NCUIH creates educational tools for policymakers, members of Congress and the general public about the health care needs of Native Americans living in urban communities.
Web Resources
Resources on Policy Priorities
2024 Policy Assessment
Last Updated November 21, 2024
2023 Policy Assessment
Last Updated January 25, 2024
2022 Policy Assessment
Last Updated March 9, 2023
2021 Policy Assessment
Last Updated December 15, 2021
2020 Policy Assessment
Last Updated December 15, 2020
The Importance of Urban Indian Health Funding for Urban Native Communities
Last Updated February 2025
Report: Impact of Federal Funding Pauses on Urban Indian Organizations - Federal Funding Disruptions Threaten Critical Services
Last Updated February 2025
Revenue Streams for Urban Indian Organizations
Last Updated May 2024
Urban Indian Health Funding (FY 2021-2023)
Last Updated January 2023
U.S. Healthcare Spending: America’s Disproportionate Investment in healthcare for American Indians and Alaska Natives
Last Updated October 2023
A Comparison of VA and IHS Funding
Last Updated March 2022
Is Funding to UIOs Actually Increasing?
Last Updated March 2022
History of Funding for UIO Health Facilities
Last Updated November 2021
NCUIH represents and coordinates the delivery of membership feedback to pertinent federal agencies on Budget Formulation-related issues and meetings.
Impact of Medicaid on Health Care for American Indian and Alaska Native People
Last Updated March 2025
Medicaid Unwinding for UIOs
Last Updated May 2023
100% FMAP for Urban Indian Organizations (One Pager)
Last Updated July 2024
Urban Confer Fact Sheet
Last Updated June 2023
Advance Appropriations for The Indian Health Service
Last Updated January 2023
AI/AN Infant and Maternal Health Disparities Data
Last Updated December 2022
AI/AN COVID-19 Data
Last Updated April 2022
UIO COVID-19 Behavioral Health Needs
Last Updated October 2021
UIO Facilities Needs 2021
Last Updated August 2021
2022-2024 Policy Achievements
Last Updated January 27, 2025
NCUIH Advocacy Impacts
Last Updated December 2021
AI/AN COVID-19 Data
Last Updated April 2022
UIO COVID-19 Behavioral Health Needs
Last Updated October 2021
MedicaidAdvance AppropriationsUrban ConferIndian Child Welfare ActNative Maternal/Child HealthNative VeteransSpecial Diabetes Program for Indians
Impact of Medicaid on Health Care for American Indian and Alaska Native People
- Approximately 2.7 million AI/AN people are enrolled in Medicaid, with 24% of AI/AN adults aged 18-64 and 23% of those over 64 benefiting from the program.
- Almost 49% of AI/AN children are enrolled in Medicaid.
- Urban Indian Organizations serve as vital health care providers.
- 59% of AI/AN people receiving care at UIOs are Medicaid beneficiaries.
- Eight out of the top ten states with the largest number of AI/AN Medicaid beneficiaries have UIOs providing essential services.
100% Federal Medical Assistance Percentage for Services at Urban Indian Organizations
Letters of Support
Resolutions
- National Council of Urban Indian Health (NCUIH)
- National Indian Health Board (NIHB)
- National Congress of American Indians (NCAI) 2015 & 2018
- Albuquerque Area Indian Health Board
- California Rural Indian Health Board (CRIHB)
- Great Lakes Area Tribal Health Board
- Northwest Portland Area Indian Health Board (NPAIHB)
- Self-Governance Communications and Education Tribal Consortium
- United South and Eastern Tribes Sovereignty Protection Fund (USET SPF)
Medicaid Unwinding
Medicaid Unwinding for UIOs
Last Updated May 2023
News
Background
What is Advance Appropriations for the Indian Health Service?
Advance appropriations is funding that becomes available one year or more after the year for which the appropriations act is passed. On December 23, 2022, Congress enacted a Fiscal Year (FY) 2023 omnibus spending package, including a historic provision providing advance appropriations for IHS. Prior to this change, the Indian healthcare system, including the Indian Health Service (IHS), Tribal facilities, and urban Indian organizations (UIOs), was the only major federal healthcare provider funded through annual appropriations. Advance appropriations will stabilize IHS funding and allow for long-term planning by insulating Indian healthcare providers from government shutdowns and continuing resolutions.
Letters of Support
- January 17, 2019, NCUIH letter to the Vice Chairman of the Senate Committee on Indian Affairs, Tom Udall
- January 12, 2022, the Native American Caucus sent a letter to House Appropriations Committee Chair DeLauro and Ranking Member Granger requesting that advance appropriations for IHS for FY 2023 be included in the final FY 2022 appropriations bill.
