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House appropriations subcommittee hears IHS FY2026 request; members press to preserve advanced appropriations
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Summary
The House appropriations subcommittee examined the Indian Health Service's FY2026 budget request, focusing on advanced appropriations, contract support costs, a proposed cut to sanitation facility construction, EHR modernization, staffing shortages and programmatic priorities such as diabetes prevention and produce prescription pilots.
The House appropriations subcommittee reviewed the Indian Health Service's fiscal year 2026 budget request Tuesday, with lawmakers pressing agency leaders to preserve advanced appropriations and pointing to persistent gaps in staffing, sanitation infrastructure and behavioral-health programs.
Acting Director Benjamin Smith said the administration's FY2026 request totals $8.1 billion, including $7.9 billion in discretionary funding and $159 million in proposed mandatory funding for the Special Diabetes Program for Indians. "The budget advances our Indian Health Service mission, which is to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level," Smith said.
Members of both parties pressed IHS officials on several high-priority items. Full Committee Chairman Tom Cole (R-Okla.) told the acting director, "you can just take that to the bank," saying the committee will "be retaining advanced appropriations" after Congress first enacted them for IHS in FY2023. Ranking Member Chellie Pingree (D-Maine) said she "strongly oppose[s] the reductions proposed in the Indian Health Service budget," and singled out an "87% reduction to sanitation facilities construction" in the administration's request, noting a remaining backlog of roughly $4.7 billion and about 1,300 sanitation projects identified.
The budget document and witnesses also addressed contract support costs and Section 105(l) leases. Smith said the request increases contract support cost funding by $657 million to a total of $1.7 billion and adds $264 million to the estimated score for Section 105(l) leases, bringing that estimate to $413 million. The agency tied those increases to the U.S. Supreme Court decision in Becerra v. San Carlos Apache Tribe.
Electronic health record modernization drew sustained attention. Smith said the request includes $191 million for a replacement EHR system and that IHS remains on target for a June 2026 pilot rollout at the Lawton service unit in Oklahoma and two remote clinics in the IHS Oklahoma City area. "We are on target for this pilot," Smith testified, describing the site as an opportunity "to stretch tests, try to break the system" before wider deployment. He estimated roughly 50 current vacancies tied to the EHR effort and said the agency would provide exact counts in follow-up.
Recruitment and retention of clinical staff was a recurring theme. Several members noted a long-standing about 30% vacancy rate across IHS positions; Smith confirmed a sustained vacancy rate near that figure and listed steps the agency is taking, including expedited hiring, expanded scholarship and loan-repayment efforts and proposals for graduate medical education. "Those providers that have an experience in rural settings tend to stay in rural settings," Smith said in response to lawmakers asking whether training and education could boost long-term staffing in remote areas.
Lawmakers also sought updates about program delivery and timeliness. Smith reported that pending purchased/referred care (PRC) claims with vendors have fallen to about 21% and that average processing times for clean PRC claims have improved. On nutrition and prevention initiatives, Smith said IHS awarded $2.5 million in FY2025 for a produce-prescription pilot to five tribal communities and emphasized the cultural importance of indigenous foods in health and food-sovereignty efforts.
Members raised additional operational concerns in the hearing, including opioid and substance-use responses, availability of sexual-assault evidence kits, and the implications of large judicial obligations for the IHS budget. Representative Betty McCollum warned that court-mandated payments and Indian water-rights settlements have eroded the discretionary funds available for direct services and called for reconsideration of how certain judgments are funded. Smith said the agency is evaluating advanced-appropriations effects and will report back once that assessment is complete.
No formal appropriation action occurred during the hearing; lawmakers said they would pursue funding decisions through the appropriations process. Several members requested additional data and written follow-ups on staffing counts, EHR vacancy details, the schedule for retiring the RPMS/Vista system, and the sanitation-construction project list.
Lawmakers closed the hearing emphasizing bipartisan support for Indian country health priorities and pledging continued oversight as appropriation work proceeds.
