NCUIH 2025 Policy Priorities Released

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NCUIH 2025 Policy Priorities

The National Council of Urban Indian Health (NCUIH) is pleased to announce the release of its 2025 Policy Priorities document, which outlines a summary of urban Indian organization (UIO) priorities for the Executive and Legislative branches of the government for 2025. These priorities were informed by NCUIH’s 2024 Policy Assessment.

NCUIH hosted five focus groups to identify UIO policy priorities for 2025, as they relate to Indian Health Service (IHS)- designated facility types (full ambulatory, limited ambulatory, outreach and referral, and outpatient and residential). NCUIH worked with UIOs to identify policy priorities in 2025 under eight themes:

  • Funding for Native Health Initiatives
  • Elevating Native Voices and Fostering Dialogue
  • Strengthening Health Outcomes: Addressing Social Determinants of Health
  • Honoring Promises to Native Veterans
  • Revitalizing Native Health: Embracing Traditional Healing and Behavioral Wellness
  • “Not One More’: Healing Generational Trauma and Protecting Native Lives
  • Addressing Workforce Recruitment and Retention Challenges
  • Improving the Indian Health Service
Read the 2025 Policy Priorities

2025 Policy Priorities:

FUNDING FOR NATIVE HEALTH INITIATIVES
Increasing Funding for Indian Health Service (IHS) and Urban Indian Health
  • Appropriate the Maximum Amount Possible for IHS and Fund Urban Indian Health at $100 million.
  • Support Participation and Continued Inclusion of Urban Indian Organizations in the IHS Budget Formulation Process.
Protecting Funding for Native Health from Political Disagreements
  • Maintain Advance Appropriations for IHS to Insulate the Indian Health System from Government Shutdowns
  • and to Protect Patient Lives.
  • Transition IHS from Discretionary to Mandatory Appropriations.
  • Transition Contract Support Costs and 105 (l) Leases to Mandatory Appropriations.
Meeting the Trust Obligation for IHS-Medicaid Beneficiaries Receiving at Urban Indian Organizations (UIOs)
  • Pass the Urban Indian Health Parity Act to Ensure Permanent Full (100%) Federal Medical Assistance
  • Percentage (FMAP) for Services Provided at UIOs (100% FMAP for UIOs).
  • Ensure that All American Indian and Alaska Native People are Exempt from Medicaid Work Requirements.
  • Allow for Audio-Only Telehealth Services for Medicare Beneficiaries at UIOs through the Telehealth for Tribal Communities Act.
Transforming Health Care Resources in Indian Country and Beyond
  • Decrease Competition and Reduce Barriers to Access to Ensure Equitable Distribution of Grant Funding.
ELEVATING NATIVE VOICES AND FOSTERING DIALOUGE
Inclusion of Urban Native Communities in Resource Allocation
  • Ensure Critical Resource and Funding Opportunities are Inclusive of Urban Native Communities and the Urban Indian Organizations that Help Serve Them.
STRENGTHENING HEALTH OUTCOMES: ADDRESSING SOCIAL DETERMINANTS OF HEALTH
Improving Native Maternal and Infant Health
  • Strengthen the Ability of the Advisory Committee on Infant and Maternal Mortality to Address Native Maternal and Infant Health.
  • Improve Funding Access for Urban Indian Organizations to expand Housing Services.
Improving Food Security for Urban American Indian and Alaska Native People
  • Increase Access to U.S. Department of Agriculture (USDA) Resources and Funding Opportunities for Urban American Indian and Alaska Native Communities and the Urban Indian Organizations that Serve Them.
  • Increase Urban Indian Organization Access to Fresh and Traditional Foods Through Increased Funding for the IHS Produce Prescription Pilot Program.
  • Permanently Reauthorize and Increase Funding for the Special Diabetes Program for Indians (SDPI) at a Minimum of $250 Million Annually
Including Urban American Indian and Alaska Native People in Preparing and Protecting Their Communities
  • Increase Emergency Preparedness through the Passage of the CDC Tribal Public Health Security and Preparedness Act.
HONORING THE PROMISES TO NATIVE VETERANS
Improving American Indian and Alaska Native Veteran Health Outcomes
