Get AI Briefings, Transcripts & Alerts on Local & National Government Meetings — Forever.
Tribal leaders press HHS for clearer HR1 exemptions, direct funding and 340B protections
Loading...
Summary
At an HHS tribal consultation, tribal leaders urged immediate protections for Indian health programs as agencies outlined HR1 implementation, new behavioral health block grants, and research investments. Tribes pressed for direct funding instead of state pass-throughs and warned that a 340B rebate model could close tribal pharmacies.
Tribal leaders pressed senior HHS officials on Wednesday for clearer guidance and more direct funding as agencies outlined plans to implement HR1, expand behavioral health programs, and bolster research and data supports for Indian country.
At the consultation, Jessica Stephens, acting group director of CMS’s Medicaid and CHIP Services (CMCS), said CMS is preparing tribal-specific guidance to implement HR1’s eligibility, redetermination and cost-sharing provisions and is coordinating with tribal technical advisory groups to ensure tribal exceptions are applied correctly. "We are committed to providing tribal-specific guidance in the not-too-distant future," Stephens said, adding that CMS leadership is working to staff and support its Division of Tribal Affairs.
Tribal leaders, however, said administrative guidance is not enough. "Tribes need direct funding and clear, government-to-government consultation so states do not dilute or divert funds meant for our communities," said Corey Bunch, noting wide variation among states in how funds reach tribal providers.
Speakers from the Indian Health Service and HRSA highlighted parts of the FY27 budget aimed at tribal health, including increased IHS appropriations and an HRSA set-aside for the National Health Service Corps. HRSA Administrator Tom Ingalls encouraged tribes to use HRSA programs and flagged a maternal health hotline as a resource.
Many tribal representatives urged that federal rural‑health transformation and other funding streams include explicit mechanisms to ensure Indian health providers — including urban Indian organizations — get access. They also asked HHS to support tribal options to establish Indian-managed care entities that would allow tribes to administer Medicaid dollars directly rather than having states control pass-through distributions.
A major flashpoint was drug pricing and the 340B program. Several leaders asked HHS and HRSA to exempt tribal health programs from any rebate model that would require tribes to pay higher upfront drug prices or add administrative burdens. "A 340B rebate model may force tribal pharmacies to close," Chief Brian Harris said, urging statutory or regulatory protection to preserve access to discounted medications for tribal communities.
HRSA and CMS officials said they are reviewing thousands of public comments submitted during the 340B notice period and acknowledged legal and judicial limits on some regulatory approaches. They told the consultation participants they would continue to review comments and explore available authorities while noting ongoing litigation that constrains immediate action.
On behavioral health, SAMHSA officials described proposed funding that would consolidate some programs into a resources line intended to be more flexible. Tribal leaders asked that proven tribal programs such as Circles of Care and tribal behavioral health grants not be supplanted without consultation; SAMHSA said the agency intends consultation and that the new structures are designed to preserve tribal access while offering flexibility.
Research and data access were recurring themes. NIH, CDC, AHRQ and ARPA‑H described ongoing and new investments — including the Native American Research Center for Health (NARCH), tribal IRB supports, training programs, and ARPA‑H pilots — and pledged work on tribal data access, data modernization, and indigenous data sovereignty policies. Agency officials said they would continue listening sessions, pilot projects and efforts to expand tribal data capabilities.
Agency leaders and tribal representatives agreed on follow-up steps: agencies will review written submissions, continue targeted consultations, provide additional guidance on HR1 exceptions, and work with tribes on data and funding design. Several panelists agreed to return at lunch for further discussion and to share contact points and written responses.
The consultation produced no formal votes or policy changes at the meeting; participants left with commitments to continue negotiations and to provide more detailed guidance and options for statutory or regulatory protections where feasible.
