Supreme Court hears dispute over whether ISDA requires IHS to reimburse tribes for contract‑support costs tied to third‑party revenue

The Supreme Court heard argument in Becerra v. Upachi Tribe, case number 23250, over whether the Indian Self‑Determination Act (ISDA) requires the Indian Health Service (IHS) to reimburse tribes for contract‑support costs (CSCs) associated with program income tribes receive from third‑party payers such as Medicare and Medicaid.

Government counsel told the Court that ISDA’s basic design requires IHS to transfer appropriated funds to tribes for the federal programs the tribes agree to run and to pay contract‑support costs to cover gaps left by the secretarial amount. But the government said the statute and implementing provisions do not allow CSCs to be calculated by deducting or otherwise accounting for third‑party revenues that tribes collect and spend independently. “That theory would upend how the statute has been administered for 35 years,” the government argued, and would conflict with a statutory prohibition, the government said, that IHS may not pay costs that are not directly attributable to the ISDA contract.

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