NCUIH July Update: Congressional Budget Updates, Medicaid Exemptions, and Secretary Kennedy’s UIO Tour

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In this Edition:

📍 Secretary Visit: Kennedy spotlights OKC Indian Clinic on second UIO tour since confirmation.

🤝 Federal Briefing: NCUIH and partners meet with new HHS Senior Advisor Mark Cruz.

🏛 FY 2026 Bill: House advances Interior bill with $8.41B for IHS and $6.05B in advance appropriations.

⚖️ Reconciliation Law: Medicaid and SNAP exemptions secured for AI/AN people, including urban Natives.

📊 Budget Request: Tribal Workgroup urges $1.09B for Urban Indian Health in FY 2027.

📝 Medicaid Waivers: NCUIH comments on Iowa work-requirement exemption; more due in August.

🏥 IHS Realignment: Urban Confer on July 28; written comments due August 28.

📆 Save the Dates: Upcoming webinars, meetings, and the October IHS–UIO Federal-Partner Summit.

Federal Engagement Highlights

HHS Secretary Kennedy Visits Second Urban Indian Organization in Oklahoma City

What’s new: On June 26, HHS Secretary Kennedy and Senior Advisor Mark Cruz visited the Oklahoma City Indian Clinic (OKCIC).

This visit is Secretary Kennedy’s second visit to an Urban Indian Organization since his confirmation in February; his first visit was to Native Health in Arizona on April 8.

NCUIH Meets with Newly Appointed Senior Advisor to HHS Secretary, Mark Cruz


On Thursday, June 20th, Mark Cruz, a citizen of the Klamath Tribes, was sworn in as Senior Advisor to the HHS Secretary.

On July 10, NCUIH joined the Coalition for Tribal Sovereignty in a meeting with Mark Cruz. Self-Governance, the role of UIOs, and opportunities to collaborate with the new admin were discussed.

Coalition for Tribal Sovereignty Updates


On July 17, NCUIH joined the Coalition for Tribal Sovereignty for an important discussion with the staff of Native American Caucus Co-Chair Nicholas J. Begich III (R-AK-At Large).

On June 25, NCUIH joined the Coalition for Tribal Sovereignty in a letter regarding the One, Big Beautiful Bill Act and Upholding Obligations to Indian Country.

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

Appropriations and Fiscal Policy Updates

Fiscal Year 2026 Updates

NCUIH worked with the Coalition for Tribal Sovereignty to support the Congressional Native American Caucus in leading a letter to Chairman Cole and Ranking Member DeLauro of the House Appropriations Committee requesting the Committee support and protect funding for Tribal Programs and UIOs in the FY26 budget. The letter closed on June 23, with 17 signees.

FY 2026 House Interior Appropriations Budget Markups on President’s Budget

By the numbers: On July 15, the House Interior Appropriations Subcommittee passed the FY2026 appropriations bill out of committee. The bill includes:

  • IHS: $8.41 billion, $168 million increase above FY 2025
  • IHS Advance Appropriations for FY27: $6.05 billion

Budget Reconciliation Signed into Law

The big picture: On July 4, 2025, the President signed the One Big Beautiful Bill Act (OBBB) into law. The OBBB is a major bill that delivers many elements of President Trump’s legislative agenda, including tax cuts, Medicaid reforms, and lifting the debt ceiling.

Go deeper: The bill contains a health title, which includes the following notable provisions:

Community Engagement Requirements for Certain Medicaid Beneficiaries:

  • AI/AN Exempt, including specific exemption for Urban Indians

Modifying Cost Sharing Requirements for Certain Expansion Individuals Under the Medicaid Program:

  • AI/AN already exempted

Moratorium on New or Increased Provider Taxes:

  • UIOs already exempted

Reduction in Expansion FMAP for States Covering Undocumented Immigrants:

  • Seven states with UIOs may be affected (California, Washington, Oregon, Minnesota, Illinois, New York, and Colorado).

