NCUIH April Policy Update: 2026-27 Policy Priorities, FY 2027 President’s Budget Update, Medicaid and 340B, and IHS Policy Developments

April 22, 2026/in Policy Blog/by NCUIH

In this Edition:

📋 NCUIH Released 2026-2027 Policy Priorities
📊 FY 2027 President’s Budget: Proposes Increase for Indian Health Service, Advance Appropriations for FY 2028
🤝 60 Bipartisan Representatives Sign Letter Supporting IHS and Urban Indian Health Funding
💰 HRSA 340B Rebate Pilot Program: NCUIH and TTAG Support for IHCP Exemption
📋 FMAP Updates for Urban Indian Organizations
💻 NCUIH Comments on IHS Health IT Modernization PATH Activities
🌾 Rural Health Transformation Fund: NCUIH Requests UIO Input
📅 Upcoming Policy Events, Deadlines, and Opportunities
🎉 Join Us April 27–30 for the 2026 NCUIH Annual Conference

NCUIH Released 2026-2027 Policy Priorities

NCUIH has released its 2026-2027 Policy Priorities, which outlines a summary of urban Indian organization (UIO) federal priorities:

Increasing Funding for IHS and the Urban Indian Health Line Item
Establishing Permanent Full (100%) Federal Medical Assistance Percentage (FMAP) for Medicaid Services at UIOs
Increasing Behavioral Health Funding
Stability in Federal Grants
Health Information Technology and Electronic Health Record Improvement

Read the full priorities.

President Releases FY 2027 Budget with Proposed Increase for IHS, Congress Requests Protection of IHS Funding

On April 3, 2026, the President released the full Fiscal Year (FY) 2027 Department of Health and Human Services Budget In Brief and the Indian Health Service (IHS) Congressional Justification. The budget prioritizes funding for IHS by proposing $9.1 billion for the Indian Health Service — an increase of more than $1 billion above FY 2026 enacted levels. It also includes:

Advance Appropriations for IHS for FY 2028: $5.6B
Read more on NCUIH’s blog.

60 Bipartisan Representatives Sign Letter Supporting IHS and Urban Indian Health Funding

In a significant show of bipartisan support, 60 Members of Congress signed a dear-colleague letter urging the protection of IHS funding and increased resources for Urban Indian Health. NCUIH supporting this effort which included requests for $106 million for Urban Indian Health, maintaining Advance Appropriations for IHS, and protecting IHS from sequestration.

Health Resources and Services Administration 340B Rebate Pilot Program Updates – NCUIH Support for Indian Health Care Provider Exemption

The Health Resources & Services Administration (HRSA) is seeking information on potential implementation of a 340B Rebate Model Pilot Program rebate pilot program, which poses administrative and financial burdens for Indian Health Care Providers (IHCPs), including Urban Indian Organizations.

NCUIH and the Centers for Medicare and Medicaid Services (CMS) Tribal Technical Advisory Group (TTAG) are supporting an exemption for IHCPs from the 340B rebate pilot program and requesting tribal consultation and urban confer.

Comments to HRSA are due April 20, 2026. Submission information can be found here.

HRSA Visit to NATIVE HEALTH in Arizona

NCUIH’s CEO participated in a HRSA visit to NATIVE HEALTH on April 9, providing an opportunity to highlight the impact of 340B on Urban Indian clinics directly to HRSA leadership. The visit included Tom Engels, HRSA Administrator; Mark Cruz, Senior Advisor to U.S. Department of Health and Human Services Secretary Kennedy; Francys Crevier, NCUIH CEO, as well as Jack Ganter, HRSA Director of Legislation and Devin Delrow, Principal Advisor for Tribal Affairs, U.S. Department of Health and Human Services.

Federal Updates: 100% FMAP for UIOs and Traditional Healing Reimbursement

FMAP Support at CMS TTAG Meeting

Federal Medical Assistance Percentage (FMAP) policy continues to be a critical issue for UIOs. Updates include:

NCUIH Board President Walter Murillo, who serves as the NCUIH representative on the CMS TTAG, raised the need of 100% Federal Medical Assistance Percentage for UIOs, specifically for Traditional Healing services reimbursement, to CMS leadership during the the March 24-25 CMS TTAG quarterly meeting.

Read more on NCUIH’s Policy Resource Center.

NCUIH Submitted Comments on IHS Health IT Modernization PATH Activities

On April 4, 2026, NCUIH submitted written comments to IHS in response to the March 5 Health IT Modernization Tribal Consultation/Urban Confer on Patients at the Heart (PATH) Electronic Health Record (EHR) activities.

NCUIH recommended that IHS ensure cohort selection equally prioritizes all facility types and provide UIOs with clear guidance on PATH EHR implementation.

