FY 2024 Spending Bill Signed into Law, Includes Modest Increase for the Indian Health Service and Maintains Advance Appropriations

The bill includes $6.96 billion for IHS and flat funding for Urban Indian Health.

On March 09, 2024, the Consolidated Appropriations Act, 2024 (H.R. 4366), also known as a ‘minibus,’ was signed into law by President Biden, finalizing appropriations for six spending accounts for fiscal year (FY) 2024. This follows a fourth continuing resolution (CR) for FY 2024 that extended partial government funding through March 8 and March 22. The bill, which passed in the House with a 339-85 vote, followed by final passage in the Senate with a 75-22 vote, is the first package of final Appropriations bills for FY 2024 and included Interior appropriations.

  • The minibus authorizes $6.96 billion for the Indian Health Service (IHS) for FY 2024, which is $3.6 million above the comparable FY 2023 level; $90.42 million for urban Indian health for FY 2024, which is equal to the FY 2023 enacted level; and advance appropriations for IHS totaling $5.19 billion for FY 2025.
  • In addition, the final package includes an authorization of $130 million for the Special Diabetes Program for Indians (SDPI) for the period of March 9 through December 31, 2024, bringing the total funding to $158 million for Calendar Year (CY) 2024 (includes SDPI funding allocated in FY 2024 CRs).

Despite cuts in funding for other programs in the Interior appropriations bill, such as a 10% cut to the Environmental Protection Agency (EPA), the Indian Health Service was thankfully able at a minimum maintain current funding levels. In addition, advance appropriations for FY 2025 were protected with a modest increase of $61.43 million, which will ensure that all AI/AN people will have continuous access to care, even in the event of a government shutdown. Finally, the reauthorization of the extremely successful SDPI will allow UIOs and other grantees to continue to use grant funding to offer a wide range of diabetes treatment and prevention services.

The National Council of Urban Indian Health (NCUIH) has long advocated for larger investments in American Indian and Alaska Native (AI/AN) health care and has called on Congress to strengthen its commitment to Indian Country with increased funding in the FY 2024 appropriations. The Tribal Budget Formulation Workgroup, a national workgroup that identifies annual Tribal funding priorities, requested full funding for IHS at $51.42 billion and $973.59 million for Urban Indian Health. Unfortunately, the final legislative text falls short of fully funding IHS so that the agency can properly provide health care services for all AI/AN people.

Bill Text:
Overview of IHS and Urban Indian Health Requests:

Table

Line Item FY 2023 Enacted FY 2024 TBFWG Request FY 2024 President’s Budget Request FY 2024 House Passed FY 2024 Senate Passed FY 2024 Enacted
Urban Indian Health $90.4 million $973.59 million $115.15 million $115.15 million $92.42 million $90.4 million
Indian Health Service $6.9 billion $50.9 billion $9.7 billion $7.078 billion $7.26 billion $6.96 billion
Advance Appropriations $5.1 billion $9.1 billion $5.13 billion $5.88 billion $5.23 billion $5.19 billion
Hospitals and Clinics $2.5 billion $12.338 billion $3.553 billion $2.66 billion $2.58 billion $2.551 billion
TECs $34.4 million _______ $34.4 million $35 million _______ $34.4 million
CHRs $65.2 million $1.247 billion $74.56 million ___________ _________ $65.2 million
Direct Operations $103.8 million $101.9 million $118.5 million $101.73 million $103.8 million $103.8 million
Mental Health $127.1 million $3.46 billion $163.99 million $130.86 million $130.16 million $129.77 million
BIA MMIW $25.1 million _________ __________ $15.56 million $26.09 million $25.1 million
EHRs $217.5 million $491.97 million $319.03 million  ________ $217.56 million $190.57 million
Produce Prescription Program $3 million _______ _________ $6 million $3 million $3 million
Key Provisions for IHS, Tribal Organizations, and UIOs:
  • $6.96 billion for IHS for FY 2024, $3.6 million above the FY 2023 level.
  • $90.419 million for Urban Indian Health for FY 2024, the same amount as the FY 2023 level.
  • $5.19 billion for advance appropriations for FY 2025, $61.43 million above the FY 2024 advance.
  • Fully funds Contract Support Costs and Payments for Tribal Leases
  • Total SDPI funding for CY 2024: $158 million
Funding Mechanism Dates Authorization Total Daily Rate 2024 Calendar Year

(Daily rate x funding period)*

CR 1 10/1/2023 – 11/17/2023 $19,726,027 $419,702 _______
CR 2 11/18/2023 – 1/19/2024 $25,890,411 $410,958 $8,219,178
CR 3 1/20/2024-3/8/2024 $20,136,986 $428,447 $20,136,986
Minibus 3/9/2024 – 12/31/2024 $130,000,000 $437,710 $130,000,000
Total 10/1/2023 – 12/31/2024 $195,753,424 ________ $158,356,164

*Calendar year funding calculated by multiplying the daily rate with the number of days in 2024 for that funding period.

Analysis:

Urban Indian Health

  • $90,419,000 for Urban Indian Health for FY 2024

Indian Health Service

  • $5,190,883,000 in advance appropriations for IHS for FY 2025
  • $6.962 billion in agency funding for IHS for FY 2024
    • Indian Health Services Account – $4,948,731,000
  • Hospitals and Health Clinics – $2,550,514,000
  • Tribal Epidemiology Centers (TECs) – $34,400,000
  • Electronic Health Records (EHRs) – $190,564,000, a $27 million decrease from FY 2023 enacted levels
  • Community Health Representative (CHRs) – $65,212,000
  • Mental health – $129,756,000
  • Produce Prescription Pilot Program – $3,000,000
  • Direct Operations – $103,805,000
  • Indian Health Care Improvement Fund – $74,138,000
  • Funds Indian Health Facilities at $813,183,000
  • Indefinite appropriation to fully fund contract support costs, which are estimated to be $1,051,000,000 in FY 2024
  • Indefinite appropriation to fully fund payments for Tribal leases, which are estimated to be $149,000,000 in FY 2024

Bureau of Indian Affairs (BIA)

  • $1,898,550,000 for Operation of Indian Programs
  • Missing and Murdered Indigenous Women (MMIW)
    • $24,898,000 for Law Enforcement Special Initiatives, of which an additional $5,000,000 is to continue addressing the MMIW effort.
  • Native Boarding School Initiative
    • $260,634,000 for Executive Direction and Administrative Services, including maintaining FY 2023 levels for the Native Boarding School Initiative.
  • Violence Against Women Act (VAWA)
    • $3,000,000 is for an initiative to support cross-designation of Tribal prosecutors as Tribal Special Assistant United States Attorneys
Topic Section Funding Language
Urban Indian Health Urban Indian Health $90,419,000 Pg. 52

“The agreement provides $90,419,000 for the Urban Indian health Program.”

