indianz.com your internet resource indianz.com on facebook indianz.com on twitter indianz.com on Google+
ph: 202 630 8439   fax: 202 318 2182
Dynamic Homes
Advertise on Indianz.Com
Home > News > Headlines
Print   Subscribe
State loses case over Indian Health Care Improvement Act
Tuesday, December 4, 2007
Filed Under: Health | Law

The state of Arizona is not entitled to recover all of its Medicaid costs under the Indian Health Care Improvement Act, a federal appeals court ruled on Monday.

The state billed over $36 million to the Health Care Financing Administration, the federal agency that administers Medicaid. The state said it was entitled to recover 100 percent of its costs for providing health care to Medicaid-eligible Indian patients.

But the 9th Circuit Court of Appeals disagreed. In a unanimous decision, a three-judge panel said the IHCIA provision at issue was ambiguous so it deferred to the government's interpretation of the law.

The ruling means the only providers that are entitled to 100 percent reimbursement for Medicaid costs are the Indian Health Service and tribes that administer care at IHS facilities.

Otherwise, states like Arizona can recover just a percentage of their Medicaid costs for Indian patients. For the coming fiscal year, the rates -- known as federal Medicaid Assistance Percentages (FMAP) -- range from 50 percent to 74 percent, depending on the state.

The ruling also means urban Indian health care providers cannot receive 100 percent of their Medicaid costs. They are reimbursed at the same rate as their respective state.

Quoting the IHCIA, the 9th Circuit said "the costs eligible for a FMAP reimbursement rate of 100 percent are 'limited to those 'received through' an IHS facility which offers, is responsible for and bills Medicaid for the services provided.'"

Even though the IHCIA has been on the books since 1976, the issue has only come up three times in the courts. The first two cases were from North Dakota and South Dakota and the states ended up losing both times.

The 9th Circuit arrived at the same outcome as the 8th Circuit in those cases. But the circuits disagreed on whether the IHCIA provision regarding Medicaid was ambiguous.

In a 2005 decision, the 8th Circuit said the legislative history for the IHCIA was "clear and consistent" with regard to the providers that are entitled to recover 100 percent of Medicaid services to Indian patients. "Nowhere does it suggest that the 100 percent FMAP applies to services provided outside of IHS facilities, such as the referrals at issue in this case," the court said.

The 9th Circuit, however, said the legislative history was not clear. So the court deferred to the Department of Health and Human Services' interpretation of which providers receive 100 percent reimbursement.

Congress is currently considering a reauthorization of the IHCIA. Tribal advocates have called for a provision to reimburse urban Indian health care providers 100 percent of their Medicaid costs.

The bill, however, has failed to pass for the last seven years due to objections from the Bush administration and Republican lawmakers. Last year, Senate Republicans blocked passage on the eve of consideration after the Department of Justice released an anonymous "white paper" objecting to numerous provisions.

This year, the Bush administration objected to extending health care benefits to urban Indians, certain Alaska Natives and lineal Indian descendants. The administration suggested that such programs might violate the U.S. Constitution because they are based on race.

9th Circuit Decision:
Arizona Health Care Cost Containment System v. McClellan (December 3, 2007) | Audio: Oral Arguments (May 15, 2007)

8th Circuit Decision:
North Dakota, South Dakota v. Centers for Medicare and Medicaid (April 6, 2005)

Department of Health and Human Services Appeals Board Decisions:
Arizona | North Dakota | South Dakota

House Energy and Commerce Committee Documents:
Summary | Manager's Amendment | Press Release | Webcast

Indian Health Care Improvement Act Amendments:
S.1200 | H.R.1328

Relevant Documents:
Letter to President Bush | Letter to Alberto Gonzales | DOJ White Paper

Relevant Links:
Arizona Health Care Cost Containment System - http://www.ahcccs.state.az.us
Centers for Medicare & Medicaid Services - http://www.cms.hhs.gov
Indian Health Service - http://www.ihs.gov
National Indian Health Board - http://www.nihb.org

Related Stories:
House subcommittee approves Indian health care bill (11/08)
IHCIA delayed but could come up next week (10/26)
Long-delayed IHCIA set for vote in Senate (10/22)
Indian health care leaders win prestigious award (10/04)
Indian Country rallies for health care in U.S. Capitol (09/13)
Indian health care markup, rally in Washington (9/12)
Senate markup on Indian Health Care Act (9/10)
IHCIA pushed as Congress returns from break (9/5)
Rally for Indian health set in DC for September 12 (9/4)
Wild horses get more money than IHS hospital (08/16)
Senate field hearing on Indian health in Montana (8/15)
Senate field hearing on health this Wednesday (8/13)
IHCIA reauthorization exchange on Senate floor (8/2)
Editorial: Indian health care a trust responsibility (7/31)
IHS suffers from long waits, inadequate funding (7/30)
White House changed testimony on trust (7/27)
IHS slow to resolve problems under Grim (7/26)
Senate confirmation hearing for Dr. Grim of IHS (7/26)
Pill 'epidemic' strikes reservations in Montana (7/23)
Senate Indian Affairs Committee renews focus (7/20)
Direct Service Tribes discuss IHS in Denver (06/27)
Emergency room at IHS facility fails inspection (05/09)
Indian Health Care Act introduced in Senate (05/02)
California tribes seek bigger share of health funding (5/1)
Belcourt: Indian Country takes path of healthy living (4/30)
House committee approves Indian health care bill (4/26)
Montana and Wyoming tribes host health conference (04/06)
Montana lawmaker presses for health care funding (4/5)
Opinion: U.S. failing to provide Indian health care (3/22)
Kara Briggs: The fight to reauthorize IHCIA (3/21)
Urban Indians hurt by IHS policy in Montana (3/20)
Health care push continues at House hearing (3/19)
DOJ's Indian white paper a political whodunit (3/14)
House hearing on Indian Health Care Improvement (3/14)
Urban Indians under attack over health care (3/12)
Fireworks at Indian health care hearing (3/9)
Senate hearing on Indian Health reauthorization (3/8)
Urban Indians in New Mexico feel left out on health (3/8)
Some urban Indians denied care at request of IHS (3/8)
Indian Health Care Act introduced in House (3/7)
Hearings on Indian Health Care Improvement Act (3/5)
Democrats promise action at USET conference (2/14)
Harjo: GOP calls Indian health care 'race-based' (2/12)
Tribes forced to ration funds for health services (2/2)
Interview: Inadequate health care in Indian Country (01/16)
Joint hearing on Indian health care act postponed (11/14)
Final push for health care bill in 109th Congress (11/13)
White House hit over delays in health care and Cobell (10/05)
Still no Indian Health Care Improvement Act (09/22)
New Standard: U.S. failing to deliver health care (7/18)
Senate panel advances Indian health care measure (10/28)
Senate committee takes up slate of Indian bills (10/27)
Hearing on Indian Health Care Improvement Act (07/13)
Oklahoma senator loses Indian health care vote (06/29)

