NCUIH September Policy Update: 2027 Policy Priorities, Appropriations Status, Medicaid Resources, and UIO Summit Preparation

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In this Edition:

  • Questions for UIOs: Request for Input and Feedback
  • New and Forthcoming NCUIH Medicaid Resources
  • New Maternal Health Resources
  • Fiscal Year 2027 Appropriations Status
  • NCUIH Regulation Tracker Updates
  • Comment Opportunity: HRSA 340B Rebate Model Pilot Program
  • Submitted Federal Comments
  • NCUIH Participates in the National Tribal Health Conference
  • NCUIH Participates in NCAI Tribal Impact Week
  • Urban Indian Organization and Federal Partners Summit – NCUIH’s Preparation and Input Sessions
  • Upcoming Events and Policy Dates
  • 2027 NCUIH Annual Conference
  • Current Funding Opportunities

Questions for UIOs: Request for Input and Feeback

Request for Information on H R 1 Medicaid Exclusions

As a member of the Centers for Medicare & Medicaid Services Tribal Technical Advisory Group (TTAG), NCUIH is working to support proper implementation of the exclusions for American Indian and Alaska Native (AI/AN) people under the new H.R. 1 Medicaid provisions.

  • What definition is your state using for the exclusions for American Indian and Alaska Native people?
  • Are you concerned that your state may not include everyone who should qualify for the American Indian and Alaska Native exclusion?

Responses can be sent to policy@ncuih.org.

New and Forthcoming NCUIH Medicaid Resources

Overview of the Impact of Medicaid on Health Care for American Indian and Alaska Native People

This updated resource explains why Medicaid matters for American Indian and Alaska Native people and UIOs. It provides data, background, and information that UIO staff and leaders can use for education and understanding Medicaid’s role in Native health care.

Medicaid Is Changing

This quick-reference resource explains the new Medicaid work and renewal requirements, who may be protected by the American Indian and Alaska Native exemption, and the basic policy changes that staff, leaders, and patients should understand.

Forthcoming Medicaid Implementation Resources

NCUIH is developing two additional resources to help UIOs respond to the new Medicaid requirements:

  • UIO Implementation Guide: Steps UIO staff should have in place and actions staff can take when applicable protections are not recognized correctly.
  • Patient Handout: Steps patients should take after receiving a Medicaid work or renewal notice.

New Maternal Health Resources

NCUIH has released new resources highlighting best practices for improving American Indian and Alaska Native maternal health outcomes:

  • When the Data Gets It Wrong: Racial Misclassification of American Indian and Alaska Native Pregnant People is a blog post on addressing racial misclassification to improve data accuracy, interventions, programming, and maternal health outcomes.
  • American Indian and Alaska Native Led Maternal Mortality Review Committees is a one-page resource with recommendations to support the establishment of American Indian and Alaska Native-led Maternal Mortality Review Committees.

View the resources at ncuih.org/maternal-health.

Fiscal Year 2027 Appropriations Status

On September 2, 2026, the Continuing Appropriations and Extensions Act, 2027 (H.R.6500) was signed into law by the President. The Continuing Resolution (CR) funds the federal government through December 11, 2026 at Fiscal Year (FY) 2026 levels. The CR:

  • Prevents the administration from implementing the Office of Management and Budget’s (OMB) proposed grants rule for the duration of the continuing resolution.
  • OMB’s proposed Regulation for Federal Financial Assistance which will impact how nearly all grant awards are administered and overseen. NCUIH previously submitted comments on the proposal.
  • Extends authorizations for important health, veterans, infrastructure, and other programs for the duration of the continuing resolution.

Read on NCUIH’s blog.

NCUIH Regulation Tracker Updates

NCUIH tracks regulations and other federal agency actions that affect UIOs and American Indian and Alaska Native people living in urban areas. Recent regulations NCUIH has tracked:

  • Four letters from the Indian Health Service (IHS) addressing efforts to combat the syphilis epidemic, open positions at Tribal facilities and UIOs, the Continuing Appropriations and Extensions Act, 2027, and Director Mark Cruz’s dual role as IHS Director and U.S. Department of Health and Human Services Advisor.
  • Two letters from the Health Resources and Services Administration (HRSA) initiating Tribal Consultation on the 340B Rebate Model Pilot Program.

Visit ncuih.org/policy/regulation-tracker to follow current agency actions.

Comment Opportunity HRSA 340B Rebate Model Pilot Program

On August 3, the Health Resources and Services Administration (HRSA) published a notice launching the 340B Rebate Model Pilot Program, which is scheduled to take effect January 1, 2027. Under the pilot, covered entities, including UIOs participating in the 340B Drug Pricing Program, would pay the full price upfront for a limited set of drugs and receive a manufacturer rebate within 10 days. HRSA held a Tribal Consultation on September 16, 2026 in response to requests from Tribal leaders and Tribal-serving organizations. Tribal stakeholders are encouraged to submit written testimony or comments directly to HRSA.

Read more on NCUIH’s blog.

Submitted Federal Comments

NCUIH Submits Comments to IHS on Health Information Technology Modernization

On September 4, NCUIH submitted comments to IHS on its Health Information Technology Modernization Roadmap to Cohorts following the August 6 Tribal Consultation and Urban Confer. NCUIH recommended that IHS clarify the criteria for Cohort One and continue engaging UIOs throughout implementation of Health Information Technology Modernization.

