On July 22, 2025, the House Appropriations Full Committee passed the Fiscal Year (FY) 2025 appropriations bill for Interior, Environment, and Related Agencies, which was previously approved by the House Subcommittee on July 15, 2025. At the Subcommittee Hearing, Chairman Cole (R-OK-04), affirmed the Committee’s continued recognition and commitment to protecting the Indian Health Service (IHS) stating the bill “advances the federal commitment to honor our trust and treaty responsibilities to American Indians and Alaska Natives through Indian Affairs and the Indian Health Service. I’m proud that the legislation prioritizes funding across Tribal accounts—ensuring the delivery of critical services in Indian Country.”

The bill provides $8.41 billion for IHS, including $6.05 billion in advance appropriations for FY 2027, despite the President’s budget not requesting advance appropriations. The Committee’s total funding for IHS is approximately $500 million higher than the President’s IHS budget authority request. The bill authorizes $105.99 million for urban Indian health – an increase of $15 million over the FY25 enacted amount. The report states that “the Committee recognizes the Federal trust responsibility to provide health care services to American Indian and Alaska Native citizens and acknowledges that approximately seventy-one percent live in urban areas.”

Other key provisions include:

• $8 million for generators at IHS/Tribal Health Programs/Urban Indian Organizations (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.
• $44.43 million, a $10 million increase, for Tribal Epidemiology Centers (TECs).

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 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.

Next Steps

The House will now need to schedule a floor vote on the Interior, Environment, and Related Agencies spending bill. The legislation is not expected to become law in its current form. House leadership will need to work with Senate Leadership to negotiate a final bill text for passage in both chambers. The Senate Appropriations Committee is scheduled to mark up the Senate Interior bill on July 24.

FY25 funding is set to end on September 30, 2025. If Congress cannot come to a funding agreement by that deadline, they will need to pass a Continuing Resolution to keep the funding levels at the FY25 level until they can reach an agreement. Should political disagreements lead to a government shutdown, UIOs and parts of IHS will be protected by Advance Appropriations.

• House Interior Appropriations bill
• Bill Report with Urban Indian Line Item
• Bill Summary

Bill Highlights

Line Item	FY 25 Enacted	FY 26 Tribal Request	FY 26 President’s Budget	FY 26 House Proposed
Urban Indian Health	$90.42 million	$770.5 million	$90.4 million	$ 105.99 million
Indian Health Service	$6.96 billion	$63 billion	$8.1 billion	$8.41 billion
Advance Appropriations	$5.19 billion	______________	Did not include	$6.05 billion
Hospital and Clinics	$2.5 billion	$13.8 billion	$2.65 billion	$2.85 billion
Tribal Epidemiology Centers	$34.4 million	______________	$34.4 million	$ 44.43 million
Mental Health	$127.1 million	$4.76 billion	$131 million	$144.95 million

Additional Key Provisions:

Produce Prescription Pilot Program: $7 million

Bill Report, Pg. 83: 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. The Committee encourages IHS to provide a briefing to the Committee not later than 90 days following the enactment of this Act on the distribution of funds and implementation efforts.

• This is a proposed $4 million increase.

Contract Support Costs – $ 1,819 billion and Tribal 105(l) leases – $366 million

Bill Report, Pg. 85: The Committee recommends an indefinite appropriation estimated to be $1,819,000,000 for contract support costs incurred by the agency as required by law. The bill continues language making available such sums as are necessary to meet the Federal Government’s full legal obligation and prohibiting the transfer of funds to any other account for any other purpose. In addition, the bill includes language specifying carryover funds may be applied to subsequent years’ contract support costs.

Bill Report, Pg. 86: The Committee recommends an indefinite appropriation estimated to be $366,000,000 for Payments for Tribal Leases incurred by the agency as required by law. The bill includes language making available such sums as necessary to meet the Federal Government’s full legal obligation and prohibits the transfer of funds to any other account for any other purpose.

Purchased and Referred Care – $1.05 billion

Bill Report, Pg. 84: The recommendation includes $1,054,066,000 for Purchase and Referred Care (PRC). The Committee is aware that some IHS areas are considered Purchased and Referred Care Dependent and Tribes in PRC-dependent areas must rely solely on PRC for emergency, hospital, and special health care services. The Committee recognizes the importance of these funds for PRC-dependent areas and directs IHS to provide a report not later than 90 days following the enactment of this Act on the funding distribution methodology and how PRC dependent areas, including those in California, are receiving the necessary PRC funds needed to purchase lifesaving care for Tribal members.

