After several years of pending requests, the Centers for Medicare & Medicaid Services (CMS) announced that it will begin developing the framework for reimbursing Traditional Health Care Practices (or traditional healing services) provided by a qualified IHS and Tribal health facility provider, which falls in line with the center’s recent health-equity focus. A request has also been made to include Urban Indian Organizations (UIOs) in the proposed framework because UIOs are critical to providing traditional healing services to urban American Indian and Alaska Native populations (AI/AN). This CMS announcement recognizes the value of Indigenous medical knowledge and opens access to these time-honored therapies for Indigenous people, including non-AI/AN covered by Medicare and Medicaid, seen at a qualifying IHS or Tribal Health Facility. However, the announcement has not been met without hesitancy for maintaining a certain level of confidentiality for some Tribal Nations’ healers and practices, but with further development and conversations with CMS, accommodations could be made.
For those influencing health care policy, it is critical to determine whether the current delivery system is well-positioned to support traditional healing services. Conversations with each Tribal Nation on their desires and capacity requirements are vital for the success of this program, but final approval will require working with the state to potentially pass legislation or submit a waiver to the federal government.
In April and May 2024, CMS provided a public comment period seeking input from Tribal Nations across the United States on developing the scope of coverage, recommendations on provider qualifications, and evaluation criteria. States with already developed models and pending requests for Medicaid reimbursement include Arizona, California, New Mexico, Oregon, and Utah. Montana could be next.
What Services Could Be Covered?
CMS is looking to reimburse costs for services and infrastructure needs submitted by IHS or Tribal health facilities.
Potential services to consider coverage for:
Improving the Modern Health Care System
With the consent of Tribal Nations and CMS reimbursement, traditional healing services can be more substantively integrated into the modern health care system. This recognition of traditional healing services from the federal government is momentous and a validation that time-honored cultural practices have a rightful place in the modern health care system.
Culturally competent health care is a professional responsibility and leads to positive health behaviors and outcomes by reducing cultural loss. Cultural loss is thought to be an underlying cause and/or contributing factor to those struggling with addiction, and immersion in Tribal cultural activities can help address the historical and intergenerational trauma.
In another movement towards Indigenous health care, the Center for Indigenous Health recently released materials to suggest the potential uses on how to spend the Tribal opioid settlement agreement funds. The uses for opioid funds could work in tandem with Medicaid reimbursements to provide a more holistic approach to providing traditional healing services to Tribal communities.
Preserving Cultural Wisdom
Many Indigenous communities are on paths of rebuilding cultural connections, which are unique to each Tribal Nation. Centuries of brutal treatment seeking to erase Tribes’ languages and cultures, including broken treaties, land theft, and government-funded boarding schools, paired with a lack of investment in the Indian Health Service, have led to lower life expectancy and higher rates of addiction, suicide, and chronic diseases.
Tribal citizens can provide cultural leadership and advice on the healing practices in their programs to improve health outcomes. In addition to improving health outcomes, this new CMS policy could help further preserve the cultural wisdom of Indigenous healers. For generations, Indigenous medical knowledge was suppressed or driven underground. Now, Indigenous practitioners could be federally compensated for their work and teachings to community members. Indigenous peoples’ trust in the federal government still has a long way to go, but recognizing the value and effectiveness of Indigenous healing knowledge is one way to affirm respect for Tribal Nations.
With Tribal Nations leading the way and CMS providing a reimbursable foundation, increased access to Indigenous medicine and healing could provide benefits to many. This change in CMS reinforces Tribal self-determination and the federal government’s treaty obligations in providing reimbursement for health care to Tribal Nations. Tribal Nations have a vested interest in cultural reclamation and revitalization, giving way to culturally competent health care to the next generations and upholding Indigenous experiential knowledge.
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