Alaska proposes Medicaid coverage of traditional healing through Tribal health programs

The Alaska Department of Health released a proposal Monday for Medicaid to cover traditional healing for Alaska Native and American Indian enrollees through Tribal health programs. Coverage would start no earlier than Jan. 1, 2028.

The department will take public comment until 5 pm Nov. 4, then ask the Centers for Medicare & Medicaid Services for a five-year Section 1115 demonstration, a federal waiver letting a state cover services Medicaid normally does not. The draft application attributes the delay before coverage begins to operational work, like adding a claim code to the Medicaid system.

Each participating Tribal health program would set its own covered practices, choosing among ceremonial practices, physical body work, counseling based in traditional approaches, talking circles and traditional nutrition education. Healers, also called Tribal doctors, would work for or contract with those programs rather than enroll in Medicaid individually.

The department projects 1,156 people would use the benefit in its second year and 2,179 in its fifth, of about 82,600 eligible. Spending would rise from $14.8 million in year two to $33.7 million in year five, roughly $97.8 million total. The department expects the federal government to pay the full cost and to deem the project budget neutral, meaning it is not likely to raise overall Medicaid spending.

The application says Tribes already fund traditional healing programs themselves. William F. Smith, chairman of the Alaska Native Health Board, backed the waiver in an Oct. 2 letter to Commissioner Heidi Hedberg, urging submission "on an expedited basis to take advantage of current budget neutrality requirements."

Federal regulators first approved this kind of coverage on Oct. 16, 2024, in Arizona, California, New Mexico and Oregon. Alaska's department will hold public hearings Oct. 14 in Juneau and Oct. 16 in Anchorage, and a federal comment period will follow the state's submission.