National Tribal Budget Formulation Workgroup Releases Recommendations for Fiscal Year 2027, Recommends Full Funding for Indian Health Service and Urban Indian Health

In April 2025, the National Tribal Budget Formulation Workgroup (NTBFW) released their fiscal year (FY) 2027 Tribal Budget Recommendations, The Federal Trust Responsibility to Tribal Nations: A Strategy to Advance Indian Health Care, as part of the Indian Health Service (IHS) Budget Formulation process. The NTBFW recommends $1.09 billion for the Urban Indian Health line item and $73 billion for IHS. The NTBFW also recommends that IHS retain and expand eligibility for Urban Indian Organizations (UIOs) to participate in grant programs and ensure that UIOs are included in exemptions for Medicaid reform, including work requirements.

Read the full recommendations here.

Background on IHS 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 (HHS) and the Director of the Office of Management and Budget (OMB). 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.

The National Council of Urban Indian Health (NCUIH) assists UIOs in advocating for their needs during the IHS Area level consultation sessions and presents information on UIOs’ priorities and needs during the February Area Report Webinar. NCUIH supports full funding for the IHS, Tribal, and UIOs (I/T/U) system.  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.

NCUIH Congratulates Mark Cruz on Appointment as HHS Senior Advisor, Reaffirming Secretary Kennedy’s Commitment to Indian Country

On Thursday, June 20th, 2025, Mark Cruz, a citizen of the Klamath Tribes, was sworn in by Secretary of Health and Human Services Robert F. Kennedy Jr. as Senior Advisor to the Secretary. Mr. Cruz’s appointment demonstrates the Secretary’s commitment to fulfilling the promise he made during his confirmation hearing to ensure that Native voices have a seat at the highest levels of the Department.

During the ceremony Secretary Kennedy said, “Indian Country is not just a concern of mine—it is a top priority. We cannot Make America Healthy Again without making Native health a central focus… it is very important to me to have a Native American in my direct inner circle so that every decision we make at HHS takes into consideration the impacts and the potential opportunities for Native Americans.”

The National Council of Urban Indian Health commends Mr. Cruz on this important appointment, and looks forward to working with Mr. Cruz and the HHS team to elevate urban Native health and uphold the trust responsibility to all Native communities, no matter where they live.

NCUIH June Update: Budget Numbers, Appropriations Timeline, Calls to Act

In this Edition:

📊 FY 2026 Budget: The President’s request funds IHS at $8.1 billion and Urban Indian Health at $90.4 million while omitting advance appropriations.

🏛 House Appropriations: At the Interior Subcommittee hearing, Reps. Simpson, Pingree, and Cole pledged to retain advance appropriations, with mark-ups set for June 23 and 26.

✉️ Native Caucus Letter: Members have until June 23 to sign the Native American Caucus letter urging protection of Tribal and Urban Indian programs.

⚖️ Reconciliation: Senate drafts keep the AI/AN Medicaid work-requirement exemption, but the SNAP exemption is absent and may be revived on the floor.

📝 NCUIH Advocacy: NCUIH submitted testimony to appropriators and circulated comment letters on SNAP and CMS waivers that defend AI/AN health protections.

🏥 IHS Consultations: Comments are open on EHR modernization and regional realignment, with an Urban Confer on July 28 and final comments due August 28.

🤝 NCAI Mid-Year: NCUIH President Walter Murillo co-chaired the Health Subcommittee as resolutions advanced priorities on Medicaid, IHS funding, and nutrition programs.

💡 Medicaid Guidance: HHS issued a memo directing states to align Medicaid payments with Medicare rates, trimming oversized state-directed payments.

📆 Save the Dates: OUIHP Executive Call (June 26), Monthly Policy Workgroup (July 16), IHS Virtual Urban Confer on IHS Proposed Realignment (July 28), and TTAG Quarterly Meeting (July 29-30).

Fiscal Year 2026 Budget Request and Appropriations

President’s Proposal: New Investments, No Advance Appropriations

The President proposes $8.1 billion dollars for the Indian Health Service and $90.4 million dollars for Urban Indian Health, with new investments in diabetes care, behavioral health, and disease-prevention initiatives, but without advance appropriations.

Key Indian Country Provisions

  • IHS: $8.1 Billion – Minor increase but largely flat.
  • Urban Indian Health: $90.4 million – flat funded
  • Advance appropriations not included, despite the inclusion for FY 2026 in the FY 2025 continuing resolution.
  • Reauthorization for the Special Diabetes Program for Indians (SDPI) – $159 million.
  • NEW: Native American Behavioral Health and Substance Use Disorder program – $80 million
  • NEW: Prevention Innovation Program- $19 million set aside for Tribes, tribal organizations, UIOs, and health service providers to Tribes serving rural communities experiencing poor chronic disease and maternal health outcomes.

House Interior Appropriations Subcommittee IHS FY 2026 Budget Hearing Highlights

Acting Director Ben Smith testified and highlighted Secretary Kennedy’s visit to NATIVE HEALTH.

Committee Chairman Cole reaffirmed commitment to stable funding for IHS: “One thing I can assure you, we didn’t get here to give it up. I can just tell you now, we will be retaining advanced appropriations.”

Subcommittee Chair Simpson and Ranking Member Pingree expressed disappointment in advance appropriations not being included in the President’s request.

Rep. Celeste Maloy (R-UT-02) applauded the work of Urban Indian Center of Salt Lake, stating “Utah has only one Urban Indian Organization—the Urban Indian Center of Salt Lake—and they’re doing terrific work. What more can Congress do to make sure centers like this get the resources they need?” In response, Acting IHS Director, Ben Smith, cited stronger consultation and issue tracking that includes UIO feedback.

Native American Caucus Dear Colleague Letter to Protect Tribal Programs in FY 2026 Closes June 23rd

Reach out to your Member of Congress to sign on by June 23rd, 2025

Requests to House Appropriations Committee:

  • Safeguard and support all federal funding flowing to Indian Country to ensure successful delivery of services.
  • Support funding necessary to maintain federal employee positions that service Tribal nations and the federal offices that provide these services.

