Tag Archive for: Budget

Senate Appropriations Committee Advances Labor Health and Human Services Spending Bill, Protects Key Indian Country Programs

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On July 31, 2025, the Senate Appropriations Full Committee passed the Fiscal Year (FY) 2026 appropriations bill for Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS). The bill includes $116.6 billion for the Department of Health and Human Services (HHS), which is $446 million above FY 2025 levels and $22 billion above the President’s request. The committee notably did not fund the administration for a Healthy America (AHA), President Trump’s proposed new agency that would consolidate programming across SAMHSA, HRSA, and other agencies as part of its HHS reorganization.  

The committee also provided level funding for key Indian country provisions including the Improving Native American Cancer Outcomes program, Good Health and Wellness in Indian Country program, Tribal Behavioral Health Grants (Native Connections), and the Minority HIV/AIDS Fund – Tribal Set Aside. 

Background 

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

Next Steps 

Senate Leadership will now work with House Leadership to develop the final LHHS appropriations spending bill. The House has not yet released their Labor-HHS appropriations bill, which is expected to be released in September. As a final appropriations bill is produced, NCUIH will continue to advocate to protect funding for Indian Country and maintain maximum funding levels. 

Bill Highlights 

Line Item  FY 2025 Enacted  FY 2026 President’s Budget Request  FY 2026 Committee Passed 
Health Resources and Services Administration $8.9 billion Fold into Administration for a Healthy America (AHA) $8.86 billion
Substance Abuse and Mental Health Services Administration $7.4 billion Fold into AHA $7.4 billion
National Institute of Health $48.6 billion $27.5 billion $48.7 billion
Centers for Disease Control $9.2 billion Fold into AHA $9.15 billion
Good Health and Wellness in Indian Country $24 million —————– $24 million
Improving Native American Cancer Outcomes $6 million —————– $6 million
Ryan White HIV/AIDS Program $2.57 billion $2.50 billion $2.57 billion
Ending the HIV Epidemic $165 million $165 million $165 million
Minority HIV/AIDS Fund $60 million Eliminated $60 million
Minority HIV/AIDS Fund – Tribal Set Aside $5 million ———— $5 million
Tribal Behavioral Health Grants (Native Connections) $23.67 million Eliminated. Created a new behavioral health program under AHA $23.67 million

Additional Key Provisions:

Health Resources and Services Administration

Federal Office of Rural Health Policy: $374 million

Bill report pg. 62: The Committee provides $373,907,000 for Rural Health programs.

  • This represents an increase of $9 million above the FY 2025 enacted level.
Native Hawaiian Health Care Program: $27 million

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

National Health Service Corps: $128.6 million

Bill report pg. 43: The Committee provides $128,600,000 for the National Health Service Corps [Corps]. The Committee recognizes the success of the Corps program in building healthy communities in areas with limited access to care. The program has shown increases in retention of healthcare professionals located in underserved areas.

Centers for Disease Control and Prevention

Good Health and Wellness in Indian Country: $24 million

Bill report pg. 82: The Committee’s recommended level includes $24,000,000 for Good Health and Wellness in Indian Country.

Office of the Secretary – General Departmental Management

Minority HIV/AIDS Fund: $56 million

Bill report pg. 237: The Committee includes $60,000,000 for the Secretary’s Minority HIV/AIDS Fund to strengthen and expand services provided by minority-serving community-based organizations [CBOs] for HIV education and awareness campaigns, testing, prevention, linkage to care, and engagement in care to racial and ethnic minority individuals at risk for or living with HIV in order to address the decline in HIV testing and the challenges with linkage to and retention in care and treatment that occurred during the COVID–19 pandemic. Funding may be prioritized for minority-serving CBOs in the South, which has the highest burden of HIV of any region nationwide. The Committee includes $5,000,000 in funding for the Tribal set aside within the MHAF. The Committee includes $5,000,000 in funding for the Tribal set aside within the MHAF.

  • The $56 million appropriated for this provision represents a $4 million decrease from the FY 2025 enacted level.

