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Court rejects Gila River tribe’s suit against VA over cost of vets’ care

After years of relatively little notice, applications to a Department of Veterans Affairs pension program for needy, elderly vets have jumped. But some advocates fear the increase is from "pension poachers," financial advisers who sell veterans unnecessary services to get the benefit.

PHOENIX – The Department of Veterans Affairs does not have to reimburse the Gila River Indian Community for health care it provided to tribal veterans, a federal court has ruled.

The Gila River Indian Community and the Gila River Health Care Corp. claimed that the Affordable Care Act required the payments, but the VA argued that the tribe had not entered into a required agreement to get paid.

A three-judge panel of the 9th U.S. Circuit Court of Appeals on Wednesday ruled in favor of the department, upholding a lower court that said federal law barred courts from interfering in decisions on veterans’ benefits, which are under the control of the VA secretary.

Requests for comment from attorneys on both sides were not immediately returned Thursday. But in a statement Thursday evening, the tribe said it may seek review of the appellate panel’s decision.

“Providing healthcare to Native American veterans is a critical aspect of the trust obligation of the United States,” Gila River Gov. Stephen Roe Lewis said in the prepared statement. “Requiring Gila River Health Care Corporation to go through the same administrative process as individual veterans is contrary to the trust obligation.”

The fight began in 2010, when the tribe said two provisions of the Affordable Care Act guaranteed that the tribe would only have to pay for veterans’ care after all other options – such as Medicaid, private health insurance of VA reimbursement – had been exhausted.

The tribe argued that Native American veterans were seeking tribal care because of “well-publicized health care scandals alleging poor quality of care and long waits for appointments at VA facilities,” court documents read. Gila River officials also argued that tribal veterans should have that choice and that the ACA was meant to “benefit Indian tribes because of a long history of underfunding for Native American health care.”

The VA said it would pay for care by those tribes with which it had entered into an agreement, and had developed a template agreement for tribes. But Gila River officials refused to agree to what it called a “one-sided” agreement that would “improperly limit the scope of what it contends is a mandatory … right to reimbursement” under the Affordable Care Act.

After three years of negotiations failed to produce an agreement, the tribe filed suit against the VA in U.S. District Court in Arizona.

The same year, the VA moved to dismiss the complaint saying the Veteran’s Judicial Review Act states that only the secretary, not the courts, can decide on issues affecting veterans’ benefits. Once the secretary decides, then the plaintiff can appeal his ruling.

The district court agreed with the VA and the appeals court affirmed Wednesday, saying the act shows that “Congress was quite serious about limiting our jurisdiction over anything dealing with the provision of veterans’ benefits.”

Lewis said the tribe will consider an appeal.

“One reason veterans choose to receive care at GRHCC is because of the high quality of care they receive at our Community run healthcare facility,” his statement said. “The VA should respect the decisions of Native veterans on where to receive care, instead of avoiding its obligation to pay for this care.

“Given the VA’s inflexible position, the Community will consider all appeal options to protect the healthcare of our veterans,” Lewis’ statement said.

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