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

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On June 9, 2026, the House Appropriations Full Committee passed the Fiscal Year (FY) 2027 appropriations bill for Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). The bill includes $110.767 billion for the Department of Health and Human Services (HHS), which is $4.03 billion below FY 2026 enacted and $12.16 billion above the President’s request. The committee notably did not fund the Administration for a Healthy America (AHA), President Trump’s proposed new agency that would consolidate programming across SAMHSA, HRSA, and other agencies as part of its HHS reorganization.

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, and Tribal Behavioral Grants (Native Connections).

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 protecting Tribal set asides.

Next Steps

House Leadership will now work with Senate Leadership to develop the final LHHS appropriations spending bill. The Senate has not yet released their Labor-HHS appropriations bill. As a final appropriations bill is produced, NCUIH will continue to work to protect funding for Indian Country and maintain maximum funding levels.

Bill Highlights

Line Item FY 2026 Enacted FY 2026 President’s Budget Request FY 2027 Committee Passed
Health Resources and Services Administration $9.2 billion Fold into Administration for a Healthy America (AHA) $8.35 billion
Substance Abuse and Mental Health Services Administration $7.4 billion Fold into AHA $7.29 billion
National Institutes of Health $48.72 billion $42.97 billion $48.82 billion
Centers for Disease Control $9.2 billion Fold into AHA (Partially) $8.16 billion
Good Health and Wellness in Indian Country $27 million — $30 million
Improving Native American Cancer Outcomes $9 million — $15 million
Ryan White HIV/AIDS Program $2.57 billion $2.50 billion $2.35 billion
Minority HIV/AIDS Fund $56 million Eliminated $20 million
Minority HIV/AIDS Fund – Tribal Set Aside No less than $6 million — $6 million
Tribal Behavioral Grants (Native Connections) $26.25 million Eliminated. Created a new behavioral health program under AHA $30 million

Additional Key Provisions:

Health Resources and Services Administration

Innovation for Maternal Health: $20.3 million (10% Tribal set-aside)
Bill report pg. 52: The Committee includes $20,300,000 for the Innovation for Maternal Health program. The Innovation for Maternal Health program supports the establishment or continuation of a program to identify, develop, or disseminate best practices to improve maternal health care quality and outcomes, improve maternal and infant health, and eliminate preventable maternal mortality and severe maternal morbidity, among other activities. This funding supports capacity building, technical assistance, and continued implementation of the Alliance for Innovation on Maternal Health Program’s patient safety bundles to all States, territories, and tribal organizations. Patient safety bundles are a set of targeted and evidence-informed best practices that, when implemented, improve patient outcomes and reduce maternal mortality and severe maternal morbidity.

  • (NEW) Tribal Set-Aside: The Committee directs HRSA to reserve at least 10 percent of available funding for Tribes and Tribal organizations.

Federal Office of Rural Health Policy: $575.77 million

Native Hawaiian Health Care Program: $27 million
Bill report pg. 38: 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: $133.1 million (15% Tribal set-aside)
Bill report pg. 40: The Committee includes $133,100,000 for the National Health Service Corps (NHSC) to support competitive awards to health care providers dedicated to working in rural, Tribal, and underserved areas.

  • Tribal Set-Aside.—Within the total provided for the NHSC, the Committee includes a set aside of not less than 15 percent 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. 73.

Office of the Secretary – General Departmental Management

Minority HIV/AIDS Fund: $20 million ($6 million Tribal set-aside)
Bill report pg. 252: 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 not less than $6,000,000 as a Tribal set-aside within the total provided for MHAF.
Substance Abuse and Mental Health Services Administration

National Center of Excellence for Eating Disorders: $4 million
Bill report pg. 162: The Committee provides $4,000,000, an increase of $2,000,000 above the fiscal year 2026 enacted level, for the National Center of Excellence for Eating Disorders. Funding will support increased engagement with primary care providers, including pediatricians, to provide specialized advice and consultation on screening and treatment for eating disorders. The Committee supports work on pediatric training models for prevention, early intervention, treatment, and ongoing support protocols for youth with, or at-risk of developing, an eating disorder. The Committee directs SAMHSA to devote sufficient resources to a competitive grant process to support the National Center of Excellence, as authorized in section 1131 of Public Law 117–328. The Committee further directs SAMHSA to provide an update in the fiscal year 2028 congressional justification detailing actions taken to support the Center of Excellence in advancing education, training, and awareness of eating disorders.

Substance Abuse Prevention Services: $204 million

Tribal Behavioral Grants (Native Connections): $30 million
Bill report pg. 161: The Committee provides $30,000,000, an increase of $3,750,000 above the fiscal year 2026 enacted 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: $23.8 million
Bill report pg. 159: The Committee includes $23,800,000 for the Zero Suicide program, which is the same as the fiscal year 2026 enacted level. Zero Suicide grants support suicide prevention efforts in health systems, including screening adults for suicide risks, providing referral services, implementing evidence based practices to provide services to adults at-risk, and raising awareness of such risks.

American Indian and Alaska Native Set Aside:$4.4 million
Bill Report pg. 159: Within the amount provided, $4,400,000 is included for Zero Suicide grants to American Indian and Alaska Native health systems, which is the same as the fiscal year 2026 enacted level.

Mental Health Services Block Grant: $1.05 billion
Bill report pg. 154: The Committee provides $1,047,571,000 for the MHBG, an increase of $35,000,000 above the fiscal year 2026 enacted level. Of the funds provided, $21,039,000 shall be derived from evaluation set aside funds available under section 241 of the PHS Act.

988 Suicide & Crisis Lifeline: $544.62 million
Bill report pg. 159: The Committee provides $544,618,000 for the 988 Suicide & Crisis Lifeline, an increase of $10,000,000 above the fiscal year 2026 enacted 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.

