With traditional Native healing practices being the cornerstone of health and wellbeing of Native communities since time immemorial, the Arizona Health Care Cost Containment System (AHCCCS) is seeking federal approval to cover these services under Medicaid. Arizona would be the first state in the country to do so.
“Title 19 Medicaid dollars cannot be used for traditional healing services as it currently stands, and that’s what we’re trying to change with our 1115 waiver request,” Alex Demyan, assistant director of the Division of Community Advocacy and Intergovernmental Relations at AHCCCS, told State of Reform.
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AHCCCS initially submitted this request in their 1115 waiver in 2015, which the Centers for Medicare and Medicaid Services (CMS) rejected. The agency submitted the request again in 2020 during the current waiver period, but CMS was unable to approve native healing services at the same time they approved other 1115 waiver requests. Demyan said AHCCCS is actively negotiating the coverage of these services, but is uncertain of when it would be approved.
Christine Holden, tribal liaison for AHCCCS, who is part of the White Mountain Apache Tribe, believes it is crucial to incorporate Native healing services into traditional Western medicine. Native healing services take on a holistic approach, where the medicine man or medicine woman does not separate the physical from the mind or spirit.
Holden noted this effort represents a new beginning, and that by incorporating traditional Native health into state systems and non-Tribal healthcare systems, Arizona is conveying that it recognizes the importance of Indigenous traditions.
“Bringing us back to our traditional ways that kept us alive for thousands and thousands of years. So, bringing that back into the western picture really will help from that Native perspective—Native identity and also respecting Tribal sovereignty and the right of Tribes to determine what their healthcare should look like without having to fit in any type of box.”
Holden cited Canada and New Zealand, which have incorporated traditional healing practices into Western medicine, which she said has assisted with improving the mental and physical health of patients. Arizona currently has 22 federally recognized tribes.
“The thing I appreciate about traditional healing is they never look at Western medicine as ‘it doesn’t have a place’ in helping our people heal,” Holden said. “They understand that it complements the traditional piece.”
Traditional Native healing practices consist of using local roots, plants, and trees as medicine or ailments. Sweat lodges continue to be used as a way of easing an individual’s challenges with mental health. Holden explained how these sweat lodges were historically used during periods of war to treat trauma and post-traumatic stress order for survivors.
“Native communities recognized this, and how powerful it is to separate the individual that goes to war, from the individual that is a family man, that is a grandfather, that is an uncle,” Holden said.
Holden explained how prior to going off to fight in wars, Native and Indigenous individuals would visit the medicine man, who would provide the individuals with warrior names.
“The way they kept our warriors from experiencing PTSD or any mental health issues when they came back from those types of situations is they would have a sweat lodge. You pray and ask for forgiveness, and move from that warrior name back to whatever your traditional name was. That gave warriors the tools to be able to separate the things that they did that they weren’t proud of—but had to do to survive—from that person.”
Burning of sage and cedar is a historic Native healing method that continues to be used today, including by Holden. She said Natives will light sage and pray, then put the sage on their feet, body, and mind, and waft in the smoke. When saying prayers, Natives believe the smoke will carry those prayers to the creator, and it’s helpful to physically see the prayers being carried.
“I’ve seen that help, especially younger kids,” Holden said. “They like to see things physically happening, and so when they see that smoke rise for them, that symbolizes okay, my prayers and what I’m asking for is being carried to [the] creator, and that helps them to hold onto that hope.”
Demyan said the waiver request seeks the maximum amount of discretion to be given to Native and Indigenous communities to establish relevant programs for each community, although CMS will enact minimal federal requirements upon approving the request. Federal requirements may include policy oversight, background checks and verification of training, among others.
“We are asking the permission to reimburse for traditional healing services using Title 19 dollars—that’s the high level,” Demyan said. “We really want to give the maximum amount of discretion to the individual Tribal communities to define what those services look like, what the qualifications for the medicine man or the traditional healing practitioner are. As a state, we don’t view it as our place to define that for the communities.”
Demyan said the proposal contemplates limiting services to individuals served in the Indian Health Services (IHS) 638 and Urban Indian facilities—for IHS 638 facilities, AHCCCS is contemplating paying the “all-inclusive rate,” that is annually established by the federal government, and is considerate of higher and lower cost services.
“On the IHS 638 system side, that’s how we’ve backed into a rate that makes sense for the facilities, and our traditional healing workgroup is comfortable, and has been comfortable with that model,” Demyan said. “Urban Indian organizations—those facilities do not get paid the AIR [all-inclusive rate], so we’re still going through the rate setting process there.”
While waiting for CMS approval, AHCCCS will continue to negotiate terms. If approved, AHCCCS will work with the traditional healing workgroup, and develop and implement policies prior to reimbursement for services.