Resilient Pathways is a collaborative initiative focused on advancing sustainable, culturally grounded pathways for traditional healing and behavioral health in Indian Country—centered on Tribal governance, sovereignty, and long-term systems change.
This project brings together Tribal leaders, healers, community members, and state partners to explore how Indigenous approaches to healing can be supported, protected, and sustained within and alongside existing healthcare systems.
The purpose of Resilient Pathways is to support informed, Tribal-led decision-making around how traditional healing can be integrated into broader health systems without compromising cultural integrity or sovereignty.
The initiative is guided by three core principles:
Resilient Pathways does not prescribe a single solution. Instead, it creates space to understand viable options, evaluate tradeoffs, and determine the path—or sequence of paths—that best fits North Dakota.
Resilient Pathways is working toward a future where:
Traditional healing practices are recognized, respected, and supported
Tribes retain authority over how healing is defined and delivered
Funding models move beyond short-term grants toward sustainable systems
Indigenous approaches are embedded across health, behavioral health, and prevention systems—not siloed
This work is about building pathways that are durable, flexible, and aligned with community priorities.
Over the past 1.5 years, a small, dedicated core group has led this initiative through:
Tribal consultation and stakeholder engagement
Surveys and listening sessions across communities
Policy research and analysis of national models
Ongoing collaboration with state and federal partners
This work has focused on identifying legitimate policy and governance pathways for supporting traditional healing—while ensuring Tribes remain in control of cultural knowledge, protocols, and participation.
Much of this early work has been supported through grant funding, which is time-limited and nearing its end.
Through this process, three primary directions have emerged.
A Section 1115 waiver is a federal policy tool that allows states, in partnership with Tribes, to test and scale innovative approaches to Medicaid services.
This pathway:
Allows traditional healing services to be billed through Medicaid
Has been approved in several states, including Arizona, California, New Mexico, and Oregon
Requires planning, evaluation, and federal approval
Is time-limited but can lead to permanent change
In North Dakota, participation would be opt-in, and it would take only one Tribe to pursue a waiver for the pathway to become available statewide.
A tribally driven model is a sovereignty-based approach in which Tribes design, govern, and deliver healing services according to their own cultural values and community priorities.
This pathway:
Operates outside of Medicaid or alongside it
Is not dependent on CMS approval
Allows Tribes to move at their own pace
Can braid funding from Tribal, federal, philanthropic, or contractual sources
States like Alaska and Washington provide examples of tribally driven or Medicaid-adjacent models that prioritize Tribal authority and flexibility.
A third possibility is to pause this work and not pursue a long-term pathway at this time.
With grant funding ending, this would mean allowing the initiative to conclude without establishing a sustainable model.
This option is included for transparency, but the Resilient Pathways initiative exists to explore more durable solutions.
North Dakota pursued a State Plan Amendment (SPA) as an initial pathway to integrate traditional healing into Medicaid.
That option was carefully developed in partnership with Tribal leaders but was not approved by CMS.
As a result, the project is now at a decision point.
The focus moving forward is to:
Clarify priorities and readiness
Evaluate governance and resource considerations
Determine which pathway—or sequence of pathways—best aligns with Tribal goals
This stage of the work emphasizes shared understanding and collective direction-setting.
Traditional healing has supported Indigenous health and resilience for generations.
Resilient Pathways is about ensuring those practices are not only preserved—but supported in ways that are sustainable, respectful, and future-facing.
This initiative recognizes that:
Healing is relational and community-based
One model will not fit all Tribes
Participation must remain voluntary and flexible
The decisions made now will shape how healing systems are supported for years to come.
The following resources provide additional context and background on the work of Resilient Pathways and related policy pathways:
Resilient Pathways Workgroup Workbook
Overview of pathways, governance considerations, and discussion materials used in facilitated sessions.
CMS-Approved Section 1115 Demonstrations
Examples from Arizona, California, New Mexico, and Oregon supporting traditional health care practices.
Tribally Driven Healing Models
Background on sovereignty-based approaches used in states such as Alaska and Washington.
CMS Traditional Healing Cheat Sheet
This brief summarizes CMS-approved Section 1115 waivers supporting Medicaid coverage of Tribal traditional healing practices.
Resilient Pathways is an ongoing process.
Updates, future convenings, and additional resources will be shared as the work continues.
For more information or to get involved, please contact:
