Action Alert: Contact Congress to Protect Funding for Indian Health TODAY

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Dear Advocates,

We need your help contacting Congress to support access to health care for Native communities!

Representative Teresa Leger Fernández is leading a letter to support funding for Urban Indian Health in the FY26 budget. The letter also includes a request to retain advance appropriations for the Indian Health Service (IHS) in FY27 and protect IHS from sequestration.

While the President’s budget says IHS funding will be preserved, it is crucial to notify Congress of your support for IHS and Urban Indian Health. We encourage you to contact your Member of Congress and request that they sign on to the Leger Fernández Urban Indian Health letter.

You can use the text below as a template to call and/or email your Representative. If you can please, call and email your representative. You can find your representative here.

Thank you for your leadership. 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 Social Media

 

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 Leger Fernández letter to the House Committee on Appropriations in support of funding for the Urban Indian Health line item for FY26.

Indian Health Service (IHS) funded Urban Indian Organizations (UIOs) provide essential healthcare services to patients from over 500 Tribes in 38 urban areas across the United States. As an integral part of the Indian health care delivery system, IHS UIOs are innovative stewards who use scarce federal resources to provide services to American Indian and Alaska Native patients. The Urban Indian Health line item historically makes up only one percent (1%) of IHS’ annual appropriation, and UIOs often only receive direct funding from the Urban Indian Health line item.

The letter requests funding for Urban Indian Health, IHS advance appropriations for FY27, and to protect IHS from sequestration. I respectfully ask that you help honor the federal trust obligation to provide health service to American Indian and Alaska Natives, no matter where they live by signing on to this letter.

Sign on to the letter by reaching out to Sofia Mingote (sofia.mingote@mail.house.gov) with any questions.

Thank you for your leadership and your commitment to urban Indian health.

Sincerely,

[contact information]

POST ON SOCIAL MEDIA

Example post:

We need your help to support urban American Indian and Alaska Native communities! Indian Health Service funded Urban Indian Organizations provide essential healthcare services to American Indian and Alaska Native patients from over 500 Tribes in 38 urban areas across the United States. Call on your Representative TODAY and urge them to sign on to the Leger Fernández Urban Indian Health funding letter.

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

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 Urges Administration and Congress to Honor Trust Responsibility in FY26 Budget

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FOR IMMEDIATE RELEASE

WASHINGTON, D.C. (May 5, 2025)– On May 2, the President released the Fiscal Year (FY) 2026 budget proposal. 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 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.” The proposal for the Department of Health and Human Services (HHS) outlines a 26.2% reduction to the overall HHS budget, amounting to $33.3 billion in cuts.

Note: Detailed agency-level budget requests are expected in the coming weeks. As such, the Indian Health Service (IHS) and Urban Indian Health line items have not yet been released. It is unclear if any programs in the Indian Health Services are proposed for elimination due to “inefficiencies”.

The CEO of NCUIH, Francys Crevier, J.D. (Algonquin), stated, “The trust responsibility for Native people extends beyond the Indian Health Service. We call on the Administration to honor its commitment to Native people and reconsider all cuts to programs serving Native communities. We further urge the administration to engage in Tribal consultation in recognition of the legal Nation-to-Nation relationship before undergoing any changes impacting Native people. Congress has long demonstrated bipartisan support for Tribal Nations and Native people, and we call upon our Congressional champions to ensure that the Indian Health Service and programs serving Native people receive the necessary resources to fulfill the trust responsibility.”

NCUIH has also joined the Coalition for Tribal Sovereignty to ensure that the administration and Congress honor the legal trust responsibility for health care for Native people. We stand with Tribal Nations in protecting all trust responsibilities and the Nation-to-Nation relationship. NCUIH opposes any cuts to programs serving Native communities.

NCUIH’s Engagement on FY26

  • On February 28, 2025, NCUIH Board President-Elect, Robyn Sunday-Allen, testified at the House Appropriations Subcommittee on Interior, Environment, and Related Agencies, urging full funding for urban Indian health and the Indian Health System. In her testimony, Robyn Sunday-Allen said, “Historically, disruptions in funding to the Indian health system have resulted in loss of life… Our care is too critical to be paused or reduced.” Ensuring mandatory and full funding for the entire Indian Health System—Tribal facilities, IHS, and UIOs—is essential for saving lives.
  • NCUIH joined the Coalition for Tribal Sovereignty in a letter to Secretary Kennedy requesting that he appeal the OMB proposed cuts to critical Tribal programming.
  • Rep. Leger Fernandez is currently circulating a Dear Colleague letter to the leadership of the House Appropriations Subcommittee on Interior, Environment, and Related Agencies, requesting robust funding for Urban Indian Health. The deadline for Congressional members to sign on is May 15.

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.

Resources

About NCUIH

The National Council of Urban Indian Health (NCUIH) is a national representative for the 41 Urban Indian Organizations contracting with the Indian Health Service under the Indian Health Care Improvement Act. NCUIH is devoted to the support and development of high quality and accessible health and public health services for American Indian and Alaska Native people living in urban areas.

NCUIH respects and supports Tribal sovereignty and the unique government-to-government relationship between our Tribal Nations and the United States. NCUIH works to support those federal laws, policies, and procedures that respect and uplift Tribal sovereignty and the government-to-government relationship. NCUIH does not support any federal law, policy, or procedure that infringes upon or in any way diminishes Tribal sovereignty or the government-to-government relationship.

###

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

Representative Leger Fernandez Reintroduces NCUIH-Endorsed Legislation to Maintain Access to Audio-Only Telehealth Services in Indian Country

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On April 3, 2025, Congresswoman Teresa Leger Fernández (D-NM-03) reintroduced the National Council of Urban Indian Health (NCUIH)-endorsed Telehealth for Tribal Communities Act of 2025 (H.R. 2639) which would make permanent a Covid-19 Public Health Emergency (PHE) temporary provision allowing audio-only telehealth services for Medicare beneficiaries receiving care through Indian health programs or urban Indian organizations (UIOs). Providing access to audio-only telehealth services allows patients to access care even when broadband access is limited or unavailable. Prior to the PHE ending in May 2023, IHS patients used audio-only services 60% of the time and video telehealth 39% of the time, demonstrating how valuable this provision is to patients. This legislation will help address the persistent challenge of accessing healthcare in Indian Country.

“The National Council of Urban Indian Health is grateful for Representative Leger Fernandez’s dedication to improving health outcomes for American Indian and Alaska Native communities. Maintaining the Public Health Emergency’s Medicare reimbursement of audio-only telehealth will help our Native elders have continuity and access to critical health care,” said Francys Crevier (Algonquin), CEO, National Council of Urban Indian Health. 

