Key takeaways
- In October 2024, federal officials let Medicaid pay for traditional practices such as talking circles, smudging and sweat lodges in Arizona, California, New Mexico and Oregon, a first for the program.
- Community health workers, including promotores de salud, have the strongest evidence: a national task force found they help control blood pressure and raise cancer screening rates.
- Blood pressure programs run with faith communities lowered the top number by about 3 points at three months, but the drop shrank to under 1 point by a year.
- Talking circles and drum circles have deep roots but only small, early studies, so their health effects are unproven rather than disproven.
- Tell your clinician every traditional remedy you use, by name, because CDC reports from 1993 and 2002 linked dozens of California children’s lead poisoning cases to powders called greta and azarcón.
On October 16, 2024, the head of the Centers for Medicare & Medicaid Services (CMS) sent a letter to tribal leaders. It announced something Medicaid had never done before1.
Four states could now use Medicaid to pay for traditional health care practices: Arizona, California, New Mexico and Oregon1. The letter’s examples included sweat lodges, smudging, talking circles and herbal remedies1.
The coverage is narrow. It runs through Indian Health Service and tribal facilities, and in three of the states, urban Indian health programs1. Still, it marks a turn: a public insurer treating a healing ceremony as health care.
Many cultures have always healed in groups. Native talking circles, church health ministries, Latino promotoras and curanderas, and community drum circles all bring people together to get well.
This article explains several of these practices, what research has tested and how they fit with medical care. It also offers a guide for joining a tradition that isn’t your own.
Federal health care made room for ceremony decades ago
The Medicaid change grew from a much older policy. In 1978, the year Congress passed the American Indian Religious Freedom Act, the Indian Health Service (IHS) adopted a policy calling for respect between traditional healing and Western medicine4. IHS guidance told staff to let patients know they were free to practice their native religion3.
When a patient or family asked for a traditional healer, IHS promised to make every effort to help. That could mean contacting a healer, giving a family privacy for a ceremony in a hospital room, or using contract health funds to pay for the visit3.
In 1994, IHS Director Michael Trujillo reissued that guidance in a formal policy. He described traditional beliefs and ceremonies as part of healing body, mind and spirit. He also committed the agency to help patients reach those practices in a way that fits each tribe’s own culture3.
The policy set limits on staff, too. They may not probe into a patient’s private beliefs. They must avoid steps that dilute or change traditional practices, and IHS support must not take control away from native healers3.
Everett Rhoades, a Kiowa physician who led IHS from 1982 to 1993, described how this played out. New IHS facilities often set aside a room, or even a building, for traditional healers4. Healing traditions showed up most often in alcohol and mental health programs4.
He also recorded hard questions. Who certifies a healer, and how does a federal agency pay one? Some people worried that folding sacred healing into a federal system could harm it4.
The 2024 approvals answer some of those questions. Healers must be employed by or under contract with an IHS, tribal or urban Indian facility, and states must confirm that patients can still choose secular care2. IHS and tribal services get full federal funding, and California started only with people in its substance use treatment system2.
Talking circles: deep roots, few finished trials
In a talking circle, each person gets a turn to speak while the others listen. A research team at Washington State University described the listeners’ role as hearing with the heart6.
Researchers have tried to measure what circles do for health, and the results are early. In a 2017 study, 39 American Indian adults with poorly controlled type 2 diabetes were divided into two groups, though not by chance5. One group added talking circles to standard diabetes education.
The talking circle group showed trends toward lower blood pressure, blood sugar and weight. Members also showed better adherence, with no incentives offered5. The authors called these positive trends and said more studies are needed, so they are not proof5.
A larger test ran into real-world trouble. With National Institutes of Health funding, researchers working with the Seattle Indian Health Board designed a randomized controlled trial of talking circles for urban Native adults with alcohol use disorders6. A randomized controlled trial assigns people by chance to one group or another, which is the fairest test of cause and effect.
