The Senate has confirmed Mark Cruz as permanent director of the Indian Health Service, filling a seat that had sat without a Senate-confirmed occupant since early 2025 at an agency responsible for the care of roughly 2.8 million American Indian and Alaska Native patients. Either way, an agency operating hospitals, health centers, and health stations across dozens of states went well over a year without confirmed leadership. Congress appropriated just over $8 billion for the agency for fiscal 2026, against a tribal health organization estimate that roughly $73 billion would be required to fully meet the health care needs of tribal nations. Mark Cruz, a citizen of the Klamath Tribes of Oregon, was confirmed on Aug. 7 to a four-year term as director of the Indian Health Service. About 2.8 million American Indian and Alaska Native patients through federal, tribal and urban Indian health programs.