Oklahoma City Indian Clinic Wellness Center Earns National Certification for Advancing Native Health and Wellness

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The Oklahoma City Indian Clinic Wellness Center has made history as the first American Indian and first Oklahoma facility to be certified by the Medical Fitness Association. This national certification represents the highest standard for medical fitness centers, recognizing organizations that meet rigorous criteria in safety, professional oversight, and evidence-based wellness programming. Certified facilities must demonstrate active medical supervision, individualized health screenings, and programs that prevent disease and promote therapeutic lifestyles. For the Oklahoma City Indian Clinic, this certification affirms a long-standing commitment to helping Native patients build healthier, stronger lives through integrative care that blends clinical medicine, behavioral health, and culturally grounded fitness initiatives like Med Fit. 

This recognition comes as the Clinic continues to draw national attention for its leadership in urban Native health. In June 2025, Secretary of Health and Human Services Robert F. Kennedy Jr. visited the Oklahoma City Indian Clinic to learn more about its innovative programs addressing food insecurity, chronic disease prevention, and the social drivers of health. During the visit, Chief Executive Officer Robyn Sunday Allen (Cherokee) highlighted how the Clinic’s integrated model—combining medical, behavioral, pharmacy, and wellness services under one roof—serves as a roadmap for improving Native health outcomes in urban settings. 

The Oklahoma City Indian Clinic’s recent achievements reflect the transformative potential of Native-led health programs when given the flexibility and resources to innovate. By achieving Medical Fitness Facility Certification, the Clinic has demonstrated not only operational excellence but also a deep commitment to culturally informed care that empowers Native communities to thrive. The National Council of Urban Indian Health proudly recognizes this milestone as a defining moment in the ongoing story of urban Native health leadership, wellness, and resilience in Indian Country.  

NCUIH Resource Highlights Substance Use Disorder and Opioid Crisis in Native Communities, Proposes Policy Solutions

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The National Council of Urban Indian Health (NCUIH) has released a new resource on Substance Use Disorder and Overdose in American Indian and Alaska Native Communities. This resource highlights the urgent need for increased support and funding to address the disproportionate impact of substance use disorder (SUD) and overdose among American Indian and Alaska Native (AI/AN) people.

ACCESS THE RESOURCE
The Crisis:


AI/AN communities continue to face the highest overdose death rates in the nation. Urban Indian Organizations (UIOs) are essential providers of culturally grounded prevention, treatment, and recovery services. However, they face persistent challenges, including limited resources, data access, and sustainable funding. The new resource provides key data, outlines barriers to care, and recommends policy solutions to strengthen UIOs’ ability to respond to this public health crisis.

Policy Solutions:

Fund the Behavioral Health and Substance Use Disorder Resources for Native Americans (BHSUDRNA) Program

Congress authorized the Behavioral Health and Substance Use Disorder Resources for Native Americans (BHSUDRNA) Program in the Consolidated Appropriations Act, 2023, 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.

  • Authorized Funding: $80 million for each of Fiscal Years (FY) 2023-2027.
  • Problem: No funds have been appropriated.
    • The President’s FY 2026 budget requested that $80 million be appropriated for this program. The House and Senate did not include this program in their FY 2026 appropriations bills.

Continuing Support for Tribal Behavioral Health Grants (Native Connections)

Native Connections is a five-year grant program that helps AI/AN communities identify and address the behavioral health needs of Native youth. The Native Connections grant program supports grantees in: reducing suicidal behavior and substance use among Native youth up to age 24; easing the impacts of substance use, mental illness, and trauma in tribal communities; and supporting youth as they transition into adulthood.

The Tribal Behavioral Health Grants line item in the Labor, Health and Human Services, Education, and Related Agencies appropriations bill funds the Native Connections program. Currently there are 12 UIOs who are active recipients.

  • Appropriations Status: Congress has maintained funding for this program in the proposed FY 2026 appropriations bills in each chamber. The Senate has proposed maintaining funding at the current level of $23.67 million. The House has proposed increasing funding to $30 million.

NCUIH Joins Families USA and 153 Partner Organizations in Urging Congress to Permanently Extend Enhanced Premium Tax Credits

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On October 16, 2025, NCUIH joined Families USA and 153 partner organizations in signing a letter to Majority Leader Thune, Minority Leader Schumer, Speaker Johnson, and Minority Leader Jeffries calling on Congress to permanently extend enhanced premium tax credits (ePTCs) that help make health coverage more affordable for millions of Americans.

The letter emphasizes that allowing the enhanced credits to expire would cause more than 20 million people, including small business owners, older adults, and families with children, to face rising health costs or lose coverage altogether. If not extended, an estimated 4 million people could lose insurance, and 11 million people with incomes between 100 and 150 percent of the Federal Poverty Level would lose access to zero-dollar premium plans.

The loss of the ePTCs will also have a significant impact on American Indian and Alaska Native (AI/AN) people. The Urban Institute estimates that 318,000 American Indian and Alaska Native (AI/AN) people are enrolled in the Marketplace in 2025 under tax credits and 126,000 AI/AN people will lose their Marketplace coverage without ePTCs, representing a 40 percent reduction for AI/ANs currently covered. Increasing premiums, even modestly, creates barriers for people with limited incomes, forcing many to choose between paying for health care and basic necessities.

Read the Full Letter Text

Dear Majority Leader Thune, Minority Leader Schumer, Speaker Johnson, and Minority Leader Jeffries:  

As millions of families across the country struggle to pay for the high and rising cost of health care, the more than 150 undersigned organizations representing patients, workers, small businesses, health care providers, public health professionals and other health care stakeholders strongly urge Congress to permanently extend the enhancements to the premium tax credit without delay and without any changes that could place health coverage out of reach for millions of vulnerable Americans. 

Without a timely extension of the enhanced premium tax credits, more than 20 million people – including about 5 million small business owners and self-employed people, along with 6 million older adults – will see their health care costs skyrocket. Roughly 4 million people are projected to lose their coverage altogether due to the higher cost. Further, if the enhancements expire, the 11 million people with Marketplace coverage who have incomes between 100 and 150 percent of the federal poverty level ($15,650 to $23,475 for an individual in 2025) would lose access to a silver plan with zero-dollar premiums. Data shows that the availability of such plans ensured that more people, and on average healthier people, are enrolled in coverage — a significant driver of recent record low numbers of Americans who are uninsured. 

Increasing the monthly cost of health care coverage, even by relatively modest amounts, for people with limited income would create significant barriers for them to maintain coverage, putting them at risk of dropping out of coverage altogether due to added confusion and red tape. Lowering income eligibility would particularly harm older adults, people in rural areas, and families with children by exposing them to skyrocketing costs. Those who could somehow manage to maintain their coverage might be forced to forgo other basic needs in order to pay for it. This reality further threatens people’s ability to treat ongoing health conditions like diabetes, heart disease, and cancer, as well as respond to new threats to their health.  

