Tag Archive for: Letters

NCUIH Urges Congress to Protect and Expand Tribal Health Set-Asides in FY 2027

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On June 4, 2026, the National Council of Urban Indian Health (NCUIH) sent a letter to Senate Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS) Appropriations Subcommittee Chair Shelley Moore Capito and Ranking Member Tammy Baldwin outlining priorities related to Tribal set-asides and other Native health investments as the subcommittee develops the Fiscal Year (FY) 2027 Labor-HHS bill. 

NCUIH outlined the following priorities to the subcommittee: 

  • Maintain all enacted Tribal set-asides at or above FY 2026 enacted levels; 
  • Adopt the Tribal set-asides included in the FY 2026 House mark that were not included in the final enacted bill, and add Tribal set-asides to health programs where AI/AN populations face disproportionate burden; 
  • Preserve designated standalone Native health programs from elimination and increase funding where possible; and 
  • Strengthen report language to ensure Tribes, Tribal organizations, and UIOs can access programs where dedicated funding is not explicitly protected in the bill. 

Read the full letter here. 

NCUIH is continuing to engage with national Native organizations and partners throughout the FY 2027 appropriations process to elevate shared priorities related to Tribal set-asides and Native health programs. These collaborative efforts help ensure policymakers are informed about the role of dedicated funding in supporting Native health services. 

CMS Releases Guidance to States on Implementation of the One Big Beautiful Bill Act 6-Month Medicaid Redeterminations – Includes AI/AN Exemption

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The Centers for Medicare and Medicaid Services (CMS) recently released a State Medicaid Director letter (SMDL) on implementing the eligibility redeterminations in Section 71107 of the One Big Beautiful Bill Act, which is also known as the “Working Families Tax Cut Legislation.” The SMDL includes a summary of the exemptions for American Indian and Alaska Native people from the 6-month renewal requirement (see page 4). NCUIH continues to urge CMS to continue to consult with Tribes to ensure proper implementation of exemptions for American Indian and Alaska Native people.

Additional Information

On July 4, 2025, the President signed the One Big Beautiful Bill Act (OBBBA) into law. The OBBBA is a major bill that delivers many elements of President Trump’s legislative agenda, including new requirements for access to Medicaid and SNAP. Fortunately, Indians, Urban Indians, California Indians, and individuals determined eligible as an Indian for the Indian Health Service under regulations promulgated by the Secretary are exempted from the Medicaid requirements in the OBBBA and included in exemptions for the Supplemental Nutrition Assistance Program (SNAP) work requirements.

Bipartisan Group of 60 Congressional Leaders Request Protection of IHS Funding and Increased Resources for Urban Indian Health

