Senate Appropriations Committee Advances Labor Health and Human Services Spending Bill, Protects Key Indian Country Programs

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On July 31, 2025, the Senate Appropriations Full Committee passed the Fiscal Year (FY) 2026 appropriations bill for Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). The bill includes $116.6 billion for the Department of Health and Human Services (HHS), which is $446 million above FY 2025 levels and $22 billion above the President’s request. The committee notably did not fund the administration for a Healthy America (AHA), President Trump’s proposed new agency that would consolidate programming across SAMHSA, HRSA, and other agencies as part of its HHS reorganization.  

The committee also provided level funding for key Indian country provisions including the Improving Native American Cancer Outcomes program, Good Health and Wellness in Indian Country program, Tribal Behavioral Health Grants (Native Connections), and the Minority HIV/AIDS Fund – Tribal Set Aside. 

Background 

NCUIH worked closely with Appropriators to advocate for increased funding for Indian Country. In written testimony, NCUIH advocated for $10 million for the Improving Native American Cancer Outcomes program, $30 million for the Good Health and Wellness in Indian Country program, and to protect funding for HIV/AIDS treatment and prevention.  

Next Steps 

Senate Leadership will now work with House Leadership to develop the final LHHS appropriations spending bill. The House has not yet released their Labor-HHS appropriations bill, which is expected to be released in September. As a final appropriations bill is produced, NCUIH will continue to advocate to protect funding for Indian Country and maintain maximum funding levels. 

Bill Highlights 

Line Item  FY 2025 Enacted  FY 2026 President’s Budget Request  FY 2026 Committee Passed 
Health Resources and Services Administration $8.9 billion Fold into Administration for a Healthy America (AHA) $8.86 billion
Substance Abuse and Mental Health Services Administration $7.4 billion Fold into AHA $7.4 billion
National Institute of Health $48.6 billion $27.5 billion $48.7 billion
Centers for Disease Control $9.2 billion Fold into AHA $9.15 billion
Good Health and Wellness in Indian Country $24 million —————– $24 million
Improving Native American Cancer Outcomes $6 million —————– $6 million
Ryan White HIV/AIDS Program $2.57 billion $2.50 billion $2.57 billion
Ending the HIV Epidemic $165 million $165 million $165 million
Minority HIV/AIDS Fund $60 million Eliminated $60 million
Minority HIV/AIDS Fund – Tribal Set Aside $5 million ———— $5 million
Tribal Behavioral Health Grants (Native Connections) $23.67 million Eliminated. Created a new behavioral health program under AHA $23.67 million

Additional Key Provisions:

Health Resources and Services Administration

Federal Office of Rural Health Policy: $374 million

Bill report pg. 62: The Committee provides $373,907,000 for Rural Health programs.

  • This represents an increase of $9 million above the FY 2025 enacted level.
Native Hawaiian Health Care Program: $27 million

Bill report pg. 42: The Committee includes no less than $27,000,000 for the Native Hawaiian Health Care Program. Of the total amount appropriated for the Native Hawaiian Health Care Program, not less than $10,000,000 shall be provided to Papa Ola Lokahi for administrative purposes authorized under 42 U.S.C. 11706, including to coordinate and support healthcare service provision to Native Hawaiians and strengthen the capacity of the Native Hawaiian Health Care Systems to provide comprehensive health education and promotion, disease prevention services, traditional healing practices, and primary health services to Native Hawaiians.

National Health Service Corps: $128.6 million

Bill report pg. 43: The Committee provides $128,600,000 for the National Health Service Corps [Corps]. The Committee recognizes the success of the Corps program in building healthy communities in areas with limited access to care. The program has shown increases in retention of healthcare professionals located in underserved areas.

Centers for Disease Control and Prevention

Good Health and Wellness in Indian Country: $24 million

Bill report pg. 82: The Committee’s recommended level includes $24,000,000 for Good Health and Wellness in Indian Country.

Office of the Secretary – General Departmental Management

Minority HIV/AIDS Fund: $56 million

Bill report pg. 237: The Committee includes $60,000,000 for the Secretary’s Minority HIV/AIDS Fund to strengthen and expand services provided by minority-serving community-based organizations [CBOs] for HIV education and awareness campaigns, testing, prevention, linkage to care, and engagement in care to racial and ethnic minority individuals at risk for or living with HIV in order to address the decline in HIV testing and the challenges with linkage to and retention in care and treatment that occurred during the COVID–19 pandemic. Funding may be prioritized for minority-serving CBOs in the South, which has the highest burden of HIV of any region nationwide. The Committee includes $5,000,000 in funding for the Tribal set aside within the MHAF. The Committee includes $5,000,000 in funding for the Tribal set aside within the MHAF.