Changes made earlier this year in H.R.1 only compound the negative impact that losing enhanced premium tax credits will have by making vulnerable families unable to re-enroll in coverage if they fail to pay even a minimal premium. In that event, they would be ineligible for coverage for an entire year until the next Open Enrollment period – leaving millions vulnerable to even higher medical bills and greater uncompensated care costs for hospitals and health care providers already on the brink.  

The harms from eliminating these specific tax credits would be felt most acutely by people in states that have failed to expand Medicaid eligibility, including Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. Collectively, over six million people in those states who do not have access to Medicaid coverage with annual incomes below $21,597 are eligible for health care tax credits and a plan with zero-dollar premiums because of the enhancements. Texas, Florida, Georgia, and South Carolina in particular are among the top states in the country in terms of having the largest number of residents utilizing enhanced premium tax credits to get coverage. 

Raising health costs for people living paycheck to paycheck will endanger people’s health while making their financial predicament even more dire. To avoid this outcome, Congress must quickly extend the health care tax credits across all currently eligible income levels, including access to a zero-dollar premium plan for the most vulnerable families. We urge you and your colleagues to act without delay.  

Read the full letter here. 

NCUIH Releases New Toolkit to Help Urban Indian Organizations Engage Members of Congress

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The National Council of Urban Indian Health (NCUIH) has released a new resource to support Urban Indian Organizations (UIOs) in strengthening relationships with policymakers: A How-To Toolkit for Inviting Members of Congress to Visit Your Urban Indian Organization. 

ACCESS THE RESOURCE

NCUIH Releases New Toolkit to Help Urban Indian Organizations Engage Members of CongressThis new toolkit provides step-by-step guidance for UIOs to invite and host Members of Congress, which provides an opportunity to showcase services provided to American Indian and Alaska Native (AI/AN) people living in urban areas, share community impact, raise awareness of urban Indian health needs, and highlight the importance of federal support for UIOs. 

Developed by NCUIH in collaboration with the Global Health Advocacy Incubator, the toolkit includes: 

  • Step-by-step instructions and best practices for scheduling a congressional visit.  
  • Template email language to help connect with congressional schedulers.  
  • Tips for highlighting the impact of UIOs and issues facing Native communities in urban areas.  

NCUIH October Policy News: Shutdown Impacts, Federal Updates, and Budget Formulation Prep

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In this Edition:

🧰 New Toolkit: NCUIH releases a step-by-step guide to help UIOs invite Members of Congress to visit their clinics.

⚠️ Government Shutdown: Congress fails to pass a Continuing Resolution; IHS operations continue through advance appropriations—IHS funding for UIOs is protected.

📢 Rapid Response: The Coalition for Tribal Sovereignty coordinated a joint letter to the Office of Management and Budget and an Action Alert for UIOs to advocate for Tribal-serving federal employees.

⚖️ Parity & Partnerships: Urban Indian Health Parity Act reintroduced; NCUIH urges bipartisan support.

🏥 Graduate Medical Pilot: VA launches PPGMER program—UIOs eligible; applications due Nov. 28.

🏛️ Federal Engagement: NCUIH meets with HHS Secretary Kennedy; STAC raises hiring freeze, staffing, and 340B concerns.

🧠 Behavioral Health: SAMHSA Native Connections grants released; NCUIH pushes for $30M funding increase in FY 2026.

🌾 Rural Health Transformation: CMS opens $50B RHTP funding for states; applications due Nov. 5.

📅 Event Updates: IHS UIO and Partner Summit postponed; NCUIH Congressional Briefing on SUD/Overdose prevention tentatively Oct. 27.

📊 FY 2028 Budget Formulation: Area consultations begin this month; NCUIH provides PowerPoint templates and TA for UIO participation.

FY 2028 Area Budget Formulation: Preparation and Tools

Why Participation Matters

  • Area consultations directly shape recommendations for national funding priorities. Each Area’s input helps determine the Urban Indian Health line item, which is averaged from regional proposals.

UIO engagement ensures that urban needs are accurately reflected in IHS budget planning.

How NCUIH is Supporting UIOs

  • Each UIO will receive an Area-specific PowerPoint template with highlighted sections to customize for your clinic and region.
  • NCUIH offers technical assistance and can help review slides or testimony before submission.

📅 Upcoming Area Consultations

  • Nashville: October 29 (Virtual)
  • Oklahoma City: November 5–6 (Hybrid)
  • Bemidji: November 18–19 (Wisconsin Dells, WI)
  • Phoenix: December 2–3 (Hybrid)
  • California: December 10
  • If your area is not listed, we have not received any information yet. Please let us know if you have heard an announcement for your area.

To schedule a prep session, contact policy@ncuih.org.

Appropriations and the Government Shutdown

When Congress failed to pass a continuing resolution by September 30, the federal government entered a shutdown.

  • IHS operations mainly continued thanks to advance appropriations.
  • On October 1, NCUIH convened a rapid response call with UIOs and issued a press release to Capitol Hill.
  • Together with CTS, NCUIH sent a letter to OMB requesting an exemption for federal employees serving Tribal Nations during any shutdowns.
  • A CTS Action Alert was shared with UIOs, including a template letter, talking points, and list of federally funded Tribal accounts.

New Resource: Toolkit on Inviting Members of Congress to Visit Your Urban Indian Organization

NCUIH released a new toolkit designed to help Urban Indian Organization (UIO) leaders invite members of Congress to visit their clinics.
The guide includes:

  • Step-by-step instructions and best practices for scheduling a congressional visit.
  • Template email language to help connect with congressional schedulers.
  • Tips for highlighting the impact of UIOs and issues facing Native communities in urban areas.

These visits serve as powerful opportunities to build relationships and raise awareness of Urban Indian health needs.

Legislative Updates

Urban Indian Health Parity Act (H.R. 4722) 

  • Reintroduced by Reps. Ruiz (CA-25) and Bacon (NE-02), this bipartisan bill would ensure UIOs receive parity in health program funding.

👉 Action for UIOs: Email Republican offices to sign on as co-sponsors.

New VA Pilot Program on Graduate Medical Education and Residency (PPGMER) – UIOs Eligible 

This new program supports physician rotations at IHS, Tribal, and UIO facilities.

NCUIH encourages UIOs to apply for eligibility under this program to strengthen urban Native clinical training capacity.

