There is considerable concern in the Indian community that the health care system built over the last 20 years to address the needs of American Indians in a culturally competent delivery system will disappear with the advent of managed care contracting for Medicare and Medicaid funding. It is estimated that 30% of all Indians are utilizing Medicare or Medicaid coverage, but that less than 0.5% of any state Medicaid funding is spent on services to Indians.
The concern is that with the “invisibility” of the urban Indian population, managed care by assignment to non-culturally sensitive providers will furthe