NCUIH is Requesting UIO Input on Rural Health Transformation Fund Awards

On December 29, 2025, the Centers for Medicare & Medicaid Services (CMS) awarded all 50 states funding through the Rural Health Transformation Fund (RHTF). Read more about this funding on NCUIH’s blog.

Request for UIOs:

Let NCUIH know if your UIO receives RHTF funding. Contact: policy@ncuih.org

2026 NCUIH Annual Conference

April 27–30, 2026, in Washington, D.C., as NCUIH marks the 50th anniversary of the Indian Health Care Improvement Act (IHCIA)—a landmark commitment to the health and well-being of American Indians and Alaska Natives—and reflects on five decades of progress, collaboration, and continued commitment to Native health.

Registration has closed.

Notable sessions include:

IHS Listening Session — An opportunity for UIOs to engage directly with IHS leadership on policy priorities.

NCUIH Annual Conference 2026 Website

Upcoming Events and Policy Dates

April 21-22 — HHS Annual Tribal Budget Consultation (Washington, DC)
April 27–30, 2026 — 2026 NCUIH Annual Conference (Washington, D.C.)
May 20 — NCUIH Monthly Policy Workgroup (virtual)

Recent NCUIH Policy Blogs

President’s Budget Proposes Increase for Indian Health Service, Advance Appropriations for FY 2028
April 3, 2026/in Policy Blog/by NCUIH
NCUIH Recognized at IHS 70th Anniversary Tribal Summit for Exceptional Partnership
March 28, 2026/in Policy Blog/by River Carroll
Tribal Leaders Recommend Increased Urban Indian Health Funding for Fiscal Year 2028
March 25, 2026/in Policy Blog/by Alex Sampson

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 Requests the Indian Health Service Strengthen Relationships with Area Offices Under the Proposed Realignment

April 22, 2026/in Policy Blog/by Alex Sampson

On February 27, 2026, the National Council of Urban Indian Health (NCUIH) submitted written comments to the Indian Health Service (IHS) Chief of Staff, Clayton Fulton, regarding IHS’ November 13, 2025, and December 5, 2025, Dear Tribal Leader and Urban Indian Organization (UIO) Leader letters (DTLLs/DULLs) and January 15, 2026, virtual Urban Confer on the IHS Proposed Realignment.

In the written comments, NCUIH recommended IHS strengthen UIOs’ relationships with Area Offices as part of the Proposed Realignment, and emphasized the importance of protecting UIO contracts, addressing IHS staffing needs, and ensuring continued engagement with UIOs, while also highlighting the importance of 100% Federal Medical Assistance Percentage (FMAP) for UIOs.

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

Background on the IHS Proposed 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’ Proposed Realignment. IHS described the goal of the Proposed 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 Proposed 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.

On November 13, 2025, IHS’ then-Acting Director, Ben Smith, published a DTLL/DULL announcing the next phase in the Agency’s proposed realignment which would include four in-person Tribal Consultation sessions and one virtual Urban Confer session. On December 5, 2025, the IHS Chief of Staff released a DTLL/DULL in response to requests for additional opportunities and added more in-person sessions and a virtual Tribal Consultation. IHS also released a realignment narrative, a draft re-organization chart, and a frequently asked questions document. During the second Urban Confer on the Proposed Realignment, IHS reiterated that no decisions had been made by IHS regarding the Proposed Realignment.

IHS also created a webpage on IHS’ website on the Proposed Realignment.

Next Steps

While the path forward is subject to change, IHS shared the Agency plans to have a Federal Register comment period (30 days) followed by a Federal Register notice with a “Transition to Future State” occurring between May and June of 2026. IHS stated that the Agency plans to continue to use Tribal Consultation and Urban Confer to keep Tribes and UIOs up to date on the Proposed Realignment.

NCUIH Engages Federal Leaders on Urban Indian Health at NATIVE HEALTH Site Visit in Arizona

April 16, 2026/in Policy Blog/by River Carroll

On April 9, 2026, Walter Murillo (Choctaw), Board President of National Council of Urban Indian Health and CEO of NATIVE HEALTH, welcomed a distinguished group of federal leaders to NATIVE HEALTH’s Arizona facility for a site visit showcasing the important role of Urban Indian Organizations (UIOs) in delivering care to Native communities. NATIVE Health is one of 11 HRSA-funded UIOs serving Native communities across the country.

The delegation included Tom Engels, Health Resources and Services Administration (HRSA) Administrator; Mark Cruz, Senior Advisor to HHS Secretary Kennedy; Jack Ganter, HRSA Director of Legislation; and Devin Delrow, Principal Advisor for Tribal Affairs, U.S. Department of Health and Human Services. NCUIH CEO, Francys Crevier (Algonquin), joined the visit, ensuring NCUIH had a direct voice in conversations with federal decision-makers.