The bill was cosponsored by Congressman Jay Obernolte (R-CA-23), Congresswoman Melanie Stansbury (D-NM-01), Congressman Raul Ruiz (D-CA-25), Congresswoman Eleanor Holmes Norton (D-DC-At Large), and Congresswoman Norma Torres (D-CA-35).

This bill is also endorsed by the National Council for Mental Wellbeing, National Indian Health Board, The Great Plains Tribal Leaders Health Board, National Congress of American Indians, Confederated Tribes of the Colville Reservation, The Navajo Nation, Northwest Portland Area Indian Health Board, and the American Telemedicine Association.

Next Steps

The bill was referred to the House Committee on Energy and Commerce and the House Committee on Ways and Means. It currently awaits consideration.

Resources

April Policy Updates: Highlights from NCUIH’s Annual Conference and Hill Day, HHS Reorganization, Medicaid Cuts, and More

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In this Edition:

📸 Annual Conference & Hill Day Recap: Key updates from Annual Conference and Hill Day activities.

🚨 UIO and HHS Partnership – Secretary Kennedy Visits Arizona Urban Indian Organization NATIVE HEALTH.

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

📜 Legislative Updates – NCUIH-Endorsed Legislation Reintroduced to Maintain Access to Audio-Only Telehealth Services in Indian Country.

🚨 Budget Resolution – Congress Passes Budget Resolution Paving the Way for Major Tax Cuts and Medicaid Spending Threats.

📬 Federal Agency Actions – Department of Health and Human Services (HHS) Announces Reorganization, Office of Management and Budget’s (OMB) HHS FY 2026 Discretionary Budget Passback.

📜 Tribal Coalition Update – A coalition of 20+ Tribal organizations mobilizes to protect the Indian Health Service (IHS) and AI/AN health programs from administrative threats.

📆 Upcoming Events – IHS Health Information Technology Modernization Tribal Consultation and Urban Confer.

NCUIH’s 2025 Conference and Hill Day

Pictured: Walter Murillo (Choctaw Nation), CEO of NATIVE HEALTH; Kitty Marx, former Director of the CMS Division of Tribal Affairs; and Francys Crevier (Algonquin), CEO of the National Council of Urban Indian Health

Pictured: Executive Director of the Department of Veterans Affairs (VA) Office of Tribal Government Relations Stephanie Birdwell (Cherokee Nation in Oklahoma) and Director of the VA Office of Tribal Health Travis Trueblood (Choctaw Nation).

 

 

Pictured: Ben Smith (Navajo Nation), Acting Director of the Indian Health Service.

NCUIH’s annual conference fostered engagement between Urban Indian Organizations (UIOs) and federal agency leaders and featured:

  • IHS Listening Session with Acting Director Ben Smith
  • Department of Veterans Affairs update with Executive Director of the Department of Veterans Affairs (VA) Office of Tribal Government Relations Stephanie Birdwell and Director of the VA Office of Tribal Health Travis Trueblood
  • Keynote address on Historical Perspectives on Centers for Medicare & Medicaid Services (CMS) Policy and UIOs with Former Director of CMS Division of Tribal Affairs Kitty Marx

The NCUIH Annual Conference concluded with a Capitol Hill Advocacy Day, where the NCUIH and leaders from UIOs met with over 50 Congressional offices. This event was significant as it provided a platform for these leaders to directly engage with policymakers, amplifying the voice of UIOs and highlighting their priorities.

Secretary Kennedy Visits Arizona Urban Indian Organization NATIVE HEALTH

L to R: Francys Crevier (Algonquin), JD, CEO of NCUIH; Kyu Rhee, President and CEO of the National Association of Community Health Centers (NACHC); Secretary Kennedy; Jessica Yanow, President and CEO of the Arizona Alliance for Community Health Centers; Walter Murillo (Choctaw), CEO of NATIVE HEALTH.

On April 8, HHS Secretary Robert F. Kennedy Jr. visited NATIVE HEALTH’S Mesa clinic to learn more about the vital work of UIOs as part of the Indian Health System. Secretary Kennedy is on a tour that includes a focus on “Tribal Health & Self-Governance” and a discussion with Navajo Nation leadership on food sovereignty initiatives.

NCUIH is hopeful that this visit was helpful in ensuring Secretary Kennedy understands the unique context and needs of the Indian health system, and that Secretary Kennedy continues to engage with Tribal and UIO leadership to ensure that the Indian health system is protected and prioritized.

Read our press release here.

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

American Federation of Government Employees v. U.S. Office of Personnel Management (OPM)​ – A lawsuit filed in the Northern District of California by federal employee unions against OPM challenging the mass firing of probationary federal employees at Departments of Veterans Affairs, Agriculture, Defense, Energy, Interior, and the Treasury. Preliminary Injunction (PI) was Granted on 3/13 and appealed up to SCOTUS. ​

  • SCOTUS question:​ Whether the Supreme Court should stay the district court’s injunction ordering six departments and agencies to immediately offer reinstatement to over 16,000 employees who were laid off.​
  • SCOTUS Granted the Motion to Stay the PI on 4/8.​

State of California v. U.S. Department of Education​ – A lawsuit filed the District of Massachusetts by eight states (CA, MA, IL, CO, NJ, WI, NY, MD) challenging the termination of $65 million worth of grants on because they funded diversity, equity and inclusion initiatives. Temporary Restraining Order (TRO) was Granted on 3/10 and appealed up to SCOTUS. ​

  • SCOTUS question: ​Whether the Supreme Court should vacate the district court’s March 10 order which requires the government to immediately reinstate millions of dollars in federal grants that had been terminated.​
  • SCOTUS Vacated the TRO on 4/4.​

Over 100 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.

Bipartisan Legislation to Maintain Access to Audio-Only Telehealth Services in Indian Country and for UIOs

On April 3, Congresswoman Teresa Leger Fernández (D-NM-03) reintroduced the NCUIH-endorsed Telehealth for Tribal Communities Act of 2025 (H.R. 2639) which would make permanent a Covid-19 Public Health Emergency (PHE) temporary provision allowing audio-only telehealth services for Medicare beneficiaries receiving care through Indian health programs or UIOs.

  • The bill was cosponsored by Congressman Jay Obernolte (R-CA-23), Congresswoman Melanie Stansbury (D-NM-01), Congressman Raul Ruiz (D-CA-25), Congresswoman Eleanor Holmes Norton (D-DC-At Large), and Congresswoman Norma Torres (D-CA-35).
  • Why it matters: Providing access to audio-only telehealth services allows patients to access care even when broadband access is limited or unavailable. Prior to the PHE ending in May 2023, IHS patients used audio-only services 60% of the time and video telehealth 39% of the time, demonstrating how valuable this provision is to patients. This legislation will help address the persistent challenge of accessing healthcare in Indian Country.

