Advocate Christ Medical Center v. Kennedy

Over 200 hospitals, led by Advocate Christ Medical Center, challenged the Department of Health and Human Services' (HHS) calculation of the Medicare fraction used to determine Disproportionate Share Hospital (DSH) adjustments, which provide extra funding to hospitals serving many low-income patients. The hospitals argued that "entitled to supplementary security income (SSI) benefits" should include all patients enrolled in SSI at hospitalization, even if not entitled to a payment that month. HHS interpreted it to mean patients eligible to receive an SSI cash payment during the month of hospitalization. The case was argued on November 5, 2024, and decided on April 29, 2025.

The Supreme Court affirmed the D.C. Circuit's decision in a 7-2 ruling. Justice Amy Coney Barrett wrote the majority opinion, joined by Chief Justice Roberts and Justices Thomas, Alito, Kagan, Gorsuch, and Kavanaugh. The Court held that an individual is "entitled to [SSI] benefits" for Medicare fraction purposes only when she is eligible to receive an SSI cash payment during the month of her hospitalization. Justice Ketanji Brown Jackson filed a dissenting opinion, joined by Justice Sonia Sotomayor.

The central dispute was the proper interpretation of the phrase "entitled to supplementary security income benefits" under subchapter XVI of the Social Security Act for the purpose of calculating the Medicare fraction in the DSH adjustment formula. The hospitals advocated for a broad interpretation including all SSI enrollees, while HHS argued for a narrow reading limited to those eligible for a cash payment during the specific month of hospitalization.

The decision favored the government's narrower interpretation, potentially reducing DSH payments to hospitals. Hospitals argued the government's approach could underpay them by over $1 billion annually. The ruling clarified a "highly technical" aspect of Medicare reimbursement, affecting how hospitals serving disadvantaged populations calculate their federal funding. The decision may limit the financial resources available to safety-net hospitals.