The Indian Self-Determination and Education Assistance Act (ISDA), 88 Stat. 2203, 25 U. S. C. § 5301 et seq., enables an Indian tribe to enter into contracts with the Indian Health Service (IHS) to assume responsibility for administering the healthcare programs that IHS would otherwise operate for the tribe. To fund the tribe's administration of such programs, IHS must turn over to the tribe the appropriated funds the agency would have used to operate the programs, as well as an additional sum to cover “contract support costs.” § 5325(a). These costs are administrative expenses incurred by the tribe that IHS does not incur when it runs the programs, typically because the agency can rely on existing Government resources unavailable to the tribe. The tribe may also collect funds due from third parties—such as Medicare, Medicaid, and private insurers—to help fnance *Briefs of amici curiae urging affrmance in both cases were fled for the Coalition of Large Tribes et al. by Jennifer H. Weddle, Troy A. Eid, John E. Echohawk, Melody L. McCoy, Kim Jerome Gottschalk, Morgan Saunders, Josh Newton, and Howard G. Arnett; for Legal Scholars by Seth P. Waxman, Kevin M. Lamb, Laura E. Powell, and Monte Mills, pro se; for NAFOA by C. Bryant Rogers, Hyland Hunt, and Ruthanne M. Deutsch; for the National Congress of American Indians et al. by Steven D. Gordon, Philip M. Baker-Shenk, and James T. Meggesto; and for the National Indian Health Board et al. by Andrew B. Brantingham, Vernle Charles (Skip) Durocher, Jr., Anthony Jones, Robert R. Yoder, and Steven Boos. the programs. The question before us is whether ISDA requires IHS to pay contract support costs to support tribal programs funded by such third-party payments.
I
In 1975, Congress passed ISDA to promote “effective and meaningful participation by the Indian people in the planning, conduct, and administration” of federal healthcare programs. § 5302(b). Such programs provide, for instance, hospitals, dental clinics, and ambulance services. After ISDA's enactment, a tribe can either continue receiving healthcare services directly from the Federal Government through IHS, or it can assume responsibility for administering those services itself. If a tribe elects the latter route, ISDA obligates IHS to enter into a “self-determination contract” with the tribe. § 5321(a)(1). Under this contract, the tribe receives funds to operate federal healthcare programs that IHS previously operated for the tribe's members.
When IHS administers healthcare programs itself, it funds its operations through congressional appropriations and third-party insurance payments. Historically, IHS's funding came from “moneys as Congress may from time to time appropriate.” § 13. But in 1976 Congress enacted the Indian Health Care Improvement Act (IHCIA), 90 Stat. 1400, 25 U. S. C. §1601 et seq., to create greater parity between IHS and other healthcare providers. After IHCIA, when IHS provides healthcare services to a tribal member with Medicare, Medicaid, or private insurance coverage, IHS may collect the funds due from those third-party insurers for the services provided to the insured tribal member. See 42 U. S. C. §§ 1395qq(a), 1396j(a); 25 U. S. C. § 1621e(a). Congress specifed that third-party collections “shall not be considered in determining appropriations” for IHS. 25 U. S. C. § 1641(a). Third-party payments now represent a “signifcant portion” of IHS's tribal healthcare budget—over $1.8 Page Proof Pending Publication Page Proof Pending Publication billion in 2024 alone. Dept. of Health and Human Servs., Fiscal Year 2024, Indian Health Service: Justifcation of Estimates for Appropriations Committees, p. CJ–193 (2023). Healthcare programs administered by tribes under self- determination contracts have a parallel funding structure. First, IHS provides to the tribes the appropriated funds that IHS would have used to operate such programs absent the self-determination contract. ISDA specifes that this sum— called the Secretarial amount—“shall not be less” than the Secretary of Health and Human Services would have otherwise allocated for the operation of the programs during the period covered by the contract. § 5325(a)(1).
Second, like IHS when it runs the healthcare programs, contracting tribes can collect revenue from third-party payers like Medicare, Medicaid, and private insurers. See 42 U. S. C. §§ 1395qq(a), 1396j(a); 25 U. S. C. § 1621e(a). ISDA calls the funds received from third-party payers “program income” and requires that tribes use those funds “to further the general purposes of the contract” with IHS.