Substance Abuse and Mental Health Services Administration

National Center of Excellence for Eating Disorders: $1 million

Bill report pg. 46: Within the total for PCTE, the Committee continues to support up to $1,000,000 in coordination with SAMHSA’s Center of Excellence for Eating Disorders, to provide trainings for primary care health professionals to screen, intervene, and refer patients to treatment for the severe mental illness of eating disorders, as authorized under section 13006 of the 21st Century Cures Act (Public Law 114–255).

Centers for Disease Control and Prevention

Substance Abuse Prevention Services: $236.88 million

Bill report pg: 188: The Committee recommends $236,879,000 for the Center for Substance Abuse Prevention [CSAP], the sole Federal organization with responsibility for improving accessibility and quality of substance use prevention services.

Tribal Behavioral Grants (Native Connections): $23.67 million

Bill report pg. 189: SAMHSA has administered Tribal Behavioral Health Grants for mental health and substance use prevention and treatment for Tribes and Tribal organizations since fiscal year 2014. In light of the continued growth of this program, as well as the urgent need among Tribal populations, the Committee continues to urge the Assistant Secretary for SAMHSA to engage with Tribes on ways to maximize participation in this program.

Zero Suicide: $26.2 million

Bill report pg. 177: The Committee includes $38,200,000 for suicide prevention programs. Of the total, $26,200,000 is for the implementation of the Zero Suicide model, which is a comprehensive, multi-setting approach to suicide prevention within health systems. 

American Indian and Alaska Native Set Aside: $3.4 million

Bill Report pg. 178: Additionally, suicide is often more prevalent in highly rural areas and among the American Indian and Alaskan Native populations. According to the CDC, American Indian/Alaska Natives [AI/AN] have the highest rates of suicide of any racial or ethnic group in the United States. In order to combat the rise in suicide rates among this population, the Committee recommends $3,400,000 for AI/AN within Zero Suicide. 

Mental Health Services Block Grant: $1.01 billion

Bill report pg. 179: The Committee provides $1,007,571,000 for the Mental Health Block Grant. This appropriation includes $21,039,000 in transfers available under section 241 of the PHS Act (Public Law 78–410 as amended).

  • The Committee recognizes that AI/AN populations in the United States have higher rates of illicit drug use, opioid misuse, and misuse of prescription drugs compared to other racial groups. The Committee encourages SAMHSA to consider the needs of Indian Tribes and tribal organizations within the MHBG.
988 Suicide & Crisis Lifeline: $534.62 million

Bill report pg. 174: —Suicide is a leading cause of death in the United States, claiming over 49,000 lives in 2023. The Committee provides $534,618,000 for the 988 Lifeline and Behavioral Health Crisis Services. This amount includes funding to continue to strengthen the 988 Lifeline and enable the program to continue to respond in a timely manner to an increasing number of contacts. The 988 Lifeline coordinates a network of independently operated crisis centers across the United States by providing suicide prevention and crisis intervention services for individuals seeking help. The Committee requests a briefing within 90 days of enactment, and quarterly briefings thereafter, on the 988 Lifeline spend plan and related activities.

Substance Use Prevention, Treatment, and Recovery Services Block Grant: $2.03 billion

Bill report pg. 190: The Committee acknowledges the important role of the Community Mental Health Services and Substance Use Prevention, Treatment, and Recovery Services Block Grants in supporting States’ efforts to provide resources for expanded mental health and substance use disorder treatment and prevention services. The Committee reiterates the request for a report, as included in Public Law 118–47, regarding the lack of transparency and information that is provided to Congress and the public about how States are distributing those funds and for what programs or services they are being used.

State Opioid Response Grants: $1.6 billion

Bill report pg. 186: The Committee provides $1,595,000,000 for grants to States to address the opioid crisis. Bill language provides not less than 4 percent for grants to Indian Tribes or tribal organizations. The Committee supports the 15 percent set-aside for States with the highest age-adjusted mortality rate related to substance use disorders, as authorized in Public Law 117–328. The Assistant Secretary is encouraged to apply a weighted formula within the set aside based on State ordinal ranking. Activities funded with this grant may include treatment, prevention, and recovery support services. The Committee continues to direct SAMHSA to conduct a yearly evaluation of the program to be transmitted to the Committees no later than 180 days after enactment of this act. SAMHSA is directed to make such evaluation publicly available on SAMHSA’s Web site. The Committee further directs SAMHSA to continue funding technical assistance within the administrative portion of the appropriated amounts for the SOR grants, to provide locally based technical assistance teams as has been done through the Opioid Response Network. The Committee recognizes the importance and essential work currently being done by the Opioid Response Network in delivering technical assistance to State and Territory SOR grantees, sub-recipients, and others addressing opioid use disorder and stimulant use disorder in their communities.

