Supreme Court to Resolve Split Over Tribal Health Care Funds

The US Supreme Court agreed Monday to consider whether tribes can sue the federal government for administrative expenses related to third-party insurers, like Medicare, Medicaid, and private insurers—an issue that has split the federal circuit courts.

In order to allow tribal participation and control over healthcare, the Indian Self-Determination and Education Assistance Act allows tribes to run their own health care programs with funding by the Indian Health Services, which is part of the Department of Health and Human Services.

Under the act, IHS must reimburse tribes for certain administrative expenses—called contract support costs—in excess of what it would have cost the IHS to administer the program directly. For example, contributions to state workers’ compensation programs for health care workers are something tribe may have to do that the federal government wouldn’t.

The act also allows tribes to bill third parties and keep the funds for health care services.

The question for the justices is whether the IHS must also reimburse tribes for extra administrative expenses associated with those third parties.

In 2021, the US Court of Appeals for the D.C. Circuit found IHS wasn’t on the hook for those costs. But since then, the Ninth and Tenth Circuits have gone the other way.

The US urged the justices to take the case to resolve the split.

“Although making a firm prediction is difficult,” the US told the justices, “the impact would fall somewhere between $800 million and $2 billion annually” and would be expected to grow over time.

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.