§ 5325(m)(1). Just as third-party collections are not considered in determining IHS's appropriations, Congress has specifed that a tribe's program income “shall not be a basis for reducing” the Secretarial amount. §5325(m)(2); see § 1641(a).
The Secretarial amount from IHS and program income from third-party payers do not, however, place contracting tribes on equal footing with IHS. Tribes incur overhead and administrative expenses that IHS does not incur when it runs the healthcare programs. For example, as a federal agency, IHS does not have to pay state-mandated workers' compensation on the salaries of its doctors—but the tribes do. IHS can also rely on other federal agencies, such as the Offce of Personnel Management, for general administrative functions—but the tribes cannot. They have to manage on their own dime the auditing, insurance, fnancial, personnel, and other management systems associated with providing healthcare under self-determination contracts.
To address this systematic shortfall in funding, Congress amended ISDA to account for “contract support costs.”
IHS is now required to cover such “reasonable costs for activities which must be carried on by a [tribe] as a contractor to ensure compliance with the terms of the [selfdetermination] contract.” § 5325(a)(2). Contract support costs eligible for repayment include “direct program expenses for the operation of the Federal program” and “any additional administrative or . . . overhead expense incurred by the [tribe] in connection with the operation of the Federal program, function, service, or activity pursuant to the contract.” § 5325(a)(3)(A). These categories of contract support costs are recoverable so long as they do not duplicate any funding provided through the Secretarial amount. Ibid. Contract support costs are limited, however, to “costs directly attributable to” self-determination contracts. § 5326. And no funds are available for “costs associated with any contract . . . entered into between [a tribe] and any entity other than [IHS].” Ibid.
II
These cases involve self-determination contracts between the IHS and two tribes: The San Carlos Apache Tribe and the Northern Arapaho Tribe.
A
The San Carlos Apache Tribe is located on the San Carlos Apache Indian Reservation, which was established in 1871 and encompasses 1.8 million acres spanning three counties in southeastern Arizona. In 2011, the Tribe entered into a three-year self-determination contract with IHS. The Tribe agreed to assume control of and manage the Community Health Representative Program, Emergency Medical Services Program, Alcohol and Substance Abuse Program, Behavioral Health Services Program, Teen Wellness Program, and Health and Human Services. App. 52. In accordance with the ISDA “model agreement” set forth in Section 5329(c), the Tribe's contract incorporated “[t]he Page Proof Pending Publication provisions of title I of [ISDA],” i. e., the provisions applicable to self-determination contracts, and specifed that “[e]ach provision of [ISDA] and each provision of this Contract shall be liberally construed for the beneft of the [Tribe].” Id., at 51.
In separate annual funding agreements incorporated into the contract, the parties specifed the amount of funds due from IHS to the Tribe each year. The funding agreements included a Scope of Work attachment that described the activities the contract required the Tribe to perform. See id., at 99–102 (FY 2013 Scope of Work). The required activities included, among other things, “[m]aintain[ing] an effcient billing system . . . to maximize third party revenues” from “Medicare, [Medicaid], Private Insurance, and IHS Contract Health Services” and “[g]enerat[ing] maximum third party revenues for all eligible patient transports.” Id., at 101–102. In 2019, the Tribe sued the Government for breach of contract. As relevant, the Tribe contended that although it used both the Secretarial amount and program income to operate its healthcare programs under the self-determination contract, IHS failed to pay contract support costs for the Tribe's healthcare services to the extent they were funded by program income. Id., at 10–11. The Tribe sought roughly $3 million in unpaid contract support costs for the three-year contract. Id., at 16–17.
The District Court dismissed the Tribe's claim, observing that ISDA's contract support cost provisions in Section 5325(a) do not mention third-party revenue. San Carlos Apache Tribe v. Azar, 482 F. Supp. 3d 932, 934–935 (Ariz. 2020).
The Ninth Circuit reversed and remanded.
