07/17/2025
President's FY 2026 Budget Proposal: Key Impacts on Tribal Health
The Trump Administration’s Fiscal Year 2026 (FY26) budget proposal outlines sweeping changes to the Department of Health and Human Services (HHS), including the creation of new agencies, elimination of critical Tribal health programs, and the restructuring of others. The National Indian Health Board (NIHB) has reviewed the proposed changes and offers the following summary of the key impacts on Tribal Nations and communities.
Creation of the Administration for a Healthy America (AHA)
The budget proposes forming a new agency, the Administration for a Healthy America (AHA), which consolidates key health programs from HRSA, SAMHSA, and other HHS offices. Many Tribal programs, including mental and behavioral health, maternal health, HIV prevention, and the Office of Minority Health, would move under AHA.
AHA would be funded at $20.6 billion, with $80 million proposed for a long-unfunded Behavioral Health and Substance Use Disorder for Native Americans program.
Despite this, the budget cuts over $128 million from existing Tribal mental health programs, including Tribal Opioid Response Grants and Zero Su***de funding.
A new Prevention Innovation Program includes a $19 million Tribal set-aside to address maternal and chronic health disparities.
Significant Program Eliminations
The proposal eliminates at least $102 million in Tribal-serving programs, including:
Good Health and Wellness in Indian Country (GHIWIC)
Racial and Ethnic Approaches to Community Health (REACH)
Center for Indigenous Innovation and Health Equity
Minority HIV/AIDS Fund
These eliminations will reduce critical public health, prevention, and innovation services across Indian Country.
Other HHS Agency Changes
Centers for Medicare and Medicaid Services (CMS)
Continues $3 million for Tribal outreach and education to improve access to Medicaid, Medicare, and CHIP.
Maintains $12.2 million for the 340B Drug Pricing Program.
Centers for Disease Control and Prevention (CDC)
Merges CDC with ASPR, resulting in cuts to key Tribal public health programs.
Maintains funding for public health workforce and disease surveillance programs.
National Institutes of Health (NIH)
Proposes cuts across NIH institutes and eliminates five programs.
While the Tribal Health Research Office remains intact, it may be affected by a $952 million cut to the NIH Office of the Director.
Administration for Children, Families, and Communities (ACFC)
Proposes cuts to Tribal-specific programs such as LIHEAP and the Community Services Block Grant.
Maintains or slightly adjusts other programs like Head Start, Family Violence Prevention, and Native American Caregivers Support.
General Departmental Management (GDM)
Relocates the Tribal Affairs Office under a new Assistant Secretary for External Affairs.
Proposes creating a new Office of Strategy for HHS Data Innovation, aimed at enhancing Tribal health data sovereignty and Native-specific research.
Why it Matters
While the FY26 budget includes new initiatives and reorganizations aimed at streamlining health services, it also proposes alarming cuts to foundational Tribal health programs. These changes could undermine federal obligations to Tribal Nations and risk worsening health disparities in Indian Country. NIHB urges Congress and the Administration to uphold the trust and treaty responsibilities by restoring and protecting funding for Tribal public health and healthcare programs.
Stay updated at https://www.nihb.org/nihb-fiscal-year-2026-presidents-proposed-budget-analysis-of-hhs-programs/ for continued analysis and advocacy updates on the FY26 budget.