- March 9, 2022, NCUIH joined NIHB and over 70 Tribal nations and national Indian organizations in sending a series of joint letters to Congress requesting advance appropriations for IHS in the Fiscal Year (FY) 2022 omnibus.
- April 25, 2022, a bipartisan group of 28 Representatives requested up to $949.9 million for urban Indian health in FY 2023 and advance appropriations for IHS until such time that authorizers move IHS to mandatory spending.
- May 27, 2022, 12 Senators requested up to $949.9 million for urban Indian health in FY 2023 and advanced appropriations for IHS until such time that authorizers move IHS to mandatory spending.
- June 3, 2022, the Native American Caucus sent a letter to House Appropriations Committee Chair DeLauro and Ranking Member Granger requesting that while the process of shifting IHS to mandatory appropriations is underway, advanced appropriations for IHS be included in the final FY 2023 Appropriations bill.
- June 24 and July 1, 2022, NCUIH sent letters to Speaker Pelosi and House Minority Leader McCarthy to support advance appropriations for IHS.
- June 29, 2022, NCUIH sent letters to the Senate Interior Appropriations Committee and the Senate Committee on Indian Affairs to support advance appropriations for IHS.
- June 30 and July 1, 2022, NCUIH sent letters to Senate Majority Leader Schumer and Senate Minority Leader McConnell to support advance appropriations for IHS.
- September 30, 2022, SCIA sent a letter to House and Senate leadership requesting that advance appropriations for IHS for FY 2024 be included in the final FY 2023 appropriations bill.
- December 6, 2022, the Native American Caucus sent a letter to House Appropriations Committee Chair DeLauro and Ranking Member Granger requesting that while the process of shifting IHS to mandatory appropriations is underway, advanced appropriations for IHS be included in the final FY 2023 Appropriations bill.
- December 12, 2022, NCUIH joined NIHB and over 130 Tribal nations and organizations in sending letters to President Biden and Congressional leadership requesting advance appropriations for IHS in the FY 2023 omnibus.
Legislation
Legislation on this effort has been introduced in 11 bills over the years starting in 2013:
- 10/2013 – Indian Health Service Advance Appropriations Act of 2013 (H.R. 3229/S. 1570)
- Sponsor: Rep. Don Young/Sen. Lisa Murkowski
- 1/2015 – Indian Health Service Advance Appropriations Act of 2015 (H.R. 395)
- Sponsor: Rep. Don Young
- 1/2017 – Indian Health Service Advance Appropriations Act of 2017 (H.R. 235)
- Sponsor: Rep. Don Young
- 2/2019 – Indian Programs Advanced Appropriations Act (H.R. 1128/S. 229)
- Sponsor: Rep. Betty McCollum/Sen. Tom Udall
- 2/2019 – Indian Health Service Advance Appropriations Act of 2019 (H.R. 1135/S. 2541)
- Sponsor: Rep. Don Young/Sen. Lisa Murkowski
- 10/2021 – Indian Health Service Advance Appropriations Act (H.R. 5549)
- Sponsor: Rep. Don Young
- 10/2021 – Indian Programs Advance Appropriations Act of 2021 (H.R. 5567/S. 2985)
- Sponsor: Rep. Betty McCollum/Sen. Ben Ray Lujan
News
Background
An Urban Confer is an established mechanism for dialogue between federal agencies and Urban Indian Organizations (UIOs). Urban Confer policies are a response to decades of deliberate federal efforts (i.e., forced assimilation, termination, relocation) that have resulted in 70% of American Indian/Alaska Native (AI/AN) people living outside of Tribal jurisdictions, thus making Urban Confer integral to address the care needs of most AI/AN persons.
Legislation
- 2/2023 – Urban Indian Health Confer Act (S. 460)
- Sponsor: Sen. Tina Smith/Sen. Markwayne Mullin
- 1/2023 – Urban Indian Health Confer Act (H.R. 630)
- Sponsor: Rep. Raul Grijalva
- 5/2022 Urban Indian Health Confer Act (S. 4323)
- Sponsor: Sen. Tina Smith
- 9/2021 Urban Indian Health Confer Act (H.R. 5221)
- Sponsor: Rep. Raul Grijalva
News
Background
The Indian Child Welfare Act (ICWA) was created in 1978 by the federal government to re-establish tribal authority over the adoption of Native American children. The goal of the Act was to strengthen and preserve Native American family structure and culture. Studies conducted in advance of ICWA’s drafting showed that between 25% and 35% of all Native children were being removed from their home by state child welfare and private adoption agencies. Of those, 85% were placed with non-Native families, even when fit and willing relatives were available. ICWA was established as a safeguard that requires placement cases involving Native American children to be heard in tribal courts, if possible, and permits a child’s tribe to be involved in state court proceedings.