  • Engage with Urban Indian Organizations to Successfully Implement the Interagency Initiative to Address Homelessness for Urban American Indians and Alaska Native Veterans.
REVITALIZING NATIVE HEALTH: EMBRACING TRADITIONAL HEALING AND BEHAVIORAL WELLNESS
Improving Behavioral Health for All American Indian and Alaska Native People
  • Increase Funding for Behavioral Health and Substance Use Disorder Resources for American Indian and Alaska Native People.
  • Respond to the Significant Increase in Overdose Deaths in Indian Country.
  • Pass the Comprehensive Addiction Resources Emergency (CARE) Act.
Improving Health Outcomes Through Traditional Healing and Culturally Based Practices
  • Improve Funding Access for Urban Indian Organizations to Expand Traditional Healing and Culturally Based Practices.
“NOT ONE MORE”: HEALING GENERATIONAL TRAUMA AND PROTECTING NATIVE LIVES
Healing from Federal Boarding Schools
  • Support Federal Initiatives to Allow the Indian Health Service to Support Healing from Boarding School Policies.
Ending the Epidemic of Missing or Murdered Indigenous Peoples (MMIP)
  • Pass the Bridging Agency Data Gaps and Ensuring Safety (BADGES) for Native Communities Act.
  • Honor Executive Order 14053: Improving Public Safety and Criminal Justice for Native Americans and
  • Addressing the Crisis of Missing or Murdered Indigenous People by Including Urban Indian Organizations in Prevention and Intervention Efforts.
ADDRESSING WORKFORCE RECRUITMENT AND RETENTION CHALLENGES
Improving the Indian Health Workforce
  • Include Urban Indian Organizations in the national Community Health Aide Program (CHAP).
  • Improve the Indian Health Workforce through the Placement of Residents at Urban Indian Organizations through the Department of Veterans Affairs Pilot Program on Graduate Medical Education and Residency Program (PPGMER).
  • Enable Urban Indian Organizations to Fill Critical Workforce Needs through University Partnerships by Passing the Medical Student Education Authorization Act.
  • Extend Federal Health Benefits to Urban Indian Organizations.
  • Improve Recruitment and Retention of Physicians at Urban Indian Organizations by Reintroducing the IHS Workforce Parity Act.
  • Increase Tax Fairness for Loan Repayment for Urban Indian Organization Staff by Reintroducing the Indian Health Service Health Professions Tax Fairness Act.
  • Permit U.S. Public Health Service Commissioned Officers to be Detailed to Urban Indian Organizations.
  • Improve Community Health Worker Coverage at Urban Indian Organizations through the Introduction of the Community Health Workers Access Act.
Accurately Account for Provider Shortages
  • Engage with the Health Resources and Services Administration (HRSA) so that Urban Indian Organizations receive Health Professional Shortage Area (HPSA) Scores that Accurately Reflect the Level of Provider Shortage for Urban Indian Organization Service Areas.
IMPROVING THE INDIAN HEALTH SERVICE
Bridging the Gap: Enhancing Patient Care by Advancing Health Information Technology
  • Improve Health Information Technology, Including Electronic Health Records Systems.
Elevate the Health Care Needs of American Indian and Alaska Native People Within the Federal Government
  • Pass the Stronger Engagement for Indian Health Needs Act to elevate the IHS Director to Assistant Secretary for Indian Health.

Bipartisan Group of 61 Congressional Leaders Request Protection of IHS Funding and Increased Resources for Urban Indian Health

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On May 15, 2025, 60 Congressional leaders joined Representative Leger Fernandez in her letter to Chairman Simpson and Ranking Member Pingree of the House Interior Appropriations Committee requesting a minimum of $100 million for Urban Indian Health, maintaining advance appropriations for the Indian Health Service (IHS), and protecting IHS from sequestration in the final fiscal year (FY) 2026 Interior, Environment, and Related Agencies Appropriations Act. The letter emphasizes that the federal government has a trust responsibility to provide federal health services to maintain and improve the health of American Indian and Alaska Native people.

