On August 1, 2024, the Senate Appropriations Full Committee passed the Fiscal Year (FY) 2025 appropriations bill for Labor, Health, and Human Services (LHHS). The bill appropriates $122.8 billion for Health and Human Services (HHS), which is $7.3 billion above the FY24 levels and $1 billion above the President’s request. These increases reflect the Committee’s dedication to protecting healthcare funding and prioritizing funding for Indian Country. The National Council of Urban Indian Health (NCUIH) applauds and thanks the Senate Appropriations Committee for including urban Indian organizations (UIOs) in the report language for the Improving Native American Cancer Outcomes program.

Next Steps

Senate Leadership will now work with House Leadership to develop the final LHHS appropriations spending bill. As a final appropriations bill is produced, NCUIH will continue to advocate to protect funding for Indian Country and maintain maximum funding levels.

• Bill Text
• Bill Report
• Bill Summary

Funding Increased and Maintained for Key Indian Country Programs

Key provisions of the bill include:

• $8 million for the Improving Native American Cancer Outcomes program, an increase of $2 million from FY24
• $24 million for the Good Health and Wellness in Indian Country program, a maintained level from FY24
• $23.67 million for Tribal Behavioral Health Grants (Native Connections), a maintained level from FY24
• $14.5 million for grants for Tribes and Tribal Organizations for Medication-Assisted Treatment for Prescription Drug and Opioid Addiction

Protects Funding for HIV/AIDS Prevention and Treatment

The Senate Appropriations Committee protected funding for HIV/AIDS prevention and treatment, including $2.57 billion for the Ryan White HIV/AIDS Program, $157.25 million for Ending the HIV Epidemic, and $60 million for the Minority HIV/AIDS Fund. The Committee emphasized their support for the Ryan White HIV/AIDS program, “which provides a wide range of community-based services, including primary and home healthcare, case management, substance use disorder treatment, mental health, and nutritional services”. The Senate bill funds critical HIV/AIDS prevention and treatment programs, many of which were cut in the House version of the bill that was passed in July 2024. NCUIH will continue to advocate to protect HIV/AIDS funding and increase Tribal set-asides, as the appropriations process continues.

Increased Funding to Address Opioid and Fentanyl Crisis

The Senate Appropriations Committee significantly increased funding for programs addressing the growing opioid and fentanyl crisis. Senate Appropriations Chair Murray (D-WA) highlighted “As communities work to tackle the devastating opioid and mental health crises, this bill provides significant new funding to support their efforts”. In particular, the bill includes $14.5 million for Tribes and Tribal Organizations for Medication-Assisted Treatment for Prescription Drug and Opioid Addiction programs.

NCUIH Advocacy to Increase Funding for Indian Country Programs

NCUIH worked closely with Appropriators to advocate for increased funding for Indian Country. In written testimony, NCUIH advocated for $10 million for the Improving Native American Cancer Outcomes program, $30 million for the Good Health and Wellness in Indian Country program, and to protect funding for HIV/AIDS treatment and prevention. NCUIH successfully advocated to include UIOs in the Native American Cancer Outcomes program and will continue to push this effort as the bill moves to conference. The Committee showed significant support for Indian Country through this appropriations process.

Bill Highlights:

Line Item	FY 2024 Enacted	FY 2025 President’s Budget Request	FY 2025 Committee  Passed
Health Resources and Services Administration	$8.9 billion	$8.26 billion	$8.94 billion
Substance Abuse and Mental Health Services Administration	$7.4 billion	$8.13 billion	$7.55 billion
National Institute of Health	$48.6 billion	$50.77 billion	$48.81 billion
Centers for Disease Control	$9.2 billion	$11.64 billion	$9.39 billion
Good Health and Wellness in Indian Country	$24 million	—————–	$24 million
Improving Native American Cancer Outcomes	$6 million	—————–	$8 million
Ryan White HIV/AIDS Program	$2.57 billion	$2.58 billion	$2.57 billion
Ending the HIV Epidemic	$165 million	$175 million	$157.25 million
Minority HIV/AIDS Fund	$60 million	$60 million	$60 million
Minority HIV/AIDS Fund – Tribal Set Aside	$5 million	————	—————
Tribal Behavioral Health Grants (Native Connections)	$23.67 million	$23.67 million	$23.67 million

Health Resources and Services Administration

Health Resources and Services Administration: $8.94 billion

• No report language.

Ryan White HIV/AIDS Program: $2.57 billion

• Bill report pg. 55: The Committee recommendation includes $2,571,041,000 for the HIV/AIDS Bureau. The mission of the Bureau is to address the unmet care and treatment needs of persons living with HIV/AIDS. The Bureau administers the Ryan White Care Act (Public Law 111–87), which provides a wide range of community-based services, including primary and home healthcare, case management, substance use disorder treatment, mental health, and nutritional services.

Federal Office of Rural Health Policy: $385.9 million

• Bill report pg. 57: The Committee recommendation for Rural Health programs is $385,907,000, an increase of $21,300,000 above the fiscal year 2024 enacted level.

Native Hawaiian Health Care Program: $27 million

• Bill report pg. 41: The Committee includes no less than $27,000,000 for the Native Hawaiian Health Care Program. Of the total amount appropriated for the Native Hawaiian Health Care Program, not less than $10,000,000 shall be provided to Papa Ola Lokahi for administrative purposes authorized under 42 U.S.C. 11706, including to coordinate and support healthcare service provision to Native Hawaiians and strengthen the capacity of the Native Hawaiian Health Care Systems to provide comprehensive health education and promotion, disease prevention services, traditional healing practices, and primary health services to Native Hawaiians.

National Health Service Corps: $128.6 million

• Bill report pg: 42: The Committee provides $128,600,000 for the National Health Service Corps [Corps]. The Committee recognizes the success of the Corps program in building healthy communities in areas with limited access to care. The program has shown increases in retention of healthcare professionals located in underserved areas.