Federal Engagement: STAC and HHS Updates

At the HHS Secretary’s Tribal Advisory Committee (STAC) meeting (Sept. 23–25): 

  • NCUIH met with HHS Secretary Kennedy, advocating for continued support for Urban Indian health, the end of the federal hiring freeze and increased IHS staffing.
  • IHS reported over 1,000 vacancies since January, despite adding 70 Commissioned Corps officers.
  • STAC members requested:
  • A Native representative on the new HHS Healthcare Advisory Committee.
  • A Tribal exemption from HRSA’s 340B rebate pilot program.
  • Litigation continues to prevent HHS from implementing its proposed reorganization.

Grant and Funding Update

SAMHSA Native Connections Grant 

Several UIOs faced grant delays this year, prompting NCUIH to elevate the issue to HHS and provide STAC talking points.

  • All FY 2025 grants have now been released.

For FY 2026:

  • Senate proposal: Maintain current $23.67M level.
    House proposal: Increase funding to $30M.
  • NCUIH continues to advocate for the higher House amount.

SAMHSA leadership reaffirmed the program’s importance:

“This program is so impactful for Tribal communities.” — Arthur Kleinschmidt, SAMHSA Principal Deputy Assistant Secretary, Sept. 24

CMS Rural Health Transformation Program (RHTP)

  • On October 8, CMS held an All-Tribes webinar on the $50 Billion Rural Health Transformation Program under the One Big Beautiful Bill Act.
  • State applications due: November 5, 2025
  • The program aims to strengthen rural and Tribal health systems through innovative funding models.

Highlighted Action from the Coalition for Tribal Sovereignty

► Coalition for Tribal Sovereignty (CTS) 

CTS Action Alert to reach out to OMB and Members of Congress– shared with all UIOs​

  • Includes template letter, talking points, and a list of funded accounts with Tribal implications.

About CTS: The Coalition for Tribal Sovereignty (CTS) is a collaborative alliance that serves as a powerful unifying voice of regional and national inter-tribal policy-oriented, non-profit organizations to engage with federal policymakers on critical issues affecting the sovereign interests, rights, and authorities of Tribal Nations, tribal citizens, and community members across the United States.

Upcoming Events and Meetings

Postponed: IHS UIO and Partner Federal Agencies Summit

  • Originally planned for October 21–22, now postponed due to the shutdown.
  • The UIO Caucus (October 20) has also been canceled.
  • New dates will be announced once federal operations resume.

Upcoming Events 

  • November 3: NIHB MMPC meeting ahead of CMS Tribal Technical Advisory Group (TTAG)
  • November 12–13: CMS TTAG Quarterly Meeting (DC)
  • November 16–21: NCAI Annual Convention & Marketplace (Seattle, WA)
  • November 19: NCUIH Monthly Policy Workgroup (Virtual)

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.

Policy Alert: Advance Appropriations for Indian Health Services Proves Critical in Shutdown, Blanket Exceptions Needed to Protect All Tribal Programs

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On September 30, 2025, Congress failed to reach an agreement on the House-passed Continuing Resolution (CR) to maintain FY 2025 funding through November 21. This failure resulted in the expiration of government funding and the first shutdown in six years. A government shutdown halts most discretionary funding, forces widespread staff furloughs, and may trigger Reductions in Force (RIFs).

“Advance funding for the Indian Health Service is saving lives today. This Administration and Congress have committed to the fulfillment of trust and treaty responsibilities. We urge Congress and the Administration to extend exceptions to all of Indian Country to reduce any further impacts and protect our communities.” – Francys Crevier (Algonquin), CEO of NCUIH.

NCUIH Action

On September 29, 2025, NCUIH signed on to a letter by the Coalition for Tribal Sovereignty (CTS) to OMB Director Russell Vought  calling for an immediate directive to except all federal employees serving Tribal Nations, Tribal citizens, and Tribal communities from any shutdown-related furloughs or reductions in force. In addition to the letter, CTS provided Director Vought with a list of funded accounts essential to protecting health services, housing, and public safety in Indian Country.

NCUIH echoes this call, stressing the urgent need for a blanket exception for all programs serving Indian Country, particularly as reports emerge of HHS staff working on IHS-related programs being furloughed.

Impacts on Indian Country

Indian Health Service (IHS)

Fortunately, due to strong bipartisan support, the Indian Health Service (IHS) received advance appropriations for FY 2026, meaning IHS will continue to receive funding and all 14,801 IHS staff will be protected from furloughs. Urban Indian Organizations are covered under the advance appropriations. While most IHS operations will continue unimpacted, several IHS accounts do not receive advance appropriations. These include facilities construction, sanitation facilities construction, Contract Support Costs and 105(l) leases, the Indian Health Care Improvement Act Fund, and Electronic Health Records line item.

Health and Human Services (HHS)

The HHS Contingency Plan states that 32,460 employees (41%) will be furloughed, and HHS will cease all non-exempt and non-excepted activities.  HHS programs are critical for Urban Indian Organizations (UIOs) and Tribal organizations. While some programs are insulated because they do not rely on an October 1 funding cycle, HHS agencies cannot award new grants during a shutdown. In addition, existing grant management activities may be deemed non-essential, leading to delays in communication and possible disruptions in disbursements.

Next Steps

There is no clear indication of how long this shutdown will last. The Senate is expected to continue debating the House-passed CR through the weekend, while the House of Representatives is not expected to return until next week.

NCUIH will work with Tribal partners, federal agencies, and congressional allies to minimize the shutdown’s impact on American Indian and Alaska Native communities.

Past experience shows any disruption in funding in the Indian health system can have grave consequences. During the 2019 government shutdown, funding disruptions led to reduced services and facility closures, resulting in tragic consequences including loss of life due to opioid overdoses in some communities.

We urge policymakers to prioritize Tribal health and safety by ensuring that all Tribal-serving staff and programs are fully protected.

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

NCUIH Urges the Indian Health Service to Protect the Urban Health Line Item During the Agency’s Strategic Realignment

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On August 28, 2025, the National Council of Urban Indian Health (NCUIH) submitted written comments to the Indian Health Service (IHS) Acting Director, P. Benjamin Smith, regarding IHS’ June 13, 2025, Dear Tribal Leader and Urban Indian Organization (UIO) Leader letter (DTLL/DULL) and the July 28, 2025, virtual Urban Confer on the IHS Strategic Realignment. NCUIH recommended IHS protect the Urban Health line item and maintain a dedicated focus on urban Indian health.

Background on IHS Strategic Realignment

On June 13, 2025, IHS published a DTLL/DULL announcing IHS was initiating Tribal Consultation and Urban Confer to receive comments and recommendations regarding IHS’ Strategic Realignment.​ IHS described the goal of the Strategic Realignment as creating a “more accountable, efficient, and responsive IHS that maximizes resources and improves outcomes while simultaneously strengthening intergovernmental relationships for better service coordination and funding access.” ​​During the Urban Confer session on the Strategic Realignment, IHS shared the agency is still in the development phase. As part of the development phase, IHS was seeking feedback from relevant stakeholders, including Tribes and UIOs.