National Institute on Minority Health and Health Disparities

Improving Native American Cancer Outcomes: $6 million

Bill report pg. 142: The Committee notes that Native Americans experience overall cancer incidence and mortality rates that are strikingly higher than non-Native populations. The Committee includes $6,000,000, for the Initiative for Improving Native American Cancer Outcomes to support efforts including research, education, outreach, and clinical access related to cancer in Native American populations. The Committee further directs NIMHD to work with NCI to locate this Initiative at an NCI designated cancer center demonstrating partnerships with Indian Tribes, Tribal organizations, and urban Indian organizations to improve the screening, diagnosis, and treatment of cancers among Native Americans, particularly those living in rural communities.

Native Hawaiian/Pacific Islander Health Research Office: $4 million

Bill report pg. 142 : The Committee recognizes the Federal trust responsibility to Native Hawaiians and the unique health challenges facing the Native Hawaiian and Pacific Islander community. The Committee also acknowledges that there is limited health research on this community, relative to other populations, particularly that disaggregates between different subpopulations. The Committee includes $4,000,000, for the Native Hawaiian/Pacific Islander Health Research Office. The Committee encourages collaboration across Institutes and with the community, including research institutions with expertise and researcher representation from the NHPI community.

Important Behavioral and Mental Health Provisions

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

Bill report pg. 184: The Committee includes $111,000,000 for medication-assisted treatment, of which $14,500,000 is for grants to Indian Tribes, tribal organizations, or consortia. These grants should target States with the highest age adjusted rates of admissions, including those that have demonstrated a dramatic age-adjusted increase in admissions for the treatment of opioid use disorders. The Committee continues to direct the Center for Substance Abuse Treatment to ensure that these grants include as an allowable use the support of medication-assisted treatment and other clinically appropriate services to achieve and maintain abstinence from all opioids, including programs that offer low-barrier or same day treatment options.

Peer-Support Specialists: $14 million

Bill report pg. 47: Within BHWET, the Committee includes $14,000,000 to fund training, internships, and certification for mental health and substance use peer support specialists to create an advanced peer workforce prepared to work in clinical settings.

Infant and Early Childhood Mental Health Program: $15 million

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

Administration for Community Living

Native American Caregiver Support Program: $24 million

Bill report pg. 225: American Caregiver Support program. This program provides grants to Tribes for the support of American Indian, Alaskan Native, and Native Hawaiian families caring for older relatives with chronic illness or disability, as well as for grandparents caring for grandchildren.

Senate Advances FY 2026 Interior Bill with Increases for IHS and Advance Appropriations for FY 2027

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On July 25, 2025, the Senate Appropriations Full Committee passed the Fiscal Year (FY) 2025 appropriations bill for Interior, Environment, and Related Agencies. The bill provides $8.1 billion for IHS, including $5.3 billion in advance appropriations for FY 2027, despite the President’s budget not requesting advance appropriations. The Committee’s total funding for IHS is the same as the President’s IHS budget authority request. The bill authorizes $90.4 million for urban Indian health – the same funding as the FY25 enacted amount. The report states that “[t]he Committee is committed to improving the health and well-being of AI/AN living in urban Indian communities.”

Background

On July 22, 2025, the House Appropriations Full Committee passed the FY 2026 appropriations bill for Interior, Environment, and Related Agencies. The House bill provides $8.41 billion for IHS, including $6.05 billion in advance appropriations for FY 2027, despite the President’s budget not requesting advance appropriations. The House Committee’s total funding for IHS is approximately $500 million higher than the President’s IHS budget authority request. The House bill authorizes $105.99 million for urban Indian health – an increase of $15 million over the FY25 enacted amount.