ICYMI:

On June 17th, 2025, Adrianne Maddux (Hopi), Executive Director of Denver Indian Health and Family Services and NCUIH Board Treasurer, attended the Tribal Leaders Diabetes Committee Meeting meeting representing Urban Indian Organizations. The next meeting is set for September 16th, 2025.

On June 12th, 2025, NCUIH submitted Written Testimony to the Senate Interior Appropriations Committee. Requests included:

  1. Protect Funding for the IHS and fund Urban Indian Health at $100 million for FY26
  2. Maintain Advance Appropriations for the IHS, until mandatory funding is achieved, and protect IHS from sequestration.
  3. Appropriate $80 million for the Native Behavioral Health Resources program
  4. Ensure Federal Policies Uphold Trust Obligations to American Indian and Alaska Native Communities

On June 12th, 2025, NCUIH submitted Written Testimony to the Senate LHHS Appropriations Committee. Requests included:

  1. Protect Funding for the Indian Health Service and fund Urban Indian Health
  2. Ensure Federal Policies Uphold Trust Obligations to American Indian and Alaska Native Communities
  3. Fund the Initiative for Improving Native American Cancer Outcomes at $10 million for FY26
  4. Fund the Good Health and Wellness in Indian Country (GHWIC) Program at $30 Million for FY26
  5. Appropriate $80 million for the Native Behavioral Health Resources program
  6. Protect Funding for HIV/AIDS Prevention and Treatment

Budget Reconciliation and Policy Development

Senate Finance Text

On June 16th, 2025, the Senate Finance Committee released their reconciliation text.

  • NCUIH worked with the Committee to maintain the AI/AN exemption for Medicaid work requirements.
  • NCUIH worked with the Committee to provide an AI/AN Exemption from new 6-month redetermination requirement for the Medicaid expansion population.

Senate Agriculture Text

On June 16th, 2025, the Senate Ag Committee also released their reconciliation text.

  • The text does not currently have an AI/AN work requirement exemption for SNAP.
  • However, the exemption could still be brought as a floor amendment.

On June 11th, 2025, NCUIH provided a letter template to UIOs to send to Senate Agriculture Chair Boozman in support of the proposal exempting Native people from work requirements and promoting Tribal administration of SNAP.

Indian Health Service Reorganization and Admin Announcements

IHS Reorganization

Announced by IHS Acting Director Ben Smith: IHS is dividing the hospital system into two regions, north and south, and the hospitals will report to Loretta Christensen. All of the IHS Area Directors will report to Dr. Beverly Cotton. IHS published a DTLL/DULL on the proposed realignment with dates for the in-person Tribal Consultation sessions and virtual Urban Confer. The virtual Urban Confer is scheduled for July 28th. Comments are due August 28th.

Admin Announcements

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June 6th Memo – Eliminating Waste, Fraud, and Abuse in Medicaid

Directs HHS to take appropriate action to ensure Medicaid payments rates are not higher than Medicare, to the extent permitted by applicable law.

Previous Trump Administration policy allows states to make State Directed Payments (SDPs) up to the average commercial rate.

NCUIH Co-Chairs and Presents at NCAI Mid-Year Convention Health Subcommittee

On June 9th, 2025, NCUIH Board President, and CEO of Native Health, Walter Murillo (Choctaw), co-chaired the Health Subcommittee at the National Congress of American Indians Mid-Year Convention, advancing resolutions on Medicaid, Indian Health Service funding, behavioral health, and nutrition. Topics for resolutions passed included:  Medicaid exemptions for AI/AN, FY26 Indian Health Service budget support, Native Connections grant support, Promoting the Director of Indian Health Service to Assistant Secretary, and SNAP work requirement exemption.

NCUIH Actions

June 14th – NCUIH Submitted Comments to IHS on the IHS Health Information Technology (HIT) Modernization: Four Directions Warehouse

NCUIH requested IHS provide clarification to UIOs on the 4DW about access for all UIOs; support IHS, Tribal, and UIO (I/T/U) facilities for data migration and transition to PATH EHR; and communicate regularly with facilities about the HIT Modernization project.

NCUIH provided a comment template to UIOs.

The next joint IHS TC/UC session on HIT Modernization will be held virtually via Zoom on August 7th, 2025, 1:30-3 PM Eastern.

Over the last month, NCUIH Submitted Comments Supporting Exempting AI/AN People from Work Requirements in Proposed Amendments to State Medicaid programs:

  • May 28th – South Carolina Palmetto Pathways to Independence
  • May 28th – CMS Georgia Pathways to Coverage Program
  • June 12th – Kentucky
  • June 18th – South Dakota

Key Upcoming Dates

Several forums this summer invite Urban participation: 

  • Office of Urban Indian Health Programs Executive Directors call – June 26th.
  • Monthly Policy Workgroup – July 16th.
  • IHS Virtual Urban Confer on IHS Proposed Realignment- July 28th.
  • Tribal Technical Advisory Group quarterly meeting – July 29–30th.
  • IHS Virtual TC/UC session on HIT Modernization- August 7th.
  • IHS Division of Behavioral Health Virtual UIO Listening Session – August (date TBD)

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 Submits Written Testimony Urging Senate to Protect Funding of Indian Health Service & Funding for Key Indian Health Programs in FY 2026

On June 12, 2025, the National Council of Urban Indian Health (NCUIH) submitted outside written testimony to the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies (LHHS) and the Senate Appropriations Committee on Interior, Environment, and Related Agencies regarding Fiscal Year (FY) 2026 funding for Urban Indian Health. NCUIH called for protecting funding for the Indian Health Service (IHS) and urban Indian Health and increased resources for American Indian and Alaska Native health programs.