  • The $56 million appropriated for this provision represents a $4 million decrease from the FY 2025 enacted level.

Substance Abuse and Mental Health Services Administration

National Center of Excellence for Eating Disorders: $1 million

Bill report pg. 46: Within the total for PCTE, the Committee continues to support up to $1,000,000 in coordination with SAMHSA’s Center of Excellence for Eating Disorders, to provide trainings for primary care health professionals to screen, intervene, and refer patients to treatment for the severe mental illness of eating disorders, as authorized under section 13006 of the 21st Century Cures Act (Public Law 114–255).

Centers for Disease Control and Prevention

Substance Abuse Prevention Services: $236.88 million

Bill report pg: 188: The Committee recommends $236,879,000 for the Center for Substance Abuse Prevention [CSAP], the sole Federal organization with responsibility for improving accessibility and quality of substance use prevention services.

Tribal Behavioral Grants (Native Connections): $23.67 million

Bill report pg. 189: SAMHSA has administered Tribal Behavioral Health Grants for mental health and substance use prevention and treatment for Tribes and Tribal organizations since fiscal year 2014. In light of the continued growth of this program, as well as the urgent need among Tribal populations, the Committee continues to urge the Assistant Secretary for SAMHSA to engage with Tribes on ways to maximize participation in this program.

Zero Suicide: $26.2 million

Bill report pg. 177: The Committee includes $38,200,000 for suicide prevention programs. Of the total, $26,200,000 is for the implementation of the Zero Suicide model, which is a comprehensive, multi-setting approach to suicide prevention within health systems. 

American Indian and Alaska Native Set Aside: $3.4 million

Bill Report pg. 178: Additionally, suicide is often more prevalent in highly rural areas and among the American Indian and Alaskan Native populations. According to the CDC, American Indian/Alaska Natives [AI/AN] have the highest rates of suicide of any racial or ethnic group in the United States. In order to combat the rise in suicide rates among this population, the Committee recommends $3,400,000 for AI/AN within Zero Suicide. 

Mental Health Services Block Grant: $1.01 billion

Bill report pg. 179: The Committee provides $1,007,571,000 for the Mental Health Block Grant. This appropriation includes $21,039,000 in transfers available under section 241 of the PHS Act (Public Law 78–410 as amended).

  • The Committee recognizes that AI/AN populations in the United States have higher rates of illicit drug use, opioid misuse, and misuse of prescription drugs compared to other racial groups. The Committee encourages SAMHSA to consider the needs of Indian Tribes and tribal organizations within the MHBG.
988 Suicide & Crisis Lifeline: $534.62 million

Bill report pg. 174: —Suicide is a leading cause of death in the United States, claiming over 49,000 lives in 2023. The Committee provides $534,618,000 for the 988 Lifeline and Behavioral Health Crisis Services. This amount includes funding to continue to strengthen the 988 Lifeline and enable the program to continue to respond in a timely manner to an increasing number of contacts. The 988 Lifeline coordinates a network of independently operated crisis centers across the United States by providing suicide prevention and crisis intervention services for individuals seeking help. The Committee requests a briefing within 90 days of enactment, and quarterly briefings thereafter, on the 988 Lifeline spend plan and related activities.

Substance Use Prevention, Treatment, and Recovery Services Block Grant: $2.03 billion

Bill report pg. 190: The Committee acknowledges the important role of the Community Mental Health Services and Substance Use Prevention, Treatment, and Recovery Services Block Grants in supporting States’ efforts to provide resources for expanded mental health and substance use disorder treatment and prevention services. The Committee reiterates the request for a report, as included in Public Law 118–47, regarding the lack of transparency and information that is provided to Congress and the public about how States are distributing those funds and for what programs or services they are being used.

