AZCIR is part of the Mental Health Parity Collaborative, a group of newsrooms that are covering stories on mental health care access and inequities in the U.S. The national partnership includes The Carter Center and newsrooms in select states throughout the nation.
Courtney Altaha and James Cody Jr. piled their belongings into a small white trailer baking under the Phoenix sun. Their boxes—filled with clothes, books, paperwork, a child’s booster seat—dwarfed the single duffle bag they’d carried when they left the Fort Apache Indian Reservation two years earlier. They came to the city in search of treatment for addictions that had robbed them of their health, house and custody of their five children.
On this late September day, Altaha and Cody were heading home as part of a small group of White Mountain Apache Tribe members impacted by fraudulent behavioral health providers and the state’s resulting crackdown. Since May, Arizona’s Medicaid agency, the Arizona Health Care Cost Containment System, has suspended more than 250 behavioral health providers. An exodus of patients followed.
The crisis has disproportionately affected Indigenous communities, who were targeted by providers that exploited reimbursement rates unique to the American Indian Health Plan. State officials rolled out a hotline to connect people with support services, but grassroots organizers—like Stolen People, Stolen Benefits, which arranged the day’s transport—have stepped up to deliver help where the state’s services fell short.
After loading their belongings into the trailer, Altaha, 28, and Cody, 29, went inside to cool down and wait to leave. They both appeared at ease, chatting casually and greeting familiar faces as they came through the door. Altaha and Cody have been together for nearly 10 years, though like most others trickling in, they’d known each other since childhood.
They had all faced challenges growing up on the Fort Apache Indian Reservation. Altaha’s family split up when she was a baby, and it wasn’t until her dad passed away when she was 9 that she met her brothers. They picked on her endlessly. Altaha got expelled from school for fighting and eventually began using alcohol and methamphetamine. Cody enjoyed mountain biking on the reservation but substance use made its way into his life as well. In 2014, Altaha and Cody began dating. They struggled to manage their addictions and take care of their growing family. Ultimately, they couldn’t.
Tribal authorities repossessed Altaha’s house after she tested positive for methamphetamine. Family members assumed custody of their five children. And after she completed a 90-day treatment program on the reservation, the couple decided to seek additional treatment in Phoenix in June 2021.
Unbeknownst to them, fraud among behavioral health providers was on the rise by the time they arrived in the Valley. Billing claims among behavioral health providers skyrocketed from $53 million in 2019 to $668 million in 2022. Altaha and Cody would bounce between fraudulent providers for two years before state officials connected the irregular billing with criminal activity targeting tribal communities and other Arizonans.
It didn’t take them long to realize something wasn’t right at their sober living home. Classes were sparse. Residents used alcohol and drugs within the facility. Staff would not let Altaha or Cody leave.
“These people were, in essence, kidnapped, and brought to the city, and robbed of any identification and telephones”
walter murillo, native health ceo
Reports of similar experiences have become more common as the crisis has come to light, said Walter Murillo, chief executive officer of Native Health, a nonprofit serving Indigenous Arizonans. Numerous patients had come to Native Health from fraudulent providers, he said—and in some instances, they’d been recruited directly from reservations under false pretenses of treatment or free housing.
“These people were, in essence, kidnapped, and brought to the city, and robbed of any identification and telephones,” Murillo said.
After a few months, Altaha and Cody left the sober living home for a new facility, one operated by a fellow White Mountain Apache Tribe member. They felt better about the treatment program at the new location until management changed. When the new operators cut back on services, the upheaval triggered a relapse. They spent several months back on the reservation using drugs and alcohol before ultimately returning to Phoenix in June 2022 to once again seek treatment. But changes in management and substandard care again threatened their abstinence. They needed to stay sober.
When Altaha’s mom saw a post on Facebook in early September that advertised group transportation for White Mountain Apache Tribe members, Altaha and Cody decided this was the right moment to return home. Most of the other people gathered at Stolen People, Stolen Benefits headquarters also had heard about the transport through Facebook and word of mouth. None of them had used the state’s official 211 crisis hotline to seek assistance.
Once members of the small group had loaded their belongings, browsed donated clothing and stocked up on snacks for the long drive home, volunteers brought everyone together.
Turning off the television playing in the background and standing at the front of the room, Native advocate Jeri Long addressed the group. She urged them to stay safe, use treatment resources on the reservation, and be thoughtful before making any decisions to return to Phoenix.