The National Council of Urban Indian Health (NCUIH) is a longstanding advocate for full funding for IHS and urban Indian health and supports the recommendations of the Tribal Budget Formation Workgroup. On February 27, 2025, NCUIH board president-elect and Oklahoma City Indian Clinic CEO Robyn Sunday-Allen (Cherokee) testified before the House Appropriations Subcommittee on Interior, Environment, and Related Agencies, urging full funding for urban Indian health and the Indian Health System.

NCUIH is also grateful for the support of Senators working to support the health of Indian Country. On May 19, 2025, 19 Senators joined Senator Tina Smith (D-MN) in a letter to Chairman Murkowski (R-AK) and Ranking Member Merkley (D-OR) of the Senate Interior Appropriations Committee requesting support for Urban Indian Health, maintaining advance appropriations for IHS, and protecting IHS from sequestration. The letter emphasized 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.

Next Steps

The Senate will now need to schedule a floor vote on the Interior, Environment, and Related Agencies spending bill. The legislation is not expected to become law in its current form. Senate leadership will need to work with House Leadership to negotiate a final bill text for passage in both chambers.

FY25 funding is set to end on September 30, 2025. If Congress cannot come to a funding agreement by that deadline, they will need to pass a Continuing Resolution to keep the funding levels at the FY25 level until they can reach an agreement. Should political disagreements lead to a government shutdown, UIOs and parts of IHS will be protected by Advance Appropriations.

Bill Highlights

Line Item FY 25 Enacted FY 26 Tribal Request FY 26 President’s Budget FY 26 House Proposed FY 26 Senate Proposed
Urban Indian Health $90.42 million $770.5 million $90.4 million $ 105.99 million $90.4 million
Indian Health Service $6.96 billion $63 billion $8.1 billion $8.41 billion $8.1 billion
Advance Appropriations $5.19 billion ___________ Did not include $6.05 billion $5.3 billion
Hospital and Clinics $2.5 billion $13.8 billion $2.65 billion $2.85 billion $2.65 billion
Tribal Epidemiology Centers $34.4 million ___________ $34.4 million $ 44.43 million ___________
Mental Health $127.1 million $4.76 billion $131 million $144.95 million $131.3 million

Additional Key Provisions:

UIO Interagency Workgroup

Bill Report, Pg. 133: Despite the excellent efforts of Urban Indian Organizations, AI/AN populations continue to be left out of many Federal initiatives. Therefore, the Committee reminds the IHS of the directive to explore the formation of an interagency working group to identify existing Federal funding supporting Urban Indian Organizations [UIOs] and determine where increases are needed, or what programs should be amended to allow for greater access by UIOs; to develop a Federal funding strategy to build out and coordinate the infrastructure necessary to pilot and scale innovative programs that address the needs and aspirations of urban AI/ANs in a holistic manner; develop a wellness centered framework to inform health services; and meet quarterly with UIOs to address other relevant issues. In addition to the Indian Health Service, the working group should consist of the U.S. Department of Health and Human Services, U.S. Department of Housing and Urban Development, U.S. Department of Agriculture, U.S. Department of Justice, U.S. Department of Education, U.S. Department of Veteran Affairs, U.S. Department of Labor, the Small Business Administration, the Economic Development Agency, FEMA, the U.S. Conference of Mayors, and others as identified by UIOs.

Produce Prescription Pilot Program: $3 million

Bill Report, Pg. 130: The bill maintains funding at fiscal year 2025 enacted levels for the Produce Prescription Pilot program.

Contract Support Costs: $1.8 billion and Tribal 105(l) Leases: $366 million

Bill Report, Pg. 134: The Committee has continued language from fiscal year 2021 establishing an indefinite appropriation for contract support costs estimated to be $1,819,000,000 in fiscal year 2026. By retaining an indefinite appropriation for this account, additional funds may be provided by the Agency if its budget estimate proves to be lower than necessary to meet the legal obligation to pay the full amount due to Tribes. The Committee believes that fully funding these costs will ensure Tribes have the resources they need to deliver program services efficiently and effectively.