  • 988 Tribal Capacity Building.—Tribal Nations continue to face unique challenges with fully adopting 988 services, including access to technology and crisis support services, intergovernmental coordination, and culturally responsive mental health services. The Committee instructs SAMHSA to complete the briefing directive included under this heading in the House Report 119–271.

Substance Use Prevention, Treatment, and Recovery Services Block Grant: $2.03 billion
Bill report pg. 163: The Committee includes $2,039,079,000 for the Substance Use Prevention, Treatment, and Recovery Services (SUPTRS) Block Grant, which is a $26,000,000 increase above the fiscal year 2026 enacted level.

State Opioid Response Grants: $1.6 billion (4.5% Tribal set aside)
Bill report pg. 163: The Committee includes $1,600,000,000 for State Opioid Response (SOR) grants, an increase of $5,000,000 above the fiscal year 2026 enacted 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 of not less than 4.5 percent for Indian Tribes and Tribal organizations.

National Institute on Minority Health and Health Disparities

Improving Native American Cancer Outcomes: $15 million
Bill report pg. 131: The Committee remains deeply concerned that Native Americans experience overall cancer incidence and mortality rates significantly higher than those of non-Native populations. The Committee includes $15,000,000, an increase of $6,000,000 from the fiscal year 2026 enacted level, to continue and expand support for existing grantees under the Initiative for Improving Native American Cancer Outcomes. This initiative supports research, education, outreach, and clinical access related to cancer in Native American communities. The Committee further directs NIMHD to continue to work with NCI to maintain support for current grantees.

Native Hawaiian/Pacific Islander Health Research Office: $7.5 million
Bill report pg. 132: The Committee provides $7,500,000, which is an increase of $2,500,000 above the fiscal year 2026 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

Infant and Early Childhood Mental Health Program: $16 million
Bill report pg. 158: The Committee provides $16,000,000 for the Infant and Early Childhood Mental Health program, an increase of $1,000,000 above fiscal year 2026 enacted 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. Increased funding is included to expand funding to additional communities, working to build the infrastructure and systems needed to deliver early childhood mental health services.

Administration for Community Living

Native American Caregiver Support Program: $16 million
Bill report pg. 211: The Committee provides $16,000,000 for the Native American Caregivers Support program. 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 Contact:Meredith Raimondi, Vice President of Policy and Communications, mraimondi@ncuih.org

Urban Indian Health Hill Day 2026: Urban Indian Leaders Make Their Voices Heard

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On April 30, 2026, NCUIH and Urban Indian Organizations (UIOs) leaders from across the country gathered in Washington, D.C. for a Capitol Hill Day. UIO leaders, staff, and members of the community participated in NCUIH’s in-person Training ahead of Hill Day, arriving prepared and equipped to increase awareness of urban Indian health needs and carried those messages directly to Capitol Hill.

This year’s Hill Day came at a critical moment. Budget conversations are actively underway in Congress, making the timing of these meetings essential to ensuring that the health needs of American Indian and Alaska Native people living in urban areas are not overlooked in policy discussions. As Congress moves forward with the appropriations process, NCUIH will build on the momentum of Hill Day by continuing to educate policymakers and raise awareness about urban Indian health needs.

Read the Full Hill Day 2026 Recap Booklet

House Advances FY 2027 Interior Bill with Increases for IHS and Advance Appropriations for FY 2028

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On June 3, 2026, the House Appropriations Full Committee passed the Fiscal Year (FY) 2027 appropriations bill for Interior, Environment, and Related Agencies, which was previously approved by the House Subcommittee on May 25, 2026. At the Subcommittee Hearing, Chairman Cole (R-OK-04), affirmed the Committee’s continued recognition and commitment to protecting the Indian Health Service (IHS) stating the bill “reflects our commitment to honoring and upholding our sacred trust and treaty oaths to protect Native American communities. I’m proud that the legislation prioritizes funding for the accounts that deliver critical services to Indian country.”

The bill provides $8.69 billion for IHS, including $6.06 billion in advance appropriations for FY 2028. The bill also expands advance appropriations to include Indian Health Facilities Sanitation Facilities Construction and Health Care Facilities Construction accounts. The bill authorizes $105.992 million for urban Indian health – an increase of $10.57 million over the FY26 enacted amount. The report states that “the Committee recognizes the Federal trust responsibility to provide health care services to American Indian and Alaska Native citizens and acknowledges that approximately seventy-one percent live in urban areas.”

Other key provisions include:

  • $7 million for the Produce Prescription Pilot Program for Tribes and UIOs to increase access to produce and other traditional foods
  • $45 million, a $5.57 million increase, for Tribal Epidemiology Centers (TECs).

Background

The National Council of Urban Indian Health (NCUIH) is a longstanding advocate for full funding for IHS and urban Indian health and supports the recommendations of the Tribal Budget Formation Workgroup. On March 17, 2026, 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 System.

NCUIH is also grateful for the support of Representatives working to support the health of Indian Country. On March 20, 2026, 59 Congressional leaders joined Representative Leger Fernandez in a bipartisan letter to Chairman Simpson and Ranking Member Pingree of the House Interior Appropriations Committee requesting support for Urban Indian Health, maintaining advance appropriations for IHS, and protecting IHS from sequestration. The letter emphasized 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.

Next Steps

The House will now need to schedule a floor vote on the Interior, Environment, and Related Agencies spending bill. The legislation is not expected to become law in its current form. House leadership will need to work with Senate Leadership to negotiate a final bill text for passage in both chambers.

FY26 funding is set to end on September 30, 2026. If Congress cannot come to a funding agreement by that deadline, they will need to pass a Continuing Resolution to keep the funding levels at the FY26 level until they reach an agreement. Should political disagreements lead to a government shutdown, UIOs and parts of IHS will be protected by Advance Appropriations.