National Center of Excellence for Eating Disorders: $1 million

• Bill report pg. 45: Within the total for PCTE, the Committee continues to support up to $1,000,000 in coordination with SAMHSA’s Center of Excellence for Eating Disorders, to provide trainings for primary care health professionals to screen, intervene, and refer patients to treatment for the severe mental illness of eating disorders, as authorized under section 13006 of the 21st Century Cures Act (Public Law 114–255).

Centers for Disease Control and Prevention

Good Health and Wellness in Indian Country: $24 million

• Bill report pg 75: The Committee’s recommended level includes $24,000,000 for Good Health and Wellness in Indian Country.

Office of the Secretary – General Departmental Management 

Minority HIV/AIDS Fund: $60 million

• Bill report pg. 237: The Committee includes $60,000,000 for the Secretary’s Minority HIV/AIDS Fund to strengthen and expand services provided by minority-serving community-based organizations [CBOs] for HIV education and awareness campaigns, testing, prevention, linkage to care, and engagement in care to racial and ethnic minority individuals at risk for or living with HIV in order to address the decline in HIV testing and the challenges with linkage to and retention in care and treatment that occurred during the COVID–19 pandemic. Funding may be prioritized for minority-serving CBOs in the South, which has the highest burden of HIV of any region nationwide.

Substance Abuse and Mental Health Services Administration

Substance Abuse and Mental Health Services Administration: $7.54 billion

• Bill report pg: 157: The Committee recommends $7,554,306,000 for the Substance Abuse and Mental Health Services Administration [SAMHSA]. The recommendation includes $133,667,000 in transfers available under section 241 of the PHS Act (Public Law 78–410 as amended) and $12,000,000 in transfers from the PPH Fund.

Substance Abuse Prevention Services: $246.88 million

• Bill report pg: 172: The Committee recommends $246,879,000 for the Center for Substance Abuse Prevention [CSAP], the sole Federal organization with responsibility for improving accessibility and quality of substance use prevention services.

Tribal Behavioral Grants (Native Connections): $23.67 million

• Bill report pg. 173: SAMHSA has administered Tribal Behavioral Health Grants for mental health and substance use prevention and treatment for Tribes and Tribal organizations since fiscal year 2014. In light of the continued growth of this program, as well as the urgent need among Tribal populations, the Committee continues to urge the Assistant Secretary for SAMHSA to engage with Tribes on ways to maximize participation in this program.

Zero Suicide: $30.2 million – $3.4 million AI/AN Set-Aside 

• Bill report pg: 162: The Committee includes $30,200,000 for suicide prevention programs. Of the total, $26,200,000 is for the implementation of the Zero Suicide model, which is a comprehensive, multi-setting approach to suicide prevention within health systems.
  • American Indian and Alaska Native Set Aside – Additionally, suicide is often more prevalent in highly rural areas and among the American Indian and Alaskan Native populations. According to the CDC, American Indian/Alaska Natives [AI/AN] have the highest rates of suicide of any racial or ethnic group in the United States. In order to combat the rise in suicide rates among this population, the Committee recommends $3,400,000 for AI/AN within Zero Suicide.

Mental Health Services Block Grant: $1.04 billion

• Bill report pg. 164: The Committee recommends $1,042,571,000 for the Mental Health Block Grant [MHBG]. The recommendation includes $21,039,000 in transfers available under section 241 of the PHS Act (Public Law 78–410 as amended). In addition to the funding made available in this bill, the Bipartisan Safer Communities Act included $250,000,000 over 4 fiscal years, with $62,500,000 made available each fiscal year through September 30, 2025, to support the MHBG.

988 Suicide & Crisis Lifeline: $539.62 million

• Bill report pg. 159: —Suicide is a leading cause of death in the United States, claiming over 49,000 lives in 2022. The Committee provides $539,618,000 for the 988 Lifeline and Behavioral Health Crisis Services. This amount includes funding to continue to strengthen the 988 Lifeline and enable the program to continue to respond in a timely manner to an increasing number of contacts. The 988 Lifeline coordinates a network of independently operated crisis centers across the United States by providing suicide prevention and crisis intervention services for individuals seeking help. The Committee requests a briefing within 90 days of enactment on the 988 Lifeline spend plan and related activities.

Substance Use Prevention, Treatment, and Recovery Services Block Grant: $2.49 billion

• Bill report pg. 174: The Committee acknowledges the important role of the Community Mental Health Services and Substance Use Prevention, Treatment, and Recovery Services Block Grants in supporting States’ efforts to provide resources for expanded mental health and substance use disorder treatment and prevention services. The Committee reiterates the request for a report as included in Public Law 118–47 regarding the lack of transparency and information that is provided to Congress and the public about how States are distributing those funds and what programs or services they are going toward.

State Opioid Response Grants: $1.6 billion

• Bill report pg. 170: The Committee provides $1,600,000,000 for grants to States to address the opioid crisis. Bill language provides not less than 4 percent for grants to Indian Tribes or Tribal organizations. The Committee supports the 15 percent set-aside for States with the highest age-adjusted mortality rate related to substance use disorders, as authorized in Public Law 117–328. The Assistant Secretary is encouraged to apply a weighted formula within the set-aside based on state ordinal ranking. Activities funded with this grant may include treatment, prevention, and recovery support services. The Committee continues to direct SAMHSA to conduct a yearly evaluation of the program to be transmitted to the Committees on Appropriations of the House of Representatives and Senate no later than 180 days after enactment of this act. SAMHSA is directed to make such evaluation publicly available on SAMHSA’s website. The Committee further directs SAMHSA to continue funding technical assistance within the administrative portion of the appropriated amounts for the SOR grants, to provide locally based technical assistance teams as has been done through the Opioid Response Network. The Committee recognizes the importance and essential work currently being done by the Opioid Response Network in delivering technical assistance to State and Territory SOR grantees, sub-recipients and others addressing opioid use disorder and stimulant use disorder in their communities.

