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Supreme Court hears dispute over whether ‘entitled to benefits’ in Medicare DISH formula means program enrollment or monthly SSI payment
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Summary
At oral argument in Advocate Christ Medical Center v. Becerra, petitioner urged the Court to read “entitled to benefits” in the DISH Medicare fraction to mean program eligibility under Supplemental Security Income (SSI), while the government urged a narrower reading limited to month‑of‑hospitalization cash‑payment entitlement; the case was submitted after rebuttal.
The Supreme Court on Tuesday heard argument in Advocate Christ Medical Center v. Becerra over whether the phrase "entitled to benefits" in the Medicare DISH (disproportionate share hospital) formula refers to broad program enrollment under Supplemental Security Income (SSI) or instead to a patient's entitlement to a monthly SSI cash payment in the month of hospitalization.
Petitioner counsel told the justices that the identical phrase should carry the same meaning in the same sentence and that Congress intended the SSI proxy in DISH to capture the class of people enrolled in the SSI program, including those who do not receive a cash check in a particular month. "A DISH proxy that does not measure the low income population is no proxy at all," petitioner argued, pressing that program eligibility — not actual receipt of a check — better tracks the statute's purpose of compensating hospitals that treat higher‑cost, low‑income patients.
The government countered that SSI "benefits are monthly cash payments" and that the DISH formula uses entitlement to such payments in the specific month of hospitalization as the appropriate, administrable proxy for low income status. Government counsel said the agency evaluates entitlement for the hospital month and that agency practice and the Court's earlier decision in Empire Health support counting only those who qualify for a cash payment in the hospital month.
Justices pressed both sides with hypotheticals and practical examples. Some asked whether people who temporarily exceed income limits, who are newly approved but have not yet received a first check, or who have their payments suspended for administrative reasons would be captured by a program‑eligibility test. Petitioner pointed to statutory text and regulations that distinguish suspensions from terminations and cited noncash benefits — including Medicaid continuation and vocational rehabilitation addressed in title 16 — as part of what petitioners contend are benefits "under" SSI.
Government counsel said the agency's operational dataset looks back up to 15 months to capture retroactive reinstatements (so that some delayed or retroactively reinstated payments are included) and described the statutory structure as focused on month‑to‑month payment determinations. He also told the Court that DISH payments are financially significant to hospitals, noting the agency's estimate that DISH distributions totaled about $9.2 billion in 2024.
Both sides acknowledged that different readings carry consequences for safety‑net and rural hospitals. Petitioner's counsel and several amici argued that excluding program‑eligible but nonpaid individuals would undercount the low‑income population DISH is intended to capture and could harm hospitals that rely on the adjustment. The government said it had longstanding administrative practices interpreting the statute in the narrower way and urged fidelity to the statute and existing precedent.
Petitioner had the final word in a brief rebuttal before the Court submitted the case. The justices gave no indication from the bench and took the case under advisement.