“The National Council of Urban Indian Health is grateful for Representative Leger Fernandez’s dedication to improving health outcomes for American Indian and Alaska Native communities. Maintaining the Public Health Emergency’s Medicare reimbursement of audio-only telehealth will help our Native elders have continuity and access to critical health care,” said Francys Crevier (Algonquin), CEO, National Council of Urban Indian Health. 

Next Steps: The bill was referred to the House Committee on Energy and Commerce and the House Committee on Ways and Means. It currently awaits consideration.

Read more on our Policy Blog.

Congress Passes Budget Resolution Paving the Way for Major Tax Cuts and Medicaid Spending Threats

On April 10, the House passed a Senate-passed budget resolution with a 216-214 vote.​ The budget resolution includes:​

  • Extension of 2017 Trump tax cuts, allows for $1.5 trillion in new tax cuts​
  • Raise debt ceiling by $5 trillion​
  • Tentative agreement on $1.5 trillion in spending cuts, minimum $4 billion.​ The Energy and Commerce Committee has been the main target of spending cuts, with the House proposing $880 million in cuts, which would mainly come from Medicaid.​ Proposed Medicaid reforms include:​
    • Medicaid Work Requirements
    • Affordable Care Act (ACA) subsidy reforms
    • Targeting “able-bodied” beneficiaries

Next Steps: With the budget resolution now passed, each chamber has begun the process of drafting the final reconciliation passage, with a target passage before September.​

Congressional Support for Medicaid and Recent NCUIH Advocacy: 

On April 16, 12 Republican House members sent a letter to House Leadership requesting no cuts to Medicaid specifically for vulnerable populations, including children, underrepresented areas, and rural communities. The letter highlights that some districts have over 50% of their population on Medicaid. Rep. Bacon (R-NE-2) and Rep. Valadao (R-CA-22) co-led the letter, who both have UIOs in their district.

On April 3, 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 opposing the budget resolution cuts that could severely impact Medicaid access for AI/AN communities.

NCUIH is participating in Capitol Hill meetings with the Partnership 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.

HHS Announces Reorganization Impacting HRSA, SAMHSA, and Indian Country Programs

On March 27, HHS announced plans for a “dramatic restructuring” in accordance with President Trump’s Executive Order, “Implementing the President’s ‘Department of Government Efficiency’ Workforce Optimization Initiative.”​ IHS is not a part of the HHS reorganization. There will be one, possibly two, tribal consultations on reorganization.

HHS stated the restructuring will include:​

  • Reducing HHS workforce by about 10,000 full-time employees​
  • Consolidating HHS’ divisions from 28 to 15, including the Health Resources and Services Administration (HRSA) and the Substance Abuse and Mental Health Services administration (SAMHSA), to create a new entity, the Administration for a Healthy America (AHA)​
  • Centralizing core functions​
  • Reducing regional offices from 10 to 5​

 Impacts to Indian Country:

  • Center for Indigenous Innovation and Health Equity within Office of Minority Health has been eliminated. This likely includes the Center’s Tribal Advisory Committee.
  • SAMHSA’s Center for Mental Health Services has been closed​. This could impact the Circles of Care Program and Native Connections grant many UIOs have​.
  • CDC Healthy Tribes Program staff were terminated. Healthy Tribes funded 3 programs:​ Good Health and Wellness in Indian Country (4 UIOs are awardees)​; Tribal Practices for Wellness in Indian Country; Tribal Epidemiology Centers Public Health Infrastructure​.

Read NCUIH’s Press Release.

NCUIH Advocacy: 

On April 4, NCUIH sent a letter to IHS Acting Director Ben Smith requesting an urgent Urban Confer NCUIH requested that IHS:

  • Safeguard and hold harmless HRSA-funded UIOs and Tribal programs Maintain SAMHSA grants for UIOs and Tribal Health Programs
  • Preserve CMS Office of Minority Health research initiatives related to AI/AN communities
  • Ensure the continuity of all Division of Tribal Affairs (DTA) offices and all Tribal Advisory Committees
  • Preserve all funding and programs designated for AI/AN people

On April 14, NCUIH sent a letter to HHS Secretary Kennedy expressing our concerns with the reorganization and potential elimination of AI/AN-serving programs. In the letter we requested that the Administration protect all-AI/AN serving health programs.

NCUIH is committed to working with the Administration to ensure that the trust responsibility is fulfilled and that UIOs have the resources needed to effectively support their patients and communities. We will continue to closely monitor the restructuring and any impacts it may have on HHS operating divisions and programs affecting the Indian Health system.

OMB’s HHS FY 2026 Discretionary Budget Passback​

On April 17, reports emerged about cuts to federal health programs in an April 10 OMB FY 2026 Discretionary Budget Passback for HHS. The OMB Passback outlines sweeping cuts to HHS, including IHS, and other HHS operating divisions and programming.

The proposed reductions include nearly $900 million in cuts to the IHS budget and the elimination of IHS advance appropriations, elimination of Tribal Behavioral Health Grants, uncertainty about HIV/AIDS programming, elimination of Food is Medicine program, and more.

  • We want to note that this Passback includes a significant proposed reduction in the IHS “Other Services” which includes the UIO line item compared to the FY2025 budget.
  • While we cannot tell from the Passback what this reduction would mean specifically for the UIO line item, we know that Tribal Management Grants and Self-Governance, which also fall under the “Other Services” category are zeroed out.
  • IHS Professions, IHS Direct Operations and Urban Health are all within the “Other Services” line and had no noted reduction so there is ambiguity in this proposal.
  • While the proposal includes a recommendation to rescind advance appropriations for FY26, advance appropriations for FY26 was included in the Continuing Resolution, so it would take an act of congress to rescind or reduce. Further, the staff for interior appropriations said they would not cut advance appropriations which means that they will most likely have level funding for at least a year.
  • This is a proposed budget and we are still awaiting the final President’s Budget which should be coming out soon.  

On April 18, NCUIH sent a letter to HHS Secretary Kennedy urging him to immediately appeal this Passback. In the letter to HHS, NCUIH informed Secretary Kennedy the of the devastating effects of these cuts and that the proposed cuts are not consistent with federal government’s trust responsibility and the Make American Healthy Again initiative.

Read more on our Policy Blog.

Coalition for Tribal Sovereignty​ Update

NCUIH has joined forces with over 20 Tribal organizations to ensure current administrative actions do not harm AI/AN people and the programs that serve them.