State Opioid Response Grants: $1.6 billion

Bill report pg. 186: The Committee provides $1,595,000,000 for grants to States to address the opioid crisis. Bill language provides not less than 4 percent for grants to Indian Tribes or tribal organizations. The Committee supports the 15 percent set-aside for States with the highest age-adjusted mortality rate related to substance use disorders, as authorized in Public Law 117–328. The Assistant Secretary is encouraged to apply a weighted formula within the set aside based on State ordinal ranking. Activities funded with this grant may include treatment, prevention, and recovery support services. The Committee continues to direct SAMHSA to conduct a yearly evaluation of the program to be transmitted to the Committees no later than 180 days after enactment of this act. SAMHSA is directed to make such evaluation publicly available on SAMHSA’s Web site. The Committee further directs SAMHSA to continue funding technical assistance within the administrative portion of the appropriated amounts for the SOR grants, to provide locally based technical assistance teams as has been done through the Opioid Response Network. The Committee recognizes the importance and essential work currently being done by the Opioid Response Network in delivering technical assistance to State and Territory SOR grantees, sub-recipients, and others addressing opioid use disorder and stimulant use disorder in their communities.

National Institute on Minority Health and Health Disparities

Improving Native American Cancer Outcomes: $6 million

Bill report pg. 142: The Committee notes that Native Americans experience overall cancer incidence and mortality rates that are strikingly higher than non-Native populations. The Committee includes $6,000,000, for the Initiative for Improving Native American Cancer Outcomes to support efforts including research, education, outreach, and clinical access related to cancer in Native American populations. The Committee further directs NIMHD to work with NCI to locate this Initiative at an NCI designated cancer center demonstrating partnerships with Indian Tribes, Tribal organizations, and urban Indian organizations to improve the screening, diagnosis, and treatment of cancers among Native Americans, particularly those living in rural communities.

Native Hawaiian/Pacific Islander Health Research Office: $4 million

Bill report pg. 142 : The Committee recognizes the Federal trust responsibility to Native Hawaiians and the unique health challenges facing the Native Hawaiian and Pacific Islander community. The Committee also acknowledges that there is limited health research on this community, relative to other populations, particularly that disaggregates between different subpopulations. The Committee includes $4,000,000, for the Native Hawaiian/Pacific Islander Health Research Office. The Committee encourages collaboration across Institutes and with the community, including research institutions with expertise and researcher representation from the NHPI community.

Important Behavioral and Mental Health Provisions

Medication-Assisted Treatment for Prescription Drug and Opioid Addiction Tribal Set Aside: $14.5 million

Bill report pg. 184: The Committee includes $111,000,000 for medication-assisted treatment, of which $14,500,000 is for grants to Indian Tribes, tribal organizations, or consortia. These grants should target States with the highest age adjusted rates of admissions, including those that have demonstrated a dramatic age-adjusted increase in admissions for the treatment of opioid use disorders. The Committee continues to direct the Center for Substance Abuse Treatment to ensure that these grants include as an allowable use the support of medication-assisted treatment and other clinically appropriate services to achieve and maintain abstinence from all opioids, including programs that offer low-barrier or same day treatment options.

Peer-Support Specialists: $14 million

Bill report pg. 47: Within BHWET, the Committee includes $14,000,000 to fund training, internships, and certification for mental health and substance use peer support specialists to create an advanced peer workforce prepared to work in clinical settings.

Infant and Early Childhood Mental Health Program: $15 million

Bill report pg. 161: The Committee provides $15,000,000 for grants to entities such as State agencies, Tribal communities, universities, or medical centers that are in different stages of developing infant and early childhood mental health services. These entities should have the capacity to lead partners in systems-level change, as well as building or enhancing the basic components of such early childhood services, including an appropriately trained workforce. Additionally, the Committee recognizes the importance of early intervention strategies to prevent the onset of mental disorders, particularly among children. Recent research has shown that half of those who will develop mental health disorders show symptoms by age 14. The Committee encourages SAMHSA to work with States to support services and activities related to infants and toddlers, such as expanding the infant and early childhood mental health workforce; increasing knowledge of infant and early childhood mental health among professionals most connected with young children to promote positive early mental health and early identification; strengthening systems and networks for referral; and improving access to quality services for children and families who are in need of support.

Administration for Community Living

Native American Caregiver Support Program: $24 million

Bill report pg. 225: American Caregiver Support program. This program provides grants to Tribes for the support of American Indian, Alaskan Native, and Native Hawaiian families caring for older relatives with chronic illness or disability, as well as for grandparents caring for grandchildren.

