Benefit-Focused Supreme Court Distinguishes “Entitled” to SSI from “Entitled” to Medicare Part A for Purposes of Medicare Disproportionate Share Hospital Adjustment

• May 14, 2025

• Kenneth R. Marcus

On April 29, 2025, the U.S. Supreme Court in Advocate Christ Medical Center v. Kennedy, Secretary of Health and Human Services, held in a 7-2 decision that for purposes of the Medicare Fraction of the disproportionate share hospital (DSH) adjustment a hospital patient is not entitled to supplemental security income (SSI) benefits where, although enrolled in the SSI program, no SSI payment was made during the month of the patient’s hospital admission. In Advocate Christ Medical Center, the Court revisited the meaning of “entitled” as it appears twice in the Medicare Fraction of the statute for the DSH adjustment—first regarding Part A and second regarding SSI. In its 2022 decision in Becerra v. Empire Health Found, the Court held that “entitled” to Medicare Part A benefits means eligible for such benefits without regard to whether a Medicare payment is made for a specific hospital stay. The more than 200 petitioner hospitals in Advocate Christ Medical Center, along with many other similarly situated hospitals nationwide, hoped that for the sake of consistency the Court would follow Empire Health and hold that, as it held regarding Medicare Part A, payment is not necessary for a patient to be considered entitled to SSI. Perhaps mindful of the words of Oscar Wilde that “[c]onsistency is the last refuge of the unimaginative,” however, the Court in Advocate Christ Medical Center held that a patient is not “entitled” to SSI if no SSI payment was made during the month of a patient’s hospital admission. The Court asserted that it applied the same “benefit-focused” analysis in Empire Health, although it devised that term for the first time in Advocate Christ Medical Center and used the term only once in this decision.

ARTICLE TAGS

• Regulation, Accreditation, and Payment Practice Group
• Government Reimbursement