In this Edition:
NCUIH Policy Priorities: NCUIH Released its 2025 Policy Priorities.
NCAI, Indian Gaming Association, and National Organizations host a Legislative Summit –NCUIH presented on an Appropriations panel and joined Capitol Hill meetings to share UIO issues alongside Tribal leaders.
Lawsuits & Court Cases Updates – Current court cases and legal action impacting American Indian and Alaska Native (AI/AN) health care and policy.
Budget Reconciliation – House Committee Advances Budget Reconciliation Text with Exemptions for AI/AN People.
FY 2026 Appropriations – President Releases FY 2026 Budget, Congress Requests Protection of IHS Funding.
Protecting AI/AN People on Medicaid – NCUIH Submits Comments Supporting Exemption of AI/AN People from Work Requirements in State Medicaid Programs.
Federal Agency Actions – Department of Health and Human Services (HHS) New DEI Rules in Grant Policy Statement and HHS Recission of Four Guidance Documents.
In Case You Missed It (ICYMI) – IHS Tribal Consultation and Urban Confer on Health IT Modernization, Recent Dear Tribal and Urban Leader Letters.
Upcoming Events – NCAI Mid-Year Conference in Mashantucket, CT.
New Resource: 2025 Policy Priorities Released
NCUIH is pleased to announce the release of its 2025 Policy Priorities document, which outlines a summary of urban Indian organization (UIO) priorities for the Executive and Legislative branches of the government for 2025, as well as talking points and recommendations for each priority.
Read the full priorities.
These priorities were informed by NCUIH’s 2024 Policy Assessment.
NCAI, Indian Gaming Association, and National Organizations Host Legislative Summit
NCUIH thanked Sen. Murkowski, Rep. Tom Cole, Rep. Sharice Davids and Rep. McCollum for supporting UIOs.
On May 13-14, the National Congress of American Indians, Indian Gaming Association (IGA), and other National organizations hosted a Legislative Summit in Washington D.C. regarding recent administration developments and Budget Reconciliation.
Speakers included national Native organizations, Administration officials, and Members of Congress to address key legislative and budgetary issues affecting Native communities. The event featured policy briefings, Capitol Hill visits, and opportunities for direct advocacy and engagement with Members of Congress.
NCUIH presented on an Appropriations panel and joined Capitol Hill meetings to share UIO issues alongside Tribal leaders.
Monitoring The Bench: Lawsuits Filed Against Recent Executive Orders and Presidential Actions
National Council of Nonprofits v. Office of Management and Budget (OMB) – Lawsuit brought in the District Court of the District of Columbia by nonprofits to stop the federal funding freeze.
- Status: Preliminary Injunction (PI) was granted on 2/25/2025 – nationwide injunction that prevents the federal government from rescinding or freezing funds that have been appropriated by Congress. Defendants filed an Appeal with the DC Circuit on 4/24/2025, regarding the decision to grant the Preliminary Injunction. Case Stayed on 5/12/2025 while the appeal is heard in the DC Circuit.
- Why this matters for UIOs: Funding at issue in the case is related to the rescinded OMB Memo (M-25-13) that directed federal agencies to pause disbursement of funds that could be implicated by Executive Orders. This includes funding related to DEI, which could implicate funding for AI/AN communities.
American Federation of Government Employees, AFL-CIO v. Trump – Lawsuit filed in the District Court of Northern California by a coalition of unions, nonprofits, and local governments over reorganization of the executive branch that would result in mass terminations.
- Status: Temporary Restraining Order (TRO) Granted on 5/9/2025, preventing the Department of Government Efficiency (DOGE) from carrying out the directive to reduce the government workforce.
“The President has neither constitutional nor, at this time, statutory authority to reorganize the executive branch.”
- Why this matters for UIOs: Reorganization of the Executive Branch includes various agencies, including HHS, which will impact AI/AN communities who receive programs and services that may be at risk of being eliminated. Could impact IHS and cause restructuring that also eliminates essential programs and services.
State of New York v. Kennedy – Lawsuit filed in the District Court of Rhode Island by 19 states and D.C. over restructuring of HHS that has resulted in mass terminations and cuts to programs.
