“I knew immediately that I was in the right place. A traditional practitioner did prayers for me. They shared some songs with me. They put me in the sweat lodge and I could identify with those ceremonies. And from that day moving forward, I was able to reconnect to my spiritual and cultural upbringing,” said Emery Tahy of his experience with the Friendship House, a Native-led recovery treatment center. Tahy explained that his experiences with addiction and recovery are inseparable from his experience as a Native American and that traditional medicine played a transformative role in his healing. For many Native Americans, stories like Tahy’s are familiar—and amplified by the deep cultural disconnect many Indigenous communities face.
The trust responsibility to American Indians and Alaska Natives—a legal obligation between the government and Native Americans built from historical treaties—requires that the US government “ensure the highest possible health status for Indians and urban Indians and to provide all resources necessary to effect that policy.” However, the state of American Indian/Alaska Native (AI/AN) healthcare in the United States is dire. The Indian Healthcare Service (IHS), the federal agency that provides medical care to 2.8 million Native Americans through a network of hospitals, clinics, and health centers across the country, is chronically underfunded. As a result, its hospitals struggle to find staff and provide adequate care. Native Americans experience disproportionately high rates of chronic conditions such as heart disease, obesity, and diabetes, as well as mental health conditions. Studies estimate that one in five Native American young adults (18–25) have a substance use disorder, 40 percent higher than the national average. During the height of the opioid crisis, the Native American community saw overdose deaths reach a rate almost three times that of white Americans. The US obligation to ensure the health of Native Americans is clearly being neglected.
Funding is not the only issue, however. As patients like Tahy explain, the Native American experience with addiction is also a result of the prejudice, racism, and segregation felt by their communities. For example, poverty rates and pollution tend to be higher in Indigenous communities. These same communities tend to lack access to affordable, quality healthcare and are disproportionately uninsured. Native youth have fewer protective factors—healthy and secure relationships, access to quality healthcare, bicultural competence, and participation in school, as well as hobbies or activities—and more risk factors—including discrimination, alienation from broader culture, generational trauma, and personal experience with violence—for substance use disorders than other youth. This means that Native American youth are left especially vulnerable to substance use disorders. Culturally competent care promotes protective factors by engaging family members, recognizing cultural differences, encouraging discussions about trauma, and uplifting aspects of Native cultures.
Traditional healing is care rooted in tribal values—addressing physical, emotional, spiritual, and mental health needs. Although different tribes have their own unique implementations of traditional healing, they all revolve around these four cardinal aspects of health. Examples of traditional healing practices include participating in talking and healing circles, making art, preparing and eating Indigenous food, storytelling, and using sweat lodges. Despite the differences between traditional healing and Western medicine, the two do not oppose each other. Both can be leveraged to comprehensively treat patients.
Many tribal leaders have claimed that Western medical practices alone cannot be used to treat many Native Americans—and have been proven right. In fact, traditional healing practices, when integrated into addiction recovery, have proven to lead to higher engagement and improved outcomes for Native Americans. In urban communities, where Indigenous patients come from more diverse backgrounds, treatment plans that combine Western and traditional practices have been especially successful. Cultural identity and spirituality are critical aspects of substance abuse recovery for Native peoples. As a licensed therapist and member of the Lone Pine Paiute-Shoshone Tribe, Kiana Maillet explains: “It is vital that we honor our traditional ways of healing… Without it, we are missing a piece of who we are.”
Until recently, affordable care of this kind was inaccessible to many Native Americans. But in October 2024, California, Arizona, New Mexico, and Oregon started a two-year pilot program that expanded Medicaid coverage to traditional healing practices provided by the IHS. The National Council of Urban Indian Health recognized this expansion as a landmark on the journey toward improved health outcomes and the growth of culturally appropriate healing practices. However, funding and accessibility remain paramount issues for Native Americans and the IHS. For example, an estimated 70,000 AI/AN people are eligible but not enrolled in Medicaid. This does not include those who are not enrolled and do not have access to IHS services.
To make matters worse, during Donald Trump’s first term, his administration allowed states to shrink Medicaid eligibility by expanding Section 1115 demonstration policies. These policies allow states more flexibility in implementing Medicaid programs by granting them the ability to limit retroactive eligibility, impose work and community engagement requirements, and implement flexible benefit designs with capped funding models. As a result, some states adopted restrictive Medicaid policies that limited access. Policy changes such as these disproportionately hinder access to Medicaid for Native Americans, abrogating the federal government’s trust responsibility. Tribal leaders advocated for exemption from these policies, but results have been inconsistent across states and limited largely to members of federally recognized tribes. Given Trump’s return to office, federal and state policy options may become even more limited.
Some tribes have begun experimenting with community-based healthcare solutions rather than relying on underfunded IHS hospitals. Community clinics have improved access to consistent, reliable healthcare for Native Americans and represent the self-reliance that tribal members desire after generations of mistreatment at the hands of the federal government. These projects have relied on a variety of funding sources such as grants, nonprofit organizations, Covid-19 relief funds, and tribal money (particularly profits from casinos). However, many tribes do not have access to fund stockpiles and are still struggling to make do with federally funded care.
The recent expansions of Medicaid in California, Arizona, New Mexico, and Oregon are steps in the right direction, but there is still a long way to go to successfully uphold the commitments made to support the health of Native peoples in the United States. Federal and state governments must expand Medicaid funding for traditional healing practices and accessible community-based solutions that put Native people first. In order to wholly fulfill their obligations, all states should make traditional healing Medicaid eligible and boost AI/AN Medicaid enrollment. It is nonnegotiable that health disparities in the United States must be addressed in more holistic ways to promote the health and well-being of the Native American population.