National Institute on Minority Health and Health Disparities

Improving Native American Cancer Outcomes: $8 million

• Bill report pg. 129: The Committee notes that Native Americans experience overall cancer incidence and mortality rates that are strikingly higher than non-Native populations. The Committee includes $8,000,000, an increase of $2,000,000, for the Initiative for Improving Native American Cancer Outcomes to support efforts including research, education, outreach, and clinical access related to cancer in Native American populations. The Committee further directs NIMHD to work with NCI to locate this Initiative at an NCI-designated cancer center demonstrating partnerships with Indian Tribes, Tribal organizations, and urban Indian organizations to improve the screening, diagnosis, and treatment of cancers among Native Americans, particularly those living in rural communities.

Native Hawaiian/Pacific Islander Health Research Office: $7 million

• Bill report pg. 130: The Committee includes $7,000,000, an increase of $3,000,000, for a Native Hawaiian/Pacific Islander Health Research Office. This office should focus on both addressing Native Hawaiian and Pacific Islander [NHPI] health disparities as well as supporting the pathway and research of NHPI investigators. The office should develop partnerships with academic institutions with a proven track record of working closely with NHPI communities and NHPI-serving organizations and located in States with significant NHPI populations to support the development of future researchers from these same communities.

Important Behavioral and Mental Health Provisions

Medication-Assisted Treatment for Prescription Drug and Opioid Addiction Tribal Set Aside: $14.5 million

• Bill report pg: 168: The Committee includes $114,000,000 for medication-assisted treatment, of which $14,500,000 is for grants to Indian Tribes, Tribal organizations, or consortia. These grants should target States with the highest age adjusted rates of admissions, including those that have demonstrated a dramatic age-adjusted increase in admissions for the treatment of opioid use disorders. The Committee continues to direct the Center for Substance Abuse Treatment to ensure that these grants include as an allowable use the support of medication assisted treatment and other clinically appropriate services to achieve and maintain abstinence from all opioids, including programs that offer low-barrier or same day treatment options.

Peer-Support Services: $14 million

• Bill report pg. 46: Within BHWET, the Committee includes $14,000,000 to fund training, internships, and certification for mental health and substance use peer support specialists to create an advanced peer workforce prepared to work in clinical settings.

Infant and Early Childhood Mental Health Program: $15 million

• Bill report pg. 161: The Committee pro- vides $15,000,000 for grants to entities such as State agencies, Tribal communities, universities, or medical centers that are in different stages of developing infant and early childhood mental health services. These entities should have the capacity to lead partners in systems-level change, as well as building or enhancing the basic components of such early childhood services, including an appropriately trained workforce. Additionally, the Committee recognizes the importance of early intervention strategies to prevent the onset of mental disorders, particularly among children. Recent research has shown that half of those who will develop mental health disorders show symptoms by age 14. The Committee encourages SAMHSA to work with States to support services and activities related to infants and toddlers, such as expanding the infant and early childhood mental health workforce; increasing knowledge of infant and early childhood mental health among professionals most connected with young children to promote positive early mental health and early identification; strengthening systems and networks for referral; and improving access to quality services for children and families who are in need of support.

On March 07, 2024, Senator Bob Casey (D-PA) introduced the NCUIH-endorsed Community Health Workers Access Act (S. 3892) which would improve local health workers’ ability to bridge gaps in health outcomes by improving Medicare coverage for their services, including personalized support for illness prevention and recovery. This bill would have a direct impact on Urban Indian Organizations (UIOs) by allowing them to bill Medicare and Medicaid for services provided by community health workers. It would also designate UIOs, community-based organization, nonprofit organizations, community health worker networks, federally qualified health centers, rural health clinics, local or State public health departments, academic institutions, health care providers, and any other organizations deemed appropriate by the Secretary as community health agencies, allowing them to bill Medicare for community health services.

Additionally, the bill encourages states to cover services provided by community health workers under their Medicaid programs. In fact, the bill would incentivize states to include community health workers under Medicaid by providing an enhanced Federal Medical Assistance Percentage (FMAP), to cover preventive services and services to address social needs furnished by community health workers.

This bill is endorsed by over 200 community health centers, Families USA, the American Cancer Society Cancer Action Network, and National Association for Community Health Workers.

NCUIH Advocacy on the Bill

NCUIH provided edits to the Senate Health, Education, Labor, and Pensions Committee, ensuring that UIOs were included in the definition of a community health agency. Last year, NCUIH also joined over 200 organizations in signing on to a letter sent to members of Congress encouraging support for this legislation.

Next Steps

The bill was referred to the Senate Committee on Finance. It currently awaits consideration.

Resources

• Senator Casey’s Press Release
• Bill Text
• One Pager on the bill
• Sign-on Support Letter for the bill.

On July 10, 2024, the House Appropriations Full Committee passed the Fiscal Year (FY) 2025 appropriations bill for Labor, Health, and Human Services (LHHS), which was previously approved by the House LHHS subcommittee on June 27, 2024. The bill appropriates $107 billion for Health and Human Services (HHS), which is $8.5 billion below the FY24 levels and $14 billion below the President’s request. Despite the sizeable cut to the LHHS spending bill and reducing funding for nearly every account to below FY24 enacted levels, Indian Country priorities received increases. The cuts to the LHHS budget are partly due to the Appropriations Leadership reallocating funds from the LHHS bill to the Interior-Environment bill to meet the mandated increases as result of the recent Supreme Court decision on contract support costs (CSCs).

Next Steps

The bill will now be sent to the House floor for a vote. A vote is expected to be scheduled in the next two weeks. In addition, the Senate is working on their own Labor, Health and Human Services spending bill. NCUIH will continue to advocate to protect funding for Indian Country and maintain funding levels passed by the House of Representatives.

