Arizona is one of four states included in a program to allow for the coverage of traditional Native American healing practices for Medicaid and Children’s Health Insurance Program recipients. It comes as part of a waiver allowing states to pilot new programs.

Nada Hassanein covers health care for Stateline and has written about this. She joined The Show to discuss how significant tribal officials are saying this approval is for their members.

Full conversation

NADA HASSANEIN: Yeah, I mean, I’m hearing it’s really quite significant. You know, the U.S. government has a long history of policies that have targeted and outlawed tribal languages, cultural and religious practices, and that includes, you know, included traditional healing.

So tribes had still practiced, but, you know, out of sight. And the Indian Religious Freedom Act wasn’t enacted until 1978. So tribal health leaders are really excited about this and hope that incorporating cultural remedies and practices will actually improve health disparities that American Indian and Alaska Native folks often grapple with.

And, you know, research is catching up and showing that, you know, incorporating you know cultural ways can help you know improve you know, for example, substance use recovery treatments, etc.

MARK BRODIE: Well, so how exactly does this work? Like if you are a member of a Native American tribe and you are a Medicaid or CHIP recipient, how do you go about trying to make sure that you can get the kind of traditional healing that you’re looking for.

HASSANEIN: Yeah, so it’s only available at tribal health facilities. So you know, an American Indian, Alaska Native person in Arizona could call their tribal health facility that they receive care at and ask what traditional healing services are offered. And that might differ from facility to facility. It differs from, you know, tribe to tribe. The self-determination and sovereignty was really baked into this so that tribes and tribal health facilities can kind of choose, you know, which traditional healing services to offer.

But yeah, I mean, it’s also available at urban Indian organizations as long as they contract with a tribal health facility. That’s the case in Arizona. So it’s available in that way.

BRODIE: I assume, though, and you kind of alluded to this, that the facilities would need providers, right, who are familiar with and know what they’re doing with these with these traditional healing services, right? Like, you can’t just offer it if you don’t have somebody who can actually provide it. 

HASSANEIN: Yeah, that’s that’s correct. And it’s it’s really important for tribes. You know, I’m hearing that they, you know, are really kind of trying to protect, you know, the sacredness of their ceremonies and practices and the authenticity of them.

And so, you know, there are a couple of organizations, for example, a couple of Navajo organizations that kind of certify, you know, licensure of traditional healers. And so that’s how they kind of make sure it’s trusted people that, you know, come from the community.

BRODIE: Understanding that the services will be different as you reference, depending on where somebody is and maybe what tribal affiliation they have. What are some of the traditional healing services that folks are looking to offer? 

HASSANEIN: Yeah, I mean, it could range from, you know, plant medicine to, you know, sweat ceremonies, you know, sweat lodge ceremonies that incorporate, you know, specific rituals, you know, talking circles. Those are just a few examples.

BRODIE: And in terms of actually getting reimbursed, like, has Medicaid come up with a coding for some of these? Like, is it an easy, I guess, logistical, administrative thing for a facility to get reimbursed for providing this? 

HASSANEIN: So, you know, it’s actually something that states, you know, are working on, that tribes are working on with states. And I should note, you know, this has only been approved in Arizona, California, New Mexico and Oregon.

And yeah, it’s it’s it’s very, you know, new still. And so, you know, I’m hearing from tribal health facilities and tribal leaders that, you know, they’re still kind of trying to figure out exactly, you know, what the billing codes would be and that kind of thing.

BRODIE: What are you hearing from tribal health officials and tribal officials generally about how often they expect these services to be used or maybe how much demand there is for these kinds of services? 

HASSANEIN: Yeah, so I’m hearing that it would kind of vary from patient to patient, right? These are kind of holistic practices that providers and traditional health practitioners would, within these tribal health facilities would kind of work with the patient to see if that’s something they want or not.

So it’s kind of an offering that I think, what I’m hearing from practitioners and providers is, that they would work with patients to see if that’s, work with individual patients to incorporate as part of their treatment plan, if that’s what they want.

BRODIE: Sure. Is there concern in this space for the potential impact of a prolonged government shutdown or if the Medicaid cuts that are planned for next year go into effect? I mean, this is only eligible, you know, Medicaid and CHIP patients are eligible for this. If there are fewer people eligible and on Medicaid, presumably, that limits the universe of potential patients who could get these services covered, right? 

HASSANEIN: Yeah, I mean, I think that’s definitely a larger context, you know, of concern here with if certain people lose eligibility, you know, then they might not get to, you know, have the coverage in order to get to the facility for care and to get this care.

You know, the Medicaid cuts, what I’m hearing from, you know, tribal health facilities is that that’s kind of the concern is if eligibility gets even on accident, someone gets, you know, kicked off the rolls, that, you know, that’s how it would affect someone’s access to this kind of care.

BRODIE: But based on your reporting, it doesn’t sound like there’s an awful lot of concern about this particular service being taken away from Medicaid enrollees. 

HASSANEIN: Yeah, that’s correct.

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