NCUIH’s Requests

Following the Urban Confer, NCUIH submitted the following requests and recommendations to IHS:

  • IHS should consider the following as part of the realignment:
    • Protect the Urban Health line item
    • Maintain a dedicated focus on urban Indian health
      • Maintain a dedicated branch of IHS for urban Indian health
      • Clarify the role of the 2023-2027 Office of Urban Indian Health Programs Strategic Plan
      • Strengthen funding streams for UIOs by advocating for 100% Federal Medical Assistance Percentage (FMAP) for UIOs
    • Ensure meaningful engagement with UIOs during the realignment process through additional Urban Confer sessions
    • Engage with the U.S. Department of Health and Human Services (HHS) to develop a Department Urban Confer policy
  • When evaluating what is working well and making adjustments that might be helpful, consider adjustments that benefit patient care:
    • Strengthening Area Offices’ relationships with Indian Health System facilities
    • Filling vacancies within IHS
  • Preserve IHS’ Tribal advisory groups

NCUIH will continue to closely follow the development and implementation of IHS’ Strategic Realignment.

NCUIH September Policy News: UIO Advocacy, Federal Updates, and Key Upcoming Dates

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In this Edition:

  • 💰 FY 2026 Labor HHS: House bill released; Indian Country program levels increase in several lines.
  • 🤝 Coalition Advocacy: CTS letter to OMB on Executive Order 14332 and Trust/Treaty obligations.
  • ⚖️ Parity & Stability: Urban Indian Health Parity Act reintroduced; bipartisan Advance Appropriations bill returns.
  • 🏥 OBBBA RHTF: CMS opens state NOFO; UIO eligibility clarified; AZ consultation proposes 10% set-aside.
  • 📑 AI/AN Medicaid Exemptions: CMS one-pager affirms protections and state implementation support.
  • 💉 Vaccines: CDC ACIP meets Sept. 18–19 (COVID-19, RSV, HepB, MMRV).
  • 🧠 Behavioral Health: Native Connections grant sustainability concerns from UIOs.
  • 💛 Diabetes Leadership: UIO representation at IHS Tribal Leaders Diabetes Committee.
  • 🔄 IHS Engagement: NCUIH comments on IHS strategic realignment and PATH EHR scope.
  • 📊 FY 2028 Budget Formulation: Area consultations anticipated to begin in November.
  • 📆 Save the Dates: UIO Focus Groups (Oct. 7–9), UIO Caucus (Oct. 20), IHS–UIO Federal Summit (Oct. 21–23), STAC/DSTAC (Sept. 22–26), NCUIH Policy Workgroup (Oct. 15).

National Tribal Health Conference 2025

National Indian Health Board Hosts NTHC
(Sept. 8–12, Phoenix, AZ)

NCUIH actively represented Urban Indian Organizations throughout the NIHB National Tribal Health Conference in Phoenix, Arizona, with multiple sessions, activities, and opportunities to spotlight UIO leadership.

Exhibit Hall Booth: Shared resources with attendees, including our Pew Behavioral Health toolkit, Hope for Life Day information, NCUIH 2026 Annual Conference Save the Dates, while engaging leaders and Tribal partners.

Federal Engagement: Met with Dr. Hartwig, the new Senior Advisor at the Indian Health Service, alongside Self-Governance Communication and Education Tribal Consortium and the National Indian Health Board.

Meredith Raimondi, Vice President of Policy and Communications, joined a panel on advocacy and messaging strategies, sharing NCUIH’s approach to advancing policy priorities and amplifying UIO perspectives in federal conversations.

Thank you to the National Indian Health Board (NIHB) for convening this year’s National Tribal Health Conference and to the Gila River Indian Community for hosting. Your partnership created a productive space for Tribal and Urban Indian Organization leaders and federal partners to advance shared priorities in Native health – in a good way.

Appropriations and Fiscal Policy Updates

Labor–Health and Human Services (LHHS) Bill – House Action

► FY 2026 HHS: $108B – $7B below FY25, $22B above President’s request, $8B below Senate proposal.
○ Does not fund the Administration for a Healthy America.
○ Make America Healthy Again Initiative: $100M (10% set-aside for Tribes, Tribal organizations, UIOs, and health service providers to Tribes serving rural communities).

  • This is a new funding line item that would allow the Secretary to invest in prevention innovation programs for rural communities and telehealth resources for chronic care and nutrition services. The Committee encourages the Secretary to support opportunities for advancing telemedicine tools and remote monitoring technologies at universities. This research should support studies on the efficacy of virtual care for managing chronic illnesses, development of AI-assisted telehealth platforms, and training programs for healthcare providers on integrating remote solutions into standard practice.

► Indian Country Programs: 
○ Good Health and Wellness in Indian Country: $30M (+$6M)
○ Improving Native American Cancer Outcomes: $14M (+$8M)
○ Minority HIV/AIDS Fund – Tribal Set Aside: $6M
○ Tribal Behavioral Health Grants (Native Connections): $30M (+$6.3M)

Next Steps: House and Senate leadership to reconcile final bill.

The House released their text for a Continuing Resolution

Timeframe: The CR will go from September 30 to November 21.
SDPI: Reauthorizes SDPI for the CR period and provides $22.7 million in funding.

Next steps: The House passed the bill on September 19. However, the Senate was unable to pass the bill. The Senate will need to come to an agreement by September 30 to prevent a government shutdown.

Federal Advocacy and Policy Updates

► One Big Beautiful Bill Act Implementation

  • CMS confirmed AI/AN exemptions from cost sharing, work requirements, and frequent eligibility redeterminations, and will provide guidance and TA to ensure proper implementation.
  • Sept. 15: CMS released a Notice of Funding Opportunity (NOFO) for States to apply for Rural Health Transformation Fund (RHTF).
  • UIOs considered CMS FQHCs (CMS definition differs from HRSA’s); UIO eligibility affirmed.
  • Aug. 19: NCUIH sent template letters to UIOs for state submissions to CMS.
  • Tribal Consultation in Arizona held Sept. 11; proposals included a 10% state set-aside for Indian Country.

Action: 1. Encourage your state to hold Tribal consultation and urban confer.

              2. Engage in Urban Confer/Tribal Consultation with your state on RHTF plans.

► Indian Programs Advance Appropriations Act

  • Reintroduced by Rep. Betty McCollum (D-MN), Rep. Tom Cole (R-OK), Sen. Mullin (R-OK), and Sen. Luján (D-NM).
  • Legislation would authorize advance appropriations to the Indian Health Service, Bureau of Indian Affairs, and Bureau of Indian Education to avoid funding lapses due to delays in enacting annual federal spending bills.