NCUIH Submits Comments to CMS on Current Procedural Terminology

On September 14, NCUIH submitted comments to the Centers for Medicare & Medicaid Services in response to its Current Procedural Terminology Request for Information – potential updates to health care coding policies. NCUIH emphasized the need to minimize administrative burden on Indian Health Care Providers – including UIOs, ensure a smooth implementation process for any future changes, and protect reliable reimbursement for services.

NCUIH Joins Indian Country Partners at the National Indian Health Board’s National Tribal Health Conference

From August 17-20, NCUIH participated in the National Indian Health Board’s National Tribal Health Conference in Phoenix, Arizona, where NCUIH and UIO leaders connected with newly confirmed IHS Director, Mark Cruz. NATIVE Health CEO, Walter Murillo (Choctaw), moderated a panel with Kelly Rowe (Grand Ronde) and Angie Wilson (Klamath) to discuss A New Era for Traditional Healing: Celebrating Progress and Shaping the Future, highlighting traditional healing practices and on-the-ground implementation experience.

NCUIH Submits Comments to Arizona Medicaid Program on Traditional Healing Demonstration

On September 6, NCUIH submitted comments on an Arizona Medicaid amendment for UIOs seeking to participate in the Traditional Healing program. NCUIH asked Arizona to ensure timely implementation of Traditional Healing reimbursement at UIOs and to identify and secure the non-federal share needed to reimburse UIOs, which do not currently receive 100% FMAP.

NCUIH Participates in NCAI Tribal Impact Days

   

   

NCUIH joined the National Congress of American Indians (NCAI) for Tribal Impact Days in Washington, D.C. During a session in the Senate Committee on Indian Affairs Hearing Room, NCUIH heard from Senators Tina Smith (D-MN), Lisa Murkowski (R-AK), and other members of Congress about their work on behalf of Indian Country. NCUIH also connected with NCAI Executive Director Larry Wright, Jr., Tribal leaders, and Native organizations working on federal policy priorities. The week concluded at the National Museum of the American Indian with a reception celebrating the Tribal Supreme Court Project’s 25 years of coordinating Supreme Court strategy on cases affecting Tribal Nations.

SAVE THE DATE: UIO and Federal Partners Summit Preparation and Input Sessions

NCUIH is preparing UIOs for the upcoming Urban Indian Organization and Federal Partners Summit in Washington, D.C. set to be held on November 19, 2026, in Washington D.C. NCUIH will host two virtual sessions to gather input, share available information, and help UIOs prepare for the Summit.

October 21: UIO Summit Preparation and Input Session. This virtual session will gather UIO input and support early preparation for the Summit. Invite forthcoming.

November 10: UIO Summit Preparation Session. This virtual session will go over general Summit prep and logistics for UIOs. Invite forthcoming.

  • NCUIH also plans to host an in-person gathering for UIOs in Washington, D.C. RSVP required. Details to follow.

Upcoming Events and Policy Dates

  • September 22-24: U.S. Department of Health and Human Services Secretary’s Tribal Advisory Committee Meeting, San Diego, California.
  • September 30: NCUIH 2027 Policy Priorities Survey deadline.
  • October 1: Written comments due to HRSA on the 340B Rebate Model Pilot Program.
  • October 13: National Indian Health Board Medicare Medicaid and Health Reform Policy Committee Face-to-Face Meeting, Washington, D.C.
  • October 14-15: Centers for Medicare & Medicaid Services Tribal Technical Advisory Group Face-to-Face Meeting, Washington, D.C.
  • October 15: IHS Division of Urban Indian Affairs UIO Chief Executive Officer Monthly Conference Call, virtual.
  • October 21: NCUIH Monthly Policy Work Group and UIO Summit Preparation and Input Session, virtual.
  • November 10: UIO Summit Preparation Session, virtual, pending IHS approval.

2027 NCUIH Annual Conference

The 2027 NCUIH Annual Conference will be held May 3-6, 2027, at Westin Washington, D.C. Downtown.

We are excited to welcome Urban Indian Organizations, health care professionals, policymakers, community leaders, advocates, and partners from across the country. Through educational sessions, networking opportunities, and advocacy-focused discussions, attendees will connect, share best practices, strengthen partnerships, and explore solutions to critical issues impacting urban Indian health. Together, we will advance efforts to improve the health and well-being of urban Indian communities.

Conference Agenda:

  • May 3: Board Training – Board Training is free and does not require conference registration. Select the “IHS and NCUIH-Sponsored Events” ticket and choose “Yes, register me” for Board Training.
  • May 4-5: Conference Programming
  • May 6: Hill Day – Participation is limited to staff and leadership of IHS-funded UIOs. Pre-registration is required and will be sent out in March 2027.

Important Deadlines:

  • Early Bird Registration Deadline: December 18, 2026
  • Call for Proposals Submission Deadline: November 3, 2026
  • Award Nominations Open: October 5, 2026

Learn more at ncuih.org/conference.

Current Funding Opportunities

Indian Health Service Fiscal Year 2026 Urban Emergency Fund

  • Purpose: To help UIOs address costs associated with one-time, non-recurring emergencies and disaster relief efforts.
  • Award: A limited discretionary fund with up to $250,000 available.
  • Application deadline: As soon as reasonably practicable after the emergency occurs.

Visit the NCUIH website to explore the full list of funding opportunities.

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.

NCUIH Calls for Meaningful Urban Indian Organization Engagement in State Implementation of New H.R. 1 Medicaid Community Engagement Requirements

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On July 31, 2026, the National Council of Urban Indian Health (NCUIH) submitted written comments to the Centers for Medicare and Medicaid Services’ (CMS) Administrator, Dr. Mehmet Oz, regarding CMS’ interim final rule with comment period (IFC), “Medicaid Program; Community Engagement Requirement for Certain Individuals.” In the written comments, NCUIH recommended that CMS advise states to engage meaningfully with Urban Indian Organizations (UIOs) through Urban Confer when developing, modifying, or implementing policies, procedures, or operational processes related to the American Indian and Alaska Native exclusion.

