continue to Engage with UIOs on Tribal Maternal Health

February 11, 2025/in Policy Blog/by Alex Sampson

On January 10, 2025, the National Council of Urban Indian Health (NCUIH) submitted written comments to the Centers for Disease Control and Prevention (CDC) following a December 4, 2024, listening session on maternal health and tribal maternal mortality review. In its comments to CDC, NCUIH recommended that CDC continue to host listening sessions on this topic. In continuing this engagement, NCUIH further recommended that CDC continue to invite Urban Indian Organizations (UIOs) to give UIOs the opportunity to share insights gained from providing services to their patient populations to support maternal health.

Background on CDC and Tribal Maternal Mortality Review

The CDC Division of Reproductive Health’s Enhancing Reviews and Surveillance to Eliminate Maternal Mortality program supports maternal mortality review committees (MMRCs) to identify and review deaths during and within a year of pregnancy, including documenting prevention opportunities. CDC works with MMRCs to improve review processes that inform recommendations for preventing future deaths.

Existing reviews include deaths during and within a year of pregnancy among American Indian and Alaska Native persons. However, there are no Tribal MMRCs. Tribal MMRCs could adapt MMRC processes to reflect community priorities and culturally appropriate approaches to maternal mortality prevention; have direct access to their data and determine the use of their data; and provide recommendations relevant to the community made by a tribally appointed committee to prevent pregnancy-related mortality.

IHS Finalizes Reorganization Office of the Director, Creates the Office of Tribal and Urban Affairs and the Division of Urban Indian Affairs

February 7, 2025/in Policy Blog/by Alex Sampson

On January 8, 2025, the Indian Health Service (IHS) published a final notice in the Federal Register amending Part G of the Statement of Organization, Functions, and Delegations of Authority of the Department of Health and Human Services (HHS) to reflect the IHS reorganization. IHS wrote that “[t]he purpose of this reorganization is to revise the current approved structure for the IHS, Office of the Director, Intergovernmental Affairs functions.” Importantly, this includes the establishment of the previously proposed Office of Tribal and Urban Affairs and Division of Urban Indian Affairs. This final notice does not include a request for feedback.

Background

In an October 10, 2024, letter to Tribal leaders and Urban Indian Organization (UIO) leaders (DTLL/DULL), IHS announced a proposed reorganization of IHS Headquarters Office of the Director (hereinafter “proposed reorganization”), which would then have impacts on how offices under the Deputy Director for Intergovernmental Affairs (DDIGA) are structured. IHS stated “[t]here are five primary objectives of the proposed reorganization, which adopts a One IHS model that:

1) Strengthens [IHS’] relationship with Indian Tribes and UIOs by streamlining operations and enhancing communications;
2) Enhances the business relationships with Indian Tribes through self-determination and self-governance;
3) Amplifies the work of the Agency with all partners by cultivating intergovernmental partnerships and furthering external relationships;
4) Modernizes the way the Agency supports Tribes pursuing [Indian Self-Determination and Education Assistance Act (ISDEAA)] opportunities by supporting ISDEAA negotiation teams across the Agency working under a One ISDEAA model; and
5) Fosters education and training throughout the entire IHS system on how ISDEAA interfaces with our everyday work.”

IHS also announced a November 13, 2024, Urban Confer and November 14, 2024, Tribal Consultation on the proposed reorganization. Enclosed with the DTLL/DULL, IHS included the draft IHS Headquarters Office of the Director Organizational Chart (hereinafter “draft organizational chart”). The draft organization chart for the proposed reorganization indicated that IHS planned to eliminate the Office of Urban Indian Health Programs (OUIHP) and create the Division of Urban Indian Affairs under the Office of Tribal and Urban Affairs. During the November 13, 2024, Urban Confer IHS stated that IHS envisions the Division of Urban Indian Affairs will be led by a director-like leader.

NCUIH’s Role

On December 16, 2024, the National Council of Urban Indian Health (NCUIH) submitted written comments to the IHS Director, Roslyn Tso, regarding IHS’ October 10, 2024, DTLL/DULL and November 13, 2024, Urban Confer on IHS’ proposed. In its comments following the Urban Confer, NCUIH submitted the following requests and recommendations to IHS:

Maintain a dedicated focus on urban Indian health
- Clarify the role of the IHS OUIHP Strategic Plan
- Clarify the role of the proposed Division of Urban Indian Affairs leader
Protect the Urban Indian Health line item
Ensure meaningful engagement with UIOs through Urban Confer throughout the reorganization process by hosting additional Urban Confers
- Extend the written comment deadline
Clarify a timeline and next steps for the reorganization

NCUIH will continue to closely follow the reorganization.

