What California's Indian Health Policy Waiver Actually Does

California's Indian Health Policy Waiver — a Medicaid Section 1115 demonstration waiver — allows the state's Medi-Cal program to reimburse certain traditional healing practices for eligible Native American and Alaska Native residents. That waiver is up for federal renewal in 2026, and what happens next could directly affect thousands of Indigenous families who rely on culturally grounded care as part of their healthcare. If you are a Native American resident of California navigating Medi-Cal or Indian Health Service coverage, here is what you need to know right now.

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Data Snapshot

According to the California Department of Health Care Services (DHCS), approximately 200,000 American Indian and Alaska Native individuals are enrolled in Medi-Cal statewide. The Indian Health Policy Waiver, operating under federal Section 1115 authority, has allowed California to extend reimbursement to traditional healing services that standard Medicaid rules would not otherwise cover. Nationally, the Indian Health Service (IHS) received approximately $7.3 billion in discretionary funding for Fiscal Year 2024, according to the HHS Budget in Brief (https://www.hhs.gov/about/budget/index.html). California's waiver represents one of the most expansive state-level efforts to integrate Indigenous healing within a Medicaid framework — and one of the few Section 1115 demonstrations in the country specifically designed around tribal health sovereignty.

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What the Indian Health Policy Waiver Covers

Section 1115 of the Social Security Act gives states the authority to apply for waivers that allow them to test new approaches to Medicaid delivery — approaches that standard federal rules would not permit. California used this authority to create a waiver that specifically addresses the healthcare needs of Native American residents.

The Indian Health Policy Waiver does several things that standard Medi-Cal does not:

  • Reimburses traditional healing practices, including ceremonies, sweat lodges, and care provided by tribal practitioners, when delivered alongside or in coordination with conventional medical services
  • Expands payment to Indian Health Service facilities and tribally operated health programs in ways that align with tribal sovereignty and cultural practice
  • Supports Urban Indian Health Organizations (UIHOs), which serve Native Americans living off-reservation in cities including Los Angeles, Sacramento, and San Francisco

For many Native American families, traditional healing is not a supplement to Western medicine — it is an integrated part of how health and wellness are understood and practiced across generations. The waiver formally acknowledges that reality within the Medicaid system, which is significant because standard Medicaid reimbursement rules are built around biomedical service categories that do not accommodate traditional healing modalities.

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Why the 2026 Renewal Is a Critical Moment

Section 1115 waivers are not permanent. They require periodic renewal through the Centers for Medicare & Medicaid Services (CMS), the federal agency that oversees Medicaid nationally. California must submit a renewal application and receive federal approval to keep the waiver active beyond its current authorization period.

If the waiver lapses or is significantly modified during renewal negotiations, the consequences could include:

  • Loss of Medi-Cal reimbursement for traditional healing services, forcing tribal health programs to absorb those costs or discontinue them
  • Reduced funding flexibility for UIHOs that serve urban Native populations who may have no other culturally appropriate care option
  • Disruption to care continuity for patients who depend on integrated traditional and conventional treatment plans

Advocates for Indigenous health equity have flagged this renewal as a pivotal moment. The outcome will depend on both the quality and scope of California's renewal application and the federal administration's current priorities for Medicaid waiver approvals — factors that are not fully within any individual's control. Staying connected to your tribal health program or a local UIHO is the most reliable way to track developments as they unfold.

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Who May Be Eligible for Medi-Cal as a Native American Resident

Medi-Cal eligibility for Native American and Alaska Native individuals in California follows several pathways. Rules are complex and vary by household situation, tribal enrollment status, and income level.

Income-Based Medi-Cal

Most adults may be eligible for Medi-Cal if their household income is at or below 138% of the Federal Poverty Level (FPL). Children and pregnant individuals may qualify at higher income thresholds — in some cases up to 266% FPL for children and 213% FPL for pregnant individuals, depending on the specific program. Benefit amounts vary by household size and income.