Indian Health Service Advance Appropriations $5,190,883,000 Pg. 51

“The agreement provides advance appropriations for the Indian Health

Services and Indian Health Facilities accounts totaling $5,190,883,000 for fiscal year 2025. Advanced

appropriations are not provided for the Electronic Health Record System, Indian Health Care

Improvement Fund, Contract Support Costs, Payments for Tribal Leases, Sanitation Facilities

Construction, and Health Care Facilities Construction. Additional details, instructions, and requirements

follow in the table at the end of this division”

Staffing for New Facilities $56,061,000 Pg. 51

“The agreement includes $56,061,000 for staffing newly opened health facilities, which is the full amount required in fiscal year 2024 based upon updated estimates provided to the Committees. Funds for staffing of new facilities are limited to facilities funded through the Health Care Facilities Construction Priority System or the Joint Venture Construction Program that have opened in fiscal year 2023 or will open in fiscal year 2024. None of these funds may be allocated to a facility until such facility has achieved beneficial occupancy status. As initial estimates included as part of the annual budget request are refined, IHS is expected to communicate updated cost estimates to the Committees.”

New Report Shows Increase in Homelessness Disproportionately Affects American Indian and Alaska Native People

In December 2023, the Department of Housing and Urban Development (HUD) published the 2023 Annual Homelessness Assessment Report (AHAR) to Congress, Part 1: Point-in-Time Estimates of Homelessness.  This report outlines the key findings of the Point-In-Time (PIT) count and Housing Inventory Count (HIC) conducted in January 2023. Specifically, this report provides 2023 national, state, and Continuums of Care (CoCs)-level PIT and HIC estimates of homelessness, as well as estimates of chronically homeless persons, homeless veterans, and homeless children and youth.

  • Overall, the report shows that there is an increase in homelessness across all genders, ages, ethnicities, and races, among individuals and families with children and in sheltered and unsheltered locations.
  • The report also showed that this increase disproportionately affected American Indian and Alaska Native (AI/AN) people, and more specifically AI/AN veterans.

Background on the HUD Annual Homelessness Report

Each year HUD reports to Congress an AHAR that provides, “nationwide estimates of homelessness, including information about the demographic characteristics of homeless persons, service use patterns, and the capacity to house homeless persons. The report is based on Homeless Management Information Systems (HMIS) data about persons who experience homelessness during a 12-month period, point-in-time counts of people experiencing homelessness on one day in January, and data about the inventory of shelter and housing available in a community.”

Key Findings on AI/AN Homelessness

In order to be included in the PIT count, “a person needs to meet the definition of experiencing homelessness used by HUD… defined as lacking a fixed, regular, and adequate nighttime residence.” The data was collected during January 2023 in an effort to meaningfully collect data on all people experiencing homelessness to identify trends and inform policy makers about the current state of U.S. homelessness. Key findings on AI/AN homelessness include the following:

  • Among all people experiencing homelessness, 4% identified as American Indian, Alaska Native, or Indigenous and were nearly twice as likely to be experiencing unsheltered homelessness than sheltered homelessness.
  • The largest percentage increase of people experiencing homelessness between 2022 and 2023 was among people who identified as American Indian, Alaska Native, or Indigenous, which increased by 18% (1,631 more people).
  • American Indian, Alaska Native, or Indigenous populations also showed a large percentage increase in both sheltered and unsheltered experiences of individual homelessness between 2022 and 2023, both of which rose by 18-19 % (or 2,860 people total).
  • 3% of all families with children experiencing homelessness in 2023 were American Indians, Alaska Natives, and Indigenous people.
  • Unaccompanied youth who identified as American Indian, Alaska Native, or Indigenous made up nearly twice as large of the share of youth located in unsheltered locations than sheltered locations (7% vs 4%).
    • The share of unaccompanied youth who identified as American Indian, Alaska Native, or Indigenous was highest in other largely urban CoCs (8%) and largely rural CoCs (7%) and lowest within largely suburban CoCs (2%).
  • Veterans who identify as American Indian, Alaska Native, or Indigenous made up a higher share of the unsheltered veteran population than the sheltered (5% vs 2%).

Background on AI/AN Homelessness

Housing Challenges for Urban AI/AN Households

AI/AN people in urban areas are “disproportionately disadvantaged economically and face cultural and experiential barriers to accessing services and achieving a measure of housing security and stability,” and when compared to all households, “have a higher median rate of cost burden and severe cost burden . . . are more likely to live in housing that lacks complete plumbing and kitchen facilities . . . [and] are more likely to live in overcrowded housing situations.” Many experts link the high rate of homelessness in AI/AN communities to the high level of poverty in AI/AN communities. Among the challenges that AI/AN people face in accessing housing and housing related services in urban areas are the lack of service organizations which assist AI/AN people, a shortage of funding sources designed to support AI/AN housing services in urban areas, and little cultural competency among mainstream providers. AI/AN people in urban areas also report an urgent need for temporary or transitional housing, especially for those seeking medical treatment, as well as a need for housing that reflects and accommodates AI/AN culture.

UIOs’ Unique Position to Address Homelessness and Social Determinants of Health

Congress has specifically declared that it is the policy of the United States, in fulfillment of its trust responsibility, to “ensure the highest possible health status for Indians and urban Indians and to provide all resources necessary to effect that policy.” UIOs are uniquely positioned to assist HUD in supporting underserved communities, ensuring access to and increasing the production of affordable housing, promoting homeownership, and advancing sustainable communities among AI/AN people.  In fact, some UIOs already provide housing services. Further, all UIOs provide numerous other social and community services to urban AI/AN people. Providing housing services aligns with UIOs’ mission to provide quality, accessible, and culturally competent health and public health services for AI/AN people living in urban settings because housing is a key social determinant of health (SDOH). HUD has also previously acknowledged the need to coordinate health, housing, and social welfare services. UIOs have the cultural competency and community connections necessary to further support HUD’s mission and assist HUD in fulfilling its trust responsibility to all AI/AN people.