In the testimonies, NCUIH requested the following:

  • Protect Funding for IHS and fund Urban Indian Health
  • Maintain Advance Appropriations for the IHS, until mandatory funding is achieved, and protect IHS from sequestration.
  • Ensure Federal Policies Uphold Trust Obligations to American Indian and Alaska Native Communities
  • Appropriate $80 million for the Native Behavioral Health Resources program
  • Fund the Initiative for Improving Native American Cancer Outcomes at $10 million for FY26
  • Fund the Good Health and Wellness in Indian Country (GHWIC) Program at $30 Million for FY26
  • Protect Funding for HIV/AIDS Prevention and Treatment

Next Steps:

This testimony will be considered by the Senate Committees and used in the development of the Committee’s priorities. NCUIH will continue to support these requests in the 119th Congress and work closely with Committee members and staff.

Background on President’s FY 2026 Budget Proposal: Increased for IHS, Stable Funding for Urban Indian Health, Advance Appropriations for IHS Not Included

The President’s FY 2026 proposed budget includes a $90.4 million for Urban Indian Health. This amount is flat with the FY 2025 enacted amount. The President’s proposal also requests $8.1 billion for IHS which includes reauthorization for the Special Diabetes Program for Indians (SDPI) for $159 million. HHS also proposes $80 million for the newly funded Native American Behavioral Health and Substance Use Disorder program to be administered through the Administration for Healthy America (AHA). HHS’ Budget in Brief and IHS Congressional Justification do not include advance appropriations for IHS, despite the inclusion of advance appropriations for FY2026 in the March 14 Continuing Resolution, which funded the government through the end of FY2025.

Read our full analysis of the President’s proposed FY 2026 budget.

NCUIH Work on FY 2026 Funding

Contact Congress to Protect Funding for Tribal Programs TODAY

Dear Friends,

NCUIH worked with the Coalition for Tribal Sovereignty to support the Congressional Native American Caucus in leading a letter to support and protect funding for Tribal Programs and Urban Indian Organizations in the FY26 budget. The letter highlights that funding flowing to Indian Country is a furtherance of trust and treaty obligations and therefore must be safeguarded from harmful cuts and changes.

It is crucial to notify Congress of your support for Tribal Programs and Urban Indian Organizations and request that they sign on to the Native American Caucus letter.

For your convenience, we have provided the text below as a template to call and/or email your Representative. If you can, we recommend you call and email your Representative. You can find your Representative here.

Your outreach on this is invaluable to providing greater access to health care for American Indian and Alaska Native people.

Sincerely,

The National Council of Urban Indian Health

Ways to Advocate

  • Contact Congress
  • Post on Facebook
CONTACT CONGRESS

Step 1: Copy the email below.

Step 2:Find your representative here.

Step 3: Go to their website and click contact.

Step 4: Paste the email into the form and send. Please contact Jeremy Grabiner (policy@ncuih.org) with questions.

Email to Your Representative

Dear Representative [NAME],

As an urban Indian health advocate, I respectfully request that you sign on to the bipartisan Congressional Native American Caucus letter to the House Committee on Appropriations in support of funding for Tribal programs, including Urban Indian Organizations in the FY26 budget.

These programs deliver on the United States’ trust and treaty obligations to Tribal Nations and Tribal citizens. As such, funding for these programs must be safeguarded to ensure successful delivery of services to Tribal citizens and Tribal Nations.

Tribal programs are unique because they are delivered in recognition of Tribal Nations’ and Native people’s unique political status under the U.S. Constitution, as recognized by the U.S. Supreme Court. I respectfully ask that you help honor the federal trust obligation to provide health services to Native people, no matter where they live, by signing on to this letter.

Sign on to the letter by reaching out to Vittoria Casey (vittoria.casey@mail.house.gov). The deadline to sign on to the letter is June 23, 2025.

Thank you for your leadership and your commitment to Indian Country.

Sincerely,

[contact information]

POST ON SOCIAL MEDIA

Example post: 

We need your help to support American Indian and Alaska Native communities! Tribal programs and Urban Indian Organizations are essential to delivering on the United States’ trust and treaty obligations, and funding for these programs must be protected. Call on your Representative TODAY and urge them to sign on to the Native American Caucus Tribal Programs support letter.

NCUIH Supports Tribal Sovereignty  

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

House Appropriations Subcommittee examines IHS Fiscal Year 2026 Budget, Bipartisan Lawmakers Defend Stable Funding for IHS

On June 5, the House Appropriations Subcommittee on Interior, Environment, and Related Agencies held a hearing where Acting Indian Health Service (IHS) Director Benjamin Smith and Chief Financial Officer Jillian Curtis testified on the President’s Fiscal Year 2026 budget request for IHS, which notably does not include advance appropriations. Members from both sides of the aisle expressed commitment to retain advanced appropriations for IHS. Questions covered support for deepened urban consultation, staffing needed for the June 2026 electronic health record launch, and continued investment in the Special Diabetes Program for Indians and related food-as-medicine pilots.

Hearing Highlights

The discussion covered core operational challenges and featured direct reference to an Urban Indian Organization (UIO) in Utah. Below are the main points raised by members and witnesses.

  • Advanced Appropriations for IHS: Bipartisan support for advance appropriations was clear. Members from both parties emphasized that advance appropriations remain essential for keeping IHS hospitals and clinics open during funding lapses like government shutdowns. House Appropriations Chairman Tom Cole (Chickasaw, R-OK-04) reiterated his support, saying, “One thing I can assure you, we didn’t get here to give it up; Congress will keep advance appropriations in place,” despite its omission from the FY 2026 request. 
  •  Urban Indian Organization Services: Rep. Celeste Maloy (R-UT-02) praised the Urban Indian Center of Salt Lake and asked how Congress can bolster urban Native health; Director Smith cited stronger consultation and issue-tracking, including UIO feedback.
  • Electronic Health Record modernization: Chair Simpson (R-ID-02) asked whether the new Oracle-Cerner platform will turn on in June 2026; Director Smith confirmed the schedule and acknowledged that “about fifty specialized positions remain open” and that IHS staffing is “still hovering near thirty percent vacant.” If vacancies persist, Ranking Member Chellie Pingree (D-ME-01) pressed for contingency plans. 
  • Special Diabetes Program for Indians (SDPI): Rep. Betty McCollum (D-MN-04) highlighted the fact that eighty percent of SDPI grants now target youth prevention, calling the program “a model the rest of public health should copy.” Members from both parties applauded complementary “food-as-medicine” pilots such as Produce Prescription.
  • Workforce Pipeline: Ranking Member Chellie Pingree (D-ME-01) urged IHS to widen its scholarship and loan-repayment programs by co-funding new rural residency rotations with the Veterans Health Administration and HRSA. Smith said the inter-agency task force is “standing up the first joint primary-care rotations for 2026 graduates” and will report back on early recruitment data.