Bill Report, Pg.  134: The recommendation includes an indefinite appropriation of an estimated $366,000,000 for the compensation of operating costs associated with facilities leased or owned by Tribes and Tribal organizations for carrying out health programs under Indian Self-Determination and Education Assistance Act (ISDEAA) contracts and compacts as required by 25 U.S.C. 5324(l).

Purchased and Referred Care: $996.75 million

Bill Report, Pg. 132: The recommendation includes $996,755,000 for purchased/referred care.

Indian Health Professions: $80.56 million

Bill Report, Pg. 133: The recommendation includes $80,568,000 for the Indian Health Professions program.

Sanitation Facilities Construction: $106.6 million

Bill Report, Pg. 134: The recommendation includes $106,627,000 for Sanitation Facilities Construction activities, equal to the enacted level.

Health Care Facilities Construction: $182.7 million

Bill Report, Pg. 135: The recommendation includes $182,679,000 for Health Care Facilities Construction, equal to the enacted level.

Dental Health: $259.5 million

Bill Report, Pg. 131: The recommendation includes $259,501,000 for dental health, an increase of $5,384,000 to the fiscal year 2025 enacted level.

Alzheimer’s Disease: FY 2025 Funding

Bill Report, Pg. 130: The bill maintains funding at fiscal year 2025 enacted levels for the Alzheimer’s program.

Maternal Health: $1 million

Bill Report, Pg. 131: The Committee recommendation supports funding for maternal health initiatives and provides an additional $1,000,000 for these efforts.

Alcohol and Substance Abuse: $267 million

Bill Report, Pg. 131: The recommendation includes $267,404,000 for alcohol and substance abuse programs, an increase of $633,000 to the fiscal year 2025 enacted level.

Bureau of Indian Affairs, Missing and Murdered Indigenous Women Initiative: $250 thousand

Bill Report, Pg. 68: The Committee recommends an additional $250,000 with an emphasis on addressing the crisis of missing, trafficked, and murdered Indigenous people, especially women, as part of the Bureau of Indian Affairs (BIA) Law Enforcement Special Initiatives.

NCUIH Contact: Meredith Raimondi, Vice President of Policy and Communications, mraimondi@ncuih.org

National Tribal Budget Formulation Workgroup Releases Recommendations for Fiscal Year 2027, Recommends Full Funding for Indian Health Service and Urban Indian Health

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In April 2025, the National Tribal Budget Formulation Workgroup (NTBFW) released their fiscal year (FY) 2027 Tribal Budget Recommendations, The Federal Trust Responsibility to Tribal Nations: A Strategy to Advance Indian Health Care, as part of the Indian Health Service (IHS) Budget Formulation process. The NTBFW recommends $1.09 billion for the Urban Indian Health line item and $73 billion for IHS. The NTBFW also recommends that IHS retain and expand eligibility for Urban Indian Organizations (UIOs) to participate in grant programs and ensure that UIOs are included in exemptions for Medicaid reform, including work requirements.

Read the full recommendations here.

Background on IHS Budget Formulation

As part of the trust responsibility to provide health care to all American Indian and Alaska Native people, Tribal leaders present their funding needs each year to the Secretary of the U.S. Department of Health and Human Services (HHS) and the Director of the Office of Management and Budget (OMB). The recommendations are formed through the Tribal Budget Formulation Workgroup and serve as a framework for the Administration in setting budget amounts for their annual requests to Congress. This process ensures the federal government has the resources to provide health care to all American Indian and Alaska Native people in fulfillment of the trust responsibility.

The National Council of Urban Indian Health (NCUIH) assists UIOs in advocating for their needs during the IHS Area level consultation sessions and presents information on UIOs’ priorities and needs during the February Area Report Webinar. NCUIH supports full funding for the IHS, Tribal, and UIOs (I/T/U) system.  NCUIH endorses a budget in which IHS, Tribal Facilities, and UIOs are all fully funded to improve health outcomes for all Native people no matter where they live.

