Courthouse Steps Decision: Becerra v. San Carlos Apache Tribe

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The Indian Self-Determination and Education Assistance Act (ISDA), which allows Native tribes to administer their healthcare programs instead of the Indian Health Service (IHS), also requires IHS to pay “contract support costs” (CSCs) to tribes to offset overhead costs incurred by the tribes while administering their healthcare programs. Becerra v. San Carlos Apache Tribe (consolidated with Becerra v. Northern Arapaho Tribe) asks whether the IHS must pay CSCs not only to support IHS-funded activities but also to support tribes’ expenditure of income collected directly from third-party insurers.

The San Carlos Apache Tribe, exercising its sovereignty in Arizona, managed its healthcare programs and billed outside insurers directly. However, the Tribe encountered difficulties funding the additional healthcare services from third-party revenue because IHS would not pay CSCs for these transactions. The Tribe sued the U.S. Department of Health & Human Services, IHS, and the United States for the CSC for the years 2011–2013. The district court dismissed the Tribe’s claim for the third-party-revenue-funded portions of the Tribe’s healthcare program from CSC reimbursement, and the Tribe appealed. The U.S. Court of Appeals for the Ninth Circuit concluded that the statutory text of 25 U.S.C. § 5325(a) warranted a reversal of the dismissal and remanded further proceedings.

The Court heard oral arguments on March 25, 2024, and ruled in the case on June 6, 2024, affirming the Ninth Circuit's holding in a 5-4 decision.

Join us for a Courthouse Steps Decision program, where we will analyze this decision and its possible ramifications.


  • Jennifer H. Weddle, Shareholder, Greenberg Traurig


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