Call for Nominations: Urban Representative to the VA Advisory Committee on Tribal and Indian Affairs (ACTIA)

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The National Council of Urban Indian Health (NCUIH) is seeking nominations for the role of Urban Representative to the Department of Veterans Affairs (VA) Advisory Committee on Tribal and Indian Affairs (ACTIA).

Nomination Submission Details

How to Apply: Submit your nomination by emailing Policy@NCUIH.org.

The nomination package should include:

    • (1) a letter of nomination by your Urban Indian Organization, or Tribe, or Tribal organization that clearly states the name and affiliation of the nominee, the basis for the nomination ( i.e. specific attributes which qualify the nominee for service in this capacity), and a statement from the nominee indicating a willingness to serve as a member of the Committee;
    • (2) the nominee’s contact information, including name, mailing address, telephone number(s), and email address;
    • (3) the nominee’s curriculum vitae or resume, not to exceed five pages, and
    • (4) a summary of the nominee’s experience and qualifications relative to the professional qualifications criteria listed above.

Deadline: Nominations must be received by NCUIH by August 25, 2025.

Role Overview

The Urban Representative will play a key role in advising the VA on matters impacting urban Native veterans and Indian Country. ACTIA provides recommendations to the VA on issues and programs affecting tribal and urban Indian veteran communities. NCUIH played a critical role in advocating for the inclusion of an Urban Representative on ACTIA. The Committee is composed of 15 voting members.

Membership Terms
  • ACTIA members typically serve one 2 year term.
Nominee Qualifications (see full details in the Federal Register Notice)
  • Demonstrated expertise and leadership in advocating for American Indian/Alaska Native veterans, particularly in urban health or related policy areas.
  • Commitment to attend and actively participate in ACTIA meetings and activities.
  • Full legislative and charter details for ACTIA participation can be found in the linked Charter and Federal Register Notice.
Reference Documents

If you are passionate about making a difference for urban Native veterans, we encourage you to apply or share this opportunity with qualified leaders in your network.

Senate Advances FY 2026 Interior Bill with Increases for IHS and Advance Appropriations for FY 2027

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On July 25, 2025, the Senate Appropriations Full Committee passed the Fiscal Year (FY) 2025 appropriations bill for Interior, Environment, and Related Agencies. The bill provides $8.1 billion for IHS, including $5.3 billion in advance appropriations for FY 2027, despite the President’s budget not requesting advance appropriations. The Committee’s total funding for IHS is the same as the President’s IHS budget authority request. The bill authorizes $90.4 million for urban Indian health – the same funding as the FY25 enacted amount. The report states that “[t]he Committee is committed to improving the health and well-being of AI/AN living in urban Indian communities.”

Background

On July 22, 2025, the House Appropriations Full Committee passed the FY 2026 appropriations bill for Interior, Environment, and Related Agencies. The House 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 House Committee’s total funding for IHS is approximately $500 million higher than the President’s IHS budget authority request. The House bill authorizes $105.99 million for urban Indian health – an increase of $15 million over the FY25 enacted amount.

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 Senators working to support the health of Indian Country. On May 19, 2025, 19 Senators joined Senator Tina Smith (D-MN) in a letter to Chairman Murkowski (R-AK) and Ranking Member Merkley (D-OR) of the Senate 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 Senate 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. Senate leadership will need to work with House Leadership to negotiate a final bill text for passage in both chambers.

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.

Bill Highlights

Line Item FY 25 Enacted FY 26 Tribal Request FY 26 President’s Budget FY 26 House Proposed FY 26 Senate Proposed
Urban Indian Health $90.42 million $770.5 million $90.4 million $ 105.99 million $90.4 million
Indian Health Service $6.96 billion $63 billion $8.1 billion $8.41 billion $8.1 billion
Advance Appropriations $5.19 billion ___________ Did not include $6.05 billion $5.3 billion
Hospital and Clinics $2.5 billion $13.8 billion $2.65 billion $2.85 billion $2.65 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 $131.3 million

Additional Key Provisions:

