TRADITIONAL HEALING

This 2023 report serves as an update to the National Council of Urban Indian Health’s (NCUIH) previous reporting on recent trends in third-party billing.

• This report focuses on how Urban Indian Organizations (UIOs) administer, evaluate, and fund traditional healing services.
• UIOs rely on Medicaid claims revenue to maintain services, but many UIOs have reported difficulty receiving reimbursement for traditional healing services.
• Recognizing the importance of culturally appropriate care, four states (Arizona, California, Oregon, and New Mexico) had initiated efforts to expand reimbursement for these services at Indian Health Service facilities, Tribal Health Centers, and UIOs. These four states submitted Traditional Healing reimbursement proposals to the Centers for Medicare & Medicaid Services (CMS) using Section 1115(a) demonstration waivers. As of fall 2024, Arizona, California, New Mexico, and Oregon have received CMS approval of their Section 1115(a) demonstration waivers seeking Medicaid reimbursement for Traditional Healing practices offered at I/T/U facilities.[1] While the California, New Mexico and Oregon waivers explicitly include UIOs as covered facilities for Traditional Healing Medicaid reimbursement, Arizona’s waiver does not explicitly include UIOs as eligible for reimbursement unless the UIO contracts with an IHS or Tribal facility.[2] Federal approval of these waivers represents a significant step forward in recognizing the value of culturally-based traditional health care practices for AI/AN people, including those living in urban areas.
  [1] Press Release, Ctrs. for Medicare & Medicaid Serv., Biden-Harris Administration Takes Groundbreaking Action to Expand Health Care Access by Covering Traditional Health Care Practices (Oct. 16, 2024), https://www.cms.gov/newsroom/press-releases/biden-harris-administration-takes-groundbreaking-action-expand-health-care-access-covering.
  [2] Letter from Daniel Tsai, Deputy Adm’r and Dir., Ctr. for Medicaid & CHIP Serv., to Carmen Heredia, Dir., Ariz. Health Care Cost Containment Sys. (Oct. 16, 2024), az-hccc-dmnstrn-apprvl-10162024.pdf, (stating that “… traditional health care practices received through IHS or Tribal facilities will be covered when provided to a Medicaid beneficiary who is able to receive services delivered by or through these qualifying providers… To be covered, the traditional health care practices must be provided by practitioners or providers who are employed by or contracted with one of these facilities (which could include an urban Indian organization contracted with an IHS or Tribal facility), in order to ensure that the practices are provided by culturally appropriate and qualified practitioners at facilities that are enrolled in Medicaid.”
• NCUIH interviewed 8 UIOs on their Traditional Healing programs to develop the thematic analysis of Traditional Healing at UIOs. In addition, NCUIH performed a meta-analysis of recent Traditional Healing literature to determine the impact of Traditional Healing on measurable health outcomes.