The evaluation will be led by Claradina Soto, who is Navajo and Jemez Pueblo, an associate professor of social medicine, population, and public health in the UCR School of Medicine. Soto joined UC Riverside earlier this year after a decade at the University of Southern California, where the project was first housed, and she brings with her a long record of community-engaged research on substance use prevention and Indigenous health. Under her leadership, the initiative will bring together tribal leaders, clinicians, health organizations, and state partners to collect and analyze data on the benefit, including how it is implemented, what barriers and facilitators shape its delivery, how services reach patients, and what participants themselves experience.

The stakes of the evaluation are rooted in a painful public health reality. California was prompted to create the traditional health care practices initiative by disproportionately high rates of opioid overdose and substance use deaths among Native American communities. Those disparities reflect generations of historical trauma, limited access to culturally appropriate care, and health systems that were often designed without input from Indigenous peoples. By embedding traditional healing into the state’s Medicaid infrastructure, California is attempting to address substance use not only with clinical tools but with practices that connect patients to community, culture, and identity.

The mechanics of the benefit are notable in the landscape of American health policy. The Centers for Medicare & Medicaid Services, the federal agency within the U.S. Department of Health and Human Services that administers the Medicare program, approved the California Department of Health Care Services to cover traditional health care practices for Medi-Cal members in Drug Medi-Cal Organized Delivery System counties. That approval came through an amendment to California’s Section 1115 waiver, a special federal agreement that allows states to test new, flexible ways of running their Medicaid programs, coordinating physical and behavioral health, and funding unique care initiatives. Through this waiver structure, services that would normally fall outside the scope of reimbursable medical care can be financed through the state’s Medicaid program.

California is one of only a few states approved to reimburse traditional healing services through Medicaid, which makes the initiative a nationally significant model for integrating Indigenous healing into health care. The services covered under the benefit are culturally grounded and diverse: ceremonies, one-on-one support from traditional healers, talking circles, prayer, and other healing approaches that complement clinical care, including treatment and recovery services for people with substance use disorders. Before the benefit was established, many Indian health clinics relied on grants or other temporary funding sources to offer these services, leaving them vulnerable to funding gaps and forcing healers and clinics to piece together support year after year. Medicaid reimbursement, by contrast, offers a durable, systemic financing mechanism that recognizes these practices as legitimate components of care.

Soto emphasized the historical weight of the moment. “This has been more than 10 years in the making, so it’s a major milestone,” she said. “California is one of only a few states where traditional healers can be reimbursed through Medicaid, creating an important opportunity to evaluate how these services are implemented and their impact on communities.” The decade-long path to the benefit reflects persistent advocacy by tribal communities and their allies, who argued that healing practices sustained for millennia deserved recognition within the systems that now serve Indigenous patients. The evaluation grant represents the next phase of that journey: turning policy achievement into evidence that can sustain and expand the work.

As principal investigator, Soto will oversee an evaluation design that combines multiple methods to capture the complexity of the benefit across the state. The project will include interviews with clinic providers and traditional healers, who can describe how the reimbursement system works in practice and where it creates friction; focus groups with community members, who can speak to the cultural fit and perceived value of the services; and surveys of patients receiving traditional healing services, which will generate quantitative data on experiences and outcomes. Guiding the entire effort will be an advisory board composed of tribal representatives, clinicians, and tribal and urban Indian organizations, ensuring that the research remains accountable to the communities it studies, a principle increasingly recognized as essential in Indigenous health research.

The significance of this work extends well beyond California’s borders. As one of the first systematic evaluations of a Medicaid-reimbursed traditional healing benefit, the project is positioned to inform national conversations about Indigenous health care and culturally grounded approaches to wellness. “The project represents a significant opportunity to contribute to national conversations about Indigenous health care and culturally grounded approaches to wellness,” Soto said. “By partnering with tribal communities, health care providers, and the DHCS, we hope to identify best practices that strengthen access to traditional healing and improve care for Native communities.” Other states watching California’s experiment will look to the evaluation’s findings as they consider whether similar benefits could work in their own Medicaid programs.

The evidence generated by the evaluation is expected to serve two audiences simultaneously. In California, it will help inform future policy decisions by the Department of Health Care Services, showing policymakers which implementation strategies succeed, which barriers must be addressed, and how the benefit might be refined or expanded. Nationally, it will provide a roadmap for other states interested in integrating Indigenous healing practices into their health care systems, offering concrete data on implementation processes, service delivery models, and participant experiences rather than leaving them to navigate uncharted territory. Soto noted that the evaluation will generate evidence on how the benefit is implemented across diverse communities and health care settings, a critical consideration in a state as large and varied as California, where tribal nations, rural clinics, and urban Indian health programs all operate under different conditions.

For the communities at the center of the initiative, the evaluation carries the promise of validation and sustainability. Traditional healing has always been central to Indigenous well-being, but its marginalization from formal health financing has limited access for many patients seeking recovery from substance use disorders. If the evaluation demonstrates that reimbursed traditional healing services improve engagement, recovery outcomes, and community health, it could cement the benefit as a permanent fixture of California’s Medicaid program and inspire a wave of adoption across the country. What began as a response to a devastating crisis of opioid overdose and substance use deaths may ultimately reshape how the American health care system understands healing itself, recognizing that for many patients, recovery begins not in a clinic exam room but in a ceremony, a talking circle, or a conversation with a healer who shares their culture and their history.