In an explicit demonstration of complex legal issues surrounding tribal self-governance, a dispute over federal health care costs has gained attention. Central to the dispute is the Indian Health Service (IHS), an agency within the Department of Health and Human Services responsible for overseeing health care programs for Native American tribes. As part of a drive towards tribal self-governance, Congress allows these tribes to contract with the IHS to manage these programs independently.
One of such tribes is the San Carlos Apache Indian Reservation. Established in 1871, the reservation spans over 2,800 square miles in southeastern Arizona. This tribe entered into an agreement with the IHS in 2011 to manage its local health programs independently, including emergency medical and substance abuse programs.
The tribe’s agreement with IHS allowed it to access federal funding, simulating the amount that would have been available had the agency managed the programs directly. However, to offset the higher administrative costs due to the absence of federal agencies’ bureaucracy and cost-saving advantages, the IHS is required by the same federal law to provide an additional pool of funds, known as contract support costs, to the tribes.
There is a third source of funding as well. The federal statute governing these contracts allows tribes to negotiate their contracts to incorporate responsibility for billing members’ insurance for services, thereby retaining third-party insurance revenue as long as they use it for health care.
The San Carlos Apache contingent sought higher contract support costs from the IHS for the years 2011 to 2013. After a federal district court in Arizona dismissed their claim, the U.S. Court of Appeals for the 9th Circuit overturned this decision, ruling in favor of the tribe due to the ambiguity of federal law over the inclusion of third-party revenue expenditure in the contract support costs. The case, Becerra v. San Carlos Apache Tribe, has both parties requesting for a Supreme Court review due to its high stakes for federal and tribal interests.
The U.S. Government is also seeking a Supreme Court review of a similar dispute with the Northern Arapho Tribe in Wyoming. This dispute also involves the interpretation of the federal law on contract support costs and self-governance,
This contentious issue is illustrative of the complex legal issues surrounding tribal self-governance and federal support. The unfolding legal developments aim to set a precedent for how the United States government supports tribal self-governance, particularly with regard to the management of federally-funded health programs.
For more details on petitions of the week – visit SCOTUS blog.