Becerra v. Empire Health Foundation, For Valley Hospital Medical Center

P R E L I M I N A R Y P R I N T
Volume 597 U. S. Part 1
Pages 424–449
OFFICIAL REPORTS
OF
T H E S U P R E M E C O U R T
June 24, 2022
REBECCA A. WOMELDORF
reporter of decisions
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424 OCTOBER
TERM, 2021
Syllabus
BECERRA, SECRETARY OF HEALTH AND HUMAN
SER
VICES v. EMPIRE HEALTH FOUNDATION, FOR
VALLEY HOSPITAL MEDICAL CENTER
certiorari to the united states court of appeals for
the ninth circuit
No. 20–1312. Argued November 29, 2021—Decided June 24, 2022
Once a person turns 65 or has received federal disability benefts for 24
months, he becomes “entitled” to benefts under Part A of Medicare.
42 U. S. C. §§ 426(a)–(b). Part A provides coverage for, among other
things, inpatient hospital treatment. See § 1395d(a). Medicare pays
hospitals a fxed rate for such treatment based on the patient's diagnosis,
regardless of the hospital's actual cost and subject to certain adjust-
ments. §§ 1395ww(d)(1)–(5). One such adjustment is the “dispropor-
tionate share hospital” (DSH) adjustment, which provides higher-than-
usual rates to hospitals that serve a higher-than-usual percentage of
low-income patients. To calculate the DSH adjustment, the Depart-
ment of Health and Human Services (HHS) adds together two statuto-
rily described fractions: the Medicare fraction—which represents the
proportion of a hospital's Medicare patients who have low incomes—and
the Medicaid fraction—which represents the proportion of a hospital's
total patients who are not entitled to Medicare and have low incomes.
Together those fractions produce the “disproportionate-patient percent-
age,” which determines whether a hospital will receive a DSH adjust-
ment, and how large it will be.
Not all patients who qualify for Medicare Part A have their hospital
treatment paid for by the program. Non-payment may occur, for exam-
ple, if a patient's stay exceeds Medicare's 90-day cap per spell of illness,
see § 1395d, or if a patient is covered by a private insurance plan, see
§ 1395y(b)(2)(A). Such limits on Medicare's coverage prompt the ques-
tion raised here: whether patients whom Medicare insures but does not
pay for on a given day are patients “who (for such days) were entitled
to [Medicare Part A] benefts” for purposes of computing a hospital's
disproportionate-patient percentage. § 1395ww(d)(5)(F)(vi)(I).
A 2004 HHS regulation says yes: If the patient meets the basic statu-
tory criteria for Medicare (i. e., is over 65 or disabled), then the patient
counts in the denominator and, if poor, in the numerator of the Medicare
fraction. See 69 Fed. Reg. 49098–49099. Respondent Empire Health
Foundation challenged that regulation as inconsistent with the statute.
The Ninth Circuit agreed. That court focused on the statute's use of

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425
Syllabus
two different phrases: “entitled to [Medicare Part A] benefts” and “eli-
g
ible for [Medicaid] assistance.” The Ninth Circuit read the latter
phrase to mean that a patient qualifes for Medicaid and the former
phrase to mean that a patient has an absolute right to payment from
Medicare. The Court granted certiorari to resolve a confict between
the Ninth Circuit and two other Circuit Courts, which had approved of
HHS's regulation.
Held: In calculating the Medicare fraction, individuals “entitled to [Medi-
care Part A] benefts” are all those qualifying for the program, regard-
less of whether they receive Medicare payments for part or all of a
hospital stay. Pp. 434–445.
HHS's regulation is consistent with the text, context, and structure
of the DSH provisions. The agency has interpreted the phrase “enti-
tled to benefts” in those provisions to mean just what it means through-
out the Medicare statute: qualifying for benefts. And counting every-
one who qualifes for Medicare benefts in the Medicare fraction—and
no one who qualifes for those benefts in the Medicaid fraction—accords
with the statute's attempt to capture, through two separate measure-
ments, two di fferent seg ments of a hospit a l's low-i ncome patient
population.
