The US Supreme Court recently heard arguments regarding whether Indian Health Services (IHS) should be reimbursed for “contract support costs” that involve third parties like Medicare and Medicaid. The ambiguity arises from the differing judgments of the US Court of Appeals for the Ninth Circuit and the Tenth Circuit.
The Ninth Circuit ruled that reimbursements from third-parties could not be excluded under its statute, while a Tenth Circuit decision suggested that third-party expenditures could indeed be considered as contract support costs.
The IHS, which falls under the Health and Human Services umbrella headed by Xavier Becerra as secretary, has been faced with the task of interpreting Congress’s Indian Self-Determination and Education Act (ISDA) and the legislative language of 25 U.S.C. § 5325, promoting Native tribes’ self-determination. However, the issue at stake is whether these legislations cover both direct and indirect costs encompassing building construction versus medical ambulatory services.
Advocates argue that such overhead costs should be covered by the IHS as the tribes lack administrative infrastructure to fund these from monies that are supposed to be reserved for health services to Native American populations. Chief Justice John Roberts has noted that the tribes suffer more financial impact the more they engage in self-determination activities.
The broader purpose of the contract as stipulated in 25 U.S.C. § 5325(m) is to allow the tribes to assert self-determination without having to bear administrative overheads that the IHS should ideally cover. This perspective was highlighted by Justice Sonia Sotomayor, who asked if the contract would deny tribes the ability to receive health services from the IHS. Tribal counsel maintained that providing tribes with greater control over their healthcare funding would, in fact, enable them to successfully function as contractors for IHS, covering contract support costs.
The court’s decision on this matter is expected to be delivered in June of this year.
For full context, you can read the original article here.