F. 4th 1236, 1245 (2022). It reasoned that the Tribe's self- determination contract incorporated ISDA, which required the Tribe to spend third-party program income on healthcare. Id., at 1241–1242. Those portions of the Tribe's healthcare programs funded by third-party income thus constituted “activities which must be carried on by [the Tribe] Page Proof Pending Publication as a contractor to ensure compliance with the terms of the contract,” § 5325(a)(2), and the contract support costs associated with those activities were incurred “in connection with the operation of the Federal program,” § 5325(a)(3)(A)(ii). Id., at 1241–1242. The text of ISDA, the Court reasoned, therefore indicated that IHS was required to reimburse the Tribe for those costs. Id., at 1243.
The Ninth Circuit stated that, at the very least, it could not “conclude that § 5325(a) unambiguously excludes [the] third-party-revenue-funded portions of the Tribe's healthcare program from [contract-support-cost] reimbursement.” Ibid. (emphasis deleted). The Court was also unable to conclude that Section 5326 “unambiguously” meant that spending of third-party insurance receipts was not “directly attributable” to the Tribe's self-determination contract. Id., at 1244. Based on these ambiguities, the Ninth Circuit applied the Indian canon and construed the statute in the Tribe's favor. Id., at 1244–1245.
B
The Northern Arapaho Tribe resides on the Wind River Reservation, which covers more than 2.2 million acres in west central Wyoming. In 2016, the Tribe entered into a self-determination contract with IHS to assume control of the reservation's health division, the Wind River Family and Community Health Care System. App. 124. In accordance with the model agreement, the contract incorporated ISDA's Title I provisions and stated that each provision of ISDA and of the contract must be “liberally construed for the beneft of the [Tribe].” Ibid. Like the San Carlos Apache Tribe's contract, the Northern Arapaho Tribe's contract also incorporated an annual funding agreement and a Scope of Work attachment. Among other things, the Scope of Work specifed that the Tribe would employ experienced individuals, such as “third-party claims specialists,” in a fnancial offce; bill and collect “[i]nsurance and [t]hird-[p]arty receivables”; “maintain accreditaPage Proof Pending Publication Page Proof Pending Publication tion standards in order to qualify for funds through third party-payers”; secure “Medicare and Medicaid numbers for billing purposes”; meet requirements for “periodic renewal of accreditation or certifcation” to “maintain eligibility for these funds”; use IHS's third-party billing system for one year to give the “Tribe time to set up its own functioning . . . third-party billing system”; and conduct “[q]uality assurance and all third-party billing processes.” Id., at 184–186.
In 2021, the Tribe sued the Government for damages and declaratory relief. As relevant, the Tribe alleged that, pursuant to the contract's requirements, it had collected third- party revenues and spent them to provide healthcare services, yet IHS had paid no contract support costs for services funded by such program income. The Tribe averred that it spent all of its program income on activities enumerated in the Scope of Work, so the income was spent as “part of the Federal program carried out by the Tribe” under the contract. Id., at 110–111. The Tribe thus contended that Section 5325(a)(3)(A) required payment of contract support costs related to the spending of those funds. It sought approximately $1.5 million in damages for the two-year period at issue. Id., at 116–117.
The District Court dismissed the complaint. Northern Arapaho Tribe v. Cochran, 548 F. Supp. 3d 1134, 1143 (Wyo. 2021). A divided panel of the Tenth Circuit reversed, with each of the three judges writing separately. 61 F. 4th 810 (2023). Judge Moritz voted to reverse because “the relevant statutory provisions are ambiguous, and the Indian canon of statutory construction resolves the ambiguity in the Tribe's favor.” Id., at 812. Judge Eid also voted to reverse, but in her view the statute unambiguously supported the Tribe's interpretation. Id., at 823–828 (opinion concurring in judgment). Judge Baldock dissented in part. Id., at 828–830. Although he also viewed the Tribe's contract support costs as reimbursable under Section 5325(a), he would nonetheless have affrmed the District Court based on the “superseding provision” of Section 5326. Id., at 828–829.
We granted certiorari in both cases. 601 U. S. ––– (2023).