• Bill Text
• Bill Report
• Bill Summary

Funding Increases for Programs to Improve Cancer Outcomes, Health & Wellness, Behavioral Health, Substance Use, and Workforce in Indian Country

Key provisions of the bill include:

• $15 million for the Improving Native American Cancer Outcomes program, an increase of $9 million from FY24
• $30 million for the Good Health and Wellness in Indian Country program, a $6 million increase from FY24
• $27.75 million for Tribal Behavioral Health Grants (Native Connections), a $5 million increase from FY24
• $16.5 million for grants for Tribes and Tribal Organizations for Medication-Assisted Treatment for Prescription Drug and Opioid Addiction
• Increases the Tribal set aside for Indian Health Service facilities, Tribally operated health programs, and Urban Indian Health Programs for the National Health Service Corps loan repayment program to 15%.

Funding Cuts for HIV/AIDS Programs

Unfortunately, the bill also includes severe cuts to HIV/AIDS funding. During the Full Appropriations Committee markup, Representative Barbara Lee (D-CA-12) stated “The bill would slash HIV/AIDS prevention research program by a shocking 21% and limit the amount of research the office of AIDS research is able to carry out. Eliminates the Ending the HIV Epidemic initiative, zeros out funding for the Ryan White project of national significance grants. Reduce minority AIDS funding at HHS and eliminate minority AIDS funding at SAMHSA.” While the bill reduces the Minority HIV/AIDS fund by $15 million to $45 million, it increases the Tribal set-aside by $1 million, bringing the total to $6 million. Many UIOs receive funding through these programs and would be greatly impacted by any loss in funding, and thus affecting health equity for urban Natives. NCUIH will continue to advocate for additional HIV/AIDS funding as the appropriations process continues.

Self-Governance at HHS

The Committee also directed the Department of Health and Human Services to extend self-governance to all programs at HHS that are critical to Tribes. The bill report states “For over forty years, Indian Tribes have proven that utilizing self-governance through the Indian Self-Determination and Education Assistance Act in Federal funding is a successful approach for improving program performance. For decades, Indian Tribes have requested the Department to expand this authority beyond the Indian Health Service to other critical HHS programs serving Tribes. Over twenty years, multiple reports and workgroups have produced evidence of the feasibility of the expansion of self-determination and self-governance within the Department. The Committee directs HHS to work with Tribal representatives to provide a plan for the expansion of self-governance at HHS including specific actions the Department can take to advance this process. Such plan is due within 180 days of enactment of this Act. In addition, the Department shall report to the Committee the amount of funding that is going to Indian Tribes for the 4 largest block grants administered by HHS within 90 days of enactment of this Act.”

NCUIH Advocacy to Increase Funding for Indian Country Programs

NCUIH worked closely with Appropriators to advocate for increased funding for Indian Country. In written testimony, NCUIH advocated for $10 million for the Improving Native American Cancer Outcomes program, $30 million for the Good Health and Wellness in Indian Country program, and to protect funding for HIV/AIDS treatment and prevention. The Committee showed significant support for Indian Country through this appropriations process.

Bill Highlights:

Line Item	FY 2024 Enacted	FY 2025 President’s Budget Request	FY 2025 Committee  Passed
Health Resources and Services Administration	$8.9 billion	$8.26 billion	$7.64 billion
Substance Abuse and Mental Health Services Administration	$7.4 billion	$8.13 billion	$7.54 billion
National Institute of Health	$48.6 billion	$50.77 billion	$48.58 billion
Centers for Disease Control	$9.2 billion	$11.64 billion	$7.45 billion
Good Health and Wellness in Indian Country	$24 million	—————–	$30 million
Improving Native American Cancer Outcomes	$6 million	—————–	$15 million
Ryan White HIV/AIDS Program	$2.57 billion	$2.58 billion	$2.38 billion
Ending the HIV Epidemic	$165 million	$175 million	$0
Minority HIV/AIDS Fund	$60 million	$60 million	$45 million
Minority HIV/AIDS Fund – Tribal Set Aside	$5 million	————	$6 million
Tribal Behavioral Health Grants (Native Connections)	$23.65 million	$23.65 million	$27.75 million

Health Resources and Services Administration

Health Resources and Services Administration: $7.64 billion

• Bill report pg. 30: The Committee recommendation for HRSA includes $7,373,110,000 in discretionary budget authority and $266,727,000 in mandatory funding.

Ryan White HIV/AIDS Program: $2.38 billion

• Bill report pg. 48: The Ryan White Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) program funds activities to address the care and treatment of persons living with HIV/AIDS who need assistance to obtain treatment. The program provides grants to States and eligible metropolitan areas to improve the quality, availability, and coordination of health care and support services to include access to HIV-related medications; grants to service providers for early intervention outpatient services; grants to organizations to provide care to HIV infected women, infants, children, and youth; and grants to organizations to support the education and training of health care providers.

Federal Office of Rural Health Policy: $400.9 million

• Bill report pg. 50: The Federal Office of Rural Health Policy’s (FORHP) programs provide funding to improve access, quality, and coordination of care in rural communities; for research on rural health issues; for technical assistance and recruitment of health care providers; for screening activities for individuals affected by the mining, transport, and processing of uranium; and for the outreach and treatment of coal miners and others with occupation-related respiratory and pulmonary impairments.

Native Hawaiian Health Care Program: $27 million

• Bill report pg. 32: The Committee continues $27,000,000 for the Native Hawaiian Health Care Program. Of the total amount appropriated for the Native Hawaiian Health Care Program, not less than $10,000,000 shall be provided to Papa Ola Lokahi for administrative purposes authorized under 42 U.S.C. 11706, including expanded research and surveillance related to the health status of Native Hawaiians and strengthening the capacity of the Native Hawaiian Health Care Systems.

