On June 6, 2024, the Supreme Court of the United States issued its opinion in Becerra v. San Carlos Apache Tribe (23-250). The question of the case was whether the Indian Health Service (IHS) must pay contract support costs (CSC) on 3rd party revenues collected from Medicare, Medicaid, and other private insurance. The Supreme Court ruled in favor of Tribes in a 5-4 decision. The Supreme Court found that,
ISDA requires IHS to pay the contract support costs that a tribe incurs when it collects and spends program income to further the functions, services, activities, and programs transferred to it from IHS in a self-determination contract. […] The Government’s arguments to the contrary find no support in ISDA’s text. […] A contrary reading of the statute would impose a penalty on tribes for opting in favor of greater self-determination.
You can read more about the oral argument and the issue in the case here. The National Indian Health Board (NIHB) filed an amicus curiae brief in this case that detailed the history of the IHCIA and how it interacts with 3rd party revenue. You can read that brief here.
“Today's Supreme Court decision represents a monumental victory for Tribal sovereignty and the future health of Our People. Now, in order to honor this decision, Congress must properly include these Contract Support Costs in future appropriations to not increase the burden on an already underfunded IHS budget,” said William “Chief Bill” Smith, Valdez Native Tribe, NIHB Chairman. “This is a win for Tribal sovereignty, and now Congress must fulfill the nation's promises to properly fund healthcare for Tribal Nations. It’s well past time to properly fund the Indian Health Service—mandatory appropriations is the path to health equity and full support for Tribal sovereignty, and the time for that is now.”
The Northern Arapaho Tribe (one of the main litigants in the case) said: “Today’s U.S. Supreme Court decision is a momentous victory for the Northern Arapaho people and the sovereignty of all tribes. This ruling upholds the promise of the Indian Self-Determination Act, which Congress passed with the intention of reimbursing Tribes for their costs in administering health care programs. A judicial finding to the contrary would have cost our Tribe alone millions of dollars, leading to reduced services and programs that our community relies upon."
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