During the visit, leaders toured the facility, engaged with staff, and witnessed firsthand how UIOs provide culturally responsive care in urban settings. NCUIH used the occasion to elevate a top priority: securing an exemption for Tribal and Urban Indian facilities from HRSA’s 340B Rebate Model Pilot. The 340B drug pricing program is essential to UIO operations, enabling facilities like NATIVE HEALTH to extend limited resources and broaden access to care for American Indian and Alaska Native patients.

NCUIH also reinforced the distinct legal and operational framework within which UIOs function — a framework that federal policy must account for. Engagements like this are critical to ensuring Native voices are part of federal decision-making and that agency leadership understands the on-the-ground realities of urban Indian health programs.

NCUIH will continue pursuing direct engagement with HRSA and HHS leadership to protect and advance UIO priorities.

Background

The 340B Drug Pricing Program allows qualifying safety-net providers, including UIOs, to purchase outpatient drugs at significantly reduced costs. These savings are reinvested to expand services and improve health outcomes for underserved populations. HRSA’s proposed 340B Rebate Model Pilot has raised concerns across the UIO community, as it could undermine the financial sustainability of programs that American Indian and Alaska Native communities in urban areas depend on. NCUIH has consistently worked to protect Tribal and Urban Indian facilities from harmful changes to the 340B program.

President’s Budget Proposes Increase for Indian Health Service, Advance Appropriations for FY 2028

April 3, 2026/in Policy Blog/by NCUIH

On April 3, 2026, the President released the full Fiscal Year (FY) 2027 Department of Health and Human Services Budget In Brief and the Indian Health Service (IHS) Congressional Justification. The budget prioritizes funding for IHS by proposing $9.1 billion for the Indian Health Service — an increase of more than $1 billion above FY 2026 enacted levels. Notably, the budget also requests $5.6 billion in advance appropriations for FY 2028, ensuring continuity of care for IHS, Tribal, and urban Indian health programs regardless of disruptions in the annual appropriations process.

The budget states that advance appropriations provide IHS with “predictable, stable funding that allows facilities to maintain operations, retain staff, and plan effectively across fiscal years.” Importantly, the budget also reflects direct Tribal input, stating that it “incorporates top tribal budget recommendations and invests in systems that enable Tribes to manage their own health programs effectively.” This commitment reflects the Administration’s recognition that funding stability and Indian Country partnership are essential to the success of the Indian health system.

Advance appropriations for IHS proved critical during the 2025 government shutdown, when IHS and urban Indian health programs were able to maintain operations and protect services for patients. Maintaining advance appropriations will help ensure the Indian health system continues to be protected from future funding disruptions.

Next Steps

The FY 2027 proposal serves as a statement of the Administration’s policy and funding priorities. The budget acts primarily as a symbolic blueprint of the President’s vision for the size and scope of the federal government. The final appropriations will be determined through the Congressional budget process. The House and Senate Appropriations Committees are currently crafting their respective FY 2027 funding bills.

NCUIH has stood alongside Tribes, Urban Indian Organizations, and the community to advocate for stable and secure resources for the Indian health system. NCUIH will continue to engage with lawmakers to ensure the Indian health system and all Tribal programs receive the resources they need. NCUIH encourages Tribal leaders and Urban Indian Organizations to share their priorities as the Congressional process moves forward.

A more detailed NCUIH analysis of the budget will be released next week.

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, Vice President of Policy and Communications, mraimondi@ncuih.org

NCUIH Recognized at IHS 70th Anniversary Tribal Summit for Exceptional Partnership

March 28, 2026/in Policy Blog/by River Carroll

WASHINGTON, D.C. (March 30, 2026) – During the Indian Health Service (IHS) 70th Anniversary Tribal Summit on February 13, 2026, the National Council of Urban Indian Health (NCUIH) was recognized as one of four exceptional partners whose leadership, advocacy, and collaboration strengthen the Indian health system.

“The success of the Indian health system depends on the strong, interwoven relationship between the IHS, Tribal governments, and urban Indian organizations.” — the Indian Health Service

Clayton Fulton (Cherokee) Chief of Staff for IHS and Walter Murillo (Choctaw), NCUIH Board President and Native Health CEO

Walter Murillo (Choctaw), NCUIH Board President and Chief Executive Officer of Native Health in Phoenix, accepted the recognition on behalf of NCUIH. The recognition highlights the vital role of NCUIH’s work with urban Indian organizations within the broader Indian health system and affirms the importance of strong partnerships between IHS, Tribal governments, and urban Indian organizations. As IHS marks 70 years of service, this recognition reflects both progress and the ongoing responsibility to support Native health systems that are responsive, coordinated, and rooted in community priorities.

NCUIH remains committed to advancing policies and partnerships that improve health outcomes and strengthen care for all Native people nationwide.

