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Health Board Celebrates Supreme Court Ruling in San Carlos Apache Tribe Case

RAPID CITY, SOUTH DAKOTA —Yesterday the U.S. Supreme Court ruled in a 5-4 decision in San Carlos Apache Tribe v. Becerra that Indian Health Service must pay tribes for overhead expenses associated with revenues earned from Medicare, Medicaid and private insurers for health care services provided to tribal health program patients.

This decision is a huge victory for tribes in the Great Plains and across the nation because it will increase federal funding for tribal health care,” said Health Board CEO, Jerilyn Church.  “It will fill a significant shortfall in tribal health budgets by reimbursing tribes for administrative costs incurred to support health programs paid for with third-party revenues.

Tribes in the Great Plains have been expanding their exercise of self-determination rights by assuming the operation of more health programs from Indian Health Service. This decision supports these efforts by eliminating a significant funding gap in the reimbursement of tribes for their contract support costs. It also provides tribes greater parity with the Indian Health Service in administering those health programs by permitting tribes to spend third-party revenues entirely on program costs rather than diverting a portion to pay administrative costs. 

In a press statement responding to the decision, the Secretary of Health and Human Services stated,  “In recognition of the potential budgetary impact of this decision, we urge Congress to act on the FY 2025 President’s Budget proposal to shift the IHS budget from discretionary to mandatory funding starting in FY 2026 to protect the overall appropriation for the Indian Health Service and create more adequate and stable funding into the future.” 

IHS Director Roselyn Tso stated that the Indian Health Service had “been preparing for this possibility in order to ensure that the transition to new CSC-related systems will cause minimal disruption to those we serve.”  She also said that “[t]he agency remains firmly committed to executing our obligations under federal law and supporting tribal self-determination and sovereignty.”  It is a positive sign that the government is looking for ways to ensure adequate funding under the Supreme Court’s mandate and to continue supporting self-determination.

The Health Board congratulates the San Carlos Apache Tribe and the Northern Arapaho Tribe on their significant victory.  The Health Board will work with its Member Tribes to exercise their self-determination rights recognized in the decision and increase federal funding available to support all health programs serving their people, federal and tribal. 

The Health Board will also work with Member Tribes to continue to urge Congress to adequately fund Indian health services, including by making the IHS budget and contract support costs appropriations mandatory.

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