III
It is undisputed that IHS must pay the Tribes the Secretarial amount and the contract support costs associated with spending that amount to operate the healthcare programs they assumed from IHS. It is also undisputed that the Tribes' contracts require them to collect program income and that IHS must cover the cost of collecting that income. See Brief for Petitioners 21, 38. The only question is whether IHS must also cover the contract support costs the Tribes incur when they spend program income on the healthcare programs.
A
The ISDA provisions that govern the amount IHS must pay as contract support costs under a self-determination contract are Sections 5325(a)(2) and (a)(3)(A). Both provisions peg the amount to the requirements of the contract. Because a self-determination contract requires a tribe to spend program income to further the programs transferred to it in the contract, these provisions require IHS to pay contract support costs when a tribe does so, just as IHS must pay contract support costs to support a tribe's spending of the Secretarial amount.
Section 5325(a)(2) defnes contract support costs as “consist[ing]” of “the reasonable costs for activities which must be carried on by a tribal organization as a contractor to ensure compliance with the terms of the contract.” 1 The 1Section 5325(a)(2) further specifes that contract support costs are for activities which “(A) normally are not carried on by [IHS] in [its] direct operation of the program; or (B) are provided by [IHS] in support of the contracted program from resources other than those under contract.” It is undisputed in these cases that the Tribes are seeking contract support costs for activities that satisfy Sections 5325(a)(2)(A) and (B). Brief for Northern Arapaho Tribe 33.
Page Proof Pending Publication touchstone for determining which “activities” must receive contract support costs is therefore “the terms of the contract.” It follows that if a tribe must collect and spend program income to ensure compliance with its contract, then the reasonable administrative and overhead costs it incurs in doing so are “contract support costs” under Section 5325(a)(2).
The Tribes' contracts and ISDA plainly require them to collect program income and spend it to comply with their contracts. Each self-determination contract entered into under ISDA must contain the provisions of the “model agreement” set forth in Section 5329(c). § 5329(a)(1). The model agreement incorporates into the contract “[t]he provisions of title I of [ISDA].” § 5329(c) (model agreement § 1(a)(1)). Title I of ISDA includes Section 5325(m)(1), which requires tribes to use “program income earned . . . in the course of carrying out a self-determination contract” to “further the general purposes of the contract.”
The “purposes” of the contract are no mystery. The model agreement requires that each self-determination contract include a “purpose” clause listing the “functions, services, activities, and programs” to be transferred from IHS to the tribe. See § 5329(c) (model agreement § 1(a)(2)). Tribes are thus contractually required to use program income to further the functions, services, activities, and programs transferred to them in their contracts. When they do so and incur reasonable costs for required support services, those costs are “contract support costs” under Section 5325(a)(2). In addition to satisfying the defnition set forth in Section 5325(a)(2), those costs are also “eligible costs for the purposes of receiving funding” under Section 5325(a)(3)(A). That provision specifes two types of “reasonable and allowable costs” that may be reimbursed. First, “direct program expenses for the operation of the Federal program that is the subject of the contract” are covered. § 5325(a)(3)(A)(i). Page Proof Pending Publication “Direct” contract support costs include the support expenses of particular programs, such as workers' compensation insurance for ambulance drivers or training for emergency room nurses. See § 5304(c). Second, “any additional administrative or other expense incurred by the governing body of the [tribe] and any overhead expense incurred by the tribal contractor in connection with the operation of the Federal program, function, service, or activity pursuant to the contract” are also eligible for funding. § 5325(a)(3)(A)(ii). Such “indirect” contract support costs encompass expenses that beneft multiple programs, such as auditing infrastructure, personnel systems, and legal services. See §5304(f).
Direct contract support costs incurred when using program income are covered because the functions, services, activities, and programs that a tribe agrees to administer in IHS's stead under a self-determination contract constitute the “Federal program that is the subject of the contract.” When IHS administers the Federal program for the tribe's members, it uses congressional appropriations and third- party insurance payments to do so. See 25 U. S. C. §§ 13, 1621e(a); 42 U. S. C. §§ 1395qq(a), 1396j(a). IHS must use the third-party collections to provide healthcare services. See 25 U. S. C. §§ 1621f(a)(1), 1641(c)(1)(B). So IHS's Federal program comprises congressionally funded and third- party funded healthcare. When that program is transferred to the tribe from IHS, the tribe, rather than IHS, becomes the entity collecting program income and spending it on the Federal program. The tribe's resultant direct contract support costs are incurred “for the operation of the Federal program that is the subject of the contract.” Those costs are thus eligible to receive funding under Section 5325(a)(3)(A)(i).