Tribal Leaders Recommend Increased Urban Indian Health Funding for Fiscal Year 2028

March 25, 2026/in Policy Blog/by Alex Sampson

On January 21-22, 2026, the Indian Health Service (IHS) held their Area Report Presentations Webinar for Fiscal Year (FY) 2028 where Tribal leaders from all 12 IHS Areas and leaders from Native organizations, including the National Council of Urban Indian Health (NCUIH), presented on their budget requests. Following the FY 2028 Area Report Presentations, Tribal leaders and organizations convened for the National Tribal Budget Formulation Work session from February 10–12.

This critical two-day session saw representatives from all 12 IHS Areas consolidate regional needs into a unified national strategy. A key highlight of these recommendations is a proposed $1.5 billion increase for the Urban Indian Health line item, elevating it to Priority 10 overall. NCUIH stands firmly behind the Workgroup’s vision and applauds the Tribal leaders’ historic commitment to closing the funding gap for urban Indian health.

Area Report Highlights

Several Areas featured the work of Urban Indian Organizations (UIOs) in their presentations and advocated for increased allocation of funding and/or resources for urban Indian health.

Area	Key Takeaways from Recommendation for Urban Indian Health
Bemidji Area	$1 billion for the Urban Health line item above the FY 2026 enacted base “Urban Health” as Priority 6
Billings Area	$2.6 billion increase above the FY 2026 enacted base “Urban Indian Health” as Priority 8
California Area	“Urban” as Hot Topic 1
Great Plains Area	$1.7 billion above the FY 2026 enacted base “Urban Indian Health” as Priority 7
Nashville Area	“Funding Increases for Urban Indian Health Programs” in the Area’s Standing Priorities
Navajo Area	$9.6 billion increase above the FY 2026 enacted base “Urban” as Priority 3
Oklahoma City Area	$576.2 million increase above the FY 2026 enacted base. “Urban Health” as Priority 5 “Urban Issues – 100% FMAP” as Hot Issue 12
Phoenix Area	$5.1 million increase above the FY 2026 enacted base “Funding to increase Urban Indian Health Programs” as Hot Issue 12
Portland Area	$1.1 billion increase above the FY 2026 enacted base “Urban Indian Health” as Hot Topic 8
Tucson Area	$1.7 billion increase above the FY 2026 enacted base

Background on Area Budget Formulation

As part of the trust responsibility to provide health care to all American Indian and Alaska Native people, Tribal leaders present their funding needs each year to the Secretary of the U.S. Department of Health and Human Services and the Director of the Office of Management and Budget. The recommendations are formed through the Tribal Budget Formulation Workgroup and serve as a framework for the Administration in setting budget amounts for their annual requests to Congress. This process ensures the federal government has the resources to provide health care to all American Indian and Alaska Native people in fulfillment of the trust responsibility.

NCUIH’s Budget Priorities

NCUIH presented the following top priorities for urban Indian health for FY 2028 during the Area Report Webinar:

Full funding for IHS and the Urban Indian line item
1. This funding is necessary to address health priorities for Native in urban areas, including:
  1. Ensuring Urban Indian Health funding keeps pace with population growth.
  2. Providing funding for UIO facilities and infrastructure.
  3. Expanding service offerings to Native patients in urban areas.
Establishing Permanent 100% FMAP for services provided to Medicaid beneficiaries at UIOs
Increased funding for behavioral health
Special Diabetes Program for Indians (SDPI) reauthorization
Funding for health information technology and electronic health records

NCUIH endorses a budget in which IHS, Tribal Facilities, and UIOs are all fully funded to improve health outcomes for all Native people no matter where they live.

Next Steps

At least one tribal representative from each Area along with technical team members will coordinate to complete follow-up work on the budget recommendation and testimony that will be presented.

Bipartisan Group of 60 Congressional Leaders Request Protection of IHS Funding and Increased Resources for Urban Indian Health

March 25, 2026/in Policy Blog/by Jeremy Grabiner

On March 20, 2026, 59 Congressional leaders joined Representative Leger Fernandez in her letter  to Chairman Simpson and Ranking Member Pingree of the House Interior Appropriations Committee requesting a minimum of $106 million for Urban Indian Health, maintaining advance appropriations for the Indian Health Service (IHS), and protecting IHS from sequestration in the final fiscal year (FY) 2027 Interior, Environment, and Related Agencies Appropriations Act. The letter emphasizes that the federal government has a trust responsibility to provide federal health services to maintain and improve the health of American Indian and Alaska Native people.

The bipartisan group of 60 Congressional leaders reiterated their support for the House Appropriations Committee’s inclusion of advance appropriations for IHS for FY 2027 in the final FY 2026 appropriations bill. Previously, IHS was the only federal health care provider funded through annual appropriations. Without advance appropriations, IHS is subject to the negative impacts of government shutdowns and continuing resolutions that can lead to serious disruptions in urban Indian organizations ability to provide critical patient services. The continued inclusion of advance appropriations is a crucial step toward ensuring long-term stable funding for IHS.

