October Term 2023 · Docket 23-250
Does the Self-Determination Act require the government to pay tribes for indirect healthcare costs?
The San Carlos Apache Tribe seeks full reimbursement for indirect costs. The Department of Health and Human Services argues the law limits this payment.
Verified source milestones
- — An official oral-argument transcript was verified.
- — An official oral-argument transcript was verified.
- — An official Court opinion was verified.
The arguments, in order
This case may have been argued more than once. Each entry below uses that session's official transcript. Later arguments do not erase earlier ones.
Argument 1 ·
What happened at the argument
Ms. Flynn argued the Act requires IHS to contract with tribes.
She stated the Act's basic design is simple.
Mr. Unikowsky argued the Act entitles tribes to recover disputed costs.
He noted the bulk of disputed costs are indirect costs.
Read the official transcript for this argument · Official argument details
Sources used for this argument breakdown
- Official Supreme Court Transcript — file page 10, lines 15-23 — Transcript, file page 10, lines 15-23
- Official Supreme Court Transcript — file page 10, lines 35-49 — Transcript, file page 10, lines 35-49
- Official Supreme Court Transcript — file page 102, lines 53-47 — Transcript, file page 102, lines 53-47
- Official Supreme Court Transcript — file page 11, lines 39-41 — Transcript, file page 11, lines 39-41
- Official Supreme Court Transcript — file page 11, lines 45-53 — Transcript, file page 11, lines 45-53
- Official Supreme Court Transcript — file page 13, lines 29-37 — Transcript, file page 13, lines 29-37
- Official Supreme Court Transcript — file page 13, lines 47-49 — Transcript, file page 13, lines 47-49
- Official Supreme Court Transcript — file page 43, lines 47-29 — Transcript, file page 43, lines 47-29
- Official Supreme Court Transcript — file page 5, lines 11-21 — Transcript, file page 5, lines 11-21
- Official Supreme Court Transcript — file page 5, lines 23-21 — Transcript, file page 5, lines 23-21
- Official Supreme Court Transcript — file page 69, lines 15-15 — Transcript, file page 69, lines 15-15
- Official Supreme Court Transcript — file page 69, lines 17-21 — Transcript, file page 69, lines 17-21
- Official Supreme Court Transcript — file page 69, lines 39-43 — Transcript, file page 69, lines 39-43
- Official Supreme Court Transcript — file page 69, lines 49-51 — Transcript, file page 69, lines 49-51
- Official Supreme Court Transcript — file page 69, lines 55-9 — Transcript, file page 69, lines 55-9
- Official Supreme Court Transcript — file page 7, lines 23-25 — Transcript, file page 7, lines 23-25
- Official Supreme Court Transcript — file page 7, lines 29-31 — Transcript, file page 7, lines 29-31
- Official Supreme Court Transcript — file page 7, lines 43-45 — Transcript, file page 7, lines 43-45
- Official Supreme Court Transcript — file page 7, lines 53-7 — Transcript, file page 7, lines 53-7
- Official Supreme Court Transcript — file page 70, lines 19-23 — Transcript, file page 70, lines 19-23
- Official Supreme Court Transcript — file page 70, lines 43-53 — Transcript, file page 70, lines 43-53
- Official Supreme Court Transcript — file page 71, lines 19-37 — Transcript, file page 71, lines 19-37
- Official Supreme Court Transcript — file page 71, lines 49-15 — Transcript, file page 71, lines 49-15
- Official Supreme Court Transcript — file page 72, lines 25-49 — Transcript, file page 72, lines 25-49
- Official Supreme Court Transcript — file page 73, lines 37-41 — Transcript, file page 73, lines 37-41
- Official Supreme Court Transcript — file page 73, lines 51-53 — Transcript, file page 73, lines 51-53
- Official Supreme Court Transcript — file page 73, lines 55-19 — Transcript, file page 73, lines 55-19
- Official Supreme Court Transcript — file page 8, lines 51-7 — Transcript, file page 8, lines 51-7
- Official Supreme Court Transcript — file page 82, lines 15-15 — Transcript, file page 82, lines 15-15
- Official Supreme Court Transcript — file page 9, lines 11-19 — Transcript, file page 9, lines 11-19
A citizen's guide to the whole case
What this case is about
The dispute centers on the Indian Self-Determination Act. The tribe claims the law mandates full cost recovery. The government disputes the scope of this obligation.
Official sources for this section
- Official Supreme Court Transcript — file page 102, lines 53-47 — Transcript, file page 102, lines 53-47
- Official Supreme Court Transcript — file page 43, lines 47-29 — Transcript, file page 43, lines 47-29
- Official Supreme Court Transcript — file page 5, lines 23-21 — Transcript, file page 5, lines 23-21
- Official Supreme Court Transcript — file page 69, lines 15-15 — Transcript, file page 69, lines 15-15
- Official Supreme Court Transcript — file page 82, lines 15-15 — Transcript, file page 82, lines 15-15
How the case got here
The Supreme Court heard oral argument in this case on March 25, 2024.