NCUIH Action

On January 26, 2022, NCUIH submitted comments to HUD, encouraging the agency to incorporate urban Natives in its FY22-26 Strategic Plan and focus areas. HUD provides housing resources and funding for Tribes, but these resources are very limited when it comes to urban AI/AN people, or not applicable at all.

NCUIH is also working to address homelessness among urban Native veterans and works closely with the Department of Veterans Affairs (VA), Department of Health and Human Services (HHS), HUD, and the White House Council on Native American Affairs (WHCNAA) on the implementation of the interagency Native American Veteran Homelessness Initiative (the Initiative). This Initiative’s overall goal is to develop relationships between VA, IHS, and other organizations serving Natives. It aims to educate Native veterans about the resources offered by the VA and IHS, particularly focusing on those at risk of homelessness or currently experiencing homelessness. These resources include emergency and transitional housing services, permanent housing solutions, case management support, employment programs, and additional assistance.

IHS Progress Report Highlights Accomplishments Regarding FMAP and Native Veteran Homelessness, Among Other Urban Indian Health Priorities

On September 30, 2023, the Indian Health Service’s (IHS) Office of Urban Indian Health Programs (OUIHP) posted a second quarter update outlining progress on the agency’s 2023 Work Plan to implement the goals from the 2023-2027 OUIHP Strategic Plan for urban Indian organizations (UIOs).

The quarterly report highlights the OUIHP accomplishments since June 2023 on the five pillars outlined in the strategic plan: provide effective, timely and transparent communication; improve OUIHP’s operational oversight and management; leverage partnerships to expand UIO resources; improve data quality; and expand the infrastructure and capacity of UIOs. Some of these accomplishments include providing technical assistance to Congressional staff regarding the extension of 100% Federal Medical Assistance Percentage (FMAP), completing revisions to the IHS Urban Confer Policy, and in collaboration with the White House Council on Native American Affairs Health Committee (WHCNAA), a brochure was developed to share information on VA services to help Native veterans who are at-risk of experiencing homelessness.

View the full list of accomplishments in the quarterly report here.

Background

In June 2023, IHS released their 2023-2027 OUIHP Strategic Plan which describes how OUIHP will achieve its mission and vision through five strategic pillars to support urban Indian organizations:

  • Provide effective, timely, and transparent communication;
  • Improve OUIHP’s operational oversight and management;
  • Leverage partnerships to expand UIO resources;
  • Improve data quality; and
  • Expand the infrastructure and capacity of UIOs.

IHS also released its corresponding work plan that outlines critical actions and activities to implement these strategic goals, and includes communications on progress, barriers encountered, and accomplishments. The OUIHP tracks progress for each activity and evaluates progress over time. According to the work plan, progress will be shared with UIOs, partners, and stakeholders quarterly.

NCUIH’s Role

NCUIH played a critical role in the drafting of the 2023-2027 OUIHP Strategic Plan and Implementation Plan. NCUIH has submitted a total of four comments to OUIHP with recommendations to strengthen the plans, specifically requesting that the agency develop quarterly reports to provide information on OUIHP’s progress towards achieving the goals and objectives described in the Strategic Plan, and making those reports publicly available.

NCUIH Joins Amicus Brief Filed by the National Indian Health Board in Support of Respondent Tribes in Becerra v. San Carlos Apache Case

On February 19, 2024, the National Council of Urban Indian Health (NCUIH) joined attorneys for the National Indian Health Board (NIHB) in filing an amicus brief in support of Respondent Tribes for Case No. 23-250, Becerra v. San Carlos Apache Tribe (consolidated with Case No. 23-235, Becerra v. Northern Arapaho Tribe). The issue at question is whether IHS is required under the Indian Self Determination and Education Assistance Act (ISDA), 25 U.S.C. §5301 et seq, to pay contract support costs for the increased overhead expenses a Tribe incurs in connection with services funded by the exact same program income from third parties that IHS uses when operating the same program. Respondent Tribes argue that “ISDA broadly requires reimbursement for ‘any overhead expense incurred by the tribal contractor in connection with the operation of the Federal program … pursuant to the contract.’ The overhead expenses Tribes incur when using program income to provide more healthcare services fall squarely within this definition.”

While the issue at hand in this matter has no strong relation to Urban Indian Organizations, how the court decides this case will affect Tribal healthcare facilities, and potentially restrict the scope of contract support costs to cover overhead costs. Failure by the federal government to cover these overhead expenses would require Tribes to divert program income away from healthcare services. NCUIH supports Tribal sovereignty and the efforts by Respondent Tribes to ensure that IHS carries out the federal trust responsibility in the manner required by IHCIA.

Summary of the Brief’s Argument

Attorneys for NIHB focused their argument on the text and history of the Indian Health Care Improvement Act (IHCIA). Congress first authorized IHS to bill and collect from Medicare and Medicaid in 1976 when Congress first passed IHCIA. The evolution of IHCIA and amendments to it reflect Congressional intent to address specific programs surrounding funding, operation, and IHS oversight of federal Indian healthcare programs. Through this, it confirms that Congress has always regarded third-party program income as essential and integral to “the Federal Program” whether operated by IHS, Indian Tribe, or tribal organization under ISDA. The main points argued within the brief are:

  • Congress enacted IHCIA to redress critical funding shortfalls in federal Indian healthcare programs;
  • IHCIA and ISDA amendments demonstrate that third-party revenues are an essential element of “the Federal program” for which IHS must pay contract support costs; and
  • While Petitioners insist program income is not part of “the Federal program,” IHS continues to treat program income as a critical part of tribally operated programs, including by transferring program income, and personnel funded by program income, to tribes that assume control of IHS healthcare programs under ISDA.

Next Steps

Oral argument for this case is scheduled for March 25th with audio available for public access during and after the oral argument. After oral argument, the Supreme Court will issue a decision on the case by June 30th, 2024.

NCUIH Urges Protection of Indian Health Care Providers’ Ability to Serve Native People Amid HHS Grant Rule Revisions

On January 18, 2024, the National Council of Urban Indian Health (NCUIH) submitted written comments to the Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) Director, Melanie Fontes Rainer, regarding the notice of proposed rulemaking (NPRM) to repromulgate and revise certain regulatory provisions of HHS’ Uniform Administrative Rule Requirements, Cost Principles, and Audit Requirements for HHS Awards (the rule). NCUIH’s comments urge HHS to ensure that the proposed revisions to not inadvertently impact Indian health care providers’ aility to serve Tribal citizens.