ANALYSIS: President Trump Proposes Increase for Indian Health Service, Stable Funding for Urban Indian Health for FY 2026

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On May 30, 2025, the Department of Health and Human Services (HHS) published their Fiscal Year (FY) 2026 Budget in Brief and the Indian Health Service (IHS) published the IHS Justification for Estimates for Appropriations Committees for FY 2026 (hereinafter Congressional Justification).

Proposed Funding for the Urban Indian Health Line Item and the Indian Health Service

The President’s Budget includes a $90.4 million for Urban Indian Health. This amount is flat with the FY 2025 enacted amount. The President’s proposal also requests $8.1 billion for IHS which includes reauthorization for the Special Diabetes Program for Indians (SDPI) for $159 million. HHS also proposes $80 million for the newly funded Native American Behavioral Health and Substance Use Disorder program to be administered through the Administration for Healthy America (AHA).

Advance Appropriations

HHS’ Budget in Brief and IHS Congressional Justification do not include advance appropriations for IHS, despite the inclusion of advance appropriations for FY2026 in the March 14 Continuing Resolution, which funded the government through the end of FY2025. Advance Appropriations are essential to provide stability and insulate to Indian health care providers from the effects of budgetary disagreements. Congress first included Advance Appropriations for IHS in the FY 2023 Omnibus and included Advance Appropriations in budgetary legislation for FY 2024 and FY 2025. Maintaining Advanced appropriations is a top priority for Indian Country, as they ensure that funding remains stable for Indian health care providers even in the event of a government shut down.

Mandatory Funding

The HHS Budget in Brief and IHS Congressional Justification do not include a request to shift the IHS budget from discretionary to mandatory appropriations either in whole or in part. The shift from discretionary to mandatory funding for the IHS budget has been a long-term request from Indian Country to ensure stable and predictable funding for the Indian health system. The budget also does not include a request to shift CSC and Section 105(l) lease funding from discretionary to mandatory, which has become a high priority issue in Indian Country this past year due to the recent Supreme Court decision in San Carlos Apache v. Becerra.

FY 2026 President’s Budget Highlights for IHS

Line Item FY 23 Enacted FY 25 Enacted FY 26 Tribal Request FY 26 President’s Budget
Urban Indian Health $90.42 million

 

 $90.4 million $770.5 million $90.4 million
Indian Health Service $6.96 billion $7.1 billion $63 billion $8.1 billion
Hospital and Clinics $2.5 billion $2.58 billion $13.8 billion $2.65 billion
Tribal Epidemiology Centers $34.4 million $34.4 million _______________ $34.4 million
Electronic Health Record System $218 million $190.56 million $659.4 million $190.5 million
Community Health Representatives $65.21 million $65.2 million $1.58 billion $65 million
Mental Health $127.1 million $130.1 million $4.76 billion $131 million

Note: While previous years’ budgets included proposals for advance appropriations and funding for the IHS Cancer Moonshot Initiative and resources for HIV, hepatitis and syphilis prevention and treatment, this year’s Budget in Brief and IHS Congressional Justification do not include these items. IHS continues to list targeting HIV, hepatitis and syphilis as services IHS offers in the IHS Congressional Justification.

Overview of HHS Budget

Indian Health Service

The Budget in Brief and IHS Congressional Justification propose funding IHS for $8.1 billion in FY 2026. The proposed funding amount includes $90.4 million for Urban Indian Health and reauthorization of SDPI for one year for $159 million. This represents an increase for IHS, flat funding for Urban Indian Health compared to FY 2025, and a decrease of $363,000 for SDPI. IHS also estimates funding Contract Support Costs (CSCs) and Section 105(l) leases through an indefinite discretionary appropriation of $1.7 billion and $413 million, respectively. This represents a proposed 47% increase for CSCs and a proposed 93% increase for Section 105(l) leases. IHS proposes a significant decrease in Sanitation Facilities Construction from $106.6 million enacted in FY 2025 to $13.49 million proposed in the IHS Congressional Justification, a $93.13 million decrease, and an increase to Clinical Service to account for $6 million to support the delivery of healthcare services for the Lumbee Tribe. The increases for CSCs and Section 105(l) leases account for the proposed funding increase for IHS, leaving the majority of the IHS’ line items flat funded.