Official sources for this section
- Official Supreme Court Transcript — file page 5, lines 11-21 — Transcript, file page 5, lines 11-21
- Official Supreme Court Transcript — file page 71, lines 49-15 — Transcript, file page 71, lines 49-15
What each side wants
The tribe wants the government to pay all disputed indirect costs.
The government wants to limit its payment obligation for these costs.
Official sources for this section
- Official Supreme Court Transcript — file page 102, lines 53-47 — Transcript, file page 102, lines 53-47
- Official Supreme Court Transcript — file page 43, lines 47-29 — Transcript, file page 43, lines 47-29
- Official Supreme Court Transcript — file page 5, lines 23-21 — Transcript, file page 5, lines 23-21
- Official Supreme Court Transcript — file page 69, lines 15-15 — Transcript, file page 69, lines 15-15
- Official Supreme Court Transcript — file page 82, lines 15-15 — Transcript, file page 82, lines 15-15
What each side says
The tribe argues the Self-Determination Act entitles them to recover these costs.
The government argues the law does not require full reimbursement for indirect expenses.
Official sources for this section
- Official Supreme Court Transcript — file page 102, lines 53-47 — Transcript, file page 102, lines 53-47
- Official Supreme Court Transcript — file page 43, lines 47-29 — Transcript, file page 43, lines 47-29
- Official Supreme Court Transcript — file page 5, lines 23-21 — Transcript, file page 5, lines 23-21
- Official Supreme Court Transcript — file page 69, lines 15-15 — Transcript, file page 69, lines 15-15
- Official Supreme Court Transcript — file page 82, lines 15-15 — Transcript, file page 82, lines 15-15
What the justices asked
Justice Kagan asked if tribes must comply with Medicare and Medicaid rules.
Justice Gorsuch asked if the government acts as the payor of last resort.
Official sources for this section
- Official Supreme Court Transcript — file page 10, lines 15-23 — Transcript, file page 10, lines 15-23
- Official Supreme Court Transcript — file page 10, lines 35-49 — Transcript, file page 10, lines 35-49
- Official Supreme Court Transcript — file page 11, lines 39-41 — Transcript, file page 11, lines 39-41
- Official Supreme Court Transcript — file page 11, lines 45-53 — Transcript, file page 11, lines 45-53
- Official Supreme Court Transcript — file page 13, lines 29-37 — Transcript, file page 13, lines 29-37
- Official Supreme Court Transcript — file page 13, lines 47-49 — Transcript, file page 13, lines 47-49
- Official Supreme Court Transcript — file page 69, lines 17-21 — Transcript, file page 69, lines 17-21
- Official Supreme Court Transcript — file page 69, lines 39-43 — Transcript, file page 69, lines 39-43
- Official Supreme Court Transcript — file page 69, lines 49-51 — Transcript, file page 69, lines 49-51
- Official Supreme Court Transcript — file page 69, lines 55-9 — Transcript, file page 69, lines 55-9
- Official Supreme Court Transcript — file page 7, lines 23-25 — Transcript, file page 7, lines 23-25
- Official Supreme Court Transcript — file page 7, lines 29-31 — Transcript, file page 7, lines 29-31
- Official Supreme Court Transcript — file page 7, lines 43-45 — Transcript, file page 7, lines 43-45
- Official Supreme Court Transcript — file page 7, lines 53-7 — Transcript, file page 7, lines 53-7
- Official Supreme Court Transcript — file page 70, lines 19-23 — Transcript, file page 70, lines 19-23
- Official Supreme Court Transcript — file page 70, lines 43-53 — Transcript, file page 70, lines 43-53
- Official Supreme Court Transcript — file page 71, lines 19-37 — Transcript, file page 71, lines 19-37
- Official Supreme Court Transcript — file page 71, lines 49-15 — Transcript, file page 71, lines 49-15
- Official Supreme Court Transcript — file page 72, lines 25-49 — Transcript, file page 72, lines 25-49
- Official Supreme Court Transcript — file page 73, lines 37-41 — Transcript, file page 73, lines 37-41
- Official Supreme Court Transcript — file page 73, lines 51-53 — Transcript, file page 73, lines 51-53
- Official Supreme Court Transcript — file page 73, lines 55-19 — Transcript, file page 73, lines 55-19
- Official Supreme Court Transcript — file page 8, lines 51-7 — Transcript, file page 8, lines 51-7
- Official Supreme Court Transcript — file page 9, lines 11-19 — Transcript, file page 9, lines 11-19
Why it matters
This case defines federal funding obligations for tribal healthcare. It determines how much money tribes receive for self-governance. It impacts the financial stability of tribal health systems.
