The bill includes Senator Padilla’s Urban Indian Health Providers Facilities Improvement Act to pave the way for increased investment in the renovation and construction of urban Indian health facilities.
Increase federal investment in renovation and construction of urban Indian health facilities.
Occurrences
We thus request the Committee honor its trust obligation by appropriating the maximum amount possible for IHS and $106 million for Urban Indian Health, which is in line with the House proposed amount for FY26. 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.”
Strike from existing law the requirement that Urban Indian Organizations (UIOs) may only use the IHS funding they already receive for renovation, construction, or expansion of facilities to meet or maintain specific accreditation standards (that are now obsolete). It would just give UIOs more flexibility to use their existing funds for infrastructure upgrades, not give them more funding or take money from anyone else.
We write to thank you for your proven commitment to the Indian health system, including Urban Indian Organizations (UIOs), and to request you continue your support by funding urban Indian health at the highest level possible, up to the demonstrated need of $770,528,000, and retaining advanced appropriations for the Indian Health Service (IHS) in the Fiscal Year (FY) 2026 Interior, Environment, and Related Agencies Appropriations Act. These requests reflect the full need for urban Indian health determined by the Tribal Budget Formulation Workgroup, which is comprised of Tribal leaders representing all twelve IHS service areas. The Workgroup recommended this funding amount for urban Indian health as a part of a $63.04 billion topline recommendation for the Indian Health Service.
“Urban Indian Organizations (UIOs) are a lifeline to Native Americans living in urban areas across California,” said Senator Alex Padilla (D-CA). “Yet, UIOs are prohibited from using Indian Health Service funding for facilities, maintenance, equipment, and other necessary construction upgrades. During the pandemic, many UIOs couldn’t get approval for ventilation upgrades, heaters, generators, and weatherization equipment. Removing this unjust burden on UIOs is a commonsense fix and would allow them to improve the quality of the culturally competent care that they provide.” ... Senators Alex Padilla (D-CA), James Lankford (R-OK) along with co-sponsors Moran (R-KS), Feinstein (D-CA), and Smith (D-MN) on the Senate Indian Affairs Committee introduced the identical Senate bill ( S. 1797 ). ... This fix is broadly supported in Indian Country and the National Congress of American Indians passed a resolution in June to “Call for Congress to Amend Section 509 of the Indian Health Care Improvement Act (IHCIA) to Remove Facility Funding Barriers for Urban Indian Organizations”.
Evidence
The amendment would strike from existing law the requirement that Urban Indian Organizations (UIOs) may only use the IHS funding they already receive for renovation, construction, or expansion of facilities to meet or maintain specific accreditation standards (that are now obsolete).
On Monday, the Senate voted on amendments to the bipartisan infrastructure package including the Padilla-Moran-Lankford Urban Indian Health Amendment, which passed 90-7.
On March 11, 2026, the National Council of Urban Indian Health (NCUIH) submitted written testimony to the House Appropriations Committee on Interior, Environment, and Related Agencies regarding Fiscal Year (FY) 2027 funding for Urban Indian Health.
On May 21, 2025, 19 Senators joined Senator Tina Smith (D-MN) in her letter to Chair Lisa Murkowski (R-AK) and Ranking Member Jeff Merkley (D-OR) of the Senate Interior Appropriations Committee requesting funding for urban Indian health at the highest level possible—up to the Tribal Formulation Workgroup’s request of $770.5 million—and retaining advance appropriations for the Indian Health Service (IHS) in the final fiscal year (FY) 2026 Interior, Environment, and Related Agencies Appropriations Act.
To amend the Indian Health Care Improvement Act to expand the funding authority for renovating, constructing, and expanding certain facilities.
The amendment is described as one to amend the Indian Health Care Improvement Act to expand the funding authority for renovating, constructing, and expanding certain facilities, and the Senate agreed to it by a 90-7 vote.
In addition to amounts otherwise available, there is appropriated to the Director of the Indian Health Service for fiscal year 2022 ... $100,000,000 ... for ... the renovation, construction, expansion, equipping, and improvement of facilities owned or leased by an Urban Indian organization.
