Utah is implementing a Medicaid program to reimburse traditional healing practices for eligible Native American beneficiaries, after the Centers for Medicare & Medicaid Services approved waiver applications from Utah and Maine in late September. The approvals push the number of states with Medicaid waivers covering traditional healing to six, adding Utah and Maine to Arizona, California, New Mexico and Oregon.
According to the National Council of Urban Indian Health, CMS confirmed it had approved section 1115 applications from Utah and Maine to provide reimbursement for traditional healing for eligible beneficiaries. The organization specifically flagged that Utah's application expressly identifies Urban Indian Organizations as eligible entities, a detail that matters because most Native Americans don't live on tribal land. Per Utah News Dispatch, approximately 87% of Native Americans live outside of tribal areas, according to the 2020 Census.
That framing puts the Urban Indian Center of Salt Lake squarely in the picture. NCUIH notes the center provides traditional healing programming as part of its care for the Salt Lake City Native community, meaning Utah's urban Native population could have a formal Medicaid pathway to practices that have often existed outside the reimbursement system entirely once the program is implemented.
A Funding Fight Still Unresolved
Not everything Utah asked for came through. CMS rejected the state's request for the federal government to reimburse 100% of the costs that urban Indian health organizations pay to provide care for Native Americans, the Utah News Dispatch reported. That denial echoes a broader pattern Urban Indian Organizations have faced nationally, where NCUIH has said such organizations have historically received a minuscule share of federal funding allocated for the Indian Health Service.
The gap is notable because Indian Health Service and tribally run health organizations receive full federal reimbursement, while urban Indian clinics have had to push for the same treatment. That disparity has shaped NCUIH's broader policy agenda: the organization's 2026-2027 priorities, shaped by five focus groups and a nationwide survey of urban Indian organizations, call for establishing permanent full federal matching funds for Medicaid services at Urban Indian Organizations.
How Other States' Waivers Work
Utah and Maine are the latest additions to a model CMS first approved in October 2024, when it signed off on section 1115 waivers in Arizona, California, New Mexico and Oregon, according to the Center for Health Care Strategies. In Arizona, New Mexico and Oregon, the waivers allow anyone covered by Medicaid and eligible for care through IHS to receive traditional health care services, the organization reported. For American Indian and Alaska Native people, states receive a 100 percent federal match for those services when delivered through IHS and tribal facilities and Urban Indian Organizations with care coordination agreements, and the practices can take place in a clinic, a patient's home, or sacred or ceremonial sites.
California's waiver works a bit differently — it currently applies only to IHS-eligible people enrolled in the state's Drug Medi-Cal Organized Delivery System, per the Center for Health Care Strategies, though CMS has given the state room to expand eligibility without a formal amendment. Oregon's 2024 approval has already produced a tangible example of how these waivers translate into practice: since that waiver took effect, the Confederated Tribes of Grand Ronde have been eligible for reimbursement for their canoe journeys, the Utah News Dispatch reported.
California's Renewal Hangs in the Balance
Unlike Utah and Maine's fresh approvals, California's traditional healing coverage rides on a much larger, pre-existing Medicaid waiver that is set to expire at the end of December. The state's renewal application was pending with CMS as of early November, according to the same Utah News Dispatch report, leaving the fate of that state's program unresolved for now.
Whether California's renewal clears CMS review before year's end — and what happens to its traditional healing coverage if it doesn't — remains an open question the dossier record doesn't yet answer. For now, the six-state landscape stands as the clearest marker of how far Medicaid's embrace of traditional healing has expanded since the first-in-the-nation traditional-healing waivers were approved for Arizona, California, New Mexico and Oregon two years ago.
