On December 12, 2025, the National Council of Urban Indian Health (NCUIH)-endorsed legislation, the Bridging Agency Data Gaps & Ensuring Safety (BADGES) for Native Communities Act (S.390) unanimously passed the Senate and will now head to the House. Senators Catherine Cortez Masto (D-N.V.), John Hoeven (R-N.D.), Ruben Gallego (D-A.Z.) and Mike Rounds (R-S.D.) reintroduced this bipartisan legislation on February 4, 2025, which is aimed at strengthening Tribal public safety. 

Specifically, the bill:

1. Requires law enforcement agencies to report on cases of Missing or Murdered Indigenous Peoples (MMIP). 
2. Establish a grant program to support states, Tribes, and Tribal organizations in the coordination of efforts related to missing and murdered persons cases and sexual assault cases.
3. Urban Indian Organizations (UIOs) are eligible entities for the missing or murdered response coordination grant program established by this bill. This could allow UIOs to establish and grow programs to assist in developing coordinated responses and investigations for MMIP.
4. Increase Tribal access to the National Missing and Unidentified Persons System (NamUs) by requiring Tribal facilitators to conduct ongoing Tribal outreach and serve as a point of contact for Tribes and law enforcement agencies, as well as conduct training and information gathering to improve the resolution of missing persons cases.
5. Require a report on Tribal law enforcement needs, including staffing, replacement and repairs for corrections facilities, infrastructure and capital for Tribal police and court facilities, and emergency communication technology. 
6. Evaluate federal law enforcement evidence collection, handling, and processing crucial to securing conviction of violent offenders.

Read the bill text here.

Background

Missing and murdered Indigenous peoples (MMIP) is a crisis that refers to the disproportionate amount of violence and abuse that affects American Indian and Alaska Native people in the United States.  NCUIH surveyed UIO leaders in 2019 on the biggest risk factors leading to American Indian and Alaska Native patients missing in their communities, and 66 percent said it was a combination of homelessness, foster system transitioning, domestic violence, substance misuse, and human trafficking, among others. According to the California Consortium of Urban Indian Health’s Red Women Rising initiative, 65 percent of urban Indian women experienced interpersonal violence, 40 percent experienced multiple forms of violence, and 48 percent experienced sexual assault.

Furthermore, an October 2021 report by the Government Accountability Office (GAO) on missing or murdered Indigenous women noted that “tribal organization officials told [GAO] that AI/AN individuals who leave rural villages to move to urban, non-Tribal areas are at a higher risk of becoming victims to violent crime, including human trafficking, which they stated is a serious concern related to the MMIP crisis. In 2020, the Not Invisible Act Commission, a commission of law enforcement, Tribal leaders, federal partners, service providers, family members of missing and murdered individuals, and survivors established by the passage of the No Invisible Act of 2019, published a report urging Congress and the Administration to take action to address the related crises of MMIP and human trafficking of Indigenous person. The BADGES for Native Communities Act is a response to the report published by the Not Invisible Act Commission.

Four In-Person Consultations and One Virtual Session Scheduled Across the Country

On November 13, 2025, Acting Director Ben Smith of the Indian Health Service (IHS) sent a letter to Tribal Leaders and Urban Indian Organization Leaders announcing the next phase in the Agency’s proposed realignment. This initiative, first introduced in the summer of 2025, is stated with an intent “to transform the IHS into a more patient-centered, self-determination-driven, operationally efficient, and fiscally sustainable health care system”.

Director Smith’s letter emphasized the Agency’s commitment to high-quality, culturally responsive care and thanked Tribal and Urban Leaders for their active engagement and thoughtful input during the initial round of Tribal Consultation and Urban Confer. He noted that feedback received made it clear that a second round of consultation would be valuable as more details about the realignment structure become available.

NCUIH submitted comments in response to the first round of confer on August 28, 2025, and recommended additional confers to provide more opportunities for feedback.

According to IHS, the realignment seeks to modernize the Agency, enhance accountability, and better align leadership functions with its contemporary mission. Smith highlighted the importance of clarifying roles, reducing administrative burdens, and allowing leaders at both headquarters and in the field to focus on policy, oversight, and partnership. The letter states that approximately 62 percent of the IHS budget is managed by Tribes and Tribal organizations through Title I contracts and Title V compacts under the Indian Self-Determination and Education Assistance Act (ISDEAA), while the remaining 38 percent supports federally operated IHS hospitals, health centers, and programs. These statistics are provided as reasoning for the need to modernize the Agency.