“There was a lot of thought that went into this and preparing it for you guys, OK?” Long said. “So, you guys, just be careful when you go back.”
Photo by Brendon Derr | AZCIR
Long and the other volunteers stood in the late-afternoon heat to wave the group off. The caravan moved slowly past sheets of plywood that lined one side of the parking lot. Each board was covered in pictures of missing tribal members yet to make the journey home.
Tribal leaders estimate that the crisis has impacted as many as 7,000 tribal members from Arizona, New Mexico, Montana, South Dakota, and North Dakota. But the White Mountain Apache Tribe stands out among the rest, said Reva Steweart, who helped found Stolen People, Stolen Benefits.
“I think White Mountain is one of the hardest-hit tribes. We have a lot of deaths from there,” she said.
As the caravan pointed east, Cody looked out his backseat window to Camelback Mountain. Hiking and riding his bike on nearby trails had helped stave off boredom and the accompanying urge to smoke, he said. He’d hoped to get back on those trails one last time. But he felt ready to return to the pine trees of the reservation. So did Altaha.
They came to Phoenix to reestablish sobriety, and they succeeded. The obstacles awaiting them on the reservation, though, were starting to sink in. They needed to get a car. They needed to find a treatment provider. They needed to get jobs. They needed a safe place to live. They needed to get custody of their children back.
First, they would need to bury one of her older brothers. He had died days earlier from liver failure—a complication from the alcohol addiction he’d battled since age 12. The week prior, Cody’s family buried two of his own brothers, who also passed due to complications from addiction.
Altaha and Cody spent the four-hour drive pointing out familiar landmarks along the route: the copper mines near Superior and the man-made hills surrounding them, rock formations that looked like SpongeBob and Patrick. A distant ridgeline north of Globe where clay buildings built generations ago still stood proudly against the sky.
Daylight faded as the caravan descended into the Salt River Canyon before it climbed back up toward the Colorado Plateau. Under the light of a nearly full moon, the driver patted the car’s dashboard with gratitude as the road finally leveled out. They’d made it through the final climb of the trip. The lights of their destination, Whiteriver, appeared in the distance.
Altaha got a call from her mom as the caravan made its final turn toward Whiteriver. Her mom had dropped off keys to a small outbuilding, and an air mattress for her and Cody to use at her grandmother’s house. They would be sleeping in an unfurnished and uninsulated shed until the funeral.
The mood in the car turned somber after Altaha hung up.
The caravan’s first passenger dropoff immediately reminded Altaha of the haunts she and Cody had left behind when they sought treatment. That house was a hangout, she said, pointing to a white, single-story home across the street. That house sold methamphetamine, she said, pointing at another.
Altaha planned to call her former treatment provider on the reservation to schedule an intake as soon as they got settled.
The caravan rumbled down a rutted dirt road through a neighborhood called Whiskey Flat as Altaha directed the driver. Altaha and Cody’s stop was next. The cars pulled into a turnaround and parked in front of one of the houses. A small fire crackled, unattended, outside of Altaha’s grandmother’s house.
Cody and one of the drivers began unloading their items from the trailer as Altaha slipped inside to greet her family. She emerged a few minutes later with a key to unlock the shed and an extension cord to run from the house to power their air mattress.
Inside, piles of nonperishable food for the upcoming funeral were stacked around the edges of the room. Altaha started pushing the items aside to make space for her and Cody to sleep.
Altaha regretted not requesting housing assistance before they left the reservation in search of treatment. The tribal authorities’ two-year waitlist meant they’d have to figure something out themselves. Their best option was to fix up Cody’s mother’s house in an outlying community about an hour from Whiteriver. The house had gaping holes in the roof and lacked running water. They’d need to make it livable before winter arrived—and before Altaha delivered their sixth child, due in March.
Altaha felt optimistic about the future. They had managed to get through the warren of predatory behavioral health providers in Phoenix and emerge, sober, on the other side. If they could do that, then she hoped they could make it through the challenges awaiting them in the community where their troubles first began.
“We’ve been working on sobriety for three years now,” said Altaha. “We finally got it straight. Everything’s on a good road and we plan to keep it that way.”
AZCIR is part of the Mental Health Parity Collaborative, a group of newsrooms that are covering stories on mental health care access and inequities in the U.S. The national partnership includes The Carter Center and newsrooms in select states throughout the nation.
Recovery from addiction is possible. For help, call the free and confidential treatment referral hotline (1-800-662-HELP), or visit findtreatment.gov
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