Excerpted From: Lilly Cushman, Health Care Law--Obligation of Indian Health Services to Fund the Administration of Tribe Run Health Care Services Has Expanded– San Carlos Apache Tribe V. Becerra, 53 F.4th 1236 (9th Cir. 2022), 20 Journal of Health & Biomedical Law 59 (2023) (67 Footnotes) (Full Document)

LillyCushmanThe Indian Self Determination Education Assistance Act (hereinafter ISDEAA), enacted in 1975, granted indigenous tribes greater autonomy to control and administer health care services to tribal members. The ISDEAA established a framework to allocate funding from the Indian Health Service (hereinafter IHS) directly to Tribes for the operation and management of their health care programs, including administrative “contract support costs” (hereinafter CSC). Tribal health care programs are additionally funded through revenue generated from reimbursements by third-party insurers. In San Carlos Apache Tribe v. Becerra, the United States Court of Appeals for the Ninth Circuit considered, as a matter of first impression, whether the Indian Health Service was required to pay contract support costs related to administering health care services that the tribes provided using the third-party revenue funds. The Ninth Circuit found that the ISDEAA necessarily requires the IHS to pay contract support costs for all activities required for compliance with the Act, including portions of the program funded by third-party revenue.

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In San Carlos Apache Tribe v. Becerra, the Ninth Circuit considered whether the health care programs funded by third-party revenue qualified as actions performed in compliance with ISDEAA. Moreover, the court considered whether IHS held an obligation to cover the associated CSC for administering these health care services under the ISDEAA. The Court determined that utilizing these funds for program administration constituted a fundamental component of ISDEAA compliance, thus mandating the IHS to reimburse the Tribe for the associated CSC. In doing so, the Court not only upheld the law but also emphasized the enduring importance of tribal sovereignty and the vital nexus between health care and self-determination.

J.D. Candidate, Suffolk University Law School, 2023; B.A. University of South Carolina, 2020.