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Supreme Court rules U.S. must pay overhead costs for tribal health care programs

This is an image of the U.S. Supreme Court building in Washington, D.C. on a partly cloudy day.
William J. Chizek
Adobe Stock
The U.S. Supreme Court building in Washington, D.C.

The U.S. Supreme Court on June 6 ruled the federal government has been underfunding Native American tribes that run their own health care programs. It’s a victory for tribes in the Mountain West and beyond.

The ruling centered on the issue of the overhead costs tribes take on when they bill private insurance companies, Medicare and Medicaid. In a 5-4 decision, the court ruled that the 1975 Indian Self-Determination Act requires the federal Indian Health Service (IHS), an agency within the Department of Health and Human Services, to cover those costs.

The ruling ensures health care programs administered by tribes operate on equal footing with those run by the IHS, said Morgan Saunders, an attorney with the Native American Rights Fund, a nonprofit law group in Colorado.

“Tribal nations are in the best position to determine what's best for their communities,” she continued. “And this funding is necessary to fulfill that exercise of sovereignty that tribes are making when they elect to contract to take over these programs.”

Saunders said the federal money can help address some of the inequities in healthcare funding for tribal communities across the country.

The Supreme Court decision is a win for the Northern Arapaho Tribe in Wyoming and the San Carlos Apache Tribe in Arizona. Both sued the government after facing millions in overhead costs in recent years. The Northern Arapaho Tribe spent $1.5 million in billing costs over a two-year period and the San Carlos Apache Tribe spent nearly $3 million over three years.

The ruling could mean the federal government pays between $800 million and $2 billion a year for all tribes that run their own healthcare programs, according to the Department of Health and Human Services.

This story was produced by the Mountain West News Bureau, a collaboration between Wyoming Public Media, Nevada Public Radio, Boise State Public Radio in Idaho, KUNR in Nevada, KUNC in Colorado and KANW in New Mexico, with support from affiliate stations across the region. Funding for the Mountain West News Bureau is provided in part by the Corporation for Public Broadcasting.

Kaleb is an award-winning journalist and KUNR’s Mountain West News Bureau reporter. His reporting covers issues related to the environment, wildlife and water in Nevada and the region.