The bipartisan group of 61 Congressional leaders reiterated their support for the House Appropriations Committee’s inclusion of advance appropriations for IHS for FY 2026 in the recent Continuing Resolution. Previously, IHS was the only federal health care provider funded through annual appropriations. Without advance appropriations, IHS is subject to the negative impacts of government shutdowns and continuing resolutions that can lead to serious disruptions in urban Indian organizations ability to provide critical patient services. The continued inclusion of advance appropriations is a crucial step toward ensuring long-term stable funding for IHS. 

This letter sends a powerful message to Chairman Simpson and Ranking Member Pingree, and Members of Congress that in order to fulfill the federal government’s trust responsibility to all Native people to provide safe and quality healthcare, funding for IHS must be significantly increased.

NCUIH is grateful for the support of the following Representatives:

  • Teresa Leger Fernandez (D-NM-3)
  • Jeff Hurd (R-CO-3)
  • Don Bacon (R-NE-2)
  • Dusty Johnson (R-SD-At Large)
  • Jared Huffman (D-CA-2)
  • Raul Ruiz (D-CA-25)
  • Kim Schrier (D-WA-8)
  • Gwen Moore (D-WI-4)
  • Seth Moulton (D-MA-6)
  • Stephen Lynch (D-MA-8)
  • Mark Takano (D-CA-39)
  • Kristen McDonald Rivet (D-MI-8)
  • Ilhan Omar (D-MN-5)
  • Haley Stevens (D-MI-11)
  • Jimmy Panetta (D-CA-19)
  • Ro Khanna (D-CA-17)
  • Shontel Brown (D-OH-11)
  • Greg Stanton (D-AZ-4)
  • Pramila Jayapal (D-WA-7)
  • Julie Johnson (D-TX-32)
  • Juila Brownley (D-CA-26)
  • Steve Cohen (D-TN-9)
  • Doris Matsui (D-CA-7)
  • Timothy Kennedy (D-NY-26)
  • Yassamin Ansari (D-AZ-3)
  • Diana DeGette (D-CO-1)
  • Melanie Stansbury (D-NM-1)
  • Gabe Vasquez (D-NM-2)
  • Salud Carabajal (D-CA-24)
  • Sharice Davids (D-KS-3)
  • Brittany Pettersen (D-CO-7)
  • Chris Deluzio (D-PA-17)
  • Jared Golden (D-ME-2)
  • Raja Krishnamoorthi (D-IL-8)
  • Chuy Garcia (D-IL-4)
  • Nanette Diaz Barragan (D-CA-44)
  • Jahana Hayes (D-CT-5)
  • Gilbert Ray Cisneros, Jr. (D-CA-31)
  • Juan Vargas (D-CA-52)
  • Shomari Figures (D-AL-2)
  • Adam Smith (D-WA-9)
  • Sara Jacobs (D-CA-51)
  • Jared Moskowitz (D-FL-23)
  • William R. Keating (D-MA-9)
  • Greg Casar (D-TX-35)
  • Janelle S. Bynum (D-OR-5)
  • Maxine Dexter (D-OR-5)
  • Robin Kelly (D-IL-2)
  • Val Hoyle (D-OR-4)
  • Joe Neguse (D-CO-2)
  • Jim Costa (D-CA-21)
  • Zoe Lofgren (D-CA-18)
  • Scott Peters (D-CA-50)
  • Darren Soto (D-FL-9)
  • Kevin Mullin (D-CA-15
  • Luz Rivas (D-CA-29)
  • Rick Larsen (D-WA-2)
  • Sam Liccardo (D-CA-16)
  • Hillary Scholten (D-MI-3)
  • Steven Horsford (D-NV-4)
  • Linda Sanchez (D-CA-38)

Full Letter Text

Dear Chairman Simpson and Ranking Member Pingree:

We write to thank you for your proven commitment to the Indian healthcare system, including Urban Indian Organizations (UIOs), and to request your continued support by funding Urban Indian Health at the highest possible level, with a minimum of $100 million, which is in line with the House proposed amount for FY 2025. Additionally, we would like to request that you retain advance appropriations for the Indian Health Service (IHS) in FY 2027 and protect IHS from sequestration in the final FY 2026 Interior, Environment, and Related Agencies Appropriations Act.