► Urban Indian Health Parity Act (H.R. 4722)

  • Reintroduced by Reps. Ruiz (CA-25) and Bacon (NE-02).
  • NCUIH is working to secure Republican co-sponsors.
  • Request for UIOs: Email Republican offices to sign on.

► American Indian and Alaska Native (AI/AN) Medicaid Exemptions

  • CMS confirms AI/AN exemptions from cost sharing, work requirements, and frequent eligibility redeterminations.
  • CMS will provide guidance and TA to ensure proper implementation.

Health & Behavioral Health Updates

► Vaccines

  • Sept. 18–19: Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) meeting — topics include COVID-19, respiratory syncytial virus (RSV), influenza, hepatitis B, and measles-mumps-rubella-varicella (MMRV).
  • AHIP (America’s Health Insurance Plans) reaffirmed that health plans will continue covering all ACIP-recommended immunizations as of September 1, 2025 — including updated COVID-19 and influenza vaccines — with no cost-sharing for patients through the end of 2026.
  • Questions for Urban Indian Organizations (UIOs): Are you administering COVID-19, RSV, and/or influenza vaccines? Which remain uncertain?

► SAMHSA Native Connections Grant

  • Several UIOs report grant funding ending, raising sustainability concerns.
  • NCUIH has engaged with HHS for clarity. The administration has directly requested the information below. Your responses are critical to protecting the program.
  • Questions for UIOs: Can you share measurable results and positive outcomes from this grant?

► Tribal Leaders Diabetes Committee Update

  • Sept. 16–17: NCUIH represented UIOs at IHS Tribal Leaders Diabetes Committee.
  • Adrianne Maddux [picture above alongside Chairman Rep.Jeff Hurd, CO-03] represented UIOs as the NCUIH representative.

Key Updates:

  • TLDC recommendation to IHS on Realignment: Conduct Tribal Consultation/Urban Confer once they have a finalized plan.
  • SDPI grantees can request supplemental funding for SDPI if their area has unobligated balances. Grantees can make one request per year only if the Tribe/UIO has spent down all of their funds. Grantees can with their area office on their request.

IHS Engagement & Consultations

► IHS Strategic Realignment – NCUIH Comments (Aug. 28)

  • Protect Urban Health line item.
  • Maintain dedicated IHS branch for urban Indian health.
  • Clarify role of 2023–2027 OUIHP Strategic Plan.
  • Advocate for 100% FMAP.
  • Hold additional Urban Confer sessions and develop HHS-wide Urban Confer policy.
  • Strengthen Area Office collaboration with IHS facilities.
  • Fill vacancies and preserve IHS Tribal advisory groups.

► PATH EHR Modernization – NCUIH Comments (Sept. 6)

  • Clarify mobile app capabilities.
  • Provide training periods before go-live to account for staff/time constraints.
  • Ensure PATH EHR capabilities include the ability to document social services provided at UIOs, including Traditional Healing and Medicine services

► FY 2028 Budget Formulation

  • Area budget formulation meetings for Fiscal Year 2028 are anticipated to begin in November.
  • UIO participation in Area Consultations is essential to secure urban line-item funding. NCUIH will share information on the Area Budget Formulation meetings and assist UIOs in preparing for their Area Consultations in October.
  • Action: Share consultation details with NCUIH at Policy@NCUIH.org.

Upcoming Summits and Meetings

► NCUIH UIO Caucus and Tacos

  • Oct. 20 | Indian Gaming Association, Washington, DC.
  • Please RSVP by October 14

► IHS UIO and Partner Federal Agencies Summit

  • Oct. 21–23 | HHS Humphrey Building (Room 800), Washington, DC.
  • Objectives: Introduce federal partners, share priorities, and explore collaboration.

►  NCUIH UIO Focus Groups

  • Oct. 7 | Full Ambulatory (1–2 p.m. ET), Outpatient/Residential (3–4 p.m. ET).
  • Oct. 8 | Limited Ambulatory (1–2 p.m. ET), Outreach/Referral (3–4 p.m. ET).
  • Oct. 9 | Make-Up Session (1–2 p.m. ET).
  • Topics: 2026 Policy Priorities, 2025 accomplishments/challenges, candid feedback.

►  Other Key Dates

  • September 18: Department of Urban Indian Affairs (DUIA) (Formerly OUIHP)-Urban Program Executive Directors/Chief Executive Officers Monthly Conference Call
  • Sept. 22–26: HHS Secretary’s Tribal Advisory Committee (STAC) and IHS Direct Service Tribes Advisory Committee (DSTAC) meetings (Martha’s Vineyard, MA)
  • September 30: Department of Justice (DOJ) Office of Violence Against Women (OVW) Task Force on Research on Violence Against American Indian and Alaska Native Women Meeting
  • Oct. 15: NCUIH Monthly Policy Workgroup (Virtual).

Federal Engagement Highlights

► Coalition for Tribal Sovereignty (CTS)

  • Aug. 28: Letter to OMB urging that implementation of EO 14332 (Improving Oversight of Federal Grantmaking) not undermine federal trust and treaty obligations.
  • CTS continues as a unifying voice of inter-tribal, policy-oriented organizations.
    [Resource: www.coalitionfortribalsovereignty.org]

About CTS: The Coalition for Tribal Sovereignty (CTS) is a collaborative alliance that serves as a powerful unifying voice of regional and national inter-tribal policy-oriented, non-profit organizations to engage with federal policymakers on critical issues affecting the sovereign interests, rights, and authorities of Tribal Nations, tribal citizens, and community members across the United States.

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.

House Appropriations Committee Advances Labor Health and Human Services Spending Bill, Increases Funding for Key Indian Country Programs

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On September 10, 2025, the House Appropriations Full Committee passed the Fiscal Year (FY) 2026 appropriations bill for Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). The bill includes $108 billion for the Department of Health and Human Services (HHS), which is $7 billion below FY 2025 levels and $14 billion above the President’s request. The committee notably provides $100 million for the Make America Health Again initiative, which includes a 10% set-aside for Tribes, Tribal organizations, urban Indian health organizations, and health service providers to Tribes serving rural communities.

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

Background

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

Next Steps

House Leadership will now work with Senate Leadership to develop the final LHHS appropriations spending bill. As a final appropriations bill is produced, NCUIH will continue to advocate to protect funding for Indian Country and maintain maximum funding levels.