UIO Interagency Workgroup

Bill Report, Pg. 133: Despite the excellent efforts of Urban Indian Organizations, AI/AN populations continue to be left out of many Federal initiatives. Therefore, the Committee reminds the IHS of the directive to explore the formation of an interagency working group to identify existing Federal funding supporting Urban Indian Organizations [UIOs] and determine where increases are needed, or what programs should be amended to allow for greater access by UIOs; to develop a Federal funding strategy to build out and coordinate the infrastructure necessary to pilot and scale innovative programs that address the needs and aspirations of urban AI/ANs in a holistic manner; develop a wellness centered framework to inform health services; and meet quarterly with UIOs to address other relevant issues. In addition to the Indian Health Service, the working group should consist of the U.S. Department of Health and Human Services, U.S. Department of Housing and Urban Development, U.S. Department of Agriculture, U.S. Department of Justice, U.S. Department of Education, U.S. Department of Veteran Affairs, U.S. Department of Labor, the Small Business Administration, the Economic Development Agency, FEMA, the U.S. Conference of Mayors, and others as identified by UIOs.

Produce Prescription Pilot Program: $3 million

Bill Report, Pg. 130: The bill maintains funding at fiscal year 2025 enacted levels for the Produce Prescription Pilot program.

Contract Support Costs: $1.8 billion and Tribal 105(l) Leases: $366 million

Bill Report, Pg. 134: The Committee has continued language from fiscal year 2021 establishing an indefinite appropriation for contract support costs estimated to be $1,819,000,000 in fiscal year 2026. By retaining an indefinite appropriation for this account, additional funds may be provided by the Agency if its budget estimate proves to be lower than necessary to meet the legal obligation to pay the full amount due to Tribes. The Committee believes that fully funding these costs will ensure Tribes have the resources they need to deliver program services efficiently and effectively.

Bill Report, Pg.  134: The recommendation includes an indefinite appropriation of an estimated $366,000,000 for the compensation of operating costs associated with facilities leased or owned by Tribes and Tribal organizations for carrying out health programs under Indian Self-Determination and Education Assistance Act (ISDEAA) contracts and compacts as required by 25 U.S.C. 5324(l).

Purchased and Referred Care: $996.75 million

Bill Report, Pg. 132: The recommendation includes $996,755,000 for purchased/referred care.

Indian Health Professions: $80.56 million

Bill Report, Pg. 133: The recommendation includes $80,568,000 for the Indian Health Professions program.

Sanitation Facilities Construction: $106.6 million

Bill Report, Pg. 134: The recommendation includes $106,627,000 for Sanitation Facilities Construction activities, equal to the enacted level.

Health Care Facilities Construction: $182.7 million

Bill Report, Pg. 135: The recommendation includes $182,679,000 for Health Care Facilities Construction, equal to the enacted level.

Dental Health: $259.5 million

Bill Report, Pg. 131: The recommendation includes $259,501,000 for dental health, an increase of $5,384,000 to the fiscal year 2025 enacted level.

Alzheimer’s Disease: FY 2025 Funding

Bill Report, Pg. 130: The bill maintains funding at fiscal year 2025 enacted levels for the Alzheimer’s program.

Maternal Health: $1 million

Bill Report, Pg. 131: The Committee recommendation supports funding for maternal health initiatives and provides an additional $1,000,000 for these efforts.

Alcohol and Substance Abuse: $267 million

Bill Report, Pg. 131: The recommendation includes $267,404,000 for alcohol and substance abuse programs, an increase of $633,000 to the fiscal year 2025 enacted level.

Bureau of Indian Affairs, Missing and Murdered Indigenous Women Initiative: $250 thousand

Bill Report, Pg. 68: The Committee recommends an additional $250,000 with an emphasis on addressing the crisis of missing, trafficked, and murdered Indigenous people, especially women, as part of the Bureau of Indian Affairs (BIA) Law Enforcement Special Initiatives.

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

Press Release: NCUIH Commends Bipartisan Effort to Improve Health Outcomes for Urban Native Communities

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FOR IMMEDIATE RELEASE

WASHINGTON, D.C. (July 23, 2025)– On July 23, 2025, Congressman Dr. Raul Ruiz (CA-25) and Congressman Don Bacon (NE-02) reintroduced the bipartisan Urban Indian Health Parity Act. This vital provision will help expand access to necessary health services for American Indian and Alaska Native families and children and ensure the federal government better fulfills its trust responsibility.