NCUIH Joins NIHB, NCAI and Self-Governance Communication and Education Tribal Consortium in Requesting the Indian Health System be Exempt from Federal Hiring Freezes

February 4, 2025/in Policy Blog/by NCUIH

On January 31, 2025, the National Council of Urban Indian Health (NCUIH) joined the National Indian Health Board (NIHB), National Congress of American Indians (NCAI), and Self-Governance Communication and Education Tribal Consortium in sending a letter to the U.S. Department of Health and Human Services (HHS) Acting Secretary, Dr. Dorothy Fink, regarding a memorandum issued by President Donald Trump instituting a federal civilian employee hiring freeze. The letter requests an exemption for the Indian Health Service (IHS) from any plans, policies, or incentives that seek to decrease its workforce because IHS is the principal health care provider for American Indian and Alaska Native people and is essential in fulfilling the United States legal and trust obligation to provide health care to American Indian and Alaska Native people. The letter also states that exempting IHS from the federal civilian position hiring freeze is critically necessary to protect public safety.

Read the full letter here.

Background on the Hiring Freeze

On January 20, 2025, President Trump issued a memorandum ordering a hiring freeze for federal civilian positions. The hiring freeze is not inclusive of military personnel. It also does not apply to positions related to immigration enforcement, national security, or public safety. The memorandum states that “nothing in this memorandum shall adversely impact the provision of Social Security, Medicare, or Veterans’ benefits.” The memorandum also instructs the Director of the Office of Management and Budget, in consultation with the Director of the Office of Personnel Management and the Administrator of the United States DOGE Service, to “submit a plan to reduce the size of the Federal Government’s workforce through efficiency improvements and attrition.”

NCUIH will continue to monitor any developments.

Action Alert: Contact Congress to Protect Indian Health System Funding

February 4, 2025/in Policy Blog/by NCUIH

Dear Advocates,

We need your help contacting Congress today!

Last week, the Office of Management and Budget (OMB) released a memorandum that temporarily froze resources critical to the operation of Tribal health care and Urban Indian Organization (UIO) facilities. While the recent OMB memorandum has been rescinded, NCUIH remains concerned about potential future impacts on the Indian health system. This is why we need your help to letting Congress know that it is critical that Indian health system funding is protected from any future disruptions.

Why is this important?

The U.S. Government has a legal obligation to provide health services to Native people, as established by the Indian Health Care Improvement Act.
Recent funding uncertainties forced UIOs to consider staffing cuts, service suspensions, and even facility closures.
Past experience shows any disruption in funding can have grave consequences on the Indian health system. During the 2019 government shutdown, funding disruptions led to reduced services and facility closures, resulting in tragic consequences including fatal opioid overdoses in some communities.
Specific Exemption Request: NCUIH is calling for a specific exemption for the entire Indian Health System, including the Tribal organizations, and UIOs, from any future funding restrictions.

You can use the text below as a template to call and/or email your Representative. If you can please, both call and email your representative. You can find your representative here.

Sincerely,
The National Council of Urban Indian Health

Ways to Advocate

Contact Congress | Post on Facebook

Contact Congress!

Step 1: Copy the email below.
Step 2: Find your representative here.
Step 3: Go to their website and click contact.
Step 4: Paste the email into the form and send. Please contact Meredith Raimondi (policy@ncuih.org) with questions.

Email to Your Representative!

Dear Representative [NAME],

As an urban Indian health advocate, I am writing to request your support in protecting Indian health system funding and ensuring that any funding restrictions or pauses explicitly exempt Tribal health programs and Urban Indian Organizations (UIOs) to prevent unintended disruptions in care, and to remain consistent with federal law and policy.

The Indian Health Care Improvement Act (IHCIA) established that “Federal health services to maintain and improve the health of the Indians are consonant with and required by the Federal Government’s historical and unique legal relationship with, and resulting responsibility to, the American Indian people.” Because these are legal obligations, programming that serves the interests of Tribes and Tribal citizens should not be included in any funding restriction or pause. This includes UIOs, which are health care Native-led nonprofit organizations that contract with the Indian Health Service to support the federal government’s legal obligation to provide health care services to Tribal citizens living in urban areas. In fact, the IHCIA directs the Secretary to “enter into contracts with, or make grants to, [UIOs] for the provision of health care and referral services for urban Indians resident in urban centers in which such organizations are situated.”