National Health Service Corps: $130 million

• Bill report pg: 36 The Committee includes $130,000,000, which is $1,400,000 above the fiscal year 2024 enacted level and $4,400,000 above the fiscal year 2025 budget request, for the National Health Service Corps (NHSC) to support competitive awards to health care providers dedicated to working in underserved communities in urban, rural, and Tribal areas.
  • Tribal Set Aside.—The Committee also includes a set aside of 15 percent within the discretionary total provided for NHSC to support awards to participating individuals that provide health services in Indian Health Service facilities, Tribally-operated health programs, and Urban Indian Health programs.

National Center of Excellence for Eating Disorders: $5 million

• Bill report pg. 133: The Committee provides $5,000,000 to improve the availability of health care providers to respond to the needs of individuals with eating disorders including the work of the National Center of Excellence for Eating Disorders to increase engagement with primary care providers, including pediatricians, to provide specialized advice and consultation related to the treatment of eating disorders. The Committee provides additional funding to support the development, in coordination with the departments of Defense and Veterans Affairs, of a Screening, Brief Intervention and Referral to Treatment model for service members, veterans, and their families.

Centers for Disease Control and Prevention

Good Health and Wellness in Indian Country: $30 million

• $30 million for Good Health and Wellness in Indian Country for FY 2025. The recommendation is $15 million above FY24 enacted levels.

Office of the Secretary – General Departmental Management 

Minority HIV/AIDS Fund: $45 million – Tribal Set Aside: $6 million

• Bill report pg. 196: The Committee includes $45,000,000 for the Minority HIV/AIDS Fund (MHAF), which is $15,000,000 below the fiscal year 2024 enacted level and the fiscal year 2025 budget request.
  • Bill report pg: 196: Tribal Set Aside.—The Committee notes that according to the CDC, HIV-positive status among Native Americans is increasing and nearly one-in-five HIV-positive Native Americans is unaware of their status. In addition, only three-in-five receive care and less than half are virally suppressed. To increase access to HIV/AIDS testing, prevention, and treatment, the Committee increases the Tribal set aside within the MHAF to $6,000,000, which is $1,000,000 above the fiscal year 2024 enacted level.

Substance Abuse and Mental Health Services Administration

Substance Abuse and Mental Health Services Administration: $7.54 billion

• Bill report pg: 124: The Committee recommendation for the Substance Abuse and Mental Health Services Administration (SAMHSA) program level includes $7,398,400,000 in discretionary budget authority, $131,667,000 in PHS Evaluation Tap Funding, and $12,000,000 in transfers from the Prevention and Public Health Fund (PPHF).

Substance Abuse Prevention Services: $203.17 million

• No report language.

Mental Health Services Block Grant: $1.02 billion

• Bill report pg. 127: The Committee provides $1,022,571,000 for the Mental Health Services Block Grant (MHBG) which is $15,000,000 above the fiscal year 2024 enacted program level and $20,000,000 below the fiscal year 2025 budget request. The MHBG provides funds to States to support mental illness prevention, treatment, and rehabilitation services. Funds are allocated according to a statutory formula among the States that have submitted approved annual plans. The Committee continues the 10 percent set aside within the MHBG for evidence-based programs that address the needs of individuals with early serious mental illness, including psychotic disorders and the 5 percent set aside for crises-based services. The Committee notes that, consistent with State plans, communities may choose to direct additional funding to crises stabilization programs.

988 Suicide & Crisis Lifeline: $519.62 million

• Bill report pg. 128: The Committee provides $519,618,000 for the 988 Suicide & Crisis Lifeline, which is the same as the fiscal year 2024 enacted program level, to support the national suicide hotline to continue to support State and local suicide prevention call centers as well as a national network of backup call centers and the national coordination of such centers.

Substance Use Prevention, Treatment, and Recovery Services Block Grant: $2.51 billion

• Bill report pg. 134: The Committee includes $2,508,079,000, which is a $500,000,000 increase to the fiscal year 2024 enacted program level, for the Substance Use Prevention, Treatment, and Recovery Services (SUPTRS) Block Grant. The SUPTRS Block Grant is a critical component of each State’s publicly funded substance use disorder system designed to address all substance use disorders—including those related to alcohol. SUPTRS Block Grant funds may support initiatives related to alcohol in settings such as emergency rooms and primary care offices. In addition, States utilize SUPTRS Block Grant funds to support alcohol use disorder treatment services in outpatient, intensive outpatient, and residential programs. Further, the Committee is also aware that SUPTRS Block Grant funds may be allocated to support medications for the treatment of alcohol use disorders, an important tool that should be available to those in need. The Committee also understands SUPTRS Block Grant funds are utilized by States to support recovery community organizations to provide recovery support for those with alcohol use disorders.

State Opioid Response Grants: $1.575 billion

• Bill report pg. 135: The Committee includes $1,575,000,000, which is the same as the fiscal year 2024 enacted program level, for State Opioid Response (SOR) grants. The Committee supports efforts from SAMHSA through SOR grants to expand access to SUD treatments in rural and underserved communities, including through funding and technical assistance.
  • Tribal Set Aside – 4%: Within the amount provided, the Committee includes a set aside for Indian Tribes and Tribal organizations of 4 percent.

Tribal Behavioral Grants (Native Connections): $27.75 million

• Bill report pg. 132: The Committee provides $27,750,000, a $5,000,000 increase from the fiscal year 2024 enacted program level, to prevent and reduce suicidal behavior and substance use, reduce the impact of trauma, and promote mental health among AI/AN youth, through age 24.

Zero Suicide: $27.2 million

• The Committee allocated $27,200,000 to Zero Suicide program, a $1 million include over FY24 enacted levels.
  • American Indian and Alaska Native Set Aside – The Committee allocated $4,400,000 to the American Indian and Alaska Native Set Aside, a $1 million increase over FY24 enacted levels.