IIJA appropriated $100 million for renovation, construction, expansion, equipping, and improvement of facilities owned or leased by Urban Indian organizations.
IHS reported that American Indian Health and Family Services of Detroit held a June 4 groundbreaking for a new Southwest Detroit health facility already under construction.
The House Interior bill proposes Urban Indian Health at $105.992 million, a $10.57 million increase from the FY 2026 enacted amount; NCUIH notes the bill still needs House floor action and final negotiation with Senate leadership.
Section 71104 of Public Law 117-58 is titled expanding the funding authority for renovating, constructing, and expanding certain facilities and amends section 509 of the Indian Health Care Improvement Act by striking limits on minor renovations and accreditation-standard purposes.
The current U.S. Code states that the Secretary may make funds available to contractors or grant recipients under the urban Indian health subchapter for renovations to facilities or construction or expansion of facilities, including leased facilities; the notes identify the 2021 Public Law 117-58 amendment.
Congress.gov lists Senator Padilla as sponsor of S.Amdt.2133, says the amendment was agreed to in the Senate by a 90-7 vote, and states its purpose was to expand funding authority for renovating, constructing, and expanding certain facilities.
Congress.gov records H.R. 3684 as passed by the Senate with an amendment on August 10, 2021, agreed to by the House on November 5, 2021, and became Public Law No. 117-58 on November 15, 2021.
Congress.gov identifies Senator Alex Padilla as sponsor of S.1797 and CRS summarizes that the bill expands IHS authority to make funds available for urban Indian organizations to renovate, construct, or expand urban Indian health facilities.
Assessments
Padilla materially advanced the promised federal outcome during his Senate term: he sponsored S.1797 and S.Amdt.2133 to expand Urban Indian Health facility funding authority, and the Senate adopted the amendment. The Infrastructure Investment and Jobs Act became Public Law 117-58 on November 15, 2021, during the same term, and included both expanded statutory authority for renovation, construction, and expansion of urban Indian health facilities and a dedicated $100 million appropriation for renovation, construction, expansion, equipping, and improvement of facilities owned or leased by Urban Indian organizations. That directly satisfies the promise to increase federal investment in these facilities.
Padilla materially advanced the policy by introducing the Urban Indian Health Providers Facilities Improvement Act and a related Senate amendment, and Congress ultimately enacted a $100 million FY2022 appropriation in the IIJA for renovation, construction, expansion, equipping, and improvement of facilities owned or leased by Urban Indian organizations. That is a direct increase in federal investment, achieved while he was serving in the Senate.
The promised outcome was an increase in federal investment for renovation and construction of urban Indian health facilities. During Padilla's Senate term, the enacted Infrastructure Investment and Jobs Act included a dedicated $100 million appropriation for renovation, construction, expansion, equipping, and improvement of facilities owned or leased by Urban Indian organizations. Padilla also introduced and advanced related legislation/amendments on Urban Indian health facility funding authority, supporting candidate credit in the federal legislative context. Because the funding became law during the same Senate term, this counts as delivered with same_term timing.
Senator Padilla made legislative efforts to support urban Indian health facilities, notably through amendments passed in the Senate that increased flexibility for Urban Indian Organizations to use existing IHS funds for facility renovations and improvements. However, there is no direct evidence of a significant increase in overall federal investment specifically for renovation and construction; the enacted measures allowed for more flexible use of current funds, not a substantial increase. Requests and advocacy for greater funding were made, but there is no confirmation of new spending enacted at the promised scale.
Senator Padilla made legislative efforts resulting in amendments that expanded flexibility for Urban Indian Organizations (UIOs) to use existing IHS funds for facility improvements. However, there is no clear evidence of a significant net increase in federal investment for renovation and construction of urban Indian health facilities, which was the explicit promise. While advocacy for increased funding and participation in appropriations requests occurred, these efforts did not result in a clear new appropriation or direct increased investment. Thus, the outcome is partial with strong legislative effort shown.