CMS Approves Historic Medicaid Waivers for Traditional Health Practices for AIAN Communities

Disparities in Health and Health Care for AIAN People

American Indian and Alaska Native (AIAN) people experience ongoing health care disparities. These include higher rates of chronic diseases, mental health issues, and substance use disorders. Many AIAN individuals face significant barriers to accessing adequate health care, leading to poorer health outcomes compared to other population groups. Factors contributing to these disparities include geographic barriers, financial limitations, and insufficient availability of culturally competent care.

Role of the Indian Health Service (IHS)

The Indian Health Service (IHS) provides health care services and prevention for AIAN communities. Despite its responsibility under treaties and laws, the IHS has struggled with underfunding, covering less than half of the health care needs of AIAN people. While IHS offers direct services at facilities managed by IHS or Tribal organizations, the services are primarily for federally recognized Tribe members. Urban Indian health programs extend these services to those who live outside reservations or do not meet certain eligibility criteria.

Importance of Health Coverage for AIAN People

Health insurance, especially Medicaid, is crucial for AIAN individuals. It helps cover medical costs and enhances access to needed health services. Approximately 23% of nonelderly AIAN adults and 44% of AIAN children rely on Medicaid and the Children’s Health Insurance Program (CHIP). States that have expanded Medicaid under the Affordable Care Act have shown lower uninsured rates among AIAN populations compared to those that have not. Medicaid also provides essential funding for IHS and Tribal health facilities, covering most of the care costs for AIAN enrollees.

Traditional Health Practices

Traditional healing practices, which include methods like talking circles and sweat lodges, are vital to AIAN culture. These practices focus on mental, emotional, and spiritual health and have been shown to improve outcomes in mental health and substance use disorders. Historically, Medicaid has not covered these services, but recent policy changes are beginning to address this gap.

Using Section 1115 Waivers for Traditional Health Practices

In October 2024, the Centers for Medicare and Medicaid Services (CMS) approved Section 1115 waivers in Arizona, California, New Mexico, and Oregon, allowing Medicaid and CHIP to cover traditional health care practices. This change may enhance access to culturally appropriate care for AIAN individuals. These waivers were developed with input from Tribal organizations, ensuring that traditional practices receive proper recognition and support.

Key details about the waivers include:

• Practice Definition: States will define traditional health practices in consultation with Tribal organizations to ensure relevant cultural appropriateness.
• Federal Match: Services provided at IHS or Tribal facilities will receive a 100% federal match. Urban Indian organizations will receive appropriate state match rates.
• Implementation Funding: States can obtain federal funding for expenses related to implementing traditional health practices, like workforce development and infrastructure upgrades.
• Access to Secular Alternatives: States must provide access to secular health services before claiming reimbursements for traditional practices.

This development marks a significant step towards improving health access and addressing the unique needs of AIAN communities.