Recent NCUIH Actions with the Coalition:

  • Sent a letter on April 18 to the HHS Secretary Kennedy, expressing concern regarding the substantial proposed budget cuts to various divisions within the HHS, including IHS and other HHS offices that together deliver critical Tribal programming, as outlined in the OMB HHS 2026 Discretionary Budget Passback.
  • Sent a letter on April 9 to the White House requesting the Administration to issue a new Executive Order protecting Tribal programs following the rescission of Executive Order 14112, “Reforming Federal Funding and Support for Tribal Nations To Better Embrace Our Trust Responsibilities and Promote the Next Era of Tribal Self-Determination.”

Learn more at www.coalitionfortribalsovereignty.org​.

Federal Agency Tribal Meetings: HHS 27th Annual Tribal Budget Consultation, HHS Secretary’s Tribal Advisory Committee, and IHS Direct Service Tribal Advisory Committee

HHS 27th Annual Tribal Budget Consultation 

On April 22-23, HHS held their 27th Annual Tribal Budget Consultation meeting in Washington D.C.  The Tribal Budget Formulation Workgroup (TBFWG) presented their budget recommendations for FY 2027, entitled The Federal Trust Responsibility to Tribal Nations: A Strategy to Advance Indian Health Care.

By the numbers: 

  • The recommendation for IHS is full mandatory funding at $73 billion, ten times the current IHS funding level, to address the need for AI/AN healthcare.
  • The TBFWG also recommends and full funding for urban Indian health at $1.094 billion, an over $1 billion increase above the FY 2024 enacted amount of $90.42 million.

On April 18, NCUIH submitted comments for the HHS FY 2027 budget request. NCUIH requested that HHS:

  • Propose full funding for the Urban Indian Health line item for a minimum of $100 million in the HHS FY 2027 Budget and funding to the maximum amount possible for the IHS overall
  • Protect funding for Indian health care providers by proposing mandatory appropriations for IHS and exempting HHS Indian Country funding, including for UIOs, from sequestration
  • Appeal the proposed reduction to HHS funding in the OMB HHS FY 2026 Discretionary Budget Passback
  • Ensure UIO inclusion in the budget formulation process
  • Additional funding priorities: Propose moving contract support costs (CSC) and 105(l) leases to mandatory funding, Protect staff serving Indian Country from reduction in force, Propose a legislative fix setting the Federal Medical Assistance Percentage (FMAP) at 100% for Medicaid services provided at UIOs.

HHS Secretary’s Tribal Advisory Committee (STAC) & IHS Direct Service Tribal Advisory Committee (DSTAC) 

On April 24, HHS STAC and IHS DSTAC meetings were held in Washington, D.C.

Key takeaways:

  • IHS is unable to hire at executive levels- which includes Director-level vacancies for the Nashville and Billings areas- because the Administration extended the hiring freeze.
  • IHS is unable to fully implement IHS’ reorganization because of the change in Administration. However, the changes within the offices under the Deputy Director for Intergovernmental and External Affairs are permanent.
  • The VA lifted the pause on the VA’s Advisory Committee on Tribal and Indian Affairs (ACTIA). Unfortunately, there was also news that there is a recommendation to eliminate the VA’s Office of Tribal Relations.
  • IHS reiterated that the United States will always have a government-to-government relationship with Tribes and a statutory relationship with UIOs, and that this will never change.

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

March 26 DULL – The Acting IHS Director Updates UIOs Leaders About Requirements Regarding the FY 2025 IHS Urban Emergency Fund (UEF).

  • The UEF is a limited, discretionary allocation fund managed by the Office of Urban Indian Health Programs (OUIHP) to address cots incurred during one-time, non-recurring emergencies and disaster relief efforts involving UIOs.
  • OUIHP has allocated $250k to UEF, but funding is not guaranteed and is subject to the availability of appropriations.
  • To be eligible for UEF – a UIO must have a contract with IHS.
    • An emergency is defined as a sudden, urgent, usually unexpected occurrence or occasion that requires immediate action to avoid imminent or substantial endangerment to public health of safety.
    • To make a request a UIO must 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.
  • Questions can be directed to Rick Muller, Acting Director, OUIHP, IHS at rick.mueller@ihs.gov.

April 7 DTLL/DULL – The Acting IHS Director writes to Tribal leaders and UIO leaders that the IHS will continue to use the competitive grant funding distribution method for the seven behavioral health initiatives.

  • The seven behavioral health initiatives are:
    • Suicide Prevention, Intervention, and Postvention (SPIP)
    • Substance Abuse, Prevention, Treatment and Aftercare (SAPTA)
    • Domestic Violence Prevention (DVP)
    • Forensic Health Care Services (FHC)
    • Zero Suicide Initiative (ZSI)
    • Behavioral Health Integration Initiative (BH2I)
  • Youth Regional Treatment Centers Aftercare Pilot (YRTC)
  • IHS published a summary report following the 2024 Tribal Consultation and Urban Confer sessions on funding methodologies for seven behavioral health initiatives.

April 8 DTLL – The HRSA Administrator writes to Tribal leaders to provide information about the National Health Service Corps (NHSC) Loan Repayment Programs.

  • HRSA expects that an additional $16 million from HRSA’s annual appropriations of NHSC Loan Repayment Programs will be dedicated to supporting clinicians serving I/T/U facilities.
  • The application window for HRSA’s NHSC Loan Repayment Programs is open until May 1, 2025.
  • HRSA is asking for Tribal leaders’ help in publicizing the information.

Upcoming Events

  • May 6-8 – IHS Bemidji Area FY 2026 Pre-Negotiation Conference in Bloomington, MN. More info here.
  • May 15 – OUIHIP-Urban Program Executive Directors/Chief Executive Officers Monthly Conference Call.
  • May 15 – IHS Health Information Technology (HIT) Modernization Tribal Consultation and Urban Confer (virtual). Register here.
  • May 21 – Next NCUIH Monthly Policy Workgroup (virtual).

 

NCUIH Urges HHS to Reconsider Proposed Budget Cuts to Indian Health Service and HHS

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FOR IMMEDIATE RELEASE

Washington, D.C. (April 18, 2025)– The National Council of Urban Indian Health (NCUIH) sent a letter to Robert F. Kennedy, Jr., Secretary of the U.S. Department of Health and Human Services (HHS), expressing deep concern over the proposed budget cuts to the Indian Health Service (IHS)  and HHS as outlined in the Office of Management and Budget’s (OMB) Fiscal Year 2026 Discretionary Budget Passback. The proposed reductions include nearly $900 million in cuts to the IHS budget and the elimination of IHS advance appropriations, which are crucial for protecting IHS funding from interruptions such as government shutdowns.The proposed changes would have detrimental effects on the health care delivery for American Indian and Alaska Native people across the United States including for Urban Indian Organizations and Tribal programs.  A recent report showed that 50% of Urban Indian Organizations could be forced to discontinue services within six months of funding disruptions.

