How to maximize current resources to rebuild & plan for the months ahead 

The longest government shutdown in history ended in November with a continuing resolution (CR) that restores funding through the end of January. There’s a small sense of normalcy trickling in for federal employees and programs, but for Tribal leaders and Native-serving health systems, the situation is more complex.  

During the shutdown, Tribal leaders, clinics, and community programs had to shift into contingency planning as federal funding became uncertain. Resources were stretched thin, and difficult decisions were made at a local level. While funding has resumed, the effects of that disruption will take time to resolve. 

The CR restored funding for several critical agencies and programs that serve American Indians and Alaska Native communities: 

  • The Bureau of Indian Affairs (BIA) and Bureau of Indian Education (BIE) have resumed normal operations—the Indian Health Service (IHS) is forward-funded, so the impact of the shutdown was minimal 
  • Crucial assistance programs like SNAP are operating again 
  • The Department of Health and Human Services is restoring more than 1,100 positions 
  • Key programs like the Special Diabetes Program for Indians (SDPI), telehealth flexibilities, Community Health Centers, and National Health Service Corps programs remain temporarily available 
  • Agencies like the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Centers for Disease Control and Prevention (CDC) continue to offer grants that support opioid response, behavioral health, and public health infrastructure 

But this stability is temporary. The current resolution only guarantees government funding at last year’s levels through the end of January.  

Another major concern is that the CR did not extend the Enhanced Premium Tax Credits (EPTC), which are set to expire on December 31, 2025. When these credits expire at the end of this month, health insurance premiums for subsidized Marketplace plans are projected to more than double in 2026. This jeopardizes coverage for about 318,000 American Indian and Alaska Native people, and the National Indian Health Board (NIHB) estimates 126,000 AI/AN individuals may lose coverage altogether. 

Private insurance plans provide crucial third-party revenue to IHS, Tribal, and Urban Indian health facilities. A large drop in coverage places even more pressure on chronically underfunded Native-serving health systems and shifts cost onto communities and patients alike. 

Recovering After Federal Government Shutdowns

Advance appropriations successfully kept IHS medical clinics open during the shutdown. This was an important victory made possible by years of advocacy from Tribes and Native organizations. However, the disruptions to other programs created a cascade of other problems.  

Across Indian Country, local leadership stepped in where federal systems fell short. Assiniboine, Blackfeet, Sioux, and Crow Nations authorized harvesting of part of their carefully restored bison herds to feed their people. The Mi’kmaq Nation in Maine stocked food pantries with trout and moose. The Comanche Nation accepted deer meat for their food banks.  

These actions reflect resilience and self-determination, but they came at a real cost. Emergency responses deplete carefully rebuilt reserves, strain staff capacity, and delay long-term priorities. Rebuilding after a government shutdown takes time, especially for Native communities that already operate with little margin.

Discretionary Funding’s Impact on Indian Country

These challenges are not new. The federal government’s trust and treaty obligations to Tribal Nations are long-standing legal commitments, yet they are funded largely through discretionary spending, making them uniquely vulnerable to political gridlock.  

While IHS medical services now receive advance appropriations, more than $1.3 billion of the IHS budget does not. This includes funding for facilities, sanitation, and infrastructure. The Bureau of Indian Affairs and Bureau of Indian Education do not receive advance appropriations at all.  

These agencies and programs also operate with chronic underfunding, causing: 

  • Critical staff positions to remain unfilled 
  • Delays in building repairs and maintenance 
  • Limitations in specialty care access 
  • Wait times for care to increase 

Political discourse in D.C. often overlooks the impact a government shutdown has on real individuals and communities. Programs and incentives intended to support equity in Native communities are frequently underfunded, delayed, paused, or cut entirely. As a result, Tribes are left managing constant uncertainty. Time and resources that could strengthen care and support community health initiatives are instead diverted to keep basic services running during periods of instability. 

What Tribal Leaders Can Do to Strengthen Funding Plans

As communities recover from this disruption, Tribal leaders are balancing immediate needs with preparation for what may come next. The following list is immediate action items that make an impact now and support long-term planning. 

Finance & Operations

  • Prepare for the EPTC expiration 
    • Model 2026 coverage scenarios to prepare for the EPTC expiration 
    • Determine the third‑party revenue risk by payer and service line 
    • Prepare for a potential increase in uninsured patients 
    • Begin immediate outreach to educate patients about the expiration of the EPTC and how it impacts their healthcare coverage 
  • Create a 13‑week cash and claims dashboard including: 
    • Daily deposits 
    • A/R aging 
    • Top denial codes 
    • 105(l) receivables 
  • Identify 3–5 high‑margin services to prioritize and 2–3 low‑margin services to temporarily scale back 

Programs & People

  • Identify existing care gaps and stand up grant capture sprints to pursue interim grants and extended programs from SAMHSA, the CDC, IHS, and others to support at-risk or absent services 
  • Cross‑train billing and front‑desk staff on eligibility support and marketplace navigation to better serve community members in need 
  • Formalize mutual‑aid agreements with regional partners to ensure food security, healthcare transportation, and behavioral health support 

Policy & Advocacy

  • Prepare testimony and community impact briefs that quantify shutdown costs and operational delays 
  • Join coalition letters seeking mandatory funding and expanded advance appropriations 
  • Track congressional timelines and updates  

Advocating for Long-Term Change

These action items will make an impact now and during future funding challenges, but long-term stability for Native communities requires more significant changes. This includes continued calls for:

  • Moving Native-serving programs from discretionary to mandatory funding 
  • Expanding advance appropriations to cover all Tribal programs and agencies, including the Bureau of Indian Affairs (BIA) and the Bureau of Indian Education (BIE), not just IHS medical services 
  • Funding levels for agencies and programs that reflect the actual needs of Native communities 

National Native-centric organizations, including the National Congress of American Indians (NCAI), make it clear that the goal of these demands is “to fully honor trust and treaty obligations and shield essential services from political brinkmanship.”

At the community level, Tribes should explore models that keep funding, care delivery, and decision-making within their own systems. Approaches like these help reduce vulnerability to federal instability while supporting long-term self-determination. 

This work takes time, trust, and strong partnerships. It requires building systems that can withstand disruption without placing the burden back onto the community. 

Turning Resilience into Stability

The end of this government shutdown once again showed the strength and resilience of American Indians and Alaska Native communities—but resilience alone should not be the only plan. 

Protecting the health of future generations means creating stable, community-controlled systems that withstand temporary funding lapses at the federal level.  

If your Tribe is thinking about what comes next—whether that means strengthening your health program operations, building financially resilient models of care, or translating federal policy into practical next steps for your community—Indigenous Pact is here to walk that path with you.   

Together we can build a healthier, more stable future for your community.