In 2024, Native healthcare achieved a milestone: Arizona, California, Oregon, and New Mexico became the first states approved to offer Medicaid and Children’s Health Insurance Program (CHIP) coverage for traditional healing practices for Native people.
Of the four states that have waivers for traditional healing, California’s will be the first to expire, on Dec. 31, 2026.
The coverage is possible through an 1115 waiver, which allows states to opt out of certain Medicaid requirements or to use Medicaid funds for practices and services not typically covered. Federal costs under the waivers cannot exceed what they would be for that state without the waiver. Waivers must be approved by the U.S. Secretary of Health and Human Services and are typically approved for an initial period of five years. The waivers allowing traditional healing coverage were approved by HHS Secretary Xavier Becerra, who served under the Biden administration.
According to KFF, waiver approval generally reflects the political priorities of the administration in power.
When waivers expire, renewal requires state and federal public notice-and-comment periods and evidence that the waiver has been effective and that the costs are budget-neutral.
In Arizona, Oregon, and New Mexico, traditional healing coverage is available for all IHS-eligible Medicaid beneficiaries. California’s coverage extends only to patients in treatment for substance use disorder.
‘Western medicine isn’t doing it.’
In 2015, Arizona became the first state to request an 1115 waiver to allow Medicaid funds to be used to cover Native American traditional healing. It would be another nine years before it was approved.
Native communities have long suffered from inadequate health care funding and access, driving extreme health disparities for Native people across the board. The federal trust and treaty obligation remains unmet, with a need estimated at around $80 billion and appropriations of roughly $8 billion.
AC Locklear (Lumbee), CEO of the National Indian Health Board, told Native News Online that the waivers could bring about a sea change in health care in Indian Country.
“Being able to pair Western medicine with some of the core cultural and traditional healing practices is really just going to be the way that we are going to be able to continue to care for our people — because Western medicine isn’t doing it,” Locklear said.
Countless studies show that cultural practices increase the efficacy of health care in Native communities, from maternal health to substance abuse treatment to end-of-life care.
The traditional healing waivers are designed for Tribes to determine which services constitute coverage and which are appropriate to formalize within a billing system.
“Tribes know who those healers are — the training, the qualifications, however they define them, exist in that community,” Locklear said. “There shouldn’t be a Western board exam, there shouldn’t be a single source within Indian Country that is the credentialer for traditional healing.”
In California, the waiver is housed within the Drug Medi-Cal Organized Delivery System (DMC-ODS), which manages the delivery and payment for substance use disorder treatment.
Counties act as a pass-through for reimbursement to providers, meaning Tribal clinics and Urban Indian Organizations must negotiate payment agreements with the county in which they operate.
Shawnte Grillo (Northern Sierra Miwok) is the health policy program coordinator at the California Consortium for Urban Indian Health, a nonprofit that provides technical assistance to the state’s Urban Indian Organizations.
Grillo said the CCUIH is hopeful about the renewal and would like to see adjustments to make for a smoother billing process and expanded access.
Grillo told Native News Online that the biggest challenge with the current system is reimbursement delays at the county level.
“It’s leaving our UIOs and Tribal facilities alike in this position where they’re waiting a long time in this arduous process before they can even start billing,” Grillo said. “A lot of them have been providing these services for years; they just never had to wait to bill Medi-Cal for it. So they’re providing these services, this process of agreements and contracting takes so long, and they’re still not getting paid.”
Roughly a third of counties in California don’t participate in the DMC-ODS system, meaning Tribal providers have no means of billing for traditional services, potentially limiting access for Native communities in those counties. Grillo said the CCUIH would like to see the waiver removed from the DMC-ODS system, so providers can bill Medi-Cal directly.
“We really want all our relatives across California to have access to these services, and we want all our Indian health care providers to be supported in this way,” Grillo said.
Providers also would like to see reimbursement expanded beyond substance abuse and behavioral health treatment.
“Traditional health care practices are effective in treating a wide array of health issues, anxiety, grief, depression, even just isolation,” Grillo said. “Having access to those practices is immensely important for the health, for the overall health.”
