On October 16, 2024, the Centers for Medicare & Medicaid Services (CMS) approved 1115 waivers in four states — Arizona, California, New Mexico, and Oregon — that, for the first time, allow state Medicaid agencies to cover American Indian and Alaska Native (AI/AN) traditional health care practices. These waiver approvals aim to support sovereign Tribal governments in providing health care services reflective of individual Tribes’ cultures and healing knowledge. In each of the four states and at the federal level, the waivers and the terms of the approvals were developed in partnership with Tribal leaders through formal Tribal consultation processes, public comment periods, and advisory groups.
Traditional health care practices, also known as traditional healing or traditional medicine, are a form of culturally centered care that has been shown to improve health and well-being, especially behavioral health and quality of life. This care can be offered as standalone services or alongside conventional Western (also known as allopathic) medical treatments to provide a multifaceted approach to health and well-being. Some traditional health care practices may be used across many cultures. For example, commonly offered traditional practices in Native American communities include talking circles, sweat lodges, and smudging. However, many other healing practices are unique to individual Native nations and locations. Because of the wide variability in traditional health care practices and the sometimes religious or spiritual meaning of these practices, the waiver approvals do not include a specific list of covered traditional healing services. Instead, the facilities providing these services can choose what to offer based on what will best meet the needs of the communities they serve.
All Medicaid benefits for AI/AN people received through IHS and Tribal facilities are paid for with a 100 percent federal match, in recognition of the federal trust responsibility to provide health care to Native people. This means states will receive a 100 percent federal match for traditional health care practices received by AI/AN people through IHS and Tribal facilities and UIOs that have care coordination agreements with IHS or Tribal facilities. States will receive their standard federal match for non‑AI/AN, IHS-eligible people who are receiving traditional health care practices.
The groundbreaking approval of these waivers has the potential to improve outcomes and decrease health disparities for Native people served by Medicaid, by improving access to culturally centered health care practices that have been used over many generations. Tribal and state leaders in Arizona, California, New Mexico, and Oregon are gearing up for implementation. Across the country, these approvals create a blueprint for other states to work in partnership with Tribal leaders to design and submit their own waivers.
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