The federal government has a trust responsibility to provide federal health services to maintain and improve the health of American Indian and Alaska Native people.  According to the Tribal Budget Formulation Workgroup (TBFWG), a workgroup comprised of Tribal leaders representing all twelve IHS service areas and serving all 574 federally recognized Tribes, “only a significant increase to the Urban Indian Health line item will allow UIOs to increase and expand services to address the needs of their Native patients, support the hiring and retention of culturally competent staff, and open new facilities to address the growing demand for UIO services.” American Indians and Alaska Natives experience major health disparities compared to the general U.S. population, including lower life expectancy, higher rates of infant and maternal mortality, and psychological or behavioral health issues. This is true regardless of where an American Indian or Alaska Native person lives. A lack of sufficient federal funding for the Indian Health Service budget plays a significant role in these continuing devastating health disparities, as the Indian health system simply does not have the necessary financial resources and support to address these inequities.

The lack of federal funding is deeply impactful for UIOs who are on the front lines in working to provide for the health and well-being of American Indian and Alaska Native people living outside of Tribal jurisdictions. UIOs are an integral part of the Indian health system, comprised of the Indian Health Service, Tribes, and UIOs (collectively I/T/U), and provide essential healthcare services, including primary care, behavioral health, and social and community services, to patients from over 500 Tribes in 38 urban areas across the United States. Unfortunately, despite being an integral part of the I/T/U system UIOs are chronically underfunded. The urban Indian health line item historically makes up only one percent (1 percent) of IHS’ annual appropriation and UIOs often only receive direct funding from the urban Indian health line item. UIOs generally do not receive direct funds from any other distinct IHS accounts, including the Hospital and Health Clinics, Indian Health Care Improvement Fund, Health Education, Indian Health Professions, or any of the line items under the IHS Facilities account.

Without a significant increase to the Urban Indian Health line item, UIOs will continue to be forced to operate on limited and inflexible budgets that limit their ability to fully address the needs of their patients. Current funding levels pose challenges for UIOs in offering competitive salaries to attract and retain qualified staff who are essential for delivering quality care to their communities. Additionally, UIOs need resources to expand their services and programs, including addressing pressing issues such as food insecurity, behavioral health challenges, and rising facilities costs. By providing UIOs with the necessary resources, we can ensure that American Indian and Alaska Native people receive the comprehensive and culturally competent healthcare services they deserve.

We appreciate the inclusion of advanced appropriations for IHS for FY 2026 in the recent Continuing Resolution. Because of this inclusion, the I/T/U system has been able to operate normally and without fear of funding lapses during the FY 2026 appropriations negotiation process. We emphasize that advanced appropriations are a crucial step towards ensuring long-term, stable funding for IHS and, therefore, it is imperative that you include advance appropriations for IHS FY 2027 in the final FY 2026 Interior, Environment, and Related Agencies Appropriations Act. Further, for the reasons discussed above, we request that you protect IHS from any sequestration measures taken in this Act, as IHS, and the urban Indian line item, cannot afford any funding reduction.

Thank you for your consideration of our request.

Coalition of Health Organizations Request Congress Increase Funding for Key IHS Resources in FY 2026 to Address Native American Health Needs

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On April 29, 2025, the American Indian/Alaska Native (AI/AN) Health Partners, a coalition of health organizations dedicated to improving health care for AI/AN people, sent letters to House and Senate Interior, Environment, and Related Agencies Subcommittee leadership regarding the fiscal year (FY) 2026 appropriations. The coalition emphasized that without sustained investment in the Indian Health Service (IHS), persistent health disparities facing AI/AN communities will continue to worsen.

