On February 3rd, 2026, U.S. Senators Catherine Cortez Masto (D-NV) and Mike Rounds (R-SD) introduced bipartisan legislation to elevate the Director of the Indian Health Service (IHS) to Assistant Secretary for Indian Health within the U.S. Department of Health and Human Services (HHS). Companion legislation was introduced in the House of Representatives by Congressmen Greg Stanton (D-Ariz.-04) and David Joyce (R-Ohio-14).

The Stronger Engagement for Indian Health Needs Act would formally elevate the IHS Director’s position within the federal government, strengthening Tribal representation in federal health decision-making and reinforcing the federal government’s trust responsibility to provide health care to American Indian and Alaska Native people.

“The shockingly unequal health outcomes in Indian Country paint a clear picture: our country has failed to live up to our obligation to provide quality health care for Tribal communities,” said Senator Cortez Masto. “This bipartisan legislation would be an important step toward giving IHS the tools and authority it needs to ensure everyone has access to excellent, affordable health care.”

“The Indian Health Service has an obligation to care for tribal members across the United States, and we have an obligation to make improvements to the system to improve patient care,” said Senator Rounds. “Our legislation would raise the role of IHS Director to Assistant Secretary for Indian Health, allowing them more authority to recruit and retain staff within the IHS system.”

“Effective healthcare delivery requires empowered leadership, and elevating the IHS Director to Assistant Secretary is a critical step in moving Indian health from an afterthought to a primary focus of federal healthcare policy,” said Francys Crevier (Algonquin), CEO of NCUIH.

On February 3, 2026, Congress passed a three-bill appropriations minibus for fiscal year (FY) 2026, which included the 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 $100 million below the FY 2025 levels and $22 billion above the President’s request. The bill also includes $200 million for the Special Diabetes Program for Indians (SDPI), which represents a $41 million increase, the largest increase for the program in 22 years.

Other Key provisions include:

• $9 million, $3 million increase, for the Improving Native American Cancer Outcomes program 
• $27 million, $3 million increase, for the Good Health and Wellness in Indian Country program 
• $25.67 million, $2 million increase, for the Tribal Behavioral Health Grants (Native Connections) 
• No less than $6 million for 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

The bill will now head to the President to sign.

• Minibus Appropriations Bill
• Labor-H Bill Report
• Bill Summary

Bill Highlights

Additional Key Provisions:

Medicare Telehealth Flexibilities: Extended through December 31, 2027.

Health Resources and Services Administration

Federal Office of Rural Health Policy: $417 million
Native Hawaiian Health Care Program: $27 million
National Health Service Corps: $130 million (15% Tribal set-aside)

• Tribal Set-Aside—The Committee includes a set-aside of 15 percent within the total funding provided for NHSC to support awards to participating individuals that provide health services in Indian Health Service facilities, Tribally-operated health programs, and Urban Indian Health programs.

Centers for Disease Control and Prevention

Good Health and Wellness in Indian Country: $27 million – $3 million increase
Public Health Infrastructure: $360 million ($10.8 million Tribal set-aside)

• The agreement includes a new requirement that three percent of total PHI funding be designated specifically for Tribes and Tribal organizations. The agreement further directs that no less than 70 percent of total PHI funding be awarded to State, local, and Territorial public health departments.

Office of the Secretary – General Departmental Management

Minority HIV/AIDS Fund: $56 million ($6 million Tribal set-aside)

• The agreement includes a Tribal set-aside of no less than $6,000,000 within the Minority HIV/AIDS Prevention and Treatment program.

Substance Abuse and Mental Health Services Administration

Eating Disorders: $2 million
Substance Abuse Prevention Services: $205 million
Tribal Behavioral Grants (Native Connections): $25.67 million
Zero Suicide: $23.8million
American Indian and Alaska Native Set Aside: $4.4 million
Minority AIDS Appropriations: $9.2 million
Mental Health Awareness Training: $28 million
Strategic Prevention Framework: $137.5 million
Mental Health Services Block Grant: $991.5 million
988 Suicide & Crisis Lifeline: $534.6 million
Substance Use Prevention, Treatment, and Recovery Services Block Grant: $1.9 billion
State Opioid Response Grants: $1.6 billion

• Within the amount provided, the bill includes a set-aside for Indian Tribes and Tribal organizations of not less than 4.25 percent.