“The proposed budget cuts are a direct threat to the health and well-being of American Indian and Alaska Native communities. We call on Secretary Kennedy to honor his commitment to prioritizing Indian Country and appeal these proposed reductions. Lives are at stake and this could have catastrophic consequences,” said NCUIH CEO Francys Crevier, JD (Algonquin).

Impact of HHS Cuts on American Indian and Alaska Native Communities

In addition to the specific cuts to the IHS, NCUIH is concerned about the broader reductions in funding to several HHS programs impacting Native health. UIOs and tribal health facilities rely on HHS grants (e.g., SAMHSA, HRSA, CDC, and HIV/AIDS initiatives) to address disparities. For example, Tribal Behavioral Health Grants (Native Connections) are eliminated in the proposal. Tribes and Urban Indian Organizations receiving Native Connections funding will lose funding that addresses suicide, substance use, and trauma impacting American Indian and Alaska Native youth.

Secretary’s Commitment to Indian Country

NCUIH appreciates Secretary Kennedy’s recent visit to Native Health, an Urban Indian Organization located in Arizona that contracts with the Indian Health Service to provide critical services to Native people. Following this visit, Secretary Kennedy praised Native Health as a model of care that should be replicated and become the standard across Indian Country. He also expressed his commitment to prioritizing Indian Country in his efforts to improve health outcomes.

Call to Action

NCUIH urges Secretary Kennedy to appeal the proposed budget cuts and uphold the federal government’s trust obligations to American Indian and Alaska Native people.  NCUIH remains committed to working alongside HHS and the current administration to ensure that the IHS and other critical programs receive the necessary funding to effectively serve American Indian and Alaska Native communities. We call for immediate action to prevent the devastating impact of the proposed budget cuts and to support the health and well-being of Indian Country.

Read the Letter
Related News
Resources

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

Senate Passes Budget Resolution Paving the Way for Major Tax Cuts and Medicaid Spending Threats

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On April 5, 2025, the Senate passed their budget resolution after an overnight voter-a-rama on various amendments. The resolution will allow Congressional Republicans craft their budget reconciliation aimed at extending the 2017 Trump tax cuts and instituting new spending cuts. The resolution also allows for $1.5 trillion in new tax cuts over a decade and $5 trillion increase to the federal borrowing limit to avoid hitting the debt ceiling.

The Senate resolution comes after they took up the House of Representatives version of a budget resolution which was previously passed on February 25, 2025. The House version allows $4.5 trillion in tax breaks and $2 trillion in spending cuts, including $880 billion from the Energy and Commerce Committee which has jurisdiction over the Medicare and Medicaid programs. An analysis by the nonpartisan Congressional Budget Office (CBO) shows that budget goals outlined in the House plan cannot be reached without reducing spending on Medicaid, despite commitments from Republicans and President Trump that they will not cut Medicaid.

The Senate voted on an amendment sponsored by Senator Hawley (R-MO) and Senator Wyden (D-OR) to remove the House proposed $880 billion cuts to the Energy and Commerce Committee. The amendment narrowly failed.

Next Steps

The House will now need to adopt the Senate-passed resolution in order to move forward with the reconciliation process.

Medicaid’s Importance for AI/AN Communities and UIOs

In 2023, approximately 2.7 million American Indian and Alaska Native (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 Urban Indian Organizations (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.

NCUIH’s Support for Medicaid

The National Council of Urban Indian Health (NCUIH) worked with Senator Schumer (D-NY) and Senator Smith (D-MN) on proposed Tribal amendments to exempt Native Medicaid Beneficiaries from any cuts to the Medicaid program. Although Tribal amendments were offered, they were unfortunately not considered by the Senate.

NCUIH has also worked with other National organizations working to protect Medicaid during the budget reconciliation process. On March 3, 2025, NCUIH joined 30 national and state level provider groups, health plan associations, and other organizations groups in signing on to the Medicaid Health Plans of America (MHPA) letter to the Chairs and Rankings Members of the Senate Finance and House Energy & Commerce Committees, expressing strong support for the importance of Medicaid and CHIP.

NCUIH also joined the Partnership for Medicaid (P4M)—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 calling on Congress to protect Medicaid, while expressing a commitment to work with policymakers to identify more sustainable strategies to strengthen Medicaid and improve on its promise of providing high quality coverage and access to care for populations in need.

  • On February 6, P4M issued a statement urging Congress to reject cuts to Medicaid during the budget reconciliation process.
  • On February 24, P4M released a statement urging Congress to vote “no” on the budget resolution which includes $880 billion in cuts for the Energy and Commerce Committee, which would likely significantly impact Medicaid.
  • On April 3, 2025, NCUIH joined the Partnership for Medicaid in a statement urging Congress to vote “no” on the budget resolution which includes $880 billion in cuts for the Energy and Commerce Committee, which would likely significantly impact Medicaid.

NCUIH Sends Letter to HHS Requesting Exemption for IHS from Workforce Reduction Initiatives, Protection for IHS Funding

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On March 12, 2025, the National Council of Urban Indian Health (NCUIH) sent a letter to the U.S. Department of Health and Human Services (HHS) Secretary, Robert F. Kennedy, Jr., urgently requesting his immediate intervention to safeguard the Indian Health Service (IHS) workforce and funding. The letter requested that Secretary Kennedy exempt IHS from all current and future workforce reduction initiatives and rescind hiring freezes, and protect IHS funding including shielding IHS from sequestration and impoundment.

Read the full letter here.

Background

The United States Senate confirmed Robert F. Kennedy, Jr. as the Secretary for HHS on February 13, 2025. During his confirmation and remarks at the February HHS Secretary Tribal Advisory Committee (STAC) meeting, Secretary Kennedy emphasized his support for Indian Country, including having a Native person at the Assistant Secretary level in HHS. NCUIH looks forward to working with Secretary Kennedy to improve the health of Indian Country. During the meeting, Secretary Kennedy offered protections to Tribal leaders and the Indian health system, stating, “When they announced $9.6 billion in cuts to my agency—10% of our workforce—the one sub-agency I insisted must be protected was IHS. We safeguarded 1,000 jobs at IHS, and we will continue to do so. As new orders and additional cuts come down, protecting these jobs remains my priority.”