Bill Highlights

Line Item FY 26 Enacted FY 27 Tribal Request FY 27 President’s Budget FY 27 House Proposed
Urban Indian Health $95.42 million $1.09 billion $95 million $105.992 million
Indian Health Service $8.05 billion $73 billion $9.1 billion $8.69 billion
Hospital and Clinics $2.63 billion $18.5 billion $2.84 billion $2.87 billion
Tribal Epidemiology Centers $39.4 million ____________ $39.4 million $45 million
Mental Health $133.69 million $5.41 billion $139 million $144.95 million

Additional Key Provisions:

Clinical Decision Support for Diabetes Management (NEW)
Bill Report, Pg. 92,93: The Committee directs IHS to evaluate and, where clinically appropriate, implement evidence-based, artificial intelligence-enabled digital tools to improve insulin management, patient safety, and clinical outcomes in IHS facilities.

Rural Health Care Access (NEW)
Bill Report, Pg. 93: The Committee remains concerned about the ongoing difficulties rural and remote Tribal communities face in accessing timely health services. To reduce geographic barriers and improve care continuity, the Committee directs the IHS to procure integrated rural health care delivery models that leverage mobile medical units, telehealth-enabled clinical services, and clinical staff augmentation to address persistent workforce gaps.

IHS Hiring Initiative Follow Up (NEW)
Bill Report, Pg. 90: The Committee commends IHS on the launch of its fiscal year 2026 hiring initiative. As it works to streamline and expedite hiring processes, the Committee expects IHS to maintain the integrity and thoroughness of the background check process, and to consider ways to collaborate with and consult Tribes on hiring system improvements and decisions affecting healthcare services. The Committee encourages IHS to provide a report not later than 90 days following the enactment of this Act on its success in addressing the high staffing vacancy rate and implementing targeted recruitment and retention strategies in underserved areas.

Current Services: $264,752,000
Bill Report, Pg. 90: The Committee acknowledges that fixed costs continue to rise and flat funding results in a cut to programmatic dollars. The recommendation provides $264,752,000 for the Agency’s requested Current Services, which covers fixed costs for fiscal year 2027, for key health services to ensure increases go directly to programs. The Committee directs IHS to provide a detailed spend plan for fixed costs not later than 60 days following the enactment of this Act, including a timeline for when the funds will be distributed.

Produce Prescription Pilot Program: $7 million
Bill Report, Pg. 90: The recommendation includes $7,000,000 for IHS to expand, in coordination with Tribes and Urban Indian Organizations, the Produce Prescription Pilot to implement a produce prescription model to increase access to produce and other traditional foods among its service population. The Committee encourages IHS to provide a briefing not later than 90 days following the enactment of this Act on the distribution of funds and implementation efforts.

Contract Support Costs – $ 1.731 billion and Tribal 105(l) leases – $720 million
Bill Report, Pg. 93: The Committee recommends an indefinite appropriation estimated to be $1,731,000,000 for contract support costs incurred by the agency as required by law. The bill continues language making available such sums as are necessary to meet the Federal Government’s full legal obligation and prohibiting the transfer of funds to any other account for any other purpose. In addition, the bill includes language specifying carryover funds may be applied to subsequent years’ contract support costs.

Bill Report, Pg. 93: The Committee recommends an indefinite appropriation estimated to be $720,000,000 for Payments for Tribal Leases incurred by the agency as required by law. The bill includes language making available such sums as necessary to meet the Federal Government’s full legal obligation and prohibits the transfer of funds to any other account for any other purpose.

Purchased and Referred Care – $1.06 billion
Bill Report, Pg. 91: The recommendation includes $1,055,713,000 for Purchased and Referred Care (PRC). The amount provided reflects the fiscal year 2026 enacted base of $996,755,000, full funding for fiscal year 2027 current services requirements estimated at $45,958,000, and $13,000,000 for the purposes described below.

The Committee is aware that delayed reimbursements can cause financial strain on the Tribal member patient and the provider. This can sometimes result in the patient being incorrectly held liable for costs and cause medical debt to appear on the patient’s credit report. Therefore, within 90 days of the enactment of this Act, the Committee directs the Indian Health Service to report on ways to improve the speed at which reimbursement payments are paid to meet the 30-day requirement. The Committee also provides $13,000,000 for additional staff and resources needed to improve reimbursement timelines.

The Committee is interested in IHS findings on the Purchased and Referred Care funding distribution methodology and how PRC dependent areas, including those in California, are receiving the necessary PRC funds needed to purchase lifesaving care for Tribal members.

Indian Health Professions: $95,252,000
Bill Report, Pg. 92: The recommendation includes $95,252,000 for Indian Health Professions programs. The Committee continues to support Indian Health Professions programs and expects IHS to allocate the funding provided across all programs, including the Scholarship Program, Loan Repayment Program, Indians Into Medicine Program (INMED), American Indians into Nursing (RAIN) Program, and the American Indians into Psychology Programs.

The Committee appreciates the opportunities made available through Indian Health Professions programs like the Loan Repayment Program (LRP). The recommendation includes $53,000,000 for LRP to help offset student loan costs in exchange for two years of service at an Indian health program. The Committee remains concerned about the tax assessments associated with this grant program and the impact tax liabilities have on this valuable program. The Committee looks forward to the report from IHS and other applicable Bureaus and Agencies with respect to tax implications, as directed in House Report 119–215.

Sanitation Facilities Construction: $130,968,000
Bill Report, Pg. 94: The recommendation includes $130,968,000 for Sanitation Facilities Construction.

Health Care Facilities Construction: $190,508,000
Bill Report, Pg. 94: The recommendation includes $190,508,000 for Health Care Facilities Construction.