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On March 20, 2026, 59 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 $106 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) 2027 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 60 Congressional leaders reiterated their support for the House Appropriations Committee’s inclusion of advance appropriations for IHS for FY 2027 in the final FY 2026 appropriations bill. 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-03)
  • Jeff Hurd (R-CO-03)
  • Dusty Johnson (R-SD-AL)
  • Yassamin Ansari (D-AZ-03)
  • Nanette Barragán (D-CA-44)
  • Ami Bera (D-CA-06)
  • Shontel Brown (D-OH-11)
  • Julia Brownley (D-CA-26)
  • Janelle Bynum (D-OR-05)
  • Salud Carbajal (D-CA-24)
  • Greg Casar (D-TX-35)
  • Gilbert Cisneros (D-CA-31)
  • Steve Cohen (D-TN-09)
  • Jasmine Crockett (D-TX-30)
  • Jason Crow (D-CO-06)
  • Sharice Davids (D-KS-03)
  • Danny Davis (D-IL-07)
  • Diana DeGette (D-CO-01)
  • Maxine Dexter (D-OR-03)
  • Shomari Figures (D-AL-02)
  • Jesús García (D-IL-04)
  • Adelita Grijalva (D-AZ-07)
  • Jahana Hayes (D-CT-05)
  • Val Hoyle (D-OR-04)
  • Jared Huffman (D-CA-02)
  • Sara Jacobs (D-CA-51)
  • Pramila Jayapal (D-WA-07)
  • Julie Johnson (D-TX-32)
  • Timothy Kennedy (D-NY-26)
  • Raja Krishnamoorthi (D-IL-08)
  • Rick Larsen (D-WA-02)
  • Stephen Lynch (D-MA-08)
  • Seth Magaziner (D-RI-02)
  • Doris Matsui (D-CA-07)
  • Lucy McBath (D-GA-06)
  • Kristen McDonald Rivet (D-MI-08)
  • Kweisi Mfume (D-MD-07)
  • Gwen Moore (D-WI-04)
  • Jared Moskowitz (D-FL-23)
  • Kevin Mullin (D-CA-15)
  • Joe Neguse (D-CO-02)
  • Ilhan Omar (D-MN-05)
  • Jimmy Panetta (D-CA-19)
  • Scott Peters (D-CA-50)
  • Brittany Pettersen (D-CO-07)
  • Luz Rivas (D-CA-29)
  • Raul Ruiz (D-CA-25)
  • Andrea Salinas (D-OR-06)
  • Hillary Scholten (D-MI-03)
  • Kim Schrier (D-WA-08)
  • Adam Smith (D-WA-09)
  • Darren Soto (D-FL-09)
  • Melanie Stansbury (D-NM-01)
  • Greg Stanton (D-AZ-04)
  • Haley Stevens (D-MI-11)
  • Mark Takano (D-CA-39)
  • Rashida Tlaib (D-MI-12)
  • Ritchie Torres (D-NY-15)
  • Juan Vargas (D-CA-52)
  • Gabe Vasquez (D-NM-02)

Full Letter Text

Dear Chairman Simpson and Ranking Member Pingree:

As you develop the Fiscal Year (FY) 2027 Interior, Environment, and Related Agencies Appropriations bill, we request that you fund Urban Indian Health at the highest possible level, with a minimum of $106 million. We also request that you retain advance appropriations for the Indian Health Service (IHS) in FY 2028 and protect IHS from any sequestration cuts.

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 2027 in the final FY2026 appropriations bill. Because of this inclusion, the I/T/U system will be able to operate normally and without fear of funding lapses during the FY 2027 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 2028 in the final FY 2027 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.

Partnership for Medicaid Urges CMS Guidance for AI/AN Medicaid Exemptions Under the One Big Beautiful Bill Act

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On November 25, 2025, NCUIH joined the Partnership for Medicaid in a letter to the Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz sharing requests and recommendations regarding the implementation of the One Big Beautiful Bill Act (OBBBA) (H.R. 1). NCUIH worked with the Partnership to urge CMS to reiterate the exemption of American Indian and Alaska Native (AI/AN) beneficiaries from the new Medicaid requirements in its guidance to states.

Read the full letter here.

Background on OBBBA and AI/AN Medicaid Exemptions

On July 4, 2025, the President signed the OBBBA into law. The OBBBA is a major bill that delivers many elements of President Trump’s legislative agenda, including new requirements for access to Medicaid and Supplemental Nutrition Assistance Program (SNAP). Indians, Urban Indians, California Indians, and individuals determined eligible as an Indian for the Indian Health Service under regulations promulgated by the Secretary are exempted from the Medicaid requirements in the OBBBA and included in exemptions for the SNAP work requirements.

Read more about these exemptions in NCUIH’s overview of the OBBBA resource.

About the Partnership for Medicaid

NCUIH is a member of the Partnership for Medicaid, which is a nonpartisan, nationwide coalition of organizations representing clinicians, health care providers, safety-net health plans, and counties. The goal of the coalition is to preserve and improve the Medicaid program.

NCUIH Sends Letter to HRSA Seeking Exemption for UIOs and Indian Health Care Providers from the 340B Rebate Model Pilot Program

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On December 8, 2025, the National Council of Urban Indian Health (NCUIH) sent a letter to the Health Resources and Services Administration (HRSA) Administrator, Thomas J. Engels, to request an exemption for Urban Indian Organizations (UIOs) and Indian Health Care Providers from HRSA’s 340B Rebate Model Pilot Program. NCUIH made this urgent request to prevent the administrative and financial burden of the Program on UIOs and Indian Health Care Providers. This request is consistent with a Tribal request that has been made by both U.S. Department of Health and Human Services’ (HHS) Secretary’s Tribal Advisory Committee (STAC) and the Centers for Medicaid and Medicare Services (CMS) Tribal Technical Advisory Group (TTAG).