What’s Next

House Interior Appropriations will propose their budget on the June 23 subcommittee markup and the June 26 full committee markup.

Background

Read our full analysis of the proposed budget: ANALYSIS: President Trump Proposes Increase for Indian Health Service, Stable Funding for Urban Indian Health for FY 2026

Lawmakers and Tribal Leaders Emphasize Importance of HHS Programs for Native Healthcare in Senate Committee on Indian Affairs Oversight Hearing

On May 14, 2025, the United States Senate Committee on Indian Affairs held an Oversight Hearing on “Delivering Essential Public Health and Social Services to Native Americans – Examining Federal Programs serving Native Americans across the Operating Divisions at the U.S. Department of Health and Human Services.” The purpose of this hearing was to examine programs within the Department of Health and Human Services (HHS), specifically non-Indian Health Service (IHS) programs, that are essential to upholding the federal government’s trust responsibility. The trust responsibility requires the federal government to provide healthcare services to American Indian and Alaska Native people.

Watch the hearing here.

Senators and Tribal Leaders Emphasize Importance of HHS Resources and Highlight UIO Stories

In her opening, Senator Lisa Murkowski (R-AK) emphasized the importance of HHS programs for American Indian and Alaska Native communities: “As we look broadly at the programs within HHS, we have to remember that for many Native communities, non-IHS programs are just as important as those under the IHS. From public health initiatives to social services, these programs often provide the only consistent access to basic supports for the most vulnerable members of Native communities.” Senator Brian Schatz (D-HI) added to this by stating that there is a bipartisan agreement within the Committee that American Indian and Alaska Native communities need more help, and that “now is the time to stand together and protect Native healthcare.”

Chairwoman Janet Alkire, Standing Rock Sioux Tribe, testified that “despite chronic underfunding, Tribal Nations, Tribal Organizations, and Urban Indian Organizations rely on HHS resources to deliver life-saving care.” She also shared a story from an urban Indian organization (UIO) who lost communication with their Project Officer and Grants Manager for the Centers for Disease Control and Prevention (CDC) Healthy Tribes Program. This led to a gap in their program and ability to provide services to their patients.

Senator Catherine Cortez Masto (D-Nevada) asked witnesses to provide details about the importance of mental health programs at HHS, specifically Native Connections, by sharing a story about a patient at a UIO in Nevada: “There’s a nine-year old girl in Nevada Urban Indians who was struggling with mental health. And she did not – could not get the care from a school or pediatrician, but it was Native Connections’ program that, according to her father, got his daughter back.”

Senator Murkowski closed the hearing by stating, “The message I would like to leave with, with all of you, is amidst this uncertainty, know that we’ve got all got to link arms and get through this together.”

Background

NCUIH worked with the National Indian Health Board in preparation of the oral testimony of Chairman Alkire. NCUIH will also be submitting written testimony to the Committee.

ANALYSIS: President Trump Proposes Increase for Indian Health Service, Stable Funding for Urban Indian Health for FY 2026

On May 30, 2025, the Department of Health and Human Services (HHS) published their Fiscal Year (FY) 2026 Budget in Brief and the Indian Health Service (IHS) published the IHS Justification for Estimates for Appropriations Committees for FY 2026 (hereinafter Congressional Justification).

Proposed Funding for the Urban Indian Health Line Item and the Indian Health Service

The President’s Budget includes a $90.4 million for Urban Indian Health. This amount is flat with the FY 2025 enacted amount. The President’s proposal also requests $8.1 billion for IHS which includes reauthorization for the Special Diabetes Program for Indians (SDPI) for $159 million. HHS also proposes $80 million for the newly funded Native American Behavioral Health and Substance Use Disorder program to be administered through the Administration for Healthy America (AHA).

Advance Appropriations

HHS’ Budget in Brief and IHS Congressional Justification do not include advance appropriations for IHS, despite the inclusion of advance appropriations for FY2026 in the March 14 Continuing Resolution, which funded the government through the end of FY2025. Advance Appropriations are essential to provide stability and insulate to Indian health care providers from the effects of budgetary disagreements. Congress first included Advance Appropriations for IHS in the FY 2023 Omnibus and included Advance Appropriations in budgetary legislation for FY 2024 and FY 2025. Maintaining Advanced appropriations is a top priority for Indian Country, as they ensure that funding remains stable for Indian health care providers even in the event of a government shut down.

Mandatory Funding

The HHS Budget in Brief and IHS Congressional Justification do not include a request to shift the IHS budget from discretionary to mandatory appropriations either in whole or in part. The shift from discretionary to mandatory funding for the IHS budget has been a long-term request from Indian Country to ensure stable and predictable funding for the Indian health system. The budget also does not include a request to shift CSC and Section 105(l) lease funding from discretionary to mandatory, which has become a high priority issue in Indian Country this past year due to the recent Supreme Court decision in San Carlos Apache v. Becerra.