(a) Empire's textual argument has a two-part structure. Echoing
the Ninth Circuit, Empire primarily contends that the words “entitled”
and “eligible” have different meanings. According to Empire, to be “el-
igible” for a beneft is to be “qualifed” to seek it; to be “entitled” to a
beneft means instead to have an “absolute right” to its payment. But
throughout the Medicare statute, “entitled to benefts” is essentially a
term of art meaning “qualifying for benefts,” i. e., being over 65 or
disabled. And in the end, Empire basically concedes that point. It
must devise a way to give “entitled to benefts” a different meaning in
the fraction descriptions than everywhere else in the Medicare statute.
So Empire shifts gears, relying now on the parenthetical phrase “(for
such days)” to transform the usual statutory meaning of “entitled to
benefts” to something different and novel. But those three little words
do not accomplish what Empire would like, having the much less radical
function of excluding days of a patient's hospital stay before he qualifes
for Medicare (e. g., turns 65). Pp. 434–441.
(1) The Medicare statute explicitly states that “[e]very individual”
who “has attained age 65” and is entitled to ordinary social security
payments and “every individual” under age 65 who has been entitled to
federal disability benefts for at least 24 months “shall be entitled to”
Medicare Part A benefts. §§ 426(a)–(b). This broad meaning of “enti-
tlement” coexists with limitations on payment. The entitlement to ben-

426 BECERRA
v. EMPIRE HEALTH FOUNDATION, FOR
VALLEY HOSPITAL MEDICAL CENTER
Syllabus
efts, the statute repeatedly says, is an entitlement to payment under
speci
fed conditions. So a person remains entitled to benefts even if he
has run into one of the statute's conditions, such as the 90-day cap on
inpatient hospital services. For example, the statute twice refers to
patients who are “entitled to benefts under part A but ha[ve] exhausted
benefts for inpatient hospital services.” §§ 1395l(a)(8)(B)(i), 1395l(t)(1)
(B)(ii). In thus describing the Part A entitlement, the statute refects
the complexity of health insurance: An insured who hits some limit on
coverage for, say, eye care is still insured. His policy will pay for more
eye care in the next coverage period and meanwhile will pay for his
knee replacement.
If “entitled to benefts” instead bore Empire's meaning, Medicare ben-
efciaries would lose important rights and protections, such as the ability
to enroll in other Medicare programs. See §§ 1395o(a), 1395w-21(a)(3),
1395w–101(a)(3)(A). Empire's interpretation would also make a hash of
provisions designed to inform Medicare benefciaries of their benefts,
see § 1395b–2(a), and to protect benefciaries from misleading marketing
materials, see § 1395w–21(a)(3). Congress could not have intended to
write a statute whose safeguards would apply or not apply, or fuctuate
constantly, based on the happenstance of whether Medicare paid for hos-
pital care on a given day. Pp. 435–439.
(2) Empire concedes that its interpretation cannot be applied
throughout the Medicare statute. To get around this, Empire claims
that the parenthetical in “patients who (for such days) were entitled to
[Part A] benefts,” § 1395ww(d)(5)(F)(vi)(I), converts the usual statutory
meaning of “entitled to benefts” to something different: actually receiv-
ing payment. That slight phrase, however, cannot bear so much inter-
pretive weight. Instead, the parenthetical works as HHS says: hand in
hand with the ordinary statutory meaning of “entitled to benefts.” It
directs HHS to count only those individuals who qualify for Medicare
on a particular day. So if a patient turns 65 on the 15th day of a 30-
day hospital stay, HHS will count only 15 days. Pp. 439–441.
(b) The structure of the relevant statutory provisions reinforces the
conclusion that “entitled to benefts” means qualifying for benefts. The
statute recompenses hospitals for serving two different low-income pop-
ulations: low-income Medicare patients and low-income non-Medicare
patients. HHS's reading of “entitled” comports with this structure: a
low-income Medicare patient always count in the Medicare fraction.