Letter Highlights

In the letter, the coalition outlined three critical areas for increased investment:

Loan repayment and scholarships: The coalition requested an $18 million increase to the IHS Loan Repayment and Scholarship Programs to help close the 30% provider vacancy rate identified by IHS. The funding would support hiring approximately 400 additional providers.

Staff Quarters: The coalition requested $11 million for new and replacement staff quarters. The letter underscored the urgent need for new and renovated staff housing, especially in rural and remote IHS service areas. Many existing staff quarters are over 40 years old and in disrepair.

Medical and Diagnostic Equipment: Outdated or obsolete medical devices continue to hinder the quality of care across the IHS/Tribal/Urban Indian (I/T/U) system. The coalition urged Congress to fund the Indian Health Facilities equipment account at no less than $42.8 million—the amount approved by the House in FY 2024—to help modernize diagnostic and treatment tools.

The AI/AN Health Partners also reminded Congress of the broader implications of underfunding IHS, highlighting health disparities for AI/AN people due to poor access to health care. Only with sufficient resources will IHS be able to fulfill the federal government’s trust responsibility to provide quality healthcare services to AI/AN people no matter where they live. resources to meet its mission to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.”

About the AI/AN Health Partners

The AI/AN Health Partners is a coalition of health organizations dedicated to improving health care for AI/ANs. Members of this coalition, all of whom signed the letters to the House and Senate appropriators, include:

  • Academy of Nutrition and Dietetics
  • American Academy of Pediatrics
  • American Association of Colleges of Nursing
  • American College of Obstetricians and Gynecologists
  • American Dental Association
  • American Dental Education Association
  • American Medical Association
  • American Psychological Association Services
  • Association of Diabetes Care & Education Specialists
  • Commissioned Officers Association of the USPHS
  • National Kidney Foundation 

Full Letter Text

The full text of the AI/AN Health Partners letter to Senate appropriators can be found below:

Dear Chairman Simpson and Ranking Member Pingree:

The AI/AN Health Partners is a coalition of health organizations dedicated to improving health care for American Indians and Alaska Natives (AI/ANs). AI/ANs face substantially poorer health outcomes, and higher mortality and morbidity rates than the general population. The Indian Health Service (IHS) is critical to how they access health care. However, the IHS must have sufficient resources to meet its mission to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.

We appreciate the continued support the Committee has given to the Indian Health Service.   We know that you have listened to testimony from tribes and tribal organizations stressing the importance of maintaining the best possible health care system for AI/ANs.   We ask that you continue that support for the FY 2026 Indian Health Service appropriation.

Over the years, our mutual goals have not deviated.  Instead, they have only become more urgent.  To provide health care for AI/ANs at a level equivalent to the rest of the nation there must be strong support for increasing and maintaining a robust health care system.  We believe that there are three initial steps to accomplish this:

  • Loan repayment and scholarships: Increase funding for Health Professions Loan Repayment and Scholarships.  For FY 2025, we requested an $18,000,000 increase in this account.   Recently, Health and Human Services Secretary Robert F. Kennedy, Jr, cited the 30 percent health care provider vacancy rate for the Service.   It has been estimated that it would take approximately $18,000,000 to close this gap and allow the IHS to hire about 400 more providers.
  • Staff quarters: Identify specific funding to address the need to provide decent staff quarters at existing healthcare facilities.  Many of the 2,700 staff quarters in the IHS health delivery system are more than 40 years old and in need of major renovation or total replacement. Additionally, in several locations, the number of housing units is insufficient. Decent and adequate staff quarters, especially in remote areas, is necessary for attracting and keeping health care providers in Indian Country.  We endorsed the Administration’s request for $11 million for new and replacement staff quarters for FY 2025.  We continue to support this request for FY 2026.
  • Medical and diagnostic equipment: Health care professionals need modern equipment to make accurate clinical diagnoses and prescribe effective medical and dental treatments. The IHS/Tribal/Urban Indian (I/T/U) health programs manage approximately 90,000 devices consisting of laboratory, imaging, patient monitoring, pharmacy, and other biomedical, diagnostic, and patient equipment. However, many of these facilities use outdated equipment like analog mammography machines. In some cases, they are using equipment that is no longer manufactured. Today’s medical devices/systems have an average life expectancy of approximately six to eight years. The IHS has calculated for several years that to replace the equipment at the end of its six to eight-year life would require approximately $100 million per year. For three fiscal years, this account has been frozen at $32,598,000. We urge the Committee for FY 2026 to fund the Indian Health Facilities equipment account at the House-approved FY 2024 amount of at least $42,862,000. 