Background

The NPRM pertains to the portions of the rule addressing applicability, and statutory and national policy requirements. Among the changes, HHS is proposing to repromulgate a section addressing discrimination and is including a section stating that HHS will follow all applicable Supreme Court decisions in administering its award programs. HHS is also proposing language providing for religious exemptions for certain provisions.

One of the ways in which the United States meets its trust obligation to provide services and resources to improve the health of American Indian and Alaska Native people is through awarding funding to Tribes, Tribal Organizations and urban Indian organizations (UIOs). HHS funding is critical to the success of the Indian Health Service, Tribes, and UIO (I/T/U) system and ensuring the federal government upholds the federal trust responsibility owed to American Indian and Alaska Native people.

NCUIH’s Recommendations

In its comments, NCUIH recommended that OCR:

  • Include language in the proposed rule that clearly states that nothing in the rule will limit ability of Tribes or UIOs to serve American Indian and Alaska Native people exclusively using HHS awards.
  • Ensure OCR and HHS grant staff are properly trained on the unique political status of American Indian and Alaska Native people.

NCUIH will continue to monitor the rulemaking process for HHS’ Uniform Administrative Requirements.

NCUIH Provides Recommendations to Federal Government Regarding Important Native Behavioral Health and Substance Use Disorder Program

On January 30, 2024, the National Council of Urban Indian Health (NCUIH) submitted written comments to the Substance Abuse and Mental Health Services Administration (SAMHSA) Office of Tribal Affairs in response to SAMHSA’s July 2023 framing paper and October 2023 urban Indian organization (UIO) listening session concerning the development of the funding formula for the Behavioral Health and Substance Use Disorder Resources for Native Americans (BHSUDRNA) Program. NCUIH’s comments make seven key recommendations to SAMSHA when developing the funding methodology for the BHSUDRNA program.

Background

NCUIH, UIOs, Tribes, and Tribal Organizations worked closely with Congress to create a new Behavioral Health program modeled in part after the Special Diabetes Program for Indians (SDPI) to expand access to behavioral health funding for Native communities. Congress authorized this program via the Consolidated Appropriations Act, 2023 (CAA 2023).  The purpose of the Program is to provide services for the prevention of, treatment of, and recovery from mental health and substance use disorders among American Indians, Alaska Natives, and Native Hawaiians. The BHSUDRNA Program will be operated by SAMHSA in consultation with the Indian Health Service. Eligible entities include Urban Indian organizations.

NCUIH’s Recommendations

In its comments, NCUIH recommended that SAMHSA:

  • Ensure noncompetitive Program awards across the IHS/Tribal Organization/UIO (I/T/U) system.
  • Account for administrative duties in the funding formula.
  • Respect Traditional Healing and Indigenous Knowledge in the funding formula.
  • Ensure program measures do not impose additional burdensome reporting requirements.
  • Ensure that all information related to program application is widely available.
  • Seek additional expert feedback from Tribal Advisory Committees and Federal Agencies
  • Continue to engage with and incorporate UIO feedback in the development of the Program.

While Congress authorized $80 million in appropriations for this Program in each of Fiscal Years (FY) 2023-2027, Congress has not yet appropriated the necessary funding for the Program since its authorization. As part of its comments, NCUIH called on the Biden Administration to request that Congress fully fund the Program at the authorized levels.

NCUIH will continue to monitor the development of the funding formula for the BHSUDRNA Program and continue to advocate for Congress to fully fund the Program.

Health Resources and Services Administration Publishes List of Health Professional Shortage Areas including UIOs

On January 2, 2024, the Health Resources and Services Administration (HRSA) published a notice informing the public of the availability of the complete lists of all geographic areas, population groups, and facilities designated as primary medical care, dental health, and mental health professional shortage areas (HPSA). The complete lists of HPSAs, which includes urban Indian organizations (UIOs), designated as of December 2, 2023, are available on HRSA’s Health Workforce Shortage Area website.

For further information on the HPSA designations listed on the website or to request additional designation, withdrawal, or reapplication for designation, please contact Anthony Estelle, Chief, Shortage Designation Branch, Division of Policy and Shortage Designation, Bureau of Health Workforce (BHW), HRSA, 5600 Fishers Lane, Room 11W16, Rockville, Maryland 20857, sdb@hrsa.gov.

Background

Section 332 of the Public Health Service (PHS) Act, 42 U.S.C. 254e, provides that the Secretary shall designate HPSAs based on criteria established by regulation. HPSAs are defined in section 332 to include (1) urban and rural geographic areas with shortages of health professionals, (2) population groups with such shortages, and (3) facilities with such shortages. Section 332 further requires that the Secretary annually publish lists of the designated geographic areas, population groups, and facilities. Using the statute and regulations, HRSA automatically designates UIOs as HPSAs.

HPSA designation offers access to potential federal assistance for healthcare facilities and providers. Public or private nonprofit entities are eligible to apply for assignment of National Health Service Corps personnel to provide primary medical care, mental health, or dental health services in or to these HPSAs. National Health Service Corps health professionals enter into service agreements to serve in federally designated HPSAs. Entities with clinical training sites located in HPSAs are eligible to receive priority for certain residency training program grants administered by HRSA’s BHW. Other federal programs also utilize HPSA designations.

NCUIH Advocacy

As part of its advocacy, the National Council of Urban Indian Health (NCUIH) engages with HRSA to ensure that UIOs receive HPSA scores that accurately reflect the level of provider shortage for UIO service. UIOs have particularly highlighted how they are negatively impacted by the way their HRSA’s HPSA scores affect their ability to hire and retain staff participating in various loan repayment programs. NCUIH continues to engage with HRSA regarding the need to develop HPSA scores which reflect the level of need in the Indian health care system, as opposed to general geographic data.

February Policy Updates: Budget Updates, Advocacy Efforts, and Legislative Anticipation

In this Edition:

 Don’t miss out on the latest updates and announcements regarding the 2024 NCUIH Annual Conference, registration, and award nomination details.

🔎 Dive into the latest updates on the FY 2024 budget and upcoming FY 2025 budget release, including advocacy efforts to protect IHS funding.

📋 Join us for our upcoming webinar on February 28: “Urban Voices Amplified: Empowering Native Votes” and explore Get Out the Vote resources.

