Tribe considers joining final year of Medicaid demonstration project

By Nicole Montesano

Smoke Signals staff writer

The Tribe’s Health & Wellness department is considering joining a program that would enable it to bill Medicaid for traditional Indigenous medical practices.

Oregon, California, Arizona and New Mexico have obtained waivers enabling Tribes in those states to bill Medicaid for traditional practices, in a demonstration project that began in 2024 and will expire in 2027, unless extended.

The Tribal Health & Wellness Center held a joint meeting with Social Services Thursday, June 11, to give Tribal members a chance to discuss the program. Response to the idea was mixed, with concerns focused on sweat lodge.

Some participants said they were concerned that the government might find a way to interfere with people’s ability to participate in attending sweat lodge by imposing external rules. They argued that such an important spiritual ceremony ought to be kept far away from government hands and government money.

“I think this really goes against who we are as Tribal people and the ceremonial ways that we have set in place,” one woman said. “I want to hear more about spiritual aspects and where this is going.”

Participants said they had fewer concerns about the several other programs proposed for inclusion.

Tribal Council members Lisa Leno and Toby McClary attended the meeting.

For the Tribe’s wellness providers, the issue seems straightforward, Tribal Executive Director of Health Services Kelly Rowe told the group: The federal government has a trust responsibility to pay for Tribes’ health care and traditional practices are health care.

“There is statistical analysis out there that shows, especially around sweat, that there are some focused outcomes around it for mental health and for substance use. In as little as three interventions, three visits, three times that people go to sweat, that it will change your mental health outcome or your substance use outcome. … it’s not separate from any of our other health care, because it is health care,” Rowe said.

Being able to bill Medicaid when applicable, she said, holds the government responsible for its trust obligations, upholds Tribal sovereignty and provides additional funds for the Tribe’s health programs.

Tribal Social Services Manager Dana Ainam said in an email that she and Rowe would be hosting one additional community input.

“We will also decide if we want to do a podcast to capture the information so there is an ongoing reference for members,” Ainam said.

Rowe said that, “The idea would be that we’re not documenting specifically what’s going on at the ceremony. We’re not going to say, ‘We went into this lodge, we did this, we poured’ – nothing like that will be on this. A very short sentence: ‘We did a sweat,’ that’s it. We’re not giving away the tradition, we’re not giving away the culture, we’re not doing anything that’s going to infringe on our rights or our traditions or that is stealing from us.”

The Tribe would bill Medicaid in cases where Medicaid-eligible participants are using the services, Rowe said, but promised that “Nobody would be turned away. … This is just for us to be able to recoup revenue” to help pay for the programs.

Some participants expressed fears that people would end up having to pay to participate in sweat ceremonies or that the medicine of the ceremony might be tainted.

One woman said she’s concerned that, “Once you start bringing money in, Medicare and Medicaid, then there’s all kinds of rules and stipulations and things that everybody wants to know. Do you have a fire truck that’s going to be near the sweat lodge … once you start doing that, people will stop going because there’s too many rules and regulations.”

She added that she is also concerned that sweat can cause harm if people don’t take it seriously enough or approach it without breaking their dependence on drugs or alcohol.

 “Not that it’s a bad medicine, but it’s just a part of the way the Spirit is,” she said. “The Spirit takes things very, very serious. You can’t play with it.”

Tribal Peer Support Specialist Ferrell DeGarmo, who offers sweat ceremonies for Tribal members, said the medicine takes care of itself.

DeGarmo said he agrees that people can cause themselves harm by approaching it in the wrong way but said that people need access, rather than gatekeeping.

“A lot of those protocols existed pre-colonization. Pre-contact,” DeGarmo said. “Now we have intergenerational trauma. We have drugs and alcohol issues. We have mental health issues. All of these things that are affecting our people now, that didn’t exist when we had all those protocols, when we were really strict. And does that mean that our people don’t deserve the medicine, just because they’re in a place with their own struggles now?”

DeGarmo said he’s already spending hours of his time seeking federal grants to help cover the costs of providing sweat ceremonies; the Medicaid program would simply save that time.

“It took me six months to chase down $20,000 – and that didn’t come from the Tribe, it didn’t come from a foundation, it came from the state,” he said. “Again, government…For me, this is an opportunity for us to reclaim our sovereignty because for the longest time, they came in, took our identity, tried to eradicate us. And then after they caused all the damage, they tried to tell us how to get well. Take this pill, go to this program, do this therapy. All that, after the damage was done. Took our hair. Meanwhile, we’ve always had the answer and a lot of us see that; culture is healing. Culture is medicine. This is the opportunity for us to reclaim that.”

Some participants suggested removing sweat and certain other ceremonies from the list, but retaining the remainder of the items, which include not only ceremonies and rituals but many of the Tribe’s activities and programs, including Canoe Journey, cradle boards, culture camp, horse therapy, Tribal youth conferences, powwows and more.

In April, Klamath Tribal Health & Family Services announced that it was the first Tribe in the U.S. to successfully bill Medicaid, administered by the Oregon Health Plan, for “culturally grounded and traditional healing services.”

Klamath Tribal Health CEO Angie Wilson said in the press release that “This is more than a policy achievement – it’s a restoration of cultural and spiritual balance. We are reclaiming our ways of healing and ensuring they are recognized as essential to the well-being of our people.”

Oregon announced the program in October 2024.

“It is long overdue that we recognize and provide true support for traditional health care practices and providers in Oregon’s Tribal communities,” Emma Sandoe, Oregon’s Medicaid director, said in the press release. “This will help improve the quality of care, healthy outcomes and access to culturally appropriate health for Tribal communities in the state.”