As of October 16, 2024, tribal elders enrolled in Medicaid in four states—Arizona, California, New Mexico, and Oregon—can access traditional health services through tribal health facilities and Urban Indian Organization facilities through a demonstration waiver.
Traditional health practices and medicine are a critical aspect of many tribal cultures and often center around connection to community and the land. They are a holistic approach to medical care that addresses physical, mental, and spiritual well-being, and can include access to medicine men with specialized skills; indigenous foods and natural remedies; practices such as sweat lodges, dancing, and music therapy; or ceremonies and other sacred practices.
Access to traditional health practices and practitioners can bridge the health gaps linked to culturally unresponsive healthcare and has been proven to lead to positive health outcomes, particularly for addiction treatment. Due to a long history of oppression, including forced land dispossession and the U.S. federal government’s failure to honor treaty obligations to provide health care into the late 1800s, American Indian and Alaska Native (AIAN) elders face significant health inequities, including high rates of chronic illnesses and lower than average life expectancy.
In addition to addressing these inequities, the expansion of Medicaid coverage for traditional health services may be a positive development for tribal elders who had personal, and often violent, experiences with Indian boarding schools in childhood, and can also serve as a form of cultural preservation.
While Indian Health Services facilities have historically provided traditional medicine and healing practices, these services are often inadequate due to limited funding and bureaucratic barriers. CMS’s decision is a historic step, but still exposes gaps in other programs that tribal elders rely on for health care, like Medicare. Traditional Medicare does not generally cover what it considers to be “alternative medicine” and Medicare Advantage Plans limit coverage to the providers and facilities that are part of the Plan.
Investing in the health of AIAN communities in Arizona, California, Oregon, and New Mexico through these Medicaid Section 1115 demonstration waivers is already paving the way for broader coverage of traditional health services, practitioners, and medicine for tribal communities all over the United States. For example, Utah has recently submitted a request to amend their Section 1115 waiver to include traditional health care for AIANs. As CMS implements these Section 1115 demonstration waivers, it should continue to engage with tribal communities to better understand the unmet needs of tribal elders and further expand coverage for traditional healthcare.
For more information on how federal programs can support the overall health and economic security of tribal elders, read our issue brief, Supporting Tribal Elders through the Older Americans Act.