FY 2026 President’s Budget Highlights for IHS

Line Item FY 23 Enacted FY 25 Enacted FY 26 Tribal Request FY 26 President’s Budget
Urban Indian Health $90.42 million

 

$90.4 million $770.5 million $90.4 million
Indian Health Service $6.96 billion $7.1 billion $63 billion $8.1 billion
Hospital and Clinics $2.5 billion $2.58 billion $13.8 billion $2.65 billion
Tribal Epidemiology Centers $34.4 million $34.4 million _______________ $34.4 million
Electronic Health Record System $218 million $190.56 million $659.4 million $190.5 million
Community Health Representatives $65.21 million $65.2 million $1.58 billion $65 million
Mental Health $127.1 million $130.1 million $4.76 billion $131 million

Note: While previous years’ budgets included proposals for advance appropriations and funding for the IHS Cancer Moonshot Initiative and resources for HIV, hepatitis and syphilis prevention and treatment, this year’s Budget in Brief and IHS Congressional Justification do not include these items. IHS continues to list targeting HIV, hepatitis and syphilis as services IHS offers in the IHS Congressional Justification.

Overview of HHS Budget

Indian Health Service

The Budget in Brief and IHS Congressional Justification propose funding IHS for $8.1 billion in FY 2026. The proposed funding amount includes $90.4 million for Urban Indian Health and reauthorization of SDPI for one year for $159 million. This represents an increase for IHS, flat funding for Urban Indian Health compared to FY 2025, and a decrease of $363,000 for SDPI. IHS also estimates funding Contract Support Costs (CSCs) and Section 105(l) leases through an indefinite discretionary appropriation of $1.7 billion and $413 million, respectively. This represents a proposed 47% increase for CSCs and a proposed 93% increase for Section 105(l) leases. IHS proposes a significant decrease in Sanitation Facilities Construction from $106.6 million enacted in FY 2025 to $13.49 million proposed in the IHS Congressional Justification, a $93.13 million decrease, and an increase to Clinical Service to account for $6 million to support the delivery of healthcare services for the Lumbee Tribe. The increases for CSCs and Section 105(l) leases account for the proposed funding increase for IHS, leaving the majority of the IHS’ line items flat funded.

IHS also included grants and other programming for which UIOs are eligible in the IHS Congressional Justification:

Dementia Models of Care Grant: For FY 2026, IHS is planning a new five-year Dementia Models of Care notice of funding opportunity and a five-year multi-service national clinical champions cooperative agreement.

Indian Health Professions: IHS also proposes flat funding of $80.56 million for Indian Health Professions. This offers additional IHS Scholarship and Loan Repayment awards, bolstering recruitment and retention efforts through these two high demand programs.

Other Agencies within HHS

Several agencies have received significant cuts within the Budget in Brief: National Institutes of Health ($17 billion); Administration for Children, Families, and Communities ($7 billion); and the Administration for a Healthy America ($6 billion).

Programs previously funded through SAMHSA have now been consolidated into the AHA. These include Mental Health ($1.5 billion), Substance Abuse Prevention ($89 million), and Substance Abuse Treatment ($20 million). The proposed funding for these programs is at a decrease compared to the FY2025 amounts. The budget also proposes to consolidate three block grants into the Behavioral Health Innovation Block Grant ($4 billion). These block grants, previously funded through SAMHSA, are the Community Mental Health Services Block Grant; Substance Use Prevention, Treatment and Recovery Support Services Block Grant; and State Opioid Response. Other agencies proposed to be consolidated into the AHA are the Health Resources and Services Administration (HRSA), Office of the Assistant Secretary for Health (OASH), National Institute for Environmental Health Sciences (NIEHS), and some programs previously funded through the Centers for Disease Control and Prevention (CDC).

Due to consolidation of programs, SAMHSA’s Tribal Behavioral Health and Opioid Response Grant is facing cuts. However, the budget does include proposed funding for the Native American Behavioral Health and Substance Use Disorder program ($80 million), which will be within AHA. This program was first authorized in 2022 and is intended to support tribes in providing culturally tailored services in addressing mental health and substance use. Additionally, within the AHA is another new program, the American Indian and Alaska Native Suicide Prevention Initiative ($4 million).

Within the budget there is a proposal to consolidate programs within the Administration for Children and Families (ACF) and the Administration for Community Living (ACL) and create a new Administration for Children, Families, and Communities (ACFC). It proposes to continue funding Native American Programs, previously funded through ACF, at $61 million. Other programs consolidated into ACFC from ACL are the Native American Nutrition and Supportive Services ($38 million) and Native American Caregiver Support Services ($12) million. In the CDC section of the Budget in Brief, there is no mention of the Healthy Tribes Program as that funding has been proposed to be cut.

In their Congressional Justification, CMS has requested $3 million to continue its American Indian and Alaska Native outreach efforts through Tribal Outreach and Education. The purpose of this program is to remove barriers for rural communities that cause disparities in health care. Funding for HHS Tribal Affairs was requested in the HHS Congressional Justification, at $730,000. This funding is used to support the Secretary’s Tribal Advisory Committee (STAC). Additionally, the Congressional Justification and Budget in Brief also highlight that HHS will make an effort to support Tribal healthcare data sovereignty and Tribal public health infrastructure.

Next Steps

The Appropriations Committees will review the President’s Budget for consideration as they craft their bills for FY 2026. NCUIH will submit testimony and send letters to House and Senate Appropriators to request full funding for FY2026. NCUIH will continue to work with the Trump Administration and Congress to push for full funding of Urban Indian Health in FY 2026.

President’s Budget Proposes Increase for Indian Health Service, Stable Funding for Urban Indian Health for FY 2026

On May 30, the President released the full Fiscal Year (FY) 2026 Department of Health and Human Services Budget In Brief. The budget “prioritizes funding for IHS,” proposing $8.1 billion for the Indian Health Service, and level funding for urban Indian health. Notably, the Secretary emphasizes the trust obligation for American Indian and Alaska Native people: “HHS has a unique responsibility to provide healthcare for tribes on remote reservations and other vulnerable communities in Indian Country.” The proposal also includes $80 million for a new Native American Behavioral Health and Substance Use Disorder program, and reauthorizes the Special Diabetes Program for Indians (SDPI) at its current funding.