This letter sends a powerful message to Chairman Simpson and Ranking Member Pingree, and Members of Congress that in order to fulfill the federal government’s trust responsibility to all Native people to provide safe and quality healthcare, funding for IHS must be significantly increased.

NCUIH is grateful for the support of the following Representatives:

Teresa Leger Fernandez (D-NM-03)
Jeff Hurd (R-CO-03)
Dusty Johnson (R-SD-AL)
Yassamin Ansari (D-AZ-03)
Nanette Barragán (D-CA-44)
Ami Bera (D-CA-06)
Shontel Brown (D-OH-11)
Julia Brownley (D-CA-26)
Janelle Bynum (D-OR-05)
Salud Carbajal (D-CA-24)
Greg Casar (D-TX-35)
Gilbert Cisneros (D-CA-31)
Steve Cohen (D-TN-09)
Jasmine Crockett (D-TX-30)
Jason Crow (D-CO-06)
Sharice Davids (D-KS-03)
Danny Davis (D-IL-07)
Diana DeGette (D-CO-01)
Maxine Dexter (D-OR-03)
Shomari Figures (D-AL-02)
Jesús García (D-IL-04)
Adelita Grijalva (D-AZ-07)
Jahana Hayes (D-CT-05)
Val Hoyle (D-OR-04)
Jared Huffman (D-CA-02)
Sara Jacobs (D-CA-51)
Pramila Jayapal (D-WA-07)
Julie Johnson (D-TX-32)
Timothy Kennedy (D-NY-26)
Raja Krishnamoorthi (D-IL-08)
Rick Larsen (D-WA-02)
Stephen Lynch (D-MA-08)
Seth Magaziner (D-RI-02)
Doris Matsui (D-CA-07)
Lucy McBath (D-GA-06)
Kristen McDonald Rivet (D-MI-08)
Kweisi Mfume (D-MD-07)
Gwen Moore (D-WI-04)
Jared Moskowitz (D-FL-23)
Kevin Mullin (D-CA-15)
Joe Neguse (D-CO-02)
Ilhan Omar (D-MN-05)
Jimmy Panetta (D-CA-19)
Scott Peters (D-CA-50)
Brittany Pettersen (D-CO-07)
Luz Rivas (D-CA-29)
Raul Ruiz (D-CA-25)
Andrea Salinas (D-OR-06)
Hillary Scholten (D-MI-03)
Kim Schrier (D-WA-08)
Adam Smith (D-WA-09)
Darren Soto (D-FL-09)
Melanie Stansbury (D-NM-01)
Greg Stanton (D-AZ-04)
Haley Stevens (D-MI-11)
Mark Takano (D-CA-39)
Rashida Tlaib (D-MI-12)
Ritchie Torres (D-NY-15)
Juan Vargas (D-CA-52)
Gabe Vasquez (D-NM-02)

Full Letter Text

Dear Chairman Simpson and Ranking Member Pingree:

As you develop the Fiscal Year (FY) 2027 Interior, Environment, and Related Agencies Appropriations bill, we request that you fund Urban Indian Health at the highest possible level, with a minimum of $106 million. We also request that you retain advance appropriations for the Indian Health Service (IHS) in FY 2028 and protect IHS from any sequestration cuts.

The federal government has a trust responsibility to provide federal health services to maintain and improve the health of American Indian and Alaska Native people. According to the Tribal Budget Formulation Workgroup (TBFWG), a workgroup comprised of Tribal leaders representing all twelve IHS service areas and serving all 574 federally recognized Tribes, “only a significant increase to the Urban Indian Health line item will allow UIOs to increase and expand services to address the needs of their Native patients, support the hiring and retention of culturally competent staff, and open new facilities to address the growing demand for UIO services.”

American Indians and Alaska Natives experience major health disparities compared to the general U.S. population, including lower life expectancy, higher rates of infant and maternal mortality, and psychological or behavioral health issues. This is true regardless of where an American Indian or Alaska Native person lives. A lack of sufficient federal funding for the Indian Health Service budget plays a significant role in these continuing devastating health disparities, as the Indian health system simply does not have the necessary financial resources and support to address these inequities.

The lack of federal funding is deeply impactful for UIOs who are on the front lines in working to provide for the health and well-being of American Indian and Alaska Native people living outside of Tribal jurisdictions. UIOs are an integral part of the Indian health system, comprised of the Indian Health Service, Tribes, and UIOs (collectively I/T/U), and provide essential healthcare services, including primary care, behavioral health, and social and community services, to patients from over 500 Tribes in 38 urban areas across the United States.

Unfortunately, despite being an integral part of the I/T/U system UIOs are chronically underfunded. The urban Indian health line item historically makes up only one percent (1 percent) of IHS’ annual appropriation and UIOs often only receive direct funding from the urban Indian health line item. UIOs generally do not receive direct funds from any other distinct IHS accounts, including the Hospital and Health Clinics, Indian Health Care Improvement Fund, Health Education, Indian Health Professions, or any of the line items under the IHS Facilities account.