Any funding restrictions or pauses affecting the Indian health system would not only contradict these legal obligations but could also have devastating consequences, jeopardizing our ability to provide care to your constituents, meet payroll for providers and staff, and maintain essential services—ultimately putting the health and well-being of Tribal citizens at serious risk. For example, during the 2019 government shutdown, several UIOs had to reduce services or close their doors entirely, forcing them to leave their patients without adequate care. One UIO had multiple opioid overdoses in their community after they were forced to close their doors, several of which were fatal. Therefore, even a temporary halt in funding could immediately deprive people and communities of their life-saving services.

Your support is vital to ensuring that we continue to deliver essential healthcare services to our community uninterrupted. I look forward to your response on this critical issue.

Sincerely,
[NAME]

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

REPORT: Urban Indian Health at Risk – Federal Funding Disruptions Threaten Critical Services

February 3, 2025/in Policy Blog, Resources/one pagers/by Meredith Raimondi

Today, February 3, 2025, the National Council of Urban Indian Health (NCUIH) releases a critical report on the potential impact of federal funding disruptions on Urban Indian Organizations (UIOs). This timely survey highlights the importance of these vital healthcare providers serving American Indians and Alaska Natives in urban areas across the United States.

Key Findings

Operational Sustainability: Over half of the surveyed UIOs report they would be unable to sustain operations beyond six months without federal funding. Alarmingly, some organizations can only maintain services for 30 days or less, underscoring the immediate threat to these essential healthcare providers.
Workforce Instability: More than 60% of UIOs face potential staff reductions, with 23.1% definitely needing to furlough or lay off staff if federal funding is disrupted. This threatens not only the livelihoods of dedicated healthcare professionals but also the continuity of care for urban Native communities.
Service Discontinuation: A significant number of UIOs anticipate discontinuing critical services if federal funding is disrupted.
- These at-risk services include:
  - Primary care
  - Behavioral health services
  - Substance abuse treatment
  - Community wellness initiatives
  - Health programs (vaccinations, testing, education)
  - Cultural and youth programming

Implications

The potential disruption of UIO services could have far-reaching consequences for urban American Indian and Alaska Native populations. UIOs serve patients from over 500 federally recognized Tribes, providing crucial primary care, behavioral health, traditional medicine, and social services. Any interruption in these services could exacerbate existing health disparities and undermine decades of progress in urban Native healthcare.

As we release this report, we call on policymakers, healthcare leaders, and advocates to recognize the critical role of UIOs in the Indian health system and take immediate action to ensure their continued operation and funding stability. The health and well-being of urban Native communities depend on the uninterrupted services provided by these organizations.

Report

IMPACT OF FEDERAL FUNDING PAUSES ON URBAN INDIAN ORGANIZATIONS

January Policy Updates: Legislative Wins, IHS Reorganization, and Upcoming Opportunities!

January 31, 2025/in Policy Blog/by NCUIH

In this Edition:

$ FY 2027 Budget Formulation: Tribal Leaders Recommend Increased Urban Indian Health Funding in Fiscal Year 2027 IHS Area Reports.

📜 Appropriations Update: Continuing Resolution Extends Funding for SDPI, Medicaid and Safety Net Programs Outlook in Budget Reconciliation.

💡 Legislative Updates: NCUIH Celebrates the Passage of Key Legislation Supporting Native Veterans and Children.

🆕 IHS Reorganization Finalized: New Division of Urban Indian Affairs and Office of Tribal and Urban Affairs Announced.

📋 119th Congressional Assignment Updates

🎤 Advocacy: NCUIH Provides Key Recommendations on CDC Maternal Health and Tribal Maternal Mortality Review.

⚖ Monitoring the Bench: Kerr v. Planned Parenthood South Atlantic on Medicaid Provider Rights.

📬 ICYMI: IHS Announcements on Contract Support Costs, Syphilis Outbreak Response, Upcoming IHS HIT Modernization Sessions, and More.

🤝 NCUIH in Action: NIHB MMPC Retreat and DOI Secretary Haaland’s farewell.

