The 2025 California Legislative Session adjourned on September 13, and the Governor’s October 13 deadline to sign or veto bills has passed, finalizing the state’s legislative actions for the year. Several key health and public safety bills were signed, while many others moved to the inactive file, becoming two-year bills for 2026. Federally, the government shutdown that began on October 1 remains unresolved, with Congress still in recess, delaying appropriations and impacting grant processing and operational stability for UIOs. A special election in early November adds further uncertainty as state and federal budget debates evolve.

August brought critical developments for Urban Indian Organizations (UIOs) at both the federal and state levels. Federally, we are deeply concerned with HHS’ reinterpretation of PRWORA, which expands verification requirements across benefit programs and creates new administrative and access risks for UIOs. FY 2026 appropriations remain unsettled, with the House proposing a $15M increase for Urban Indian Health and the Senate holding flat, while implementation of H.R. 1 (“One Big Beautiful Bill”) will begin in January 2026, reshaping Medicaid through cost-sharing, asset tests, and work rules—though AI/AN exemptions remain in place. Risks also persist around SAMHSA funding and new federal grant restrictions tied to equity language. At the state level, several Medi-Cal State Plan Amendments were noticed in August with September comment deadlines, and key bills on telehealth, community health workers, perinatal care, and patient privacy are advancing, while AB 1113 (restricting FQHC spending) became a two-year bill. Over 650 measures faced suspense hearings at the end of August, and SEIU-UHW has filed a 2026 ballot initiative that would impose new financial mandates on community health centers, raising significant concerns for UIO operations.

CCUIH 2025–26 MAY REVISION BUDGET POLICY ANALYSIS
Impacts on Urban Indian Organizations and AI/AN Communities

BUDGET LANDSCAPE :
The May Revision to the Governor’s 2025–26 Budget reflects a projected $12 billion shortfall, with significant reliance on deferrals, program delays, and spending reductions. While General Fund spending in Health and Human Services increases on paper, this section begins the detailed analysis of each budget area. It provides the foundation of the document by addressing the most direct and significant implications for Urban Indian Organizations (UIOs), particularly in Medi-Cal and public health policy. While the total Health and Human Services budget increases on paper, this growth is driven by rising Medi-Cal caseloads and federally mandated costs. For Urban Indian Organizations (UIOs), the budget presents serious structural risks, including care disruptions, uncompensated care burdens, and defunding of culturally grounded care models. The May Revision offers few, if any, targeted protections for American Indian and Alaska Native (AI/AN) communities in urban areas.

All eyes are on May 14, when the Governor’s May Revision will be released—expected to outline a two-year spending plan with deep cuts across health and human services. CCUIH is monitoring closely for impacts to Urban Indian health, especially in behavioral health, workforce, and prevention. At the federal level, IHS announced it will maintain competitive behavioral health grant funding through FY27, continued its PATH EHR rollout, and included UIOs in revenue cycle planning. Meanwhile, the Trump administration’s upcoming budget proposal is expected to target Medicaid, IHS, and non-defense discretionary programs. In April, CCUIH testified on AB 1113, tracked 74 active state bills, and held nine congressional meetings during the NCUIH Annual Conference to defend UIO funding and share patient impact stories. The policy team also advanced coalition efforts with CPCA, CPEHN, DHCS, Cal Wellness, and others to shape state and federal policy for AI/AN health equity.

The March 2025 Legislative Report highlights CCUIH’s advocacy at both the federal and state levels to ensure Urban Indian Organizations (UIOs) are prioritized in key policy decisions. At the federal level, CCUIH participated in the California Area IHS Urban Confer, emphasizing IHS accountability, data transparency, and financial stability for UIOs. As federal budget cuts loom, CCUIH is ramping up advocacy to protect UIO funding following the recent stopgap extension. The report also addresses potential IHS lease terminations and the urgent need for continued support. On the state side, CCUIH is advancing legislation on healthcare expansion, telehealth, and workforce development, with several priority bills moving forward. Additionally, DHCS released the long-awaited BHIN on reimbursement for Traditional Healers and Natural Helpers under the 1115 waiver—an important milestone for culturally responsive care. CCUIH will host an informational session for UIOs on March 31 to support implementation.

The year has started with major challenges for Urban Indian health, from funding threats to policy changes that could impact care. CCUIH is actively engaged in advocacy, tracking key legislation, and preparing for critical discussions at the February 24 budget hearing. Now is the time for action—your voice and engagement are crucial to protecting Urban Indian health services.