On Monday, June 1, 2026, the Centers for Medicare & Medicaid Services (CMS) released draft implementation guidance to assist states in carrying out a series of changes to state-operated Medicaid programs enacted under H.R. 1.
When Congress passed H.R. 1, it exempted American Indian and Alaska Native (AI/AN) people and individuals eligible for services at an IHS facility, Tribally-operated facility, or Urban Indian Organization (I/T/U) from the proposed changes. Congress did so in recognition of its federal trust and treaty responsibilities and obligations and in recognition of Medicaid’s vital role in fulfilling those obligations.
NIHB has produced an initial analysis of the rule and how it specifically impacts American Indian and Alaska Native people, which you can read here.
NIHB will continue to analyze the forthcoming H.R. 1 implementation and advocate on behalf of all 575+ Tribal communities to ensure that federal trust and treaty obligations are upheld and that Medicaid remains a strong and reliable resource for Indian Country.
Medicaid is a cornerstone program through which the federal government meets its responsibility to provide health care to Tribal communities, and protecting access to coverage remains essential.
CMS is welcoming public comments on the Interim Final Rule and Comment Period (IFC) until July 31, 2026. Comments can be submitted electronically using the Regulations.gov submission portal. Comments are also accepted via regular, express, or overnight mail, and addresses are listed on the Regulations.gov website.
If you have questions or would like additional information, please contact NIHB’s Federal Relations Team at [email protected].