🔍 Registration Open!: NCUIH 2025 Annual Conference (April 22–25).

📆 Important Dates and Events: Georgetown University Center for Children and Families and NCUIH Webinar on Potential Impacts of Proposed Federal Medicaid Cuts on Native Communities, NCAI 2025 Winter Session, and More.

📋 Funding Opportunities: HRSA Behavioral Health Workforce Development Technical Assistance Program Applications Open and more!

Tribal Leaders Recommend Increased Urban Indian Health Funding in Fiscal Year 2027 Area Reports

On January 22-23, 2025, IHS held their Area Report Presentations Webinar for Fiscal Year (FY) 2027 where Tribal leaders from all 12 IHS Areas and leaders from Native organizations, including NCUIH, presented on their budget requests. Tribal leaders spoke about the need to increase urban Indian health funding. 

What is it?: As part of the trust responsibility to provide health care to all American Indian and Alaska Native (AI/AN) people, Tribal Leaders present their funding needs each year to the Secretary of HHS and the Director of the Office of Management and Budget. The recommendations are formed through the Tribal Budget Formulation Work Group and serve as a framework for the Administration in setting budget amounts for their annual requests to Congress.
What are they saying?: Several Areas featured the work of UIOs in their presentations and advocated for increased allocation of funding and resources for urban Indian health. Several Area Tribal Representatives highlighted the importance of funding the Urban Indian Health line item, with 8 of the 12 IHS Areas including funding for Urban areas either in their top priorities or as a Hot Topic issue.

For example, Debbie Danforth, Tribal Representative for the Bemidji Area stated that “Urban Indian health centers need critical funding increases to serve large American Indian populations in urban settings… currently, there is a need for FMAP support and expansion of funds for [urbans].”

Stephen Kutz, Cowlitz Tribal Council and Portland Area Representative also stated that there needs to be increased funding for the Urban Health Line item noting that UIOs are “the most underfunded part of our health care system and yet some of our neediest people are seeing those…the funding is not adequate to give them all the services they need.”

Alexandra Payan, NCUIH’s Interim Director of Federal Relations, presented the top priorities for urban Indian health for FY 2027 during the Area Report Webinar:

Full funding for UIOs with no cuts during sequestration
100% FMAP for UIOs
Recruitment and retention of workforce
Special Diabetes Program for Indians (SDPI) reauthorization
Increased resources for: food/housing insecurity and Traditional Healing services

Next Steps: On February 11-12, 2025, IHS will host the FY 2027 National Tribal Budget Formulation Work Session.  This is a 2-day annual meeting where the two tribal representatives from each Area come together to review and consolidate all the Area’s Budget recommendations into a comprehensive set of national health priorities and budget recommendations.

Appropriations Update: Continuing Resolution and Budget Reconciliation

On December 21, 2024, a Continuing Resolution (CR) was passed which extends government funding from December 20, 2024, to March 14, 2025, including the Special Diabetes Program for Indians (SDPI) at $39.3 million through March 31, 2025.

Read more on NCUIH’s blog.

Reconciliation: Congressional leadership is prioritizing a single budget reconciliation bill anticipated for completion in early April. Key areas of focus:

Border policy
Tax reform
Debt ceiling
Medicaid and Supplemental Nutrition Assistance Program (SNAP) reforms

NCUIH is advocating for:

Inclusion of the Indian Health Service Professions Tax Fairness Act to make IIHS scholarships and loan repayment program payments tax-exempt.
Adding Contract Support Costs to the reconciliation package.

Medicaid and Safety-Net Program Updates

Proposed Medicaid Changes: House Republicans may propose $2.3 trillion in cuts to offset tax cuts. Proposed Medicaid changes include:

Medicaid work requirements: $120 billion
Per capita caps on state funding: $918 billion
Lower Federal Medical Assistance Percentage (FMAP) floor: $387 billion
Ending higher Medicaid reimbursements for “able-bodied” adults: $690 billion

Safety-Net Programs at Risk:

Proposals include cuts to SNAP, Temporary Assistance for Needy Families (TANF), and elimination of the Social Services Block Grant.

Earmark Requests:

Congressionally Directed Spending, or Earmarks, are an additional funding opportunity, where Members can advocate for programs and projects that are important to their state or district.
If anyone is interested in applying for an Earmark for FY26 or would like more information, please reach out to Jeremy at jgrabiner@ncuih.org to schedule a meeting.

