For the first time, traditional Native healing services could be covered under Medicaid for Utah’s tribes

The proposal comes in a new bill, SB181, from Sen. Luz Escamilla. And it could support more than 1,000 Indigenous residents in getting the care they want and need.

(Leah Hogsten | The Salt Lake Tribune) Utah Navajo Health System’s Monument Valley Clinic on Aug. 24, 2020. The clinic provides traditional tribal healing services to patients who prefer that approach.

The Navajo, or Diné, language doesn’t have a word for diabetes, so when Ernest Harry Begay sees Native patients who have the condition he instead translates it to them as “being killed by sugar.”

Many of his patients don’t speak English as a first language and don’t trust Western medicine. They want to be healed through the traditional Indigenous methods the tribe has used for generations, and Begay offers that care as a licensed counselor and healer in the Utah Navajo Health System. He and other providers will prescribe herbs, prayers and songs to tackle the illness that has become more common across the sovereign nation.

“There’s a special ceremony against the negative energy of diabetes,” Begay said. “We believe it can really help.”

The problem is, though, that those services generally aren’t covered by health insurance. And they’re specifically excluded from Utah’s Medicaid coverage — which is for low-income individuals and which many of Begay’s patients rely on. That means those he sees are often paying out of pocket for traditional healing. Others, he said, are going without the care at all because they can’t afford it.

But a new bill making its way through the Utah Legislature aims to address that gap.

SB181 from Senate Minority Leader Luz Escamilla, D-Salt Lake City, would include traditional Native medicine for reimbursement for those with Medicaid — providing a waiver for the first time for that type of specialized care. The hope is that it would open up access and address longstanding health disparities for Native residents across Utah, who are disproportionately impacted by conditions including diabetes.

The state, if the bill is passed before the end of the session next month, would follow New Mexico, which is currently the only state that is federally approved to have traditional healing services billable under Medicaid. But Arizona and California have also recently submitted requests to do so, as well.

Utah would similarly have to submit a waiver to the federal government for approval; it could take several months to get that signoff.

“This is a very narrow piece, just to this specific community,” Escamilla said during a hearing on the bill this week, when it passed through the Senate Revenue Committee on a unanimous vote; it moves next to the full Senate.

But, she said, “it’s an important way of improving health outcomes for our Native Americans here.”

Utah’s Medicaid enrollees — which total about 500,000 residents, according to data from the state — are 3% Native American, which means up to about 15,000 residents here could benefit from traditional tribal health coverage as part of their plans, if they choose to use that type of medicine.

The state, though, estimates about 1,100 Native Americans with Medicaid will use the coverage for traditional healing services, according to the fiscal note on the bill. The highest percentage of residents on Medicaid in the state is in San Juan County, where the Navajo Nation is.

The cost would be shared by the state and matching federal funds. It’s estimated at about $2.6 million in expenses for fiscal 2026 and $5 million for fiscal 2027; the federal government provides 70% of the Medicaid reimbursement funds for Utah.

It would be up to the governments of each of Utah’s eight sovereign tribes, as well as individual urban Indian centers, to decide which specific services and providers are covered. But the Utah Navajo Health System, where Begay works, is expected to be.

(Screenshot) Ernest Harry Begay, a traditional counselor with the Utah Navajo Health System, speaks to the Utah Legislature in favor of traditional Native medicine being covered under Medicaid on Nov. 14, 2023.

Begay, who spoke to the Legislature about the bill in November and helped draft both it and Arizona’s waiver, said: “We will make history, and Utah will help out Native Americans again.”

The Utah Navajo Health System provides traditional healing services, as well as Western medicine, counseling, dental health, education and behavioral therapy. But there is a divide between generations, Begay noted, with which patients prefer the Indigenous approach. That method mostly includes using special herbs collected on the Navajo Nation, which includes a corner of southeastern Utah and stretches into New Mexico and Arizona, and blessing those to heal.

“In the Navajo mentality, we have herbs that heal,” Begay said. “And then there’s an offering to them, a special expression of prayer to the deities that made those herbs.”

They are used for many chronic illnesses, he said, including cancer. And they have been part of the treatment for COVID, too. “It really works,” Begay added.

He typically focuses his work on those with substance abuse disorders and, for that, he also incorporates sweat lodges into the treatment plan.

The Utah Navajo Health System has four clinics in the state, in Montezuma Creek, Blanding, Monument Valley and Navajo Mountain.

The Ute Tribe, in eastern Utah, has a clinic in collaboration with the national Indian Health Service. The Paiute Indian Tribe in south-central Utah runs its own services with FourPoints Health and recently opened a new facility.

One hurdle to getting that traditional care is distance, according to a 2021 survey of one Utah tribe, with most tribes in remote and rural areas of the state. But the biggest worry, 25% of the respondents said, was a lack of financial resources to pay for it.

Additionally, 41% said they’d like to see more culturally appropriate care for their community, according to the study from the Association for Utah Community Health.

Escamilla and Begay said with extended coverage under Medicaid, the hope is those clinics across the state will start to see more patients who feel like they can now afford to get the care they want and need. And maybe some illnesses can be addressed to where they won’t need a name.

Begay said: “This is the next step.” And there is a Navajo, or Diné, way to say that he’s happy about that: baa shił hózhǫ́.