Background on the IFC

On July 4, 2025, the President signed the H.R. 1 into law. The H.R. 1 delivers many elements of President Trump’s legislative agenda, including new requirements for access to Medicaid and Supplemental Nutrition Assistance Program (SNAP). Indians, Urban Indians, California Indians, and individuals determined eligible as an Indian for the Indian Health Service under regulations promulgated by the Secretary are excluded from the Medicaid requirements in the H.R. 1 and included in exclusions for the SNAP work requirements.

On June 3, 2026, CMS published the (IFC) in the Federal Register to interpret and implement the community engagement requirement in the H.R. 1.

NCUIH’s Recommendations

In its comments, NCUIH recommended CMS:

  • Advise states to accept self-attestation as sufficient to establish eligibility for the American Indian and Alaska Native exclusion
  • Advise states to partner with UIOs, Tribes, and Tribal Organizations to prevent procedural disenrollments of American Indian and Alaska Native beneficiaries
  • Require states to collect data on implementation of the American Indian and Alaska Native exclusion
  • Use strong, consistent language in every instance of the final rule when discussing states not reverifying American Indian and Alaska Native status
  • Advise states to engage meaningfully with UIOs through Urban Confer when developing, modifying, or implementing policies, procedures, or operational processes related to the American Indian and Alaska Native exclusion

NCUIH will continue to closely follow the development and implementation of CMS’ final rule.

NCUIH Resources:

  • Overview of the Impact of Medicaid on Health Care for American Indian and Alaska Native People: This updated resource explains why Medicaid matters for American Indian and Alaska Native people and UIOs. It provides data, background, and information that UIO staff and leaders can use for education and understanding Medicaid’s role in Native health care.
  • Medicaid Is Changing: This quick-reference resource explains the new Medicaid work and renewal requirements, who may be protected by the American Indian and Alaska Native exemption, and the basic policy changes that staff, leaders, and patients should understand.

House Unanimously Passes NCUIH-Endorsed Bipartisan Bill to Elevate Indian Health Service Leadership Within HHS

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On September 15, 2026, the House unanimously passed the bipartisan Stronger Engagement for Indian Health Needs Act of 2025 (H.R.741). The bill, which was introduced in the House of Representatives by Congressmen Greg Stanton (D-AZ-04) and David Joyce (R-OH-14), 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 bill was endorsed by the National Council of Urban Indian Health (NCUIH), National Congress of American Indians, and the National Indian Health Board.

Representative Stanton Press Release.

Next Steps

The bill will now need to be passed by the Senate. The Senate currently has companion legislation which was introduced by U.S. Senators Catherine Cortez Masto (D-NV) and Mike Rounds (R-SD).

Congress Extends Government Funding Through December

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On September 2, 2026, the Continuing Appropriations and Extensions Act, 2027 (H.R.6500) was signed into law by the President. The Continuing Resolution (CR) will maintain funding for the federal government at the Fiscal Year (FY) 2026 levels through December 11, 2026. Additionally, the CR also delays OMB’s proposed overhaul of the Uniform Guidance rule governing federal financial assistance, prohibiting the agency from finalizing that rule before December 11, 2026.

Congress will now have until the end of the CR to negotiate and pass full-year FY 2027 appropriations bill. NCUIH will monitor congressional negotiations as they work towards a final full year appropriations bill.

HRSA to Hold Tribal Consultation on 340B Rebate Model Pilot Program

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WASHINGTON, D.C. (September 3, 2026) – The Health Resources and Services Administration (HRSA) will hold a Tribal Consultation on its 340B Rebate Model Pilot Program on Wednesday, September 16, 2026, from 3:00 to 5:00 p.m. ET. The virtual session, held via Zoom and initiated pursuant to Executive Order 13175, was announced in an August 28, 2026, Dear Tribal Leader Letter from RADM Krista Pedley, Acting Associate Administrator, in response to requests from Tribal leaders and Tribal-serving organizations. Tribal stakeholders who are unable to attend are encouraged to submit written testimony or comments directly to HRSA.

The National Council of Urban Indian Health (NCUIH) encourages Tribal representatives to register and engage in this important consultation. Feedback that may be helpful to include could address anticipated cash-flow or operational impacts specific to your organization, how current 340B savings support patient care, administrative or staffing capacity needed to manage rebate claims, and any experience with delayed or denied claims in similar programs.

In the Dear Tribal Leader Letter announcing the Consultation, RADM Krista Pedley, HRSA’s Acting Associate Administrator, wrote that HRSA intends to use the session to discuss how the Rebate Pilot will help the agency balance Tribal stakeholder concerns against its goal of testing a rebate model in the 340B Program, gather data on how the 340B ceiling price is effectuated through rebates, generate data relevant to other federal drug pricing programs including the Medicare Drug Price Negotiation Program, and improve transparency to inform future policy decisions. HRSA framed the session as an opportunity to hear directly from Tribes, describing its intent to “welcome concerns and input” as the agency works to implement the Pilot, and characterizing the Consultation as part of the agency’s broader government-to-government relationship with Tribal Nations.

Background

On August 3, 2026, HRSA published a Federal Register notice launching the 340B Rebate Model Pilot Program, effective January 1, 2027. Under the Pilot, covered entities, including UIOs participating in 340B, would pay full price upfront for a limited set of drugs and receive a rebate from the manufacturer within a 10-day window. HRSA states that this design is expected to keep cash-flow impact minimal for covered entities generally.

