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Evergreen Ledger

2SHB 1583

In Committee

House

Traditional health/medicaid

Concerning medicaid coverage for traditional health care practices.

This status may be delayed. See Action History below for the latest updates.

How does a bill become law?
  1. Introduced: The bill is filed and assigned a number.
  2. Committee: A subject-matter committee holds hearings, takes public testimony, and decides whether to advance the bill.
  3. Floor Vote: The full chamber (House or Senate) debates and votes on the bill.
  4. Opposite Chamber: The bill repeats the committee and floor vote process in the other chamber.
  5. Governor: The Governor reviews the bill and decides whether to sign or veto it.
  6. Signed: The bill has been signed into law.
Introduced: February 27, 2025
Last Action: January 12, 2026
Status: H Rules X
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AI Analysis

This analysis was generated by AI and may contain errors. It is not legal advice. Always refer to the official bill text for authoritative information.
People & CommunitiesPeople-leaningCorporate & Wealthy Interests

This bill requires Washington’s Health Care Authority to seek federal approval to cover traditional health care practices under Medicaid for American Indian and Alaska Native beneficiaries, using a federal waiver to access full federal funding and avoid state costs. It also updates legal definitions to better support tribal health programs and providers.

  • Requires the Washington State Health Care Authority to apply for a federal Section 1115(a) waiver by September 1, 2025 to allow Medicaid coverage of traditional health care practices.
  • If approved, Medicaid must cover traditional health care services provided by Indian Health Service facilities or tribally operated facilities under the Indian Self-Determination and Education Assistance Act.
  • Defines 'traditional health care practices' broadly as knowledge, skills, and treatments rooted in Indigenous cultural traditions, used for health maintenance and treatment of physical or mental illness.
  • Reenacts and amends definitions in RCW 43.71B.010, including updated definitions for terms like 'American Indian or Alaska Native', 'tribal organization', 'urban Indian', and 'community health aide'.
  • Requires coverage to be available only to Medicaid beneficiaries who can receive services through eligible tribal or federal Indian health providers.

Who is affected

  • American Indian and Alaska Native Medicaid beneficiaries — Medicaid beneficiaries who are American Indian or Alaska Native and receive care through Indian Health Service facilities, tribal facilities, or urban Indian organizations may gain access to covered traditional health care services.
  • Indian Health Service facilities and tribal/urban Indian health providers — Tribal health programs and urban Indian organizations that provide traditional health care services may be able to bill Medicaid for these services after federal approval.
  • Washington State Health Care Authority — The Washington State Health Care Authority will need to apply for a federal waiver and manage new coverage requirements for traditional health care services.
  • State Indian health advisory and reinvestment bodies — The governor’s Indian Health Advisory Council and the Indian Health Improvement Reinvestment Committee may have expanded roles in overseeing implementation and use of new funding.
Effective: July 1, 2025Fiscal impact: The bill aims to generate new state savings by leveraging a federal waiver (per CMS Letter 16-002) to receive 100% federal Medicaid matching funds for covering traditional health care practices, with savings redirected into the Indian Health Improvement Reinvestment Account.
Model: Intel/Qwen3-Coder-Next-int4-AutoRoundGenerated: Mar 19, 2026 at 7:06 PM

Pro/Con Analysis

Stronger case for benefits

Potential Benefits (5)

  • Expands Medicaid coverage to include traditional Indigenous health practices — including behavioral health, dental, and community health aide services — delivered by IHS or tribal facilities, improving access to culturally appropriate care for American Indian and Alaska Native Medicaid beneficiaries, many of whom face significant barriers to care.

    HealthcarePeopleRef: Sec. 2 (new); RCW 43.71B.010(16) (definition of 'traditional health care practices')

  • The bill leverages CMS Letter 16-002 to secure 100% federal matching funds for traditional health care services, generating new state savings that are statutorily directed to the Indian Health Improvement Reinvestment Account — meaning no new state costs and potential net savings for the state general fund.

    FinancialPeopleRef: Fiscal Impact summary; RCW 43.71B.010(13) (definition of 'new state savings')

  • Formal recognition and inclusion of urban Indian organizations and broader definitions of providers (e.g., behavioral health aides, dental health aide therapists) expands eligibility for Medicaid billing under traditional health care, increasing access for urban Native populations who are often underserved.

    HealthcarePeopleRef: Sec. 2 (new); RCW 43.71B.010(7), (11), (20), (21) (expanded definitions of community health aides, Indian health care providers, urban Indian, and urban Indian organizations)

  • By tying coverage to services delivered through tribal or IHS facilities, the bill reinforces tribal sovereignty and self-determination in health care delivery — aligning with the Indian Self-Determination and Education Assistance Act and supporting tribal control over culturally appropriate care models.

    Rights & LibertiesPeopleRef: Sec. 2 (new), requiring coverage only for beneficiaries served by eligible tribal or federal Indian health providers

  • Redirecting new state savings into the Indian Health Improvement Reinvestment Account supports long-term investment in culturally grounded prevention, behavioral health, and trauma-informed care — which can reduce emergency room visits, incarceration, and homelessness among Native populations.

    Public SafetyPeopleRef: Fiscal Impact summary; RCW 43.71B.010(14), (15) (Reinvestment Account and Committee)
Potential Concerns (1)

  • The bill requires the Health Care Authority to expend state staff and administrative resources to pursue a federal waiver, with no guarantee of approval — delays or denial could result in wasted state resources and delayed or no coverage expansion for tribal providers.

    HealthcarePeopleRef: Sec. 2 (new), requiring HCA to apply for Section 1115(a) waiver by 9/1/25

Who Is Most Affected

American Indian and Alaska Native Medicaid beneficiariesPositive Impact

American Indian and Alaska Native Medicaid beneficiaries — especially those served by tribal or urban Indian health programs — gain access to covered traditional care (e.g., healing practices, community health aides, dental therapy), improving health outcomes and cultural continuity. This is especially impactful for low-income Native individuals who previously had no Medicaid-covered path to such services.

Indian Health Service facilities and tribal/urban Indian health providersPositive Impact

Tribal and urban Indian health providers gain the ability to bill Medicaid for traditional services — expanding revenue streams and enabling sustainability of culturally grounded care models. This supports tribal self-determination and helps retain Indigenous health workers in communities.

Washington State Health Care AuthorityMixed Impact

The Washington State Health Care Authority gains authority to pursue federal waiver approval and manage new coverage, but must invest staff time and administrative capacity to apply and comply with CMS requirements — though no new state funding is required.

State Indian health advisory and reinvestment bodiesPositive Impact

The Indian Health Advisory Council and Reinvestment Committee gain expanded oversight and funding allocation authority, enabling more targeted investment in tribal-led health initiatives — strengthening tribal-state partnership and accountability.