INVESTING IN WELLNESS:
Financing Strategies for Behavioral Health
National Council of Urban Indian Health
712 H St NE
#5030
Washington, DC 20002-3627
Phone: 202.544.0344
Investing in Wellness: Financing Strategies for Behavioral Health in Indian Country
NCUIH developed the “Investing in Wellness: Financing Strategies for Behavioral Health in Indian Country” toolkit and strategy guides to provide key information and resources to develop applicable and practical financing strategies for Indian Health Care Providers to strengthen access to prevention, treatment, and recovery services for Indian Health Service beneficiaries. Discover valuable insights and resources to enhance behavioral health programming and initiatives through sustainable financing opportunities for American Indian and Alaska Native communities.
Toolkit
This toolkit was developed in response to the critical need for sustainable funding to address the disproportionate burden of behavioral health conditions in Indian Country. It seeks to bridge the gap that current funding models create by providing the necessary information and resources to develop practical financing strategies tailored to the AI/AN health care system. These strategies aim to enhance access to prevention, treatment, and recovery services for AI/AN beneficiaries, encompassing Tribal Nations, Tribal health organizations, and Urban Indian Organizations (UIOs).
Download Toolkit
Strategy Guides
The strategy guides are easy-to-use overviews of each strategy for Indian Health Care Providers.
Strategy 1: Enhancing Behavioral Health Care Access Through Optimizing Medicaid Reimbursement
Optimizing Medicaid reimbursement for behavioral health services is a critical strategy for improving access to care and financial sustainability for Indian Health Care Providers (IHCP). Because Medicaid plays a crucial role in funding healthcare services for American Indian and Alaska Native people, Medicaid reimbursement is a vital revenue source for the I/T/U facilities. Collaboration and engagement with state Medicaid agencies, pursuing Federally Qualified Health Cetner/ Community Health Center (FQHC/CHC) designations, and leveraging models like Primary Care Case Management (PCCM) can enhance reimbursement while addressing critical behavioral health needs in American Indian and Alaska Native communities.
Download Strategy Guide 1
Strategy 2: Traditional Healing as a Financially Sustainable Strategy for Improving Behavioral Health
Traditional Healing offers a culturally grounded approach to behavioral health that strengthens spiritual, mental, emotional, and physical wellness while remaining financially sustainable. Many Urban Indian Organizations report that programs rooted in ceremony, cultural practices, and community-based care are both effective and cost-efficient, with lower implementation costs and stronger engagement. When integrated thoughtfully into behavioral health programming, Traditional Healing can improve access to care, support long-term sustainability, and reinforce community trust, identity, and self-determination.
Caption for All
Traditional Healing is not only culturally grounded, it is financially sustainable. NCUIH’s Investing in Wellness resources explore how Traditional Healing can strengthen behavioral health services while supporting community trust and long-term program sustainability.
Learn more: https://ncuih.org/investinginwellness
Download Strategy Guide 2
Strategy 3: Cultivating Funding Opportunities for Behavioral Health Programming
Sustaining behavioral health programming requires coordinated approaches to federal, state, and private funding. Diversifying funding sources helps Urban Indian Organizations strengthen program stability, reduce reliance on a single revenue stream, and support long-term growth. By leveraging existing mechanisms such as grants, waivers, and partnerships with nonprofits, universities, and public agencies, organizations can expand capacity, increase service availability, and replicate successful, community-driven behavioral health models rooted in sovereignty and self-determination.
Download Strategy Guide 3
Strategy 4: Investing in Prevention, Crisis Care, and Integrated Services
Investing in prevention, crisis care, and integrated services strengthens behavioral health systems by addressing needs early and reducing reliance on emergency and inpatient care. Prevention-focused programs, community-based supports, and early intervention improve long-term outcomes while lowering overall costs. Integrated behavioral health and primary care models further improve access, reduce stigma, and enhance coordination across services. Together, these approaches support holistic care, strengthen community resilience, and promote sustainable behavioral health systems rooted in community well-being.
Download Strategy Guide 4
Strategy 5: Strategies to Build, Expand, and Sustain the Behavioral Health Workforce
A strong behavioral health system depends on a well-supported and culturally grounded workforce. Investing in recruitment, training, and retention of American Indian and Alaska Native professionals helps ensure care that reflects community values and lived experience. Workforce strategies such as apprenticeships, mentorship programs, continuous training, and hybrid service models—including telehealth—expand access while supporting provider sustainability. Together, these approaches strengthen continuity of care, improve trust, and support long-term behavioral health capacity in Native communities.
Download Strategy Guide 5
Advancing Behavioral Health Financing: UIO Stories
Through the Behavioral Health Technical Assistance project, supported by the Pew Charitable Trusts and Bloomberg Philanthropies, NCUIH provided individualized support to Urban Indian Organizations (UIOs) working to advance sustainable behavioral health financing. The one-pagers below highlight each UIO’s TA focus, the challenges they faced, the support NCUIH provided, and key implementation outcomes. These resources are designed to help other UIOs learn from peer experiences and identify strategies applicable to their own organizations.
Urban Indian Center of Salt Lake
Advancing Traditional Healing Through Medicaid Policy Pathways
First Nations Community HealthSource
Navigating Medicaid Waivers to Support Traditional Healing Services
Native American Lifelines
Strengthening Behavioral Health Sustainability Through Workforce & Billing Strategies
Support for this project was provided by The Pew Charitable Trusts and Bloomberg Philanthropies. The views expressed herein are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts and Bloomberg Philanthropies.