In a momentous decision on June 6, 2024, the U.S. Supreme Court delivered a resounding victory for Native American tribes. The Court ruled that the Indian Health Service (IHS) must fully reimburse tribes for administrative expenses related to managing their healthcare programs. This landmark 5-4 decision, arising from the consolidated cases of Becerra v. San Carlos Apache Tribe¹  and Becerra v. Northern Arapaho Tribe², upholds the provisions of the 1975 Indian Self-Determination and Education Assistance Act (ISDEAA), a cornerstone of tribal self-determination.

Chief Justice John Roberts, writing for the majority, asserted that denying reimbursement for these costs would essentially penalize “tribes opting in favor of greater self-determination.” Justices Neil Gorsuch, Elena Kagan, Sonia Sotomayor, and Ketanji Brown Jackson each concurred. The Court affirmed that the ISDEAA requires the IHS to cover the reasonable administrative and overhead costs incurred by tribes when they utilize revenues from third-party payers such as Medicare, Medicaid, and private insurance. This ruling ensures that tribally-ran healthcare programs are on an equal footing with those operated directly by the IHS, potentially leading to improved healthcare services for Native American communities. Roberts emphasized, “If the IHS did not reimburse the contract support costs necessary for tribes to run their healthcare programs, that would impose a penalty on tribes for opting in favor of greater self-determination.”

Justice Brett Kavanaugh, dissenting along with Justices Clarence Thomas, Samuel Alito, and Amy Coney Barrett, wrote “For the past 30 years, the Executive Branch has interpreted the relevant statutory provisions … to require tribes to pay those overhead costs out of the third-party income collected from Medicare, Medicaid, and private insurers.” 

Kavanaugh further warned that this decision could divert significant funds from other vital federal programs or necessitate additional taxation. Specifically, Kavanaugh stated “if Congress does not change the overall annual appropriations for Indian healthcare, the Court’s decision will divert funding from poorer tribes to richer tribes potentially impacting poorer tribes more adversely than affluent ones.” Overall, his statement emphasizes concerns that the decision might lead to a reallocation of resources.

The ruling resolves conflicting decisions from lower courts and has far-reaching implications for Native American tribes. By mandating full reimbursement for contract support costs, the decision supports the federal government’s trust responsibility to Native American tribes. The decision is applauded as a significant victory for tribal sovereignty and self-determination.

Leaders in the Native American community have hailed the ruling as a significant step forward. National Congress of American Indians President Mark Macarro expressed his support, stating, “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.”

Following the ruling, Secretary of Health and Human Services Xavier Becerra reiterated the administration’s commitment to supporting tribal self-determination and sovereignty. Recognizing the potential budgetary impact of the decision, Becerra and IHS Director Roselyn Tso called on Congress to shift the IHS budget from discretionary to mandatory funding starting in fiscal year 2026. This change aims to protect the overall appropriation for the IHS and ensure more adequate and stable funding for tribal healthcare programs, a potential solution that could help mitigate the ruling’s financial implications. Becerra stated, “We remain firmly committed to executing our obligations under federal law and supporting tribal self-determination and sovereignty.”

The Supreme Court’s decision is a beacon of hope for tribes and their healthcare programs. By affirming the tribes’ right to full reimbursement for administrative costs, the ruling supports the principles of the ISDEAA and empowers tribes to manage their healthcare services effectively. 

Footnotes

1. Becerra v. San Carlos Apache Tribe, No. 23-250, 2024 WL 2853107 (U.S. June 6, 2024). [Back]
2. Consolidated with Becerra v. San Carlos Apache Tribe, No. 23-250, 2024 WL 2853107 (U.S. June 6, 2024). [Back]