Tribal leaders press HHS for far larger IHS funding, warn EHR modernization can’t eclipse sanitation and contract obligations

Tribal leaders and HHS officials met in Washington for a Tribal Budget Consultation dominated by calls for far larger Indian Health Service funding and clearer safeguards for tribal program dollars.

Assistant Secretary for Financial Resources Gus Chiarello outlined HHS budget figures and proposals, including a department-wide FY2027 discretionary request and a $9.1 billion IHS operating request. Chiarello said the administration is prioritizing IHS investments and planned reforms and that his office will press for “radical transparency” about how funds are spent.

But tribal leaders said the proposed increases fall well short of need. Ron Allen, chair of the Jamestown S'Klallam Tribe, told the meeting that tribes’ own budget work group recommends roughly $76 billion to fully fund Indian Health Service functions. “The true need today is not $8 or $9 billion. It’s like $75, 76, 77 billion,” Allen said, citing metrics tribes use to estimate full service costs.

Chief Harris and several other attendees warned that shifting funds into EHR modernization without protecting sanitation, staffing and purchase-referred care (PRC) would leave essential services underfunded. “When we look at the IHS budget alone… it wasn’t covering the base,” Chief Harris said, urging HHS to preserve sanitation and PRC dollars.

Chiarello acknowledged those trade-offs and said he would press staff to explain why certain decisions were made and to visit tribal sites. He described the FY2027 proposal’s targeted items for tribes — including indefinite discretionary appropriations for contract support costs, additional advanced appropriations, EHR modernization funding and resources aimed at facilities backlog — and said the administration will ask “why these trade‑offs are being made.”

Tribal leaders also pressed for programmatic protections: maintenance or expansion of advanced appropriations for IHS, full funding for contract support costs and Section 105 lease obligations, and permanent reauthorization and advance appropriations for the Special Diabetes Program for Indians (SDPI). Peter Lenkeek of the Crow Creek Sioux Tribe urged HHS to preserve the SDPI at no less than $200 million annually and to protect sanitation facility construction funding.

Several speakers recommended expanding tribal access to third‑party revenue streams — particularly Medicare and Medicaid (CMS) billing — without requiring additional state approvals or plan amendments. Delegations said barriers imposed at the state level limit tribes’ ability to generate revenue that offsets underfunding.

There were repeated calls for HHS to consult more meaningfully with tribes before reorganizing programs or moving authorities between agencies. “We’re not really initiated by tribal direction and were created without meaningful proactive tribal consultation,” one tribal leader said of aspects of the administration’s priority outline.

The consultation produced no formal decisions or votes. HHS officials pledged follow-up site visits, to continue distributing advanced appropriations promptly, and to maintain open lines with tribal leaders as the FY2028 budget formulation begins.

The session closed with commitments to follow up on tribal requests for clearer accounting of trade-offs and for protections of statutory obligations that affect tribal health operations.