That is so regardless of whether the Medicare program is actually pay-
ing for a day of his care—because that fact has no relationship to his
fnancial status. Empire's interpretation, by contrast, fts poorly with
the statutory structure. Its who-paid-for-a-day-of-care test has no rela-
tionship to a patient's fnancial status. So on Empire's view, a patient
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427
Syllabus
could phase in and out of the Medicare fraction regardless of income.
Empire
responds by asserting that any low-income person excluded
from the Medicare fraction (say, because of exhaustion of benefts) would
get counted instead in the Medicaid fraction. But even if that is true,
Empire's scheme would result in patients ping-ponging back and forth
between the two fractions based on the happenstance of actual Medicare
payments. In any event, Empire is too quick to claim that those who
(on its view) are tossed from the Medicare fraction for non-income-based
reasons like exhaustion of benefts would still wind up in the Medicaid
fraction. Applying Empire's reading of “for such days,” a low-income
patient who has exhausted his coverage would not get counted at all, in
either fraction, but he would remain just as low-income and impose just
as high costs on the hospital treating him. Empire's only response is
to insist that its interpretation must be right because it usually (though
not always) leads to higher DSH payments. But the point of the stat-
ute is not to pay hospitals the most money possible; it is to compensate
them for serving a disproportionate share of low-i ncome patients.
Pp. 442–445.
958 F. 3d 873, reversed and remanded.
Kagan, J., delivered the opinion of the Court, in which Thomas,
Breyer, Sotomayor, and Barrett, JJ., joined. Kavanaugh, J., fled a
dissenting opinion, in which Roberts, C. J., and Alito and Gorsuch, JJ.,
joined, post, p. 445.
Jonathan C. Bond argued the cause for petitioner. With
him on the briefs were Solicitor General Prelogar, Acting
Solicitor General Fletcher, Acting Assistant Solicitor Gen-
eral Boynton, Deputy Solicitor General Kneedler, Mark B.
Stern, and Stephanie R. Marcus.
Daniel J. Hettich argued the cause for respondent. With
him on the brief were Ashley C. Parrish, Jeffrey S. Bucholtz,
Anne M. Voigts, and Matthew V. H. Noller.*
*Michael Pepso n and Cyn th i a Fleming Crawfo rd fi led a br ief for
the Amer icans for Prosper ity Foundati on as ami cu s cur i ae urg i ng
reversal.
Briefs of amici curiae urging affrmance were fled for Certain Hospi-
tals et al. by David A. Hickerson; and for the Federation of American
Hospitals by Kelly A. Carroll.

428 BECERRA
v. EMPIRE HEALTH FOUNDATION, FOR
VALLEY HOSPITAL MEDICAL CENTER
Opinion of the Court
Justice Kagan delivered the opinion of the Court.
T
he Medicare program reimburses hospitals at higher-
than-usual rates when they serve a higher-than-usual per-
centage of low-income patients. The enhanced rates are cal-
culated by adding together two fractions, called the Medicare
fraction and the Medicaid fraction. Roughly speaking, the
former measures the hospital's low-income senior-citizen
population, and the latter the hospital's low-income non-
senior population.
This case raises a technical but important question about
the Medicare fraction. The statutory description of that
fraction refers to “the number of [a] hospital's patient days”
attributable to low-income patients “who (for such days)
were entitled to benefts under part A of [Medicare].” 42
U. S. C. § 1395ww(d)(5)(F)(vi)(I). According to the Depart-
ment of Health and Human Services (HHS), a person is “enti-
tled to [Part A] benefts” under the statute if he qualifes for
the Medicare program—essentially, if he is over 65 or dis-
abled. That remains so even when Medicare is not paying
for part or all of his hospital stay—for example, because a
private insurer is legally responsible or because he has used
up his allotted coverage. Today, we approve HHS's under-
standing of the Medicare fraction.
I
The Medicare program provides Gover nment-funded
hea lth i nsurance to over 64 mi ll i on elder ly or disabled
Americans. (The vast majority of that number are senior
citizens.) When a person turns 65 or has received federal
disability benefts for 24 months, he automatically (i. e., with-
out application or other fling) becomes “entitled” to benefts
under Medicare Part A. §§ 426(a)–(b). The most signif-
cant Part A beneft is coverage for inpatient hospital treat-
ment; Part A also covers associated physician and skilled
nursing services. See § 1395d(a); HHS, CMS Ruling No.
