A recent decision in the Sixth Circuit Court of Appeals benefits not only Varnum client Saginaw Chippewa Indian Tribe but also clarifies an issue of importance to tribes across the country.
On April 25, the Sixth Circuit held a lower court erred when opining that the tribe’s claims administrator, Blue Cross Blue Shield of Michigan, was not required to pay claims using Medicare-like rates. The lower court had ruled the discounted rates only applied when spending federal dollars. On appeal, the Sixth Circuit held there is no such requirement in federal law to obtain Medicare-like rates.
“The district court erred in reading into the regulatory text a requirement that the tribe use CHS funds to pay for (discounted) care,” the panel’s majority said in its opinion. “Given that the regulation makes a ‘tribe or tribal organization’ the primary actor, rather than the tribe’s CHS program itself, a direct tie to the CHS program – such as the exclusive use of funds earmarked for CHS expenses – is not required.”
The ruling lets tribes determine for themselves how to administer their health care programs.
Varnum attorneys Perrin Rynders and Herman Hofman represented the tribe in the case, Saginaw Chippewa Indian Tribe of Michigan et al v. Blue Cross Blue Shield of Michigan, which has been pending since 2016. In 2018, the Sixth Circuit overturned the lower court’s dismissal of the case. The recent decision overturns a May 2021 District Court ruling granting summary judgment to Blue Cross Blue Shield of Michigan. The case now returns to the lower court for a trial on the merits.