Recruiting began just as COVID-19 stay-at-home orders took effect. The circles moved online, enrollment lagged, and the trial was stopped6. A smaller version without a comparison group did run with 51 adults, who rated the circles helpful and culturally fitting and reported drinking less6.
Without a comparison group, no one can tell how much of that change the circles caused. That is the fair summary today: promising, built with communities, and not yet tested at scale.
Promotoras and community health workers have the strongest evidence
Community health workers are trained frontline workers who usually come from the communities they serve7. In Latino communities they are often called promotores de salud, or promotoras. Other names include community health representatives and community health advisors7.
The Community Preventive Services Task Force, a panel that reviews public health programs, has studied their work closely. In 2015 it found strong evidence that they help prevent heart disease when they work as part of a care team7.
In studies of team-based care, the share of patients with blood pressure under control rose by a median of 17.6 percentage points7. Systolic pressure, the top number, fell by a median of 6 points, and LDL cholesterol fell by 15.5 mg/dL7. The programs cost about $17,670 per year of healthy life gained, in 2015 dollars, which counts as cost-effective7.
Cancer screening shows a similar pattern. In 35 studies, programs using community health workers raised breast cancer screening by a median of 12.7 percentage points8. Across the Task Force’s cancer screening studies, gains were bigger when workers also removed practical barriers, such as translating or arranging rides8.
Our earlier article on peer support covered their strong results in diabetes care. Our reading of all this: a promotora brings trust a clinic can’t buy. She speaks the language, knows the neighborhood and can walk someone through a system that feels closed.
Church health ministries reach people where they already gather
Many congregations host blood pressure checks, walking groups, cooking classes and health fairs. Researchers have studied these programs for decades.
A 2004 review in the American Journal of Public Health found 28 reports on faith-based programs that measured results9. They were linked to lower cholesterol, blood pressure and weight, and to more mammograms9. The authors urged churches and researchers to evaluate programs more often9.
A 2023 review in PLOS Global Public Health pulled together 24 publications on blood pressure programs in faith settings10. At three months, systolic pressure fell by about 3 points on average. By 12 months, the drop was less than 1 point10. Weight fell by a little under 1 kilogram, roughly 2 pounds10.
The authors rated the evidence for effectiveness as limited. They also wrote that faith institutions probably hold untapped potential, especially when programs respect local culture and involve faith leaders10.
In our view, small average effects don’t make these programs useless. A congregation can reach people who rarely see a doctor. But the fading effect suggests a one-time program isn’t enough; habits need ongoing support. A separate article in this series on faith and wellness goes deeper into church health programs.
Curanderismo: a living tradition with a university classroom
Curanderas and curanderos are folk healers, and curanderismo is the name for their work. According to the University of New Mexico (UNM), its roots run to Indigenous Mexican healing and to Spain, which carried North African influences11. A healer may perform a limpia, a cleansing meant to clear the energy or spirit of someone who is suffering11.
UNM offers the subject through classes brought to campus by Eliseo “Cheo” Torres, a professor emeritus11. Students can take credit courses, summer sessions, continuing education or free online courses11.
The online course on body treatments covers empacho (an intestinal blockage), ventosas (fire cupping), the work of the huesero or bone setter, and espanto, sometimes translated as magical fright12. More than 13,700 learners had enrolled in that course alone as of October 202612. The course says plainly that finishing it does not make anyone a certified healer12.
Curanderismo treats body, emotion and spirit together. Practices such as prayer and spiritual cleansing raise different questions than remedies that are swallowed. The safety section below explains why that difference matters.
Drum circles: one small study with intriguing results
Drumming is part of healing and celebration in many cultures. In a study published in 2016, researchers in London tested group drumming with adults who used mental health services13.
For 10 weeks, participants met for 90-minute sessions in a community space, led by a professional drummer with no therapy goals13. Thirty people in the drumming group and 15 in a comparison group finished the study13.
The drummers’ depression scores improved by week 6, and anxiety by week 10. Social resilience rose too, though the gain in well-being fell just short of statistical significance. The significant changes held three months later. The comparison group showed no significant change13.
