This chapter discusses indigenous movement dynamics in Acre State over a period of some eight years after 1999, when a new state government took office with a pro-indigenous agenda and when changes in federal government policy led to widespread outsourcing of indigenous health services. This period saw the focus of the Acre Movimento Indígena shift from an emphasis on rights-claiming mobilization outside the state to direct participation in the management of outsourced government health services – and then back again. The chapter explores the complex and sometimes contradictory strategies and tactics that representatives of Acre’s Indigenous Peoples’ Movement have deployed in response to the dilemmas of engagement with the state.