Without a significant increase to the Urban Indian Health line item, UIOs will continue to be forced to operate on limited and inflexible budgets that limit their ability to fully address the needs of their patients. Current funding levels pose challenges for UIOs in offering competitive salaries to attract and retain qualified staff who are essential for delivering quality care to their communities. Additionally, UIOs need resources to expand their services and programs, including addressing pressing issues such as food insecurity, behavioral health challenges, and rising facilities costs. By providing UIOs with the necessary resources, we can ensure that American Indian and Alaska Native people receive the comprehensive and culturally competent healthcare services they deserve.

We appreciate the inclusion of advanced appropriations for IHS for FY 2027 in the final FY2026 appropriations bill. Because of this inclusion, the I/T/U system will be able to operate normally and without fear of funding lapses during the FY 2027 appropriations negotiation process. We emphasize that advanced appropriations are a crucial step towards ensuring long-term, stable funding for IHS and, therefore, it is imperative that you include advance appropriations for IHS FY 2028 in the final FY 2027 Interior, Environment, and Related Agencies Appropriations Act. Further, for the reasons discussed above, we request that you protect IHS from any sequestration measures taken in this Act, as IHS, and the urban Indian line item, cannot afford any funding reduction.

Thank you for your consideration of our request.

NCUIH March Policy Update: Congressional Testimony, Medicaid Guidance, and IHS Policy Developments

March 23, 2026/in Policy Blog/by NCUIH

In this Edition:

🎙 NCUIH Testified Before Congress on Urban Indian Health
🏥 HHS Secretary Kennedy Jr. Announced $1 Billion for IHS Infrastructure
🤝 NCUIH in Action: Recent Policy Engagement with IHS and HHS leaders
📋 Medicaid Redetermination Guidance Included an AI/AN Exemption
🏛 Bipartisan Bill Would Elevate Indian Health Service Leadership Within HHS
💻 IHS Requested Feedback on Health IT Modernization PATH Activities
🌾 NCUIH Requested Input on Rural Health Transformation Fund Awards
📅 Upcoming Policy Events, Deadlines, and Opportunities
🎉 Join Us in April for the 2026 NCUIH Annual Conference

NCUIH Testifies Before Congress on Urban Indian Health

On March 17, 2026, NCUIH CEO Francys Crevier, testified before the House Appropriations Subcommittee on Interior, Environment, and Related Agencies during the American Indian and Alaska Native Public Witness hearing. Testifying on behalf of the National Council of Urban Indian Health (NCUIH) and the 41 Urban Indian Organizations (UIOs) it represents, she elevated the role of UIOs in the Indian health system and urged Congress to protect funding for the Indian Health Service, provide $106 million for Urban Indian Health in FY27, maintain advance appropriations, and include UIOs in the Behavioral Health Pilot Program.

Her testimony underscored that Urban Indian Organizations remain an essential part of the Indian health system and continue to meet growing need in Native communities across the country. As stated in her testimony, “The three requests before you today are targeted and achievable: fund Urban Indian Health at $106 million, maintain advance appropriations, and include UIOs in the Behavioral Health Pilot Program.”

She also emphasized that these requests are grounded in the federal government’s trust responsibility to provide health care for American Indian and Alaska Native people, including those living in urban areas. Her testimony reinforced that sustained investment in urban Indian health is necessary to protect services, strengthen care delivery, and ensure Native communities are not left behind.

NCUIH also submitted written testimony.

Read more about the hearing on NCUIH’s blog.

Interior Subcommittee Chairman Mike Simpson (ID-02-R) and Appropriations Committee Chairman Tom Cole (OK-04-R) both reaffirmed the committee’s commitment to advancing progress in Indian health care and protecting and maintaining stable funding for IHS.

U.S. Department of Health and Human Services Secretary Kennedy Jr. Announces $1 Billion in Infrastructure Investment for IHS

HHS Secretary Kennedy Jr. announced a $1 billion investment toward priority Indian Health Service facilities infrastructure projects beginning in FY 2027.

Funding is from existing departmental resources drawn from the HHS Nonrecurring Expenses Fund.
Announcement was made at the February 12 IHS Tribal Summit.

NCUIH in Action: Recent Policy Engagement

NCUIH engaged in several recent convenings, including:

IHS Tribal Self-Governance Advisory Committee (TSGAC) Meeting
February 24–25, 2026 | Washington, D.C.
Discussion included the recently announced $1 billion IHS infrastructure initiative.
Native American Coalition for Economic Prosperity (NACEP) Fourth Convening of the Government-to-Government Roundtable Series
February 25, 2026 | Washington, D.C.
Discussion also included the $1 billion IHS infrastructure initiative.