National Institute on Minority Health and Health Disparities

Improving Native American Cancer Outcomes: $9 million – $3 million increase
Native Hawaiian/Pacific Islander Health Research Office: $5 million – $1 million increase

Important Behavioral and Mental Health Provisions

Medication-Assisted Treatment for Prescription Drug and Opioid Addiction: $114 million

• Tribal Set Aside: $15.5 million

Peer-Support Specialists: $15 million
Infant and Early Childhood Mental Health Program: $15 million

Administration for Community Living

Native American Caregiver Support Program: $14 million

In this Edition:

• 💰 $5 Million Increase for Urban Indian Health in Fiscal Year 2027
• 📄 2025 Policy Assessment Released
• 🏥 Indian Health Service Realignment: Comments Due February 9
• ⚖ Court Grants Injunction on Health Resources and Services Administration 340B Rebate Pilot Program
• 💬 Medicare and Medicaid Billing Challenges Request for Information
• 💡 California Urban Indian Organization Social Determinants of Health Survey
• 📅 Upcoming Events and Key Dates

Fiscal Year 2026 Appropriations Enacted with Increase for Urban Indian Health

Congress enacted Fiscal Year 2026 appropriations, including increased investments across Indian Health Service and Tribal health programs.

• $95.42 million for Urban Indian Health, a $5 million increase over Fiscal Year 2025
• $5.31 billion in advance appropriations for Fiscal Year 2027
• Senate report language directing the Indian Health Service to explore an interagency working group to support Urban Indian Organizations

Additional provisions include:

• $5 million for generators at Indian Health Service, Tribal, and Urban Indian facilities
• $7 million for the Produce Prescription Pilot Program
• $39.43 million for Tribal Epidemiology Centers

2025 NCUIH Policy Assessment Released

The National Council of Urban Indian Health released its 2025 Policy Assessment, which will inform the development of the organization’s 2026 policy priorities.

Key focus areas include:

• Advance appropriations for the Indian Health Service
• Impacts of federal policy changes on Urban Indian Organization funding
• Executive orders affecting diversity, equity, inclusion, and accessibility programs
• Achieving full Medicaid parity for Urban Indian Organizations
• Strengthening the Urban Indian health workforce
• Food is Medicine initiatives addressing food insecurity and health

→ Go Deeper: Access the Policy Assessment via the NCUIH Policy Resource Center.

Rural Health Transformation Funding Update

Rural Health Transformation Funding Awards in States

Several states have received Rural Health Transformation funding and included Tribes or Tribal organizations as partners, subrecipients, or priority populations in their state plans.

• State awards range from approximately $160 million to $280 million
• Multiple states explicitly list Tribes or Tribal organizations as subrecipients, including Michigan, Montana, Nebraska, and Oregon
• Some states reference Tribal workforce development, training pipelines, and long-term retention strategies
• New Mexico’s plan allows Tribes to apply directly for a competitive grant program funded through the state’s allocation

Why it matters: These state plans may present opportunities for Urban Indian Organizations to engage in implementation, partnerships, and future funding discussions.

Federal Agency Updates

Indian Health Service Realignment: Comments Due February 9

The Indian Health Service is seeking Tribal and Urban Indian Organization input on its proposed agency realignment.

• Urban confer held January 15
• NCUIH hosted a preparation session for Urban Indian Organizations on January 14
• Written comments are due February 9, 2026 
• NCUIH will provide a comment template for Urban Indian Organizations

Federal Court Update

Court Grants Injunction on Health Resources and Services Administration 340B Rebate Pilot Program

A federal court granted an injunction halting implementation of the Health Resources and Services Administration’s proposed 340B Rebate Pilot Program.

