Traditional Health Care Practices waiver
The Health Care Authority (HCA) and Tribal partners are pursuing a Section 1115 waiver for Washington state that focuses on spiritual, cultural, and traditional healing in Native communities.
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Share your thoughts on Washington state's Traditional Health Care Practices waiver
We invite you to provide public comment on our draft application for a Traditional Health Care Practices waiver. This is a five-year Section 1115 waiver available through the Centers for Medicare & Medicaid Services (CMS).
The public comment period begins Wednesday, November 5 and ends Friday, December 5, 2025.
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
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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
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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
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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
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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
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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
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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 98948Meeting ID: 817 3643 0815
Call in:
1-253-215-8782 (Tacoma)
1-253-205-0468 (U.S.)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 98226Meeting ID: 875 6272 8945
Call in:
1-253-215-8782 (Tacoma)
1-253-205-0468 (U.S.)
Additional opportunities for Tribes
In December 2025, we will also offer a listening session and Tribal Consultation for Tribes to share their input.
Note: 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.
- Listening session and Tribal Consultation schedule
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Meeting type Date and time Zoom and call-in information OTA listening session
Attendees can join virtually or call in.
Thursday, December 11, 2025
10–11 a.m.Meeting ID: 845 3876 0381
Call in:
1-253-215-8782 (Tacoma)
1-253-205-0468 (U.S.)OTA Tribal Consultation
Attendees can attend in person, join virtually, or call in.
Tuesday, December 16, 2025
10:30 a.m.–noon.Health Care Authority
Cherry Street Plaza
Eagle Conference Room 552
626 8th Avenue SE
Olympia, WA 98501
How to provide public comment
Share your input by:
- Attending a public hearing (see dates and times above).
- Emailing us.
- Mailing us or dropping off at:
Health Care Authority, Office of Tribal Affairs
Regarding: Traditional Health Care Practices waiver public comment
Attention: Lena Nachand
P.O. Box 45502
Olympia, WA 98504-5502
Note: If physically dropping off your comments at HCA, you can leave with the front desk/reception. View our visitor map with parking instructions. Please email our waiver team if you need a hard-printed copy of the application.
The deadline to provide public comment is Friday, December 5 at 5 p.m. (Pacific).
We strongly encourage early submissions.
- Who can provide input
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Public comment is open to anyone who would like to share input, especially Tribal Nations, Indian health care providers, UIHOs, Tribal health organizations, and Native-serving organizations. We also encourage health care and social service providers, hospitals and health systems, community-based organizations, the public, and anyone else interested in sharing their input.
- How we’ll use your input
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Input we receive will help us learn more about people’s thoughts on reimbursing traditional health care services. It will also help inform our state’s waiver application. After we submit the application to CMS, we’ll provide a summary of the comments we received during the public comment period.
Resources
- Draft application and other materials
- Public hearings
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- Public hearing slide deck (held on November 14 and 19, 2025)
- News
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- Get updates on our waiver work!
- Announcements:
- Waiver-related
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- 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.