- Status: Motion for PI was filed on 5/9/2025. Still awaiting a hearing and ruling.
- Why this matters for UIOs: Plaintiffs include 12 states where UIOs are located: AZ, CA, CO, IL, MD, MN, NJ, NM, NY, OR, WA, and WI. Restructuring of HHS has led to mass terminations and elimination of programs within the CDC, FDA, SAMHSA, ACF, and ACL.
State of Colorado v. U.S. Department of Health and Human Services – Lawsuit filed in the District Court of Rhode Island by 23 states and D.C. over termination of $11 billion in public health funding that was authorized in response to the COVID-19 pandemic but intended to be used beyond the pandemic itself.
- Status: TRO Granted 4/3/2025, requiring Defendants to cease withholding funds and to make funds available.
- Why this matters for UIOs: Plaintiffs include 15 states where UIOs are located: AZ, CA, CO, IL, MD, MA, MI, MN, NV, NM, NY, OR, PA, WA, and WI. Funding includes SAMHSA programs and CDC grants with state health departments.
Over 300 lawsuits have been filed against recent executive orders and presidential actions, covering issues like agency data access, federal employee terminations, and elimination of diversity, equity, and inclusion (DEI) initiatives. NCUIH continues tracking these cases to identify any rulings that may impact UIOs.
House Advances Reconciliation Bill with Exemptions for American Indian and Alaska Native People from Community Engagement Requirements
On May 22, the House of Representatives voted 215-214-1 to pass a major reconciliation bill that would deliver the major 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.
Community Engagement Requirements for Certain Medicaid Beneficiaries – First Ever Inclusion of “Urban Indians” in Exemption:
- 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.
Other Key Provisions:
- Modifying Cost Sharing Requirements for Certain Expansion Individuals Under the Medicaid Program – AI/AN beneficiaries are already exempted
- Moratorium on New or Increased Provider Taxes – UIOs are already exempted due to their tax status
- Reduction in Expansion FMAP for States Covering Undocumented Immigrants – Seven stated with UIOs provide such coverage (California, Washington, Oregon, Minnesota, Illinois, New York, and Colorado).
Read more on these provisions here.
Next Steps: Budget reconciliation package will need to proceed to the House floor for a vote. Once passed, the Senate will take up the package and provide their edits.
Recent NCUIH Efforts: On May 8, NCUIH joined the Partnership for Medicaid—which is a nonpartisan, nationwide coalition of organizations representing clinicians, health care providers, safety-net health plans, and counties with the goal to preserve and improve the Medicaid program— in a statement of concern regarding coverage losses and benefits and provider payment reductions outlined by the recent Congressional Budget Office report on Medicaid policy options being considered by Congress as part of reconciliation. NCUIH also joined the Partnership in a reconciliation letter to House Energy and Commerce to protect Medicaid on May 9.
NCUIH has worked with UIO leaders and national partners, including the National Indian Health Board (NIHB) and the Medicaid Medicare Policy Committee (MMPC), to ensure that American Indian and Alaska Native Medicaid beneficiaries are protected from harmful policy changes. NCUIH participated in over 60 Capitol Hill meetings to emphasize the importance of Medicaid’s role in AI/AN communities, and to spotlight the unique needs of UIOs.
- Why it Matters: In 2023, approximately 2.7 million AI/AN people were enrolled in Medicaid across the United States, according to American Community Service data. Medicaid is a major source of health care funding, particularly for UIOs, which provide essential healthcare services to AI/AN people living in urban areas. The proposed Medicaid cuts would threaten the ability of UIOs to sustain necessary service offerings, potentially reducing access to essential health care services for urban AI/AN people.
- Read NCUIH’s comprehensive overview highlighting the crucial role Medicaid plays in providing health care to AI/AN communities.
President Releases FY 2026 Budget, Congress Requests Protection of IHS Funding
On May 2, the President released the FY 2026 budget proposal, which acts primarily as a symbolic blueprint of the President’s vision for the size and scope of the federal government.
By the numbers: The proposal for HHS outlines a 26.2% reduction to the overall HHS budget, amounting to $33.3 billion in cuts.
