... Manyopportunitiesforchangeexistinthecurrentenvironment.Overthenextfouryears,Tribes,AIHC,andpartnershavetheopportunitytoidentifyandimplementnew,moreimpactfulwaysofaddressingthe health ofIndianpeople.The2010‐2013 American Indian Health CareDeliveryPlanisaguideforfurtheringthateffortandforachievinghealthyoutcomesandcomprehensive,culturallyappropriate health servicesfor American Indians/AlaskaNativesinWashington. II. Health DisparitiesandServiceDeliveryA. American Indian Health CareDeliveryPlanTheWashingtonState Health ServicesActof1993originallyauthorizedthe American Indian Health CareDeliveryPlan.In1995,responsibilityfortheplanwastransferredfromthe Health CareAuthoritytotheDepartmentof Health, whichallocatedfundstodeveloptheplan.ThepurposeoftheplanasstatedinRCW43.70.590wasto: ... 4Roberts,JimandJones,Joshua. Health DisparitiesChallengePublic Health Among Native Americans.NorthwestPublic Health Journal:UniversityofWashingtonSchoolofPublic Health &CommunityMedicine,Winter2004. ... Indianhistory, health issues,andchallengesexperiencedbythispopulationandtheUrbanIndian Health Organizationthatservethem.“Fewpeoplerealizethatthemajorityof American IndiansandAlaskaNativesintheUnitedStatesarenowlivingin American cities,notonreservations.Yet,Federal health carepolicytoward American IndiansandAlaskaNativescontinuestofocuslargelyontheneedsofthoselivingonreservationsinruralareas—needsthat,despitedemonstrableprogresssincethecreationoftheIndian Health Service(I.H.S.)in1955,remainsubstantial(Kauffmanetal.,1997).ThepurposeofthisIssueBriefistodescribethelargeandgrowingurbanIndianpopulation,their health status,andthemajorfederal health programs(i.e.,I.H.S.andMedicare)andfederal‐stateprograms(i.e.,MedicaidandChild Health InsuranceProgram)thatareavailabletoimprove Native Americans’accesstoneeded health services.InsettingforththecircumstancesofurbanIndians,thisIssueBriefdoesnotintendtosuggestthatthe health careneedsofIndianpeoplelivinginruralareasareinanywaylesscompelling.AGrowingPopulationofUrbanIndiansIn1990,overhalfofthe2million American IndiansandAlaskaNativesintheUnitedStateslivedinurbanareas...Incontrast,anestimated430,000Indianslivedon279federalandstatereservationsthatyear,andanother40,000livedinAlaska Native villages(Snipp,1996).WhoareUrbanIndians?UrbanIndiansaremembersof,ordescendantsofmembersof,oneofthemanyIndiantribesorotherorganizedgroupsofaboriginalinhabitantsoftheAmericaswholiveincities.TheIndian Health CareImprovementActdefinestheterm“UrbanIndian”tomeananyindividualwho“residesinanurbancenter”…and“meetsoneormoreofthefourcriteria”forqualifyingasan“Indian”undertheAct.ThemigrationofIndiansfromthereservationsto American citiesoccurredthroughoutthepastcenturyandisexpectedtocontinue.TheproportionofIndianslivinginwhattheCensusBureaudefinesas“urbanizedareas”grewfrom45percentin1970to56percentin1990(U.S.CensusBureau,2001,personalcommunication).Historically,thismigrationreflectedfederalgovernment“relocation”policiesineffectduringthe1950’s.Over160,000 American IndiansandAlaskaNativeswereforciblymovedfromtheirreservationsintocitiestopromoteassimilationintothedominantU.S.society(Kauffmanetal.,2000;Hall,...