In closing we are reminded of inspiring and guiding words from Native Americans: 

“Let us put our minds together and see what kind of life we can make for our children.”  Sitting Bear

“Look and listen for the welfare of the whole people, and have always in view not only the present, but also coming generations – the unborn of the future nation.”  Constitution of the Iroquois Confederation

Thank you for considering our IHS funding requests for FY 2026.  We look forward to working with you to ensure the best possible health care for American Indians and Alaska Natives.

Senators Send Bipartisan Letter Urging HHS Secretary Kennedy to Address IHS Staffing Shortages

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On May 6, 2025, Senators Jeff Merkley (D-OR), Brian Schatz (D-HI), and Lisa Murkowski (R-AK), sent a letter to HHS Secretary Kennedy, demanding action to provide IHS with the resources and staff required to deliver health care services to American Indian and Alaska Native people. Additionally, they request that any actions impacting Tribal health care delivery be stopped until Tribal Consultation can occur.

In the letter, the Senators emphasized that IHS’ ability to provide health care has been impeded by recent federal actions, which does not align with the federal trust responsibility. While IHS received an exemption from probationary employee staffing reductions and a limited exemption from the hiring freeze, they note other positions should be exempt from the hiring freeze due to the important role they play in the delivery of wrap around health care services. Emphasis was also made on how IHS facilities being understaffed can impact accreditation and further harm the ability to provide life-saving care for American Indian and Alaska Native communities and threaten their ability to receive Medicaid and Medicare reimbursement. Lastly, the Senators raised concern over changes to IHS being implemented without consultation with Tribes, explaining that these actions have harmed the federal-Tribal relationship. They advise HHS to seek Tribal input on federal actions that have an impact on American Indian and Alaska Native communities.

The letter concludes by requesting that Secretary Kennedy meet with the Senate Appropriations Committee and Senate Committee on Indian Affairs to address the concerns outlined in the letter. NCUIH will monitor for any response.

Full Letter Text

Dear Secretary Kennedy:

We write to express our deep concerns regarding the Indian Health Service’s (IHS) ability to meet its health care obligation amid recent federal actions that diminish the quality of and access to health care and erode the federal government’s trust responsibility by failing to meaningfully consult with Tribal governments. We urge you to take immediate action to ensure that the IHS programs serving Native communities have the resources and staffing necessary to fulfill their missions and halt any further actions affecting Tribal health care delivery without first engaging in meaningful Tribal consultation.

The IHS provides health care services to approximately 2.8 million American Indians and Alaska Natives, an obligation enshrined in federal law, treaties and through the trust responsibility. As trustee, you must know that the IHS service population is among the most vulnerable in our nation, falling behind in nearly every health metric. American Indians and Alaska Natives experience disproportionate rates of mortality from most major health issues, including chronic liver disease and cirrhosis, diabetes, unintentional injuries, assault and homicide, and suicide, and currently have an average life expectancy equal to that of the general U.S. population living in 1944.[1] Accordingly, the National Indian Health Board recently passed a resolution emphasizing the need for continued and increased staff at IHS, urging the federal government to exempt the IHS and other Indian health programs from any staffing cuts and to instead commit to prioritizing hiring for Tribal health programs, including the IHS.[2] So while we appreciate that you have exempted IHS from probationary employee staffing reductions and exempted a limited number of IHS employees from the hiring freeze to date, it is critical that other Native-serving agencies within your Department be treated similarly.[3]