“This modernization will strengthen patient care within IHS-operated facilities and elevate the Agency’s inherent Federal functions—ensuring that we are an effective partner and support system for self-determination, no matter how each Tribe chooses to exercise that right,” Smith wrote.

IHS will hold four in-person Tribal Consultation sessions and one virtual Urban Confer session.

Feedback from the sessions and written comments must be submitted by February 9, 2026. Comments for the Tribal Consultation should be emailed to consultation@ihs.gov, and Urban Confer comments to urbanconfer@ihs.gov, with the subject line “IHS Proposed Realignment.”

After the comment period, IHS will begin an internal deliberation phase to review all feedback before moving forward with the finalization and implementation of the realignment plan.

In this Edition:

• 📡 Senate Hearing on Shutdown Impacts in Native Communities
• 🏛️ Federal Funding Continued Through a New Continuing Resolution
• 🎤 Congressional Briefing on Preventing Substance Use Disorder and Overdose
• 📘 New Resources: AARP Family Caregiving Guide and Overview of the One Big Beautiful Bill Act (OBBBA)
• 🏥 Updates on Affordable Care Act Premium Tax Credits for American Indian and Alaska Native People
• 📝 Indian Health Service Fiscal Year 2028 Budget Formulation and Updated Information
• 🤝 Tribal Government-to-Government Roundtable on Strengthening Tribal Sovereignty
• 👥 Staffing Updates at the Department of Health and Human Services and the Indian Health Service
• ⚖️ Office of Management and Budget Deregulatory Memo and New Supplemental Nutrition Assistance Program Provisions
• 💊 Health Resources and Services Administration Updates on the 340B Rebate Pilot and the Ryan White Program
• 📊 Data Standards Committee Updates on Medicaid Enrollment, Health Information Technology Modernization, and NCUIH’s New Substance Use Disorder Fact Sheet

Appropriations and Shutdown Updates

Senate Committee on Indian Affairs Oversight Hearing

On October 29, 2025 the Senate Committee on Indian Affairs (SCIA) held an Oversight hearing addressed shutdown impacts on Native communities.

Vice Chairman Senator Schatz stated:

• “Native programs are not Diversity, Equity, and Inclusion spending or charity—they are the law.”
• “Attempting to cancel funds for Native programs, RIFing more that 42,000 federal employees, and eliminating tribal consultation policies – that’s not the Unites States government meeting its trust and legal obligations.”

Continuing Resolution / Federal Funding

On November 12, 2025, Congress reached an agreement on a Continuing Resolution (CR) to maintain FY 2025 funding through January 30, 2026.

• Prevents further shutdown disruptions that heavily impact Indian Country and Urban Indian Organizations.

The CR included language that reversed the RIF actions taken since October 1, as well as protections against future RIFs for the duration of the CR.

The CR also extended several key policy riders important to Indian country through January 30, 2026: 

• Funding for the Special Diabetes Program for Indians (SDPI) at $159 million annualized.
• Extension of the Medicare telehealth flexibilities, which allows IHS, Tribal, and Urban Indian programs to resume billing Medicare for tele-visits.
• Extension of Community Health Center and National Health Service Corps funding.

Legislative Updates

Federal Medical Assistance Percentage (FMAP) Update

Bipartisan Urban Indian Health Parity Act (H.R. 4722): Ongoing advocacy for extending the Federal Medical Assistance Percentage increase for Urban Indian Organizations.

• Reintroduced by Reps. Ruiz (CA-25) and Bacon (NE-02)
• NCUIH is working to secure republican co-sponsors.
• Request for Urban Indian Organizations: Email Republican offices to sign on to the House bill.

Special Diabetes Program for Indians (SDPI) 

Legislation supporting funding and reauthorization of SDPI has been introduced in the House and the Senate.

H.R.5488 – Bipartisan Special Diabetes Program for Indians Reauthorization Act of 2025

• $160 million for FY 2026-2030

S.2211 – Bipartisan Special Diabetes Program Reauthorization Act of 2025

• $160 million for FY 2026-2027

NCUIH Hosted Congressional Briefing

NCUIH hosted a congressional briefing on policy solutions to prevent Substance Use Disorder (SUD) and overdose in Native communities.