“We are grateful that Representatives Ruiz and Bacon are once again championing this bipartisan effort. Fulfilling the federal trust responsibility means ensuring all Native people have access to critical resources. With strong support across Indian Country, we urge Congress to act swiftly to pass this important legislation and improve health outcomes for Native communities,” stated Francys Crevier, JD (Algonquin), CEO, National Council of Urban Indian Health

“American Indian and Alaska Native communities deserve more than promises, they deserve action,” said Congressman Dr. Raul Ruiz (CA-25). “While there is broad, bipartisan recognition of the need to improve tribal health care—including statements of support from Secretary Kennedy—we have yet to see a detailed, actionable plan to make that a reality. The Urban Indian Parity Act is a practical, bipartisan step they can take right now to close health care gaps, strengthen the Indian Health Service, and protect Native patients—regardless of where they live.”

“I am pleased to join Dr. Ruiz on this bipartisan legislation to ensure Native Americans living in urban areas have access to quality healthcare,” remarked Congressman Don Bacon (NE-02). “Nebraska is home to approximately 16,000 American Indian and Alaska Natives and this legislation will strengthen our healthcare system by providing Urban Indian Organizations with the resources they need to serve their communities effectively.”

This bill would amend the Social Security Act to set the federal medical assistance percentage (FMAP) at 100% for services provided to Medicaid beneficiaries at urban Indian organizations (100% FMAP for UIOs). States have received 100% FMAP for services provided to IHS/Medicaid beneficiaries at Indian Health Service and Tribal facilities for decades. Congress has been working toward parity through legislation since 1999. Extending 100% FMAP to UIOs will require the federal government to bear the cost of Medicaid services provided to American Indian and Alaska Native patients no matter which facet of the Indian health system they utilize, as is required by the trust responsibility. Parity for UIOs is essential to enable them to collaborate effectively with states to strengthen the Medicaid program for the 46% of Native patients they serve who are Medicaid beneficiaries.

NCUIH released a report and one pager highlighting the importance of 100% FMAP, which includes case studies of two states, Washington and Montana, that successfully utilized the American Rescue Plan Act’s (ARPA) temporary authorization of 100% FMAP for UIOs to increase funding support for their UIOs. It also provides an extensive history of 100% FMAP in the Indian health care system.

Ruiz, Bacon Press Release

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

House Advances FY 2026 Interior Bill with Increases for IHS and Advance Appropriations for FY 2027

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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.

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

Congressional Native American Caucus Leaders Lead Letter to Safeguard FY 2026 Tribal Program Funding

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On June 23, 2025, 15 Congressional leaders joined the Native American Caucus co-chair Sharice Davids (D-KS-03) and vice-chair Nick Begich (R-AK) in their Dear Colleague letter to House Appropriations Chair Tom Cole (R‑OK‑04) and Ranking Member Rosa DeLauro (D‑CT‑03) requesting the FY 2026 spending bills fully protect funding for Tribal programs. The letter emphasizes that programs such as Indian Health Service (IHS), Bureau of Indian Affairs, Bureau of Indian Education, and related Department of Justice initiatives are not discretionary benefits but an expression of, as the letter states, “… the United States’ trust and treaty obligations to Tribal Nations and Tribal citizens and communities.” 

The letter calls for safeguarding every federal dollar that reaches Indian Country—including direct Tribal line items, set‑asides, and broader accounts leveraged by Tribes—while expanding self‑determination, self‑governance, and more stable funding mechanisms.

NCUIH is grateful for the support of the following Representatives:

  • Sharice L. Davids (D-KS-03)
  • Nicholas J. Begich III (R-AK-At Large)
  • Greg Stanton (D-AZ-04)
  • Melanie Stansbury (D-NM-01)
  • Dusty Johnson (R-SD-At Large)
  • Timothy M. Kennedy (D-NY-26)
  • Joe Neguse (D-CO-02) 
  • Raul Ruiz, M.D. (D-CA-25)
  • Gabe Vasquez (D-NM-02)
  • Angie Craig (D-MN-02)
  • Jared Huffman (D-CA-02)
  • Brian Babin, D.D.S. (R-TX-36)
  • Marilyn Strickland (D-WA-10)
  • Kelly Morrison (D-MN-03)
  • Emily Randall (D-WA-06)
  • Salud Carbajal (D-CA-24)
  • Cleo Fields (D-LA-06)

Background 

NCUIH has worked tirelessly with Congressional leaders and partners to protect funding for IHS and other key programs in the upcoming FY 2026 appropriations bills. NCUIH worked with the Coalition for Tribal Sovereignty to help secure signees for this Native American Caucus Dear Colleague letter. Additionally, NCUIH has provided oral and written testimony to the committee and support for a Congressional Dear Colleague letter in support of Urban Indian Health. 