National Institute on Minority Health and Health Disparities

Improving Native American Cancer Outcomes: $15 million

• Bill report pg. 107: The Committee continues to be concerned that Native Americans experience overall cancer incidence and mortality rates that are strikingly higher than non-Native populations. The Committee includes $15,000,000, which is an increase of $9,000,000 above the fiscal year 2024 enacted level, to continue an initiative for Improving Native American Cancer Outcomes to support efforts including research, education, outreach, and clinical access related to cancer in Native American populations. The Committee further directs NIMHD to work with NCI to locate this initiative at an NCI-designated cancer center demonstrating partnerships with Indian Tribes and Tribal organizations to improve the screening, diagnosis, and treatment of cancers among Native Americans, particularly those living in rural communities.

Native Hawaiian/Pacific Islander Health Research Office: $5 million

• Bill report pg. 108: —The Committee provides $5,000,000, which is an increase of $1,000,000 above the fiscal year 2024 enacted level, for the Native Hawaiian/ Pacific Islander Health Research Office (NHPIHRO) with a focus on both addressing Native Hawaiian and Pacific Islander (NHPI) health disparities, as well as supporting the pathway and research of NHPI investigators. The Committee encourages NHPIHRO to develop partnerships with academic institutions with a proven track record of working closely with NHPI communities and NHPI serving organizations located in states with significant NHPI populations to support the development of future researchers from these same communities.

Important Behavioral and Mental Health Provisions

Medication-Assisted Treatment for Prescription Drug and Opioid Addiction Tribal Set Aside: $16.5 million

• $16.5 million for grants for Tribes and Tribal Organizations for Medication-Assisted Treatment for Prescription Drug and Opioid Addiction

Peer-Support Services: $15 million

• Bill report pg. 39: The Committee supports community based experiential training for students preparing to become peer support specialists and other types of behavioral health-related paraprofessionals. The Committee includes a $1,000,000 increase for this activity.

Infant and Early Childhood Mental Health Program: $15 million

• Bill report pg. 130: The Committee provides $15,000,000, which is the same as the fiscal year 2024 enacted program level, for the Infant and Early Childhood Mental Health program, for grants to human service agencies and nonprofit organizations to provide age-appropriate mental health promotion and early intervention or treatment for children with or with significant risk of developing mental illness including through direct services, assessments, and trainings for clinicians and education providers.

The House Appropriations Full Committee passed an Interior bill that includes $8.56 billion for IHS and $99.99 million for Urban Indian Health.

On July 9, 2024, the House Appropriations Full Committee passed the Fiscal Year (FY) 2025 appropriations bill for Interior, Environment, and Related Agencies, which was previously approved by the House Subcommittee on June 28, 2024. The bill authorizes $8.56 billion for the Indian Health Service (IHS)— an increase of $1.6 billion from FY24 and $561.64 million above the President’s request. The bill also provides $99.99 million for Urban Indian health, which is $9.5 million above the FY24 enacted amount and $5 million above the President’s budget request. The Committee report included language that affirmed the trust responsibility for all Native people including those who reside in urban areas.

Other key provisions include: maintaining advance appropriations for IHS for FY26 with an increase to $5.98 billion from $5.19 billion in FY25, $8 million for generators at IHS/Tribal Health Programs/Urban Indian Organizations (UIOs), $7 million, a $4 million increase, for the Produce Prescription Pilot Program for Tribes and UIOs to increase access to produce and other traditional foods, as well as $44.43 million, a $10 million increase, for Tribal Epidemiology Centers (TECs).

NCUIH recently worked closely with Representatives Gallego and Grijalva on leading a Congressional letter signed by 52 House members to the House Committee on Appropriations for FY 2025. The letter has bipartisan support and calls for support for Urban Indian Health based on the TBFWG’s recommendation and to maintain advance appropriations for IHS until such time that authorizers move IHS to mandatory spending. NCUIH also joined the National Indian Health Board, National Congress of American Indians, and 25 other organizations on a letter urging Congressional Appropriations leaders to transition Contract Support Cost and 105(l) leases to mandatory appropriations.

• Bill Report with Urban Indian Health Line Item
• Draft House Interior Appropriations Bill
• Bill Summary

Next Steps

The House is scheduled to vote on the Interior, Environment, and Related Agencies spending bill the week of July 22. The legislation is not expected to become law in its current form. House leadership will need to work with Senate Leadership to negotiate a final bill text for passage in both chambers. The Senate Appropriations Committee is tentatively scheduled to mark up the Senate Interior bill the week of July 22.

FY24 funding is set to end on September 30, 2024. If Congress cannot come to a funding agreement by that deadline, they will need to pass a Continuing Resolution to keep the funding levels at the FY24 level until they can reach an agreement. Should political disagreements lead to a government shutdown, UIOs and parts of IHS will be protected by Advance Appropriations.

Bi-Partisan Support for IHS Funding and Advance Appropriations in Bill Hearing

Throughout the appropriations process, there has been clear bipartisan support for the Indian Health Service:

“I refuse to balance the budget on the backs of tribes. I am proud this bill makes strong investments to further the federal government’s trust and treaty commitments to the Tribes.” – Chairman Mike Simpson (R-ID-2)

“The measure [Interior Bill] before us today impacts vast aspects of American Life. It also advances the federal commitment to honor our trust and treaty responsibilities to American Indian and Alaska Native communities. Essential resources are delivered at the total funding level at $38.4 billion,” said Appropriations Chairman Tom Cole (R-OK-4), “Delivering on our trust and treaty commitments are of critical importance to my home state of Oklahoma and to all people of Indian Country.”

“I want to show my pride and appreciation for the continued nonpartisan trust and treaty responsibility that’s the hallmark of this Interior bill. Chairman Cole I want to thank you for raising interior allocation to allow us to meet the increased responsibilities for contract support costs,” said Rep. Betty McCollum (D-MN-4), and she also acknowledged the inclusion of advance appropriations for IHS, “Chairman Simpson I appreciate you once again prioritizing funding for life, health and safety issues for Indian Country, including advance appropriations for the Indian Health Service for a third year in a row.”