🏛 Stay informed on NCUIH’s policy priorities for 2024, as outlined in the recently released Policy Assessment, and the key issues shaping advocacy efforts for urban Natives.

 Discover NCUIH’s active engagement in various events and initiatives, including representation at important receptions and legislative launches.

📆 Mark your calendars for crucial upcoming events, and federal agency comment opportunities, including consultations/confers on Native health care, behavioral health, and more.

2024 NCUIH Annual Conference Registration & UIO Award Nomination

NCUIH

Register now before rates go up in March!

Sponsorships: Several different sponsorship levels remain. If you are interested in sponsoring the conference, please see our sponsor guide.

Room Reservations: The negotiated room rate of $369 per night (plus tax) for single/double occupancy rooms is available until April 5, 2024. We encourage you to book your room soon to secure this special rate. To make your reservation at the Hilton Washington DC Capitol Hill, click here to access the room block.

NCUIH

As part of our commitment to uplifting Native excellence, NCUIH is seeking nominations for individuals and or organizations who have made remarkable contributions to the field of urban Indian health. We invite you to nominate candidates for the following prestigious awards:

  • UIO Staff Member of the Year Award;
  • UIO Visionary Award;
  • Urban Indian Legacy Award; and,
  • Tribal Leader Impact Award.

Awards will be presented during the NCUIH Annual Conference on April 29-May 2, 2024, in Washington, D.C. Visit the conference website for further details on the nomination process. The deadline for submissions is Friday, March 15, 2024.

Submit Nomination

Budget Update: FY 2024 Deal Reached, FY 2025 Anticipated Budget Release

An EKG line across a map of America.

Fiscal Year 2024 Budget Status:

  • On January 27, top Appropriators announced a deal had been reached on the allocation for FY 2024 spending bills.
  • On January 29, NCUIH sent a letter to Congressional leadership to request that IHS be protected from sequestration in the funding bill.
  • What’s next: Congress is in recess until February 28, and they will have three days to pass a CR or budget deal.

Fiscal Year 2025 Budget Status:

  • Release of President Biden’s FY 2025 Budget is anticipated between March 11-15.
  • NCUIH signed on to the Partners in Health and Association of American Indian Physicians letter to House and Senate Interior-Environment Appropriations Subcommittee Leadership in support of the inclusion of $30 million new funding to address chronic clinical staff shortages across Indian Country through Graduate Medical Education (GME) programming in the FY2025 Interior, Environment, and Related Agencies appropriations bills.

Urban Voices Amplified: Empowering Native Votes in Collaboration with the National Urban Indian Family Coalition

NCUIH

February 28, 2024 | 1:00 – 2:00 p.m. EST

Join us on February 28th, 2024, for a webinar hosted by the NCUIH Policy team.

  • In collaboration with the National Urban Indian Family Coalition (NUIFC) and UIO partners, we will delve into vital topics related to Get Out the Vote (GOTV) and mobilizing Native votes.
  • This event will focus on key strategies and information essential in an election year, addressing the significance of Native American civic participation.
  • Why it matters: Be part of an insightful discussion about voter registration, mobilization efforts, and the pivotal role Native voices play in shaping our communities during this important electoral season. Don’t miss out on this opportunity to engage in the dialogue that impacts us all.

Register to Attend

NCUIH Releases 2023 Annual Policy Assessment

NCUIH

On January 25, 2024, NCUIH released its 2023 Policy Assessment which includes findings from focus groups held with UIO leaders and helps set NCUIH’s policy priorities for 2024. Key findings include:

  • Funding is a Key Focus and Challenge
  • UIOs Need More Diverse Resources to Address Food Insecurity
  • Workforce Recruitment and Retention is a Concern Amid a Competitive Market

What else?: NCUIH hosted a Policy Preview Webinar for UIO leaders:

Watch the webinar to hear about the findings of NCUIH’s 2023 Policy Assessment and for a comprehensive understanding of the key issues shaping advocacy efforts and influencing the policy landscape for urban Native health in 2024.

NCUIH in Action: State of Indian Nations, Meetings on the Hill, HRSA Maternal Health & Mortality Initiative Launch, & More

NCUIH

Earlier this month, NCUIH attended the 2024 State of Indian Nations Address hosted by the National Congress of American Indians!

  • We were inspired by the powerful words of Tribal leaders, elders, and especially the passionate youth who spoke about their visions for a brighter and more equitable future.
  • Together, we’re committed to working towards unity, progress, and opportunity for all Native people.

On February 15th, NCUIH worked with the National Congress of American Indians & National Indian Health Board to facilitate and staff Congressional meetings for Tribal Leaders and provided talking points on the issue of 100% Federal Medical Assistance Percentage (FMAP) for UIOs.

NCUIH

NCUIH Policy Analyst, Emily Larsen, Representative Mary Peltola (D-AK), NCUIH VP of Policy and Communications, Meredith Raimondi.

NCUIH

Sean Gard, Rep. Moore Chief of Staff, Representative Gwen Moore (D-WI), NCUIH Policy Analyst, Emily Larsen.

On February 14, NCUIH represented UIOs at the National Native American Boarding School Healing Coalition (NABS)’s lunch & learn with Congressional Native American Caucus Co-Chairs, Reps. Tom Cole (Chickasaw) (R-OK-04) and Sharice Davids (Ho-Chunk) (D-KS-03) regarding the Truth and Healing Commission on Indian Boarding School Policies Act of 2024 (H.R. 7227).

Representative Cole (R-OK) and Representative Davids (D-KS)

Representative Cole (R-OK) and Representative Davids (D-KS)

NCUIH

  • Go deeper: Reps. Cole and Davids reintroduced this legislation to investigate, document, and report on the histories of Indian boarding schools, Indian boarding school policies, and long-term impacts on Native communities.

On February 8, the Senate Committee on Indian Affairs (SCIA) held a hearing that includes an NCUIH-endorsed bill, the IHS Workforce Parity Act (S.3022), which expands healthcare provider access to IHS scholarship and loan repayment programs.

Senate Committee on Indian Affairs (SCIA)

Senate Committee on Indian Affairs (SCIA)

  • What they’re saying: The Honorable Melanie Anne Egorin, Assistant Secretary of Legislation for HHS, testified that this legislation “builds capacity and it builds the ability to recruit and retain [health care providers], which is a critical need.”
  • What’s next: The bill awaits a full committee vote and NCUIH will continue to advocate for this bill to become law.