Bill Highlights

Line Item FY 2025 Enacted FY 2026 President’s Budget Request FY 2026 Committee Passed
Health Resources and Services Administration $8.3 billion Fold into Administration for a Healthy America (AHA) $7.4 billion
Substance Abuse and Mental Health Services Administration $7.4 billion Fold into AHA $7.1 billion
National Institute of Health $48.6 billion $27.5 billion $47.8 billion
Centers for Disease Control $9.2 billion Fold into AHA $7.5 billion
Good Health and Wellness in Indian Country $24 million —————– $30 million
Improving Native American Cancer Outcomes $6 million —————– $14 million
Ryan White HIV/AIDS Program $2.57 billion $2.50 billion $2.04 billion
Ending the HIV Epidemic $165 million $165 million $165 million
Minority HIV/AIDS Fund $60 million Eliminated $20 million
Minority HIV/AIDS Fund – Tribal Set Aside $5 million ———— No less than $6 million
Tribal Behavioral Health Grants (Native Connections) $23.67 million Eliminated. Created a new behavioral health program under AHA $30 million

Additional Key Provisions:

Office of the Secretary

Make America Healthy Again Initiative: $100,000,000 (10% set-aside for Tribes, Tribal organizations, urban Indian health organizations, and health service providers to Tribes serving rural communities).

Bill Report pg. 203: The Committee includes $100,000,000 for the Secretary’s Make America Healthy Again (MAHA) initiative. This funding will allow the Secretary to invest in prevention innovation programs for rural communities as proposed in the fiscal year 2026 budget request. Within the funding provided for this suite of innovation programs, the Committee includes a 10 percent set-aside for Tribes, Tribal organizations, urban Indian health organizations, and health service providers to Tribes serving rural communities. This funding is also available for the Secretary to invest in telehealth resources for chronic care and nutrition services, as proposed in the fiscal year 2026 budget request. Within such funding, the Committee encourages the Secretary to support opportunities for advancing telemedicine tools and remote monitoring technologies at universities. This research should support studies on the efficacy of virtual care for managing chronic illnesses, development of AI-assisted telehealth platforms, and training programs for healthcare providers on integrating remote solutions into standard practice.

Health Resources and Services Administration

Federal Office of Rural Health Policy: $515 million

Bill report pg. 50: The Committee provides $ 515,407,000for Rural Health programs.

  • This represents an increase of $150 million above the FY 2025 enacted level.

Native Hawaiian Health Care Program: $27 million

Bill report pg. 32: The Committee continues $27,000,000 for the Native Hawaiian Health Care Program. Of the total amount appropriated for the Native Hawaiian Health Care Program, not less than $10,000,000 shall be provided to Papa Ola Lokahi for administrative purposes authorized under 42 U.S.C. 11706, including expanded research and surveillance related to the health status of Native Hawaiians and strengthening the capacity of the Native Hawaiian Health Care Systems.

National Health Service Corps: $130 million (15% Tribal set-aside)

Bill Report pg. 39: The Committee includes $130,000,000, for the National Health Service Corps (NHSC) to support competitive awards to health care providers dedicated to working in underserved communities in urban, rural, and Tribal areas.

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

Centers for Disease Control and Prevention

Good Health and Wellness in Indian Country: $30 million (bill report pg. 68).

Office of the Secretary – General Departmental Management

Minority HIV/AIDS Fund: $20 million

Bill report pg. 211: The Committee includes $20,000,000 for the Secretary’s Minority HIV/AIDS Fund (MHAF). Tribal Set-Aside.—The Committee notes that according to the CDC, HIV-positive status among Native Americans is increasing and nearly one-in-five HIV-positive Native Americans is unaware of their status. In addition, only three-in-five receive care and less than half are virally suppressed. To increase access to HIV/AIDS testing, prevention, and treatment, the Committee reserves no less than $6,000,000 as a Tribal set-aside within the MHAF.

Substance Abuse and Mental Health Services Administration

Eating Disorders: $5 million

Bill report pg. 146: The Committee provides $5,000,000 to improve the availability of health care providers to respond to the needs of individuals with eating disorders including the work of the National Center of Excellence for Eating Disorders to increase engagement with primary care providers, including pediatricians, to provide specialized advice and consultation related to the screening and treatment of eating disorders. The Committee encourages SAMHSA to conduct a public service announcement with the purpose of raising awareness about identifying, preventing, and treating eating disorders.

Substance Abuse Prevention Services: $205 million

Bill report pg: 152: The recommendation represents a $32 million reduction from the FY25 enacted level.

Tribal Behavioral Grants (Native Connections): $28 million

Bill report pg. 145: The Committee provides $30,000,000, which is a $7,250,000 increase above the fiscal year 2025 enacted program level, to prevent and reduce suicidal behavior and substance use, reduce the impact of trauma, and promote mental health among AI/AN youth, through age 24.

Zero Suicide: $23.8million

American Indian and Alaska Native Set Aside: $4.4 million

Mental Health Services Block Grant: $1.02 billion

Bill report pg. 141: The Committee provides $1,017,571,000 for the MHBG, which is $10,000,000 above the fiscal year 2025 enacted program level. Of the funds provided, $21,039,000 shall be derived from evaluation set-aside funds available under section 241 of the PHS Act. The MHBG provides funds to States to support mental illness prevention, treatment, and rehabilitation services. Funds are allocated according to a statutory formula among the States that have submitted approved annual plans. The Committee continues the 10 percent set-aside within the MHBG for evidence-based programs that address the needs of individuals with early serious mental illness, including psychotic disorders among at-risk youth and young adults, and the 5 percent set-aside for crisis-based services. The Committee notes that, consistent with State plans, communities may choose to direct additional funding to crisis stabilization programs.

988 Suicide & Crisis Lifeline: $520 million

Bill report pg. 139: — The Committee provides $519,618,000 for the 988 Suicide & Crisis Lifeline, which is the same as the fiscal year 2025 enacted program level, to support the national suicide hotline to continue to support State and local suicide prevention call centers as well as a national network of backup call centers and the national coordination of such centers.

Substance Use Prevention, Treatment, and Recovery Services Block Grant: $2 billion

Bill report pg. 148: The Committee includes $2,013,079,000 for the SUPTRS Block Grant, which is a $5,000,000 increase above the fiscal year 2025 enacted program level.

State Opioid Response Grants: $1.6 billion

Bill report pg. 147: The Committee includes $1,575,000,000 for State Opioid Response (SOR) grants, which is the same as the fiscal year 2025 enacted program level. The Committee supports efforts from SAMHSA through SOR grants to expand access to substance use disorder treatments in rural and underserved communities, including through funding and technical assistance. Within the amount provided, the Committee includes a set-aside for Indian Tribes and Tribal organizations of not less than 5 percent.