Committee leadership also signified their support of the transition of Contract Support Costs to mandatory funding:

Ranking Member Pingree (D-ME-1) shared, “I want to acknowledge and thank Chairman Cole for adjusting the Interior Allocation to accommodate the $739 million increase required by the result of the Supreme Court decision on contract support costs. These costs will continue to rise, and I hope we can work together to make these funds mandatory.”

Appropriations Ranking Member Rosa De Lauro (D-CT-3), shared her support for funding contract support costs, “It is my hope that we can work together to see the funding needed to address rising contract support costs is made mandatory.”

Bill Highlights

LINE ITEM	FY24 ENACTED	FY25 TBFWG REQUEST	FY25 PRESIDENT’S BUDGET	FY25 HOUSE PROPOSED
URBAN INDIAN HEALTH	$90,419,000	$965,254,000	$94,990,000	$99,992,000
INDIAN HEALTH SERVICE	$6,961,914,000	$53,852,801,000	$8,000,000,000	$8,561,647,000
ADVANCE APPROPRIATIONS	$5,190,000,000	————————-	$5,129,458,000	$5,975,150,000
PRODUCE PRESCRIPTION PILOT PROGRAM	$3,000,000	————————-	—————————-	$7,000,000
TRIBAL EPIDEMIOLOGY CENTERS	$34,433,000		$34,433,000	$44,433,000
CONTRACT SUPPORT COSTS	$1,051,000,000	Move to Mandatory	$ 979,000,000	$2,036,000,000
105 (L) LEASES	$149,000,000	$261,000,000	$349,000,000	$400,000,000
ALCOHOL AND SUBSTANCE ABUSE	$266,636,000	$4,859,237,000	$291,389,000	$282,380,000
GENERATORS AT I/T/US	$3,000,000	————————-	—————————-	$8,000,000
MATERNAL HEALTH	$2,000,000	————————-	—————————-	$3,000,000
DENTAL HEALTH	$252,561,000	$3,174,342,000	$276,085,000	$283,080,000

Indian Health Service: $8.56 billion

• Bill Report, Pg.93: The recommendation includes $5,274,783,000 that is available for obligation in fiscal year 2025 for the Indian Health Services Account, $326,052,000 above the fiscal year 2024 enacted level. This includes $4,684,029,000 provided as a fiscal year 2025 advance and $590,754,000 recommended in this bill and available in this fiscal year. These funds are available for two years unless otherwise specified.

Urban Indian Health: $99.99 million

• Bill Report, pg. 95: The Committee recognizes the Federal trust responsibility to provide health care services to American Indian and Alaska Native citizens and acknowledges that approximately seventy-one percent live in urban areas. The recommendation includes $99,992,000, $9,573,000 above the fiscal year 2024 enacted level and $5,000,000 above the President’s budget request, for Urban Indian Health programs.

Contract Support Costs – $2.036 billion and Tribal 105(l) leases – $400 million

• Bill Report, pg. 96: The Committee recommends an indefinite appropriation estimated to be $2,036,000,000 for contract support costs incurred by the agency as required by law. It does not include the Administration’s request for Administrative Costs. The bill continues language making available such sums as are necessary to meet the Federal government’s full legal obligation and prohibiting the transfer of funds to any other account for any other purpose. In addition, the bill includes language specifying carryover funds may be applied to subsequent years’ contract support costs.
  • In a recent Supreme Court opinion, Becerra v. San Carlos Apache, found that self-determination contracts between Tribes and IHS require spending and collection of third-party revenue, therefore, by doing so and incurring administrative costs, IHS is then required to reimburse for those contract support costs.
• Bill Report, pg. 96: The Committee recommends an indefinite appropriation estimated to be $400,000,000 for Payments for Tribal Leases incurred by the agency as required by law. It does not include the Administration’s request for Administrative Costs. The bill includes language making available such sums as necessary to meet the Federal government’s full legal obligation and prohibits the transfer of funds to any other account for any other purpose.

Hospitals and Health Clinics: $2.84 billion

• Bill Report, pg. 93: The recommendation includes $2,845,868,000 for Hospitals and Health Clinics, $295,354,000 above the fiscal year 2024 enacted level.

Direct Operations: $105.96 million

• No report language

Indian Health Care Improvement Fund: $75.47 million

• Bill Report, pg. 96: The Committee does not accept the IHS’s proposal to move the Indian Health Care Improvement Fund within the Hospitals and Health Clinics funding. The recommendation provides $75,472,000 for the Indian Health Care Improvement Fund, which is $1,334,000 above the fiscal year 2024 enacted level.

Purchased and Referred Care: $1.04 billion

• Bill Report, pg. 94: The recommendation includes $1,048,804,000, $52,049,000 above the fiscal year 2024 enacted level, for Purchase and Referred Care (PRC).

Public Health Nursing: $120.95 million

• No report language.

Immunization AK: $2.3 million

• No report language.

Indian Health Professions: $89.25 million

• Bill Report, pg. 95: The recommendation includes $89,252,000 for Indian Health Professions programs, $8,684,000 above the fiscal year 2024 enacted level and $8,000,000 above the President’s budget request. The Committee continues to support Indian Health Professions programs and expects IHS to allocate the increase provided across all programs, including the Scholarship Program, Loan Repayment Program, Indians into Medicine Program (INMED), American Indians into Nursing (RAIN) Program, and the American Indians into Psychology Programs.

Tribal Management: $2.98 million

• No report language.

Self-Governance: $6.18 million

• No report language.

Maintenance and Improvement: $174.35 million

• No report language.

Sanitation Facilities Construction: $127.96 million

• Bill Report, pg. 97: The Committee continues advance appropriations for programs advanced in fiscal year 2024 and expands advance appropriations to the Indian Health Facilities Sanitation Facilities Construction and Health Care Facilities Construction accounts.