On January 25, NCUIH represented UIOs at the Health Resources & Services Administration (HRSA) Maternal Health & Mortality Initiative launch event.

NCUIH Public Policy Manager, Mary Jomia, Antigone Dempsey, Division of Policy and Data Director, HRSA/HHS, Acting Senior Advisor, Amelia Khalil.

NCUIH Public Policy Manager, Mary Jomia, Antigone Dempsey, Division of Policy and Data Director, HRSA/HHS, Acting Senior Advisor, Amelia Khalil.

  • Why it matters: The initiative will strengthen HRSA’s maternal health work and maximize the impact of HRSA grants and programs to address maternal health disparities, including in American Indian and Alaska Native communities.

On January 24, NCUIH represented UIOs at the Sanofi Health Equity Heroes reception.

NCUIH VP of Policy and Communications, Meredith Raimondi, NCUIH Public Policy Manager, Mary Jomia.

NCUIH VP of Policy and Communications, Meredith Raimondi, NCUIH Public Policy Manager, Mary Jomia.

IHS National Tribal Budget Formulation Workgroup Recommends $55.9 Billion for IHS in FY 2026

NCUIH President-elect Walter Murillo (Choctaw), CEO Francys Crevier (Algonquin), and NCUIH board member Maureen Rosette (Chippewa Cree)

NCUIH President-elect Walter Murillo (Choctaw), CEO Francys Crevier (Algonquin), and NCUIH board member Maureen Rosette (Chippewa Cree)

On January 24-25, IHS held its’ FY 2026 National Tribal Budget Formulation Workgroup Area Report Webinar where Tribal leaders from all 12 IHS Areas and leaders from Native organizations presented their budget priorities and hot issues for FY 2026. Meredith Raimondi, VP of Policy and Communications, presented on NCUIH’s priorities.

On February 12-13, NCUIH President-elect Walter Murillo (Choctaw), CEO Francys Crevier (Algonquin), and NCUIH board member Maureen Rosette (Chippewa Cree) joined the IHS National Tribal Budget Work Session where all of the Area’s budget recommendations are consolidated into a comprehensive set of national health priorities and budget recommendations. Mr. Murillo presented urban Indian health priorities.

  • Tribes drive the budget formulation process to ensure the IHS budget reflects the evolving health needs of American Indian and Alaska Native people and communities.
  • NCUIH always supports the Tribal Budget Formulation Workgroup budget request and advocates for full mandatory funding for IHS.
  • NCUIH is grateful for the Tribal Budget Formulation Workgroup’s advocacy for a fully funded Indian health care system, including Urban Indian Organizations.
  • The bottom line: Total Tribal recommendation for IHS for FY2026: $55.9 billion.
  • The bottom line: Total Tribal recommendation for Urban Indian Health for FY2026: $765.5 million, $195.9 million less than the FY2025 request.

Go deeper: Visit our Policy Blog to learn more about specific NCUIH and Area Recommendations.

Monitoring the Bench: Supreme Court Updates from NCUIH

Illustration of two gavels forming an x in front of the Supreme Court building

Becerra v. San Carlos Apache/Becerra v. Northern Arapaho Tribe (Consolidated)

  • Issue: Whether IHS must pay “contract support costs” not only to support IHS-funded activities but also to support the Tribe’s expenditure of income collected from third parties.
  • Relation to UIOs: No strong relation to UIOs because it relates to CSCs, but will affect Tribal healthcare facilities, and potentially restrict the scope of CSCs to cover services at Tribal facilities.
  • Case Status: Oral Argument set for March 25.
  • NCUIH Action: On February 14. NCUIH signed on to an amicus brief led by the National Indian Health Board in support of Respondent Tribes. The brief was submitted to the Court on February 19th.

Relentless, Inc. v. Department of Commerce and Loper Bright Enterprises v. Raimondo   

  • Issue: Whether the court should overrule Chevron v. Natural Resources Defense Council, or at least clarify that statutory silence concerning controversial powers expressly but narrowly granted elsewhere in the statute does not constitute an ambiguity requiring deference to the agency.
  • Relation to UIOs: Both cases have the potential to overturn Chevron deference, which would open up administrative agencies to more litigation and create discrepancies in how regulations are enforced.
  • Case Status: Oral Argument was held on January 17, 2024.
  • NCUIH Action: Monitoring.

Corner Post, Inc. v. Board of Governors of the Federal Reserve System

  • Issue: Whether a plaintiff’s Administrative Procedure Act claim “first accrues” under 28 U.S.C. § 2401(a) when an agency issues a rule — regardless of whether that rule injures the plaintiff on that date — or when the rule first causes a plaintiff to “suffer [] legal wrong” or be “adversely affected or aggrieved.”
  • Relation to UIOs: This would determine when an injury accrues, which impacts the amount of time a challenge could be made against an agency’s action.
  • Case Status: Oral Argument was held on February 20.
  • NCUIH Action: Monitoring.

NCUIH Advocates for Tribal Sovereignty and Cultural Sensitivity in HHS Proposed Rule on Grantmaking & SAMHSA Native Behavioral Health Program

Illustration of Congress with empty speech bubbles

On January 18, NCUIH submitted comments to the Department of Health and Human Services (HHS) Office of Civil Rights (OCR) regarding its Proposed Rule on HHS Grants Regulation.

  • The bottom line: NCUIH requested that HHS includes language in the proposed rule that clearly states that nothing in the rule will limit the ability of Tribes or UIOs to serve American Indian and Alaska Native people exclusively using HHS awards, and that OCR and HHS grant staff are properly trained on the unique political status of American Indian and Alaska Native people.

On January 31, NCUIH submitted comments to the Substance Abuse and Mental Health Services Administration (SAMHSA) Office of Tribal Affairs regarding its Behavioral Health and Substance Use Disorder Resources for Native Americans Program.

  • The bottom line: NCUIH recommended that SAMHSA ensures noncompetitive Program awards across the I/T/U system, accounts for administrative duties in the funding formula, respects Traditional Healing and Indigenous Knowledge in the funding formula, ensures program measures do not impose additional burdensome reporting requirements, ensures that all information related to program application is widely available, seeks additional expert feedback from Tribal Advisory Committees and Federal Agencies, and continues to engage with and incorporate UIO feedback in the Program’s development.

