The U.S. Centers for Medicare & Medicaid Services (CMS) recently expanded tribal health care reimbursement options in state-based and pediatric programs. The move could help palliative care providers improve access and disparities among underserved indigenous populations.
CMS has approved coverage amendments that allow certain state Medicaid programs and Children’s Health Insurance Programs (CHIP) to cover traditional health care practices provided by tribal and Indian Health Service (IHS) facilities and urban Indian organizations (UIO). Impacted Medicaid state programs include Arizona, California, New Mexico and Oregon.
The agency has cited goals to improve culturally appropriate health care delivery and outcomes among tribal communities.
“By strengthening access to traditional health care practices, these innovative state demonstrations can play a crucial role in reducing health disparities and improving health across tribal communities,” CMS Administrator Chiquita Brooks-LaSure said in a press release shared Palliative Care News.
American Indian and Alaska Native populations have higher mortality rates compared to caucasians, according to research from the American Public Health Association. This trend is in part due to inadequate access to health care, unmet needs related to social determinants of health and greater risk of developing chronic diseases such as cancer, heart disease and diabetes, the research found.
Palliative care and hospice providers have sought to improve disparities among tribal and indigenous groups, with some focusing on cultural awareness training and education as key initiatives. Current reimbursement structures have complicated providers’ ability to both understand and address the needs of these underserved populations.
Tribal communities are not part of the United States health system and are not required to submit data on health outcomes, experiences or services, which can limit the scope of understanding among payers and providers, U.S. Department of Health & Human Services (HHS) Secretary Xavier Becerra previously stated.
“Traditional health care practices have been a way of life in many communities,” Becerra said in the CMS announcement. “But, too often, health insurance does not cover them. With Medicaid and CHIP’s inclusion of traditional health care practices at certain IHS facilities, we are extending access to culturally appropriate, quality health care in tribal communities.”
Data has increasingly pointed to a growing need for improved palliative care support among underserved and seriously ill indigenous populations. Recent research published in the Journal of Pain and Symptom Management found four common themes impacting palliative care delivery and access among American Indian and Alaska Native communities:
- Fragmented health care delivery and lack of resources
- Geographical and weather-related factors, including travel costs
- Workforce elements such as inadequate staffing, insufficient care continuity and unfamiliarity with cultural practices
- Historical trauma and racism
Allowing for expanded traditional health care coverage could help bridge gaps of lagging physical, emotional and practical support structures, according to IHS Director Roselyn Tso. Traditional healers and practitioners play a significant role in health care delivery among tribal and indigenous communities, Tso indicated.
“American Indian and Alaska Natives have been endowed by our ancestors a deep and priceless wealth of traditional healing knowledge,” Tso said in the CMS news release. “These practices have sustained our people’s health for generations and continue to serve as a vital link between culture, science and wellness in many of our communities. We appreciate the [Biden-Harris] Administration’s commitment to move forward with covering this care, and the IHS is honored to be a partner in this essential work.”
The changes to traditional health care coverage are among the latest iterations in CMS’ health equity focus. The agency in recent years has released strategies to address factors fueling health disparities among underserved communities, including American Indian, indigenous and tribal groups.
One of these strategies included the 2022 launch of the CMS Framework for Advancing Health Care in Rural, Tribal, and Geographically Isolated Communities, which outlined priorities to expand access to health care coverage, benefits and services to patients in rural, tribal, frontier or geographically isolated areas. Additionally, the agency prioritized strengthening support for health care professionals serving these regions.
“[We] will keep pushing to … eliminate racial inequities in our health care system,” President Joe Biden said in a White House email correspondence to Hospice News. “Health care is a right, not a privilege. But for millions of Americans, health care is too expensive. We’re making enormous progress, but we know the fight is still unfinished.”