Legislative Updates: Key Bills on Child Welfare and Native Veterans Signed into Law

Native American Child Protection Act (H.R. 663)

Signed into law on December 23, 2024.

What is it?: This bill would reauthorize and revise Programs to investigate and prosecute child abuse, child neglect, and family violence involving Native American children.
How does it impact UIOs? The bill makes UIOs eligible for the Indian Child Abuse Treatment Grant Program, creates a National Indian Child Resource and Family Services Center (the Center) that will provide technical assistance and training to Tribes, Tribal organizations, and UIOs, and allows UIO representatives with expertise in child abuse and child neglect to sit on a 12-member Advisory Board to advise and assist the Center.

Elizabeth Dole Home Care Act of 2024 (S.141)

Signed into law on December 23, 2024.

What is it?: The bill is a comprehensive package of bills that significantly expands and reforms the delivery of services at the U.S. Department of Veterans Affairs (VA) for veterans, service members, and their families.
How does it impact UIOs? This legislation directs the VA to collaborate with the Director of the Indian Health Service (IHS) and representatives from Tribal health programs and UIOs to ensure the availability of home-and community-based services for AI/AN Veterans.

Lumbee Fairness Act (H.R. 1101)

On December 17, 2024, the Lumbee Fairness Act passed the House. It did not pass the Senate and was reintroduced in the House on January 16, 2025.

What’s New?: On January 23, 2025, President Trump signed a memorandum to the Secretary of the Interior to submit a plan to advance full federal recognition of the Lumbee Tribe of North Carolina.

119th Congressional Assignment Updates:

Senate:

Senate has switched to Republican control (53-47).
The Majority Leader is John Thune (R-SD).
The Democratic Leader is Chuck Schumer (D-NY).

House:

The House continues to be under Republican control (219-215, with one vacancy).
The Speaker of the House is Mike Johnson (R- LA-4).
The Minority Leader is Hakeem Jefferies (NY–8).

Relevant Senate Committee Leaders:

Senate Finance – Chairman Mike Crapo (R-ID), Ranking Member Ron Wyden (D-OR)
Senate Indian Affairs – Chairwoman Lisa Murkowski (R –AL), Ranking Member Brian Schatz (D- HI)
Senate Health, Education, Labor and Pensions (HELP) – Chairman Bill Cassidy (R-LA), Ranking Member Bernie Sanders (D-VT)
Senate Appropriations – Chair Susan Collins (R-ME), Ranking Member Patty Murray (D-WA)

Relevant House Committee Leaders:

House Energy and Commerce – Chairman Brett Guthrie (R–KY-2), Ranking Member Frank Pallone (D-NJ-6)
House Ways and Means – Chairman Jason Smith (R–MO-8), Ranking Member Richard Neal (D-MA-1)
House Natural Resources – Chairman Bruce Westerman (R-AR-4), Ranking Member Jared Huffman (D-CA-2)
House Appropriations – Chair Tom Cole (R-OK-4) (Chickasaw), Ranking Member, Rosa DeLauro (D-CT-3)

Committee Updates

Senator Moran has joined the Senate Committee of Indian Affairs (SCIA).
Rep. Maloy (R-02-UT) has joined the House Interior Appropriations Committee.

IHS Publishes Final Notice on IHS Reorganization, Includes Information on Division of Urban Indian Affairs

On January 8, 2025, IHS published a final notice in the Federal Register detailing the reorganization of IHS Headquarters, including:

Establishment of the Office of Tribal and Urban Affairs and the Division of Urban Indian Affairs.
These changes were discussed during the November 13, 2024, Urban Confer.
No feedback is being requested on this notice.

NCUIH Provides Key Recommendations on CDC Maternal Health and Tribal Maternal Mortality Review

On January 10, 2025, NCUIH submitted comments to the Centers for Disease Control and Prevention (CDC) regarding its Maternal Health and Tribal Maternal Mortality Review.

Go Deeper: NCUIH recommended that the agency continue to engage in listening sessions on maternal health and Tribal maternal mortality review and continue to invite UIOs to these listening sessions to give UIOs the opportunity to share insights gained from providing services to their patient populations to support maternal health.