The President’s funding request overview states that the Administration will “Maintain Support for Tribal Nations”, stating, “the Budget preserves Federal funding for the Indian Health Service and supports core programs at the Bureau of Indian Affairs and Bureau of Indian Education, sustaining the Federal Government’s support for core programs that benefit tribal communities.” It also indicates plans to “streamline other programs for tribal communities, to reduce inefficiencies and eliminate funding for programs and activities found to be ineffective.”
Next Steps: The administration is expected to release its full Budget in Brief in the coming weeks. In the meantime, the House and Senate Appropriations Committees will craft their respective FY 2026 funding bills. NCUIH will continue to engage with lawmakers to ensure the Indian Health System and all Tribal programs receive the resources they need.
Congressional Advocacy for Indian Health:
Senate Indian Affairs Committee (SCIA) Oversight Hearing
On May 14, 2025, SCIA held an oversight hearing to examine delivering essential public health and social services to Native Americans. Hearing focused on federal programs serving Native Americans across the operating divisions at the HHS. Chairwoman Janet Alkire was NIHB and NCUIH’s shared witness and incorporated UIOs into her testimony.
NCUIH also worked with Senator Cortez Masto who shared story shared by Nevada Urban Indians and Native Connections: “I am so concerned about the cuts to mental health services that we fought for in our communities. There is a program called Native Connections, and I know about it because in my state, I have talked with so many of my Native community members. There’s a nine-year-old girl at Nevada Urban Indians who was struggling with her mental health, and she did not, could not get care from a school or a pediatrician. But it was Native Connections program that, according to her father, got his daughter back. It’s a Native Connections program, and so I don’t know if any of you are familiar with it, if we could talk about it, but please stress the importance of why funding for programs, particularly in this mental health and Native Connections, is so important.”
Congressional Leaders Letter Requesting Protection of IHS Funding and Increased Resources for Urban Indian Health
NCUIH supported House and Senate Dear Colleague Letters requesting that the Interior Appropriations Committees retain advance appropriations for IHS in FY27, protect IHS from sequestration, and provide robust funding for urban Indian health in the final FY 2026 appropriations bill.
Senators Urge HHS Secretary Kennedy to Address IHS Staffing Shortages
On May 6, Senators Jeff Merkley (D-OR), Brian Schatz (D-HI), and Lisa Murkowski (R-AK), sent a letter to HHS Secretary Kennedy:
- Demanding urgent action from HHS Secretary Robert F. Kennedy, Jr. to ensure the IHS has the necessary resources and staffing to fully deliver health care services for AI/AN people, as required by federal law.
- Calling for the IHS to immediately halt any further actions affecting Tribal health care delivery without first engaging in meaningful Tribal consultation.
NCUIH has worked closely with these offices to inform them of impacts of IHS workforce changes impacting UIOs.
Read more on NCUIH’s blog.
NCUIH Submits Comments Supporting Exemption of AI/AN People from Work Requirements in State Medicaid Programs
Earlier this month, NCUIH submitted comments to CMS and state Medicaid programs supporting the exemption of AI/AN people from work requirements for Arizona, Arkansas, Iowa, and Utah.
HHS Updates: New DEI Rules in Grant Policy Statement and Recission of Four Guidance Documents
New DEI Rules in HHS’ Updated Grants Policy Statement
HHS recently released an updated HHS Grants Policy Statement (GPS), which is effective April 16, 2025, and “replaces all prior versions.”
- This version of the GPS includes rules on prohibiting DEI.
- The DEI rule is consistent with recent EOs on DEI.
- Impact on IHS/Tribes/UIOs: Based on the February 25, 2025, Advisory Opinion from the HHS General Counsel, the GPS DEI rule will not impact the I/T/U’s ability to serve AI/AN people because the EOs do not impact the government-to-government relationship between the United States and Tribes and do not impact the United States’ obligations to Tribes and their citizens, including healthcare obligations. Instead, restrictions on UIO will be on operations, such as hiring.
We recommend your UIO discusses how potential “DEI programming” may affect your particular program with compliance and/or legal advisors.