Resolutions
- National Congress of American Indians (NCAI) 2015 & 2016
- National Native American Bar Association
- American Bar Association
News
Background
- AI/AN Data on Infant and Maternal Health Disparities Infographic
- According to the HHS Office of Minority Health, AI/AN infants have almost twice the infant mortality rate as non-Hispanic whites. Additionally, AI/AN infants are also almost three (3) times more likely than non-Hispanic white infants to die from accidental deaths before the age of one year and are fifty (50) percent more likely to die from complications related to low birthweights as compared to the same group.
- Data from 2019 showed that AI/AN mothers were almost three times as likely to receive late or no prenatal care as compared to non-Hispanic white mothers.
- Among the factors which negatively impact maternal and infant health outcomes in AI/AN communities are difficulty accessing health insurance and health care services, discrimination, homelessness, pollution, environmental degradation, high levels of sexual and interpersonal violence, and intergenerational trauma resulting in behavioral health problems.
Health and Resources and Services Administration (HRSA) Advisory Committee on Infant and Maternal Mortality (ACIMM)
- The ACIMM advises the HHS Secretary on department activities, partnerships, policies, and programs directed at reducing infant mortality, maternal mortality and severe maternal morbidity, and improving the health status of infants of women before, during, or after pregnancy.
- HRSA ACIMM report to HHS Secretary Xavier Becerra titled: “Making Amends: Recommended Strategies and Actions to Improve the Health and Safety of American Indian and Alaska Native Mothers and Infants.”
- On September 14, 2022, NCUIH’s Vice President of Public Policy testified before the HRSA ACIMM on urban Indian disparities and policy changes to address these disparities.
American Academy of Pediatrics (AAP) Committee on Native American Child Health (CONACH)
- The AAP CONACH develops policies and programs that improve the health of AI/AN children and advocates for AI/AN child health. The CONACH also conducts pediatric consultations visits to Indian Health Services and Tribal health facilities. CONACH Committee members maintain contact with tribal, urban, and IHS programs, and keep up with important changes, legislation, and regulations that affect AI/AN health in general and AI/AN child health.
- February 2023 – NCUIH Director of Congressional Relations presented before the AAP CONACH to highlight NCUIH policy priorities and efforts within the Native child health space.
- February 2023 – NCUIH VP of Policy and Communications participated in the AAP briefing before Congress to discuss advance appropriations for IHS and what it means for Native youth.
News
Background
- UIOs currently serve seven of the ten urban areas with the largest AI/AN veteran populations, including the following areas: Phoenix, Arizona; Los Angeles, CA; Dallas, Texas; Oklahoma City, Oklahoma; New York City, New York; and Chicago, Illinois.
- Native veterans have served in the United States military in every armed conflict in the Nation’s history and have traditionally served at a higher rate than any other population in the United States. In return for their service, the United States promised all veterans, including Native veterans, “exceptional health care that improves their health and well-being.” However, of the estimated 86.2 percent of AI/AN veterans that live in urban areas, they generally have higher unemployment, lower education attainment, lower income, higher VA-service connected disability, and generally live in poorer housing conditions than non-Native veterans also living in urban areas.
- NCUIH testimony to Senate Committee on Veterans’ Affairs: “Native American Veterans: Ensuring Access to VA Health Care and Benefits.”
- President Biden’s Interagency Initiative to Address Homelessness for Urban Native Veterans
VHA-IHS Memorandum of Understanding (MOU)
Hearings
- October 2019 – NCUIH Testifies Before Congress on “Native Veterans’ Access To Healthcare”
- March 2021 – NCUIH Submits Testimony to House and Senate Veterans Affairs Committees
- September 2022 – NCUIH testimony on Native Veterans Suicide Prevention to the House Committee on Veterans Affairs
- November 2022 – Congressional Hearing Showcases Urgency of Stabilizing Indian Health Service Funding for Native Veterans
News
Background
- Currently, 31 UIOs receive Special Diabetes Program for Indians (SDPI) funds.
- SDPI’s integrated approach to diabetes healthcare and prevention programs in Indian country has become a resounding success and is one of the most successful public health programs ever implemented.
- For example, due to the SDPI program, rates of End Stage Renal Disease and diabetic eye disease have dropped by more than half. A report from the Assistant Secretary for Preparedness and Response found that SDPI is responsible for saving Medicare $52 million per year.
- Despite these successes, Natives continue to have the highest diabetes prevalence rate of all racial and ethnic groups in the United States, including those living in urban areas. The CDC reports that 14.5% of Native adults living in urban areas are diagnosed with diabetes.
