Included in the White House’s $1 billion budget increase request for the Indian Health Service (IHS) — released Friday with the president’s 2027 budget proposal — are cuts to some of the agency’s critical programs as it struggles from years of underfunding.
Overall, the budget proposal requests $9.094 billion for the Indian Health Service, a $1.1 billion increase over the fiscal year 2026 funding levels enacted by Congress. Even with the increase, the budget still falls about $64 billion short of what is needed to fully fund the agency, according to the National Tribal Budget Formulation Workgroup.
Under the budget request, Facilities could see cuts up to $67 million, despite tribal leaders expressing a desperate need for funds to repair crumbling health care buildings.
At last month’s appropriations hearing, Pueblo of Acoma Gov. Charles Riley said his tribe was essentially forced to take over the operations of its IHS facility in October 2025. The building was in a state of deterioration and lacked hot water; the tribe spent its own funds to make the repairs.
The IHS is in dire need of new and updated facilities, with the average age of IHS buildings at nearly 40 years old, 10 times the average age of hospitals in the United States. The agency made headlines recently as it prepared to break ground on a long-awaited project in Albuquerque, as it began digging through a 30-year backlog of repairs and construction.
Other line items seeing cuts include Urban Health, which funds 30 Urban Indian Organizations that provide health services to Native people living in cities. Recruiting and training for providers would also see cuts as the agency contends with a 30% vacancy rate.
Among the slashed budget items would be a 75% decrease in funding for the Special Diabetes Program for Indians. The program was launched in 1997 to target catastrophic levels of diabetes in Indian Country. Since then, it has pumped $3 billion into diabetes treatment and prevention in tribal communities. While the program has been tied to significant decreases in diabetes in American Indians and Alaska Natives, Native people continue to have the highest rates of diabetes of any demographic in the U.S.
Increases
A top-line item for the increased funding includes $5.6 billion for advance appropriations for 2028 and increases of $372 billion. Advocates have long pushed for advance appropriations for the agency, which were first included in the 2023 omnibus spending package. The appropriations proved essential during last year’s 43-day government shutdown, allowing it to operate without impacts to its key services.
Rolled into the budget request is $287.07 million to modernize the agency’s electronic health records (EHR) system. Last month, at a House Appropriations Committee hearing, National Indian Health Board CEO A.C. Lockclear (Lumbee) pointed to the Workgroup estimate that it would take nearly $7 billion to fully update the EHR system.
“This is more than just technology,” Lockclear said at the hearing. “It’s about protecting sensitive data in an increasingly vulnerable system and building infrastructure that is secure, interoperable, and grounded in tribal data sovereignty.”
Another line item seeing an increase is Hospitals and Health Clinics at $2.84 billion, up $202.6 million from fiscal year 2026 enacted levels. It includes funding for five new facilities in Alaska, Arizona, Nebraska and Washington. The amount is still short of the $18 billion needed, as estimated by the Workgroup.
