Supreme Court Enforces Reforms in Tribal Healthcare Funding and Support Costs
Jameson Savage
July 3, 2024

Reading Time: 2 minutes

In a landmark decision on June 6, 2024, the United States Supreme Court ruled in favor of the San Carlos Apache Tribe and the Northern Arapaho Tribe, requiring the Indian Health Service (IHS) to pay eligible Contract Support Costs (CSC) for expenditures of third-party reimbursements under the Indian Self-Determination and Education Assistance Act (ISDEAA) contracts and compacts​​​​.

This significant ruling emphasizes the federal government’s responsibility to ensure adequate funding for tribal healthcare programs. The IHS is actively working on implementing this decision and has initiated a comprehensive plan of action, including a consultation with tribes to refine the methodology for calculating CSC on these reimbursements​​.

Key Points:

CSC on Third-Party Reimbursements: The Supreme Court’s decision mandates that the IHS cover the CSC on program income and third-party reimbursements. This is a critical step in upholding the financial integrity of tribal health services and ensuring they receive full support​​.

Immediate Actions and Tribal Consultation: The IHS will convene a CSC Advisory Group in July 2024 to begin discussions on the methodology for CSC calculation. Full tribal consultation is planned for August 2024 to gather feedback and ensure the process aligns with tribal needs​​.

Interim Guidance: An interim methodology has been established to process claims for CSC related to expenditures of third-party reimbursements. Tribes are encouraged to review this interim guidance and submit any urgent requests prior to the completion of the consultation process​​.

Fiscal Impact and Future Planning: Recognizing the potential budgetary implications, there is a strong call for Congress to adopt the President’s Budget proposal for FY 2025, which aims to transition the IHS budget to mandatory funding from FY 2026 onwards. This change is crucial for securing stable and sufficient funding for IHS programs​​.

Key Documents in the Ruling

CSC Recoupment Guidance: This document outlines how tribes can claim Contract Support Costs (CSC) for third-party reimbursements, including eligibility, submission, and calculation guidelines.

Click Here to Read More 

DTLL on Supreme Court Ruling: This letter summarizes the Supreme Court’s decision requiring the IHS to cover CSC for third-party reimbursements and details next steps for tribes.

Click Here to Read More 

If you’re wondering how this ruling might affect your tribe, contact us at or (949) 476-8828. Our dedicated Healthcare Team specializes in providing tailored solutions to navigate complex healthcare funding issues and ensuring that your tribe receives the necessary support.