National Institute on Minority Health and Health Disparities

Improving Native American Cancer Outcomes: $14 million

Bill report pg. 118: The Committee continues to be concerned that Native Americans experience overall cancer incidence and mortality rates that are strikingly higher than non-Native populations. The Committee includes $14,000,000, which is an increase of $8,000,000 above the fiscal year 2024 enacted level, to continue the Initiative for Improving Native American Cancer Outcomes to support efforts including research, education, outreach, and clinical access related to cancer in Native American populations. The Committee further directs NIMHD to work with NCI to continue support for the current grantees

Native Hawaiian/Pacific Islander Health Research Office: $6 million

Bill report pg. 119: —The Committee provides $6,000,000, which is an increase of $2,000,000 above the fiscal year 2024 enacted level, for the Native Hawaiian/ Pacific Islander Health Research Office (NHPIHRO) with a focus on both addressing Native Hawaiian and Pacific Islander (NHPI) health disparities, as well as supporting the pathway and research of NHPI investigators. The Committee encourages NHPIHRO to develop partnerships with academic institutions with a proven track record of working closely with NHPI communities and NHPI-serving organizations located in States with significant NHPI populations to support the development of future researchers from these same communities.

Important Behavioral and Mental Health Provisions

Medication-Assisted Treatment for Prescription Drug and Opioid Addiction Tribal Set Aside: $20 million

Peer-Support Specialists: $15 million

Bill report pg. 42: The Committee supports community based experiential training for students preparing to become peer support specialists and other types of behavioral health-related paraprofessionals. The Committee includes a $1,000,000 increase for this activity.

Infant and Early Childhood Mental Health Program: $15 million

Bill report pg. 143: The Committee provides $15,000,000 for the Infant and Early Childhood Mental Health program, which is the same as the fiscal year 2025 enacted program level, to support human service agencies and nonprofit organizations that provide age-appropriate mental health promotion and early intervention or treatment for children with significant risk of developing mental illness including through direct services, assessments, and trainings for clinicians and education providers.

Administration for Community Living

Native American Caregiver Support Program: $14 million

Bill report pg. 181: The Committee provides $14,000,000 for the Native American Caregivers Support program, which is a $2,000,000 increase above the fiscal year 2025 enacted program level. This program provides formula grants to Tribes for the support of American Indian, Alaskan Native, and Native Hawaiian families caring for older relatives with chronic illness or disabilities

NCUIH, NIHB, and 19 Organizations Call on Congress to Safeguard Maternal and Child Health Programs for Native Families from FY 2026 Budget Cuts

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On July 24, 2025, NCUIH joined the National Indian Health Board and 19 organizations who serve American Indian and Alaska Native (AI/AN) families, mothers, and infants across Indian Country in sending a letter to House and Senate leadership urging Congress to protect investments for AI/AN families in fiscal year (FY) 2026.

The President’s proposed FY 2026 budget includes a new agency, the Administration for Healthy America (AHA) that would consolidate programming across Substance Abuse and Mental Health Administration (SAMHSA), Health Resources and Services Administration (HRSA), and other agencies, and shift transfers several programs to the new agency as part of its HHS reorganization. The proposal would reduce funding for HRSA Maternal and Child Health (MCH) Block Grants and maintain funding for Head Start, while eliminating $274 million in maternal and child health programs across the Department of Health and Human Services (HHS) that AI/AN communities rely on. Several successful programs that are slated for elimination are:

  • Administration for Children and Families (ACF) Low-Income Home Energy Assistance Program (LIHEAP)
  • Centers for Disease Control and Prevention (CDC) Maternal and Infant branch, including initiatives like the Safe Motherhood & Infant Health program which funds the Hear Her Campaign, Pregnancy Risk Assessment Monitoring System (PRAMS), and Adverse Childhood Experiences (ACES) 
  • HRSA Healthy Start program

Senate Labor-HHS Bill Maintains Funding for Programs Cited in Letter 

On July 31, 2025, the Senate Appropriations Full Committee passed their FY 2026 appropriations bill for Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS), and notably did not fund the AHA. The Senate bill does not eliminate LIHEAP, Healthy Start, or the Safe Motherhood & Infant Health program. The bill proposed funding for Head Start at $12.36 billion, and proposed funding for HRSA Maternal and Child Health Block Grants for FY2026 at $799 million, $32.7 million above the President’s request and $14 million below the FY 2025 enacted amount.

The House has not yet released their Labor-HHS appropriations bill, which is expected to be released in September.

  • Read NCUIH’s analysis of the Senate Labor-HHS bill here.

Full Letter Text

Dear Speaker Johnson, Leader Thune, Leader Schumer, and Leader Jeffries:

On behalf of the undersigned organizations who serve American Indian and Alaska Native (AI/AN) families, mothers, and infants across Indian Country, we write to express deep concern regarding the proposed budget reductions to critical divisions and departments within the Department of Health and Human Services (HHS), as outlined in the Fiscal Year (FY) 2026 Budget Proposal. We are greatly appreciative of both the Administration and the House Appropriations Subcommittee on the Interior, Environment, and Related Agencies for proposing increases to the Indian Health Service (IHS) budget. However, the IHS is only one agency of many within HHS that discharge the federal government’s trust obligation to provide for the healthcare of Indians. The proposed FY 2026 budget will eliminate $274 million across multiple maternal and child health programs1 that AI/AN communities have come to rely on. We respectfully urge Congress to protect investments for AI/AN families to support the health of current and future generations.

Tribal Nations hold a unique political government-to-government relationship with the United States, carried out through the federal government’s trust and treaty obligations which are carried out, in part, through a series of federal statutory mandates and programming to AI/AN citizens. This includes set-asides, program funding, and the federal personnel necessary to administer Tribal programs. These are legal obligations rooted in treaties, trust obligations, the U.S. Constitution, and federal statutes.

Despite operating with minimal federal resources, Tribal and Native-led programs continue to provide culturally-responsive care to AI/AN families. AI/AN communities remain chronically underserved, contributing to AI/AN women being three times more likely to die from pregnancy- related causes than non-Hispanic white (NHW) women2 and AI/AN infants facing mortality rates twice as high as NHW infants.3 These unacceptable disparities reflect longstanding underinvestment in maternal and child health for Tribal communities.

The proposed FY26 reorganization under the new Administration for a Healthy America (AHA) will centralize oversight of most maternal health programs. However, it is alarming that several successful programs are slated for elimination under the Administration for Children and Families (ACF), Centers for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA). These programs include the ACF Low-Income Home Energy Assistance Program (LIHEAP), the CDC Maternal and Infant branch, and HRSA’s Healthy Start. These vital programs are often lifesaving, and their removal will severely impact AI/AN family health outcomes.

