Last week, the Centers for Medicare & Medicaid Services (CMS) approved Section 1115 demonstration applications submitted by the states of Maine and Utah, authorizing Medicaid reimbursement for traditional health care practices delivered to American Indian and Alaska Native people in both states.
While both waivers expand access to traditional health care practices, the scope of each waiver differs.
The Maine waiver expands reimbursement for traditional health care practices through Indian Health Services or Tribal facilities to eligible individuals. The Utah waiver allows for federal Medicaid reimbursement for traditional health care practices provided to eligible beneficiaries through IHS facilities, Tribal health systems, or urban Indian organization facilities.
The National Indian Health Board (NIHB) thanks the CMS Tribal Technical Advisory Group and the Medicaid and Medicare Policy Committee for their years of work to make this possible. NIHB also extends its sincere gratitude to U.S. Department of Health and Human Services Secretary Robert F. Kennedy, Jr. and Administrator Mehmet Oz for this action, and for their sustained attention to the health and wellbeing of Tribal communities. NIHB looks forward to seeing CMS extend similar consideration to the outstanding proposed waivers in additional states.
What the approvals mean
Traditional health care practices have sustained Tribal Nations since time immemorial. Though approaches are different across Tribes, common threads include sweat lodges, talking circles, smudging, traditional ceremonies, cultural teachings, and the gathering, preparation, and use of traditional foods and medicines. What unites these practices is that such traditional uses treat the whole person — supporting mind, body, and spirit, and helping individuals reconnect with cultural identity and community.
For generations, Tribes offering these services to their citizens financed them through a patchwork of federal appropriations, Tribal revenues, and grant funding. Medicaid reimbursement changes that equation. It acknowledges the clinical and cultural value of these practices, and it gives Tribes in Maine and Utah a sustainable path to expand their availability. This approval also represents a significant step in the federal government’s fulfillment of its trust responsibility and treaty obligations.
Years of Tribal advocacy
The approvals answer a direct request from Indian Country. Utah submitted its proposal in November 2024. Maine submitted in July 2025. Medicaid reimbursement provides a sustainable funding pathway, allowing Tribes in Maine and Utah to expand access to practices that support holistic health and strengthen cultural connections. With these approvals, Tribes in Maine and Utah join Tribes in Arizona, California, New Mexico, and Oregon – whose waivers were approved by CMS in October of 2024.
Gratitude for leadership
NIHB is grateful to Secretary Kennedy for his personal commitment to Indian Country. Over the past eighteen months, the Secretary has traveled across the country to meet directly with Tribal health care providers and has participated in traditional healing himself. The firsthand understanding — that holistic approaches to health are often more effective than treating discrete symptoms — has directly shaped this Administration’s willingness to act.
NIHB is equally grateful to Administrator Oz and the CMS team for their recognition of traditional healing’s role in Tribal communities and for moving these applications forward.
Today’s approvals also reflect alignment with the Administration’s Make America Healthy Again priorities. Traditional healing is holistic, preventive, community-centered, and grounded in whole, nutrient-dense traditional foods — an approach to health that Tribal Nations have practiced since long before it had a policy name.
You can read more about the approved Section 1115 demonstrations here and here.
Quotes
“Traditional healing has kept our people well since time immemorial. Today, the Federal government is continuing to recognize what Tribal Nations have always known — that healing the whole person works. This decision solidifies the foundation for Traditional Medicine’s role in our healthcare system, and we will continue to support the growth and evaluation of these methods of care. We are grateful to Secretary Kennedy and Administrator Oz for listening to Indian Country and for acting on what they heard.” – A.C. Locklear, CEO, National Indian Health Board
“For Tribal citizens in Maine and Utah, this means access to care that reflects who they are. Our communities should never have to choose between the medicine of our ancestors and the coverage that makes care possible. Today’s decision honors both, and it honors the trust and treaty obligations this country owes to Tribal Nations.” – Chief William “Bill” Smith, Chairman, National Indian Health Board
Looking ahead
The approvals mark a significant step towards the federal government advancing its fulfillment of its federal trust responsibility and treaty obligations as well as strengthening the foundation for traditional health care practices for Medicaid beneficiaries. Other states and Tribes continue to develop proposals of their own, including Minnesota’s Mino Bimaadiziwin-Wičhózani waiver.
NIHB will continue working alongside TTAG, MMPC, Tribal leaders, and federal partners to ensure that every Tribal Nation seeking to offer traditional healing to its citizens has a sustainable path to do so. If you have questions about the status of waivers or are curious about how to start a conversation about waivers in your state, contact [email protected].
