The national effort to improve services to children with special health care needs presents unique challenges for the delivery of services to American Indian families This study took place in New Mexico American Indian families whose children have special needs and health care providers were interviewed Their responses about obstacles to health care for their children and suggestions for improving services were examined Generally, both groups identified similar obstacles, although important differences between groups were noted The findings point to the need for understanding cultural barriers and the unique concerns of low income families living in rural areas This has important implications for planning changes in the health care system for American Indian children with special needs.