Modifications to SNAP Work Requirements for Able-Bodied Adults:

  • AI/AN Exempt, including specific exemption for Urban Indians

More Frequent Medicaid Redetermination Period:

  • AI/AN Exempt, including specific exemption for Urban Indians

NCUIH, along with partner organizations, worked to ensure AI/AN exemptions were included in the final bill.

National Tribal Budget Formulation Workgroup Releases Recommendations for FY 2027

By the numbers: FY 2027 Tribal Budget Recommendations

  • $1.09 billion for the Urban Indian Health line item
  • $73 billion for IHS

IHS retains and expands eligibility for UIOs to participate in grant programs and ensures that UIOs are included in exemptions for Medicaid reform, including work requirements.

Federal Comments Submitted

On June 14, NCUIH submitted comments to IHS regarding the January 13, 2025, Dear Tribal Leader and UIO Leader letter and May 15, 2025, joint Tribal Consultation and Urban Confer session on Health Information Technology (HIT) Modernization: Four Directions Warehouse (4DW) NCUIH made the following comments, requests and recommendations:

  • Provide clarification to UIOs on the 4DW about access for all UIOs, including those who are not using the Resource and Patient Management System (RPMS) or Patients at the Heart (PATH) electronic health record (EHR), or who do not have access to the D1 network because they are non-domain members
  • Support IHS, Tribal, and UIO (I/T/U) facilities for data migration and transition to PATH EHR by doing the following:
  • Develop materials to prepare I/T/U facilities for data migration and the PATH EHR transition
  • Ensure site selection for the implementation cohort includes all I/T/U facility types
  • Communicate regularly with facilities- virtually and in person- about the HIT Modernization project by doing the following:
  • Share information on the HIT Modernization project in an in-person format in addition to the quarterly joint TC/UC sessions
  • Reschedule the cancelled February 2025 open dialogue

NCUIH created a comment template and distributed it to UIOs prior to the submission deadline.

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

CMS Medicaid Work Requirement Waivers

The Big Picture: Medicaid waivers allow states to propose changes to how they administer their Medicaid programs, including adding work requirements. These requirements can affect access to care for American Indian and Alaska Native (AI/AN) people. NCUIH supports exemptions that reflect the federal trust responsibility and protect coverage. Comments were submitted on Iowa’s waiver, with Kentucky and South Carolina waivers under review. Since the passage of the One Big Beautiful Bill (OBBB), states will have to implement the required changes, including work requirements and the corresponding exceptions for AI/AN people. NCUIH is continuing to monitor state actions to impose work requirements to ensure alignment with the OBBB requirements.

Comments to CMS supporting the exemption of AI/AN people from work requirements in state Medicaid programs:

  • June 25 – Iowa

Upcoming comment opportunities being analyzed by NCUIH:

  • August 9 – Kentucky
  • August 9 – South Carolina

Key Upcoming Dates

Upcoming highlight:

IHS UIO and Partner Federal Agencies Summit October 21-23:

On July 1, 2025, IHS invited UIOs to join an in person meeting with IHS partner federal agencies.

  • Proposed Dates: Tuesday, October 21 – Thursday, October 23, 2025
  • Location: HHS – Humphrey Building, Room 800, Washington, DC
  • More details regarding federal agencies, draft agenda, and sponsored travel and lodging will be forthcoming.

