A drumming circle at the Friendship House in San Francisco. Friendship House is a Native-led recovery treatment program that provides culturally relevant care.
San Francisco Chronicle/Hearst Newspapers/Getty Images
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San Francisco Chronicle/Hearst Newspapers/Getty Images
Emery Tahy of San Francisco knows firsthand the struggles of addiction and recovery — a journey that, for him, is intertwined with his experience as a Native American.
In his twenties, Tahy landed on the streets of Phoenix battling severe depression and alcohol-induced seizures. About four years ago, Tahy said, he was on the brink of suicide when his siblings intervened and petitioned for court-ordered treatment.
While Tahy was detoxing in a psychiatric ward, he learned about the Friendship House, a Native-led recovery treatment program in San Francisco. As soon as he was released from the Arizona hospital, he headed to California.
“I knew immediately that I was in the right place,” said Tahy, 43. “A traditional practitioner did prayers for me. They shared some songs with me. They put me in the sweat lodge and I could identify with those ceremonies. And from that day moving forward, I was able to reconnect to my spiritual and cultural upbringing.”
Now, for the first time, Medicaid in California, Medi-Cal, as well as in Arizona, New Mexico and Oregon, is set to cover traditional health practices such as music therapy, sweat lodges, and dancing to help with physical and mental health.
The Centers for Medicare & Medicaid Services announced the move this week. It’s a two-year pilot program that applies at Indian Health Service facilities, tribal facilities, and urban Indian organizations.
In California, two new categories of intervention will be covered by the Medi-Cal expansion. People suffering from a substance use disorder can seek therapy from traditional healers who offer ceremonial rituals, or, they can work with trusted figures within tribal communities such as elected officials or spiritual leaders who offer psychological support, trauma counseling and recovery guidance. California is home to the largest Native American population in the U.S., and Gov. Gavin Newsom said in a press release announcing the expansion that the state is “committed to healing the historical wounds inflicted on tribes, including the health disparities Native communities face.”
Emery Tahy
Maira Garcia
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Maira Garcia
Seeking healing from addiction
Tahy’s battle with alcoholism began when he was a small child. He said he took his first sip of beer when he was 4, surrounded by parents, uncles, aunts, and grandparents who all drank heavily on the Navajo Nation.
“I’m a full-blooded American Indian,” said Tahy, recounting the difficulties he faced in his youth. “Growing up I was subjected to a lot of prejudice, racism and segregation. I didn’t have any pride in who I was. I feel like drugs and alcohol were a way to cope with that shame. Alcohol helped me socialize and gave me courage.”
During his teenage years, Tahy drank and began dabbling in marijuana, cocaine and crystal meth. All the while, he said, his family instilled a meaningful relationship to his culture.
“I was always encouraged by my grandparents, on my mom’s side, to learn and be connected to traditional Navajo ways of life,” Tahy said. “There was a deep connection to family, land and ceremonial activities connected to seasonal changes.”
Tahy’s story is not unique. Native American communities suffer from some of the highest rates of addiction and overdose deaths in the country, and health experts have long argued that Western medicine alone cannot adequately treat substance use disorders in Native American populations.
Native American organizations gathered at Friendship House in 2022 for a ceremony to pray for the success of The Village SF, a health care and community hub for Natives in San Francisco.
Friendship House
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Friendship House
The crisis is compounded by centuries of historical trauma.
Roselyn Tso, who directs the federal Indian Health Service, or IHS, has championed Medicaid’s coverage of traditional healing. She said in the announcement from CMS that “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.”
Until now some Native Americans have accessed traditional health care practices through IHS appropriations, Tribal resources, various pilot programs, and grants. This is the first time Medicaid will cover these services.
Bridging tradition and modern medicine
While clinical approaches like detox, medication-assisted treatment and behavioral therapy are essential to treating substance use disorders, they often fail to address the cultural and spiritual needs of Native patients.
“Traditional practices are, by nature, holistic,” said Damian Chase-Begay, a researcher focused on American Indian health at the University of Montana. “They are treating the person physically, mentally, spiritually and emotionally. They benefit the whole being, not just the physical symptoms.”
Studies have shown that integrating cultural practices into addiction treatment can lead to higher engagement and more positive recovery outcomes, though most of the current research is qualitative, not quantitative.
For years, health care practitioners dedicated to Indigenous communities struggled with the limitations of what insurance would cover. Medi-Cal, the state’s Medicaid program for low-income residents, reimburses for medical prescriptions or talk therapy, but traditional healing methods were often excluded from coverage, leaving many Native American patients without access to treatments that aligned with their cultural values.
“What California is now covering under Medi-Cal is exactly what our Native communities have been asking to be covered for years,” Chase-Begay said. “This kind of support, had it been in place, could have helped stop some intergenerational trauma and substance use years ago. I’m so thrilled that it’s in place now, but it’s long overdue.”
The new Medi-Cal policy is set to take effect next year, with Indian Health Service providers in qualifying counties able to request reimbursement for these services starting in January 2025. It will expire at the end of 2026 unless extended.
“It is vital that we honor our traditional ways of healing,” said Kiana Maillet, a licensed therapist in San Diego and a member of the Lone Pine Paiute-Shoshone Tribe. “Traditional healing is deeply ingrained in our cultures. Without it, we are missing a piece of who we are.”
As for Tahy, he hasn’t touched a drop of alcohol since starting therapy at Friendship House. He now holds a full time job as an evaluator for the Native American Health Center in San Francisco. Soon he will complete a master’s degree in American Indian studies. And, a few months ago, he completed the San Francisco marathon.