Secretary Kennedy Visits Arizona Urban Indian Organization NATIVE HEALTH

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FOR IMMEDIATE RELEASE

MESA, AZ (April 8, 2025)– Today, Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. visited NATIVE HEALTH’S Mesa clinic to learn more about the vital work of Urban Indian Organizations as part of the Indian Health System. Secretary Kennedy is on a tour that includes a focus on “Tribal Health & Self-Governance” and a discussion with Navajo Nation leadership on food sovereignty initiatives.

“NATIVE HEALTH is a shining example of innovative health care in Arizona, demonstrating the success of services developed by Native people for Native people. Secretary Kennedy’s commitment to protecting the Indian Health Service, including Urban Indian Organizations, reflects a shared dedication to better health outcomes for all Native people. We are especially encouraged by his willingness to engage directly with the community, witnessing firsthand the innovation and success of programs like NATIVE HEALTH and listening to Native leaders. Together, we aim to build on this foundation, fostering collaboration and sustainable progress for future generations,” said NCUIH CEO Francys Crevier (Algonquin).


HHS Secretary Kennedy speaks with NCUIH President and NATIVE HEALTH CEO Walter Murillo (Choctaw) at NATIVE HEALTH Mesa.

Native Leaders Urge Secretary Kennedy to Honor Trust and Treaty Obligations

Recently, Secretary Kennedy met with the HHS Tribal Advisory Committee and promised to protect IHS from any administrative changes. On February 25, HHS also issued an Advisory Opinion reiterating the “legal obligation to provide health care for Indian Tribes and their citizens.” The advisory opinion affirms that during his first administration, President Trump sought to enhance federal programs addressing the concerns of American Indian and Alaska Native communities.

Administrative changes have recently been announced at HHS, and NCUIH has called upon the administration to honor the advisory opinion so that programs for Tribes and their citizens do not become collateral damage during reform efforts. NCUIH is hopeful that the administration will continue to engage in opportunities to hear from Native leaders as we work together to uplift the health care of all Native people.


L to R:
Francys Crevier (Algonquin), JD, CEO of NCUIH
Kyu Rhee, President and CEO of the National Association of Community Health Centers (NACHC)
Secretary Kennedy
Jessica Yanow, President and CEO of the Arizona Alliance for Community Health Centers
Walter Murillo (Choctaw), CEO of NATIVE HEALTH

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

HHS Announces Reorganization Impacting HRSA and SAMHSA

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On March 27, 2025, the Department of Health and Human Services (HHS) announced plans for a “dramatic restructuring”. HHS will implement a restructuring plan that will combine operating divisions, such as the Health Resources and Services Administration (HRSA) and the Substance Abuse and Mental Health Services Administration (SAMHSA), into a new entity: the Administration for a Healthy America (AHA). According to the announcement, HHS will reduce its staff by an additional 10,000 staff, for a total HHS staffing reduction of 20,000 staff since the start of the Administration.

The announcement does not mention the Indian Health Service or any potential impacts this restructuring may have on IHS or the Indian health care system generally. Therefore, it’s not possible to know how this restructuring may impact Urban Indian Organizations, including those funded through HRSA and SAMHSA. However, the statement indicates the changes will “serve multiple goals without impacting critical services.”

NCUIH is committed to working with the Administration to ensure that the trust responsibility is fulfilled and that UIOs have the resources needed to effectively support their patients and communities. We will continue to closely monitor the restructuring and any impacts it may have on HHS operating divisions and programs affecting the Indian Health system.

Read HHS Statement

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

March Policy Updates: Key Policy Changes, Funding News, and Upcoming Events

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🤝 Register for NCUIH’s 2025 Conference and Hill Day!

🆕 New Resource: NCUIH releases new resource highlighting Medicaid’s crucial role for Native communities.

🚨 Proposed Medicaid Changes – NCUIH works with partners to support Medicaid and Children’s Health Insurance Program (CHIP).

📜 Legislative Updates – Senate Committee on Indian Affairs (SCIA) advances NCUIH-endorsed legislation impacting Native communities.

🏛 Appropriations Updates – Status of Continuing Resolution and Fiscal Year (FY) 2025 Funding.

⚖ Lawsuits & Court Cases Updates – Current court cases and legal action impacting Native health care and policy.

📬 Federal Agency Notices and Comment Opportunities – U.S. Department of Housing & Urban Development (HUD) releases advisory opinion on application of DEI executive orders, Executive Order 14112 rescinded, Department of Health and Human Services (HHS) releases revised notice and comment policy, and Government Accountability Office continues to list the Indian Health Service (IHS) on high-risk list.

🎤 NCUIH in Action – NCUIH joins federal agency tribal advisory groups in key discussions impacting Native communities.

📜 Tribal Coalition Update – A coalition of 20+ Tribal organizations mobilizes to protect IHS and Native health programs from administrative threats.

📆 Upcoming Events – Tribal Self-Governance Conference, HHS FY 2027 Annual Tribal Budget Consultation, and Federal Tribal Advisory Committees.

Register for NCUIH’s 2025 Conference and Hill Day!

Join us for Hill Day! 

We invite you to participate in Hill Day on Friday, April 25, 2025, in Washington, D.C. This is an opportunity to meet with congressional offices, share the impact of Urban Indian Organizations (UIOs), and highlight the importance of policies that support urban Indian health.

To join us, please complete the participation form by Monday, April 7, 2025. 

Call for Nominations! 

As part of our commitment to uplifting excellence in health care, we are seeking nominations for individuals and organizations who have made remarkable contributions to the field of urban Indian health.

Please submit your nominations using this form, which includes detailed instructions on the nomination process and criteria for each award. The deadline for submissions is Friday, March 28, 2025.

NCUIH Releases New Resource Highlighting Medicaid’s Crucial Role for American Indian and Alaska Native Communities

NCUIH has released a comprehensive overview highlighting the crucial role Medicaid plays in providing health care to Native communities. This report emphasizes the importance of preserving Medicaid resources and exempting Native beneficiaries from work requirements to fulfill the federal government’s trust responsibility.

Access the resource.

By the numbers:

  • Approximately 2.7 million Native people are enrolled in Medicaid, with 24% of Native adults aged 18-64 and 23% of those over 64 benefiting from the program.
  • Almost 49% of Native children are enrolled in Medicaid.
  • UIOs serve as vital health care providers.
    • 59% of Native people receiving care at UIOs are Medicaid beneficiaries.
    • Eight out of the top ten states with the largest number of Native Medicaid beneficiaries have UIOs providing essential services

Read more on our blog.