Indian Health Professions: $95,252,000

Bill Report, Pg. 85: The recommendation includes $95,252,000 for Indian Health Professions programs. The Committee continues to support Indian Health Professions programs and expects IHS to allocate the funding provided across all programs, including the Scholarship Program, Loan Repayment Program, Indians Into Medicine Program (INMED), American Indians into Nursing (RAIN) Program, and the American Indians into Psychology Programs.

Sanitation Facilities Construction: $130,968,000

Bill Report, Pg. 86: The recommendation includes $130,968,000 for Sanitation Facilities Construction.

Health Care Facilities Construction: $188,702,000

Bill Report, Pg. 86: The recommendation includes $188,702,000 for Health Care Facilities Construction. The recommendation includes $14,000,000 for Staff Quarters for staff housing across the IHS health care delivery system to support the recruitment and retention of quality healthcare professionals across Indian country.

Equipment – Generators:  $8 million

Bill Report, Pg. 86: To increase the resilience of these facilities, the recommendation includes $8,000,000 to purchase generators, including for IHS, Tribal Health Programs, and Urban Indian Organizations located in areas impacted by de-energization events.

Dental Health: $287 million

Bill Report, Pg. 83: The recommendation includes $287,085,000 for Dental Health services.

• Also includes $8,000,000 to expand Dental Support Centers to all 12 service areas and $6,500,000 to install an electronic Dental Records System.

Alzheimer’s Disease: $6 million

Bill Report, Pg. 83: The recommendation includes $6,000,000 to continue Alzheimer’s and related dementia activities. These funds will enable awardees to continue to implement locally developed models of culturally appropriate screening, diagnostics, and management of people living with Alzheimer’s and other related dementia. This funding also supports the Dementia ECHO program, designed to support clinicians and caregivers to strengthen their knowledge and care around dementia for Tribal patients.

Maternal Health: $3 million

Bill Report, Pg. 83: The recommendation also includes $3,000,000 for Improving Maternal Health. The Committee also recognizes the importance of in vitro diagnostics tools for the detection of diseases, infections, and other medical conditions. These tools provide valuable information to aid providers in accurate diagnostics, treatment planning, and monitoring of patient health. The Committee encourages the use of in vitro diagnostics in IHS health clinics and medical facilities.

Alcohol and Substance Abuse: $286 million

Bill Report, Pg. 84: The recommendation includes $286,389,000 for Alcohol and Substance Abuse programs.

Bureau of Indian Affairs, Missing and Murdered Indigenous Women Initiative: $31 million

Bill Report, Pg. 43: The recommendation includes $31,000,000 for the Missing and Murdered Indigenous Women Initiative to address the crisis of missing and murdered indigenous women, including for criminal investigators, software platforms, and evidence recovery equipment. The Committee directs BIA to work with Tribal and Federal law enforcement agencies to facilitate sharing law enforcement and public records data and other technological tools to assist those agencies in finding missing individuals.

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

Contact your member of Congress today to ensure support for Tribal Programs in FY 2026 Appropriations!

As the House and Senate consider Fiscal Year (FY) 2026 appropriations, we recommend that our network submit a written letter and contact your Senators and Representatives to ask them to urge members of the Senate and House Appropriations Committees to protect and hold harmless all Tribal programs and programs that benefit Tribal Nations and citizens from FY 2026 appropriations reductions. This is especially important, given the deep reductions to Tribal programs proposed by the Administration through the President’s Budget Request.

Template Letter to Congress

Template Script

Hello,
On behalf of [YOUR ORGANIZATION or TRIBE], we urge Representative/Senator [NAME] to protect and hold harmless all Tribal programs and programs that benefit Tribal Nations and citizens during the FY 2026 appropriations process by expressing your support for Tribal programs to the leadership of the [HOUSE/SENATE] Appropriations Committee.

Resources

To find the contact information for your Representative, please click here, and to find the contact information for your Senator, please click here.

Released on June 13, 2025, the IHS Dear Tribal Leader/Urban Leader Letter invites comment on a proposed Strategic Realignment designed to make the Agency more patient-centered, operationally efficient, and supportive of Tribal self-governance. Feedback is requested on three focus areas—Delivery of Direct Patient Care, Enterprise/Operational Management, and Supporting Tribal Self-Determination. Engagement opportunities include four in-person Tribal Consultations (Seattle 7/8, Phoenix 7/10, Minneapolis 7/15, Washington D.C. 7/23) and a virtual Urban Confer on Monday, July 28th, 2025, from 1:00 PM – 3:00 PM EST.  Written comments for both tracks are due August 28, 2025, sent to consultation@ihs.gov (Tribal leaders) or urbanconfer@ihs.gov (UIO leaders) with “IHS Strategic Realignment” in the subject line. NCUIH is monitoring for any further details or other information from IHS about what the proposed realignment will entail and how it will affect the Indian health system.  