• Kerry Hawk-Lessard of Native American LifeLines presented on local initiatives and community-based efforts.
• NCUIH called on Congress to fund behavioral health programs that serve Native communities, especially in urban areas.

Highlights emphasized:

• The urgent need for culturally grounded prevention and treatment.
• The role of Urban Indian Organizations (UIOs) as essential access points.

New Resources Highlight

Overview of the One Big Beautiful Bill Act (OBBBA)

NCUIH has developed a one pager on key provisions and exemptions impacting American Indian and Alaska Native people in the OBBBA.

• This resource is available on the NCUIH Policy Resource Center webpage.

AARP Family Caregiving Guide

• The AARP Family Caregiving Guides support people navigating all stages of caregiving.

The guides include resources to:

• Find help assessing needs.
• Start important conversations.
• Evaluate your loved one’s needs.
• Develop or update a caregiving plan.
• Coordinate help while maintaining caretaker well-being.
• Manage grief and plan for life after caregiving.

Access here: https://www.aarp.org/caregiving/prepare-to-care-planning-guide/

Substance Use Disorder Fact Sheet​​

NCUIH Policy and Data Teams developed a new two-page fact sheet addressing:

• Disparities in overdose deaths among American Indian and Alaska Native people.
• The essential role of Urban Indian Organizations.
• Policy recommendations and needed federal actions.
• Fact sheet available for download on the NCUIH website.

NCUIH Advocacy for Premium Tax Credits

The letter highlights new analysis illustrating the impact on American Indian and Alaska Native families if enhanced premium tax credits expire. The Urban Institute estimates show:

• A significant portion of American Indian and Alaska Native people (318,000) rely on Marketplace plans with premium tax credits.
• Without enhanced tax credits, many (126,000) would lose coverage—representing an estimated 40 percent reduction for American Indian and Alaska Native enrollees.

NCUIH continues advocating for restored and enhanced Affordable Care Act premium tax credits for American Indian and Alaska Native families.

Indian Health Service Fiscal Year 2028 Budget Formulation

Indian Health Service has begun Fiscal Year 2028 budget formulation consultations.

Urban Indian Organization participation remains important for:

• Identifying priority service needs.
• Ensuring representation in federal budget recommendations.

NCUIH Technical Assistance: 

• NCUIH held a prep session for UIOs on October 15.
• NCUIH sent out slide templates and talking points to UIOs by Area.
• If your UIO would like to schedule a one-on-one session with NCUIH to prepare for your respective Area budget consultation, please don’t hesitate to reach out to policy@ncuih.org.

Upcoming scheduled consultations:  

• Phoenix: December 2-3, 9am-5pm AZ time (Hybrid)
• Alaska: December 9-11
• California: December 10
• Great Plains: December 10, 9am-3pm CST (virtual)

Updated Information Overall Funding Target  

• The total funding amount to meet for fiscal year 2028 is $29.8 billion.
• This recommendation is $43.2 billion less than the previous year’s recommendation.
• Due to the drastic decrease in recommended funding, the total recommendation for the Urban Health line item will likely be considerably less than previous years.
• NCUIH sent out updated resources with updated numbers.

Tribal Government-to-Government Roundtable Series

Third convening focused on preserving, protecting, and strengthening Tribal sovereignty.

NCUIH connected with:

• Rep. Begich (R-AK), Vice Chair of the Native American Caucus
• HHS Secretary Robert Kennedy Jr.
• HHS Senior Advisor Mark Cruz
• HHS Senior Advisor for Medicaid, Charles Chapman
• White House Office of Intergovernmental Affairs
• Tribal leaders

Federal Staffing Updates: IHS Announces New Chief of Staff

Indian Health Service

The Indian Health Service announced a new Chief of Staff, Clayton Fulton (Citizen of the Cherokee Nation)

• Responsible for overseeing the coordination of key agency activities and supporting the Office of the Director in a broad range of duties related to the development and implementation of IHS initiatives and priorities.
• NCUIH met with Clayton on Nov. 4 to discuss urban Indian health priorities.

NCUIH Leadership Meeting with Mark Cruz

• The NCUIH Board met with Senior Advisor to the HHS Secretary, Mark Cruz, on October 21 to discuss federal priorities.

Reduction in Force (RIFs)  

• IHS was not included in RIFs; HHS also extended that to tribal programs in other operating divisions.
• There is ongoing litigation regarding the RIFs.

