What you need to know: California is expanding access to culturally-based substance use disorder (SUD) treatment services. Today marks the first time Medi-Cal will cover traditional health care practices that are deeply rooted in cultural practices and have been shown to improve health outcomes, particularly for individuals with SUDs. 

Sacramento, California – Governor Gavin Newsom announced today that California is expanding access to culturally-based substance use disorder (SUD) treatment services.  

After years of working toward this milestone, today marks the first time Medi-Cal will cover traditional health care practices in use since time immemorial. These are deeply rooted in cultural practices and have been shown to improve health outcomes, particularly for individuals with SUDs.

Native Americans continue to be disproportionately impacted by the opioid epidemic, with higher overdose death rates than other racial and ethnic groups in the United States.

As the home of the largest population of Native Americans in the country, California is committed to helping heal the historical wounds inflicted on tribes – including the glaring health disparities we see between Native communities and other groups. Like many of the issues that plague successive generations of Native people, those inequities can be traced back to the historical atrocities the U.S. inflicted on tribes across the country. By supporting greater access to traditional medicine and healing, we are taking another step toward a healthier, brighter future. - Governor Gavin Newsom

“Native American communities have long faced barriers to accessing traditional medicines and healing resources in this State,” said Tribal Affairs Secretary Christina Snider-Ashtari. “Support for these critical practices will again allow the rich and diverse Native populations who have lived here since time immemorial – along with those who now call California home – to access time-honored and tested methods to bolster wellness in Native families, communities, and tribal nations.”

Traditional healers and natural helpers

The Centers for Medicare & Medicaid Services’ (CMS) approval for California, alongside Arizona, New Mexico, and Oregon, allows two new categories of interventions to be covered by Medi-Cal, as developed by the state in partnership with tribal partners:  

- The first, provided by traditional healers, includes music therapy (i.e., traditional music, songs, dancing, and drumming) and spiritual interventions (i.e., ceremonies, rituals, and herbal remedies). A traditional healer is any person currently recognized as a spiritual leader with at least two years of experience practicing in a setting recognized by a Native American tribe and who is contracted or employed by an Indian Health Care Provider (IHCP).
- The second, provided through natural helpers, includes navigational support, psychological skill building, self-management, and trauma support. A natural helper is a health advisor who delivers health, recovery, and social supports in the context of tribal cultures. Natural helpers can be spiritual leaders, elected officials, or paraprofessionals who are trusted members of a Native American tribe.

This marks a significant milestone in the state’s ongoing efforts to recognize the valuable contributions of traditional healing practices within the health care system. Traditional healing services have been trusted and tested methods of care for Native Americans for generations. They are deeply rooted in cultural practices and have been shown to improve health outcomes, particularly for individuals with SUDs.

Studies have demonstrated that these culturally centered approaches can enhance engagement and recovery outcomes, making them an essential component of holistic care for Native communities. Additionally, the state recognizes that tribal communities understand themselves best – and that each tribe has different needs, traditions, and histories – so each participating IHCP will create its own process to identify and credential its own traditional healers and natural helpers.

“CMS’ approval is first and foremost the fulfillment of the efforts of our tribal leader and Urban Indian Organization partners whose vision and steadfast advocacy made this a priority,” said State Medicaid Director Tyler Sadwith. “I am immensely proud that California tribal and Urban Indian communities now have access to culturally based traditional healing practices through Medi-Cal, marking a historic step toward health equity and honoring the rich traditions of our diverse Native communities.”

“It is vital that we honor our traditional ways of healing and understand they are as important and valuable as Western medicine,” said Kiana Maillet, licensed therapist and owner of Hiichido Licensed Clinical Social Worker Professional Corporation. “Traditional healing is deeply engrained in our blood memory, our cultures, and our communities. Without it, we are missing a piece of who we are. As we continue to regain access to traditional ways – ways that our ancestors were punished for in the past – we move forward with healing from historical traumas and improving the health of our future generations.”

Starting January 1, 2025, IHCPs can request Medi-Cal reimbursement for Traditional Healer and Natural Helper Services provided to residents of qualifying counties. In the coming months, the state will consult with tribes and tribal partners to develop guidance.

Bigger picture

In 2019, Governor Newsom apologized on behalf of the State of California to California Native American peoples, and announced the creation of the California Truth and Healing Council. Through collaborative and consultative work of the Council, the Governor’s Office of Tribal Affairs, and tribes across the state, a number of policies and programs have been developed so that the state can better address historical injustices and support tribes and tribal work in everything from health to climate. 

Medi-Cal coverage for traditional healer and natural helper services strengthens the longstanding investments the state has made to expand SUD prevention, treatment, recovery, and harm reduction resources for California tribal and Urban Indian communities through the Tribal MAT Project. 

This work also builds on the state’s broader efforts to address the opioid crisis and overdose epidemic, which is outlined in the Governor’s Master Plan for Tackling the Fentanyl and Opioid Crisis and on opioids.ca.gov, a one-stop tool for Californians seeking resources for prevention and treatment, as well as information on how California is working to hold Big Pharma and drug traffickers accountable in this crisis. More information on the state’s efforts can be found here.