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.

From November 5–December 20, 2025, HCA held a formal public period for people to share their input on reimbursing traditional health care services. This information is helping us finalize Washington state’s waiver application, which we plan to submit to the Centers for Medicare & Medicaid Services (CMS) in 2026.

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, 2027.

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.

Tribal Roundtables

In March, we are offering a Tribal Roundtable discussion for Tribes to share their input.

You must be officially chosen by your Tribal Council as an elected official or appointed representative to participate in government-to-government discussions with the state.

Tribal Roundtable details

Meeting type	Date and time	Zoom and call-in information
There are no Tribal Roundtable discussions scheduled at this time.	N/A	N/A

Resources

Draft application and other materials

• Traditional Health Care Practices waiver draft application
• Executive summary
• Dear Tribal Leader Letters (DTLLs):
  • Notice of Roundtable (March 19)
  • Notice of Roundtable (January 27)
  • Tribal Consultation rescheduled (December 16)
  • Tribal public comment notice extension (December 1)
  • Tribal public comment notice (October 30)
  • Initial letter about HCA’s intent to apply for a Traditional Health Care Practices waiver (August 19)
• Public comment notice
• Public hearing slide deck

News

• Get updates on our waiver work!
• Announcements:
  • Reminder about tomorrow's Tribal Consultation for Traditional Health Care Practices waiver (December 15)
  • Don't miss this week's public hearing on WA’s Traditional Health Care Practices waiver (December 8)
  • Public comment period extended for WA’s Traditional Health Care Practices waiver (December 1)
  • Change in location for Wednesday's Traditional Health Care Practices waiver public hearing (November 17)
  • Want to learn more about WA's Traditional Health Care Practices waiver? Attend one of our public hearings! (November 12)
  • Public comment now open (November 5)

Waiver-related

• Visit the CMS website to view all state Section 1115 waivers. Once HCA submits Washington's Traditional Health Care Practices waiver, it will be available on this page, made searchable by state, newest waivers, and other filters.