The Urban Institute partnered with the Northwest Portland Area Indian Health Board and the Indian Health Service (IHS) to host a National Roundtable on the Indian Health System and Medicaid Reform. This summary of the August 2005 event details how pending Medicaid cuts may have serious ramifications for the Indian Health System and includes recommendations for reform. Although the federal government has a special trust responsibility for the health of American Indians and Alaska Natives, the IHS has been chronically underfunded even with Medicaid reimbursements. The health status of Indians remains far below that of the general U.S. population.