Meeting Objectives: 

  • Introduce federal partners and share current priorities
  • Learn about your organization’s initiatives and challenges
  • Discuss potential areas of alignment and collaboration

What to Watch: Additional Upcoming Events and Important Dates

  • July 23: NCUIH Webinar: Navigating Behavioral Health Financing for Urban Indian Organizations
  • July 24: OUIHP-Urban Program Executive Directors/Chief Executive Officers Monthly Conference Call (Virtual)
  • July 28: IHS Urban Confer on IHS Proposed Realignment (Virtual)
  • July 29: NIHB Medicare, Medicaid and Health Reform Policy Committee (MMPC) Face-to-Face meeting (Washington D.C.)
  • July 30-31: CMS Quarterly Tribal Technical Advisory Group (TTAG) Face-to-Face Meeting (Washington D.C.)
  • August 7: IHS Health Information Technology (HIT) Modernization Tribal Consultation and Urban Confer: PATH EHR Scope and Capabilities (Virtual)
  • Aug 11: FY 2027-2028 National Tribal Budget Formulation Planning and Evaluation Meeting (Hybrid, Washington D.C.)
  • August 20: NCUIH Monthly Policy Workgroup (Virtual)
  • Date TBD (August): IHS Division of Behavioral Health (DBH) Listening Session for UIOs – Hosted by NCUIH
    – Do UIOs have any topics/questions they would like to bring up during the listening session?
  • September 3-5: VA Advisory Committee on Tribal and Indian Affairs (ACTIA) Meeting (Honolulu, HI)

Urban Confer: Indian Health Service Strategic Realignment

On June 13, 2025, IHS released a Dear Tribal Leader Letter/ Dear Urban Leader Letter initiating consultation and confer and requesting comments and recommendations regarding the proposed realignment of the Indian Health Service (IHS). IHS will hold a virtual Urban Confer on Monday, July 28th, 2025, from 1:00 PM – 3:00 PM EST.

  • NCUIH held a prep session for the Urban Confer on July 16th.
  • Written comments are due on August 28th, 2025.

More information can be found on the NCUIH Policy Blog post on this consultation and confer.

Registration Link: https://ihs-gov.zoomgov.com/meeting/register/q6joL7ncQgS1z5tf0xl9vw

About NCUIH

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

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

NCUIH Policy Updates

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Welcome to our new Policy Updates! We’re still figuring it out so please bear with us!

Let’s dive in.

1 Big Thing: 10 Senators Request $950 Million for Urban Indian Health

Senator Tina Smith led a letter to the Senate Appropriations Committee asking for bold and robust funding for urban Indian health.

The big picture: NCUIH worked with Senator Smith to secure the support of 10 Senators for increased resources for UIOs.

What they asked for:

  • $949.9 million for urban Indian health,
  • mandatory funding for the Indian Health Service (IHS),
  • securing advance appropriations for IHS

What they’re saying: “This funding request is essential to providing quality, culturally-competent health care to AI/AN people living in urban areas.”

Why it matters: Funding for urban Indian health increased by 17% last year and the traction we’re gaining among Senators will be instrumental as budget negotiations happen in the coming months.

What’s next: Funding runs out on September 30 and it’s unclear if Congress will pass a budget or do a continuing resolution instead.

2. On our radar: Senator Cantwell asks for permanent FMAP for UIOs at Hearing with Roselyn Tso

Nomination Hearing to consider Roselyn Tso to be Director of the Indian Health Service, Department of Health and Human Services (May 25, 2022)

What they’re saying: “I wanted to ask you about 100 percent FMAP funding for our urban Indian health…So the issue is that the impacted urban Indian health care organizations are not treated the same, so they don’t get the whole 100 percent of funding. We were able to fix this I think for one or two years, but to me, it’s a big inequity in the delivery of care. So can you commit to securing 100 percent FMAP funding on a permanent basis for Indian health clinics in urban areas?” said Senator Maria Cantwell (D-WA).

Ms. Tso’s response: “I agree that we need to have equity in terms of funding for all the programs that serve American Indians and Alaska Natives. We also know, I also know that there are some limitations. Indian Health Service nor the department makes a determination on 100 percent FMAP payments. However, we can work with states. We can work with our partners to make sure that there’s education and information flowing of how important this need is. So I will work with you on this if I am confirmed.”

Why it matters: Ms. Tso has been nominated to run the Indian Health Service and President Biden has supported 100% FMAP for services provided at Urban Indian Organizations (UIOs).