NCUIH appreciates HRSA’s engagement on this issue and has shared with the agency that a 10-day rebate window may still pose challenges for Indian Health Care Providers operating on tight margins, particularly if a rebate claim is denied and enters an appeals process, which could further delay payment. NCUIH’s analysis shows that UIO 340B participants’ cash outlay could rise by as much as $342,716.14 annually under this model. Twenty-five of the 41 IHS-funded UIOs currently participate in the 340B program, and many operate with limited cash reserves and narrow margins that leave little capacity to absorb delayed rebate payments.

Tribes and Indian Health Care Providers have engaged in advocacy on HRSA’s 340B Rebate Model Pilot Program since it was announced, and across both iterations of the proposed program. NCUIH has consistently advocated for an exemption for Indian Health Care Providers, including UIOs.

In December 2025, NCUIH sent a letter to HRSA Administrator Thomas J. Engels requesting an exemption for UIOs and Indian Health Care Providers from the Pilot, and published a press release and one-pager on the issue, impact, and policy ask.

In April 2026, NCUIH submitted formal comments to HRSA requesting an exemption for Indian Health Care Providers, including UIOs, consistent with requests developed alongside the HHS Secretary’s Tribal Advisory Committee (STAC) and the CMS Tribal Technical Advisory Group (TTAG). See the TTAG comment letter to HRSA (April 20, 2026).

Participant Information

What: HRSA Tribal Consultation on the 340B Rebate Model Pilot Program
Date: Wednesday, September 16, 2026 Time: 3:00 – 5:00 p.m. ET
Location: Virtual (Zoom) Registration: Register here
Written comment deadline: Thursday, October 1, 2026, to tribalconsultation@hrsa.gov
Questions: Commander Sharyl Trail, Director, HRSA Office of Tribal Affairs, strail@hrsa.gov

Resources

The Need for Exemption for Indian Health Care Providers from 340B Pilot
HRSA Federal Register Notice on the 340B Rebate Model Pilot Program (August 3, 2026)

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.

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

 

NCUIH August Policy Update: Senate Confirms Mark Cruz as IHS Director, UIO FMAP Updates, and FY 2027 Appropriations

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In this Edition:

  • Questions for UIOs: Request for Input and Feedback
  • Senate Confirms Mark Cruz as Indian Health Service Director
  • Federal Leaders Visit Arizona UIOs
  • Federal Medical Assistance Percentage (FMAP) Updates
  • New NCUIH Medicaid Resources
  • Fiscal Year 2027 Appropriations Status and Updates
  • NCUIH Speaks at Congressional Briefing Launching the Native Children’s Commission Implementation Act
  • NCUIH Endorses Bill to Improve Public Health Emergency Preparedness for Indian Health Care Providers
  • Submitted Federal Comments (H.R. 1 Implementation and Special Diabetes Program for Indians Funding) and Upcoming Comment Opportunities
  • Upcoming Events, Policy Dates, and Funding Opportunities

Questions for UIOs: Request for Input and Feedback

  • Rural Health Transformation Program (RHTP): NCUIH is gathering UIO experiences with RHTP and requests that Urban Indian Organizations let NCUIH know if their organization receives funding and how you are engaging with your state. More information on the Rural Health Transformation Fund is available on the NCUIH Policy Resource Center Webpage.
  • Special Diabetes Program for Indians (SDPI) 25% Supplemental Funding:IHS announced that current SDPI grant recipients will receive a Calendar Year 2026 administrative grant supplement totaling 25% of their annual SDPI grant award using one-time, unobligated funding. Have any UIO SDPI grantees received their supplemental funding?
  • UIO Listening Session with the Indian Health Service (IHS) Division of Behavioral Health (DBH): NCUIH is facilitating a virtual UIO listening session with IHS DBH on September 17, 2026, at 1:00 PM ET. Register at ncuih.org/events. Please let us know any questions you have for DBH, behavioral health challenges and successes at your UIO, and topics you want covered during the session.

Responses can be sent to policy@ncuih.org.

Senate Confirms Mark Cruz as Indian Health Service Director

On August 7, 2026, the Senate confirmed Mark Cruz, a citizen of the Klamath Tribes, as Director of the Indian Health Service (IHS). NCUIH submitted questions for the record ahead of his June 24 nomination hearing, including on IHS’s role in supporting Urban Indian Organizations (UIOs) and efforts to secure 100% Federal Medical Assistance Percentage (FMAP) for UIOs.

NCUIH will continue to engage with Director Cruz and IHS on priorities including full and stable funding for IHS including urban Indian health, Medicaid parity for UIOs, and investments in Native behavioral health programs.

[Read the full Blog Post]

Federal Leaders Visit Arizona UIOs

Dr. Caprice Knapp (CMS), Erin Tawney (HHS), and other agency representatives visited the NATIVE HEALTH Phoenix clinic alongside Native American Connections and NCUIH. The visit highlighted how UIOs are transforming Medicaid and Children’s Health Insurance Program (CHIP) coverage into improved health outcomes for Native communities.

NCUIH also joined the HHS Administration for Native Americans (ANA) and Pew Charitable Trusts in a visit to Native American Connections to see firsthand how UIOs provide culturally responsive care to American Indian and Alaska Native people in urban settings.

We thank CMS, HHS, and Pew for joining us in showcasing the important role of Urban Indian Organizations in the Indian Health System.