NCUIH Joins Coalition in Urging Bipartisan Support for Medicaid and CHIP Programs

On March 3, NCUIH joined 30 national and state level provider groups, health plan associations, other groups in signing on to the Medicaid Health Plans of America (MHPA) letter to the Chairs and Rankings Members of the Senate Finance and House Energy & Commerce Committees, expressing strong support for the importance of Medicaid and CHIP.

  • Why it Matters: In 2023, approximately 2.7 million Native 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 Native people living in urban areas. The letter emphasizes the importance of Medicaid and CHIP as a source of funding for critical safety net facilities and encourages Congressional leadership to continue in a tradition of bipartisan support for these vital programs.
  • Read more on our blog.

NCUIH continues to collaborate with partners to protect essential funding for Medicaid and CHIP.

Senate Committee on Indian Affairs Advances NCUIH-Endorsed Legislation Impacting Native Communities

On March 6, the Senate Committee on Indian Affairs (SCIA) advanced 25 bills impacting Native communities. Among them were three NCUIH-endorsed bills: the Truth and Healing Commission on Indian Boarding School Policies Act of 2025 (S.761), the Bridging Agency Data Gaps and Ensuring Safety (BADGES) for Native Communities Act (S.390), and the IHS Workforce Parity Act (S.632).

S. 632 – IHS Workforce Parity Act  

  • This legislation amends the Indian Health Care Improvement Act to allow Indian Health Service scholarship and loan recipients (including those work at UIOs) to fulfill service obligations through half-time clinical practice

S. 761 – Truth & Healing Commission on Boarding Schools  

  • This legislation establishes a formal commission to investigate, document, and acknowledge past injustices of the federal government’s Indian Boarding School Policies.

S.390 – BADGES for Native Communities Act 

  • This bill requires law enforcement agencies to report on cases of missing or murdered Native people.
  • UIOs are eligible entities for the missing or murdered response coordination grant program, established by the bill, allowing UIOs to create and grow programs to assist in developing coordinated responses and investigations for MMIP.

Next Steps: The bills have been advanced to the full Senate for consideration, and NCUIH will continue to closely monitor their progress.

Read more on our blog.

Continuing Resolution and FY 2025 Funding

On March 14, 2025, The House and Senate passed a Continuing Resolution (CR) to extend government funding set to expire on March 14, 2025, until September 30, 2025.

Key Provisions:

  • Maintains advance appropriations for IHS.
  • Extends funding for the Special Diabetes Program for Indians (SDPI). Brings total FY25 funding to $159,422,727.
  • Extends Medicare Telehealth Flexibilities

NOTE: Our Policy Alert sent out on March 14, 2025, stated that the CR eliminated funding for FY24 earmarked projects. Further analysis shows that the CR simply prevents the FY24 projects from being funded twice and does not rescind any funding appropriated for such projects in the original FY24 appropriations bill. 

Read more on our blog.

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

State of New York v. Trump – A lawsuit filed in the District Court of Rhode Island by 22 states to stop the federal funding freeze.

  • The court issued a Preliminary Injunction on March 6, 2025, preventing the federal government from pausing, freezing, canceling, or impeding the disbursement of appropriated federal funds.
  • The defendants filed an appeal on March 10 with the First Circuit.

National Council of Nonprofits v. Office of Management and Budget (OMB) – A lawsuit filed in the District Court of the District of Columbia by nonprofits challenging the federal funding freeze.

  • The court granted a preliminary injunction on February 25, 2025, blocking the government from freezing or rescinding any appropriated funds nationwide.

Pueblo of Isleta v. Secretary of the Department of the Interior – A lawsuit filed on March 7, 2025, in the District Court for the District of Columbia by Tribes impacted by the Bureau of Indian Education (BIE) reorganization and staff reductions.

  • The lawsuit claims BIE failed to consult Tribes before implementing these changes, which have affected student services and school maintenance.

Over 100 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.

HUD Memo on Application of DEI Executive Orders

On March 13, the United States Department of Housing and Urban Development (HUD) General Counsel issued a memorandum  on application of DEI executive orders.

  • This memorandum states that the Executive Orders on DEI do not apply to HUD’s legal obligation to provide housing for Indian Tribes and their citizens.
  • The Executive Orders on DEI also do not apply to the government-to-government relationship that underlies those obligations.

Executive Order 14112 Rescinded

On March 14th, President Trump Rescinded Executive Order 14112 of December 6, 2023 (Reforming Federal Funding and Support for Tribal Nations to Better Embrace Our Trust Responsibilities and Promote the Next Era of Tribal Self-Determination).

  • On March 14, President Trump signed an Executive Order entitled “Additional Rescissions of Harmful Executive Orders and Actions.” Section 2(p) rescinds Executive Order 14112 of December 6, 2023.
  • NCUIH is analyzing this impact on UIOs.

NCUIH remains committed to upholding the federal trust responsibility for Native healthcare.

HHS Revised Notice and Comment Policy & Upcoming Federal Agency Comment Opportunities

HHS Revised Notice & Comment Policy: HHS has updated procedures on how Tribal and Urban Indian input is solicited.

On March 3, HHS announced in a policy statement that HHS is rescinding a 1971 statement of policy that waived Administrative Procedure Act (APA) exemptions for rules and regulations relating to public property, loans, grants, benefits, or contracts.

  • HHS states that HHS will continue to follow notice and comment rulemaking procedures in all instances in which it is required to do so by the statutory text of the APA.
  • HHS and IHS both have Tribal Consultation policies and IHS’ has an Urban Confer policy. Thus, even if HHS may not provide a notice and comment period in the Federal Register, if the matter concerns Tribes, a Tribal Consultation may be required per HHS and IHS policies or an Urban Confer may be required per IHS policy if UIOs are implicated.
  • However, for activities outside of IHS, an Urban Confer may not be required because HHS does not have an Urban Confer Requirement. There may also be instances where engagement may not be required even if Tribal and/or UIO interests are impacted.

Upcoming Federal Agency Comment Opportunities:

Apr. 21 – HHS 27th Annual Tribal Budget Consultation (ATBC)

  • The 27th HHS ATBC will be on April 22-23, 2025, at HHS. The ATBC will provide a forum for Tribes to collectively share their views and priorities with HHS officials on national health and human services funding priorities and make recommendations for the Department’s FY 2027 budget request.
  • Comment Deadline: The written comment period is open until April 21, 2025, at 5 p.m. EDT to consultation@hhs.gov.

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

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

March 6 DTLL – IHS Process for Requesting a Tribal Delegation Meeting with IHS Director

  • The IHS Acting Director writes to Tribal Leaders to share updates on enhancements to the process for requesting a Tribal Delegation Meeting (TDM) with the IHS Director.
  • Direct all TDM requests IHSTribalDelegationMeeting@ihs.gov
  • All TDMs will be scheduled by the IHS TDM Coordinator no sooner than 2 weeks after a TDM request is received.
  • The IHS is also inviting Tribal Leaders to contribute to a display honoring Tribal Nations that will be installed at IHS Headquarters.