Equipment – Generators:  $2.5 million in addition to FY26 amounts ($5 million)
Bill Report, Pg. 94: $2,500,000, in addition to amounts provided in fiscal year 2026, to purchase generators, including for IHS, Tribal Health Programs, and Urban Indian Organizations facilities located in areas impacted by de-energization events to increase the resilience of these facilities.

Dental Health: $287 million
Bill Report, Pg. 91: The recommendation includes $287,085,000 for Dental Health services.

  • Also includes $1,500,000 to expand Dental Support Centers to all 12 service areas and $2,500,000 to install an electronic Dental Records System.

Alzheimer’s Disease: $6 million
Bill Report, Pg. 90: The recommendation includes $6,000,000 to continue Alzheimer’s and related dementia activities. These funds will enable awardees to continue to implement locally developed models of culturally appropriate screening, diagnostics, and management of people living with Alzheimer’s and other related dementia. This funding also supports the Dementia ECHO program, designed to support clinicians and caregivers to strengthen their knowledge and care around dementia for Tribal patients.

Improving Maternal Health: $3 million
Bill Report, Pg. 91: The recommendation also includes $3,000,000 for Improving Maternal Health. The Committee also recognizes the importance of in vitro diagnostics tools for the detection of diseases, infections, and other medical conditions. These tools provide valuable information to aid providers in accurate diagnostics, treatment planning, and monitoring of patient health. The Committee encourages the use of in vitro diagnostics in IHS health clinics and medical facilities.

Alcohol and Substance Abuse: $286 million
Bill Report, Pg. 91: The recommendation includes $286,389,000 for Alcohol and Substance Abuse programs.

Behavioral Health Pilot Program
Bill Report, Pg. 91: The Committee looks forward to the report on the status and outcomes of the new behavioral health pilot program that was enacted in fiscal year 2026 that supports grants to Indian Tribes, Tribal organizations, or consortia of Indian Tribes to operate and implement special behavioral health programs authorized by the Indian Health Care Improvement Act (25 U.S.C. 1665 et seq.) on or near an Indian Reservation.

Bureau of Indian Affairs, Missing and Murdered Indigenous Women Initiative: $33 million
Bill Report, Pg. 46: The recommendation includes $33,000,000 for the Missing and Murdered Indigenous Women Initiative to address the s women, including for criminal investigators, software platforms, and evidence recovery equipment. The Committee directs BIA to work with Tribal and Federal law enforcement agencies to facilitate sharing law enforcement and public records data and other technology.

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

Trump Submits Nomination of Mark Cruz for Director of the Indian Health Service

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On June 1, 2026, President Trump submitted the appointment of Mark Cruz, a citizen of the Klamath Tribes, as the Director of the Indian Health Service (IHS). Cruz currently serves as Senior Advisor to Secretary of Health and Human Services Robert F. Kennedy Jr., as one of the highest-ranking Native officials within HHS. Cruz holds a Bachelor of Arts in Political Science from Pepperdine University and a Master of Arts in Urban Education Policy from Brown University.

The position of IHS Director has been vacant since the resignation of former Director Roselyn Tso. On December 2,2025, IHS Chief of Staff Clayton Fulton assumed the acting director role during the leadership transition. As the IHS Director, Cruz will be responsible for administering a nationwide program that is responsible for providing comprehensive health care services to American Indians and Alaska Natives through the Indian Health Service, Tribes, Tribal organizations, and urban Indian organizations.

The National Council of Urban Indian Health has previously stressed the importance of appointing a permanent IHS Director and called for the elevation of the role to Assistant Secretary.

Next Steps

The nomination will now be referred to the Senate Committee on Indian Affairs, which will schedule a confirmation hearing before a full Senate floor vote.

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

NCUIH Submits Comments to DEA Urging Inclusion of Urban Indian Organizations in Telemedicine Prescribing Rule

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On May 8, 2026, the National Council of Urban Indian Health (NCUIH) submitted written comments to Drug Enforcement Administration (DEA) Administrator Terrance C. Cole in response to the agency’s consultation on Special Registrations for Telemedicine and Limited State Telemedicine Registrations (Docket No. DEA-407, 90 FR 6541, January 17, 2025). NCUIH’s comments urge DEA to ensure that Urban Indian Organizations (UIOs) are explicitly included in the final rule’s special registration framework, and that administrative requirements do not create barriers that effectively prohibit UIO participation.

Background

The DEA’s proposed final rule would establish a permanent special registration framework for practitioners seeking to prescribe controlled substances, including medications for opioid use disorder (MOUD) such as buprenorphine, via telemedicine. The rule is consequential for UIOs because the current COVID-era telemedicine flexibilities expire on December 31, 2026, and UIOs have no existing statutory pathway to prescribe controlled substances via telemedicine. Federal law provides an existing telemedicine exception for IHS and Tribal practitioners, but that exception was designed as a rural access provision and is unavailable to UIO practitioners, who serve urban populations by definition. When COVID-era flexibilities lapse, UIO practitioners will have no pathway to initiate new patients on controlled substances via telemedicine. The special registration framework DEA is now creating represents the right and potentially only vehicle to establish a permanent solution.

NCUIH holds the urban Indian seat on the CMS Tribal Technical Advisory Group (TTAG) and has engaged on this rulemaking since the 2023 proposed rules on telemedicine prescribing. NCUIH’s comments address the distinct legal and regulatory circumstances of the urban Indian health system.

Current Action

When the COVID-era telemedicine flexibilities expire on December 31, 2026, an urban AI/AN patient who is ready to begin opioid use disorder treatment but cannot make an in-person appointment will have nowhere to turn. Unlike patients seen at IHS or Tribal facilities, UIO patients cannot fall back on a statutory alternative. They simply go without care. For many, loss of telemedicine prescribing flexibility would not redirect them to in-person care. It would drive them out of treatment entirely.

