On June 6, 2024, the U.S. Supreme Court affirmed that the 1975 Indian Self-Determination Act (ISDA) requires the Indian Health Service (IHS) to reimburse Tribal Nations that contract the administration and operation of healthcare programs for their expenditures of revenues collected from third-party payors like Medicare, Medicaid, and private insurers. This ensures that Tribal Nation healthcare programs operate on equal footing with IHS-run programs, as intended by the ISDA. The Court consolidated Becerra v. San Carlos Apache Tribe and Becerra v. Northern Arapaho Tribe and held that the ISDA and the ISDA contracts require the Tribal Nations to collect revenues from third-party payors and spend that revenue to further their respective healthcare programs. As a result, the costs to Tribal Nations of spending these revenues on further healthcare services must also be eligible for contract support cost reimbursement from IHS.

“Today’s decision is a victory for Tribal Self-Determination and Tribal Sovereignty,” said National Congress of American Indians President Mark Macarro. “This ruling will help ensure that Tribal Nations administering healthcare services to their citizens and communities do so with the full funding to which they are entitled under federal law and their contracts with the Indian Health Service.”

John Echohawk, Executive Director of the Native American Rights Fund agreed. “Congress passed the Indian Self-Determination Act with the purpose of empowering Tribal Nations and ensuring that Tribally-run healthcare programs would be on equal footing with those run by the Indian Health Service. This decision honors the commitment Congress made to Tribal Nations’ rights to self-determination.”

Becerra v. San Carlos Apache Tribe and Becerra v. Northern Arapaho Tribeaffirm the Ninth and Tenth Circuit Court of Appeals’ wins by the Tribes making these victories applicable nationwide. Both Tribal Nations sued to ensure full contract support cost reimbursement from IHS related to the direct healthcare services they provide on their respective reservations. Today’s decision follows two previous rulings by the Court that under ISDA, Tribal Nations are eligible for contract support costs because they incur overhead and other costs to run their healthcare programs that IHS-run programs do not.

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