No needles or threads were visible, but government and tribal officials were clearly trying to stitch a safety net for American Indian children Tuesday.

Whatever net they create will be expected to cushion both individual American Indians and their tribes from the dangers that result from lack of health care. And while parts of the safety net are already strong, other parts must be woven from scratch.The Utah Health Department is playing host through Wednesday to representatives of 13 states during the Western Summit on Indian Health Care. Representatives from tribes, tribal and state health programs, governors' offices, congressional delegations and others will formulate recommendations on how a collaboration between tribes and governments might provide access to health care for American Indians, particularly children. Those suggestions will be given to policymakers and to the Western Governors Association, which has become increasingly involved with the issue.

Besides looking at how health programs might work, individual groups also tackled financing and administering the programs, and legal issues.

It's a serious concern for Utah policymakers. Two key barriers exist to providing adequate health care to American Indians: financing and the remoteness of some tribes from good facilities and health-care providers, according to Judy Edwards, Utah Health Department liaison for Indian health programs.

The last census showed that American Indians have higher unemployment of those over age 16 (16.2 percent compared to the U.S. average of 6.4 percent) and lower incomes (the American Indian median household income is $19,897 compared to $30,056). That combination puts American Indians at a terrible disadvantage.

The Indian Health Service operates only one facility, in remote Fort Duchesne. "There are clearly inadequate facilities," Edwards said. "And tribes are trying to manage with little funding and resources."

But making certain that American Indians can access both preventive and treatment services is not just a nice plan, she said. "It goes back to the treaties. Part of the negotiation for land was assuring health care and the legal obligation to provide health services has been tested. It's solid. How it is delivered is the challenge."

Tribes have been faced with trying to become their own providers, creating their own managed-care systems, according to representatives from the Health Care Finance Administration's Denver office. But they don't have the money to do it.

The summit is trying to create a blueprint for how such a system might work, based on a strong partnership with tribal, state and federal governments.

Congress' 1996 Balanced Budget Act created the Children's Health Insurance Plan (CHIP), which targets children living below twice the poverty level who have no access to insurance. And American Indian children were a specific focus of the act.

Utah has chosen to run a non-Medicaid CHIP program, according to Chad Westover, Health Department CHIP planner. The department estimates 30,000 children are eligible, and another 15,000 who qualify for Medicaid could be enrolled in that program through CHIP outreach efforts. An unknown portion of those children are American Indian. To administer CHIP, officials have contracted with managed-care plans in urban areas and public health facilities in rural areas. Now they must figure out how tribes can access them.

One of the beauties of the CHIP plan, according to Westover, is it provides both treatment and preventive services. Treatment carries a small, income-based co-payment; prevention has no co-payment.

But the program went into effect only two weeks ago. And how well it will work for American Indians depends in large part on what the summit recommends and officials approve.

The conference is co-sponsored for the first time by the Kaiser Foundation, a philanthropic group that focuses on health-care issues.