American Indian and Alaska Native people have the highest rate of fatal opioid overdoses of any population in the United States. Opioid overdose deaths among AI/AN people doubled between 2019 and 2021. UIOs serve these communities as primary care, behavioral health, and overdose prevention and treatment providers and they are located in counties at the center of the crisis. NCUIH’s 2024 CDC-commissioned needs assessment found that UIOs are located in counties that averaged 2,056 overdose mortalities in the first half of 2023, compared to a national county average of 209. Despite this, only 20 percent of UIOs offer medication-assisted treatment on-site, 60 percent reported legal or financial barriers to MAT provision, and 60 percent expressed interest in offering MAT but lacked the resources to do so, a direct consequence of the regulatory gap the final rule has an opportunity to close.

NCUIH’s comments make four key recommendations to DEA:

  1. Explicitly include UIO practitioners in any exemption or accessible special registration pathway established by the final rule, and recognize that IHS-eligible patients receiving care at UIOs are covered by any such pathway.
  2. Ensure administrative requirements do not effectively prohibit UIO participation, including the nationwide Prescription Drug Monitoring Program (PDMP) check requirement that was widely criticized across the 35,454 public comments submitted to the formal docket. UIOs are small, under-resourced organizations serving highly mobile, multi-state patient populations, and they lack the administrative infrastructure to absorb requirements designed for large health systems.
  3. Permit audio-only telemedicine for all OUD treatment encounters where audio-video is unavailable or not accepted by the patient, consistent with the accommodation already established in the DEA-948 final rule. Prior to the expiration of COVID-era flexibilities, IHS patients used audio-only telehealth 60 percent of the time. Restricting OUD prescribing to audio-video encounters would exclude patients without reliable internet access or video technology from tele-MOUD access.
  4. Apply continuity-of-care supply limits under the Special Registration framework sufficient to support sustained treatment for patients who face significant barriers to in-person follow-up, including transience, housing instability, and transportation barriers.

NCUIH will continue to monitor DEA’s telemedicine prescribing rulemaking and engage with federal partners to ensure that UIOs and the urban AI/AN communities they serve are not excluded from policies that expand access to life-saving SUD treatment.

NCUIH May Policy Update: 2026 Annual Conference and HIll Day Recap, Special Diabetes Program for Indians, and Indian Health Service Funding updates and more!

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In this Edition:

  • 💰 Notice of Funding Opportunities
  • 🏛️ NCUIH 2026 Annual Conference and Hill Day Recap
  • 📜 Public Health Service Access Act (S. 4416) Introduced
  • 💰 FY 2027 Funding Updates: House Proposes Increased Funding for IHS
  • 🏛️ 21 Senators Support Indian Health Service and Urban Indian Health Funding
  • 🩺 Special Diabetes Program for Indians Updates
  • 💊 Federal Medical Assistance Percentage Updates
  • 📅 FY 2028 Department of Health and Human Services Annual Tribal Budget Consultation and Secretary’s Tribal Advisory Committee Recap
  • 💉 NCUIH Submits Comments to Health Resources and Services Administration on 340B Rebate Pilot Program
  • 💻 NCUIH Comments on Telehealth Prescribing Flexibility,
  • 🏛️Center for Indigenous Innovation and Health Tribal Advisory Committee Accepting Nominations
  • 📅 Upcoming Events and Policy Dates
  • 📝 ICYMI: Recent NCUIH Policy Blog Posts

Current Funding Opportunities

SAMHSA | Now Live – Garrett Lee Smith State/Tribal Suicide Prevention and Early Intervention Due: June 15, 2026

VA | Staff Sergeant Fox Suicide Prevention Grant Program Due: June 12, 2026

  • Funds community-based organizations to provide or coordinate non-clinical suicide prevention services for Veterans, Active-Duty Service Members, and their families.
  • Award: $100,000 – $750,000 · Total program funding: $111M
  • Full details: https://www.mentalhealth.va.gov/ssgfox-grants/

IHS | Phase 2 Produce Prescription Pilot Program (P4) Due: June 22, 2026

  • Supports produce prescription programs in Tribal communities, including UIOs, enabling AI/AN individuals to receive produce prescriptions redeemable for nutritious foods through approved community organizations or health care providers. UIOs are eligible. Up to 18 awards expected.
  • Award: $200,000 – $250,000 · Total pool: $3.5M
  • Full details: https://www.grants.gov/search-results-detail/362483

IHS | IHS FY 2026 Urban Emergency Fund (UEF) Due: No fixed deadline — submit as soon as reasonably practicable after an emergency occurs.

  • Helps UIOs address costs associated with one-time, non-recurring emergencies and disaster relief efforts.
  • Award: Up to $250,000 (subject to availability of appropriations; not guaranteed)
  • Full details: Submit a written request to the applicable IHS Area Director, with copies to the Area Chief Contracting Officer and the UIO’s Contracting Officer Representative.

NCUIH’s 2026 Annual Conference – Recap

NCUIH held its 2026 Annual Conference in Washington, D.C., from April 27–30, marking the 50th anniversary of the Indian Health Care Improvement Act. Key highlights from this year’s conference included:

  • Rep. Pingree
  • Department of Health and Human Services updates
  • Substance Abuse and Mental Health Services Administration updates
  • Centers for Medicare and Medicaid Services video presentation

NCUIH’s 2026 Hill Day – 60 Visits!

