In a 7-2 decision (PDF), the Supreme Court on April 29 upheld the Department of Health and Human Services’ (HHS’) calculation of Medicare disproportionate share hospital (DSH) payments, affirming the decision of the U.S. Court of Appeals for the District of Columbia Circuit. In Advocate Christ Medical Center v. Becerra, over 200 hospital plaintiffs challenged the HHS’ interpretation of when an individual is entitled to supplemental security income (SSI) benefits in determining which low-income patient days are included in the Medicare fraction of the DSH calculation. In calculating DSH payments from 2006 to 2009, the HHS maintained that an individual is entitled to SSI benefits (and thus included in the numerator of the Medicare fraction) only if that individual receives SSI cash benefits during the month of their hospitalization. The plaintiff hospitals disagreed with this interpretation, arguing that the agency should include patients who are deemed eligible for SSI benefits, even if they do not receive cash benefits in a given month. The AAMC, the American Hospital Association, and other hospital associations supported the plaintiffs’ position in an amicus brief (PDF), noting the harm the HHS’ interpretation has on hospitals’ DSH payments [refer to Washington Highlights, Aug. 22, 2024].
The majority sided with the HHS, concluding that “an individual is ‘entitled to [SSI] benefits’ … when she is eligible to receive an SSI cash payment” and dismissed plaintiffs’ arguments that the receipt of noncash benefits should be included in determining SSI eligibility and that SSI eligibility continues for a 12-month period. In her dissenting opinion, Justice Ketanji Brown Jackson disagreed with the majority’s interpretation of SSI eligibility and cited the 2024 amicus brief, stressing that undercounting low-income patients in the DSH formula could “cause many such hospitals to close their doors entirely, such that patients from our Nation’s poorest communities may not be served at all.”