The impacts of the hiring freeze for other positions playing crucial roles administering services at IHS continues to exacerbate existing clinical staffing issues. IHS cannot deliver quality health care without sufficient personnel – not just physicians, nurses, dentists, and mental health professionals, but also laboratory technicians who perform tests and process and collect specimens, and administrative personnel who perform essential tasks, including billing, appointment scheduling, and ensuring IHS facilities maintain their accreditation. Additionally, the civilian staff reductions at the U.S. Public Health Service (USPHS) headquarters threatens support functions for approximately 1,200 USPHS officers serving at IHS and Tribal facilities. The loss of administrative infrastructure for payroll, assignments, and special pays will disrupt healthcare delivery in remote Tribal communities. In short, all these positions are imperative to delivery of wrap around health care services to American Indian and Alaska Natives, and staffing cuts, hiring freezes, and staff buyouts are exacerbating the already chronic problem of understaffing at IHS.[4]

Such cuts also put IHS facility accreditation in danger, as understaffed facilities have little chance of meeting accreditation standards. Losing accreditation would further erode trust in the system and limit access to life-saving care for Native communities. Additionally, staffing issues can negatively impact the ability of a facility to meet the CMS Medicare Conditions of Participation and Coverage (COPs) or Conditions for Coverage (CFC) requirements. Several high-profile instances where IHS hospitals were found to be in severe condition previously led inspectors from the Centers for Medicare and Medicaid Services (CMS) to threaten the loss of Medicare and Medicaid reimbursement and participation in third-party insurance networks.[5] The all too frequent occurrence of incidents that put IHS facility accreditation in jeopardy are precisely why Congress provides $58 million annually for accreditation emergencies: to help IHS make emergency hires to maintain accreditation — and ultimately save lives.

Finally, we must remind you that meaningful Tribal consultation should be at the forefront of any discussions regarding potential changes at HHS, including the IHS. This foundational tenet of the federal government’s trust relationship empowers Tribes to be a part of policymaking on a government-to-government basis. We are concerned about reports that senior officials from HHS agencies are being reassigned to IHS positions in Alaska, Montana, and Oklahoma without consideration of Tribal needs, Indian Preference requirements, or IHS service priorities. It appears that HHS has failed to meaningfully consult with Tribes on recent actions, which has negatively impacted the federal-Tribal relationship, and we urge you to seek Tribal input and consult on any future federal action impacting their interests.

Native communities deserve reliable access to quality health care, and we urge you to reevaluate all actions that jeopardize delivery of any health care services for American Indians and Alaska Natives. We look forward to your prompt response and request a bipartisan meeting with you and the Senate Appropriations Committee and the Senate Committee on Indian Affairs staff to address our concerns set forth above.

Resources on NCUIH Advocacy:

[1] FY2025 Indian Country Budget Hearing – Testimony provided by the Indian Health Service (May 15, 2024) https://www.appropriations.senate.gov/imo/media/doc/download_testimony75.pdf. American Indian and Alaska Natives also face higher rates of colorectal, kidney, liver, lung, and stomach cancers than non-Hispanic White people.

[2] National Indian Health Board, Resolution 2025-24 (Mar. 11, 2025), available at https://www.nihb.org/wpcontent/uploads/2025/03/25-04-Resolution-on-IHS-Exemption-from-RIF-in-EO-14210.pdf

[3] For example, recent staffing cuts at the Centers for Disease Control’s (CDC) Healthy Tribes Program threaten to rollback chronic disease prevention advancements particular to Native communities. And with the recent HHS announcement that CDC will decrease its workforce by 2,400 employees, National Institutes of Health by 1,200, and Centers for Medicare and Medicaid Services (CMS) by 300, with additional cuts pending in future reductions in force, impacts to non-IHS Native-serving agencies within HHS is concerning. See https://www.hhs.gov/pressroom/hhs-restructuring-doge.html.