CMS–1498–R, p. 10 (Apr. 28, 2010), https://www.cms.gov/
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429
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reg u lati ons-and-g uidance/g uidance/r u li ngs/downloads/
cms1498r
.pdf (CMS–1498–R). In addition, entitlement to
Part A generally enables a patient to enroll (if he wishes) in
Medicare's other programs: Part B's coverage for outpatient
care; Part C's coverage through privately administered
Medicare Advantage plans; and Part D's coverage for pre-
scription drugs. See §§ 1395o(a)(1), 1395w–21(a)(3), 1395w–
101(a)(3)(A).
The Medicare program pays a hospit a l a fixed rate
for treating each Medicare patient, based on the patient's
diag nosis and regardless of the hospit a l's ac tua l costs.
§§ 1395ww(d)(1)–(4). The rates are designed to refect the
amounts an efficiently run hospital, in the same reg ion,
would expend to treat a patient with the same diagnosis.
See 42 CFR § 412.2 (2022). If the hospital spends anything
more, it suffers a fnancial loss. The fat-rate payment sys-
tem thus gives hospitals an incentive to provide effcient
levels of medical service.
But Congress, recognizing complexity in healthcare, pro-
vided for various hospital-specifc rate adjustments—includ-
ing the one at issue here for treating low-income patients.
The “disproportionate share hospital” (DSH) adjustment
gives hospitals serving an “unusually high percentage of low-
income patients” enhanced Medicare payments. Sebelius v.
Auburn Regional Medical Center, 568 U. S. 145, 150 (2013).
The mark-up refects that low-income individuals are often
more expensive to treat than higher income ones, even for
the same medical conditions. In compensating for that dis-
parity, the DSH adjustment encourages hospitals to treat
low-income patients.
To calculate a hospital's DSH adjustment, HHS adds to-
gether two statutorily described fractions, usually called the
Medicare fraction and the Medicaid fraction. Those frac-
tions are designed to capture two different low-income popu-
lations that a hospital serves. The Medicare fraction repre-
sents the proportion of a hospital's Medicare patients who
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430 BECERRA
v. EMPIRE HEALTH FOUNDATION, FOR
VALLEY HOSPITAL MEDICAL CENTER
Opinion of the Court
have low incomes, as identifed by their entitlement to sup-
plement
ary security income (SSI) benefts. SSI is a “wel-
fare program” providing benefts to “fnancially needy indi-
viduals” who (like Medicare patients generally) are over 65
or disabled. Bowen v. Galbreath, 485 U. S. 74, 75 (1988); see
§§ 1382(a)(1), 1382c(a)(1). The Medicaid fraction represents
the proportion of a hospital's patients who are not entitled
to Medicare and have low incomes, as identifed by their
eligibility for Medicaid. The Medicaid program provides
health insurance to all low-income individuals, regardless of
age or disability. See § 1396d(a). So at a high level of gen-
erality, the Medicare fraction is a measure of a hospital's se-
nior (or disabled) low-income population, while the Medicaid
fraction is a measure of a hospital's non-senior (except for
disabled) low-income population.
With that under your belt, you might be ready to absorb
the relevant statutory language (but don't bet on it). The
Medicare fraction is described as:
“[a] fraction (expressed as a percentage), the numerator
of which is the number of [a] hospital's patient days for
[the fscal year] which were made up of patients who
(for such days) were entitled to benefts under part A of
[Medicare] and were entitled to [SSI] benefts[ ], and the
denominator of which is the number of such hospital's
patient days for such fscal year which were made up of
patients who (for such days) were entitled to benefts
under [Medicare] part A.” § 1395ww(d)(5)(F)(vi)(I).
That is a mouthful (and without the brackets, it's even
worse). So again, in general terms: The numerator is the
number of patient days attributable to Medicare patients
who are poor. The denominator is the number of patient
days attributable to all Medicare patients. Divide the for-
mer by the latter to get the fraction “expressed as a percent-
age.” Ibid.
