Supreme Court Issues Major Ruling

( – In a victory for Native American tribes against the federal government, described as a landmark ruling, the US Supreme Court affirmed their rights to receive reimbursement for healthcare administration costs.

The narrow 5-4 decision stemmed from a lawsuit, Becerra, Secretary of Health and Human Services, et al. v. San Carlos Apache Tribe, initiated by the San Carlos Apache Tribe and Northern Arapaho Tribe.

The Court found that tribes are eligible for reimbursement for indirect costs associated with providing services, regardless of the funding source, whether it be the Indian Health Service (IHS) or other entities, reports Native News Online.

Chief Justice John Roberts, authoring the majority opinion, interpreted the 1975 Indian Self-Determination and Education Assistance Act (ISDA) as mandating the IHS to cover the contract support costs incurred by tribes when they utilize and manage program income—revenues from third-party payers such as Medicare, Medicaid, and private insurers.

“If IHS does not cover costs to support a tribe’s expenditure of program income, the tribe would have to divert some program income to pay such costs, or it would have to pay them out of its own pocket. Either way, the tribe would face a systemic funding shortfall relative to IHS—a penalty for pursuing self-determination,” Roberts noted.

He further noted that the self-determination contracts of these tribes require them to allocate program income to enhance services and functions they have assumed from IHS, necessitating ISDA-mandated support from IHS for these costs.

Roberts was supported in his view by Justices Sonia Sotomayor, Elena Kagan, Neil Gorsuch, and Ketanji Brown Jackson. Justice Brent Kavanaugh, dissenting, was joined by conservative Justices Samuel Alito, Clarence Thomas, and Amy Coney Barrett in opposition.

Notably, Justice Gorsuch, although not the primary author, is regarded within Indian Country as profoundly knowledgeable in Indian federal law.

The proceedings, which combined the San Carlos Apache Tribe’s case with a similar one brought by the Northern Arapaho Tribe from Ethete, Wyoming, took place on March 25, 2024.

The crux of the issue was the obligation of IHS to fund not only activities it directly supports but also those financed through external sources by the tribes.

The federal government contended that siding with the tribes would necessitate significant budget reallocations by Congress to meet the heightened contract support costs, though the specifics of potential cuts remained unclear.

Despite frequent requests, IHS has historically been underfunded, often receiving a fraction of what is necessary to fully support Indian health care or to accommodate increased obligations, the report notes.

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