Read the full letter here.

Background on the 340B Rebate Model Pilot Program

On July 31, 2025, HRSA announced the voluntary 340B Rebate Model Pilot Program for drugs on the Centers for Medicare and Medicaid Services’ (CMS) Medicare Drug Price Negotiation Selected Drug List for year 2026 from qualifying manufacturers meeting specific criteria. Under the Program, covered entities continue to make purchases through their 340B wholesaler account and request rebates on select drugs after the purchase is made. Read here for more information on the Program.

NCUIH Sends Letter to HHS Requesting Exemption for IHS from Workforce Reduction Initiatives, Protection for IHS Funding

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On March 12, 2025, the National Council of Urban Indian Health (NCUIH) sent a letter to the U.S. Department of Health and Human Services (HHS) Secretary, Robert F. Kennedy, Jr., urgently requesting his immediate intervention to safeguard the Indian Health Service (IHS) workforce and funding. The letter requested that Secretary Kennedy exempt IHS from all current and future workforce reduction initiatives and rescind hiring freezes, and protect IHS funding including shielding IHS from sequestration and impoundment.

Read the full letter here.

Background

The United States Senate confirmed Robert F. Kennedy, Jr. as the Secretary for HHS on February 13, 2025. During his confirmation and remarks at the February HHS Secretary Tribal Advisory Committee (STAC) meeting, Secretary Kennedy emphasized his support for Indian Country, including having a Native person at the Assistant Secretary level in HHS. NCUIH looks forward to working with Secretary Kennedy to improve the health of Indian Country. During the meeting, Secretary Kennedy offered protections to Tribal leaders and the Indian health system, stating, “When they announced $9.6 billion in cuts to my agency—10% of our workforce—the one sub-agency I insisted must be protected was IHS. We safeguarded 1,000 jobs at IHS, and we will continue to do so. As new orders and additional cuts come down, protecting these jobs remains my priority.”

NCUIH Joins Indian Country Coalition in Urging the Department of Health and Human Services Secretary to Uphold Tribal Sovereignty and Protect Funding for Native Programs

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On February 14, 2025, the National Council of Urban Indian Health (NCUIH) joined a coalition of Tribal Organizations and national Native organizations in sending a letter to the U.S. Department of Health and Human Services (HHS) Secretary, Robert F. Kennedy, Jr., to congratulate Secretary Kennedy on his confirmation and request to meet to discuss implementing President Trump’s priorities in a manner that recognizes the sovereign governmental status of Tribal Nations and the United States’ longstanding trust and treaty obligations. The letter also requests that HHS ensure funding to Tribal Nations, Tribal citizens, and Tribal communities is neither paused nor reduced. Additionally, it urges HHS to exempt the Indian Health Service (IHS) and all employees in Tribal offices—or those responsible for delivering services or funding to Tribal Nations, their citizens, or communities—from any workforce reductions.

Read the letter here.

About the Tribal Coalition

NCUIH has joined a coalition with over 20 Tribal organizations to ensure administrative actions account for the government-to-government relationship between Tribes and the United States and the trust and treaty responsibility to Tribal nations and citizens.

The coalition has been active in creating joint messages to share with policy makers, sending letters to key administration officials, and developing advocacy strategies. Access the Tribal Coalition’s online resource hub, where you can find our letters and other advocacy tools.

NCUIH Joins Indian Country Coalition in Urging Office of Personnel Management to Protect Federal Employees Serving Indian Country from Workforce Reductions

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On February 14, 2025, the National Council of Urban Indian Health (NCUIH) joined a coalition of Tribes, Tribal Organizations and other national Native organizations in sending a letter to the Office of Personnel Management (OPM) Acting Director, Charles Ezell, requesting OPM take action to protect Federal employees who serve Indian Country from the planned reductions in force (RIF) as outlined in Executive Order 14210.