Indirect contract support costs that result from spending program income must be covered by IHS for the same reason. A tribe's self-determination contract requires it to Page Proof Pending Publication spend program income on furthering the Federal programs, functions, services, or activities it assumes from IHS. §§ 5325(m)(1), 5329(c). When the tribe does so—as IHS did when it operated the program, function, service, or activity— and incurs administrative and overhead expenses, those expenses are incurred “in connection with the operation of the Federal program, function, service, or activity pursuant to the contract.” Such expenses are thus eligible for reimbursement under Section 5325(a)(3)(A)(ii).
The self-determination contracts of the San Carlos Apache Tribe and the Northern Arapaho Tribe go to some length to require them to collect program income by maintaining third-party billing systems and generating maximum third- party revenues. See App. 101–102, 184–186. Once the Tribes collect third-party income, they must use it.
§§ 5325(m)(1), 5329(c). The Tribes aver that they have collected and spent program income as required by their contracts to carry out the operations IHS transferred to them. Id., at 9–11, 109–115; Brief for Northern Arapaho Tribe 29 (“Northern Arapaho is prepared to prove that every penny of program income was, in fact, spent on activities enumerated in the contractual scope of work.”). The reasonable direct and indirect contract support costs they incurred as a result are eligible for repayment under Section 5325(a) because they were incurred to “ensure compliance with the terms of the contract,” § 5325(a)(2), and “for the operation of” and “in connection with the operation of” the “Federal program” they assumed from IHS, § 5325(a)(3)(A).2 2To the extent that the Tribes spent program income on activities enumerated in their contractual Scope of Work, they spent it on the “Federal program” they expressly agreed to assume from IHS. Contract support costs incurred in connection with that spending are recoverable. § 5325(a)(3)(A). Although Section 5325(m)(1)'s requirement that the Tribes spend program income to further the “general purposes” of their self-determination contracts allows them some fexibility in their spending, we need not decide the extent of that fexibility in these cases. The only question before us now is whether the Tribes can recover contract support Page Proof Pending Publication
B
IHS's obligation to pay contract support costs is limited by Section 5326, but the limitations of that provision do not preclude payment of costs incurred by the required spending of program income under a self-determination contract. Section 5326 requires that IHS pay contract support costs “only for costs directly attributable to contracts . . . pursuant to [ISDA].” It further provides that no funds “shall be available for any contract support costs or indirect costs associated with any contract, grant, cooperative agreement, self-governance compact, or funding agreement entered into between [a tribe] and any entity other than [IHS].” § 5326. When a tribe spends program income to further the healthcare programs it assumes from IHS and incurs contract support costs, the costs it incurs are “directly attributable” to the self-determination contract. Contrary to the Government's assertion, there is no extended chain of causation: The Tribes' self-determination contracts require the collection of program income. See supra, at 230, 231–232. The self-determination contracts then require the expenditure of program income. And the self-determination contracts govern the activities on which that income may be spent. The required contract support costs that result are “directly attributable” to the binding terms of the contract. Nor are such costs “associated with” any contract between a tribe and a third party. Those costs are instead associated with the contract referred to in the phrase “contract support costs.” In other words, the costs are “associated with” the “contract” that requires the work that generates the costs— the self-determination contract.
A tribe's contracts with third-party payers are quite different. A Medicare or Medicaid provider agreement, for example, does not generate contract support costs by costs at all when they collect and spend program income pursuant to their contracts.
Page Proof Pending Publication Page Proof Pending Publication specifying which healthcare services a tribe must provide; rather, it simply serves as a predicate for the tribe to collect program income after it has already rendered services to a tribal member who is a Medicare or Medicaid benefciary. And when a tribe bills a private insurance company for services rendered to an insured tribal member, the tribe might have no pre-existing and ongoing agreement with the insurance company at all.
