Traditional Health Care Practices waiver

About the waiver

We believe American Indian/Alaska Native (AI/AN) people should have access to traditional health care — also known as Traditional Indian Medicine — to support their health and well-being. Together with Tribes, we can strengthen traditional health care as an Apple Health (Medicaid) benefit and strengthen Native communities.

Read the executive summary for more details.

Our goals

Washington state is seeking CMS approval to implement a waiver to:

• Affirm Tribal Sovereignty by recognizing traditional health care practices as an essential component of the AI/AN health system in Washington state.
• Expand people’s access to traditional health care practices provided by or through qualified facilities in Washington state.
• Integrate traditional health care practices into the broader continuum of care, complementing Western medical practices with options that reflect AI/AN cultures, values, and connectedness.
• Improve health outcomes for AI/AN people and increase the use of traditional health care practices in Native communities.

If approved, the waiver could begin as soon as July 1, 2026.

Background

American Indian and Alaska Native (AI/AN) people have long recognized that traditional health care practices are essential to healing and wellness. The 29 federally recognized Tribes in Washington state have rooted these practices—often called Traditional Indian Medicine—in their cultures.

For years, Tribes have championed the recognition of these valued practices and worked toward sustainable funding to expand and ensure timely access to this vital care.

How the waiver will work

If CMS approves the waiver, it will allow certain types of facilities in Washington state to provide traditional health care services as "qualifying facilities," including:

• Indian Health Service (IHS) facilities
• Tribal facilities
• Urban Indian Health Organizations (UIHOs), depending on state funding from the Legislature

When a qualifying facility provides traditional health care services to an eligible Apple Health or Children’s Health Insurance Program (CHIP) enrollee, Medicaid will reimburse (pay) that facility for the service. Such services must be provided by practitioners or providers who are employed by or contracted with a qualifying facility.

Qualifying facilities that receive Medicaid reimbursement (payment) for providing traditional health care is a significant step in:

• Improving access to culturally relevant, holistic care
• Addressing health disparities
• Promoting health equity
• Helping preserve cultural practices

It also empowers Tribes to provide whole-person care, which better serves their communities through a stronger, more effective health care system for AI/AN people.

Whole-person care considers a person’s entire well-being, including physical health, mental and emotional health, substance use, spiritual and cultural needs, and social factors.

Examples of traditional health care practices

This could include drumming, talking circles, sweats, spiritual counseling, rites of passage ceremonies, cultural guidance for traditional plant and food gathering, preparation and preservation, and more.

Why this waiver is so important

The waiver is one way we can ensure Tribes are recognized — and paid — for providing traditional health care services. This waiver also builds off the 2023 Washington State Indian Health Improvement Advisory Plan. We remain committed to strengthening Tribal-state partnerships, improving access to essential care for AI/AN people, and supporting Indian health care development.

Public hearings (webinars)

In partnership with Lummi Nation and Yakama Nation, we will offer two public hearings to share information about the waiver. During the hearings, attendees will have an opportunity to ask questions and provide input. Attendees can attend in person, join virtually, or call in.

Public hearing schedule

Tribe	Date and time	Location	Zoom and call-in information
Yakama Nation	Friday, November 14, 2025 1–2:30 p.m.	Legends Casino Hotel 580 Fort Road Toppenish, WA 98948	Join on Zoom Meeting ID: 817 3643 0815 Call in: 1-253-215-8782 (Tacoma) 1-253-205-0468 (U.S.) See more information on how to join.
Lummi Nation	Wednesday, November 19, 2025 1–2:30 p.m.	Lummi Nation Administration Building Kwelshan Conference Room, 2nd floor  2565 Kwina Road Bellingham, WA 98226	Join on Zoom Meeting ID: 875 6272 8945 Call in: 1-253-215-8782 (Tacoma) 1-253-205-0468 (U.S.) See more information on how to join.

Additional opportunities for Tribes