Health Care Facilities Construction: $185.7 million

• Bill Report, pg. 97: The recommendation includes $185,702,000 for Health Care Facilities Construction, $3,023,000 above the fiscal year 2024 enacted level. The recommendation includes $14,000,000, for Staff Quarters, $3,000,000 above the fiscal year 2024 enacted level, for staff housing across the IHS health care delivery system to support the recruitment and retention of quality healthcare professionals across Indian country.

Facility and Environmental Health Support: $323.96 million

• No report language.

Dental Health: $238 million

• Bill Report, pg. 94: The recommendation includes $283,085,000 for Dental Health services, $30,524,000 above the fiscal year 2024 enacted level and $7,000,000 above the President’s budget request.
  • Also includes $8,000,000 to expand Dental Support Centers to all 12 service areas and $6,500,000 to install a electronic Dental Records System.

Equipment – Generators:  $8 million

• Bill Report, pg. 97: To increase the resilience of these facilities, the recommendation includes $8,000,000 to purchase generators, $5,000,000 above the fiscal year 2024 enacted level, including for IHS, Tribal Health Programs, and Urban Indian Organizations located in areas impacted by de-energization events.

Bureau of Indian Affairs, Missing and Murdered Indigenous Women Initiative: $30 million

• Bill Report, pg. 47: Within the increase provided, the recommendation includes an additional $13,500,000 for the Missing and Murdered Indigenous Women Initiative. A total of $30,000,000 is provided to address the crisis of missing and murdered indigenous women, including resources for criminal investigators, software platforms, and evidence recovery equipment. The Committee directs BIA to work with Tribal and Federal law enforcement agencies to facilitate sharing law enforcement and public records data and other technological tools to assist those agencies in finding missing individuals.

Community Health Representatives: $69.62 million

• No report language.

Mental Health: $140.74 million

• Bill Report, pg. 94: The recommendation includes $140,746,000 for Mental Health/Social Services, $10,981,000 above the fiscal year 2024 enacted level.

Alcohol and Substance Abuse: $282.38 million

• Bill Report, pg. 94: The recommendation includes $282,389,000, $15,753,000 above the fiscal year 2024 enacted level, for Alcohol and Substance Abuse programs.

Produce Prescription Pilot Program: $7 million

• Bill Report, pg. 93: The recommendation includes $7,000,000, $4,000,000 above the fiscal year 2024 enacted level, for IHS to expand, in coordination with Tribes and Urban Indian Organizations (UIOs), the Produce Prescription Pilot to implement a produce prescription model to increase access to produce and other traditional foods among its service population. The Committee encourages IHS to provide a briefing to the Committee not later than 90 days following the enactment of this Act on the distribution of funds and implementation efforts

Tribal Epidemiology Centers: $44.43 million

• Bill Report, pg. 93: The Committee recognizes the importance of Tribal Epidemiology Centers (TEC) which conduct epidemiology and public health functions critical to the delivery of health care services for Tribal and urban Indian communities. The recommendation includes $44,433,000 for TECs, $10,000,000 above the fiscal year 2024 enacted level.

Maternal Health: $3 million

• Bill Report, pg. 93: The recommendation includes $3,000,000, $1,000,000 above the fiscal year 2024 enacted level, for Improving Maternal Health.

Alzheimer’s Disease: $6 million

• Bill Report pg. 93: The recommendation includes $6,000,000, $500,000 above the fiscal year 2024 enacted level, to continue Alzheimer’s and related dementia activities. These funds will enable awardees to continue to implement locally developed models of culturally appropriate screening, diagnostics, and management of people living with Alzheimer’s and other related dementia. This funding also supports the Dementia ECHO program, designed to support clinicians and caregivers to strengthen their knowledge and care around dementia for Tribal patients.

Background and Advocacy

On March 9, 2024, President Biden released his budget request for FY25 which included $8.2 billion for IHS and proposed mandatory funding for IHS from FY 2026 to FY 2034 to the amount of $288.9 billion over-ten years as well as exempting IHS from sequestration. This mandatory formula would culminate in $42 billion for IHS in FY 2033, to account for inflation, staffing increases, long-COVID treatment, and construction costs. On March 11, 2024, IHS published their FY 2024 Congressional Justification with the full details of the President’s Budget, which includes $95 million for urban Indian health – a 5% increase above the FY 2024 enacted amount of $90.42 million.

• President’s FY 2025 Budget
• IHS FY 2025 Congressional Justification
• NCUIH Analysis of President’s FY 2025 Budget

NCUIH also requested full funding for urban Indian health for FY 2025 at $963.5 million for urban Indian Health in FY25 in accordance with the Tribal Budget Formulation Workgroup recommendations. NCUIH requested that advance appropriations be maintained for the Indian Health Service (IHS) until mandatory funding is achieved. This budget recommendation is the result of Tribal leaders, over several decades, providing budget recommendations to phase in funding increases over 10-12 years to address growing health disparities that have largely been ignored.

On May 8, 2024, NCUIH Board Member and Executive Director of Helena Indian Alliance – Leo Pocha Clinic, Todd Wilson (Crow), testified before and submitted public witness written testimony to the House Appropriations Subcommittee on Interior, Environment, and Related Agencies regarding FY 2025 funding. NCUIH requested full funding for IHS at $53.8 billion and $ 965.3 million for Urban Indian Health for FY 2025 as requested by the Tribal Budget Formulation Workgroup (TBFWG), maintain advance appropriations for IHS, and protecting IHS from sequestration.

NCUIH recently worked closely with Representatives Gallego and Grijalva on leading a Congressional letter signed by 52 House members to the House Committee on Appropriations for FY 2025. The letter has bipartisan support and calls for support for Urban Indian Health based on the TBFWG’s recommendation and to maintain advance appropriations for IHS until such time that authorizers move IHS to mandatory spending. On May 14, 2024, a group of 20 Senators sent a letter to the Senate Interior Appropriations Committee with the same requests.