June, 1, 2026
For many Americans, conversations about Native health remain narrowly framed around reservation-based care or the Indian Health Service. But the reality is far broader—and far more connected to the future of public health in cities and communities across the country.
Today, nearly 70% of American Indian and Alaska Native people live in urban areas. Across those communities, Urban Indian Organizations (UIOs) provide healthcare, behavioral health services, care coordination, maternal health support, and culturally grounded community care to Native patients representing more than 500 Tribes.
The National Council of Urban Indian Health (NCUIH) works nationally to support and advocate for these organizations at a moment when many are navigating growing threats tied to Medicaid cuts, federal funding instability, and agency restructuring.
“The biggest shift has been the scale of federal uncertainty,” said Francys Crevier, JD (Algonquin), CEO of NCUIH. “Threats to Medicaid, federal funding, agency restructuring, and appropriations have moved from background concerns to more immediate risks for Urban Indian Organizations.”
For Crevier, these are not abstract policy debates. When Urban Indian Organizations lose resources, Native communities lose access to care.
Why Sovereignty Matters for Health
One of the clearest themes throughout the conversation was the connection between sovereignty and health outcomes.
“Health policy for American Indian and Alaska Native communities is shaped by the degree to which the federal government honors Tribal sovereignty and the trust responsibility owed to AI/AN people,” Crevier explained.
That relationship affects everything from funding levels to whether care systems are culturally responsive and community-rooted.
“When federal policy honors Tribal sovereignty and the trust responsibility, Tribes and UIOs are properly resourced and better positioned to deliver culturally grounded care to their communities.”
When those obligations are ignored, the consequences become visible quickly: fragmented systems, insufficient services, staffing strain, and reduced access to care.
Crevier emphasized that sovereignty is not separate from health policy—it shapes the conditions under which health systems succeed or fail.
The Stakes of Medicaid Cuts
Urban Indian Organizations are especially vulnerable to Medicaid disruptions because of how they are funded.
“People often assume UIOs are funded like other parts of the Indian health system or like mainstream clinics,” Crevier said. “But UIOs operate with limited IHS funding, depend heavily on third-party reimbursement, and are not automatically resourced to meet the full needs of urban Native communities.”
Close to 60% of UIO patients rely on Medicaid.
That means cuts or restructuring would immediately impact primary care, behavioral health, maternal health services, and care coordination.
The funding gap is already stark. In 2021, U.S. health spending reached nearly $13,000 per person, while Congress appropriated only $891 per American Indian and Alaska Native patient treated through a UIO.
At the same time, Native communities continue facing disparities that are often undercounted because of data invisibility and racial misclassification.
“When Native people are misclassified or missing from data, disparities are underestimated and resources do not follow need,” Crevier said.
What Urban Indian Organizations Are Building
Despite those pressures, Crevier pointed to significant innovation happening across Urban Indian Organizations nationwide.
“UIOs are demonstrating that culturally grounded care leads to better engagement, trust, and health outcomes for Native patients,” she said.
Many organizations integrate primary care, behavioral health, traditional healing practices, maternal health services, and community-based supports under one model of care.
“These approaches strengthen patient trust, improve continuity of care, and show the broader health field that culturally responsive, community-rooted care is not supplemental—it is effective healthcare.”
That framing matters because Native health is too often discussed through a deficit lens.
“The narrative needs to move away from a deficit-based perspective,” Crevier said. “Native communities are diverse, urban Native people must be visible, and UIOs should be understood as Native-led, community-rooted infrastructure that advances sovereignty, culture, prevention, and health equity.”
Building Power Across Movements
Crevier also described growing opportunities for coalition-building across health justice and civil rights movements.
“The strongest alignment is around Medicaid defense, federal funding protection, inclusion in health data, behavioral health, maternal health, food and housing security, and culturally grounded care.”
This work includes partnerships with national Native organizations, health equity groups, and broader advocacy coalitions working to protect healthcare access and public health infrastructure.
For philanthropy, Crevier described this moment as both urgent and generative.
“UIOs need protection from harmful policy shifts, and they also need flexible investment to build infrastructure, data capacity, workforce, and sustainable culturally grounded models.”
That includes long-term support for advocacy, communications, reimbursement systems, technical assistance, and rapid response capacity.
Above all, Crevier emphasized the importance of relationships grounded in trust and respect for Native leadership.
“Meaningful partnership means resourcing Native-led priorities and supporting community-driven solutions,” she said. “It means supporting long-term capacity rather than one-off projects, respecting community expertise, and investing in relationships.”
“These are the foundations of work that will make a meaningful difference and have a lasting impact for generations to come.”
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