Full Letter Text:

Dear Chairman Cole and Ranking Member DeLauro,

We are contacting you on behalf of the undersigned members of the Congressional Native American Caucus to urge you to protect and support funding for Tribal programs for Fiscal Year (FY) 2026.

As you both know very well, Tribal programs are different from other federal programs. Tribal programs deliver on the United States’ trust and treaty obligations to Tribal Nations and Tribal citizens and communities. Examples of essential services provided under these obligations include healthcare through the Indian Health Service, land management, law enforcement, and public safety through the Bureau of Indian Affairs, education through the Bureau of Indian Education, criminal prosecution by the Department of Justice, and other important services. Tribal programs are also unique because they are delivered in recognition of Tribal Nations’ and Native people’s unique political status under the U.S. Constitution, as recognized by the U.S. Supreme Court.

All federal funding that flows to Indian Country should be considered delivered in furtherance of trust and treaty obligations—despite the varied delivery methods. This includes funding specific to Tribal programs, Tribal set-asides, and more widely available funding that Indian Country has accessed to fill gaps in funding deficits. It also includes funding used to provide direct services and funding Tribal Nations have accepted through self-determination contracts, self-governance compacts, or otherwise to deliver governmental services to their own communities. Any improvements to these programs should focus on increasing the efficiency of federal dollars by expanding self-determination and self-governance models and creating more stable funding mechanisms.

We respectfully ask that you safeguard and support all federal funding flowing to Indian Country to ensure successful delivery of services. We also ask that you support funding necessary to maintain federal employee positions that service Tribal nations and the federal offices that provide these services.

Congress’s full and stable delivery of federal funding obligated to Indian Country will directly result in enhanced economic development and capacity building that benefits Tribal communities and their surrounding states and localities. Full, sustained, and advanced funding will strengthen local communities and provide the federal government a valuable return on investment.

If you have any questions, please feel free to contact Co-Chair Davids’ office at (202) 225-2865 or Vice Chair Begich’s office at (202) 225-5765. Thank you for considering our views when negotiating the final FY26 appropriations bills.

Coalition for Tribal Sovereignty Action Alert: Call on Congress to Support Tribal Programs in FY2026 Appropriations

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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

Download Letter

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.

Senate Passes Reconciliation Bill with Exemptions for American Indian and Alaska Native People from Community Engagement Requirements for SNAP and Medicaid

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On July 1, 2025, the Senate passed their budget reconciliation bill. The Senate’s One Big Beautiful Bill Act is a major bill that would deliver the significant elements of President Trump’s legislative agenda, including tax cuts, Medicaid reforms, and lifting the debt ceiling. The bill contains a health title, which includes Medicaid reform provisions, such as cost-sharing and provider tax changes. The Senate bill has notable provisions impacting American Indian and Alaska Native healthcare compared to the House-passed bill: exempts American Indian and Alaska Native beneficiaries, including “Urban Indians”, from the Medicaid and Supplemental Nutrition Assistance Program (SNAP) community engagement requirements and exempts American Indian and Alaska Native beneficiaries from more frequent eligibility redetermination requirements.

NCUIH Action

The National Council of Urban Indian Health (NCUIH) has worked with Urban Indian Organization (UIO) leaders and national partners, including the National Indian Health Board, and the National Congress of American Indians, and the Coalition for Tribal Sovereignty to ensure that American Indian and Alaska Native Medicaid and SNAP beneficiaries are protected from harmful policy changes.

Next Steps

The bill will return to the House to be voted on, and its passage remains unclear. There is a stated deadline of July 4.

Analysis

Community Engagement Requirements for Certain Medicaid Beneficiaries

What it Does: States would be required to implement community engagement requirements for able-bodied adults without dependents. Compliance may be achieved through:

  • Working, volunteering, or participating in a work program for at least 80 hours/month; or
  • Enrolling in educational programs totaling 80 hours/month.

