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.
Assessments
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.