A new federal program could influence healthcare delivery in rural communities nationwide, including tribal areas, and Native leaders are working to ensure tribal perspectives are part of the conversation.
In October 2025, tribal health representatives and policymakers met in Washington, D.C. to discuss the Rural Health Transformation Program, a provision included in the One Big Beautiful Bill Act passed earlier this year. The meeting was hosted by the National Indian Health Board (NIHB), which convened a Tribal Caucus to gather tribal feedback and outline priorities related to the program’s potential implementation.
The Rural Health Transformation Program is intended to support improvements in rural healthcare infrastructure, workforce capacity, and access to care. While the program is broadly focused on rural health systems and administered through state-led plans, tribal leaders view it as an opportunity to advocate for tribal inclusion within those state frameworks.
Why This Matters for Tribal Nations
Tribal communities continue to face significant health disparities, including higher rates of chronic disease, aging facilities, and persistent workforce shortages. Many tribes operate their own health systems under federal trust responsibilities, yet these systems remain chronically underfunded.
If states choose to include tribal health systems in their transformation plans, the program could potentially support efforts such as:
-
Expanding tribally operated clinics and hospitals
-
Upgrading medical equipment and facilities
-
Developing housing for rural healthcare workers
-
Strengthening emergency and specialty services in remote areas
-
Supporting culturally appropriate care, including traditional healing practices where allowed
Tribal Input and Ongoing Advocacy
At the NIHB-hosted caucus, tribal leaders emphasized that consultation alone does not guarantee inclusion. Participants stressed the need for clear mechanisms that allow tribes to participate meaningfully in state planning processes and to access funding without excessive administrative barriers.
Key priorities raised by tribal representatives included:
-
Simplified funding pathways for small and rural tribal governments
-
Recognition of traditional healing and Indigenous care models
-
Support for Native healthcare workforce development
-
Planning for sustainability beyond short-term funding cycles
The Centers for Medicare and Medicaid Services (CMS) is responsible for approving state transformation plans and has indicated that tribal consultation is expected as part of broader stakeholder engagement, though specific tribal funding pathways are not mandated in statute.
Looking Ahead
Tribal leaders note that rural and tribal health systems are often overlooked in federal health policy implementation. As states begin developing their Rural Health Transformation plans, tribes are preparing to engage with state agencies, advocate for inclusion, and develop internal strategies to participate where possible.
Additional roundtables and listening sessions are anticipated as implementation guidance continues to develop, and tribal nations are monitoring next steps closely to determine how this program may intersect with their health systems.