Federal Medical Assistance Percentage (FMAP) Updates

  • Current legislation:The bipartisan Urban Indian Health Parity Act (H.R. 4722) would provide 100% federal medical assistance percentage (FMAP) for services provided to Medicaid beneficiaries at UIOs.
NCUIH Joined the Centers for Medicare & Medicaid Services Tribal Technical Advisory Group in Hill Meetings on AI/AN Medicare and Medicaid Priorities, including 100% FMAP for UIOs.
  • On July 27, NCUIH joined the CMS Tribal Technical Advisory Group (TTAG) Hill Day to provide education on TTAG Medicare and Medicaid priorities, including 100% FMAP for UIOs.
  • Offices visited: Sens. Baldwin (D-WI), Smith (D-MN), Cassidy (R-LA, HELP Chair), Johnson (R-WI), Slotkin (D-MI), Peters (D-MI), Murkowski (R-AK), and Merkley (D-OR).

New NCUIH Medicaid Resources

  • Updated Resource: Overview of the Impact of Medicaid on Health Care for American Indian and Alaska Native People— refreshed data on American Indian and Alaska Native (AI/AN) Medicaid enrollment and the role of UIOs as providers for AI/AN Medicaid beneficiaries. [Link]
  • New Resource: Medicaid is Changing — Medicaid Work Requirements and the AI/AN Exemption — outlines the work, renewal, and cost-sharing changes taking effect in 2027 and what the AI/AN exemption protects. [Link]

Fiscal Year 2027 Appropriations Status and Updates

On August 8, the Senate passed a continuing resolution (CR)by a vote of 90-6 that would fund the government through December 11. The CR:

  • Prevents implementation of the Office of Management and Budget’s (OMB) proposed grants rule through the duration of the CR; and
  • Extends authorizations of important health, veterans, infrastructure, and other programs for the duration of the CR.

Next Steps: The House returns from recess on August 31 and must act on the Senate’s version before the September 30 funding deadline. NCUIH will continue to work to protect funding for Indian Country.

NCUIH Joins Tribal Leaders and Senate Champions to Celebrate Introduction of the Native Children’s Commission Implementation Act

On July 23, NCUIH’s Board President Robyn Sunday-Allen (Cherokee Nation), who also serves as Chief Executive Officer of the Oklahoma City Indian Clinic (OKCIC), spoke at the congressional briefing launching the Native Children’s Commission Implementation Act, introduced July 14 by Sens. Lisa Murkowski (R-AK) and Brian Schatz (D-HI).

[Read NCUIH’s press release on the event.]

This bi-partisan legislation would address longstanding challenges facing Native children and families across child welfare, education, health care, juvenile justice, housing, workforce development, nutrition, and data systems, and represents one of the most significant investments in Native children and families in a generation.

UIO inclusions in the bill:

  • Tribal Perinatal Workforce Demonstration Grants (Sec. 403): The section establishes a grant program for eligible entities to recruit, train, and retain maternity care providers, behavioral health providers, dietitians, doulas, and other perinatal health workers. Urban Indian organizations are named as eligible entities for the program.
  • HRSA Tribal Advisory Committee (Sec. 401): This new committee, composed of at least 12 members, would be appointed from nominations submitted by Indian Tribes, Tribal organizations, and urban Indian organizations.
  • SAMHSA Tribal Technical Advisory Committee (Sec. 404): Of at least 14 members, two seats are reserved for representatives of “national Tribal organizations or urban Indian organizations” with national expertise in behavioral health.
  • NIH Tribal Health Research Office and Tribal Advisory Committee (Sec. 301): The bill establishes a new Tribal Health Research Office within the Office of the Director of NIH, along with a Tribal Advisory Committee of at least 17 members. Notably, two of those seats are specifically reserved for representatives of urban Indian organizations.
  • Native Infant and Maternal Health Data (Sec. 302): The bill directs CDC to enter into cooperative agreements with Indian Tribes, Tribal organizations, Tribal Epidemiology Centers, Papa Ola Lokahi, and urban Indian organizations to address misclassification and under sampling of Native infant and maternal health data.

[Read NCUIH’s analysis on the bill.]

NCUIH Endorses Bill to Improve Public Health Emergency Preparedness (PHEP) for Indian Health Care Providers

Introduced July 21 by Sen. Warren (D-MA), Sen. Heinrich (D-NM), Rep. Stansbury (D-NM-01), and Rep. Leger Fernández (D-NM-03), the CDC Tribal Public Health Security and Preparedness Act would allow Tribes to apply directly to CDC for Public Health Emergency Preparedness (PHEP) program funds.

  • Authorizes$750 millionfor each fiscal year, 2026 through 2028, for the PHEP program, 5% Tribal set-aside.
  • UIOs are included in several consultation provisions that would ensure they are included in crafting public health plans.

[Read NCUIH’s analysis on the bill.]

NCUIH Submits Comments to CMS on Interim Final Rule on H.R. 1 Implementation

On July 31, NCUIH submitted comments on the CMS interim final rule on H.R. 1 implementation. In its comments, NCUIH encouraged CMS to provide clear guidance and support for implementation of the American Indian and Alaska Native Medicaid provisions, promote collaboration with UIOs, Tribes, and Tribal Organizations, strengthen oversight and data collection efforts, and ensure meaningful engagement with UIOs.

NCUIH Submits Comments to IHS on Additional Special Diabetes Program for Indians Funding

IHS requested feedback on $70 million in additional Special Diabetes Program for Indians (SDPI) funding — $50 million from the Fiscal Year 2026 funding increase and $20 million in one-time unobligated SDPI funding. In its comments, NCUIH encouraged IHS to provide flexibility in the use of funding, promote local decision-making, engage with Tribes and UIOs, and allow sufficient time for feedback.

