Today, President Trump sent the Fiscal Year (FY) 2027 President’s Budget Request to Congress. After careful review, NIHB has collected our initial reaction and perspective on the most important aspects of the proposal impacting Indian health.
Overall, the Administration is requesting $9.094 billion for the Indian Health Service (IHS), a $1.1 billion increase over the FY 2026 funding levels enacted by Congress. Additional detail can be found in the congressional justification.
The Administration’s priorities include many meaningful advancements on longstanding Tribal priorities. Specifically, support for Advance Appropriations, which the proposed budget would increase by $800 million. Additionally, the Request calls for substantial investment in Electronic Health Record (EHR) modernization and continued increases in funding for Health Care Facilities Construction, a major priority of the Administration, both of which are longstanding priorities for NIHB.
Additional highlights of the President’s Budget Request to Congress for IHS include:
- Would provide $5.6 billion in advance appropriations for FY28, an increase of $327 million, continuing to provide essential protections from government shutdowns.
- Would provide $287.07 million for EHR modernization, a $96.44 million increase.
- Would fully fund Contract Support Costs (CSC) and 105(l) lease agreements, as required by law, providing an estimated $1.96 billion in CSC and $929 million in 105(l) leases.
- Would provide $2.84 billion for Hospitals and Health Clinics, a $202.6 million increase over FY26 enacted levels. Also includes funding for five new facilities in Alaska, Arizona, Nebraska, and Washington, across multiple line items.
- Would cut Sanitation Facilities Construction by 87%, requesting $14 million to further these efforts.
- Would increase Purchased/Referred Care by $57.7 million, requesting $1.05 billion for PRC in FY27.
- Would provide $95 million for Urban Indian Health, a $418,000 decrease of funding.
- Includes $49 million for the Special Diabetes Program for Indians (SDPI) for FY 27, reflecting the $50 million Congress authorized for the remainder of Calendar Year 2026, following the end of FY 26, less the $1 million sequestration IHS previously announced. For FY 26, Congress authorized SDPI funding at $200 million.
Overall, the President proposes $111.1 billion in funding for all of Health and Human Services (HHS), a 12% decrease from enacted FY2026 levels. NIHB will release a full analysis of the President’s Budget Request to Congress for HHS funding in the coming days and continue to share our perspective as dialogue continues.