Specifically, the Letter asks Acting Director Ezell to exempt from any workforce reductions all employees of the Indian Health Service (IHS), Bureau of Indian Affairs (BIA), Bureau of Indian Education (BIE), and all Tribal offices throughout all Federal agencies, as well as other Federal employees whose role is to deliver services or funding to Tribal Nations or their citizens or communities. The Letter states that exercising RIF exemption authority with respect to these employees is necessary to fulfill the trust and treaty obligations owed to American Indian and Alaska Native people by the United States and to protect the unique political relationship with Tribal Nations and their citizens and communities. Exercising this authority also aligns with past and present federal practices and is necessary to avoid creating unintended life-or-death.

Following this advocacy, a February 17 report confirmed that U.S. Department of Health and Human Services (HHS) Secretary Kennedy rescinded the layoffs of 950 IHS employees. For NCUIH’s blog on the rescinded layoffs, click here.

About the Tribal Coalition

NCUIH has joined a coalition with over 20 Tribal organizations to ensure administrative actions account for the government-to-government relationship between Tribes and the United States and the trust and treaty responsibility to Tribal nations and citizens.

The coalition has been active in creating joint messages to share with policy makers, sending letters to key administration officials, and developing advocacy strategies. Access the Tribal Coalition’s online resource hub, where you can find our letters and other advocacy tools.

NCUIH Joins Indian Country Coalition in Urging Office of Management and Budget Director to Uphold Tribal Sovereignty and Protect Funding for Native Programs

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On February 14, 2025, the National Council of Urban Indian Health (NCUIH) joined a coalition of Tribal Organizations and national Native organizations in sending a letter to the Office of Management and Budget (OMB) Director, Russell Vought, to congratulate Director Vought on his confirmation and request to meet to discuss implementing President Trump’s priorities in a manner that recognizes the sovereign governmental status of Tribal Nations and the United States’ longstanding trust and treaty obligations. The letter also urges OMB to issue a mandate to all federal agencies to ensure that Tribal Nations and Tribal-serving entities are not further impacted by implementation of the President’s Executive Orders and policies, and exempt all Tribal programs across federal agencies from efforts to pause or reduce federal funding.

About the Tribal Coalition

NCUIH has joined a coalition with over 20 Tribal organizations to ensure administrative actions account for the government-to-government relationship between Tribes and the United States and the trust and treaty responsibility to Tribal nations and citizens.

The coalition has been active in creating joint messages to share with policy makers, sending letters to key administration officials, and developing advocacy strategies. Access the Tribal Coalition’s online resource hub, where you can find our letters and other advocacy tools.

NCUIH Joins NIHB in Letter to Congressional Leadership Advocating for Protecting the Indian Health System from Funding Freezes

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On January 31, 2025, the National Council of Urban Indian Health (NCUIH) joined the National Indian Health Board (NIHB) in sending a letter to House and Senate leadership to communicate concerns about the impacts of the Office of Management and Budget’s (OMB) now-rescinded memorandum that implemented a temporary pause in federal funding. In the Letter, NCUIH and NIHB urged Congress to communicate and work with Administration officials on guidance about the unique relationship Tribes have with the United States and include a broad Tribal exemption from any future funding restrictions or pauses.

While the recent OMB memorandum has been rescinded, we will continue to monitor this situation and any potential impacts on Indian Health Service funding.

Read the full letter here.

Background on the OMB Memorandum

In a memorandum dated January 27, 2025, the OMB Acting Director, Matthew Vaeth, instructed the heads of executive departments and agencies to temporary pause agency grant, loan, and other financial assistance programs. The now-rescinded memorandum would have temporarily paused “all activities related to obligation or disbursement of all Federal financial assistance, and other relevant agency activities that may be implicated” by recent executive order (EOs). These EOs concern topics such as financial assistance for foreign aid, nongovernmental organizations, diversity, equity and inclusion (DEI) programs, “woke gender ideology,” and the green new deal. OMB later rescinded the memorandum in a memorandum dated January 29, 2025.

NCUIH will continue to monitor any developments.