... UnlikeI.H.S. and tribalclinicswhereservicesarefreetotheeligibleIndianclient,medical and dentalservicesaturbanIndianprogramsareprovidedonaslidingfeebasis.Thescope of servicesaturbanIndianprogramsisrestrictedtoprimarycare.Referralsforinpatienthospitalcare,specialtyservices,diagnostics,etc.,areattheclient’sexpense.Effortsaremadetomitigatetheseexpensesthroughnegotiations and otherarrangements. Of theurbanIndianprogramsthatprovidemedicalcare,severalfunctionas“safetynet”clinicsfortheuninsured,notunlikethefederally‐fundedcommunity health centerswithwhichtheyhavemuch in common(Rosenbaum,2000).PolicyImplicationsThegrowingrecognition of urbanIndians and their health careneedsraisesimportantissuesforbothfederal and statepolicymakers.Amongtheseare:thecollection and reporting of dataonthe health status of urbanIndians and theiraccessto health careservices;theadequacy of theTitleVprogramforservingthe health needs of urbanIndians; and thechangesneeded in theMedicaidprogramtoimproveaccess of eligibleurbanIndianstocoveredservices.ConclusionDramaticchangeshaveoccurred in IndianCountry in thepastcentury.Amongthesehasbeenthequietmigration of Indiansfromreservationstourbanareas,sothattodaythemajority of AmericanIndians and AlaskaNativeslive in cities.Policymakersatboththefederal and statelevelsmustunderstandthatIndianCountrynowextendsbeyondthereservationborders and intoAmerica’scities. In leavingtheirreservations,urbanIndiansdidnotalwaysescapetheconditionsthatmadelifesodifficultformanytribalcommunities,includingpoverty,racism,inadequateeducation,alcoholism,drugdependence,teenpregnancy,etc.Theseconditionsareacutelyfelt in citiesastheloss of culturalidentity,familysupport, and socialcontact,combinedwiththepressures of money,jobs,crowding,competition—placeurbanIndiansatgreatphysical and emotionalriskfor health problems.” ... (make)recommendationstoproviders and facilities’methodsforcoordinating and jointventuringwiththeIndian health servicesforservicedelivery (find)methodstoimproveAmericanIndianspecific health programming, and; ... (create)co‐fundingrecommendations and opportunitiesfortheunmet health servicesprogrammingneeds of AmericanIndiansAseparatelaw,RCW43.70.052(4)alsodirectedtheDepartment of Health in consultation and collaborationwiththefederallyrecognizedtribes,urbanorotherIndian health serviceorganizations, and thefederalareaIndian health service,(to)design,develop, and maintainanAmericanIndian‐specific health data,statisticsinformationsystem.Thedepartmentrulesregardingconfidentialityshallapplytosafeguardtheinformationfrominappropriateuseorrelease.”Thefirstplanwaspublished in July1997,markingthebeginning of asignificantpartnershipbetweenWashington’sTribes and Department of Health toidentify and address health disparitiesaffectingAmericanIndians and AlaskaNatives.Anadvisorygroupwascreatedtodevelopthefirstplan,comprised of AmericanIndian and non‐Indian health careproviders and representatives of tribal,state, and localorganizations.Thethreeprimaryplanobjectivessetforthbythisgroupaptlydescribethepremise of theplantoday:...