[4] Last year, IHS experienced nearly 2,000 vacancies, and a 2018 GAO report found that IHS had an overall health care provider vacancy rate of 25 percent across service areas. See IHS Workforce Parity Act and Tribal Access to Clean Water Act of 2023: Hearing on S. 4022 and S. 2385 Before the S. Comm. on Indian Affs., 118th Cong. 1 (2024); S. GOV’T ACCOUNTABILITY OFF., GAO-18-580, INDIAN HEALTH SERVICE: AGENCY FACES ONGOING CHALLENGES FILLING PROVIDER VACANCIES 9-10 (Aug. 2018) (statement of Melanie Anne Egorin, Assistant Sec’y for Legis., U.S. Dep’t of Health & Human Res.).

[5] For example, between 2015 and 2017, CMS inspectors found that a baby was born in a bathroom at the Rosebud IHS hospital and, in another instance, a heart attack victim did not receive care for 90 minutes (in fact, the emergency room had been closed for six months). CMS officials also witnessed repeated deficiencies in the emergency room at the IHS hospital in Pine Ridge. At that facility, officials reported that a diabetic man who said he had gone days without insulin was forced to wait two hours before receiving care, at which point his glucose levels were severe enough to cause organ damage. He ultimately died the next day after he needed surgery to treat a severely damaged small intestine. See Roll Call – The Never Ending Crisis at the Indian Health Service (2018) https://rollcall.com/2018/03/05/the-never-ending-crisis-at-the-indian-health-service/

Tribal Leaders Highlight the Importance of Medicaid at Hearing

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On April 4, 2025, the House Natural Resources Subcommittee on Indian and Insular Affairs held a hearing on “Examining 50 Years of the Indian Self-Determination and Education Assistance Act in Indian Country” in Oklahoma City, Oklahoma. The Subcommittee on Indian and Insular Affairs members asked Tribal leaders about the impacts of self-determination contracts. In the hearing, Tribal leaders expressed the successes of self-governance agreements in areas of agriculture, healthcare, and Department of Justice programs, as well as the need for additional funding and support for these contracts. In terms of healthcare, it was highlighted that Medicaid is an essential funding source that funds healthcare related self-governance agreements, and that any cuts to Medicaid would impact Tribes’ ability to manage their health systems.

During the hearing, Rep. Leger Fernandez (D-NM-3), Ranking Member of the Subcommittee on Indian and Insular Affairs, noted the connection between Medicaid and self-determination, “I am very concerned about the Medicaid cuts because we know that Indian self-determination does not exist in a vacuum, that when I was helping set up those clinics and when you were setting up your own clinics, you were relying on third party funding. Everybody’s shaking their head because it’s simply true, you’re relying on those Medicaid dollars to come in so that you could increase services because, sadly, we underfund IHS. We’ve had hearings on that and it breaks my heart every time we read the numbers of how every other agency for their healthcare gets paid so much more.

If you cut Medicaid funding, tribes might have to cut services, they might have to cut staff. And this is a — is a major problem. So a $880 billion cut to Medicaid doesn’t just hurt other communities, it hurts this amazing goal and promise of Indian self-determination.”

In response to questions regarding the implications of cuts to Medicaid, Martin Harvier, President of Salt River Pima-Maricopa Indian Community, shared, “We face a stark reality, residents in our community, on average, die more than 30 years younger than residents of Scottsdale, only a few miles away. It will be a challenge to meet our five-and-five goal. if there are significant cuts to Medicaid. IHS only funds about 65 percent of our operational budgets so we, like other tribes, rely on third party revenue to supplement our programing.

And the vast majority comes from Medicaid. Any cut to Medicaid would, significantly, reduce the budget of our health system. And without an equal increase in IHS funds, we would have limited capacity to expand programs and facilities that are needed. A cut to Medicaid would make it nearly impossible to keep up with the demand for service.”

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.

Budget Reconciliation and Medicaid

On April 5, 2025, the Senate passed their budget resolution. 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 House version passed on February 25, 2025, 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

Resources

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.

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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.

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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