Comment Opportunity — Due September 5: IHS Health Information Technology Modernization: Roadmap to Cohorts

On August 6, IHS held a Tribal Consultation and Urban Confer session on Health Information Technology (HIT) Modernization: Roadmap to Cohorts. Formation of Cohort 1 for implementing the Patients at the Heart (PATH) electronic health record (EHR) is dependent on funding, but IHS is envisioning two federal sites and one Tribal site.

IHS is seeking responses to: 

  1. What additional information or content would be helpful to determine readiness at your site?
  2. What questions do you have about requirements or level commitment needed to support PATH EHR implementation?
  3. What questions or recommendations do you have regarding the cohort identification process?

Comments are due to IHS by September 5, 2026. 

  1. Email Urban Confer comments to: urbanconfer@ihs.gov

Upcoming Events and Policy Dates

September 1-3: NCUIH UIO Focus Groups — Setting Policy Priorities for 2027 (ncuih.org/events)

  • September 1: Full Ambulatory | 1:00-2:00 p.m. ET; Outpatient and Residential | 3:00-4:00 p.m. ET
  • September 2: Limited Ambulatory | 1:00-2:00 p.m. ET; Outreach and Referral | 3:00-4:00 p.m. ET
  • September 3: Make-Up Session | 1:00-2:00 p.m. ET

September 15-16: IHS Tribal Leaders Diabetes Committee (TLDC) Quarterly Meeting (virtual)

September 15-17: National Congress of American Indians (NCAI) Tribal Impact Days (Washington, D.C.)

September 16: NCUIH Monthly Policy Workgroup and IHS DBH Prep Session for UIOs (virtual)

September 17: NCUIH and IHS DBH Listening Session (virtual – register at ncuih.org/events) | 1:00-2:00 p.m. ET

Current Funding Opportunities

Visit the NCUIH Website to apply and explore the Full List of Opportunities.

HHS Administration for Native Americans (ANA): AI3 Action Institute — Artificial Intelligence for American Indians (AI3) 

  • Urban Indian Organizations are eligible.
  • The award is $3,500,000 total (single award).
  • The application deadline is August 27, 2026.

HHS ANA: National Center for Native Training and Technical Assistance Cooperative Agreement 

  • Urban Indian Organizations are eligible.
  • The award is $3,100,000 total (single award) over a 3-year project period.
  • The application deadline is August 27, 2026.

HHS ANA: Economic Advancement Grants for Local Empowerment (EAGLE) 

  • Urban Indian Organizations are eligible.
  • The award is up to $900,000 per project over a 3-year project period.
  • The application deadline is August 27, 2026.

Indian Health Service Addressing Dementia in Tribal and Urban Indian Communities: CAReS Program 

  • Urban Indian Organizations are eligible.
  • Option A offers up to $750,000 per year for five years to one national awardee to expand dementia care through mini-projects, training, and technical assistance.
  • Option B offers up to $300,000 per year for five years to one national awardee to develop a caregiver support and training center.
  • The application deadline is September 4, 2026.

Indian Health Service Fiscal Year 2026 Urban Emergency Fund (UEF) 

  • The purpose of this fund is to help Urban Indian Organizations address costs associated with one-time, non-recurring emergencies and disaster relief efforts.
  • The award is a limited discretionary fund, with up to $250,000 available.
  • The application deadline is as soon as reasonably practicable after the emergency occurs.

 

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.

NCUIH Releases Updated Resource on the Impact of Medicaid on Health Care for American Indian and Alaska Native People

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Washington, DC, August 14, 2026 — The National Council of Urban Indian Health (NCUIH) has released an updated resource, Overview of the Impact of Medicaid on Health Care for American Indian and Alaska Native People, detailing Medicaid’s role in American Indian, Alaska Native, and Urban Indian health care and the changes to the program taking effect under the One Big Beautiful Bill Act (OBBBA). This report updates NCUIH’s March 2025 Medicaid resource with new 2023 enrollment data and an overview of the OBBBA exemption protecting AI/AN beneficiaries. For a quick-reference summary of the OBBBA changes, see NCUIH’s related resource, Medicaid is Changing. 

Access the Resource
Medicaid Is Critical to Health Care for American Indian and Alaska Native People 

The federal government has a trust responsibility to provide federal health services to maintain and improve the health of AI/AN and Urban Indian people. Medicaid, a joint federal-state program, is essential to fulfilling that responsibility for eligible AI/AN beneficiaries. In 2023: 

  • 2.7 million AI/AN people were enrolled in Medicaid nationwide. 
  • 24% of AI/AN adults ages 18-64 were enrolled in Medicaid. 
  • 23% of AI/AN adults over 64 were enrolled in Medicaid. 
  • 49% of AI/AN children ages 0-18 were enrolled in Medicaid. 
Urban Indian Organizations Are Necessary Medicaid Providers 

Urban Indian Organizations (UIOs) are a critical access point for AI/AN Medicaid beneficiaries, particularly given that the majority of the AI/AN population lives in urban areas. 

