New Waiver Approvals Make Room for Traditional Health Care Practices in Tribal Communities

On October 16, 2024, the Centers for Medicare & Medicaid Services (CMS) announced the approval of 1115 demonstration waiver amendments for four states—Arizona, California, Oregon, and New Mexico—allowing Medicaid and the Children’s Health Insurance Program (CHIP) to cover traditional health care practices provided at Indian Health Service (IHS) facilities, Tribal facilities, and urban Indian organizations (I/T/Us).  

Traditional health care practices have been used for centuries in Native communities and are often viewed as fundamental to wellness and community health. These practices, ranging from herbal medicine to spiritual healing, provide care that can complement conventional western medical approaches. For Native communities, traditional health care practices are part of a holistic approach to health and are important to ensuring access to culturally appropriate health care and addressing health disparities. Historically, however, these services have not been covered by Medicaid and CHIP.  

Challenges Facing Native Communities 

The IHS is a federal agency within the federal Department of Health and Human Services that provides health care services to American Indians and Alaska Natives (AI/AN). The IHS operates health care facilities across the country and its delivery system includes facilities operated by tribes, tribal organizations, and urban Indian organizations. To receive services through the IHS system, AI/AN individuals must be members of a federally recognized tribe and live within the geographical service area of IHS-funded programs.  

 As of 2022, around 2.8 million AI/AN individuals have been served by an I/T/U, with more than one million covered by Medicaid and CHIP. The AI/AN population experiences significant health challenges compared to the general U.S. population, including higher rates of chronic illnesses  such as heart disease, cancer, chronic liver disease, and mental health conditions. AI/AN communities often face barriers to accessing care, including high rates of poverty, lack of transportation, and long travel distances to health care facilities. Many tribal members live in rural areas with limited access to functioning vehicles and telehealth is often not a viable option due to a lack of high-speed internet or private Wi-Fi in the areas. According to the CMS Tribal Technical Advisory Group, underfunding of the IHS leaves many I/T/U facilities to operate on small budgets with dated technology and limited staff with the “funding crisis” a contributing factor to poor health outcomes. CMS’ approval of 1115 demonstration waivers that enable integration of traditional health care practices and allow for payment of these services through Medicaid and CHIP can help address some of the challenges related to federal funding limitations of the IHS in participating demonstration states.  

The Importance of Traditional Health Care Practices 

In 2023, the National Council of Urban Indian Health completed an analysis of traditional health care practices and health outcomes. The analysis found that incorporating traditional health care practices had “large positive effects” on treatment outcomes for mental health and substance use. Services in the analysis included talking circles, sweat lodges, and traditional food interventions. These services can be provided outside of a health care facility and do not require a licensed practitioner, allowing for broader access to services for the AI/AN populations.  

If these demonstrations prove successful in improving access to culturally relevant care and positive health outcomes, it could encourage other states to seek similar approvals to better improve care for Tribal communities that rely on I/T/U facilities and lead to broader federal support. In the long term, this could also encourage more widespread integration of culturally tailored health care practices across the health care ecosystem.  

As we reflect on these important policy changes, it is crucial to continue advocating for culturally responsive health care approaches that honor traditional practices of AI/AN communities. Aurrera Health Group remains committed to supporting initiatives that improve health care access and outcomes for Native populations, recognizing the importance of cultural understanding in delivering comprehensive and equitable care. 

Catherine Gekas Steeby [Deputy Director]