The Supreme Court ruled against the Biden administration on Thursday on how to divide up limited funds for tribal healthcare.

Chief Justice John Roberts wrote a 5-4 decision in Becerra v. San Carlos Apache Tribe that said tribes could sue the federal government to regain certain administrative expenses to manage their own healthcare programs.

The core of the case focused on the Indian Self-Determination and Education Assistance Act, which is intended to promote tribal self-determination. The law gives tribes the ability to run their own healthcare programs using funds the Indian Health Service would otherwise use to provide the same care.

Tribal plaintiffs argued they are entitled to funds for the costs associated with both its base pool of federal healthcare funds and third-party insurance revenue. The question for the justices was whether the IHS should also reimburse tribes for additional administrative expenses associated with those third parties. Roberts, joined by Justices Neil Gorsuch, Elena Kagan, Sonia Sotomayor, and Ketanji Brown Jackson, held that the IHS should. Roberts and Gorsuch are the only members of the 6-3 Republican-appointed majority who sided with the tribes in the case.

A 2021 ruling from the U.S. Court of Appeals for the District of Columbia Circuit found the IHS was not responsible for the costs, but the 10th U.S. Circuit Court of Appeals ruled differently, prompting the federal government to tap the justices to resolve the split.

Justice Brett Kavanaugh, a Republican-appointed member, dissented from the case. He was joined by other Republican-appointed Justices Clarence Thomas, Samuel Alito, and Amy Coney Barrett.

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“For the past 30 years, the Executive Branch has interpreted the relevant statutory provisions … to require tribes to pay those overhead costs out of the third-party income collected from Medicare, Medicaid, and private insurers. And Congress has never overturned that consistent Executive Branch practice,” Kavanaugh wrote.

“But today, the Court upends that long-settled understanding and requires the Federal Government to furnish additional funding to the tribes for the costs of spending the third-party income. I respectfully dissent,” Kavanaugh added.