NCUIH’s 2026 Hill Day was a major success, with 60 congressional office visits. Attendees urged Congress to take action on key policy priorities, including:

  • Urban Indian Health Funding
  • 100% Federal Medical Assistance Percentage for Urban Indian Organizations
  • Substance Abuse and Mental Health Services Administration Grants

NCUIH Bi-Partisan Legislation Introduced to Strengthen Urban Indian Organization Workforce

Public Health Service Access Act (S. 4416)

The Public Health Service Access Act is a legislative amendment to the Public Health Service Act that would authorize the Indian Health Service to detail U.S. Public Health Service Commissioned Officers directly to Urban Indian Organizations.

  • Introduced on April 28 by Sen. Murkowski (R-AK), Sen. Murray (D-WA), Sen. Tillis (R-NC), and Sen. Cortez Masto (D-NV)
    Public Health Service Access Act (S. 4416)

Next Steps: The bill has been referred to the Senate Committee on Health, Education, Labor and Pensions.

[Read more on NCUIH’s blog]

FY 2027 Funding Updates: House Proposes Increased Funding for IHS, Congressional and Federal Support for UIOs

On May 20, The House released their FY 2027 Interior Appropriations Bill which proposes:

  • $8.69 billion for Fiscal Year 2027 for the Indian Health Service, which is an increase of $639.8 million above the Fiscal Year 2026 enacted level.
  • $6.06 billion in Fiscal Year 2028 advance appropriations.

NCUIH submitted written testimony to House and Senate Interior and Labor-HHS Appropriations Subcommittees, requesting increased funding for urban Indian health and protection of key Indian Country programs.

FY 2027 Appropriations discussions are underway:

  • House Interior Subcommittee Markup was held on 5/21/2026 and the full Committee markup is scheduled for June 3.
  • House Labor-HHS subcommittee and full committee markups are scheduled for June 5th and 9th.

21 Senators Support Indian Health Service and Urban Indian Health Funding

On April 15, 21 U.S. Senators signed a dear-colleague letter to Senate Interior Appropriations Committee leadership for FY 2027 funding. NCUIH conducted outreach to Members of Congress in support of this effort, which included requests for

  • Full funding for Urban Indian Health and the Indian Health Service
  • Maintaining Advance Appropriations for the Indian Health Service

Read more on NCUIH’s Policy Resource Center.

Indian Health Service Chief of Staff Clayton Fulton highlights importance of UIOs at House Interior Appropriations Subcommittee budget hearing to examine the IHS Fiscal Year 2027 Budget Request

“Our urbans do incredible work for the amount of dollars that we provide them each year. They do incredible access, and we work very diligently with them and the National Council on urban Indian health to make sure that they are well accessed, whether that’s creating access to our grant programs like behavioral health, additional grants that we have in urban programs and securing them so that has been primarily our partnership, and continue to work with them.”

— Indian Health Service Chief of Staff Clayton Fulton, April 30 Indian Health Service Budget Hearing

Special Diabetes Program for Indians Updates: Funding Status, Budget Context, and Congressional Implications

The Special Diabetes Program for Indians received $200 million in FY 2026 — the highest funding level in the program’s history, representing a 25% increase. Key updates include:

  1. FY 2026 Funding: $200 million enacted; highest level in Special Diabetes Program for Indians history (+25% increase). Current authorization expires December 31, 2026.
  2. FY 2027 President’s Budget: The $49.4 million reflected in the FY 2027 President’s Budget represents approximately one quarter of the annual $200 million level — roughly three months of funding before the authorization expires — minus $1 million in automatic sequestration cuts.
  3. Program Risk: No funding authority after January 1, 2027, without reauthorization. 31 UIOs receive SDPI grants. A lapse in authorization would cut off diabetes prevention and treatment services at tribal and urban Indian programs.

Pending Legislation:

  • Special Diabetes Program Reauthorization Act of 2025 (S.2211) – Introduced by Senators Collins and Shaheen on July 8, 2025, to reauthorize both the Special Diabetes Program for Type 1 Diabetes and the Special Diabetes Program for Indians.
  • House companion bill, H.R. 5461, was also introduced.

Congress must act to pass S. 2211 or comparable reauthorization legislation before December 31, 2026, to prevent a lapse in program authority.

Read more on NCUIH’s blog.

FY 2028 Department of Health and Human Services Annual Tribal Budget Consultation – Recap

On April 24, NCUIH submitted formal comments to the FY 2028 HHS Annual Tribal Budget Consultation. Key requests included:

  • Funding for Urban Indian Health and IHS at the full amount requested by Tribes
  • Mandatory appropriations for the Indian Health Service and exemption of HHS Indian Country funding from sequestration
  • UIO inclusion in budget formulation
  • Legislative fix to set FMAP at 100% for Medicaid services provided at UIOs.

The FY 2028 HHS Annual Tribal Budget Consultation was held April 21-22 in Washington, D.C. Support was shown for urban Indian health as HHS leadership highlighted their visits to UIOs and Tribal leaders raised that the proposed decrease for Urban Indian Health in the FY 2027 President’s Budget threatens UIOs and supported 100% Federal Medical Assistance Percentage (FMAP) for UIOs.

Department of Health and Human Services Secretary’s Tribal Advisory Committee Meeting – Recap

On April 23, NCUIH attended the HHS Secretary’s Tribal Advisory Committee (STAC) meeting.

Key highlights include:

  1. Secretary Kennedy named Urban Indian Organizations — including Native Health, Native American Connections, and Oklahoma City Indian Clinic — as models for traditional food integration and traditional healing-based substance use treatment.
  2. NCUIH acknowledged the Secretary for his support of 100% FMAP for UIOs, which he committed to working with Senator Cantwell on at an April 22 Senate Finance committee Hearing.

SAMHSA Issues Updated Harm Reduction Funding Guidance – What Can and Cannot Be Supported

SAMHSA has issued updated guidance clarifying what supplies and services can and cannot be supported with SAMHSA funding.

We encourage UIOs to review the Dear Colleague letter to assess any implications for your specific grants.