“The budget prioritizes funding for IHS, providing $7.9 billion to fulfill our promises to tribal nations. In particular, the budget prioritizes funding for direct health services as well as funding for staffing and operational costs of new facilities opening in FY 2026. This investment will ensure access to care in remote and underserved communities. Within AHA, the budget includes $80 million for a newly funded Native American Behavioral Health and Substance Use Disorder program. It will provide funding directly to tribes to support culturally tailored mental health, prevention, and treatment efforts for behavioral health issues in Indian Country.”

– FY2026 Budget in Brief (May 30, 2025)

Next Steps

The FY 2026 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 2026 funding bills.

IHS Acting Director Ben Smith and Finance Director Jillian Curtis will testify before the House Appropriations Committee on Thursday, June 5.

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.

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

Related News

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

May Policy Update: NCUIH Releases Priorities, Tracks Lawsuits, and Defends Medicaid

In this Edition:

📸 NCUIH Policy Priorities: NCUIH Released its 2025 Policy Priorities.

🚨 NCAI, Indian Gaming Association, and National Organizations host a Legislative Summit –NCUIH presented on an Appropriations panel and joined Capitol Hill meetings to share UIO issues alongside Tribal leaders.

⚖ Lawsuits & Court Cases Updates – Current court cases and legal action impacting American Indian and Alaska Native (AI/AN) health care and policy.

🚨 Budget Reconciliation – House Committee Advances Budget Reconciliation Text with Exemptions for AI/AN People.

📜 FY 2026 Appropriations – President Releases FY 2026 Budget, Congress Requests Protection of IHS Funding.

Protecting AI/AN People on Medicaid – NCUIH Submits Comments Supporting Exemption of AI/AN People from Work Requirements in State Medicaid Programs.

📬 Federal Agency Actions – Department of Health and Human Services (HHS) New DEI Rules in Grant Policy Statement and HHS Recission of Four Guidance Documents.

In Case You Missed It (ICYMI) – IHS Tribal Consultation and Urban Confer on Health IT Modernization, Recent Dear Tribal and Urban Leader Letters.

📆 Upcoming Events – NCAI Mid-Year Conference in Mashantucket, CT.

New Resource: 2025 Policy Priorities Released

NCUIH is pleased to announce the release of its 2025 Policy Priorities document, which outlines a summary of urban Indian organization (UIO) priorities for the Executive and Legislative branches of the government for 2025, as well as talking points and recommendations for each priority.

Read the full priorities.

These priorities were informed by NCUIH’s 2024 Policy Assessment.

NCAI, Indian Gaming Association, and National Organizations Host Legislative Summit

NCUIH thanked Sen. Murkowski, Rep. Tom Cole, Rep. Sharice Davids and Rep. McCollum for supporting UIOs.

On May 13-14, the National Congress of American Indians, Indian Gaming Association (IGA), and other National organizations hosted a Legislative Summit in Washington D.C. regarding recent administration developments and Budget Reconciliation.

Speakers included national Native organizations, Administration officials, and Members of Congress to address key legislative and budgetary issues affecting Native communities. The event featured policy briefings, Capitol Hill visits, and opportunities for direct advocacy and engagement with Members of Congress.

NCUIH presented on an Appropriations panel and joined Capitol Hill meetings to share UIO issues alongside Tribal leaders.

Monitoring The Bench: Lawsuits Filed Against Recent Executive Orders and Presidential Actions

National Council of Nonprofits v. Office of Management and Budget (OMB)​ – Lawsuit brought in the District Court of the District of Columbia by nonprofits to stop the federal funding freeze.

  • Status: Preliminary Injunction (PI) was granted on 2/25/2025 – nationwide injunction that prevents the federal government from rescinding or freezing funds that have been appropriated by Congress. Defendants filed an Appeal with the DC Circuit on 4/24/2025, regarding the decision to grant the Preliminary Injunction. Case Stayed on 5/12/2025 while the appeal is heard in the DC Circuit.
  • Why this matters for UIOs: Funding at issue in the case is related to the rescinded OMB Memo (M-25-13) that directed federal agencies to pause disbursement of funds that could be implicated by Executive Orders. This includes funding related to DEI, which could implicate funding for AI/AN communities.

American Federation of Government Employees, AFL-CIO v. Trump​ – Lawsuit filed in the District Court of Northern California by a coalition of unions, nonprofits, and local governments over reorganization of the executive branch that would result in mass terminations.

  • Status: Temporary Restraining Order (TRO) Granted on 5/9/2025, preventing the Department of Government Efficiency (DOGE) from carrying out the directive to reduce the government workforce.

“The President has neither constitutional nor, at this time, statutory authority to reorganize the executive branch.”

  • Why this matters for UIOs: Reorganization of the Executive Branch includes various agencies, including HHS, which will impact AI/AN communities who receive programs and services that may be at risk of being eliminated. Could impact IHS and cause restructuring that also eliminates essential programs and services.

State of New York v. Kennedy – Lawsuit filed in the District Court of Rhode Island by 19 states and D.C. over restructuring of HHS that has resulted in mass terminations and cuts to programs.

  • Status: Motion for PI was filed on 5/9/2025. Still awaiting a hearing and ruling.
  • Why this matters for UIOs: Plaintiffs include 12 states where UIOs are located: AZ, CA, CO, IL, MD, MN, NJ, NM, NY, OR, WA, and WI. Restructuring of HHS has led to mass terminations and elimination of programs within the CDC, FDA, SAMHSA, ACF, and ACL.

State of Colorado v. U.S. Department of Health and Human Services – Lawsuit filed in the District Court of Rhode Island by 23 states and D.C. over termination of $11 billion in public health funding that was authorized in response to the COVID-19 pandemic but intended to be used beyond the pandemic itself.

  • Status: TRO Granted 4/3/2025, requiring Defendants to cease withholding funds and to make funds available.
  • Why this matters for UIOs: Plaintiffs include 15 states where UIOs are located: AZ, CA, CO, IL, MD, MA, MI, MN, NV, NM, NY, OR, PA, WA, and WI. Funding includes SAMHSA programs and CDC grants with state health departments.