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And similarly for the Medicaid fraction. That fraction is
descr
ibed as:
“[a] fraction (expressed as a percentage), the numerator
of which is the number of [a] hospital's patient days for
[the fscal year] which consist of patients who (for such
days) were eligible for medical assistance under [Medic-
aid], but who were not entitled to benefts under part A
of [Medicare], and the denominator of which is the total
number of the hospital's patient days for such [fscal
year].” § 1395ww(d)(5)(F)(vi)(II).
That too is a lot to digest. So again, in general terms: The
numerator is the number of patient days attributable to non-
Medicare patients who are poor. The denominator is the
total number of patient days. Divide the former by the
latter to get the second percentage the DSH calculation
requires.
1
Once both percentages have been calculated, they are
added together to produce the “disproportionate-patient per-
centage.” That percentage determines whether a hospital
will receive a DSH adjustment, and if so, how large it will
be. The combined percentage must usually equal or ex-
ceed 15% for a hospit a l to get an adjustment. See
§ 1395ww(d)(5)(F)(v). So, for example, if a hospital's Medi-
1
You may have noticed that the denominator of the Medicare fraction
(the number of patient days attributable to Medicare patients) is smaller
than the denominator of the Medicaid fraction (the total number of patient
days). That means each low-income patient day included in the Medicare
fraction will count for more than each low-income patient day included in
the Medicaid fraction. So, to use an overly simplifed example, a hospital
with 100 of the former will get a larger rate adjustment than a hospital
with 100 of the latter. Although Congress did not explain that difference,
it presumably refects the Medicare-centric perspective of what is, after
all, a Medicare payment scheme. (The Medicaid statute separately re-
quires States to make DSH payments, using a different formula that fo-
cuses on a hospital's Medicaid population. See 42 U. S. C. § 1396r–4. But
that statutory provision is not at issue here.)
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432 BECERRA
v. EMPIRE HEALTH FOUNDATION, FOR
VALLEY HOSPITAL MEDICAL CENTER
Opinion of the Court
care fraction is 10% and its Medicaid fraction is 5%, then the
hospit
al would qualify for increased rates. The higher the
disproportionate-patient percentage goes, the greater the
rate mark-up that the hospital will receive. §§ 1395ww(d)
(5)(F)(vii)–(xiv).
This case is about how to count patients who qualify for
Medicare Part A—because they are over 65 or disabled—
at times when the program is not paying for their hospital
treatment. Such non-payment may occur for a number of
reasons. For one, Medicare usually pays for only the frst
90 days of a hospital stay associated with a single “spell of
illness.” See § 1395d; 42 CFR § 409.61(a). If a patient's
stay for an illness exceeds that limit, his coverage is “ex-
hausted.” § 409.61(a). For another, Medicare pays for hos-
pital treatment only once a patient has used up other medical
insurance. See § 1395y(b)(2)(A). So if a patient has a pri-
vate insurance plan, or is injured by a tortfeasor with insur-
ance, Medicare will not pay unless and until that other policy
runs dry. Limits like those prompt the question presented
here: Are patients whom Medicare insures but does not pay
for on a given day “entitled to [Medicare Part A] benefts,”
for purposes of computing a hospital's disproportionate-
patient percentage? §§ 1395ww(d)(5)(F)(vi)(I–II).
