Huge Win for IHS Clinics

San Carlos Apache Tribe vs Becerra

Huge Win for IHS Clinics

San Carlos Apache Tribe vs Becerra

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Via Bloomberg Law

The Supreme Court made a decision about money for Tribal health care. They basically ruled that Tribes can ask the federal government to pay back certain costs for running their own health programs.

The Supreme Court ruled against the Biden administration on how to divvy up a limited pot of money for tribal health care.

The 5-4 ruling written by Chief Justice John Roberts on Thursday said tribes can sue the federal government to recoup certain administrative expenses associated with running their own health care programs.

Justice Brett Kavanaugh, joined by Clarence Thomas, Samuel Alito, and Amy Coney Barrett, dissented.

The case centers on the Indian Self-Determination and Education Assistance Act, which is intended to encourage tribal self-determination.

The law allows tribes to run their own health care programs using money the Indian Health Service would otherwise tap to provide the same care.

Roberts said a contrary ruling would frustrate the purpose of the law.

It was passed to ensure that tribes had “an effective voice in planning and implementation of programs responsive to the true needs of their communities,” he said. But a ruling in the other direction would inflict “a penalty on tribes for opting in favor of greater self-determination.”

Funding Gap

All parties agree that the government must reimburse tribal-run programs for at least some administrative costs. That’s because tribes incur overhead and administrative expenses that the government doesn’t. For example, the government can rely on the Office of Personnel Management for general administrative functions, whereas tribes can’t.

So, reimbursement of those costs are “necessary to prevent a funding gap between tribes and IHS,” Roberts said.

The question for the justices was whether the government also had to reimburse administrative costs associated with third-party payers like Medicare, Medicaid, and private insurers.

The majority held that the statute clearly covers those costs as well, siding with the two tribes that sued the government for additional funds.

The San Carlos Apache Tribe in southeastern Arizona says the government underpaid it by about $3 million for a three-year contract. The Northern Arapaho Tribe in west central Wyoming says they were underpaid approximately $1.5 million over two years.

Divert Funding

The dissent, however, said the court’s decision upends the government’s “long-settled understanding” that tribes must pay for these costs.

Moreover, given that the funds appropriated for tribal health care is necessarily limited, the court’s ruling will “divert funding from poorer tribes” who can’t run their own programs to “richer tribes” that can,” Kavanaugh said. 

Noting that Congress currently “appropriates about $8 billion annually for Indian health care,” he said the court’s decision could “cost between $800 million and $2 billion annually” and possibly billions more retroactively. 

The cases are Becerra v. San Carlos Apache Tribe, U.S., No. 23-250 and Becerra v. Northern Arapaho Tribe, U.S., No. 23-253. 

Here's a simplified breakdown of the main points:

Background: There's a law called the Indian Self-Determination and Education Assistance Act. It helps tribes run their own health care programs with money that would normally go to the Indian Health Service (IHS).

The Ruling: The Supreme Court said Tribes can get reimbursed for extra administrative costs, like handling paperwork and managing the programs. This includes costs from dealing with Medicare, Medicaid, and private insurance.(3rd Party Revenue)

The Disagreement: Not all the justices agreed. Some argued that this decision might take money away from poorer tribes who can't run their own programs. It was 5-4 in favor.

Impact: The Tribes who brought the case said the government owed them money—$3 million to the San Carlos Apache Tribe and $1.5 million to the Northern Arapaho Tribe. The decision could lead to the government paying tribes between $800 million and $2 billion more each year.

Final thoughts: In short, the Supreme Court decided that the government needs to pay Tribes back for the costs of running their health programs, which is a win for the Tribes seeking more control and better funding for their health care.

As always, If you don’t know now you know, a Native!



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Wilma Mankiller, born on November 18, 1945, in Tahlequah, Oklahoma, was a visionary leader, activist, and the first woman elected as Principal Chief of the Cherokee Nation. With courage, determination, and a deep commitment to her community, Mankiller left an indelible mark on Native rights and women's empowerment. 

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