WSR 25-21-155

HEALTH CARE AUTHORITY

[Filed October 22, 2025, 10:53 a.m.]

Effective date: If approved, the traditional health care practices waiver could begin as soon as July 1, 2026.

The health care authority (HCA), in partnership with tribes in Washington state, will submit a five-year traditional health care practices waiver application to the Centers for Medicare and Medicaid Services (CMS). This waiver is a section 1115 waiver and, if approved, could begin as soon as July 1, 2026.

American Indian and Alaska Native people have long recognized that traditional health care practices are essential to healing and wellness. The 29 federally recognized tribes in Washington state have rooted these practices, often called traditional Indian medicine, in their cultures. For years, tribes have championed the recognition of these valued practices and worked toward sustainable funding to expand and ensure timely access to this vital care.

About the waiver: The traditional health care practices waiver is one way we can ensure tribes are recognized, and paid, for providing traditional health care services. Under this waiver, CMS would allow certain types of facilities to provide traditional health care services as "qualifying facilities," including:

When a qualifying facility provides traditional health care services to an eligible apple health or children's health insurance program enrollee, medicaid will reimburse (pay) that facility for the service. This is a significant step in:

Public comment period: As part of the waiver application, HCA is holding a public comment period from November 5 to December 5, 2025. During this time, people can share their input on the waiver application or other comments about traditional health care practices.

Public comment is open to anyone who would like to share their input, especially tribal nations, Indian health care providers, UIHOs, tribal health organizations, and native-serving organizations. We also encourage health care and social service providers, hospitals and health systems, community-based organizations, the public, and anyone else interested in sharing their input.

The deadline to provide public comment is Friday, December 5, at 5:00 p.m. Pacific Time.

Public hearings: In partnership with Lummi Nation and Yakama Nation, we will offer two public hearings to share information about the waiver. During the hearings, attendees will have an opportunity to ask questions and provide input. Attendees can attend in person, join virtually, or call in.

More information, including full details about the waiver and other ways to provide public comment, is available on our traditional health care practices waiver page.

Contact: For additional information, contact medicaid transformation tribal liaison, Lena Nachand.