Notification of HHS Documents Identified for Rescission
On May 14, 2025, HHS published a Rule in the Federal Register announcing documents identified for recission:
- Extension of Designation of Scarce Materials or Threatened Materials Subject to COVID-19 Hoarding Prevention Measures; Extension of Effective Date With Modifications, 86 FR 35810 (July 7, 2021).
- Opioid Drugs in Maintenance and Detoxification Treatment of Opiate Addiction; Repeal of Current Regulations and Issuance of New Regulations: Delay of Effective Date and Resultant Amendments to the Final Rule, 66 FR 15347 (Mar. 19, 2001).
- Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder, 86 FR 22439 (Apr. 28, 2021).
- Notification of Interpretation and Enforcement of Section 1557 of the Affordable Care Act and Title IX of the Education Amendments of 1972, 86 FR 27984 (May 25, 2021).
NCUIH is still analyzing this notice and impacts.
ICYMI: IHS Tribal Consultation and Urban Confer on Health IT Modernization, Recent Dear Tribal and Urban Leader Letters
IHS Tribal Consultation and Urban Confer on Health IT Modernization
On May 15, IHS held a Tribal Consultation and Urban Confer (TC/UC) regarding Health Information Technology (HIT) Modernization: Four Directions Warehouse. Key updates:
- The expected go-live date for the pilot (Lawton and the three service units) will being Spring 2026. IHS is preparing for pilot go-life between now and then.
- IHS anticipates beginning PATH EHR go-lives for cohorts which will include Tribal, Urban, and federal partners.
- Written comments and recommendation are due Saturday, June 14, 2025. Email to either consultation@ihs.gov or urbanconfer@ihs.gov.
The next joint IHS TC/UC session on HIT Modernization will be on PATH EHR Scope and Capabilities and held virtually via Zoom on August 7, 2025, 1:30-3:00 PM Eastern. Register here.
Recent Dear Tribal and Urban Leader Letters (DTLL/DULL)
April 22 DTLL – The HRSA Administrator writes to Tribal leaders to share updates on HRSA regional office structure and reaffirm his commitment to ensuring that no programs, services, or communications are interrupted.
Regional Offices are now closed in the following regions:
- Region 1 – Boston: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont
- Region 2 – New York: New York, New Jersey, the U.S. Virgin Islands, and Puerto Rico
- Region 5 – Chicago: Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin
- Region 9 – San Francisco: Arizona, California, Hawaii, Nevada and the Pacific Islands (American Samoa, Federated States of Micronesia, Guam, Marshall Islands, Northern Mariana Islands and Palau)
- Region 10 – Seattle: Alaska, Idaho, Oregon, and Washington
May 20 DTLL – CDC writes to Tribal leaders to provide information about a webinar CDC is hosting entitled “Partnering with Tribal Nations to Prevent and Respond to New World Screwworm.”
- Webinar: Wednesday, June 4, 2025, 3-4 PM Eastern. Register here.
- Tribal nations, tribal communities, tribal serving organizations, and healthcare providers, veterinarians, and livestock ranchers and farmers living and working on tribal lands are welcome to attend.
- The webinar will provide an overview on: The New World Screwworm (NWS) and the current situation in Central America and Mexico, how the NWS is a threat to Tribal nations and Tribal communities, and how to identify and treat infestations.
Upcoming Events
- June 8-11 – NCAI Mid-Year Conference in Mashantucket, CT. Register here.
- June 10 – CMS All Tribes Call
- June 18 – Next NCUIH Monthly Policy Workgroup (virtual)
- June 17-18 – Virtual Tribal Leaders Diabetes Committee (detailed forthcoming)
One more thing: Coalition for Tribal Sovereignty
The Coalition for Tribal Sovereignty (CTS) is a collaborative alliance that serves as a powerful unifying voice of regional and national inter-tribal policy-oriented, non-profit organizations to engage with federal policymakers on critical issues affecting the sovereign interests, rights, and authorities of Tribal Nations, tribal citizens, and community members across the United States.
The Coalition:
- Creates joint messages to share with policy makers
- Sends letters to key administration officials
- Develops advocacy strategies
Learn more at www.coalitionfortribalsovereignty.org
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.