Registration Link: https://ihs-gov.zoomgov.com/meeting/register/q6joL7ncQgS1z5tf0xl9vw

In this Edition:

FY 2026 Budget: The President’s request funds IHS at $8.1 billion and Urban Indian Health at $90.4 million while omitting advance appropriations.

 House Appropriations: At the Interior Subcommittee hearing, Reps. Simpson, Pingree, and Cole pledged to retain advance appropriations, with mark-ups set for June 23 and 26.

 Native Caucus Letter: Members have until June 23 to sign the Native American Caucus letter urging protection of Tribal and Urban Indian programs.

Reconciliation: Senate drafts keep the AI/AN Medicaid work-requirement exemption, but the SNAP exemption is absent and may be revived on the floor.

NCUIH Advocacy: NCUIH submitted testimony to appropriators and circulated comment letters on SNAP and CMS waivers that defend AI/AN health protections.

 IHS Consultations: Comments are open on EHR modernization and regional realignment, with an Urban Confer on July 28 and final comments due August 28.

 NCAI Mid-Year: NCUIH President Walter Murillo co-chaired the Health Subcommittee as resolutions advanced priorities on Medicaid, IHS funding, and nutrition programs.

Medicaid Guidance: HHS issued a memo directing states to align Medicaid payments with Medicare rates, trimming oversized state-directed payments.

Save the Dates: OUIHP Executive Call (June 26), Monthly Policy Workgroup (July 16), IHS Virtual Urban Confer on IHS Proposed Realignment (July 28), and TTAG Quarterly Meeting (July 29-30).

Fiscal Year 2026 Budget Request and Appropriations

President’s Proposal: New Investments, No Advance Appropriations

The President proposes $8.1 billion dollars for the Indian Health Service and $90.4 million dollars for Urban Indian Health, with new investments in diabetes care, behavioral health, and disease-prevention initiatives, but without advance appropriations.

Key Indian Country Provisions

• IHS: $8.1 Billion – Minor increase but largely flat.
• Urban Indian Health: $90.4 million – flat funded
• Advance appropriations not included, despite the inclusion for FY 2026 in the FY 2025 continuing resolution.
• Reauthorization for the Special Diabetes Program for Indians (SDPI) – $159 million.
• NEW: Native American Behavioral Health and Substance Use Disorder program – $80 million
• NEW: Prevention Innovation Program- $19 million set aside for Tribes, tribal organizations, UIOs, and health service providers to Tribes serving rural communities experiencing poor chronic disease and maternal health outcomes.

House Interior Appropriations Subcommittee IHS FY 2026 Budget Hearing Highlights

Acting Director Ben Smith testified and highlighted Secretary Kennedy’s visit to NATIVE HEALTH.

Committee Chairman Cole reaffirmed commitment to stable funding for IHS: “One thing I can assure you, we didn’t get here to give it up. I can just tell you now, we will be retaining advanced appropriations.”

Subcommittee Chair Simpson and Ranking Member Pingree expressed disappointment in advance appropriations not being included in the President’s request.

Rep. Celeste Maloy (R-UT-02) applauded the work of Urban Indian Center of Salt Lake, stating “Utah has only one Urban Indian Organization—the Urban Indian Center of Salt Lake—and they’re doing terrific work. What more can Congress do to make sure centers like this get the resources they need?” In response, Acting IHS Director, Ben Smith, cited stronger consultation and issue tracking that includes UIO feedback.

Native American Caucus Dear Colleague Letter to Protect Tribal Programs in FY 2026 Closes June 23rd

Reach out to your Member of Congress to sign on by June 23rd, 2025

Requests to House Appropriations Committee:

• Safeguard and support all federal funding flowing to Indian Country to ensure successful delivery of services.
• Support funding necessary to maintain federal employee positions that service Tribal nations and the federal offices that provide these services.

ICYMI:

On June 17th, 2025, Adrianne Maddux (Hopi), Executive Director of Denver Indian Health and Family Services and NCUIH Board Treasurer, attended the Tribal Leaders Diabetes Committee Meeting meeting representing Urban Indian Organizations. The next meeting is set for September 16th, 2025.