The history of Section 5326 confrms this analysis. Congress enacted this provision in 1998 after the Tenth Circuit's decision in Ramah Navajo Chapter v. Lujan, 112 F. 3d 1455 (1997). Ramah involved a Tribe that had self-determination contracts with the Bureau of Indian Affairs (BIA) for various programs, including law enforcement, and separate contracts with the State of New Mexico for criminal justice and juvenile offender restitution programs. Id., at 1458–1459. The Tenth Circuit held that the BIA was required to pay the Tribe's full indirect contract support costs—not only for the programs administered under the BIA contracts, but also for those administered under the state contracts. Id., at 1462– 1463. The Government and the Tribes agree that Congress added Section 5326 to override Ramah and clarify that IHS may not pay costs incurred to support non-ISDA contracts. See Brief for Petitioners 8; Brief for Northern Arapaho Tribe 46; Brief for San Carlos Apache Tribe 12–14.
The direct attribution and association problems present in Ramah are not implicated here. In Ramah, the state contracts, not the BIA contracts, required the activities that resulted in the contract support costs for the criminal justice and juvenile offender restitution programs. Although those costs might have had an attenuated relation to the programs operated under the BIA contracts, they were “directly attributable” to and “associated with” the state contracts, not the BIA self-determination contracts. Here, the self- determination contract itself requires tribes to spend program income to further healthcare programming. The contract support costs tribes incur when they do so are recoverable under Sections 5325(a) and 5326.
IV
A
The Government's arguments to the contrary fnd no support in ISDA's text. The Government begins with the premise that Section 5325(a)(2)'s requirement to pay contract support costs is “tied to” Section 5325(a)(1)'s Secretarial amount. Brief for Petitioners 21. But nothing in Section 5325(a)(2) suggests that contract support costs are limited to programs funded by the Secretarial amount. In fact, Section 5325(a)(2) defnes contract support costs as tied to “the terms of the contract,” which require tribes to fund programs with program income. See §§ 5325(m)(1), 5329(c). The Government then attempts to extend its fawed premise to Section 5325(a)(3)(A), asserting that the contract support costs of spending program income are ineligible for repayment under that provision because the “Federal program” comprises only the Secretarial amount. Id., at 22. But besides reciting Section 5325(a)(3)(A), the Government cites no statutory text to support this assertion. Ibid. And Section 5325(a)(3)(A) refers to eligible costs for the operation of the “Federal program” without limiting that program to the Secretarial amount.
B
Leaving the text behind, the Government argues that the tribes should not get contract support costs for spending program income because that would give them the fexibility to spend such income on a broader range of activities than IHS can. Id., at 29. But none of the Government's cited differences withstand scrutiny.
First, the Government says that IHS cannot offer healthcare services to non-Indians unless the benefciary tribe requests it, whereas a tribe running its own programs can Page Proof Pending Publication Page Proof Pending Publication unilaterally decide to offer such services. Ibid. This difference is irrelevant. Before either IHS or a contracting tribe may offer healthcare services to non-Indians, both must make the same determination: Whether such services will result in a denial or diminution of services to eligible Indians. §§ 1680c(c)(1)(B), (c)(2). And the fact that the contracting tribe can act unilaterally in this regard is the natural result of self-determination.
Next, the Government says that when IHS collects Medicare and Medicaid proceeds, it must “frst” use such proceeds to ensure compliance with those programs. Id., at 29 (quoting § 1641(c)(1)(B)). But tribes also have to ensure compliance with Medicare and Medicaid requirements using program income. § 1641(d)(2)(A).
Finally, the Government contends that while Congress has prohibited IHS from using Medicare and Medicaid proceeds to construct new facilities, tribes do not face this prohibition and thereby have greater ability to expand their operations. Id., at 30. But to the extent that a tribe expands its programs beyond the “Federal program,” IHS would not have to pay contract support costs for the tribe's new programs. Even if there are minor differences between what IHS and tribes can do with program income, that should not be surprising given ISDA's design to provide tribes greater fexibility in planning and implementing healthcare programs attuned to the needs of their communities. See § 5302(a). The Government points to nothing in ISDA's text to suggest that those differences excuse IHS from paying contract support costs when tribes spend program income on the programs they have assumed from IHS.
