A May 2000 agreement with the Advisory Council on Historic Preservation and the State Historic Preservation Officer called for development of a cultural management plan for the Highlands to begin by November 2000. The Forest Service has blamed lack of funds and personnel for a year's delay in starting the Plan. However, at this writing a tribal/agency team has begun work.

Top priority for the Pit River, Modoc and Klamath Tribes and the Native Coalition is implementing the National Register of Historic Places' directive to evaluate areas outside the Traditional Cultural District for areas of significance. A number of sites in the Fourmile Hill area, just outside District boundaries, are of concern. Had cultural management planning begun in a timely manner, these evaluations could have been completed by the time of the appeal decision, and possibly influenced the issuance of development permits.

The spiritual significance of the Medicine Lake Highlands is widely known in the Native world. The National Congress of American Indians, the oldest and largest national Native organization, has stated: "Whereas, the Medicine Lake Highlands are vital to the spiritual way of life of Native Peoples of California and Oregon, and other traditional people of the earth, as a place of prayer, vision, healing and renewal … it is of supreme importance to preserve the Medicine Lake Highlands' whole primeval environs including its forests, springs, lakes, animals, and plants; and to live up to our responsibility as Native People, given by the Creator, to be the caretakers of the earth…."

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