CMS Guidance to States on Implementation of One Big Beautiful Bill Act 6-Month Medicaid Redeterminations – includes AI/AN Exemption

The Centers for Medicare & Medicaid Services (CMS) issued guidance to states on implementation of 6-month Medicaid redeterminations, and the guidance included an American Indian and Alaska Native exemption that also applies to Urban Indians.

NCUIH-Endorsed Bipartisan Bill to Elevate Indian Health Service Leadership Within HHS Introduced in Senate

The Stronger Engagement for Indian Health Needs Act is a bipartisan bill supported by NCUIH that would elevate the IHS Director to Assistant Secretary for Indian Health within HHS.

Why it matters:

This would strengthen Tribal representation in federal health decision-making and reinforce the federal government’s trust responsibility to provide health care to American Indian and Alaska Native people.

Legislative updates include:

Senate bill introduced February 5, 2026 by Senators Catherine Cortez Masto (D-NV) and Mike Rounds (R-SD)
House bill introduced January 28, 2026 by Representatives Greg Stanton (D-AZ-04) and David Joyce (R-OH-14)

NCUIH Provided Comments to IHS on Proposed Realignment following Second Round of Urban Confer

Following IHS’ January 15 virtual Urban Confer session on the IHS Strategic Realignment, NCUIH submitted written comments to IHS emphasizing the importance of protecting UIO contracts, maintaining Area offices and strengthening partnerships, addressing IHS staffing needs, and ensuring continued engagement with UIOs, while also highlighting the importance of 100% Federal Medical Assistance Percentage (FMAP) for UIOs.

IHS’ Realignment plans (communicated during the January 15 Urban Confer):

April 1: Federal Register Comment Period (30 days)
May 22: Federal Register Notice
May-June: Transition to Future State

IHS Requested Feedback on Health IT Modernization PATH Activities

On March 5, IHS held a Health IT Modernization Information Session on Patients at the Heart (PATH) electronic health record (EHR) activities. Planned go-live for the pilot site for implementing PATH EHR is the beginning of August 2026.
During the session, IHS shared consultation and confer questions for Tribes and UIOs, including:

What clarifications are needed regarding the PATH EHR activities?
What additional information or content would help sites better understand PATH EHR implementation?
What additional information or content would be helpful to better understand PATH EHR implementation at your site?
•What potential opportunities do you foresee for staff or patients in implementing PATH EHR?

Written comments are due by Saturday, April 4, 2026, to urbanconfer@ihs.gov with the subject line: Health IT Modernization CY 03-5-2026.

NCUIH is Requesting UIO Input on Rural Health Transformation Fund Awards

On December 29, 2025, The Centers for Medicare & Medicaid Services (CMS) awarded all 50 states funding through the Rural Health Transformation Fund (RHTF). Read more about this funding on NCUIH’s blog.

NCUIH is asking Urban Indian Organizations to share whether they receive this funding.

Request for UIOs:

Let NCUIH know if your UIO receives RHTF funding. Contact: policy@ncuih.org

Upcoming Events and Key Dates Requests for Information

March 25–26, 2026 — CMS Tribal Technical Advisory Group Quarterly Meeting (Washington, D.C.)
April 4, 2026 — Written comments due for IHS Health IT Modernization PATH activities
April 6–9, 2026 — Tribal Self-Governance Conference (Phoenix, Arizona). Register here.
April 15, 2026 — NCUIH Monthly Policy Workgroup (Virtual)
April 27–30, 2026— 2026 NCUIH Annual Conference (Washington, D.C.)

2026 NCUIH Annual Conference

Join us April 27–30, 2026, in Washington, D.C., as NCUIH marks the 50th anniversary of the Indian Health Care Improvement Act (IHCIA)—a landmark commitment to the health and well‑being of American Indians and Alaska Natives—and reflects on five decades of progress, collaboration, and continued commitment to Native health.

Register to attend: https://ncuih.org/conference/

NCUIH Annual Conference 2026 Website

Recent NCUIH Policy Blogs

1. Serving Native Community Across New York City: The Work of the New York Indian Council
March 3, 2026/in Policy Blog/by River Carroll
HHS Secretary Kennedy Jr. Announces $1 Billion in Infrastructure Investment for IHS
March 4, 2026/in Policy Blog/by Jeremy Grabiner
NCUIH Submits Written Testimony Urging House to Protect Funding of Indian Health Service and Urban Indian Health
March 13, 2026/in Policy Blog/by Jeremy Grabiner
NCUIH Testifies Before Congress on Native Health Priorities
March 17, 2026/in Policy Blog/by NCUIH

NCUIH Policy Blog

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 CEO Francys Crevier Testifies on Importance of Native Health Care

March 18, 2026/in Policy Blog/by Jeremy Grabiner

On March 17, 2026, National Council of Urban Indian Health (NCUIH) CEO Francys Crevier testified before the House Appropriations Subcommittee on Interior, Environment, and Related Agencies, urging full funding for urban Indian health and the Indian Health Service (IHS).