C
As for the dissent, its central assertion is that the support costs tribes incur when they spend program income are not incurred in the “performance of their contracts.” Post, at 248 (opinion of Kavanaugh, J.). But the Tribes' contracts plainly require them to collect income from third-party insurers. See supra, at 230, 231–232. And by incorporating Section 5325(m)(1), see §§ 5329(a)(1), (c), self-determination contracts plainly require tribes to use that income “to further the general purposes of the[ir] contract[s].” The dissent complains that “the contracts do not address how the tribes must spend their third-party income.” Post, at 250. But as we have explained, the “purpose” clause of each contract describes the programs which tribes must further using program income. See supra, at 234. The support costs tribes incur when they do so are incurred in the “performance of their contracts” to “ensure compliance with the terms of the[ir] contract[s].” Post, at 248; § 5325(a)(2). And those costs are “directly attributable” to and “associated with” tribes' self-determination contracts. See supra, at 237. Obfuscating this straightforward reading of the relevant ISDA provisions, the dissent points to Section 5388(j) and the costliness of ISDA's mandates. But Section 5388(j) does not apply to self-determination contracts, and complaints about costs are the domain of Congress, not this Court.
V
Aside from being inconsistent with the statute's text, IHS's failure to cover contract support costs for healthcare funded by program income inficts a penalty on tribes for opting in favor of greater self-determination. Congress designed the statute to avoid such a counterproductive result. Underlying ISDA was a congressional fnding that federal domination of Indian service programs had denied tribes an effective voice in the planning and implementation of programs responsive to the true needs of their communities. See § 5301(a)(1). Congress thus designed ISDA to promote “maximum Indian participation” in the administration of healthcare programs. § 5302(a). To that end, Congress's Page Proof Pending Publication consistent directive to IHS is to place contracting tribes in the same fnancial position as IHS, so that tribes do not face a self-determination penalty when they take control of their own healthcare.
When tribes enter into self-determination contracts and assume control of IHS's programs, they receive the same amount of congressionally appropriated funds to run the programs as IHS would have. See § 5325(a)(1). Congress also allows tribes, like IHS, to fund the programs with income from third-party payers.
See 42 U. S. C. §§ 1395qq(a), 1396j(a); 25 U. S. C. § 1621e(a). To be clear, IHS needs to collect these funds just to cover its obligations to tribal members. Indeed, 60 percent or more of the yearly budget of some IHS healthcare facilities relies on third-party revenues. Dept. of Health and Human Servs., Fiscal Year 2024, IHS, at CJ–193; see also IHS, Indian Health Manual § 5–1.1(B) (2024) (“[T]hird-party billing and collections have become critical activities for the IHS. . . . Safeguarding this revenue stream and related assets is vital to IHS health care programs.”). Like IHS, tribes choosing self-determination in healthcare need to collect and spend program income if they are to maintain the same level of services they received from IHS. For that reason, Congress specifcally instructed IHS that program income “shall not be a basis for reducing” a tribe's Secretarial amount. § 5325(m)(2).
Contract support costs are necessary to prevent a funding gap between tribes and IHS. By defnition, these are costs that IHS does not incur when it provides healthcare services funded by congressional appropriations and third-party income. §§ 5325(a)(2)(A) and (B). But they are costs that tribes must bear when they provide, on their own, healthcare services funded by the Secretarial amount and program income. If IHS does not cover costs to support a tribe's expenditure of program income, the tribe would have to divert some program income to pay such costs, or it would have to pay them out of its own pocket. Either way, the tribe would Page Proof Pending Publication face a systemic funding shortfall relative to IHS—a penalty for pursuing self-determination.
* * * The self-determination contracts of the San Carlos Apache Tribe and Northern Arapaho Tribe require them to collect and spend program income to further the functions, services, activities, and programs transferred to them from IHS. When the Tribes do so and incur administrative costs, ISDA requires IHS to pay those support costs.
The judgments of the Courts of Appeals for the Ninth and Tenth Circuits are Affrmed.