NCUIH Submits Comments to Health Resources and Services Administration Supporting Indian Health Care Provider Exemption from 340B Rebate Pilot Program

On April 20, NCUIH submitted comments to the Health Resources and Services Administration (HRSA) in response to its Request for Information on the 340B Rebate Model Pilot Program, which poses significant administrative and financial burdens for UIOs.

  • Requests include tribal consultation/urban confer and exemption for IHS, Tribal, and UIO providers from any rebate-based 340B pilot model.

NCUIH and CMS Tribal Technical Advisory Group Support Flexibility in Telehealth Prescribing for Urban Indian Organizations

The Drug Enforcement Administration (DEA) is conducting Tribal consultation on a framework for prescribing controlled substances via telemedicine and is seeking input on the unique healthcare access challenges facing urban American Indian and Alaska Native communities.

  • May 8 – NCUIH submitted comments to the DEA highlighting the statutory exclusion of UIOs from the existing Indian health telemedicine exception.
  • May 7 – NCUIH worked with UIOs and the CMS Tribal Technical Advisory Group (TTAG) in sending a letter to DEA, which included urban American Indian and Alaska Native patient access barriers, the critical role of audio-only telehealth, and the need for telehealth flexibilities for patient treatment.

HHS is Accepting Nominations for the Center for Indigenous Innovation and Health Tribal Advisory Committee

The HHS Office of Minority Health is accepting nominations for the Center for Indigenous Innovation and Health Tribal Advisory Committee (CIIH TAC).

  • TAC Membership: 3 delegates from IHS geographic areas and 3 National At-Large Member positions (must be nominated by an elected Tribal leader).
  • Nomination accepted until roles filled

Learn more on the Federal Register Notice.

Upcoming Events and Policy Dates

  • May 27 — Department of Veterans Affairs I/T/U Reimbursement Agreement Webinar (link)
  • June 2 — Indian Health Service Tribal Leaders Diabetes Committee Quarterly Meeting (virtual)

Recent NCUIH Policy Blogs

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.

Special Diabetes Program for Indians Faces Funding Cliff Without Congressional Reauthorization

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The Consolidated Appropriations Act, 2026 (P.L. 119-75), signed into law in February 2026, reauthorized the Special Diabetes Program for Indians (SDPI) at $200 million per year — a 25% increase and the highest funding level in program history. The law also sets the stage for a critical decision point: SDPI’s authorization expires December 31, 2026, and without further Congressional action, the program will lose all funding authority on January 1, 2027.

SDPI is authorized under Section 330C of the Public Health Service Act. The $49.4 million reflected in the FY 2027 President’s Budget represents approximately one quarter of the annual $200 million level — roughly three months of funding before the authorization expires — minus $1 million in automatic sequestration cuts. The Office of Management and Budget (OMB) also elected not to include any mandatory program funding projections across the government in this year’s budget submission, which further contributes to SDPI appearing as a reduction.

Thirty-one Urban Indian Organizations (UIOs) receive SDPI grants. A lapse in authorization would cut off diabetes prevention and treatment services at tribal and urban Indian programs.

Congressional Action

At the April 21, 2026, Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies (LHHS) hearing on the FY 2027 HHS budget, Senator Jeanne Shaheen (D-NH) raised SDPI as part of a broader statement on the administration’s proposed cuts to diabetes prevention and research. Noting that 42 million Americans are currently living with diabetes and that American Indian and Alaska Native communities face disproportionately high rates of the disease, Senator Shaheen highlighted the apparent 75% reduction to SDPI alongside the elimination of CDC diabetes education programs and the termination of a major diabetes and dementia research study. Senator Shaheen, along with Senator Susan Collins (R-ME), led the bipartisan effort that secured the most recent SDPI reauthorization and the $200 million funding level enacted in February 2026.

Pending Legislation

On July 8, 2025, Senators Collins and Shaheen introduced S. 2211, the Special Diabetes Program Reauthorization Act of 2025, to reauthorize both the Special Diabetes Program for Type 1 Diabetes and the Special Diabetes Program for Indians. The bill was referred to the Senate Committee on Health, Education, Labor, and Pensions (HELP), where it remains pending. A House companion bill, H.R. 5461, was also introduced. The legislation has drawn bipartisan support, with 11 cosponsors across both parties. Congress must pass reauthorization legislation before December 31, 2026, to prevent a lapse in program authority.

Background

SDPI was established to address the disproportionately high rates of diabetes among American Indian and Alaska Native populations. The program funds prevention, treatment, and education initiatives at tribal and urban Indian health programs across the country. As a mandatory appropriation, SDPI requires periodic Congressional reauthorization to continue — it does not renew automatically each year like discretionary programs.

Next Steps

Congress must act to pass S. 2211 or comparable reauthorization legislation before December 31, 2026, to prevent a lapse in program authority. NCUIH will continue to monitor SDPI reauthorization efforts and advocate for continuation of the program at the full $200 million funding level.

IHS Announces SDPI Grant Supplements, Consultation and Confer

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On May 21, 2026, the Indian Health Service (IHS) issued a Dear Tribal Leader and Urban Indian Organization Leader letter announcing two significant actions related to the Special Diabetes Program for Indians (SDPI): administrative grant supplements for all current grantees and a commitment to Tribal Consultation and Urban Confer on additional funding. The letter was signed by IHS Chief of Staff Clayton Fulton.

Background

The Consolidated Appropriations Act, 2026 (P.L. 119-75), signed into law in February 2026, reauthorized SDPI at $200 million per year — a $41 million increase above the prior funding level and the highest authorization in program history. The law also provided $50 million for the first three months of FY 2027, extending authorization through December 31, 2026.