Read Written Testimony

What They’re Saying: Congressional Support for Strengthening Indian Health Services

Interior Subcommittee Chairman Mike Simpson (ID-02-R) reaffirmed the committee’s commitment to advancing progress in Indian health care, “Indian Country has been and will continue to be a bipartisan priority for this community.” He also emphasized the importance of protecting and maintaining stable funding for IHS. “We are not going back on that [advance appropriations]. We need to make it mandatory funding. Indian health service is the only health care program that isn’t mandatory funding”

Appropriations Committee Chairman Tom Cole (OK-04-R) similarly highlighted the committee’s commitment to maintaining advance appropriations. “This committee will not be eliminating advance funding. It’s just not going to happen. It’s a bipartisan commitment.”

Why It Matters: The Urgency of Action

Protecting the Entire Indian Health System

Responsible Stewardship and the Case for Increased Investment
Ms. Crevier highlighted the Oklahoma City Indian Clinic as a model of what responsible federal investment in Urban Indian Health looks like. Roughly half of every dollar the clinic spends goes directly to preventative care, and six out of the clinic’s top ten diagnoses are preventative care diagnoses. Ms. Crevier emphasized that this is exactly why increased investment pays off — and called on Congress to fully fund IHS and fund Urban Indian Health, maintain advance appropriations, and protect IHS funding from any cuts, sequestrations, or funding freezes. As she testified, these are “not new asks — they are overdue asks.”
Cancer: Rising Concern in Indian Country
Ms. Crevier underscored the alarming rise in cancer rates in Indian Country. She highlighted that the Oklahoma City Indian Clinic is now diagnosing over 20 new cancer cases every single month. In response, the clinic has hired a full-time oncology nurse case manager and a part-time oncologist. Ms. Crevier urged Congress to protect funding for programs like the Native American Cancer Outcomes Program, which she described as more critical than ever.
A Growing Behavioral Health Crisis Demands Action
Ms. Crevier testified to a growing behavioral health crisis unfolding inside Urban Indian clinics, where they have seen a surge in anxiety and depression, disproportionately affecting young Native people. She noted that while clinics are not traditionally equipped for robust behavioral health services, patients are coming to them anyway, and demand is outpacing available resources. Ms. Crevier called on Congress to protect SAMHSA programs like Native Connections, which plays a critical role in addressing Native youth suicide, and urged the committee to include Urban Indian Organizations in the Behavioral Health Pilot Program established this year.

Next Steps

NCUIH will continue to advocate for protecting and fully funding the Indian Health System–including UIOs, Tribes, and IHS—so that no Native person goes without life-saving care. NCUIH stands ready to work with Congress and federal agencies to ensure that all Native people have consistent, high-quality health care.

NCUIH Testifies Before Congress on Native Health Priorities

March 17, 2026/in Policy Blog/by NCUIH

Today, the National Council of Urban Indian Health (NCUIH) is participating in congressional hearings that help shape federal funding decisions affecting Native communities across the country.

The U.S. House Appropriations Subcommittee on Interior, Environment, and Related Agencies is holding American Indian and Alaska Native Public Witness hearings on March 17–18, 2026. These hearings provide an important opportunity for Native leaders and organizations to speak directly to Congress about community needs ahead of the Fiscal Year 2027 federal budget.

Why These Hearings Matter

Funding decisions made by Congress determine how health care and public health services are delivered to American Indian and Alaska Native people. These hearings are one of the few chances each year for Native voices to be formally placed on the congressional record before appropriations levels are set.

NCUIH’s testimony highlights:

The federal trust responsibility to provide health care to Native people
The growing health needs of Native communities, including rising cancer rates and behavioral health challenges
The importance of stable, sustained funding to ensure access to preventive care and life‑saving services

NCUIH’s testimony helps ensure that Congress understands how federal investments in Native health directly affect patients, families, and communities nationwide.

NCUIH Testimony

NCUIH will testify on Tuesday, March 17, 2026 at 2:10 PM ET (estimated, but subject to change).

Watch Live

Hearings: Livestream Links, List of Witnesses and Testimony

The hearings are open to the public and will be livestreamed. Links below include the livestream information, the full list of witnesses, and all submitted written testimony, including NCUIH’s.

Interior, Environment, and Related Agencies – American Indian and Alaska Native Public Witness (Day 1, Morning Session)

Interior, Environment, and Related Agencies – American Indian and Alaska Native Public Witness (Day 1, Afternoon Session)

NCUIH Testimony

Interior, Environment, and Related Agencies – American Indian and Alaska Native Public Witness (Day 2, Morning Session)

Interior, Environment, and Related Agencies – American Indian and Alaska Native Public Witness (Day 2, Afternoon Session)

Next Steps

NCUIH will continue working with Congress throughout the federal budget process to advance policies and funding that protect and strengthen the health of Native communities across the country.