Upcoming Urban Confer Comment Opportunities

Laptop with an envelope as the screen

IHS Urban Confer on Fentanyl and Opioid Supplemental

  • On February 2, 2024, IHS held an Urban Confer seeking guidance and recommendations on the potential implementation of $250 million included in the Administration’s recent supplemental request to support funding for fentanyl and opioid programming.
  • IHS intends to make this funding available to the whole I/T/U system.
  • Written comments can be emailed to urbanconfer@ihs.gov, with the following subject line: Supplemental Request for Fentanyl and Opioid Abuse Funding.
  • The comment submission deadline for this Urban Confer is Monday, March 4, 2024.

IHS Urban Confer on Health IT Modernization

  • The first session was held on February 8 on Enterprise Collaboration Group (ECG). IHS provided an overview of the ECG, a body that gathers insights from subject matter experts who are end-users of the enterprise EHR. ECGs will be broken up into Domain Groups comprised of EHR users in the I/T/U. 60 Tribes and 14 UIOs have submitted a statement of interest (SOI) to indicate their interest in partnering with IHS on the shared enterprise solution.
  • Written comments are can be emailed within 30 days following each session to urbanconfer@ihs.gov – SUBJECT LINE: Health IT Modernization.
  • The comment submission deadline for this Urban Confer is March 8, 2024.

Upcoming Events and Important Dates

Calendar with events on it

Upcoming Events:

  • Feb 26 – 29– VA Advisory Committee on Tribal and Indian Affairs
  • Feb 27 – IHS National Tribal Advisory Committee (NTAC) on Behavioral Health Q1 Meeting
  • Feb 28 – NCUIH Webinar – Urban Voices Amplified: Empowering Native Votes
  • March 4 – Comments due for IHS Urban Confer on $250 Million Fentanyl and Opioid Programs
  • March 5 – MMPC Face-to-Face Meeting
  • March 5 – 6 – Tribal Leaders Diabetes Committee (TLDC) Meeting (hybrid)
  • March 6 – 7 – Centers for Medicare & Medicaid Services (CMS) Tribal Technical Advisory Group (TTAG) Face-to-Face Meeting (hybrid)
  • March 18 – 19 – American Academy of Pediatrics (AAP) Committee on Native American Child Health (CONACH) Meeting
  • March 19 – 21 – IHS 2024 National Combined Council Virtual Meeting

ICYMI:

  • On January 18, IHS hosted a Tribal Consultation on the Definition of Indian Tribe. Consulting on what definition of Indian Tribe should be included in the updated IHS Tribal Consultation Polic9 (List Act Definition (25 U.S.C. § 5130); or ISDEAA Definition (25 U.S.C. § 5304(e))).

Recent Dear Tribal Leader Letters (DTLLs) and Dear Urban Leader Letters (DULLs)

  • January 18: IHS DTLL/DULL – IHS – Tribal Consultation/Urban Confer on Health IT Modernization

    – This letter informs Tribal/UIO leaders about a series of four Tribal Consultation and Urban Confer sessions in calendar year 2024 on Health IT Modernization.

    -The first session was held on February 8 on Enterprise Collaboration Group (ECG).

    -Session 2: Deployment and Cohort Planning (virtual) will be held on May 9, 2024 from 1:30 p.m. – 3:00 p.m. ET. Register here.

    -Session 3: Multi-Tenant Domain Considerations (virtual) will be held on August 8, 2024 from 1:30 p.m. – 3:00 p.m. ET. Register here.

    -Session 4: Site Readiness and Training (hybrid) will be held on November 7, 2024 from 1:30 p.m. – 3:00 p.m. ET. Register here.

  • January 22IHS DULL – IHS Fiscal Year 2023 Budget to Support UIOs

    – The purpose of the FY23 Budget Report is to provide financial transparency and accountability for the Urban Indian Health Budget line. The report details the funds distributed by OUIHP and IHS Area Offices. View the budget report here.

    – The funds have been allocated for program administration, contract and grant awards, HIT, and Urban Indian Health initiatives.

  • January 22IHS DTLL/DULL – IHS Agency Accomplishments During the First Quarter of Fiscal Year 2024

    -The IHS FY 2024 First Quarter Performance Report was released. View the report here.

    -Some of the achievements included: IHS receiving its first-ever advance appropriations, progress to modernize HIT, and a breakthrough partnership with the U.S. Department of Veterans Affairs.

  • January 31: IHS DTLL/DULL – Director Writes to Communicate Key Leadership Changes

  • February 15 – IHS DTLL/DULL – The IHS Chief Medical Officer shares an update on efforts by the Agency to address the syphilis epidemic in Indian Country.

    -IHS data shows that syphilis screening in IHS facilities has increased by 98 percent from 2022 to 2023.

    -The letter includes resources and an STI toolkit for facilities to use to combat the syphilis epidemic.

One last thing, check out these upcoming funding opportunities:

  • National Institute of Food and Agriculture, U.S. Department of Agriculture – The Gus Schumacher Nutrition Incentive Program – Produce Prescription Program

    – Deadline: February 28, 2024 (Apply)

  • IHS – Indian Health Service Scholarship Program (IHSSP)

    -Deadline: February 28, 2024 (Apply)

  • AmeriCorps – Forest Corps Recruiting Native Youth for Opportunities to Support Cultural Resource Management Projects

    – Deadline: February 29, 2024 (Apply)

Veterans Save $2.5 Million Thanks to Department of Veteran Affairs Copay Exemption Championed by NCUIH and Native Partner Organizations

On February 13, 2024, the Department of Veterans Affairs (VA) announced that it has exempted or reimbursed more than 143,000 copayments totaling approximately $2.5 million for more than 3,800 eligible American Indian and Alaska Native Veterans.

This comes less than a year after the VA implemented a final rule, championed by the National Council of Urban Indian Health (NCUIH), that exempts eligible American Indian and Alaska Native Veterans to make copayments for health care and urgent care received through VA ― making VA health care more accessible and affordable. Under this policy, VA also reimburses for copayments paid on or after January 5, 2022.

Learn more about copayment exemptions for Native American and Alaska Native Veterans and VA benefits and programs for American Indian and Alaska Native Veterans.