IHS also included grants and other programming for which UIOs are eligible in the IHS Congressional Justification:

Dementia Models of Care Grant: For FY 2026, IHS is planning a new five-year Dementia Models of Care notice of funding opportunity and a five-year multi-service national clinical champions cooperative agreement.

Indian Health Professions: IHS also proposes flat funding of $80.56 million for Indian Health Professions. This offers additional IHS Scholarship and Loan Repayment awards, bolstering recruitment and retention efforts through these two high demand programs.

Other Agencies within HHS

Several agencies have received significant cuts within the Budget in Brief: National Institutes of Health ($17 billion); Administration for Children, Families, and Communities ($7 billion); and the Administration for a Healthy America ($6 billion).

Programs previously funded through SAMHSA have now been consolidated into the AHA. These include Mental Health ($1.5 billion), Substance Abuse Prevention ($89 million), and Substance Abuse Treatment ($20 million). The proposed funding for these programs is at a decrease compared to the FY2025 amounts. The budget also proposes to consolidate three block grants into the Behavioral Health Innovation Block Grant ($4 billion). These block grants, previously funded through SAMHSA, are the Community Mental Health Services Block Grant; Substance Use Prevention, Treatment and Recovery Support Services Block Grant; and State Opioid Response. Other agencies proposed to be consolidated into the AHA are the Health Resources and Services Administration (HRSA), Office of the Assistant Secretary for Health (OASH), National Institute for Environmental Health Sciences (NIEHS), and some programs previously funded through the Centers for Disease Control and Prevention (CDC).

Due to consolidation of programs, SAMHSA’s Tribal Behavioral Health and Opioid Response Grant is facing cuts. However, the budget does include proposed funding for the Native American Behavioral Health and Substance Use Disorder program ($80 million), which will be within AHA. This program was first authorized in 2022 and is intended to support tribes in providing culturally tailored services in addressing mental health and substance use. Additionally, within the AHA is another new program, the American Indian and Alaska Native Suicide Prevention Initiative ($4 million).

Within the budget there is a proposal to consolidate programs within the Administration for Children and Families (ACF) and the Administration for Community Living (ACL) and create a new Administration for Children, Families, and Communities (ACFC). It proposes to continue funding Native American Programs, previously funded through ACF, at $61 million. Other programs consolidated into ACFC from ACL are the Native American Nutrition and Supportive Services ($38 million) and Native American Caregiver Support Services ($12) million. In the CDC section of the Budget in Brief, there is no mention of the Healthy Tribes Program as that funding has been proposed to be cut.

In their Congressional Justification, CMS has requested $3 million to continue its American Indian and Alaska Native outreach efforts through Tribal Outreach and Education. The purpose of this program is to remove barriers for rural communities that cause disparities in health care. Funding for HHS Tribal Affairs was requested in the HHS Congressional Justification, at $730,000. This funding is used to support the Secretary’s Tribal Advisory Committee (STAC). Additionally, the Congressional Justification and Budget in Brief also highlight that HHS will make an effort to support Tribal healthcare data sovereignty and Tribal public health infrastructure.

Next Steps

The Appropriations Committees will review the President’s Budget for consideration as they craft their bills for FY 2026. NCUIH will submit testimony and send letters to House and Senate Appropriators to request full funding for FY2026. NCUIH will continue to work with the Trump Administration and Congress to push for full funding of Urban Indian Health in FY 2026.

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.

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.

PRESS RELEASE: NCUIH Urges Senate Appropriations Committee to Match House Funding Request of $81 Million for Urban Indian Health

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FOR IMMEDIATE RELEASE 

Contact: Meredith Raimondi
202-544-0344
mraimondi@ncuih.org

NCUIH Urges Senate Appropriations Committee to Match House Funding Request of $81 Million for Urban Indian Health

NCUIH sent a letter to the Senate Appropriations Committee to request the same funding level as included in Chairwoman McCollum’s House bill for urban Indian health.

