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Supreme Court Ruling Is a Victory for Tribal Health Finance
Photo: Al Drago/Getty Images
The Supreme Court ruled that the Federal Indian Health Service is obligated to reimburse Tribes for the overhead costs of health care services contracted from third parties, including private insurers, Medicare, and Medicaid.
The Supreme Court’s 5-4 decision in Becerra v. San Carlos Apache Tribe, issued Thursday, is a win for tribal finances, according to attorney Mike Andrews, senior vice president at MaquireWoods Consulting. Andrews is head of the firm’s American Indian policy group and former chief counsel of the Senate Committee on Indian Affairs.
The case involves reimbursement for third-party billing, Andrews said. Tribes have paid for third-party administrative services. In some cases, third-party charges represent millions of dollars, he said.
Because non-tribal providers also aren’t reimbursed for administrative expenses, the tribes were asking for what other hospitals don’t get, Andrews said.
However, in 2019, Congress authorized Tribes to allow third-party billing administrative costs to be covered.
It took a Supreme Court ruling for the tribes to be reimbursed.
The four dissenting Supreme Court justices — Brett Cavanaugh, Amy Coney Barrett, Samuel Alito and Clarence Thomas — didn’t want to give tribes a benefit that wasn’t available to everyone else, Andrews said.
When contacted, the Indian Health Service (IHS) forwarded comment to Health and Human Services Secretary Xavier Becerra.
“The court has rendered its ruling and we remain firmly committed to carrying out our obligations under federal law and supporting tribal self-determination and sovereignty,” Becerra said. “In recognition of the potential budgetary impact of this decision, we urge Congress to act on the President’s FY 2025 budget proposal to change the IHS budget from discretionary to mandatory funding beginning in FY 2026 to protect the overall allocation for the Indian Health Service and create more adequate and stable funding in the future.”
In terms of federal cost, administrative reimbursement represents a small portion of the overall budget, Andrews said.
“I thought this was a resolution for tribal sovereignty,” Andrews said. “This is a victory for the tribes.”
WHY DOES IT MATTER
In the 5-4 decision, the justices stated that the Indian Self-Determination Act (ISDA) of 1975 requires the Indian Health Service to reimburse Tribal Nations for the expenses of prescriptions collected from third-party payers such as Medicare, Medicaid and private insurers.
The court consolidated Becerra v. San Carlos Apache Tribe and Becerra v. Northern Arapaho Tribe, and held that the Indian Self-Determination Act and ISDA contracts require Tribal Nations to collect revenues from third-party payors and spend those revenues to promote their respective health programs.
“Today’s decision is a victory for tribal self-determination and tribal sovereignty,” National Congress of American Indians (NCAI) President Mark Macarro said in a statement. “This ruling ensures that Tribal Nations that administer health services to their citizens and communities do so with all the funding to which they are entitled under federal law and contracts with the Indian Health Service.”
John Echohawk, executive director of the Native American Rights Fund (NARF), said in a statement: “Congress passed the Indian Self-Determination Act with the goal of empowering Tribal Nations and ensuring that tribally-run health programs would be up to par. equality with those administered by the Indian Health Service. This decision honors the commitment Congress made to the rights of Tribal Nations to self-determination.
THE BIGGEST TREND
The ruling states that federal support for tribally-administered health programs must be on par with IHS-administered programs.
San Carlos and Becerra Apache Tribe v. Northern Arapaho Tribe affirms the Tribes’ victories in the Ninth and Tenth Circuit Court of Appeals, making these victories applicable nationwide. Both Tribal Nations sued to secure full reimbursement for IHS contractual support costs related to the direct health services they provide on their respective reservations.
Send an email to the writer: SMorse@himss.org