Copyright © Indianz.Com
More headlines...
Local Links:
Federal Register | Indian Gaming | Jobs & Notices | In The Hoop | Message Board
Latest News:
Native Sun News: Tribes discuss water concerns at conference (8/1)
Puyallup fashion designer survives 2nd week on Project Runway (8/1)
Report shows dip in Indian Country detention center population (8/1)
House committee passes bill to protect Gun Lake Tribe's casino (8/1)
George Rivera: Pojoaque Pueblo contributes to state with casino (8/1)
Ted Nugent: Media to blame for tribes canceling casino concerts (8/1)
Chippewa Cree Tribe takes Original American Foundation money (8/1)
Cayuga Nation welcomes 2nd Circuit decision in foreclosure suit (8/1)
Senate Indian Affairs Committee supports bills for Nevada tribes (8/1)
Support grows for trail to recognize forced march of Ponca Tribe (8/1)
Leadership flap in Cheyenne and Arapaho Tribes appears settled (8/1)
Canada posts reports of salaries earned by First Nations leaders (8/1)
Montana to open satellite voting office on Blackfeet Reservation (8/1)
BIA officer involved in fatal shooting on Wind River Reservation (8/1)
Editorial: BIA fails to explain need for federal recognition reform (8/1)
Rep. Young apologizes for grabbing arm of Congressional staffer (8/1)
Chumash Tribe dispels drought concerns amid casino expansion (8/1)
Lawmakers ask DOJ to back bill to reverse online gaming opinion (8/1)
Native Sun News: Lawmakers seek distribution of Cobell checks (7/31)
2nd Circuit protects Cayuga Nation from foreclosure proceeding (7/31)
Senate Indian Affairs Committee passes seven bills at meeting (7/31)
David Wilkins: Finding some common ground on disenrollments (7/31)
Erik Stegman: Racist mascots continue to hurt our Native youth (7/31)
Tribes participate in 400-mile journey from Colorado to Arizona (7/31)
Sen. Tester questions void in leadership at IHS regional offices (7/31)
Matika Wilbur continues photo trip throughout Indian Country (7/31)
Proposed bill targets 'halfbreed' and 'breed' names in Montana (7/31)
Saginaw Chippewa Tribe records high levels of bacteria in river (7/31)
KUOW: Tightening the screws on tribal payday loan operations (7/31)
Notah Begay to be inducted into Stanford Athletics Hall of Fame (7/31)
St. Regis Mohawk Tribe fires police chief following investigation (7/31)
Opinion: Native Americans shackled in poverty by federal policy (7/31)
Fact Checker: Three Pinocchios for Washington team's new site (7/31)
Column: Revisiting Johnny Cash's classic Indian rights recording (7/31)
Column: Sen. McCain breaks promise on Tohono O'odham casino (7/31)
Survey shows support for smoke-free tribal casinos in Wisconsin (7/31)
Prairie Island Tribe arrests woman for possessing meth at casino (7/31)
Chumash Tribe hosts public meeting on $160M casino expansion (7/31)
Crews stop spread of fires that came near Barona Band's casino (7/31)
Native Sun News: Website tracks missing and murdered women (7/30)
Native Sun News: AmeriCorps expands efforts in Indian Country (7/30)
House Natural Resources Committee markup on four tribal bills (7/30)
Mark Begich: A permanent fix for tribal contract support costs (7/30)
Paul Moorehead: Let's get back to promoting self-government (7/30)
Tanya Lee: Violence against Native women a national disgrace (7/30)
Rep. Markwayne Mullin named one of 50 Most Beautiful on Hill (7/30)
Tribes criticize veto provisions in BIA federal recognition rule (7/30)
Great Plains tribes hold conference to safeguard water rights (7/30)
Yurok Tribe wraps up marijuana raids with nearly 13K plants (7/30)
more headlines...

Home | Arts & Entertainment | Business | Canada | Cobell Lawsuit | Education | Environment | Federal Recognition | Federal Register | Forum | Health | Humor | Indian Gaming | Indian Trust | Jack Abramoff Scandal | Jobs & Notices | Law | National | News | Opinion | Politics | Sports | Technology | World

Indianz.Com Terms of Service | Indianz.Com Privacy Policy
About Indianz.Com | Advertise on Indianz.Com

Indianz.Com is a product of Noble Savage Media, LLC and Ho-Chunk, Inc.