Special Protections for Native Americans Under the ACA

The Affordable Care Act (ACA) includes specific provisions for American Indians and Alaska Natives that go beyond standard Medicaid rules:

  • Tribal members at or below 300% FPL may qualify for cost-sharing exemptions in Marketplace plans
  • Native Americans are exempt from certain Medicaid asset tests that apply to other applicants
  • Enrollment in Medi-Cal is available year-round for Native Americans — there is no waiting for an open enrollment period, which is a meaningful distinction for people whose circumstances change unexpectedly

Indian Health Service and Tribal Health Programs

Even without Medi-Cal enrollment, you may be able to access care through:

  • Indian Health Service (IHS) facilities, which provide care to members of federally recognized tribes
  • Tribally operated health programs, which may offer expanded services tailored to community needs
  • Urban Indian Health Organizations (UIHOs), which serve Native Americans in urban areas regardless of tribal enrollment status

Many of these facilities accept Medi-Cal, Medicare, and private insurance — and provide care regardless of ability to pay for those who meet their eligibility criteria.

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Documents You May Need to Apply for Medi-Cal

Gathering documents before you apply can reduce processing delays. Depending on your situation, you may need:

  • Proof of identity: state-issued ID, driver's license, tribal ID card, or passport
  • Proof of California residency: utility bill, lease agreement, or mail from a government agency
  • Proof of income: recent pay stubs, tax returns, or a written self-employment statement
  • Tribal enrollment documentation (if applicable): Certificate of Indian Blood (CIB) or tribal enrollment card — this documentation may unlock additional eligibility pathways and cost-sharing protections
  • Social Security number (required for most applicants, though exceptions exist)
  • Immigration documents (if applicable)

You do not need to be a U.S. citizen to apply for Medi-Cal in California. Undocumented residents may qualify for full-scope Medi-Cal under California's expanded eligibility rules, which extend further than federal Medicaid minimums.

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How to Apply for Medi-Cal

There are several ways to apply, and you do not need to use all of them — choose the one that fits your situation:

  1. Online: Apply through Covered California at coveredca.gov or through your county's BenefitsCal portal at benefitscal.com
  2. By phone: Call your county Department of Social Services or Health and Human Services office directly
  3. In person: Visit your county Medi-Cal office — staff can assist with the application at no cost
  4. Through a tribal health program or UIHO: Many tribal health facilities have certified enrollment assisters who can help you apply for Medi-Cal and connect you to services covered under the Indian Health Policy Waiver at the same time

California is generally required to process Medi-Cal applications within 45 days for most applicants, or 90 days for disability-based applications. Processing times can vary by county.

Note: If you submit a form or request assistance through any third-party service, review any consent language carefully before providing your contact information.

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What Happens If the Waiver Is Not Renewed

If the Indian Health Policy Waiver lapses or is substantially narrowed, the most immediate impact would be felt by tribal health programs and UIHOs that have built traditional healing services into their standard care models. Patients who currently receive reimbursed traditional healing as part of their Medi-Cal benefits could see those services discontinued or shifted to out-of-pocket costs — a significant burden for households already managing limited incomes.

Tribal governments, advocacy organizations, and California DHCS are expected to be active participants in the renewal process. If you want to stay informed or make your voice heard, contacting your tribal government's health department or a local UIHO is a practical and direct first step.

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Concrete Next Steps for Native American Residents

Regardless of how the waiver renewal proceeds, there are actions you can take now:

  • Contact your tribal health program or UIHO to ask how the renewal may affect your current care plan and what alternatives may be available
  • Verify your Medi-Cal enrollment status through your county office or BenefitsCal (benefitscal.com) — if you are not enrolled and may be eligible, the year-round enrollment window for Native Americans means you can apply at any time
  • Ask about traditional healing coverage when you visit an IHS or tribal facility — not all services are reimbursed under the current waiver, and a benefits coordinator can clarify what is covered for your specific situation
  • Check Benefits.gov for a broader overview of federal programs that may be available to you and your household

Program eligibility and availability vary by state. Not affiliated with any government agency.

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Last reviewed: July 2025