Upcoming Federal Agency Comment Opportunities:

February 8, 2025 – HHS Scientific Report of the 2025 Dietary Guidelines Advisory Committee (DGAC)

Overview: On December 10, 2024, the 2025 DGAC released its Scientific Report. The Report discusses the importance of Traditional Foods for AI/AN people and states that more research is needed on the dietary patterns and preferences of AI/AN populations to address knowledge gaps regarding AI/AN diets. Read more on NCUIH’s blog.
Comment Deadline: February 8, 2025. Follow the instructions for submitting comments at www.regulations.gov.

Monitoring the Bench: Kerr v. Planned Parenthood South Atlantic

Kerr v. Planned Parenthood South Atlantic

Issue: Whether the Medicaid Act’s any-qualified-provider provision unambiguously confers a private right upon a Medicaid beneficiary to choose a specific provider.
Relation to UIOs: Could limit the providers Medicaid beneficiaries are able to see and change the definition of who a “qualified” provider is. If a provider is no longer considered “qualified,” they would then be cut off from receiving Medicaid funding. While UIOs are unlikely to be removed as providers, it is important to track to see where SCOTUS stands on Medicaid issues.
Case Status: Supreme Court granted certiorari to hear the case on December 18, 2024. No oral argument has been scheduled yet.

ICYMI: Recent Dear Tribal and Urban Leader Letters (DTLL/DULL)

December 20, 2024, DTLL – IHS Contract Support Costs (CSC) decision.

The IHS Director writes to Tribal leaders to announce the Agency’s decision on how the IHS will calculate Contract Support Costs (CSC) on expenditures of third-party reimbursements and provide next steps.
IHS enclosed a template and certification form that will be used to estimate eligible CSC for anticipated expenditures of program income and will be immediately effective.
Both the template and certification form will also be used in final reconciliations of the CSC incurred by Tribes and Tribal Organizations for the expenditure of program income.

December 26, 2024, DTLL/DULL – IHS shares information on addressing the escalating cases of syphilis in Tribal communities.

Based on the feedback provided by Tribal Leaders during a Tribal Consultation on August 5, 2024, the National Syphilis and Congenital Syphilis Syndemic Federal Task Force is working to expand access to syphilis testing and treatment, enhance data collection and heighten surveillance, increase awareness and education among provider groups and engage communities and health departments.
In October 2024, IHS announced the allocation of $12.3 million to 17 Tribal and Urban Indian Organizations across 11 states as part of the Ending HIV/HCV/Syphilis Epidemics in Indian Country Initiative.
OASH intends to support the deployment of up to 45 Commissioned Corps officers to the Great Plains Area from January 5, 2025, through March 31, 2025, to support local public health efforts on the ground to address syphilis infections.

December 26, 2024, DTLL/DULL – IHS letter informing that IHS will proceed with the competitive grant funding distribution method for the Community Opioid Intervention and Prevention Program (COIPP).

The IHS Director writes to Tribal leaders and UIO leaders to share that IHS will proceed with the competitive grant funding distribution method for the COIPP.
IHS receives $11 million annually for COIPP and $9.5 million for grants which includes funds for Tribes and a set-aside for Urban Indian Organizations.

January 2, 2025, DTLL/DULL – IHS letter to announce the appointment of Dr. Chris Poole to serve as the Director of the IHS Bemidji Area.

The IHS Director writes to Tribal leaders and UIO leaders to announce the appointment of Dr. Chris Poole, an enrolled member of the Choctaw Nation of Oklahoma, to serve as the Director of IHS’ Bemidji Area.
Dr. Poole is responsible for providing leadership in the administration of a comprehensive Federal, Tribal, and Urban Indian health care system for AI/AN people.

January 10, 2025, DTLL – IHS announces the Calendar Year (CY) 2025 All-Inclusive Rates (AIR) have been published.

The IHS Director writes to Tribal leaders to announce that the Federal Register Notice for the CY 2025 AIR was published on December 16, 2024.

January 13, 2025, DTLL/DULL – IHS announces upcoming sessions on IHS’ Health Information Technology (HIT) Modernization Program.

