The Supreme Court has agreed to review a case brought forward by the San Carlos Apache tribe, asserting that the federal government has not adequately provided funds required for the tribe’s health services.
Central to the case is the debate over whether the Indian Health Service (IHS) should compensate the tribe for overhead costs related to health services provided with the assistance of third-party insurers, such as Medicaid or private insurance. According to court documents, the San Carlos Apache incurred approximately $3 million in overhead expenses over a three-year period due to these services.
While the IHS contends that it already offers tribes an administrative fee for health services, it argues against reimbursing overhead costs for services covered by a third party. The agency believes that obligating such payments would significantly expand its responsibilities, potentially impacting the healthcare budget for underserved tribal communities.
The IHS declined to comment on the ongoing litigation when approached. However, an attorney representing the tribe criticized the case as another attempt by the IHS to hinder tribal governments' efforts to provide quality healthcare amid severe resource constraints.
Lloyd Miller, the attorney, cited previous Supreme Court rulings rejecting government attempts to limit contract support cost payments to tribes operating self-determination contracts. The San Carlos Apache and the Northern Arapaho Tribe are jointly suing the IHS over the agency’s obligations under the Indian Self-Determination and Education Assistance Act, which empowered tribes to manage previously IHS-provided health services.
The Northern Arapaho Business Council expressed confidence in the High Court’s decision aligning with the 10th Circuit Court of Appeals, emphasizing the need for reimbursement to cover all healthcare-related expenses linked to program administration.
Both parties acknowledge the inadequacy of IHS funding, leading to persisting health disparities within American Indian communities. Despite spending significantly less per capita compared to Medicaid and Medicare, the IHS warns that reimbursing third-party overhead costs could substantially burden the agency with additional annual expenses ranging from $800 million to $2 billion.
Appeals courts in the 9th and 10th circuits ruled in favor of the tribes. The IHS appealed to the Supreme Court, expressing concerns that upholding these decisions might enable tribes collecting third-party payments to significantly increase their IHS funding, potentially affecting non-contracting tribes' programs or services.
While both the tribes and IHS agree that the Supreme Court should address the matter, the tribes advocate for upholding the circuit courts' decisions, emphasizing their quest for fair funding to bridge the healthcare gap rather than seeking an undue financial advantage.
