The U.S. Senate confirmed Mark Cruz, a citizen of the Klamath Tribes, to a four-year term as director of the Indian Health Service (IHS) on Friday. The position of IHS director had been vacant since late 2025.
Cruz, who also serves as a senior adviser on tribal health to Health Secretary Robert F. Kennedy Jr., stated at his July confirmation hearing that he would advocate strongly to improve health outcomes for Native Americans and Alaska Natives. He previously oversaw the Office of Indian Energy and Economic Development under the U.S. Bureau of Indian Affairs during the Trump administration.
The IHS is responsible for providing healthcare to approximately 2.8 million Native American and Alaska Native patients, operating 21 hospitals and 78 smaller health centers nationwide. A 2023 U.S. Government Accountability Office report indicated that the average age of these facilities is around 40 years, with one-third in poor physical condition. The agency is currently grappling with high provider vacancy rates and a substantial backlog of facilities requiring replacement.
Cruz has pledged to address these issues, aiming to better protect tribal health programs from federal budget disruptions and to fund overhead costs incurred by tribes managing their own healthcare systems.
The National Congress of American Indians (NCAI) stated that Cruz's confirmation arrives at a critical time. NCAI executive director Larry Wright Jr. expressed congratulations and anticipation of working together to ensure the federal government upholds its trust and treaty obligations.
The National Indian Health Board also welcomed Cruz's appointment. According to the board's estimates, fully meeting the healthcare needs of tribal nations would require approximately $73 billion, while Congress appropriated just over $8 billion for the IHS in fiscal year 2026.
Cruz's confirmation was part of a larger vote that confirmed over 70 other nominees before the Senate's August recess. The vote concluded 51-47.