The bottom line: If Ms. Tso is confirmed, NCUIH can work with her on long-term solutions for UIOs including collaborating with states.

3. Washington Post Op-ed: The injustices endured by Native American youths continue to this day

What they’re saying: “In short: The legacy of denying Native young people basic — let alone quality — education, health care and opportunities continues to this day. To end this injustice, our country has an obligation to support Native American youths even more fervently now after oppressing them for centuries,” said Katrina vanden Heuvel.

By the numbers: The column explains that IHS provides health care to 2.2 million Native Americans, but IHS would need to double its funding to provide even the base level of care that federal prisoners receive.

Our thought bubble: This article in the Washington Post is an example of connecting the dots on issues that matter in Indian Country. More awareness about the injustices faced by Native American youth is critical to increased funding for Indian health. It cites NCUIH’s legislative priorities!

Go deeper: https://www.washingtonpost.com/opinions/2022/05/31/injustices-native-american-youth/

4. NCUIH Recognized Political Allies at the 2022 Conference: No More Broken Promises

The Congressional Urban Indian Health Champion Awards were given to four members of Congress for their outstanding advocacy on behalf of urban Indian health: Senator Alex Padilla (D-CA), Senator Jerry Moran (R-KS), Representative Teresa Leger Fernandez (D-NM-03), and Representative David Joyce (R-OH-14). Libby Washburn (Chickasaw Nation of Oklahoma), the former Special Assistant to the President for Native Affairs, was awarded the Advocacy and Leadership in Urban Indian Health award.

What they’re saying: “We know that there are more Native Americans living off our Tribal lands than on, and we know that the United States’ trust duty to provide quality healthcare does not stop when you move into a city or town. We also know that too often the urban Indian health centers are overlooked and underfunded,” said Representative Leger Fernandez in her remarks.

PRESS RELEASE: NCUIH Honors 2022 Urban Indian Health Champions

5. Catch up quick: Senators Highlight the Needs of Urban Indians in IHS FY 2023 Appropriations Hearing

Senator Chris Van Hollen’s state of Maryland is served by Native American LifeLines of Baltimore and he noted, “In the state of Maryland, we have 40,000 individuals who identify themselves as American Indian or part American Indian, and nearly half of that population resides in Baltimore.”

On May 11, 2022, the Senate held a hearing to review the Fiscal Year (FY) 2023 President’s Budget for the Indian Health Service (IHS) with Acting Director, Elizabeth Fowler.

What they discussed: The President’s mandatory funding request, as well as addressing the needs of urban Indian communities and UIOs.

What they’re saying: Senator Chris Van Hollen (D-MD) followed up with Ms. Fowler, on the establishment of an Urban Indian Interagency Workgroup and highlighted the many underserved American Indians/Alaska Natives (AI/ANs) residing in urban areas: “In my view, this is a population that has not received the attention or services that are deserved.”

Go deeper: In February, 14 Senators sent a letter to the Biden Administration requesting the establishment of an Urban Indian Interagency Work Group.

The big picture: Ms. Fowler stated that “the Indian Health Service considers urban Indian organizations to be a vital component of the Indian health system” and expressed support for the creation of any urban interagency efforts.

Also: Senator Jeff Merkley (D-OR) emphasized the importance of UIOs and asked Ms. Fowler if more grants went out to UIOs as a result of the 17% increase in funding.

  • Ms. Fowler informed that while IHS did not fund any additional UIOs with that funding, the funding will allow some referral-only programs to initiate clinical services to provide their patients.
  • Senator Merkley noted that the committee will submit questions for the record to “better understand how we are spending the additional money in that account and understanding how urban Indian population is being better served, what specific changes have occurred.”

Learn more: Senators Highlight the Needs of Urban Indians in IHS FY 2023 Appropriations Hearing

Next week, on June 10 at 1:00 pm ET, IHS is hosting a Virtual Urban Confer on Urban Indian Organizations All-Inclusive Rate.