House approves Medicaid waiver request to reimburse traditional healing services for Native Americans after debate

The Utah House on Feb. 28 approved second-substitute SB181, which directs the Department of Health and Human Services to apply for a Medicaid waiver to permit reimbursement for qualified traditional healing services for American Indian and Alaska Native Medicaid beneficiaries in Utah.

Sponsor Representative Watkins told colleagues the bill would allow Indian Health Service reimbursement for ‘‘qualified traditional medicine services’’ and would require the department to pursue a federal Medicaid waiver. ‘‘This bill will allow Indian Health Service reimbursement for qualified traditional medicine services provided for their Medicaid beneficiaries who live here in Utah,’’ Watkins said.

The measure drew questions about what activities would be covered. Representative McPherson asked what ‘‘traditional healing services’’ might include; Watkins responded that they can include ‘‘a sweat lodge, chants and herbs,’’ and sometimes sand drawings used in traditional ceremonies.

Members also debated fiscal and constitutional issues. Representative McPherson expressed concern about funding the services ‘‘through the Medicaid expansion’’ and asked whether the measure would divert existing Medicaid funds; Watkins said most costs would be federally reimbursed and the bill’s fiscal note largely reflected administrative expenses, which he said were small. ‘‘All but the little bit that's on the fiscal note,’’ Watkins said when asked about federal reimbursement.

Representative Brammer raised a constitutional question, citing Article I, Section 4 of the Utah Constitution and asking whether public dollars could be used in ways that support religious exercise. ‘‘I think that it is a religious exercise,’’ Brammer said, arguing public funds should not be used for religious worship. Colleagues responded that the legislation is limited to health services and contains safeguards: Representative Romero, who serves on the Native American legislative liaison task force, said the bill is ‘‘a traditional practice’’ that increases Native patients’ willingness to seek care and noted similar laws in New Mexico and Arizona.

Supporters emphasized cultural competency and treaty obligations. Representative Lyman framed the provision as a treaty responsibility and noted practical benefits seen at Utah Navajo Health Systems, where traditional facilities have aided patient engagement. ‘‘I've seen it work phenomenally well,’’ Lyman said.

The House closed debate under a previous-question motion and voted to pass second-substitute SB181, 43 yeas to 23 nays. The bill will be signed by the Speaker and transmitted to the Senate for concurrence.

Next steps: SB181 is sent to the Senate for its consideration and the department would begin the waiver process only if the federal criteria and administrative rules are satisfied.