HHS officials back tribal data and funding reforms as tribes push wider self-governance

Federal health officials and tribal leaders on a Strengthening Tribal Health Sovereignty panel urged new steps to give tribal nations more control over health programs, data and funding mechanisms while pressing for statutory and budget changes they say are necessary to sustain services.

At the panel, Clayton Fulton, chief of staff at the Indian Health Service, said roughly "65 percent of our budget go directly into tribal hands" and described self-governance tools such as ISDEAA contracts, contract support costs (CSC) and Section 105(l) leases as central to tribes' capacity to deliver care. "That close connection, that political accountability ... is our goal," Fulton said, arguing the agency should focus on processing payments quickly and providing technical assistance to tribes.

Kim Kovol, Principal Deputy Director for the Administration for Children and Families, said ACF is advancing a modernization effort "guided by tribal input" and highlighted Public Law 477 (PL 477) as a mechanism that lets tribes "design, integrate, and manage services in ways that reflect tribal priorities." She invited tribal leaders to engage with ACF advisory channels and regional technical advisory committees.

Dr. Jay Bhattacharya, speaking for NIH and CDC functions at the panel, described recent NIH listening sessions that informed a forthcoming NIH tribal data sovereignty policy and said the agency has issued guidance on Indigenous biospecimen disposition and an AI/AN intramural IRB approach. "The biospecimens that we analyze belong to you, and we want to make sure that we respect that in every single aspect of our research work," he said. Bhattacharya also said CDC is exploring ways for tribes to access certain public-health infrastructure funds more directly rather than routing them only through states.

Tribal leaders used the session to press on three intertwined themes: expand programs eligible for PL 477; preserve and protect funding flows that support self-governance (including CSC and 105(l) leases); and reduce administrative barriers that hinder tribes from executing projects. Loni Greninger (Jamestown) and others urged ACF to clarify why some tribal PL 477 Head Start plans were approved while others were not and to ensure consistency in approvals and funding.

Speakers from Alaska and other regions described urgent infrastructure problems that have immediate health consequences, including frozen septic systems and threatened water lines caused by extreme weather and permafrost melt. "We're having a lot of community septic systems completely frozen," Victor Joseph said, stressing the need for sustained operation-and-maintenance funding rather than one-time surge funds.

Several tribal participants urged that research funding be made available to tribes and tribal colleges first so communities can build their own research capacity rather than relying on external institutions. Tyler LaPlaunt advocated for replicating the NIH Tribal Health Research Office (THRO) model across HHS divisions.

Panelists agreed on the need for better interagency coordination. Ron Allen and Clayton Fulton flagged limitations created by statutory divisions between housing and sanitation funding and discussed pursuing an A-19 process for legislative changes to reduce artificial barriers between HUD-funded housing construction and IHS sanitation programs.

The panel closed with officials saying they will continue consultations and technical engagement. Kovol invited tribal leaders to participate on ACF advisory committees; Bhattacharya said NIH and CDC efforts are moving toward formal tribal consultation; and IHS officials said they plan to push implementation and budget actions where possible while also noting many changes require congressional or OMB action.

The session ended with a call from tribal leaders to translate the discussion into sustained budget and statutory action rather than intermittent programs.