Cruz was confirmed to serve a four-year term as director of the Indian Health Service, a position that has sat vacant since late 2025. At his July confirmation hearing, Cruz said he would advocate “ferociously” to improve health outcomes in Indian Country and bring lived experience to the role. Cruz is a senior adviser on tribal health to Health Secretary Robert F. Kennedy Jr. and will retain that newly created role while leading the IHS. In Trump’s first administration, Cruz oversaw the Office of Indian Energy and Economic Development under the U.S. Bureau of Indian Affairs. The National Indian Health Board also applauded Cruz’s confirmation.