SDPI is authorized under Section 330C of the Public Health Service Act. Unlike discretionary programs, SDPI requires periodic Congressional reauthorization to continue and does not renew automatically. Thirty-one Urban Indian Organizations (UIOs) are among the 310 current SDPI grant recipients. SDPI grants are awarded on a calendar year cycle, distinct from the federal fiscal year appropriations cycle.

IHS Actions

Administrative supplements. IHS will distribute 25 percent administrative supplements to all 310 current SDPI grant recipients, drawing on one-time unobligated carryover SDPI funding. Remaining CY 2026 annual grant funding will be made available to recipients on or before June 30, 2026.

Tribal Consultation and Urban Confer. IHS announced its intention to conduct Tribal Consultation and Urban Confer regarding the use of additional SDPI funds resulting from the FY 2026 reauthorization increase. Details on the process will be forthcoming.

TLDC Engagement

The IHS Tribal Leaders Diabetes Committee (TLDC) is charged under IHS Circular 25-11 with making recommendations to the IHS Director on the distribution of SDPI funds and broad-based policy and advocacy priorities related to diabetes in American Indian and Alaska Native (AI/AN) communities. The TLDC has been actively engaged with IHS on SDPI funding administration. NCUIH serves as a technical advisor to the TLDC, representing the interests of urban AI/AN communities and the UIOs that serve them.

Next Steps

NCUIH will continue to monitor developments related to SDPI reauthorization, the forthcoming Tribal Consultation and Urban Confer process, and IHS’s administration of SDPI funding.

NCUIH Honors Senator Tina Smith for Her Leadership and Legacy in Urban Indian Health

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FOR IMMEDIATE RELEASE

WASHINGTON, D.C. (May 20, 2026) – The National Council of Urban Indian Health (NCUIH) presented the Urban Indian Health Champion Award to Senator Tina Smith (D-MN) during NCUIH’s 2026 Annual Conference.

For years, Senator Smith has shown up for urban Indian health in ways that matter. In 2020, she co-introduced the bipartisan Coverage for Urban Indian Health Providers Act, which extended Federal Tort Claims Act (FTCA) coverage to Urban Indian Organizations (UIOs), a concrete win for UIOs and the communities they serve. That victory is just one example of the impactful change Senator Smith has worked to deliver for Indian Country.

From Left to Right: Dr. Patrick Rock CEO Indian Health Board of Minneapolis (IHB) (Leech Lake Band of Ojibwe), Senator Tina Smith, Joni Buffalohead, Chairwoman (Sisseton Wahpeton Oyate), Mike Goze, IHB Board member (Ho-Chunk Nation of Wisconsin)

Year after year, Senator Smith has also led the Senate Dear Colleague letter to the Interior Appropriations Subcommittee, which requested the maximum funding for urban Indian health and advance appropriations for the Indian Health Service. It is a consistent, reliable act of leadership that UIOs across the country depend on.

As Senator Smith prepares to conclude her Senate service at the end of her term, this award also celebrates her legacy. Over the course of her tenure, she has helped transform how Congress thinks about urban Indian health. We are deeply grateful for everything she has done for urban Indian communities and honored to recognize her with this award.

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.

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

Murkowski, Tillis, Murray, and Cortez Masto Introduce Bipartisan Bill to Strengthen Urban Indian Organization Workforce

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U.S. Senators Lisa Murkowski (R-AK), Patty Murray (D-WA), Thom Tillis (R-NC), and Catherine Cortez Masto (D-NV) have introduced bipartisan legislation to allow U.S. Public Health Service Commissioned Corps officers (PHSCOs) to be detailed directly to Urban Indian Organizations (UIOs).

Recently, Secretary Kennedy assigned 70 officers to Indian Health Service facilities to help stabilize staffing needs. Allowing PHCSOs to be detailed directly to UIOs is a longstanding priority that would improve capacity to serve patients and families.

“UIOs provide far more than a place for an annual check-up; they deliver culturally grounded care that reflects the needs and values of the communities they serve,” said Senator Murkowski. “All Native people deserve access to quality health care, whether they live in a city or a rural community. Ensuring these facilities are adequately staffed will strengthen health outcomes for American Indian and Alaska Native communities nationwide and help fill a critical gap in care.”

“Nevada’s Urban Indian health facilities are chronically understaffed,” said Senator Cortez Masto. “Even the best doctors and nurses can’t provide patients with the quality of care that they need if there simply aren’t enough of them. This commonsense fix gives the Department of Health and Human Services the flexibility it needs to ensure that Tribal communities across the Silver State can get the health care they need.”

“We are grateful to Senators Murkowski, Murray, Tillis, and Cortez Masto for championing this bipartisan effort to allow U.S. Public Health Service Commissioned Officers to be detailed directly at urban Indian organizations. Due to limited funding, Urban Indian Organizations continue to face significant challenges in recruiting and retaining skilled health care professionals, and detailing Commissioned Officers help them address workforce shortages and increase collaboration across the federal health care system. We urge Congress to pass this legislation swiftly so that Urban Indian Organizations can benefit from this vital workforce support.” — Francys Crevier (Algonquin), CEO of NCUIH

Background

The Public Health Services for Advancing Care and Creating Efficient Support Systems in Underserved Communities Act, or the PHS ACCESS Act, would amend Section 214 of the Public Health Service Act to formally authorize the Health and Human Services (HHS) Secretary to detail PHCSOs to UIOs to perform work related to the functions of HHS. Detailing officers to UIOs would help address persistent workforce shortages at UIOs, bring skilled, federally-supported clinicians and public health professionals into urban Indian health settings, and strengthen coordination across the broader Indian health system.

Next Steps

The bill has been referred to the Senate Committee on Health, Education, Labor, and Pensions. The bill will need to be passed out of the Committee before receiving full consideration from the Senate.