The IHS Director writes to Tribal leaders and UIO leaders to announce four upcoming information sessions in CY 2025 regarding the IHS HIT Modernization Program.
Session I: Open Dialogue with IHS Health IT Modernization Program Leadership – Thursday, February 13, 2025, 1:30-3 PM EST. Register here.
Session II: Four Directions Warehouse – Thursday, May 15, 2025, 1:30-3 PM EST. Register here.
Session III: PATH EHR Scope and Capabilities – Thursday, August 7, 2025, 1:30-3 PM EST. Register here.
Session IV: Pilot Site Implementation Pathway – Thursday, November 6, 2025, 1:30-3 PM EST. Register here.
In conjunction with ongoing Agency outreach, IHS will also be seeking recommendations and feedback via Tribal Consultation and Urban Confer.
Written Comments: IHS is accepting written comments and recommendations on each HIT Modernization Program information session within 30 days following each scheduled session. Email to either consultation@ihs.gov or urbanconfer@ihs.gov.

NCUIH in Action:

On January 14-16, NCUIH represented UIOs at the NIHB Medicare, Medicaid and Health Reform Policy Committee (MMPC) Retreat in Hollywood, Florida.

On January 19, NCUIH attended the Department of Interior Secretary Haaland’s farewell speech in Washington D.C.

Registration is Open! NCUIH 2025 Annual Conference (April 22 – April 25)

REGISTER HERE

Conference Schedule Overview

Tuesday, April 22: Training for Urban Indian Organization Boards of Directors
Wednesday and Thursday, April 23 – 24: Conference Programming
Friday, April 25: Capitol Hill Visits for Urban Indian Organizations
Note: Hill Visits are for UIOs only.

Sponsorship Opportunities Are Available!

There are several different sponsorship levels to meet your needs.
If you are interested in sponsoring our conference, please see our sponsor guide and contact our Development department at development@ncuih.org.
Conference Location – Room Block Information Coming Soon!
Westin Washington, DC Downtown, 999 9th St NW, Washington, D.C. 20001
Contact: Should you have any questions or require additional information, please do not hesitate to contact conference organizers at conference@ncuih.org.

Learn more: https://ncuih.org/conference/

NCUIH Annual Conference Call for Proposals Due January 31

NCUIH is accepting proposals from AI/AN serving organizations, with a priority for UIOs to present their capacity-building best practices, successes, and innovations at our 2025  annual conference on April 22-24, 2025.  Selected proposal presenters will receive a reduced registration to attend the conference. To learn more and submit a proposal, please view the submission form. Interested individuals and organizations may request to present during one of the following options:

Concurrent 40-minute break-out session;
Poster presentation during conference reception; or,
15-minute lightning presentations to share best practices.

Learn more: https://ncuih.org/conference/#Proposals

Upcoming Events and Important Dates

February 10-13 – National Congress of American Indians (NCAI) 2025 Executive Council Winter Session (ECWS) in Washington D.C. Register here.
February 11-12 – IHS FY 2027 National Tribal Budget Formulation Work Session (Hybrid – Arlington, VA). Join via Zoom.
February 19 – NCUIH Monthly Policy Workgroup.
February 20 – Office of Urban Indian Health Programs (OUIHIP) Urban Program Executive Directors/Chief Executive Officers Monthly Conference Call.

One last thing, check out these upcoming funding opportunities:

The Health Resources and Services Administration (HRSA) is accepting applications for its Behavioral Health Workforce Development (BHWD) Technical Assistance Program.

This program provides support to HRSA’s BHWD recipients to expand the number of highly trained behavioral health providers nationwide. Eligible programs include the Behavioral Health Workforce Education and Training Program for Professionals, Behavioral Health Workforce Education and Training Program for Paraprofessionals, and the Graduate Psychology Education program. Funding is expected to be multi-year, with an estimated award date of September 1, 2025.
Application Deadline Date: March 3, 2025 (Apply).

HRSA is accepting applications for its Behavioral Health Workforce Education and Training (BHWET) Program for Paraprofessionals

The purpose of the BHWET Program for Paraprofessionals is to develop and expand community-based experiential training such as field placements and internships to increase the skills, knowledge and capacity of students preparing to become mental health workers, peer support specialists, and other behavioral health paraprofessionals.
Application Deadline Date: March 18, 2025 (Apply).

The Substance Abuse and Mental Health Administration is accepting applications for its Circles of Care for American Indian/Alaska Natives Program.

The purpose of this program is to provide AI/AN organizations with the resources to plan and design a family-driven, community-based, and culturally and linguistically competent system of care. Grant recipients are expected to organize a spectrum of community-based services and supports for AI/AN children who are experiencing or are at risk of mental health challenges.
Application Deadline Date: March 17, 2025 (Apply).