Advocate Christ v. Kennedy (Social Security Benefits)

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In Advocate Christ Medical Center v. Kennedy, the Supreme Court addressed how to calculate the Medicare “disproportionate share hospital” (DSH) adjustment—a statutory formula that provides extra funding to hospitals serving many low-income patients. At issue was how to interpret the term “entitled to [SSI] benefits” in the Medicare fraction of that formula. A coalition of over 200 hospitals argued that this phrase should include all patients enrolled in the Supplemental Security Income (SSI) system, regardless of whether they actually received SSI payments during the month of their hospital stay. The Department of Health and Human Services, by contrast, only counted patients who were actually eligible for a cash SSI payment during their hospitalization month.

Writing for the Court, Justice Barrett rejected the hospitals’ broader interpretation. The Court held that a person is “entitled to SSI benefits” only if they are eligible for a cash SSI payment during the specific month of their hospital stay. The Court emphasized that SSI benefits are determined monthly and are strictly cash-based under subchapter XVI. It dismissed the hospitals’ argument that noncash services like Medicaid continuation or vocational training should count, finding those benefits either irrelevant or located in different statutory subchapters.

The Court also distinguished this case from Empire Health, a prior decision interpreting Medicare Part A entitlement, explaining that SSI and Medicare are fundamentally different programs—SSI requires fluctuating monthly eligibility based on income and resources, while Medicare provides broader and more automatic coverage.

The Court ultimately upheld the D.C. Circuit’s decision and ruled in favor of HHS. Justice Barrett’s majority opinion was joined by Chief Justice Roberts and Justices Thomas, Alito, Kagan, Gorsuch, and Kavanaugh. Justice Jackson dissented, joined by Justice Sotomayor.

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