Background

The copayment exemption is a significant step to upholding the federal government’s trust responsibility to “maintain and improve the health of the Indians.” American Indians and Alaska Natives serve in the military at one of the highest rates of any group in the United States and many Native veterans receive healthcare from the Veterans Health Administration, an agency within VA, in addition to utilizing IHS, Tribal, and UIO facilities. Unfortunately, American Indian and Alaska Native Veterans generally have a higher prevalence of mental health disorders compared with White veterans, and among all veterans, the prevalence of suicidal ideation is highest for those reporting a diagnosis of depression, anxiety, or post-traumatic stress disorder. Further, an estimated 86.2 percent of American Indian and Alaska Native Veterans that live in urban areas generally have higher unemployment, lower education attainment, lower income, higher VA-service connected disability, and generally live in poorer housing conditions than non-Native Veterans also living in urban areas.

On April 4, 2023, VA published a final rule in the Federal Register establishing the waiver process for Veterans to submit documentation to have their VA copays waived. This rule implements Section 3002 of the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020 Public Law 116-315, signed into law on January 5, 2021, which prohibits collection of a health care copayment by the Secretary of Veterans Affairs from an American Indian and Alaska Native Veteran who meets the definitions of “Indian” or “urban Indian” under the Indian Health Care Improvement Act (IHCIA).

NCUIH’s Role

NCUIH has championed this copayment exemption and continues to advocate for Native Veterans living in urban areas to ensure that they have access to the high-quality, culturally competent care that the country owes to them for their service because of the federal trust responsibility. In February 2023, NCUIH submitted comments to the VA in response to the then proposed rule on the copayment exemption for American Indian and Alaska Native Veterans, stressing our support for this long overdue federal action and the need throughout Indian Country. Because the proposed rule only required VA to cover the first three urgent care visits in a calendar year, NCUIH and partnering Native organizations strongly urged the VA to cover all urgent care visits needed by Indian or urban Indian Veterans, which the VA adopted in the final rule. Moreover, NCUIH stressed that Native Veterans are entitled to the copayment exemption because of the federal government’s responsibility to provide and support services for Native Veterans in fulfilment of the trust responsibility for health care provisions for all American Indians and Alaska Native people.

NCUIH is encouraged to see the impact this rule has made in Indian Country and we will continue to engage with the VA on issues related to American Indian and Alaska Native Veterans living in urban areas.

Tribal Leaders Recommend Increased Urban Indian Health Funding in Fiscal Year 2026 Area Reports

On January 24-25, 2024, the Indian Health Service (IHS) held their Area Report Presentations Webinar for Fiscal Year (FY) 2026 where Tribal leaders from all 12 IHS Areas and leaders from Native organizations, including the National Council of Urban Indian Health (NCUIH), presented on their budget requests. Tribal leaders spoke about the need to increase urban Indian health funding.  Phoenix Area representative and Chairwoman of the Fallon Paiute-Shoshone tribe, Cathi Willams-Tuni, even noted that urban health line item has “…remained static for way, way too long.”

Common themes among Area reports were the need for increased funding for mental and behavioral health, electronic health records (EHR), permanent authorization of the Special Diabetes Program for Indians (SDPI), and permanent exemption from sequestration.

NCUIH always supports the Workgroup’s recommendation for the IHS budget and is grateful for Tribal Leaders’ support for increased funding in the urban health line item.

Area Report Highlights

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

The Bemidji Area stressed that UIOs are forced to use grants that are restrictive in nature leaving highly accessed urban sites financially unstable. They recommended an increase of $914 million above the FY2023 planning base for the Urban Indian Health line item for FY2026 and noted that increased funding would support authorized new programs and services for UIOs.

The Billings Area included urban Indian health as a top priority and recommended an increase of $1.3 billion over the FY2023 planning base for the Urban Indian Health line item for FY 2026.

The Oklahoma Area included a request to increase funding for the urban Indian health line item by $467.5 million above the FY 2023 recommendation as a priority for FY2026 in their Area report.

The Phoenix Area included urban Indian health funding as a top priority and recommended an increase of $103.7 million above the FY2023 planning base for FY2026. The Phoenix Area also noted that UIOs have many unmet construction, maintenance and improvement needs.

The Portland Area recommended a 2% increase over the FY 2023 planning base to the urban Indian health line item for FY 2026. The Area representative also noted that when UIOs are not sufficiently funded, tribal members will come to tribal clinics and get denied Purchase Referred Care (PRC) because they live in urban areas.

The Tucson Area highlighted the need for increased funding for the Urban Health line item and recommended $1.4 billion over the FY 2023 planning base for FY2026. The Tucson Area also included the need for 100% Federal Medical Assistance Percentage (FMAP) for Medicaid services at UIOs in their Area report. They also presented on the Tucson Indian Center’s successes such as celebrating 60 years of serving the Tucson American Indian community and launching primary care and behavioral health services in January 2024.

NCUIH Presents Priorities at Area Presentations Webinar

Meredith Raimondi, NCUIH’s Vice President of Public Policy and Communications, presented the top priorities for urban Indian health FY 2026 during the Area Report Webinar. NCUIH supports full funding for the IHS, Tribal, and urban Indian organization (UIO) (I/T/U) system.  We endorse a budget in which IHS, Tribal Facilities, and UIOs are all fully funded to improve health outcomes for all Native people no matter where they live.

  1. Maintaining the Tribal Budget Workgroup’s most recent request for Urban Indian health, with no cuts for sequestration.
    1. This funding is necessary to address health priorities for Native in urban areas, including:
        1. Ensuring Urban Indian Health funding keeps pace with population growth.
        2. Providing funding for UIO facilities and infrastructure.
        3. Expanding service offerings to Native patients in urban areas.
  2. Establishing Permanent 100% Federal Medical Assistance Percentages (FMAP) for services provided to Medicaid beneficiaries at UIOs
  3. Recruitment and Retention of Workforce
  4. SDPI reauthorization
  5. Increased funding and resources for Traditional Healing services, food and housing insecurity

Background on Area Budget Formulation

As part of the trust responsibility to provide health care to all American Indians and Alaska Natives, Tribal Leaders present their funding needs each year to the Secretary of HHS and the Director of the Office of Management and Budget. The recommendations are formed through the Tribal Budget Formulation Work Group and serve as a framework for the Administration in setting budget amounts for their annual requests to Congress. This process ensures the federal government has the resources to provide health care to all American Indians and Alaska Natives in fulfillment of the trust responsibility.

Next Steps

On February 13-14, 2024, IHS will host the FY 2026 National Tribal Budget Formulation Work Session.  This is a 2-day annual meeting where the two tribal representatives from each Area come together to review and consolidate all the Area’s Budget recommendations into a comprehensive set of national health priorities and budget recommendations. Work session activities include:

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