Over 300 lawsuits have been filed against recent executive orders and presidential actions, covering issues like agency data access, federal employee terminations, and elimination of diversity, equity, and inclusion (DEI) initiatives. NCUIH continues tracking these cases to identify any rulings that may impact UIOs.

House Advances Reconciliation Bill with Exemptions for American Indian and Alaska Native People from Community Engagement Requirements

On May 22, the House of Representatives voted 215-214-1 to pass a major reconciliation bill that would deliver the major elements of President Trump’s legislative agenda, including tax cuts, Medicaid reforms, and lifting the debt ceiling. The bill contains a health title, which includes Medicaid reform provisions, such as cost-sharing and provider tax changes.

Community Engagement Requirements for Certain Medicaid Beneficiaries – First Ever Inclusion of “Urban Indians” in Exemption:

  • What it does: States would be required to implement community engagement requirements for able-bodied adults without dependents. Compliance may be achieved through:- Working, volunteering, or participating in a work program for at least 80 hours/month; or
    – Enrolling in educational programs totaling 80 hours/month.
  • Impact on Indian Country –The bill exempts American Indian and Alaska Native beneficiaries from these requirements. Specifically, it states that “specified excluded individuals” include:- Indians and Urban Indians as defined in the Indian Health Care Improvement Act (IHCIA);
    – California Indians as described in Section 809(a) of the IHCIA;
    – Individuals determined eligible as an Indian for the Indian Health Service under regulations promulgated by the Secretary.
  • The work requirements go into effect on December 31, 2026.

Other Key Provisions:

  • Modifying Cost Sharing Requirements for Certain Expansion Individuals Under the Medicaid Program – AI/AN beneficiaries are already exempted
  • Moratorium on New or Increased Provider Taxes – UIOs are already exempted due to their tax status
  • Reduction in Expansion FMAP for States Covering Undocumented Immigrants – Seven stated with UIOs provide such coverage (California, Washington, Oregon, Minnesota, Illinois, New York, and Colorado).

Read more on these provisions here

Next Steps: Budget reconciliation package will need to proceed to the House floor for a vote. Once passed, the Senate will take up the package and provide their edits.

Recent NCUIH Efforts: On May 8, NCUIH joined the Partnership for Medicaid—which is a nonpartisan, nationwide coalition of organizations representing clinicians, health care providers, safety-net health plans, and counties with the goal to preserve and improve the Medicaid program— in a statement of concern regarding coverage losses and benefits and provider payment reductions outlined by the recent Congressional Budget Office report on Medicaid policy options being considered by Congress as part of reconciliation. NCUIH also joined the Partnership in a reconciliation letter to House Energy and Commerce to protect Medicaid on May 9.

NCUIH has worked with UIO leaders and national partners, including the National Indian Health Board (NIHB) and the Medicaid Medicare Policy Committee (MMPC), to ensure that American Indian and Alaska Native Medicaid beneficiaries are protected from harmful policy changes. NCUIH participated in over 60 Capitol Hill meetings to emphasize the importance of Medicaid’s role in AI/AN communities, and to spotlight the unique needs of UIOs.

  • Why it Matters: In 2023, approximately 2.7 million AI/AN people were enrolled in Medicaid across the United States, according to American Community Service data. Medicaid is a major source of health care funding, particularly for UIOs, which provide essential healthcare services to AI/AN people living in urban areas. The proposed Medicaid cuts would threaten the ability of UIOs to sustain necessary service offerings, potentially reducing access to essential health care services for urban AI/AN people.
  • Read NCUIH’s comprehensive overview highlighting the crucial role Medicaid plays in providing health care to AI/AN communities.

President Releases FY 2026 Budget, Congress Requests Protection of IHS Funding

On May 2, the President released the FY 2026 budget proposal, which acts primarily as a symbolic blueprint of the President’s vision for the size and scope of the federal government.

By the numbers: The proposal for HHS outlines a 26.2% reduction to the overall HHS budget, amounting to $33.3 billion in cuts.

The President’s funding request overview states that the Administration will “Maintain Support for Tribal Nations”, stating, “the Budget preserves Federal funding for the Indian Health Service and supports core programs at the Bureau of Indian Affairs and Bureau of Indian Education, sustaining the Federal Government’s support for core programs that benefit tribal communities.” It also indicates plans to “streamline other programs for tribal communities, to reduce inefficiencies and eliminate funding for programs and activities found to be ineffective.”

Next Steps: The administration is expected to release its full Budget in Brief in the coming weeks. In the meantime, the House and Senate Appropriations Committees will craft their respective FY 2026 funding bills. NCUIH will continue to engage with lawmakers to ensure the Indian Health System and all Tribal programs receive the resources they need.

Congressional Advocacy for Indian Health:

Senate Indian Affairs Committee (SCIA) Oversight Hearing 

On May 14, 2025, SCIA held an oversight hearing to examine delivering essential public health and social services to Native Americans. Hearing focused on federal programs serving Native Americans across the operating divisions at the HHS. Chairwoman Janet Alkire was NIHB and NCUIH’s shared witness and incorporated UIOs into her testimony.

NCUIH also worked with Senator Cortez Masto who shared story shared by Nevada Urban Indians and Native Connections: “I am so concerned about the cuts to mental health services that we fought for in our communities. There is a program called Native Connections, and I know about it because in my state, I have talked with so many of my Native community members. There’s a nine-year-old girl at Nevada Urban Indians who was struggling with her mental health, and she did not, could not get care from a school or a pediatrician. But it was Native Connections program that, according to her father, got his daughter back. It’s a Native Connections program, and so I don’t know if any of you are familiar with it, if we could talk about it, but please stress the importance of why funding for programs, particularly in this mental health and Native Connections, is so important.”

Congressional Leaders Letter Requesting Protection of IHS Funding and Increased Resources for Urban Indian Health 

NCUIH supported House and Senate Dear Colleague Letters requesting that the Interior Appropriations Committees retain advance appropriations for IHS in FY27, protect IHS from sequestration, and provide robust funding for urban Indian health in the final FY 2026 appropriations bill.

