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CMS Approves Traditional Healing 1115 Demonstrations for Arizona, New Mexico, California, and Oregon

A Historic Win for Indian Country



Yesterday, October 16, 2024, the Centers for Medicaid and Medicare Services (CMS) issued approvals for section 1115 demonstrations to allow for Tribal traditional healing reimbursement in Arizona, New Mexico, California, and Oregon. Medicaid 1115 demonstration waivers grant state Medicaid programs the flexibility to waive specific federal requirements to perform a “demonstration project” to show how a particular approach can provide better services that improve a Medicaid program. Arizona, New Mexico, California, and Oregon have all included traditional healing elements in their 1115 demonstration requests that have been set aside for further federal review—until today. 

In a Dear Tribal Leader Letter, CMS Administrator Chiquita Brooks-LaSure detailed the extent of the approvals and stated that “Today’s action is an important step towards improving access to culturally appropriate health care and improving the quality of care and health outcomes for Tribal communities.” Traditional healing is a critical element of health for American Indian and Alaska Native peoples. Access to reimbursement for traditional healing services through these approved 1115 demonstrations marks a significant step forward for the federal government’s fulfillment of the trust and treaty obligations to Tribes. 

“Since time immemorial, our people have developed and utilized approaches and understandings to health and healing that is central to our culture and identities as Native peoples,” said William “Chief Bill” Smith (Valdez Native), Chairman and Alaska Area Representative of the National Indian Health Board.  “This is an important step towards the U.S. government’s long-awaited acknowledgment of Tribes’ sovereign right to provide health care services in alignment with our knowledges and practices of wellness.”



CMS’s approval of these 1115 demonstration waivers is historic. This is the first time that reimbursement for traditional healing services has been permitted through Medicaid and the Children’s Health Insurance Program (CHIP). Tribes have spent a significant length of time advocating for these 1115 demonstrations to be approved: Arizona included traditional healing services in its 1115 demonstration request to CMS on the federal level for the first time in 2015. Tribes from the four states and the CMS Tribal Technical Advisory Group have worked tirelessly with CMS to make traditional healing services eligible for reimbursement through Medicaid and CHIP a reality.

NIHB In Action 

"For years Tribes have fought tirelessly to increase access to traditional healing for their people,” said A.C. Locklear (Lumbee), Interim CEO of the National Indian Health Board. "Through our collective efforts, we clearly demonstrated the importance of integrating traditional healing into our health care practices to improve the health outcomes of our People.”

NIHB has made efforts to raise awareness and engage Indian Country about traditional healing reimbursement through Medicaid and CHIP. NIHB presented at multiple Area Indian Health Boards and the 2024 Association of American Indian Physicians (AAIP) Cross-Cultural Medicine Workshop to share information on the March 2024 CMS consultation concerning its draft framework for reviewing 1115 demonstrations proposing Medicaid coverage for traditional health care practices. In May of this year, NIHB submitted comments on the Draft Framework, sharing input NIHB gathered from a roundtable of traditional healers. Additionally, NIHB has hosted a series of discussion-based workshops at the National Tribal Health Conference and the National Congress of American Indians Mid-Year Conference as well as a virtual All Tribes Roundtable to educate Tribal leaders and Tribal health professionals on the traditional healing reimbursement and learn more about the foundations of traditional healing Tribes want CMS to understand most.

What is Next? How Can I Learn More?

CMS will host an All Tribes Consultation Webinar on Medicaid Coverage of Traditional Health Care Practices Received Through Indian Health Service Facilities, Tribal Facilities, and Urban Indian Organization Facilities on Thursday, October 31, 2024, 2:00-3:00 PM ET to provide an overview of CMS’ approval of the four demonstration amendments that allow for Medicaid and Children’s Health Insurance Program coverage of traditional health care practices.

You can review the CMS-issued approvals by state here:

You can learn more about the significance of 1115 demonstrations with traditional healing components and Arizona, New Mexico, California, and Oregon’s original waiver requests in the Spring Issue of NIHB’s Health Reporter here.

If you have any questions about these Traditional Healing 1115 Demonstrations or NIHB’s work in this area, please contact Alanna Cronk, Government Relations Coordinator at acronk@nihb.org. 

National Indian Health Board | www.nihb.org | 202-507-4070

Visit the NIHB COVID-19 Tribal Resource Center at:

 www.nihb.org/covid-19

For media inquiries, contact Ned Johnson at njohnson@nihb.org.

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