Impact on Indian Country: The bill exempts American Indian and Alaska Native beneficiaries from these requirements. Specifically, it states that “specified excluded individuals” include:

  • Indians and Urban Indians as defined in the Indian Health Care Improvement Act (IHCIA);
  • California Indians as described in Section 809(a) of the IHCIA;
  • Individuals determined eligible as an Indian for the Indian Health Service under regulations promulgated by the Secretary.

The work requirements go into effect on December 31, 2026.

Modifying Cost Sharing Requirements for Certain Expansion Individuals Under the Medicaid Program

What it Does:Requires states 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.
  • May not exceed five percent of the individual’s income.

Impact on Indian Country:American Indian and Alaska Native beneficiaries are already exempted from cost-sharing provisions for those who receive a “service directly by the Indian Health Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization or through referral under contract health services for which payment may be made under this subchapter.” This exemption will remain in place.

Moratorium on New or Increased Provider Taxes

What it does: Reduces the safe harbor limit for states that have adopted the Affordable Care Act (ACA) expansion by 0.5% annually starting in fiscal year 2028 until the safe harbor limit reaches 3.5% in FY 2032.

Potential Impact on Urban Indian Organizations: UIOs are exempt from provider taxes due to their tax status and will not be affected by this provision.

Reduction in Expansion FMAP for States Covering Undocumented Immigrants

What it Does:Reduces by 10% the Federal Medical Assistance Percentage (FMAP) for Medicaid Expansion States who use their Medicaid infrastructure to provide health care coverage for undocumented immigrants under Medicaid or another state-based program.

Impact on States with Urban Indian Organizations: Seven states currently provide such coverage: California, Washington, Oregon, Minnesota, Illinois, New York, and Colorado, all of which have UIOs. States will have to individually decide on how and if they will adapt their programs to adjust to the potential decrease in federal funding. Several states, including California, Minnesota, and Illinois, have announced plans to freeze or cut these programs.

Modifications to SNAP Work Requirements for Able-Bodied Adults

What it does: Instituting exceptions to the SNAP work requirements for able-bodied adults.

Impact on Indian Country: The bill exempts American Indian and Alaska Native beneficiaries from these requirements. Specifically, it states that “specified excluded individuals” include:

  • Indians and Urban Indians as defined in the Indian Health Care Improvement Act (IHCIA);
  • California Indians as described in Section 809(a) of the IHCIA.
Medicaid Redetermination Period

What it does: Requires states to conduct eligibility redeterminations at least every 6 months for Medicaid expansion adults beginning after December 31, 2026. It also requires the Secretary of Health and Human Services to issue guidance within 180 days of enactment.

Impact on Indian Country: The bill exempts American Indian and Alaska Native beneficiaries from these requirements. Specifically, it states that “specified excluded individuals” include:

  • Indians and Urban Indians as defined in the Indian Health Care Improvement Act (IHCIA);
  • California Indians as described in Section 809(a) of the IHCIA;
  • Individuals determined eligible as an Indian for the Indian Health Service under regulations promulgated by the Secretary.

IHS Seeks Feedback on Strategic Realignment; Virtual Urban Confer Set for July 28

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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

HHS Secretary Kennedy Visits Second Urban Indian Organization in Oklahoma City

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Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. along with Senior Advisor Mark Cruz (Klamath) visited the Oklahoma City Indian Clinic (OKCIC

On June 26th, 2025, the Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. along with Senior Advisor Mark Cruz (Klamath) visited the Oklahoma City Indian Clinic (OKCIC) to learn more about their work as an Urban Indian Organization within the Indian Health System. Secretary Kennedy spent time in the clinic’s food resource center, discussing the links between nutrition, chronic disease prevention, and the persistent food insecurity faced by many Native families living in cities. Secretary Kennedy was joined on his visit by Tribal leaders and the Oklahoma IHS Area Director.  

OKCIC Chief Executive Officer, Robyn Sunday Allen (Cherokee), walked the Secretary through the clinic’s integrated care model—combining primary care, behavioral health, pharmacy, and culturally grounded wellness programs under one roof. Kennedy praised OKCIC’s community-centered approach as a practical roadmap for addressing social drivers of health and pledged continued collaboration with Urban Indian Organizations to ensure that Native people in urban settings receive equitable, high-quality care. This visit is Secretary Kennedy’s second visit to an Urban Indian Organization since his confirmation in February, his first visit was to Native Health in Arizona on April 8.