Senators Urge HHS Secretary Kennedy to Address IHS Staffing Shortages

On May 6, Senators Jeff Merkley (D-OR), Brian Schatz (D-HI), and Lisa Murkowski (R-AK), sent a letter to HHS Secretary Kennedy:

  • Demanding urgent action from HHS Secretary Robert F. Kennedy, Jr. to ensure the IHS has the necessary resources and staffing to fully deliver health care services for AI/AN people, as required by federal law.
  • Calling for the IHS to immediately halt any further actions affecting Tribal health care delivery without first engaging in meaningful Tribal consultation.

NCUIH has worked closely with these offices to inform them of impacts of IHS workforce changes impacting UIOs.

Read more on NCUIH’s blog

NCUIH Submits Comments Supporting Exemption of AI/AN People from Work Requirements in State Medicaid Programs

Earlier this month, NCUIH submitted comments to CMS and state Medicaid programs supporting the exemption of AI/AN people from work requirements for Arizona, Arkansas, Iowa, and Utah.

HHS Updates: New DEI Rules in Grant Policy Statement and Recission of Four Guidance Documents

New DEI Rules in HHS’ Updated Grants Policy Statement

HHS recently released an updated HHS Grants Policy Statement (GPS), which is effective April 16, 2025, and “replaces all prior versions.”

  • This version of the GPS includes rules on prohibiting DEI.
  • The DEI rule is consistent with recent EOs on DEI.
  • Impact on IHS/Tribes/UIOs: Based on the February 25, 2025, Advisory Opinion from the HHS General Counsel, the GPS DEI rule will not impact the I/T/U’s ability to serve AI/AN people because the EOs do not impact the government-to-government relationship between the United States and Tribes and do not impact the United States’ obligations to Tribes and their citizens, including healthcare obligations. Instead, restrictions on UIO will be on operations, such as hiring.

We recommend your UIO discusses how potential “DEI programming” may affect your particular program with compliance and/or legal advisors.  

Notification of HHS Documents Identified for Rescission

On May 14, 2025, HHS published a Rule in the Federal Register announcing documents identified for recission:

  • Extension of Designation of Scarce Materials or Threatened Materials Subject to COVID-19 Hoarding Prevention Measures; Extension of Effective Date With Modifications, 86 FR 35810 (July 7, 2021).
  • Opioid Drugs in Maintenance and Detoxification Treatment of Opiate Addiction; Repeal of Current Regulations and Issuance of New Regulations: Delay of Effective Date and Resultant Amendments to the Final Rule, 66 FR 15347 (Mar. 19, 2001).
  • Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder, 86 FR 22439 (Apr. 28, 2021).
  • Notification of Interpretation and Enforcement of Section 1557 of the Affordable Care Act and Title IX of the Education Amendments of 1972, 86 FR 27984 (May 25, 2021).

NCUIH is still analyzing this notice and impacts.

ICYMI: IHS Tribal Consultation and Urban Confer on Health IT Modernization, Recent Dear Tribal and Urban Leader Letters

IHS Tribal Consultation and Urban Confer on Health IT Modernization

On May 15, IHS held a Tribal Consultation and Urban Confer (TC/UC) regarding Health Information Technology (HIT) Modernization: Four Directions Warehouse. Key updates:

  • The expected go-live date for the pilot (Lawton and the three service units) will being Spring 2026. IHS is preparing for pilot go-life between now and then.
  • IHS anticipates beginning PATH EHR go-lives for cohorts which will include Tribal, Urban, and federal partners.
  • Written comments and recommendation are due Saturday, June 14, 2025. Email to either consultation@ihs.gov or urbanconfer@ihs.gov.

The next joint IHS TC/UC session on HIT Modernization will be on PATH EHR Scope and Capabilities and held virtually via Zoom on August 7, 2025, 1:30-3:00 PM Eastern. Register here.

Recent Dear Tribal and Urban Leader Letters (DTLL/DULL)

April 22 DTLL – The HRSA Administrator writes to Tribal leaders to share updates on HRSA regional office structure and reaffirm his commitment to ensuring that no programs, services, or communications are interrupted.

Regional Offices are now closed in the following regions:

  • Region 1 – Boston: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont
  • Region 2 – New York: New York, New Jersey, the U.S. Virgin Islands, and Puerto Rico
  • Region 5 – Chicago: Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin
  • Region 9 – San Francisco: Arizona, California, Hawaii, Nevada and the Pacific Islands (American Samoa, Federated States of Micronesia, Guam, Marshall Islands, Northern Mariana Islands and Palau)
  • Region 10 – Seattle: Alaska, Idaho, Oregon, and Washington

May 20 DTLL – CDC writes to Tribal leaders to provide information about a webinar CDC is hosting entitled “Partnering with Tribal Nations to Prevent and Respond to New World Screwworm.”

  • Webinar: Wednesday, June 4, 2025, 3-4 PM Eastern. Register here.
  • Tribal nations, tribal communities, tribal serving organizations, and healthcare providers, veterinarians, and livestock ranchers and farmers living and working on tribal lands are welcome to attend.
  • The webinar will provide an overview on: The New World Screwworm (NWS) and the current situation in Central America and Mexico, how the NWS is a threat to Tribal nations and Tribal communities, and how to identify and treat infestations.

Upcoming Events

  • June 8-11 – NCAI Mid-Year Conference in Mashantucket, CT. Register here.
  • June 10 – CMS All Tribes Call
  • June 18 – Next NCUIH Monthly Policy Workgroup (virtual)
  • June 17-18 – Virtual Tribal Leaders Diabetes Committee (detailed forthcoming)

One more thing: Coalition for Tribal Sovereignty

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

The Coalition:

  • Creates joint messages to share with policy makers
  • Sends letters to key administration officials
  • Develops advocacy strategies

Learn more at www.coalitionfortribalsovereignty.org

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.