... UnlikeI.H.S.andtribalclinicswhereservicesarefreeto the eligibleIndianclient,medicalanddentalservicesaturbanIndianprogramsareprovidedonaslidingfeebasis. The scope of servicesaturbanIndianprogramsisrestrictedtoprimarycare.Referralsforinpatienthospitalcare,specialtyservices,diagnostics,etc.,areat the client’sexpense.Effortsaremadetomitigatetheseexpensesthroughnegotiationsandotherarrangements. Of the urbanIndianprogramsthatprovidemedicalcare,severalfunctionas“safetynet”clinicsfor the uninsured,notunlike the federally‐fundedcommunity health centerswithwhichtheyhavemuchincommon(Rosenbaum,2000).PolicyImplications The growingrecognition of urbanIndiansandtheir health careneedsraisesimportantissuesforbothfederalandstatepolicymakers.Amongtheseare: the collectionandreporting of dataon the health status of urbanIndiansandtheiraccessto health careservices; the adequacy of the TitleVprogramforserving the health needs of urbanIndians;and the changesneededin the Medicaidprogramtoimproveaccess of eligibleurbanIndianstocoveredservices.ConclusionDramaticchangeshaveoccurredinIndianCountryin the pastcentury.Amongthesehasbeen the quietmigration of Indiansfromreservationstourbanareas,sothattoday the majority of AmericanIndiansandAlaskaNativesliveincities.Policymakersatboth the federalandstatelevelsmustunderstandthatIndianCountrynowextendsbeyond the reservationbordersandintoAmerica’scities.Inleavingtheirreservations,urbanIndiansdidnotalwaysescape the conditionsthatmadelifesodifficultformanytribalcommunities,includingpoverty,racism,inadequateeducation,alcoholism,drugdependence,teenpregnancy,etc.Theseconditionsareacutelyfeltincitiesas the loss of culturalidentity,familysupport,andsocialcontact,combinedwith the pressures of money,jobs,crowding,competition—placeurbanIndiansatgreatphysicalandemotionalriskfor health problems.” ... areanincreasednumber of Tribalrepresentativesservingonrelevantstatecommitteesandtaskforces.SectionVI,GoalsandObjectives,identifies the priorityissueareastargetedtobeaddressedover the nextfouryears. The goalsarethosethatAIHC,Tribes,UrbanIndian Health Organizations(UIHO),and the statewillworktogetherontofurther the mission of eliminatingIndian health disparities. The firstcomponent,TribalForumfor Improving AI/AN Health, focusesonstrategiestostrengthen the collectivevoiceforTribesandUrbanIndian Health Programstogreaterinfluence health policyandassurefullaccess by AI/ANsto health servicesandprogramsin the state.ThisgoalalsoincludeseffortstodevelopandimplementstrongerstrategiesforaddressingIndian health disparitiesand the development of moreeffectivecommunicationavenuesbetweenTribesand the statesoTribesareaware of emergent health news,information,andopportunities.Whileplansin the pasthaveservedwellininformingindividuals,Tribes,andorganizationson the poorstatus of Indian health andidentifyingpolicyworkbeingaccomplished,furthercollaborativeconversationsandeffortsacrosstribes,systems,organizations,andresearchinstitutionsmustbepursuedtostrategicallyaddressthesedisparities.Thiscomponentoutlineshowthatmightbegintobeaccomplishedover the nextfouryears. The four health priorityareas—Maternal‐Infant Health, Long‐TermCare,Oral Health, andMental Health services—wereidentifiedat the 2008TribalLeaders Health Summitandserveas the areas of disparitiesfromwhich the broaderworkdescribedabovecouldbeshaped.Eachpriorityareaincludes:(a)Goalstatement;(b)Problemstatement;(c)Anysupportingdata;and(d)Strategies(objectives)foraddressing the problem. The strategiesarerecommendationsdevelopedinAmericanIndian Health Commissionpositionpapersat the TribalLeaders Health SummitinNovember2008andsubsequentlyapproved by commissiondelegatesin2009.AtargetedfocusinthesefourpriorityTribal health areaswillallowustonotonlydevelopsolutionstothesespecificproblems;itwillalsoserveasawaytofurtherdefine the process by whichadditionalIndian health disparitiescanbeaddressedin the future. The strategiesidentifiedinthissectionwillbepursuedbasedonresourceavailabilityineacharea. The finalsection,Tribal Health ProgramsinWashingtonState,providesspecificinformationaboutexistingTribalandUrbanIndian health programsandclinics.Italsoprovidesinformationabout the types of servicethatareprovided by eachsiteinordertocomplete the profile of the Indian health deliverysysteminourstate. Opportunities for Change: Improving the Health ... Understand the health status of AmericanIndiansin the state2. Developstrategiestoimprovetheir health status3. Closegapsin the provision of health careservices The planhasbeen the result of activecollaborationbetweentribes,tribalorganizations,and the department.Ithasalsohelpedtosparkadditionalcollaborationwithotherstateagenciesandvariouspublicandnon‐profitentitiesinWashington.While the planseekstoprovideacomprehensiveoverview of the progress,opportunitiesandchallengesthattribesand the statefaceineliminating health disparitiesaffectingWashington’sAI/ANpopulation,it by nomeansisasubstitutefor the government‐to‐governmentrelationshipthatexistsbetweenfederallyrecognizedTribesandstategovernment.Through the auspices of the commission,tribescontinuetobe the drivingforcein the plan’scontentandscope.B....