On June 12th, 2025, NCUIH submitted Written Testimony to the Senate Interior Appropriations Committee. Requests included:

1. Protect Funding for the IHS and fund Urban Indian Health at $100 million for FY26
2. Maintain Advance Appropriations for the IHS, until mandatory funding is achieved, and protect IHS from sequestration.
3. Appropriate $80 million for the Native Behavioral Health Resources program
4. Ensure Federal Policies Uphold Trust Obligations to American Indian and Alaska Native Communities

On June 12th, 2025, NCUIH submitted Written Testimony to the Senate LHHS Appropriations Committee. Requests included:

1. Protect Funding for the Indian Health Service and fund Urban Indian Health
2. Ensure Federal Policies Uphold Trust Obligations to American Indian and Alaska Native Communities
3. Fund the Initiative for Improving Native American Cancer Outcomes at $10 million for FY26
4. Fund the Good Health and Wellness in Indian Country (GHWIC) Program at $30 Million for FY26
5. Appropriate $80 million for the Native Behavioral Health Resources program
6. Protect Funding for HIV/AIDS Prevention and Treatment

Budget Reconciliation and Policy Development

Senate Finance Text

On June 16th, 2025, the Senate Finance Committee released their reconciliation text.

• NCUIH worked with the Committee to maintain the AI/AN exemption for Medicaid work requirements.
• NCUIH worked with the Committee to provide an AI/AN Exemption from new 6-month redetermination requirement for the Medicaid expansion population.

Senate Agriculture Text

On June 16th, 2025, the Senate Ag Committee also released their reconciliation text.

• The text does not currently have an AI/AN work requirement exemption for SNAP.
• However, the exemption could still be brought as a floor amendment.

On June 11th, 2025, NCUIH provided a letter template to UIOs to send to Senate Agriculture Chair Boozman in support of the proposal exempting Native people from work requirements and promoting Tribal administration of SNAP.

Indian Health Service Reorganization and Admin Announcements

IHS Reorganization

Announced by IHS Acting Director Ben Smith: IHS is dividing the hospital system into two regions, north and south, and the hospitals will report to Loretta Christensen. All of the IHS Area Directors will report to Dr. Beverly Cotton. IHS published a DTLL/DULL on the proposed realignment with dates for the in-person Tribal Consultation sessions and virtual Urban Confer. The virtual Urban Confer is scheduled for July 28th. Comments are due August 28th.

Admin Announcements

June 6th Memo – Eliminating Waste, Fraud, and Abuse in Medicaid

Directs HHS to take appropriate action to ensure Medicaid payments rates are not higher than Medicare, to the extent permitted by applicable law.

Previous Trump Administration policy allows states to make State Directed Payments (SDPs) up to the average commercial rate.

NCUIH Co-Chairs and Presents at NCAI Mid-Year Convention Health Subcommittee

On June 9th, 2025, NCUIH Board President, and CEO of Native Health, Walter Murillo (Choctaw), co-chaired the Health Subcommittee at the National Congress of American Indians Mid-Year Convention, advancing resolutions on Medicaid, Indian Health Service funding, behavioral health, and nutrition. Topics for resolutions passed included:  Medicaid exemptions for AI/AN, FY26 Indian Health Service budget support, Native Connections grant support, Promoting the Director of Indian Health Service to Assistant Secretary, and SNAP work requirement exemption.

NCUIH Actions

June 14th – NCUIH Submitted Comments to IHS on the IHS Health Information Technology (HIT) Modernization: Four Directions Warehouse

NCUIH requested IHS provide clarification to UIOs on the 4DW about access for all UIOs; support IHS, Tribal, and UIO (I/T/U) facilities for data migration and transition to PATH EHR; and communicate regularly with facilities about the HIT Modernization project.

NCUIH provided a comment template to UIOs.

The next joint IHS TC/UC session on HIT Modernization will be held virtually via Zoom on August 7th, 2025, 1:30-3 PM Eastern.

Over the last month, NCUIH Submitted Comments Supporting Exempting AI/AN People from Work Requirements in Proposed Amendments to State Medicaid programs:

• May 28th – South Carolina Palmetto Pathways to Independence
• May 28th – CMS Georgia Pathways to Coverage Program
• June 12th – Kentucky
• June 18th – South Dakota

Key Upcoming Dates

Several forums this summer invite Urban participation: 

• Office of Urban Indian Health Programs Executive Directors call – June 26th.
• Monthly Policy Workgroup – July 16th.
• IHS Virtual Urban Confer on IHS Proposed Realignment- July 28th.
• Tribal Technical Advisory Group quarterly meeting – July 29–30th.
• IHS Virtual TC/UC session on HIT Modernization- August 7th.
• IHS Division of Behavioral Health Virtual UIO Listening Session – August (date TBD)

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.