Plain-English summary
Court says hospitals count patients eligible for SSI during their hospital month when computing DSH payments
The Court held that, for Medicare disproportionate-share (DSH) payment calculations, a patient is "entitled to" Supplemental Security Income (SSI) when she is eligible for an SSI cash payment during the month of hospitalization. The decision affirms the D.C. Circuit and upholds the government’s interpretation of the statute.
Why this matters
Hospitals that serve large numbers of low-income patients depend on DSH payments to cover higher treatment costs. This ruling preserves the government’s method for counting eligible SSI patients in the DSH formula, affecting how much extra Medicare funding hospitals receive and influencing hospitals’ finances and ability to serve vulnerable communities.
Who may feel it
- Hospitals that serve many low-income or disabled patients (safety-net hospitals)
- Medicare program administrators and HHS
- Low-income Medicare beneficiaries and SSI applicants
- State Medicaid programs and taxpayers
Key questions
- What does the statute mean by an individual being "entitled to" SSI benefits for purposes of the Medicare DSH patient-count fraction?
- Must an actual SSI cash payment be made during the hospitalization month for the patient to be counted, or is eligibility enough?