New Tribal Healthcare Initiatives

Date

02/21/25

Recent research indicates that the average life expectancy for American Indian and Alaska Native (AIAN) populations in the United States is truncated relative to other racial and ethnic groups. In 2021, the life expectancy for AIANs was found to be 70.6 years, which is much lower than the 84.1-year, 78.8-year, and 76.3-year life expectancies of Asian/Pacific Islander, Hispanic, and non-Hispanic White populations, respectively.1 Notably, AIAN populations experience an increased risk of mortality from drug and alcohol-related causes.1 Socioeconomic factors such as poverty, inadequate insurance, and reduced access to preventative healthcare contribute to AIAN health variations, as highlighted by a recent Commonwealth Fund report.

A new National Institutes of Health (NIH) program, Native Collective Research Effort to Enhance Wellness (N CREW), will address overdose, substance use, mental health, and pain in AIAN populations. Its three goals aim to 1) support Tribe or Native American Serving Organizations (T/NASOs) in leading community-based research projects; 2) enhance T/NASO capacity to conduct research by providing technical assistance and developing accessible training, resources, and tools; and 3) improve the accessibility and quality of health data to optimize local decision making. The N CREW Program has two phases and is projected to span seven years, beginning in Fiscal Year 24.

In October 2024, the Centers for Medicare & Medicaid Services (CMS) approved 1115 waivers in four states (Arizona, California, New Mexico, and Oregon) to expand Medicaid coverage to include traditional AIAN healthcare practices. These waivers will allow sovereign Tribal governments to provide care that reflects each Tribe’s culture and traditions. Staff members providing traditional healing services will be required to be employed by or contracted to an established facility, which must document the practitioners’ qualifications. These waiver approvals have the potential to greatly benefit AIAN populations as Medicaid already plays a crucial role in AIAN healthcare coverage and is projected to cover almost 13% of the total funding for Indian Health Service programs in 2025.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has developed a new tool, Native Communities: Alcohol Intervention Review (NativeAIR), to provide evidence-based information for community efforts to minimize the impact of unhealthy alcohol habits. The tool highlights 39 interventions dedicated to treating alcohol use disorder and preventing fetal alcohol spectrum disorders and alcohol misuse. The interventions are heterogeneous and vary in their outcomes, costs, cultural engagement, setting, participants, modality of delivery, staffing needs, research design, developmental stage of research, and potential. Notably, many of the included interventions incorporate cultural considerations.

The NIH Helping to End Addiction Long-term Initiative (NIH HEAL Initiative) developed new overdose resources, based on findings from the HEALing Communities Study. These resources were designed to allow communities to tailor each resource to fit their unique needs. Given the extensive heterogeneity within AIAN communities, many could greatly benefit from the customizable features these tools provide.

For more information on the N CREW Program, read the N CREW Program Q&A webpage. To learn more about the Indian Health Service and Medicaid’s role in supporting AIAN healthcare, read the Center for Health Care Strategies’ report, “Strengthening Medicaid and Tribal Relationships to Better Support Native Populations.” To learn more about NativeAIR, refer to the NIAAA webpage. For a better understanding of the NIH HEAL Initiative’s new overdose resources, read the Academy’s recent story, “NIH HEAL Initiative – Overdose Resources Announced.” The Academy’s Substance Use Tools & Resources collection has many more resources focused on the social determinants of health for individuals struggling with substance use.

Singh GK, Lee H, Kim LH, Williams SD. Social Determinants of Health Among American Indians and Alaska Natives and Tribal Communities: Comparison with Other Major Racial and Ethnic Groups in the United States, 1990-2022. Int J MCH AIDS. 2024;13:e010.