Supreme Court Decides Advocate Christ Medical Center, et al. v. Kennedy

On April 29, 2025, the U.S. Supreme Court decided Advocate Christ Medical Center, et al. v. Kennedy, No. 23-715, holding that for purposes of calculating the Medicare fraction, an individual is entitled to supplemental security income (SSI) benefits when she is eligible to receive a cash payment during the month of her hospitalization.

Congress provides several “hospital-specific rate adjustments” under the Medicare program, including the “disproportionate share hospital” (DSH) adjustment. The DSH provides enhanced Medicare payments to hospitals that serve an unusually high percentage of low-income patients. It is calculated by adding together two statutorily prescribed fractions — the Medicare fraction and the Medicaid fraction. The Medicare fraction “represents the proportion of a hospital’s Medicare patients who have low incomes, as identified by their entitlement to [SSI] benefits.” At issue in Advocate Christ Medical Center is the Medicare fraction’s numerator, which counts “ ‘the number of patient days attributable to Medicare patients who are poor’ — i.e., those Medicare patients who are entitled to SSI benefits under subchapter XVI.” 

The question before the Court was which patients count as “entitled to supplementary security income benefits . . . under subchapter XVI.” The Department of Health and Human Services (HHS) had determined only patients who were “ ‘entitled to receive SSI benefits during the month’ in which they were hospitalized” are included. Petitioners, a group of more than 200 hospitals, argued the subchapter encompasses all patients enrolled in the SSI system during their hospitalization, even if not entitled to SSI payments during that month. The District Court and D.C. Circuit agreed with HHS’s reading of the statutory text.

The Court engaged in a detailed analysis of the text of the Medicare statute to determine when an individual is entitled to SSI benefits under subchapter XVI. First, the Court determined that SSI benefits are cash benefits. Section 1381a provides that individuals will be “paid” the benefits, which the Court believed “obviously connotes a cash benefit.” Second, the Court determined eligibility for these cash benefits is determined on a monthly basis, citing several sections in subchapter XVI, including Section 1382(c)(1), which provides that eligibility is determined based on an individual’s “income, resources, and other relevant characteristics in such month.” 

The Court therefore concluded that an individual is entitled to SSI benefits “when she is eligible to receive an SSI cash payment.” Because eligibility is determined on a monthly basis, the individual is only “entitled to [SSI benefits]” if she is eligible during the month of her hospitalization.

Justice Barrett delivered the opinion of the Court, in which Chief Justice Roberts and Justices Thomas, Alito, Kagan, Gorsuch, and Kavanaugh joined. Justice Jackson filed a dissenting opinion, in which Justice Sotomayor joined.