Justices Consider Meaning of “Entitled to Benefits” in Relation to Disproportionate Share Payment Formula

While many were paying attention to the national elections, the United States Supreme Court heard oral arguments in Advocate Christ Medical Center v. Becerra on November 5, 2024. The Advocate Christ Medical Center case involves a challenge by over 200 hospitals to  the government’s interpretations of the term “entitled to benefits” under Medicare Part A benefits compared to Supplemental Security Income (SSI) benefits. 

An earlier Supreme Court case, Becerra v. Empire Health Foundation held that persons “entitled to benefits” included all individuals who qualified for Medicare benefits regardless of whether Medicare paid for the hospital stay. However, Empire Health expressly left open the question of whether that interpretation also applied to SSI benefits. If the interpretation is the same,  certain low income individuals would be “entitled to benefits” under SSI  and the hospitals would receive disproportionate share payments regardless of  whether participants actually received SSI benefits. In the case currently before the Court, however, the U.S. Court of Appeals for the D.C. Circuit agreed with the government’s position that there are key distinctions between the programs, so the meaning of the term “entitled to benefits” was different between the two different programs.

At the Supreme Court oral argument, he plaintiff hospitals argued that the same term should have the same meaning  and participants eligible for SSI benefits therefore should be included in the DSH payment.  Otherwise, the government undercounts low income patients that the hospitals are required to treat.

The Solicitor General countered that “the rule is not an actual receipt rule,” supporting the HHS interpretation that SSI recipients should only be counted for the purposes of disproportionate share in months where they are owed cash benefits.

The Justices did not appear to strongly signal how they will rule. Justices Alito and Kagan both questioned how the interpretation of “entitled to benefits” might be different because the nature of the Medicare and SSI programs were fundamentally different. Justices Thomas, Barrett and Jackson asked questions indicating  concerns whether the eligibility for payments or actual receipt of payments met the purpose of the formula in determining who is in the low-income population that should trigger the disproportionate share payments.