Washington, DC (June 10, 2019) — Today, the National Council of Urban Indian Health sent a letter to the Senate Appropriations Committee requesting to match the funding for the urban Indian health line item in the House Appropriations bill that recently passed out of the full Appropriations Committee. Last month, the Senate held their first hearing on the Interior budget with Secretary Bernhardt.

“After years of stagnation and chronic underfunding to the urban Indian health budget, NCUIH would like to see the Senate follow the House by also including $81 million for the urban Indian health item. NCUIH urges the Senate to follow the House bill’s example which incorporates a solution of addressing the unmet needs of urban Indians by increasing the overall IHS budget without taking away from the other line items,” said NCUIH Executive Director Francys Crevier.

Urban Indian Organizations (UIOs) are the only part of the Indian health System (IHS/Tribal facilities/UIOs) that only receive funding from one source within the IHS budget – the urban Indian line item. The 41 UIOs in 22 states are an integral part of the Indian health system.  Currently, UIOs receive less than 1% of the IHS budget creating serious budget constraints while still providing culturally-competent and quality healthcare.

The House Interior Appropriations Bill authored by Chairwoman Betty McCollum includes $81 million for the urban Indian health line item, which is an approximately $30 million increase from current levels. The House Bill will next move to the floor for a vote.

As the Senate continues to develop their Interior Appropriations bill, NCUIH requests that they include the $81 million for urban Indian health. This needed increase would allow UIOs to hire more staff, expand vital services from behavioral health to substance misuse programs, and improve health outcomes for the growing demand for health care for urban Indians.

Budget Formulation Update: The National Tribal Budget Formulation Workgroup’s Recommendations Include Urban Indian Health Increase for the Indian Health Service Fiscal Year 2021 Budget

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May 6, 2019 Update

Last month Tribal sovereign leaders on the National Tribal Budget Formulation Workgroup (TBFWG) met to provide input regarding the Indian Health Service (IHS) budget request for FY 2021 (FY). After a thorough discussion of healthcare needs, their recommendations include $2.7 billion in program increases for the most critical health issues, including $50.9 Million for Urban Indian Health. The National Council of Urban Indian Health provided testimony concerning the status of the Urban Indian Health Programs (UIHPs). The TBFWG recommendations are an approximate 46% increase above the Fiscal Year 2019 funding, highlighting the crucial need for funding of the Indian healthcare system. Additionally, a recommendation was made to fund the Special Diabetes Program for Indians, increasing funding to $200 million per year, to include inflation. 105(l) leases were also a subject of importance, and while IHS does have an obligation towards fulfilling its 105(l) leases, adequate steps have been encouraged to protect other IHS programs for FY2021. The TBFWG understands that before significant steps are taken to address the healthcare concerns in Indian country, the fundamentals such as the I/T/U system, must have precedence.

April 30, 2019: The National Tribal Budget Formulation Workgroup’s Recommendations on the Indian Health Service Fiscal Year 2021 Budget

https://www.tribalselfgov.org/wp-content/uploads/2019/04/307871_NIHB-IHS-Budget-Book_WEB.pdf

March 14, 2019: NCUIH Recommendations for the FY 2021 Indian Health Service Budget

Hot Topics/Requests – National Budget Recommendations

  • Hot Topics/Requests 1: Increased funding for urban Indian line item to at least 2% of IHS or $116m
  • HotTopics/Requests 2: Respecting Tribal requests for direct funding but ensuring grants to continue for Title V UIOs only
  • Hot Topics/Requests 3: Implementation of unfunded IHCIA provisions
  • Hot Topics/Requests 4: Ensuring UIHPs are held harmless from unrelated budget shortfalls, including creating a new line item for §105(l) leases
  • Hot Topics/Requests 5: Funding initiatives should include funds for Title V UIHPs
    • Opioid funding
    • Behavioral health funding
  • Hot Topics/Requests 6: 100% FMAP for UIHPs
  • Hot Topics/Requests 7: Funds for UIHPs to modernize Health IT
  • Hot Topics/Requests 8: Suicide and substance use disorder among youth
    • -One urban youth residential treatment center

Priorities

  • Priority 1: Advanced appropriations
  • Priority 2: SDPI
  • Priority 3: Substance use and mental health
  • Priority 4: Opioids funding