Traditional healing services provided through the Indian Health Service (IHS) and Tribally-operated health facilities in Arizona will now be covered by the Arizona Health Care Cost Containment System (AHCCCS), the state’s Medicaid program. Photo by Shondiin Silversmith | Arizona Mirror

Indigenous people have relied on traditional healing practices within their communities for generations and continue to do so alongside Western medicine within various tribal health care facilities across Arizona.

Even though traditional healing services have not been covered under federal programs like Medicaid, many health care facilities in tribal communities continue to offer these services to Indigenous patients.

Because the services were being offered at some tribal health care facilities, a working group through the Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid program, was established to figure out how traditional healing services could be reimbursed.

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Dr. John Molina, who is Pascua Yaqui and Yavapai Apache from the Arizona Advisory Council on Indian Health Care, is part of the AHCCCS traditional healing workgroup.

He said the group’s work started more than 10 years ago and has been driven by the fact that there is still “a significant presence of traditional healing services” that patients are utilizing within tribal communities.

“This is something that our people are still using, even though many folks believe that traditional healing services are probably a thing of the past,” Molina said. “It really isn’t.”

After about a decade of work, AHCCCS received approval in October from the Centers for Medicare and Medicaid Services (CMS) to cover traditional healing services provided through the Indian Health Service (IHS) and tribally-operated health facilities in Arizona.

Indigenous traditional healing is a whole medical system encompassing a range of holistic treatments used by Indigenous healers to treat many acute and chronic conditions or promote health and well-being, according to the National Institutes of Health/National Center for Complementary and Alternative Medicine (NCCAM).

“Federal approval of coverage for traditional healing services in Arizona and multiple other states represents a watershed moment in recognizing the importance of culturally competent care,” AHCCCS Director Carmen Heredia said in a statement. The administration first sought reimbursement for traditional healing through Medicaid in 2015 and again in 2020.

“As we continue this work in partnership with Arizona’s Indigenous communities, we look forward to the positive impact these services will have on the health and well-being of our members,” Heredia said.

According to the agency, CMS approval allows AHCCCS to establish a process and policies for reimbursing services provided by traditional healers employed by or contracted with an IHS or tribally operated health center. Urban Indian Organizations may also offer services through a care coordination agreement with an approved IHS or tribally operated facility.

According to the agency, traditional healing services can be provided only to AHCCCS members eligible to receive services through an IHS or tribally operated facility.

Christine Holden, the tribal liaison for AHCCCS, said getting federal approval is the first step, and AHCCCS will move forward with plans to get state approval.

Once AHCCCS receives the necessary approval from the Arizona legislature, a timeline will be established for implementation, and members and providers will be notified of the effective date.

Traditional healing services take various forms, including sweat lodges, smudging, and ceremonies. AHCCCS stated that federal approval represents a critical first step toward allowing traditional healers to bill for services under Medicaid.

Molina said this reassures that the IHS facilities and other tribally-operated health facilities in Arizona can continue to offer these services, but give those who have yet to provide them a chance to do so.

“Traditional healing services are so part of our lifestyle (and) our culture because it brings a sense of wellness and healing that sometimes Western medicine does not,” Molina said.

Molina said traditional healing incorporates the spiritual aspect of our well-being and health, which Indigenous people have done for centuries, even before colonization.

“It’s been a cornerstone of our culture and of our health, the wellness of our communities,” he added. “So, it only makes sense that this is something that our people would be very open to continue to work in their communities and with their families.”

Holden said integrating traditional healing practices into Medicaid is not just a policy change, but recognition.

“It is recognition of the value that tribes, our cultures, and our traditions have and what incorporating those practices into the Western system means for our people,” Holden said. “It’s a more inclusive health care system that is responsive to our cultural needs.”

Holden, who is White Mountain Apache and Hopi, said making traditional healing services more widely available is huge for Indigenous communities in Arizona because tribes have been using those practices since time immemorial.

“This is a step in the right direction in terms of expanding that availability and ensuring inclusivity,” she said.

Approval of traditional healing services on the federal level not only respects Indigenous traditional knowledge but also Tribal sovereignty.

“We have a right to determine the management of our healthcare,” Molina said. “As Indigenous nations across the country, we’re exercising our sovereign right to have these healing services.”

Holden said that AHCCCS’s ability to reimburse for traditional healing services is very much about respecting tribal sovereignty.

“Tribes have the right to determine what health care looks like, and they are the best situated to determine what that health care looks like for their members,” she said.

Holden said this move honors the autonomy of tribal nations in integrating their cultural practices into the modern health care system. She said this not only strengthens Indigenous communities but also sets a precedent for the community to stay true to ensuring health equity on a national and global scale.

“I’m hopeful that this will be a push in the right direction and setting a new precedent across the United States so that all of our relatives have the option to seek their traditional healing practices and incorporate that into their health care,” she added.

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