Case Info: Advocate Christ Medical v. Becerra, Sec. of H&HS | Case No. 23-715 | Date Argued: 11/5/24 | Date Decided: 4/29/25

Link to Docket: Here.

Background:

Because low-income patients are often costlier to treat, Congress directed the government to reimburse hospitals that treat a disproportionate share of low--income patients at higher Medicare rates. A hospital qualifies for higher payments in part based on the number of days that a hospital provides inpatient care to senior (or disabled) low- income patients, measured as those who "were entitled to benefits under part A of [Medicare] and were entitled to supplementary security income [SSI] benefits." 42 U.S.C.§ 1395ww(d)(5)(F)(vi)(I).

In Becerra v. Empire Health Foundation, this Court agreed with the agency that "entitled to [Medicare part A] benefits" included "all those qualifying for the [Medicare] program," whether or not Medicare paid for that hospital stay. 597 U.S. 424, 445 (2022). But Empire expressly left open the question of whether "entitled to [SSI] benefits" likewise includes all those who qualify for the SSI program. Id. at 434 n.2. The agency still insists, contrary to its Medicare interpretation, that only patients who received an SSI cash payment for the month of their hospital stay are "entitled to benefits."

This case thus presents Empire's open question: Does the phrase "entitled ... to benefits," used twice in the same sentence of the Medicare Act, mean the same thing for Medicare part A and SSI, such that it includes all who meet basic program eligibility criteria, whether or not benefits are actually received.

Question Presented: Does the phrase "entitled ... to benefits," used twice in the same sentence of the Medicare Act, mean the same thing for Medicare part A and supplementary security income (SSI), such that it includes all who meet basic program eligibility criteria, whether or not benefits are actually received.

Holding: In calculating the Medicare fraction, an individual is “entitled to[SSI] benefits” for purposes of the Medicare fraction when she is eligi­ble to receive an SSI cash payment during the month of her hospitali­zation.

Result: Affirmed.

Voting Breakdown: 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.

Link to Opinion: Here.

Advocates:

• For Petitioners: Melissa Arbus Sherry
• For Respondent: Ephraim McDowell, Assistant to the Solicitor General, Department of Justice

Website Link to Opinion Summary: Here.

Apple Podcast Link to Opinion Summary: Here.