Becerra v. Empire Health Foundation | Case No. 20-1312 | Date Argued: 11/29/2021 | Date Decided: 6/24/2022

Background: The Medicare statute provides that a hospital that serves a "significantly disproportionate number of low-income patients" is entitled to an upward adjustment in the rate at which the federal government reimburses the hospital for services provided to Medicare patients. 42 U.S.C. §§ 1395ww(d)(5)(F)(i)(I), (ii). That adjustment-known as a "disproportionate share hospital" (DSH) adjustment-requires a determination of the percentage of the hospital's patients who are eligible for Medicaid, the low-income healthcare program.

Question Presented: Whether the Secretary has permissibly included in a hospital's Medicare fraction all of the hospital's patient days of individuals who satisfy the requirements to be entitled to Medicare Part A benefits, regardless of whether Medicare actually paid the hospital for those particular days.

Holding: In calculating the Medicare fraction, individuals “entitled to [Medicare Part A] benefits” are all those qualifying for the program, regardless of whether they receive Medicare payments for part or all of a hospital stay.

Result: Judgment REVERSED and case REMANDED.

Voting Breakdown: 5-4. Justice Kagan delivered the opinion of the Court, in which Justices Thomas, Breyer, Sotomayor and Barrett joined. Justice Kavanaugh filed a dissenting opinion, in which Chief Justice Roberts and Justices Alito and Gorsuch joined.

Link to Opinion: Here.

Oral Advocates:

For Petitioner: Jonathan C. Bond, Assistant to the Solicitor