Official sources for this section
- Official Supreme Court Transcript — file page 102, lines 53-47 — Transcript, file page 102, lines 53-47
- Official Supreme Court Transcript — file page 43, lines 47-29 — Transcript, file page 43, lines 47-29
- Official Supreme Court Transcript — file page 5, lines 23-21 — Transcript, file page 5, lines 23-21
- Official Supreme Court Transcript — file page 69, lines 15-15 — Transcript, file page 69, lines 15-15
- Official Supreme Court Transcript — file page 82, lines 15-15 — Transcript, file page 82, lines 15-15
What happens next
This article currently covers the argument record. Use the official docket link for later case activity.
Official sources for this section
- Official Supreme Court Transcript — file page 10, lines 15-23 — Transcript, file page 10, lines 15-23
- Official Supreme Court Transcript — file page 10, lines 35-49 — Transcript, file page 10, lines 35-49
- Official Supreme Court Transcript — file page 11, lines 39-41 — Transcript, file page 11, lines 39-41
- Official Supreme Court Transcript — file page 11, lines 45-53 — Transcript, file page 11, lines 45-53
- Official Supreme Court Transcript — file page 13, lines 29-37 — Transcript, file page 13, lines 29-37
- Official Supreme Court Transcript — file page 13, lines 47-49 — Transcript, file page 13, lines 47-49
- Official Supreme Court Transcript — file page 5, lines 11-21 — Transcript, file page 5, lines 11-21
- Official Supreme Court Transcript — file page 69, lines 17-21 — Transcript, file page 69, lines 17-21
- Official Supreme Court Transcript — file page 69, lines 39-43 — Transcript, file page 69, lines 39-43
- Official Supreme Court Transcript — file page 69, lines 49-51 — Transcript, file page 69, lines 49-51
- Official Supreme Court Transcript — file page 69, lines 55-9 — Transcript, file page 69, lines 55-9
- Official Supreme Court Transcript — file page 7, lines 23-25 — Transcript, file page 7, lines 23-25
- Official Supreme Court Transcript — file page 7, lines 29-31 — Transcript, file page 7, lines 29-31
- Official Supreme Court Transcript — file page 7, lines 43-45 — Transcript, file page 7, lines 43-45
- Official Supreme Court Transcript — file page 7, lines 53-7 — Transcript, file page 7, lines 53-7
- Official Supreme Court Transcript — file page 70, lines 19-23 — Transcript, file page 70, lines 19-23
- Official Supreme Court Transcript — file page 70, lines 43-53 — Transcript, file page 70, lines 43-53
- Official Supreme Court Transcript — file page 71, lines 19-37 — Transcript, file page 71, lines 19-37
- Official Supreme Court Transcript — file page 71, lines 49-15 — Transcript, file page 71, lines 49-15
- Official Supreme Court Transcript — file page 72, lines 25-49 — Transcript, file page 72, lines 25-49
- Official Supreme Court Transcript — file page 73, lines 37-41 — Transcript, file page 73, lines 37-41
- Official Supreme Court Transcript — file page 73, lines 51-53 — Transcript, file page 73, lines 51-53
- Official Supreme Court Transcript — file page 73, lines 55-19 — Transcript, file page 73, lines 55-19
- Official Supreme Court Transcript — file page 8, lines 51-7 — Transcript, file page 8, lines 51-7
- Official Supreme Court Transcript — file page 9, lines 11-19 — Transcript, file page 9, lines 11-19
Official Court provenance
Official docket and case history · Official Supreme Court oral-argument detail page
Verified official opinions and orders
Title and summary sources
- Official Supreme Court Transcript — file page 102, lines 53-47 — Transcript, file page 102, lines 53-47
- Official Supreme Court Transcript — file page 43, lines 47-29 — Transcript, file page 43, lines 47-29
- Official Supreme Court Transcript — file page 5, lines 23-21 — Transcript, file page 5, lines 23-21
- Official Supreme Court Transcript — file page 69, lines 15-15 — Transcript, file page 69, lines 15-15
- Official Supreme Court Transcript — file page 82, lines 15-15 — Transcript, file page 82, lines 15-15
- Official Supreme Court Transcript — file page 102, lines 53-47 — Transcript, file page 102, lines 53-47
- Official Supreme Court Transcript — file page 43, lines 47-29 — Transcript, file page 43, lines 47-29
- Official Supreme Court Transcript — file page 5, lines 23-21 — Transcript, file page 5, lines 23-21
- Official Supreme Court Transcript — file page 69, lines 15-15 — Transcript, file page 69, lines 15-15
- Official Supreme Court Transcript — file page 82, lines 15-15 — Transcript, file page 82, lines 15-15
Revision history
- Revision 1 · Post Opinion ·
Correction: Rewritten to the concise citizen-facing editorial standard.
- Revision 2 · Post Opinion ·
Correction: Migrated to the dated official Court activity contract without model use.