While AHA will oversee the administration of the Maternal, Infant and Early Childhood Home Visiting (MIECHV) program, funding for the Maternal and Child Health (MCH) Block Grants will be reduced by $46.45 million compared to FY25. Currently, Tribes do not receive MCH Block Grants funding directly, but instead must rely on states to distribute these resources. While AHA supports state authority in administering these funds, Tribal Nations, recognized as sovereign governments, should also have the authority to directly access MCH funding through a dedicated Tribal set-aside. This direct access would greatly benefit AI/AN populations by expanding access to culturally appropriate programming targeted to improve health outcomes. Potential cuts to these vital programs would significantly impact Indian Country’s ability to deliver culturally-appropriate services and conduct culturally responsive research. Such reductions represent a harmful divestment from the limited resources that support the health and well-being of Tribal families. Consolidating or eliminating these programs would jeopardize critical infrastructure that Tribal Nations rely on.

Administration for Children and Families (ACF): The consolidation of ACF will dismantle critical programs like LIHEAP and flat line funding for Head Start. In FY25, LIHEAP block grants were funded at $400,025,000 while Head Start was funded at $12.2 billion. The loss and reduction of these funds will undoubtedly leave a gap in local programming and services, often provided in rural and remote areas.

LIHEAP ensures Tribal families have access to heating, cooling, and electricity, resources that are increasingly urgent for rising energy costs and inflation. In many cases, LIHEAP offsets household costs to ensure other basic needs such as food and medications are met. LIHEAP is a safety net for millions of families and the elimination of funding will undoubtedly harm low- income households.

The Budget Justification proposes funding Head Start at FY25 funding levels with a $356.8 million set-aside for AI/AN Head Start and we are thankful to see the Secretary’s preservation of these funds. However, the Justification itself states that Head Start is expected to fund 21,789 fewer slots for children and 7,591 Head Start staff. Many Tribal governments supplement funding gaps within their Head Start programs, but without a funding increase Tribal resources will be exhausted. AI/AN Head Start programs cannot afford to stretch their existing funds further than they already do. The failure to increase appropriations for Head Start would further exacerbate the lack of early education programming available for rural and remote AI/AN communities. We respectfully request an increase in appropriations for Head Start FY26 and beyond.

We would also like to bring to your attention HHS’s intent to reform principles guiding the modernization of the Head Start program for the 21st century. We request your support in seeking additional information from the Administration regarding the potential impact of these proposed reforms impact on AI/AN Head Start programs. We also urge you to direct HHS to conduct formal Tribal consultation on these proposed reforms. Any proposed reforms affecting AI/AN Head Start programs must respect Tribal sovereignty and preserve the current structure of direct federal funding to AI/AN Head Start agencies without state involvement or interference.

These programs serve as an extension of federal obligations and must be maintained and increased under the Administration for Children, Families, and Communities (ACFC) or AHA. Any proposed reforms must respect the unique needs of and sovereignty of Tribal Nations.

Centers for Disease Control and Prevention (CDC): At CDC, the proposed reorganization would eliminate numerous maternal and child health initiatives, including the Safe Motherhood and Infant Health program, funded at $108 million in FY23, which includes the Hear Her campaign; the Pregnancy Risk Assessment Monitoring System (PRAMS); and the Adverse Childhood Experiences (ACES).

The Hear Her campaign was one of the only federal programs that directly invested in culturally appropriate models that fit the needs of Indian Country. This program built trusting relationships with our people, which have been setback by this rushed reorganization. Moreover, the termination of PRAMS will significantly undermine AI/AN data collection and analysis. PRAMS remains one of the few national tools available to track maternal and infant health disparities in AI/AN populations. Without it, federal and Tribal health agencies will lose a vital tool for identifying risks, informing interventions, and saving lives.

Recent reductions in force (RIFs) have included the dismissal of staff from the Reproductive Health Division and Hear Her campaign, both of which are essential to supporting maternal and child health in Tribal communities. We have also received reports of the Healthy Native Babies Project consultants being terminated, which has abruptly halted access to culturally tailored resources available for pregnant women, families, and healthcare professionals. Eliminating these programs are not the solution for improving maternal and child health in Indian Country.

In the interest of honoring the federal government’s trust and treaty obligations, we respectfully call on your leadership to maintain investments that ensure the health of our current and future generations.

Health Resources Services and Administration (HRSA): The proposed reduction of HRSA, to other divisions will significantly endanger AI/AN maternal and child health services across Indian Country. Tribal communities heavily rely on the Maternal and Child Health Block Grant and Healthy Start.

The Maternal and Child Health Block Grant is proposed to receive $767.3 million in funding, representing a $46.45 million decrease from FY24 and FY25. The reorganization provides an opportunity to establish a dedicated Tribal set-aside within the Maternal and Child Health Block Grant. Currently, states receive funding through a formula- based allocation which includes AI/AN individuals, but those dollars do not always flow to the Tribe to support the programs for that population. We strongly recommend the creation of a Tribal set-aside within the Maternal and Child Health Block Grant to improve health outcomes for AI/AN women, children, and families.

In FY25, the Healthy Start initiative received $45.5 million. Healthy Start is only authorized through FY 2025, but its full elimination would be catastrophic. Healthy Start is designed to improve health outcomes during pregnancy and the postpartum period, reduce infant mortality, and mitigate adverse perinatal outcomes. In 2022 alone, Healthy Start reached 85,000 participants. The Healthy Start program supports high-risk pregnant individuals through home visiting services, health education, case management, and linkages to prenatal and pediatric care—all tailored to the specific needs of Tribal communities. Without HRSA and Healthy Start, the maternal and child health crisis will worsen in Indian Country.

Conclusion 

To ensure that the federal trust responsibility is not impeded by the HHS reorganization efforts, we respectfully request your leadership protecting funding for our Tribal Nations and AI/AN families. Improving maternal and child health outcomes for AI/AN communities requires more than programmatic support, it requires meaningful policy change from Congress.

Congress must act to strengthen Native maternal and child health by strengthening funding for programs Native moms and children rely on and creating legislation that recognizes Tribal sovereignty and ensures sustained, direct funding for Tribes, Tribal organizations, and urban Indian organizations. We urge Congress to include dedicated provisions for AI/AN maternal and child health in any forthcoming legislation to fulfill its trust and treaty obligations.

Sincerely, 

National Indian Child Welfare Association
National Indian Head Start Directors Association
National Indian Health Board
National Council on Urban Indian Health
National Hispanic Council on Aging
Native Organizers Alliance
Native American Women’s Dialog on Infant Mortality
Navajo Maternal and Child Health Project
United South and Eastern Tribes Sovereignty Protection Fund
California Rural Indian Health Board
Albuquerque Area Indian Health Board, Inc.
American Indian Health Commission
Seattle Indian Health Board
Sacred Bundle Birthwork
Xa?Xa? Indigenous Birth Justice
Hummingbird Indigenous Family Services
What to Expect Project
Chamber of Mothers
Yellowtail Lactation Consultants
Encoded 4 Story
Indigena Consulting