For many Indigenous and Alaska Native people, traditional healing is not an alternative to healthcare. It is a core part of it. Yet access to it remains strikingly limited, even within the systems specifically built to serve Indigenous communities. Expanding that access is not just a cultural nicety. It is a genuine, underfunded piece of closing one of the country's most persistent health equity gaps.
The Access Gap Is Real and Documented
Traditional healing is a right the federal government has formally recognized. The 1978 American Indian Religious Freedom Act, later expanded in 1994, established that when a patient at an Indian Health Service facility requests a traditional healer, every effort will be made to comply, including providing space for ceremony or authorizing funds for a healer's services.
But the reality on the ground falls well short of that commitment. A federal review found that just 33 percent of Indian Health Service and tribal facilities offering mental health services actually provided traditional healing alongside them. That gap is compounded by a geographic mismatch. Many of those facilities are located on or near reservations, but roughly 70 percent of Indigenous people in the United States live in urban areas, far from the clinics that do offer traditional services.
Why the Gap Persists
The shortfall is not due to a lack of recognized need. It is structural, and it traces back to chronic underfunding of Indigenous health systems overall.
- The Indian Health Service is funded at a fraction of comparable programs. Per person spending has been documented at roughly 4,078 dollars, compared with 8,109 dollars for Medicaid, 10,692 dollars for the Veterans Health Administration, and 13,185 dollars for Medicare, despite Indigenous communities facing some of the highest health disparities in the country.
- Urban Indigenous health programs are even more underfunded. These programs, which serve the majority of Indigenous people living outside reservation areas, receive roughly 672 dollars per person served, compared with a national average of more than 11,000 dollars per person across the broader healthcare system.
- Reimbursement mechanisms are unresolved. Traditional healing is often not covered by Medicaid or private insurance, leaving tribes and urban Indigenous organizations to rely on time consuming, short term grant funding that makes sustained programming difficult.
- Credentialing remains an unsettled question. Tribes have consistently asserted that they, not federal agencies, should determine who qualifies as a legitimate traditional healer. Reconciling that tribal authority with federal payment systems built around civil service and competitive bidding requirements has been a persistent administrative challenge.
Why This Matters Beyond Access Alone
Expanding access to traditional healing is not only about honoring cultural tradition, though that alone would be reason enough. It is also about closing a documented health outcomes gap. Indigenous communities face significantly higher rates of poor health, chronic disease, and behavioral health conditions than the general population, shaped by a long history of policy failures, discrimination in care delivery, and for many patients a justified, historically rooted mistrust of mainstream healthcare institutions.
Traditional healing offers something that is not easily replicated by adding another biomedical clinic alone: care delivered by practitioners the community already trusts, grounded in cultural and spiritual frameworks that many Indigenous patients find biomedical care alone does not fully address, particularly for behavioral and mental health needs. Multiple tribal health programs have found that combining traditional healing with clinical behavioral health services measurably improves patient engagement and outcomes compared with biomedical care offered in isolation.
What Progress Looks Like
There is real, encouraging movement on this front, though it remains far from complete.
- State Medicaid reform. States including Arizona and California have pursued federal authorization through Medicaid Section 1115 waivers to reimburse traditional healing services for Indigenous beneficiaries, a shift that would meaningfully expand who can actually afford to access these services.
- Tribally led credentialing. Recent federal guidance has moved toward supporting tribally led credentialing and billing systems for traditional healers, respecting the principle that tribes are best positioned to determine legitimacy within their own traditions.
- Innovative delivery models. Programs such as Alaska's Behavioral Health Aide Program have found ways to train and deploy community based practitioners more flexibly than traditional clinical staffing models allow, helping close urban and rural access gaps alike.
What Real Progress Requires
Meaningful expansion of access will require movement on several fronts at once: sustained federal investment in the Indian Health Service and urban Indigenous health programs, durable Medicaid and insurance reimbursement pathways for traditional healing services rather than short term grants, and continued respect for tribal sovereignty in determining who qualifies as a legitimate healer within their own tradition rather than imposing external, one size fits all credentialing standards.
The Bottom Line
The federal government formally recognized the value of traditional healing access nearly five decades ago. What has been missing since is not recognition. It is follow through: the funding, the reimbursement infrastructure, and the respect for tribal authority needed to make that recognition real for the majority of Indigenous people who currently cannot access it, especially those living in urban areas far from reservation based clinics. Closing that gap is a genuine, addressable health equity issue, not a symbolic one.
Earth Peace Labs is building a network of holistic practitioners, healing centers, and retreats to widen this access for our members and the communities we serve.