HHS Grants  

• Cruz warned that funding may be cut across HHS authorizing divisions.
• Please let NCUIH know if you have any issues with your grant funding.

HHS Key Staffing Updates  

• IHS Director still has not been appointed. Acting Director Smith can serve until mid-November.
• Dr. Kim Hartwood started at IHS as Chief of Strategic Initiatives.
• The Senior Advisor who worked with Secretary Kennedy on SAMHSA matters, Chris Jones, resigned last Friday. Mark Cruz has been asked to caretake SAMHSA.
• Administration for Children and Families has a new Assistant Secretary – Alex Adams. Has experience working with Idaho Tribes.

Regulatory Updates: Office of Management and Budget and U.S. Department of Agriculture

Office of Management and Budget Deregulatory Memo

The memo is on streamlining the administration’s deregulatory efforts.

• Lays out guidance to agencies on how it should conduct Tribal consultation during a deregulation review process.
• Discussed that most deregulatory efforts should not trigger Tribal consultation, and that if there is a need for Tribal consultation, that general notice and comment period for stakeholders is considered sufficient consultation.
• Issues guidance on how political appointees can repeal regulations without a formal notice or comment period if the official deems the regulation unlawful.

U.S. Department of Agriculture Memo: Supplemental Nutrition Assistance Program (SNAP) Provisions in OBBBA 

OBBBA modifies exemptions to the Able-Bodied Adults Without Dependents (ABAWD) time limit rule of receiving SNAP for only 3 months in a 3-year period if they do not meet certain work requirements by:

• Expanding the age range to 18-64 (previously 18-54)
• Limits the exception for a parent with responsibility for a dependent child to children under 14 years of age (previously 18 years of age)
• Eliminating certain exemptions (homeless individuals, veterans, and foster youth).

New Exceptions for AI/AN people are not subject to the time limit:

• “An Indian” as defined in paragraph (13) of section 4 of the IHCIA;
• “An Urban Indian” as defined in paragraph (28) of Section 4 of the IHCIA; and
• “A California Indian” as described in section 809(a) of the IHCIA.

Health Resources and Services Administration (HRSA) Updates

340B Rebate Pilot Program

Background:

• Under the Program, covered entities continue to make purchases through their 340B wholesaler account and request rebates on specific drugs dispensed to 340B eligible patients after the purchase is made.
• All covered outpatient drugs, without a rebate model approved by HRSA, are subject to upfront discounted 340B prices.
• The Office of Pharmacy Affairs (OPA) has approved eight manufacturers’ plans for participation in the 340B Rebate Model Pilot Program for the January 1, 2026, start date.
• Ryan White HIV/AIDS Program

Background:

• HRSA is proposing to implement a funding methodology that calculates Ryan White HIV/AIDS Program (RWHAP) Part A and B formula awards based on living HIV and AIDS case data. This methodology would use the most recent address, rather than residence at diagnosis.
• The methodology for determining RWHAP Part A and B eligibility would remain unchanged.

Data Standards Committee Updates

Centers for Medicare & Medicaid Services Tribal Technical Advisory Group (TTAG) Data Subcommittee

Updates from July and August meetings:

• National Indian Health Board presentation on Indian Health Service registrants enrolled in Medicaid from 2019–2023.
• Some states with Medicaid expansion saw significant increases in enrollment.
• In 2023, approximately 57.1 percent of Indian Health Service registrants were enrolled in Medicaid.
• Wide variation in accuracy between Indian Health Service registrant data and the American Community Survey population across states.

No September or October updates due to the government shutdown.

Upcoming Tribal Consultations and Events

Consultation/Confer Dates:

• Urban Confer (virtual only): Thursday, January 8, 2026, 1:00 – 4:00 PM ET
• NCUIH will be holding a virtual prep session on January 7, 2025, at 1pm ET

Tribal Consultations (in person only):  

• Monday, December 15, 2025, 1:00 – 4:00 PM CT (Durant, OK)
• Tuesday, December 16, 2025, 1:00 – 4:00 PM MT (Denver, CO)
• Wednesday, December 17, 2025, 1:00 – 4:00 PM PT (San Diego, CA)
• Tuesday, January 6, 2026, 1:00 – 4:00 PM PT (Seattle, WA)

Comments:

• Comment submissions close on February 9th, 2025.

Other Upcoming Events:

• December 17: NCUIH Monthly Policy Workgroup (virtual)

About NCUIH

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

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