25 U.S.C. § 1623

Special rules relating to Indians

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(a) No Cost-sharing for Indians with income at or below 300 percent of poverty enrolled in coverage through a State Exchange

For provisions prohibiting cost sharing for Indians enrolled in any qualified health plan in the individual market through an Exchange, see section 18071(d) of title 42.

(b) Payer of last resort

Health programs operated by the Indian Health Service, Indian tribes, tribal organizations, and Urban Indian organizations (as those terms are defined in section 1603 of this title) shall be the payer of last resort for services provided by such Service, tribes, or organizations to individuals eligible for services through such programs, notwithstanding any Federal, State, or local law to the contrary.

(Pub. L. 111–148, title II, § 2901(a), (b), Mar. 23, 2010, 124 Stat. 333.)Editorial NotesCodification

Section is comprised of subsecs. (a) and (b) of section 2901 of Pub. L. 111–148. Subsections (c) and (d) of section 2901 amended sections 1396a and 1320b–9, respectively, of Title 42, The Public Health and Welfare.

Section was enacted as part of the Patient Protection and Affordable Care Act, and not as part of the Indian Health Care Improvement Act which comprises this chapter.

Notes of Decisions

Cited in 8 cases (4 in the last 5 years), 2016–2024 · leading case: Rancheria v. Hargan, 296 F. Supp. 3d 256 (D.C. Cir. 2017).

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Rancheria v. Hargan, 296 F. Supp. 3d 256 (D.C. Cir. 2017). · cites it 6× “25 U.S.C. § 1623 . "Alternate resources" include Medicare, Medicaid, and private insurance.”

Gila River Indian Cmty. v. U.S. Dept. of Vets. Affairs, 899 F.3d 1076 (9th Cir. 2018). · cites it 3× “The Community sought review of the VA’s determination that two provisions of the Patient Protection and Affordable Care Act – 25 U.S.C. §§ 1623 (b) and 1645(c) – did not require the VA to reimburse the Community absent a sharing agreement.”

Navajo Health Found.-Sage Mem'l Hosp., Inc. v. Burwell, 263 F. Supp. 3d 1083 (D.N.M. 2016). “” Obamacare Subtitle K, § 2901, codified at 25 U.S.C. § 1623 (b). Using the canon of statutory construction in pari materia, which says that statutes on the same matter or subject are to be construed together, the Court holds that the congressional intent to include Medicare and…”

Caremark, LLC v. Choctaw Nation, 104 F.4th 81 (9th Cir. 2024). “” 25 U.S.C. § 1623 (b). In these circumstances, when the Nation’s pharmacies fill prescriptions for the tribal members, the pharmacies may seek recovery of these costs from private insurers under the Recovery Act.”

Redding Rancheria v. Burwell (D.D.C. 2017). · cites it 6× “25 U.S.C. § 1623 . “Alternate resources” include Medicare, Medicaid, and private insurance.”

QualiCenters Salem, LLC v. Shasta Admin. Servs., Inc. (D. Or. 2022). · cites it 4× “Shasta contends that even though such patients are eligible for Medicare, the Medicare Secondary Payer Act (MSPA) generally requires that employer plans pay as the primary insurer for the first 33 months of treatment, but that under 25 U.S.C. § 1623 , plans operated by tribal…”

Saginaw Chippewa Indian Tribe of Michigan v. Blue Cross Blue Shield of Michigan (E.D. Mich. 2023). “To overcome these financial barriers, the CHS programs are deemed the “payer of last resort” for healthcare costs, 25 U.S.C. § 1623 . Medicare, Medicaid, or private insurance may furnish funding first.”

QualiCenters Salem, LLC v. Shasta Admin. Servs., Inc. (D. Or. 2022). “Specifically, Shasta claims QualiCenters violated 25 U.S.C. § 1623 (b) by Page 4 - AMENDED ORDER failing to bill Medicare and attempting to collect from Shasta.”

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