A new state report – co-created with community leaders – offers reflection, guidance and recommendations for action to better use Medicaid to support the health and well-being of American Indian communities.

“Pathways to Racial Equity in Medicaid: Improving the Health and Opportunity of American Indians in Minnesota” aims to address the ongoing health disparities experienced by American Indian communities in the state.

The report from the Minnesota Department of Human Services is the result of extensive community engagement, incorporating guidance from American Indian community members, Tribal leaders and health care providers. The findings underscore the urgent need for systemic changes in health care delivery to center Indigenous knowledge and practices. The report calls for a fundamental rethinking of how health is defined and how health systems operate, advocating for an approach that embraces holistic, culturally relevant practices rather than Western biomedical models.

“Improving how we administer Medicaid is crucial as we collectively work toward achieving health equity with American Indian communities in Minnesota,” said Dr. Nathan Chomilo, Medicaid Medical Director and the report’s lead author. “The time for action is now. It is imperative that we implement these recommendations to create a health care system that is truly responsive and culturally inclusive for all people in Minnesota.”

The report includes three main calls for action:

• Invest in traditional healing. To expand access to traditional healing services, the report proposes engaging with Tribal Nations and urban American Indian clinics to explore covering traditional healing practices through Medicaid. This could include applying for a federal waiver or incorporating traditional healing into Medicaid to address social drivers of health. 
• Reframe definitions of health and well-being. A collaborative effort with Tribal Nations and urban American Indian communities is vital to developing a shared definition of health and well-being that reflects Indigenous values and cultural practices. The report encourages DHS to work with federal partners to ensure that Medicaid rules and regulations support this vision. This aligns with the 2022 guidance from the White House on Indigenous knowledge.
• Establish a Pathways to American Indian and Tribal Health Integration (PATH-I) Team: Creating a dedicated PATH-I team at DHS would enhance community engagement and ensure that cultural competence is integrated across state agencies. The team would focus on ongoing dialogue with community members, share information about Medicaid resources, and improve coordination among state and local health systems.

There remains much for state officials and workers to learn from, and to create together with, urban American Indian communities and Tribal Nations.

“As a Native person who has been on Medicaid in Minnesota and now works for DHS, I have personally experienced the frustrations of Medicaid’s complicated application process and barriers to care,” said Takayla Lightfield, the report’s lead facilitator. “Being able sit down and to talk with other Native people during a shared meal and hear their stories directly presented two opportunities: talking about recent changes in Medicaid coverage that community members were not aware of, and coming up with ideas together on how changes can continue to be made to Medicaid for the betterment of our relatives’ lives. There’s a lot more work to be done, and community needs to be included.”

“Through this experience, I have learned to translate the daily challenges my patients face into advocacy at the policy level, to help focus on their holistic health rather than individual issues,” said Dr. Charity Reynolds, Medical Director for Fond du Lac Human Services Division and a co-creator of the report. “It’s crucial that decision-making processes include representation from the communities being served, ensuring that those impacted have a seat at the table.”

“I appreciated the collective work we did together as community partners and leaders on this report,” said Dr. Antony Stately, CEO of the Native American Community Clinic (NACC) and a co-creator of the report. “It was helpful for me to hear the perspectives of others, learn their experiences of frustration and success in serving our community, and witness the power of putting our minds together to imagine creative solutions for improving the health and well-being of our relatives.”

DHS will begin to implement the report’s recommendations immediately, working closely with American Indian communities. The agency encourages community members, Tribal Nations, providers and community-based organizations to engage in ongoing dialogue.

This is the second report to explore how Medicaid can reduce racial health disparities. In 2022, DHS published “Building Racial Equity into the Walls of Minnesota Medicaid: A Focus on U.S.-born Black Minnesotans” (PDF).

For more information about the Pathways report, please visit "Pathways to Racial Equity in Medicaid: Improving the Health and Opportunity of American Indians in Minnesota" (PDF).