On April 29, the U.S. Supreme Court issued a 7-2 decision in Advocate Christ Medical Center, et al. v. Kennedy, ruling against more than 200 hospitals that challenged the government’s method for calculating disproportionate share hospital (DSH) eligibility and payments. The court upheld the current Centers for Medicare & Medicaid Services (CMS) policy, which requires that a patient be actively receiving Supplemental Security Income (SSI) payments at the time of hospitalization to count toward a hospital’s “Medicare fraction” for DSH calculation purposes. America’s Essential Hospitals signed an amicus brief in support of the hospital in 2024.
Hospitals’ DSH eligibility and size of DSH payment is derived from two fractions: the Medicare fraction, representing the proportion of Medicare patients who have low incomes, and the Medicaid fraction, representing the proportion patients who are eligible for Medicaid but not Medicare. The plaintiffs had argued that the Medicare fraction should be determined from a patient’s SSI eligibility, rather than the issuance of a cash payment during the month of their stay.
As the decision affirms current policy, CMS will not redetermine DSH eligibility or recalculate DSH payments.
Contact Director of Policy Rob Nelb, MPH, at rnelb@essentialhospitals.org or 202.585.0127 with questions.
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