Why it matters: 

• Prevents financial strain from paying full drug prices upfront
• Avoids administrative disruptions to reimbursement and claims processing
• Aligns with requests from the Secretary’s Tribal Advisory Committee and the Tribal Technical Advisory Group

NCUIH continues to advocate for exemptions for Indian health care providers.

Advocacy Highlights and Requests for Information

Medicare and Medicaid Billing and Claims Processing Challenges 

The National Indian Health Board’s Medicare, Medicaid, and Health Reform Policy Committee is collecting information on denied billing and claims processing challenges affecting Indian Health Service, Tribal, and Urban Indian providers.

• Goal: Identify consistent issues across Indian Health Service Areas
• Deadline: February 9, 2026 
• Submissions will be de-identified and elevated to the Centers for Medicare and Medicaid Services Tribal Technical Advisory Group

Indian Health Service Loan Scholarship Program Recipients at Urban Indian Organizations 

NCUIH is seeking input from Urban Indian Organizations on participation in the Indian Health Service Loan Scholarship Program.

• Does your organization currently employ any recipients of the Indian Health Service Loan Scholarship Program?
• If your organization previously employed recipients, did they remain at your Urban Indian Organization after completing their service obligation?

How to Respond: Please share your responses by emailing policy@ncuih.org.

New NCUIH Research Opportunity (California Urban Indian Organizations)

Earn $750+ for Your Organization

The National Council of Urban Indian Health launched a survey to collect insights from California Urban Indian Organizations on key Social Determinants of Health affecting urban American Indian and Alaska Native communities.

• Eligible organizations: California-based Urban Indian Organizations only
• Stipend: $750+ per completed response
• Limit: One response per Urban Indian Organization
• Survey closes: January 31, 2026 

Go Deeper: Access the survey via the National Council of Urban Indian Health website.
Contact: Sophie Chishty, NCUIH Research Associate, at schishty@ncuih.org.

Federal Budget Process

Fiscal Year 2028 Indian Health Service Budget Formulation

• Tribal request: $29.8 billion in full mandatory funding
• Indian Health Service Area budget consultations held October–December
• January 21–22: Area report presentation webinars
• January 22: NCUIH presents Urban Indian Health priorities
• February 10–11: National Tribal Budget Formulation Work Session

Upcoming Events and Important Dates

• February 9: State of Indian Nations Address (Washington, District of Columbia)
• February 10–12: National Congress of American Indians Executive Council Winter Session and Hill Day
• February 12: Indian Health Service Tribal Summit (70th Anniversary)
• February 18: National Council of Urban Indian Health Monthly Policy Workgroup (virtual)
• February 19: Department of Urban Indian Affairs Executive Directors and Chief Executive Officers Call

2026 NCUIH Annual Conference

2026 NCUIH Annual Conference Registration Open

Join us for our 2026 Annual Conference on April 27–30, 2026, at The Westin Downtown in Washington, D.C. The conference will bring together Urban Indian Organizations, health leaders, policymakers, and partners to share strategies, strengthen systems, and advance urban Indian health nationwide. Programming includes UIO board training, two full days of conference sessions, and a Hill Day for Urban Indian Organizations. Registration and hotel room block are open!

Recent NCUIH Policy Blogs

• 1/6/2026- Congressional Leaders Release Three Bill Minibus for FY 2027 with Increases for Urban Indian Health and Advance Appropriations for Indian Health Service
• 1/15/2026- Fresno American Indian Health Project Marks the Opening of Renewed Native Wellness and Youth Services Spaces
• 1/22/2026- CMS Announces Rural Health Transformation Program Awards in All 50 States, Including Tribal Set-Asides and Initiatives in Several States

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.

Fresno American Indian Health Project recently gathered community members, staff, and partners to mark the opening of its newly renovated Native Wellness and Youth Services spaces. The moment reflects continued investment in care that is shaped by community, culture, and trust. 

The renewed spaces were designed to better support Native youth and families accessing wellness and behavioral health services in Fresno. Community members and partners recognized the importance of environments that feel welcoming, grounded, and reflective of the people they serve. 

FAIHP continues to show how intentional spaces can strengthen care, connection, and long-term wellness for urban Native communities across California.