United States Government Accountability Office Continues to List IHS on High-Risk List

On February 25, 2025, the United States Government Accountability Office (GAO) updated GAO’s “High Risk List” by adding a new area on federal disaster assistance and released the report “Heightened Attention Could Save Billions More an Improve Government Efficiency and Effectiveness.”

  • GAO continues to list “Improving Federal Management of Program that Serve Tribes and Their Members” – including IHS- on the High-Risk List.
  • GAO states that IHS has met one criterion for removal from the High-Risk List- “Leadership Commitment”- but the four other criteria- “Capacity,” “Action Plan,” “Monitoring,” and “Demonstrated Progress”- are partially met and still need attention.

NCUIH will continue to monitor for any developments. Read more on our blog.

UIOs at the Joint Session of Congress

Two Native health leaders were invited to attend the Joint Session of Congress in Washington, D.C. on March 4. Dr. Linda Son-Stone, CEO of First Nations Community HealthSource, attended as a guest of Congresswoman Melanie Stansbury (NM-01). Walter Murillo, CEO of Native Health Phoenix and NCUIH Board President, attended as a guest of Congressman Greg Stanton (AZ-04). Both Stansbury and Stanton are members of the Native American Caucus.

The Joint Session of Congress presents an opportunity to emphasize the importance of honoring the federal trust responsibility to provide adequate healthcare to Native people. Both leaders have dedicated their careers to advocating for the health and well-being of urban Native populations. Their invitations are a recognition of the key role of UIOs in providing healthcare to Native communities.

Read NCUIH’s press release here.

NCUIH in Action

HHS Secretary Robert R. Kennedy Jr. and NCUIH CEO Francys Crevier (Algonquin) at the HHS Secretary Tribal Advisory Committee on February 26.

NCUIH Joins Federal Agency Tribal Advisory Groups in Key Discussions Impacting Native Communities

February 25-26: HHS Secretary Tribal Advisory Committee (STAC)

What they are saying:

  • HHS announced the establishment of the Make American Healthy Again Commission – Chaired by Secretary Kennedy.
  • Assistant Secretary for Financial Resources noted that IHS will not face sequestration with a new CR.
  • Health Resources and Services Administration encouraged urban Indian health clinics to apply for the National Maternal Health Mental Health Hotline and the National Health Service Loan Repayment Program.
  • Center for Medicaid and CHIP Services acknowledged that Medicaid resources for IHS, Tribal, and urban Indian health programs are critical.
  • Substance Abuse and Mental Health Services Administration (SAMHSA) shared that SAMHSA continues to prioritize Tribes and Tribal organization for funding and anticipates more funding in FY25.
  • IHS noted that it is getting back into core duties and IHS priorities and strategic goals have not changed.
  • During the meeting, Secretary Kennedy offered protections to Tribal leaders and the Indian health system, stating, “When they announced $9.6 billion in cuts to my agency—10% of our workforce—the one sub-agency I insisted must be protected was IHS. We safeguarded 1,000 jobs at IHS, and we will continue to do so. As new orders and additional cuts come down, protecting these jobs remains my priority.”
    • Did you know?: On March 12, NCUIH sent a letter to HHS requesting that Secretary Kennedy intervene to exempt IHS from workforce reductions and hiring freezes and protect IHS funding from sequestration and impoundment.

February 25-26: Department of Veterans Affairs (VA) Advisory Committee on Tribal and Indian Affairs

What they are saying:

  • The Office of Urban Indian Health Programs noted a key change in the proposed IHS reorganization includes the creation of a dedicated VA office within IHS to focus solely on VA partnerships.
    • While the reorganization is progressing, implementation has been delayed, especially due to a hiring freeze preventing the appointment of a director.
  • VA Office of Tribal Health (OTH) spoke about the “Clinic in a Clinic” program.
    • This is a program that combines VHA and IHS to allow VHA providers to work at Indian health facilities to provide care directly to Native patients.
    • There are currently two Clinic in a Clinic programs on the Navajo Nation. OTH is looking to expand this program to more clinics, and it can be implemented at any IHS, Tribal Program, or UIO facility.

HHS Secretary Robert R. Kennedy Jr. and NCUIH CEO Francys Crevier (Algonquin) at the HHS Secretary Tribal Advisory Committee on February 26.

March 26-27: CMS Tribal Technical Advisory Group (TTAG) Face to Face Meeting 

What they are saying:

  • Walter Murillo spoke about the importance of including UIOs in state Traditional Healing waivers allowing state Medicaid agencies to cover Traditional Healing services at IHS/Tribal/UIO facilities, and the need for 100% Federal Medical Assistance Percentage (FMAP) for services provided to Medicaid beneficiaries at UIOs.
  • Drew Snyder, Director of the Center for Medicaid and CHIP Services, Deputy Administrator, committed to fruitful relationship with the TTAG on all matters that impact Tribal communities.
  • Kitty Marx, Director of CMS Division of Tribal Affairs (DTA), is retiring. Dr. Susan Karol, Chief Medical Officer at DTA, will be Acting Director of DTA for 120 days, then they will be posting for a permanent position.

Tribal Coalition Update

NCUIH has joined forces with over 20 Tribal organizations to ensure current administrative actions do not harm Native people and the programs that serve them.

Recent Coalition Action:

  • Sent letters on February 21 to HUD, Treasury, Defense, and Small Business Administration, and BIA secretaries regarding treatment of Tribal Nations in implementation of Administration priorities.
  • Sent letters to Senate Leadership on February 20 and House Leadership on February 25 expressing concern and highlighting opportunities for Indian Country as Congress considers budget reconciliation legislation.

Learn more at www.thecoalitiongroup.net

Upcoming Events and Dates to Know

Upcoming Events 

  • April 7-10: Tribal Self-Governance Conference in Chandler, AZ. Register here.
  • April 16: Next NCUIH Monthly Policy Workgroup (virtual).
  • April 17: Office of Urban Indian Health Programs (OUIHIP) Urban Program Executive Directors/Chief Executive Officers Monthly Conference Call.
  • April 22-23: HHS FY 2027 Annual Tribal Budget Consultation. Register here.
  • April 22-25: NCUIH 2025 Annual Conference and Hill Day in Washington, D.C. Register here.
  • April 24: 2nd 2025 HHS STAC Meeting.
  • April 24: IHS Direct Service Tribe Advisory Committee (DSTAC) 3rd Quarterly Meeting.