Saliva tests suggested a shift away from inflammation, though the changes were small and their meaning is unclear13.
The study was not randomized: people were assigned by where they lived. The drumming group also started out more depressed, which can make improvement look larger13. Treat drumming as promising and enjoyable, not as a replacement for depression treatment.
What the evidence shows, practice by practice
| Practice | What research found | Evidence rating |
|---|---|---|
| Community health workers and promotoras on care teams, for heart disease prevention | More patients with blood pressure under control; lower cholesterol; cost-effective7 | |
| Community health workers for breast cancer screening | Screening up a median of 12.7 points across 35 studies8 | |
| Blood pressure programs in faith settings | About 3 points lower at 3 months, under 1 point at 12 months10 | |
| Talking circles for diabetes or alcohol use | Encouraging trends in small studies; randomized trial stopped early56 | |
| Group drumming for mood | Less depression and anxiety in one nonrandomized study of 45 people13 | |
| Ceremonies within IHS and tribal care | Supported as a right and a cultural practice; health outcomes not measured in trials34 | |
| Powdered remedies greta and azarcón | Linked to lead poisoning in children1415 |
A “not enough evidence” rating for ceremonies is not a judgment of their worth. Trials measure blood pressure and symptoms. They aren’t designed to measure belonging, meaning or a person’s place in a community.
The one safety rule: name every remedy out loud
A 1993 CDC report described 40 young children in California who were found with high blood lead levels in 1991 and 1992 after being given traditional remedies14. Two remedies, azarcón and greta, accounted for 36 of the cases. Families used them for stomach complaints and to prevent illness14.
Twenty-four of the 40 children had no symptoms. Many families denied using remedies at first. In the case that started the inquiry, a mother acknowledged giving her son greta regularly since he was 8 months old, but only after the interviewer used the word “greta”14. Families may not think of these powders as medicine, so CDC advised asking about them by their common names14.
A 2002 CDC report found that greta powder from one California home was about 77% lead15. Two children in that family needed chelation, a drug treatment that pulls lead out of the body15.
These cases don’t define curanderismo or any tradition. They show why anything that is swallowed, rubbed in or given to a child belongs on your health record.
- Don’t stop a prescribed medicine because a ceremony or group helped you feel better. Keep both, and talk with your prescriber.
- Tell your clinician the name of each remedy, tea or powder you use, in the language you know it by14.
- Ask for a blood lead test if a child has taken an imported powder remedy1415.
- If you have heart disease, are pregnant or take daily medicine, ask your clinician before joining a heat ceremony such as a sweat lodge.
- Call Poison Control at 1-800-222-1222 if a child swallows a remedy that worries you. Call 911 for trouble breathing, a seizure or collapse.
How to take part in a tradition that isn’t yours
Natural health and community healing share a core belief: people get well in relationship, with family, neighbors, land and spirit. Respecting that belief means respecting the people who keep these traditions alive.
The IHS policy offers a useful model for outsiders. Don’t pry into private beliefs, don’t water practices down, and leave control with the healers3. Practices also differ from tribe to tribe, so what one community welcomes, another may keep private1.
Keeping your clinician in the loop takes one sentence. You might say: “I also see a curandera and use a few home remedies. Here are their names, so you can tell me if any of them clash with my medicine.”
With a healer, the mirror version works: “I take medicine for my blood pressure. Is there anything in this remedy I should check with my doctor first?”
Questions readers ask
Does Medicaid cover traditional healing where I live?
The October 2024 approvals covered only Arizona, California, New Mexico and Oregon, and only through IHS, tribal or (outside Arizona) urban Indian facilities1. California began with substance use treatment only. KFF reported in late 2024 that California’s waiver was set to expire at the end of 2026, the earliest of the four, and that renewals were uncertain under the Trump administration2. Ask your clinic what is covered now.
Can someone who isn’t Native join a talking circle?
It depends on who hosts it and why. Practices vary among tribes, so ask the organizer whether the circle is open, and accept a no gracefully1. Where Medicaid pays for talking circles, they are offered through tribal and Indian health facilities1.
