Tribal budget workgroup asks Congress for $76 billion to fully fund Indian Health Service, urges mandatory status for CSC and 105(l) payments

A National Tribal Budget Formulation workgroup delivered a sweeping FY2028 request that would substantially increase Indian Health Service funding and change how some tribal-contract obligations are financed.

The workgroup presented a needs-based IHS estimate of roughly $76.1 billion for fiscal 2028 and urged that IHS and certain related obligations be treated as mandatory spending rather than discretionary appropriations. "We request full and mandatory funding to the Indian Health Service at $76 billion in FY 2028," the workgroup said during its presentation, arguing that current appropriations leave IHS chronically underfunded.

Workgroup leaders asked for multiple statutory and budgetary changes: advance appropriations for all IHS accounts to prevent year-to-year instability; reclassification of contract support costs (CSC) and Section 105(l) lease payments as mandatory over discretionary funding; exemption of IHS appropriations from sequestration and rescissions; and protected tribal provisions within Medicaid and Medicare. The workgroup said CSC and 105(l) payments now represent a large and growing share of IHS costs and that recent Supreme Court guidance (referred to in the session) supports full funding obligations.

The presentation included program-level recommendations: $56.19 billion for clinical services (including preventive care, dental and behavioral health), $7.6 billion for facilities (maintenance, sanitation facilities construction and health-care facilities construction), $10.7 billion recommended for contract support costs, $947 million for Section 105(l) leases and $559 million to fully fund the Special Diabetes Program for Indians (SDPI). The workgroup also highlighted persistent workforce shortages (IHS data cited vacancy rates of 32 to 37 percent for clinicians) and gaps in third-party revenue collection.

HHS officials acknowledged the scope of the requests but described limits of the federal budget and appropriations process. Mark Cruz, a senior advisor in HHS, said the department has channels (A-19 proposals, OMB engagement and congressional outreach) to pursue legislative or technical changes but noted that translating tribal priorities into Hill action requires sustained advocacy and clearer messaging to congressional offices.

Panel members discussed operational fixes as well as legislative ones. Clayton Fulton (IHS) said the agency is preparing IIJA sanitation funding announcements and emphasized execution and timely delivery of funds. Tribal leaders repeatedly urged that the federal government's trust responsibility requires predictable, mandatory funding so health systems in Indian Country are not vulnerable to shifting discretionary decisions.

The workgroup asked OMB and HHS leadership to engage substantively in tribal budget formulation and to bring the workgroup's priorities into interagency budget discussions. The presentation closed with calls to continue coordination across agencies, involve tribal technical advisors, and bring youth and future leaders into the budget process.