  • 1.9 million AI/AN people were enrolled in Medicaid in states with UIOs. 
  • 59% of AI/AN people receiving care at UIOs were Medicaid beneficiaries. 
  • 8 out of the top 10 states with the largest number of AI/AN Medicaid beneficiaries are served by UIOs, including California, Oklahoma, Arizona, Texas, New Mexico, New York, Washington, and Illinois. 
Medicaid Is Changing Under the One Big Beautiful Bill Act 

Starting in 2027, most Medicaid enrollees will face new work requirements, more frequent eligibility redeterminations, and new cost-sharing charges under the OBBBA. Indians, Urban Indians, California Indians, and individuals otherwise determined eligible for the Indian Health Service are exempt from these changes: 

  • No Work Requirement: No work, school, or volunteer hour requirement to keep Medicaid. 
  • 12-Month Renewal: The current 12-month renewal cadence is retained, rather than the new 6-month redetermination cycle for expansion adults. 
  • Cost-Sharing Protection: No new cost sharing for services at an Indian health care provider or through qualifying referred care. 

Note: This protection applies specifically to care received at an Indian health care provider or through a qualifying referral from one. It does not extend to cost sharing for Medicaid services received elsewhere. 

Some states have already begun implementing these changes ahead of the national deadline. UIOs and patients should confirm their state’s specific timeline with their state Medicaid agency. 

Call to Action 

Primary Ask: Ensure Proper Implementation of the AI/AN and Urban Indian Medicaid Work Requirement Exemption 

States may not yet have sufficient information to reliably identify everyone who qualifies for the AI/AN exemption before outreach occurs, creating a risk of misidentification or confusing notices. HHS and CMS should issue binding guidance so states apply the AI/AN exemption automatically, ensuring implementation does not create new barriers for AI/AN and Urban Indian people. 

Ongoing Priority: Preserve and Maintain All Existing Medicaid Resources for the Indian Health System 

Cuts to Medicaid place a heavier burden on states and can force Indian health care providers to reduce essential services. Preserving Medicaid resources is critical to ensuring AI/AN and Urban Indian beneficiaries can access necessary care and to fulfilling the trust responsibility.

Additional Medicaid Implementation Resources

NCUIH has developed resources to help Urban Indian Organizations (UIOs) and patients prepare for Medicaid implementation and respond when applicable American Indian and Alaska Native protections may not be recognized correctly.

Protecting Medicaid Coverage for American Indian and Alaska Native Patients: Implementation Guide for Urban Indian Organizations

A practical two-page guide to help UIO staff prepare for Medicaid implementation, establish local response procedures, and respond when a patient receives a Medicaid work or renewal notice that may not apply to them.

Download the UIO Implementation Guide

Got a Medicaid Work or Renewal Notice?

A one-page patient handout explaining what to do after receiving a Medicaid work or renewal notice and how to get help determining whether federal AI/AN protections may apply.

Download Patient Handout

Questions or implementation problems? Contact policy@ncuih.org.

NCUIH Releases New Resource on Medicaid Work Requirements and the AI/AN Exemption

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Washington, DC, August 14, 2026 — The National Council of Urban Indian Health (NCUIH) has released a new resource, Medicaid is Changing, outlining upcoming changes to Medicaid under the One Big Beautiful Bill Act (OBBBA) and the protections in place for American Indian, Alaska Native, and Urban Indian beneficiaries. 

Access the Resource

Starting in 2027, most Medicaid enrollees will face new work requirements, more frequent eligibility redeterminations, and new cost-sharing charges for some expansion adults. Indians, Urban Indians, California Indians, and individuals otherwise determined eligible for the Indian Health Service are exempt from these changes.

As of August 2026, some states have already begun implementing these changes ahead of the national deadline. UIOs and patients should confirm their state’s specific timeline with their state Medicaid agency.

What Is the AI/AN and Urban Indian Medicaid Exemption?

Indians, Urban Indians, California Indians, and individuals otherwise determined eligible for the Indian Health Service are exempt from the OBBBA’s new Medicaid work requirements, six-month redetermination cycle, and cost-sharing changes. This exemption is written into the statute itself.

What the Exemption Protects
  • No Work Requirement: No work, school, or volunteer hour requirement to keep Medicaid. (OBBBA § 71119(a))
  • 12-Month Renewal: The current 12-month renewal cadence is retained, rather than the new 6-month redetermination cycle. (OBBBA § 71107)
  • Cost-Sharing Protection: No new cost sharing for services at an Indian health care provider or through qualifying referred care. (ARRA § 5006, 42 U.S.C. § 1396o(j))
    • Note: This protection applies specifically to care received at an Indian health care provider or through a qualifying referral from one. It does not extend to cost sharing for Medicaid services received elsewhere.
Call to Action
Primary Ask: Ensure Proper Implementation of the AI/AN and Urban Indian Medicaid Work Requirement Exemption

States may not yet have sufficient information to reliably identify everyone who qualifies for the AI/AN exemption before outreach occurs, creating a risk of misidentification or confusing notices. HHS and CMS should issue binding guidance so states apply the AI/AN exemption automatically, ensuring implementation does not create new barriers for AI/AN and Urban Indian people.

Ongoing Priority: Preserve and Maintain All Existing Medicaid Resources for the Indian Health System

Cuts to Medicaid place a heavier burden on states and can force Indian health care providers to reduce essential services. Preserving Medicaid resources is critical to ensuring AI/AN and Urban Indian beneficiaries can access necessary care and to fulfilling the trust responsibility.

Frequently Asked Questions

Do American Indian and Alaska Native people have to comply with the new Medicaid work requirements?

No. AI/AN and Urban Indian Medicaid beneficiaries are statutorily exempt from the OBBBA’s community engagement and work requirements.

Will AI/AN Medicaid beneficiaries have their eligibility checked every six months?

No. The exemption preserves the current 12-month Medicaid renewal cycle for AI/AN and Urban Indian beneficiaries. 