How do I find a promotora or community health worker?
Ask your clinic, your local health department or a community health center. These workers may be paid staff or trained volunteers, and they often work alongside nurses and doctors7.
Is it safe to see a traditional healer and a doctor at the same time?
It can be, as long as both know about each other. The main risks come from remedies you swallow and from stopping prescribed treatment. In the CDC lead cases, families often denied using a remedy at first and mentioned it only later14.
The bottom line
Group healing is older than any clinic, and federal health care has slowly made room for it, from a 1978 Indian Health Service policy to 2024 Medicaid coverage. The best evidence supports community health workers and promotoras, who reliably help with blood pressure and cancer screening. Talking circles, church programs and drum circles show early or modest promise.
Take part with respect, keep your clinician informed and name every remedy out loud. A ceremony can offer meaning and belonging that no pill provides, and medical care offers tested treatment for disease. You can have both.
Related reading
About this article
This article was researched using official U.S. government sources, Community Preventive Services Task Force findings and peer-reviewed studies, listed below, and was reviewed in October 2026. It is general education, not medical, legal or financial advice..
Sources
- Centers for Medicare & Medicaid Services. Letter to Tribal Leaders on Medicaid and CHIP coverage of traditional health care practices. CMS, October 16, 2024. medicaid.gov
- KFF. “Section 1115 Waiver Watch: Medicaid Services for Traditional American Indian and Alaska Native Health Care Practices.” KFF, 2024. kff.org
- Indian Health Service. Special General Memorandum 94-08, “Statement of Policy for the Traditional Cultural Advocacy Program.” IHS, 1994. ihs.gov
- Rhoades ER. “The Indian Health Service and Traditional Indian Medicine.” AMA Journal of Ethics, 2009. journalofethics.ama-assn.org
- Wilken M, Nunn M. “Talking Circles to Improve Diabetes Self-care Management.” The Diabetes Educator, 2017 (AGRIS record). agris.fao.org
- Washington State University IREACH. “Randomized Clinical Trial of Harm Reduction Talking Circles for Urban American Indians and Alaska Natives with Alcohol Use Disorders.” WSU. ireach.wsu.edu
- Community Preventive Services Task Force. “Heart Disease and Stroke Prevention: Interventions Engaging Community Health Workers.” The Community Guide, 2015. thecommunityguide.org
- Community Preventive Services Task Force. “Cancer Screening: Interventions Engaging Community Health Workers – Breast Cancer.” The Community Guide, updated 2026. thecommunityguide.org
- DeHaven MJ, Hunter IB, Wilder L, Walton JW, Berry J. “Health Programs in Faith-Based Organizations: Are They Effective?” American Journal of Public Health, 2004 (UT Southwestern repository). pubmed.ncbi.nlm.nih.gov
- Sanusi A, Elsey H, Golder S, Sanusi O, Oluyase A. “Cardiovascular health promotion: A systematic review involving effectiveness of faith-based institutions in facilitating maintenance of normal blood pressure.” PLOS Global Public Health, 2023 (White Rose repository). eprints.whiterose.ac.uk
- University of New Mexico Online. “Curanderismo: A Popular UNM Class is Available in a Variety of Formats.” UNM, 2023. online.unm.edu
- University of New Mexico. “Curanderismo: Traditional Healing of the Body.” Coursera course page. coursera.org
- Fancourt D, Perkins R, Ascenso S, et al. “Effects of Group Drumming Interventions on Anxiety, Depression, Social Resilience and Inflammatory Immune Response among Mental Health Service Users.” PLoS ONE, 2016. pubmed.ncbi.nlm.nih.gov
- Centers for Disease Control and Prevention. “Lead Poisoning Associated with Use of Traditional Ethnic Remedies — California, 1991–1992.” MMWR, 1993. cdc.gov
- Centers for Disease Control and Prevention. “Childhood Lead Poisoning Associated with Tamarind Candy and Folk Remedies — California, 1999–2000.” MMWR, 2002. cdc.gov