Urban Indian Health Program 

ISSUE

The IHS provides a comprehensive health service delivery system for 

approximately 2.2 million of the nation’s estimated 3.7 million 

American Indians and Alaska Natives. Approximately 70 percent of 

American Indians and Alaska Natives live in urban areas, with 25 

percent of them residing in counties served by urban Indian health 

programs authorized and funded through Public Law 94-437, Title V.

BACKGROUND

Urban Indians not only share the same health problems as the general 

Indian population, their health problems are exacerbated in terms of 

mental and physical hardships because of the lack of family and traditional cultural environments. Urban 

Indian youth are at greater risk for serious mental health and substance abuse problems, suicide, 

increased gang activity, teen pregnancy, abuse, and neglect. Recent studies of the urban Indian 

population document poor health status and reveal that lack of adequate health care services are a serious 

problem for most families. This is reflected in a 2004 report “The Health Status of Urban American 

Indians and Alaska Natives: An Analysis of Select Vital Records and Census Data Sources” by the 

Urban Indian Health Institute, a division of the Seattle Indian Health Board. The report, which was 

limited to the counties served by Title V funded urban Indian programs, demonstrated that although 

progress had been made toward better health among this population, substantial health disparities 

continue to exist when compared to the general population. 

SITUATION

Section 3 of P.L. 94-437, the Indian Health Care Improvement Act, declares that “it is the policy of the 

Nation, in fulfillment of its special responsibilities and legal obligations to the American Indian people, 

to ensure the highest possible health status for Indians and urban Indians.” The IHS provides contracts 

and grants to 41 urban-centered, nonprofit urban Indian organizations providing health care services at 59 

locations throughout the United States. The programs define their scopes of services based upon the 

documented and unmet needs of the urban Indian communities they serve. The 41 programs engage in a 

variety of culturally appropriate activities to increase access to health services for urban Indians. These 

services range from the provision of outreach and referral services to the delivery of comprehensive 

ambulatory health care. Title V funds are but one source of funding for urban Indian health programs; 

most obtain supplemental resources from other federal, state, local, and private sources. 

OPTIONS/PLANS

Since January 2006, the IHS has implemented HHS priorities directed at ensuring accountability and 

provision of high quality health services for the urban Indian population served by the IHS. Based on 

special provisions for Indians in the Affordable Care Act (ACA) and the Indian Health Care 

Improvement Act, the IHS is strategically planning for the expansion of health care coverage and quality 

services for the underinsured and underserved urban Indian population. The primary area of focus 

involves aligning with the ACA Health Insurance Marketplace to increase the number of urban Indians 

served, enhance revenues, and improve quality of care and customer service. This includes the 

development of new approaches and the refining of proven process for coordinated care services, 

supports, and networks as valued and essential services. 

ADDITIONAL INFORMATION

For referral to the appropriate spokesperson, contact the IHS Public Affairs Staff at 301-443-3593. 

October 2018