Will AI/AN people face new Medicaid cost-sharing charges?

No. Federal law already prohibits cost sharing for services furnished to Indians through Indian health programs, and this protection remains in place under the OBBBA.

When do the OBBBA Medicaid changes take effect?

As of August 2026, the new work requirements and six-month redeterminations are already in effect in Nebraska and Montana, with Arkansas notifying enrollees ahead of a January 1, 2027 compliance start and Iowa following in December 2026. All other states must comply by January 1, 2027.

Who is covered by the AI/AN and Urban Indian Medicaid exemption?

Indians, Urban Indians, California Indians, and individuals otherwise determined eligible for services from the Indian Health Service.

Additional Medicaid Implementation Resources

NCUIH has developed resources to help Urban Indian Organizations (UIOs) and patients prepare for Medicaid implementation and respond when applicable American Indian and Alaska Native protections may not be recognized correctly.

Protecting Medicaid Coverage for American Indian and Alaska Native Patients: Implementation Guide for Urban Indian Organizations

A practical two-page guide to help UIO staff prepare for Medicaid implementation, establish local response procedures, and respond when a patient receives a Medicaid work or renewal notice that may not apply to them.

Download the UIO Implementation Guide

Got a Medicaid Work or Renewal Notice?

A one-page patient handout explaining what to do after receiving a Medicaid work or renewal notice and how to get help determining whether federal AI/AN protections may apply.

Download Patient Handout

Questions or implementation problems? Contact policy@ncuih.org.

NCUIH Endorses Bicameral Bill to Improve Public Health Emergency Preparedness for Indian Health Care Providers

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On July 21, 2026, Senator Elizabeth Warren (D-Mass.), Senator Martin Heinrich (D-N.M.), Representative Melanie Stansbury (D-NM-01), Representative Teresa Leger Fernandez (D-NM-03) introduced the Centers for Disease Control and Prevention (CDC) Tribal Public Health Security and Preparedness Act (S.5056/ H.R.9820). The bill would allow Tribes to apply directly to the Centers for Disease Control and Prevention (CDC) for Public Health Emergency Preparedness (PHEP) program funds. Currently, only states and certain local entities may apply for PHEP funds to respond to public health emergencies. The bill authorizes $750 million for each of fiscal years 2026 through 2028 for the PHEP program 5% tribal set-aside of the total CDC PHEP funds.  Additionally, urban Indian organizations (UIOs) are included in several important consultation provisions in the bill that would ensure they are included in crafting public health plans.

“The National Council of Urban Indian Health (NCUIH) is pleased to endorse the CDC Tribal Public Health Security and Preparedness Act which provides Tribes access to Public Health Emergency Preparedness (PHEP) program funds and includes urban Indian organization input on the development of public health plans. This bill’s equitable access to critical preparedness funds will ensure Indian Country will be better prepared to respond to future public health emergencies.” – Francys Crevier (Algonquin), CEO, NCUIH.

The CDC Tribal Public Health Security and Preparedness Act is cosponsored by U.S. Senators Tina Smith (D-Minn.), Bernie Sanders (I-Vt.), Amy Klobuchar (D-Minn.), Tammy Baldwin (D-Ill.), Cory Booker (D-N.J.), and Ron Wyden (D-Ore.).

The bill has been endorsed by leading Native American advocacy groups— including the National Congress of American Indians, National Indian Health Board, and NCUIH. It currently awaits consideration.

Resources

Senate Confirms Mark Cruz as Director of the Indian Health Service

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FOR IMMEDIATE RELEASE

WASHINGTON, D.C. (August 7, 2026)– The National Council of Urban Indian Health (NCUIH) applauds the U.S. Senate’s confirmation of Mark Cruz (Klamath Tribes) as Director of the Indian Health Service (IHS). The Senate confirmed Mr. Cruz today, following a favorable vote by the Senate Committee on Indian Affairs (SCIA) on July 22, 2026, and a nomination hearing before SCIA on June 24, 2026.

Director Cruz’s confirmation ends more than a year without a Senate-confirmed IHS Director, which began when former Director Roselyn Tso (Navajo) resigned at the start of the current administration. NCUIH previously stressed the importance of appointing a permanent IHS Director and called for the elevation of the role to Assistant Secretary. IHS Chief of Staff Clayton Fulton has served in an acting capacity since December 2025.

As IHS Director, Director Cruz will oversee a nationwide health care delivery system serving approximately 2.8 million American Indians and Alaska Natives through the Indian health system. Mr. Cruz will continue to jointly serve as Senior Advisor to HHS Secretary Robert F. Kennedy Jr., where he is one of the highest-ranking Native officials within the Department.

During his confirmation hearing, Director Cruz pledged his commitment to the work ahead, stating: “Tribal leaders and Congress can count on me to engage early, listen carefully, and be transparent. I am realistic about the challenges but optimistic about what we can achieve together. With strong federal, Tribal, and urban Indian health partners, outcomes will continue to improve.”

Director Cruz’s confirmation drew broad support from Indian Country. The National Congress of American Indians (NCAI) applauded the nomination and called for the Senate’s swift confirmation, citing Cruz’s advocacy for historic increases in IHS appropriations, his work mobilizing more than 70 Public Health Service officers to IHS facilities, and his efforts to reduce barriers for Tribal Nations developing culturally grounded health responses. The committee received more than 40 letters from Tribes and Tribal organizations in support of his confirmation.

NCUIH will continue to engage with Director Cruz and IHS on priorities including full and stable funding for IHS including urban Indian health, Medicaid parity for UIOs, and investments in Native behavioral health programs.

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