Trump administration OKs Native traditional healing for two states’ Medicaid programs

The Trump administration has approved two states’ requests to expand Medicaid to cover Native American traditional healing practices, even as it prepares to enforce rules that are expected to drop millions of people from the government health insurance program.

Health and Human Services Secretary Robert F. Kennedy Jr. announced in September that the federal agency had approved traditional healing programs for Utah and Maine. The agency did so through waivers, which give a state permission to pay for certain programs that normally fall outside of Medicaid’s rules.

The move increased to six the number of states with Medicaid waivers for traditional healing, including Arizona, California, New Mexico, and Oregon.

But in California, a Medicaid waiver that provides federal funding for that state’s traditional healing program, among other things, is set to expire at the end of December. The state’s renewal application was pending with the Centers for Medicare & Medicaid Services as of early November.

In approving Utah’s waiver, CMS wrote that studies have found traditional healthcare practices can reduce symptoms of post-traumatic stress, depression, anxiety, and other mental health issues.

Indigenous health providers share hopes, concerns about Medicaid covering traditional healing

“Emerging evidence supports benefits for physical health functioning and chronic disease symptom management as well,” the approval letter said.

Native health leaders said they are encouraged by the expansion. This way, tribal healthcare can become more aligned to the various Native cultures across the country.

“That’s our goal, to have health within our communities as we define health to be,” said Art Martinez, a commissioner of the Nevada Department of Native American Affairs and citizen of the Chumash Tribe.

After Kennedy joined the Trump administration in 2025, he pledged to improve Native American access to healthcare through, as a spokesperson put it, “culturally relevant, community-driven solutions.”

Since then, the Trump administration has been limiting Medicaid eligibility. Last year, President Donald Trump signed the One Big Beautiful Bill Act, which added work requirements and other eligibility restrictions that are expected to result in approximately 10 million more people than projected going without health coverage. Native Americans are exempt from work requirements, though Native health leaders are concerned that they will see unmerited disenrollments.

The traditional healing benefit allows Native American health providers to bill Medicaid for practices such as sweat lodge ceremonies and for community events such as canoe journeys.

The canoe journey is used by tribes in the Pacific Northwest to increase community belonging. Since CMS approved Oregon’s traditional healing waiver in 2024, the Confederated Tribes of Grand Ronde have been eligible for reimbursement for their canoe journeys.

“We’re river people,” said Kelly Rowe, the tribes’ executive director of health services. “We got a lot of our elders out on the water who’d never been in a canoe, and it was like the aha moment, and that’s exactly what good medicine is, you know.”

Though modern Western medicine remains an important part of healthcare, Rowe said, she’s glad to see broader recognition of the importance of tribal cultural traditions as another integral component.

“We’re not just here to give you medicine and exams and Western medicine,” Rowe said. “We’re here to be part of what’s happening in the daily life of the tribe.”

In Utah, the state’s request for traditional healing services included urban Indian health organizations as eligible providers. This helps bring those cultural traditions to people living off-reservation, said Matt Poss, executive director of the Urban Indian Center of Salt Lake.

For those who weren’t born and raised on a reservation, maintaining ties to their culture and traditions can be difficult. Urban Indian health organizations can help fill those gaps.

“Native health is not just going to a clinic and getting a vaccine or seeing your provider,” Poss said. “It’s being connected to community.”

The future of California’s traditional healing program depends on whether CMS renews a sweeping Medicaid waiver that expires at the end of December. The waiver covers many areas of health programming besides traditional healing, including programs for people who are homeless or about to leave jail and children with complex medical needs.

CMS sent the state a letter more than 700 pages long directing it to align its Medicaid waiver programs with the federal changes that went into effect in October.

California health officials said the letter clarified that eligibility for Medicaid had been narrowed to certain immigration statuses. In 2024, California opened its Medi-Cal program to all residents, regardless of immigration status, although it has rolled back some coverage benefits amid rising healthcare costs and federal cuts.

Health programs run by tribes have long included what’s considered traditional healing under the federal waivers, Martinez said. However, some tribes have had to scale back their services through the years because they weren’t sustainable without dedicated funding, he said.

Utah didn’t get everything it asked for in its waiver application. CMS rejected the state’s request for the federal government to reimburse 100% of the costs that urban Indian health organizations pay to provide care for Native Americans.

All other tribal health providers, including the Indian Health Service and tribally run health organizations, receive 100% Medicaid reimbursement. According to the National Council of Urban Indian Health, urban Indian health organizations have historically received a minuscule amount of the federal funding allocated for the Indian Health Service. Approximately 87% of Native Americans live outside of tribal areas, according to the 2020 Census.

Poss said that his efforts to secure the full reimbursement rate will continue, though it remains a lengthy and challenging process.