{"ID":63696,"name":"Advocate Christ Medical Center v. Kennedy","href":"https:\/\/api.oyez.org\/cases\/2024\/23-715","view_count":0,"docket_number":"23-715","additional_docket_numbers":null,"manner_of_jurisdiction":"Writ of \u003Ci\u003Ecertiorari\u003C\/i\u003E","first_party":"Advocate Christ Medical Center, et al.","second_party":"Robert F. Kennedy, Jr., Secretary of Health and Human Services","timeline":[{"event":"Granted","dates":[1717995600],"href":"https:\/\/api.oyez.org\/case_timeline\/case_timeline\/55509"},{"event":"Argued","dates":[1730786400],"href":"https:\/\/api.oyez.org\/case_timeline\/case_timeline\/55510"},{"event":"Decided","dates":[1745902800],"href":"https:\/\/api.oyez.org\/case_timeline\/case_timeline\/55648"}],"lower_court":{"ID":16,"name":"United States Court of Appeals for the District of Columbia Circuit","href":"https:\/\/api.oyez.org\/taxonomy\/term\/16"},"facts_of_the_case":"\u003Cp\u003EThis case involves the calculation of Medicare reimbursements to hospitals under the \u201cdisproportionate share hospital\u201d (DSH) adjustment, which provides additional compensation to hospitals serving a high percentage of low-income patients. The adjustment is based on two formulas: the Medicare fraction and the Medicaid fraction. The Medicare fraction, which is at the center of this dispute, represents the percentage of a hospital\u0027s Medicare patients who are also entitled to Supplemental Security Income (SSI) benefits.\u003C\/p\u003E\n\u003Cp\u003EOver 200 hospitals are challenging the Department of Health and Human Services\u2019 (HHS) interpretation of who counts as \u201centitled to supplementary security income benefits\u201d for the Medicare fraction calculation. HHS considers only patients who qualify for the monthly SSI cash payment during their hospital stay, while the hospitals argue that all patients enrolled in the SSI program should be included, even if they don\u0027t receive a payment that month. The hospitals also dispute HHS\u2019s matching process and seek access to detailed SSI payment codes for their patients. After being denied relief by HHS\u2019s internal review board and the Centers for Medicare and Medicaid Services, the hospitals sought judicial review, but the district court granted summary judgment to HHS. The U.S. Circuit Court for the D.C. Circuit affirmed.\u003C\/p\u003E\n","question":"\u003Cp\u003EDoes the phrase \u201centitled\u2026 to benefits\u201d include all who meet basic program eligibility criteria, whether or not benefits are actually received?\u003C\/p\u003E\n","conclusion":"\u003Cp\u003EAn individual is \u201centitled to [SSI] benefits\u201d under subchapter XVI for purposes of the Medicare fraction only if the person is eligible to receive a cash payment during the month of their hospitalization. Justice Amy Coney Barrett authored the 7-2 majority opinion of the Court, joined by Chief Justice John Roberts and Justices Clarence Thomas, Samuel Alito, Elena Kagan, Neil Gorsuch, and Brett Kavanaugh.\u003C\/p\u003E\n\u003Cp\u003ECongress designed the Medicare Disproportionate Share Hospital (DSH) adjustment to provide extra funding to hospitals treating a large number of low-income patients. This adjustment is partly determined using the \u201cMedicare fraction,\u201d which measures the proportion of Medicare patients who also qualify for Supplemental Security Income (SSI). The statutory language refers to patients \u201centitled to [SSI] benefits under subchapter XVI.\u201d The Court interpreted this to mean patients who are actually eligible to receive an SSI cash payment during the hospital stay month. This interpretation followed from several provisions in subchapter XVI demonstrating that SSI consists solely of monthly cash payments and eligibility is determined month by month. Terms such as \u201cpaid\u201d and \u201cpayable\u201d and monthly income evaluations underscore that SSI benefits are defined as monthly cash entitlements, not continuous enrollment in the program regardless of payment status.\u003C\/p\u003E\n\u003Cp\u003EThe Court found alternative arguments offered by the hospitals unpersuasive. Non-cash programs like vocational rehabilitation or Medicaid continuation are not SSI benefits under subchapter XVI; they either reside in other statutory subchapters or administer distinct programs. The Court also dismissed the view that finding a person ineligible for SSI for 12 continuous months is what marks the end of entitlement. While administrative statutes may require re-application after 12 months of ineligibility, SSI eligibility still depends on month-by-month financial qualification. Finally, the Court declined to broaden the statutory intent to optimize funding for needy hospitals beyond the method Congress explicitly chose. Having determined that entitlement is tied to monthly cash payment eligibility, the Court upheld HHS\u2019s method of calculating the Medicare fraction accordingly.\u003C\/p\u003E\n\u003Cp\u003EJustice Ketanji Brown Jackson authored a dissenting opinion, in which Justice Sonia Sotomayor joined.\u003C\/p\u003E\n","advocates":[{"advocate":{"ID":36607,"name":"Melissa Arbus Sherry","href":"https:\/\/api.oyez.org\/people\/melissa_arbus_sherry","view_count":0,"last_name":"Sherry","roles":null,"thumbnail":null,"length_of_service":0,"identifier":"melissa_arbus_sherry"},"advocate_description":"for the Petitioners","href":"https:\/\/api.oyez.org\/case_advocate\/case_advocate\/23624"},{"advocate":{"ID":63571,"name":"Ephraim McDowell","href":"https:\/\/api.oyez.org\/people\/ephraim_mcdowell","view_count":0,"last_name":"McDowell","roles":null,"thumbnail":null,"length_of_service":0,"identifier":"ephraim_mcdowell"},"advocate_description":"for the Respondent","href":"https:\/\/api.oyez.org\/case_advocate\/case_advocate\/23625"}],"oral_argument_audio":[{"id":25667,"title":"Oral Argument - November 05, 2024","public_note":null,"unavailable":false,"display_title":null,"href":"https:\/\/api.oyez.org\/case_media\/oral_argument_audio\/25667"}],"citation":{"volume":"605","page":null,"year":"2025","href":"https:\/\/api.oyez.org\/case_citation\/case_citation\/28030"},"decisions":null,"first_party_label":"Petitioner","second_party_label":"Respondent","heard_by":[{"ID":63493,"name":"Roberts Court (2022-)","href":"https:\/\/api.oyez.org\/courts\/roberts13","view_count":0,"members":[{"ID":15086,"name":"John G. 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