Medicaid will cover traditional healing practices for Native Americans in 4 states

Emery Tahy of San Francisco knows firsthand the struggles of addiction and recovery, a journey that, for him, is intertwined with his experience as a Native American.

In his early twenties, Tahy landed on the streets of Phoenix battling severe depression and alcohol-induced seizures. About four years ago, Tahy said, he was on the verge of suicide when his siblings stepped in and sought court-ordered treatment.

While Tahy was detoxing in a psychiatric ward, he learned about Friendship House, a Native-led recovery treatment program in San Francisco. As soon as he was released from the hospital in Arizona, he headed to California.

“I knew immediately I was in the right place,” said Tahy, 43. “A traditional practitioner said prayers for me. They shared some songs with me. They put me in the sweat lodge and I could identify with those ceremonies. And from that day on, I was able to reconnect with my spiritual and cultural education”.

Now, for the first time, Medicaid in California, Medi-Cal, as well as Arizona, New Mexico and Oregon, covers traditional health practices such as music therapy, sweatshops and dance to help with physical and mental health. .

The Centers for Medicare and Medicaid Services announced the move this week. It is a two-year pilot program that applies to Indian Health Service facilities, tribal facilities, and urban Indian organizations.

In California, two new intervention categories will be covered by the Medi-Cal expansion. People with a substance use disorder can seek therapy from traditional healers who offer ceremonial rituals, or they can work with trusted figures within tribal communities, such as elected officials or spiritual leaders who offer psychological support, trauma counseling and recovery guidance. California is home to the largest Native American population in the United States, and Gov. Gavin Newsom said in a news release announcing the expansion that the state is “committed to healing the historic wounds inflicted on tribes , including the health disparities experienced by Native communities.”

Seeking addiction healing

Tahy’s battle with alcoholism began when he was a young child. He said he took his first sip of beer when he was 4 years old, surrounded by parents, uncles, aunts and grandparents who drank heavily on the Navajo Nation.

“I’m an American Indian by blood,” Tahy said, recounting the hardships he faced in his youth. “Growing up I was subjected to a lot of prejudice, racism and segregation. He had no pride in who he was. I think drugs and alcohol were a way to deal with that shame. Alcohol helped me socialize and gave me courage.”

During his teenage years, Tahy drank and began using marijuana, cocaine, and crystal meth. Meanwhile, he said, his family instilled a meaningful relationship with his culture.

“My grandparents on my mother’s side always encouraged me to learn and be connected to traditional Navajo ways of life,” Tahy said. “There was a deep connection to family, land and ceremonial activities related to seasonal changes.”

Tahy’s story is not unique. Native American communities suffer some of the highest rates of addiction and overdose deaths in the country, and health experts have long argued that Western medicine alone cannot adequately treat substance use disorders in Native American populations.

The crisis is exacerbated by centuries of historical trauma.

Roselyn Tso, who heads the Indian Federal Health Service, or IHS, has advocated for Medicaid coverage of traditional healing. He said in the CMS announcement that “these practices have kept our people healthy for generations and continue to serve as a vital link between culture, science and wellness in many of our communities.”

To date, some Native Americans have accessed traditional health practices through IHS appropriations, tribal resources, various pilot programs, and grants. This is the first time Medicaid has covered these services.

It unites tradition and modern medicine

Although clinical approaches such as detoxification, medication-assisted treatment, and behavioral therapy are essential to treating substance use disorders, they often fail to address the cultural and spiritual needs of Native patients.

“Traditional practices are, by nature, holistic,” said Damian Chase-Begay, a researcher focused on American Indian health at the University of Montana. “They are treating the person physically, mentally, spiritually and emotionally. They benefit the whole being, not just the physical symptoms.”

Studies have shown that integrating cultural practices into addiction treatment can lead to greater engagement and more positive recovery outcomes, although most current research is qualitative, not quantitative.

For years, health professionals working in indigenous communities struggled with the limitations of what insurance would cover. Medi-Cal, the state’s Medicaid program for low-income residents, reimburses for medical prescriptions or talk therapy, but traditional healing methods were often excluded from coverage, leaving many Native American patients without access to treatments that align with their cultural values.

“What California now covers under Medi-Cal is exactly what our Native communities have been asking to be covered for years,” Chase-Begay said. “This kind of support, if it had been put in place, could have helped stop some intergenerational trauma and substance use years ago. I’m so excited that it’s now in place, but it’s long overdue.”

The new Medi-Cal policy will go into effect next year, with Indian health care providers in eligible counties able to apply for reimbursement for those services starting in January 2025. It will expire at the end of 2026 unless extended.

“It’s vital that we honor our traditional forms of healing,” said Kiana Maillet, a licensed therapist in San Diego and a member of the Lone Pine Paiute-Shoshone Tribe. “Traditional healing is deeply rooted in our cultures. Without it, we are missing a part of who we are.”

As for Tahy, he hasn’t touched a drop of alcohol since starting therapy at Friendship House. He now holds a full-time job as an evaluator at the Native American Health Center in San Francisco. He will soon complete a master’s degree in American Indian studies. And, a few months ago, he completed the San Francisco Marathon.

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