An HHS regulation, issued in 2004, says those patients
remain so entitled. See 69 Fed. Reg. 48916. Under the
regulation, whether Medicare is actually paying for a pa-
tient's hospital treatment is irrelevant. So, for example, it
does not matter that a patient has exhausted his 90 days of
coverage for an illness, or that a private insurer is paying
for his hospital stay. As long as the patient meets the basic
statutory criteria for Medicare (i. e., he is over 65 or dis-
abled), then the patient counts in the denominator and, if he
is poor, in the numerator of the Medicare fraction (as “enti-
tled to [Medicare Part A] benefts”). See id., at 49098–
49099. And by the same token, he does not count in the
numerator of the Medicaid fraction (which includes only

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as: 597 U. S. 424 (2022)
433
Opinion of the Court
those “not entitled to [Medicare Part A] benefts”). See
ib
id. As HHS explained in 2004, the effect of the regulation
varies depending on the makeup of a hospital's patient popu-
lation. See ibid. But for most hospitals, the regulation has
worked to decrease DSH payments, because as benefciaries
are added to the Medicare fraction's denominator (even
though poor benefciaries are also added to its numerator), a
hospital's Medicare fraction generally (though not always)
goes down. See Letter from E. Prelogar, Solicitor General,
to S. Harris, Clerk of Court (Nov. 23, 2021).
Respondent Empire Health Foundation challenged the
regulation as inconsistent with the statutory fraction de-
scriptions, and the Court of Appeals for the Ninth Circuit
agreed. See Empire Health Foundation v. Azar, 958 F. 3d
873 (2020). The court focused on the statute's use of two
different phrases: “entitled to [Medicare Part A] benefts”
and (in the Medicaid fraction alone) “eligible for [Medicaid]
assistance.” Id., at 885. Relying on Circuit precedent, the
court read the latter, “eligible” phrase to “mean that a pa-
tient simply meets the Medicaid statutory criteria”—regard-
less of whether “Medicaid actually paid” for a given service
on a given day. Ibid. That approach, of course, is analo-
gous to the one the HHS regulation adopts for Medicare
benefciaries. But the Ninth Circuit reasoned that the stat-
utory language relating to Medicare is different: It asks
whether a person is “entitled to” (not “eligible for”) benefts.
And the word “entitled,” the court held (relying on the same
precedent), “mean[s] that a patient has an `absolute right . . .
to payment.' ” Ibid. (ellipsis in original). So even if a pa-
tient is over 65, he is not “entitled to [Medicare Part A] bene-
fts” within the meaning of the statute for any hospital stay,
or part thereof, Medicare is not paying for.
As the Ninth Circuit recognized, two other Courts of Ap-
peals had deferred to HHS's contrary view of the statute and
upheld the regulation. See Metropolitan Hospital v. De-
partment of Health and Human Servs., 712 F. 3d 248 (CA6
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434 BECERRA
v. EMPIRE HEALTH FOUNDATION, FOR
VALLEY HOSPITAL MEDICAL CENTER
Opinion of the Court
2013); Catholic Health Initiatives Iowa Corp. v. Sebelius,
718
F. 3d 914 (CADC 2013). We granted certiorari to re-
solve the confict. See 594 U. S. ––– (2021).
2
II
HHS's regulation correctly construes the statutory lan-
guage at issue. The ordinary meaning of the fraction de-
scriptions, as is obvious to any ordinary reader, does not
exactly leap off the page. See Catholic Health Initiatives,
718 F. 3d, at 916 (The “language is downright byzantine”).
The provisions are technical: They call to mind Justice
Frankfurter's injunction that when a statute is “addressed
to specialists, [it] must be read by judges with the minds of
the specialists.” Some Refections on the Reading of Stat-
utes, 47 Colum. L. Rev. 527, 536 (1947). But when read in
that suitable way, the fraction descriptions disclose a surpris-
ingly clear meaning—the one chosen by HHS. The text and
context support the agency's reading: HHS has interpreted
the words in those provisions to mean just what they mean
throughout the Medicare statute. And so too the structure
of the DSH provisions supports HHS: Counting everyone
who qualifes for Medicare benefts in the Medicare frac-
tion—and no one who qualifes for those benefts in the Med-
icaid fraction—accords with the statute's attempt to capture,
through two separate measurements, two different segments
of a hospital's low-income patient population.
A
Speaking of twos, Empire's textual argument also has a
bifurcated structure—but neither part can produce its de-
sired result. Empire primarily contends, echoing the Ninth
Circuit, that “different words [mean] different things” when
2
This case does not raise the question whether HHS has properly inter-
preted the phrase “entitled to [SSI] benefts” in the Medicare fraction.
Accordingly, we express no view on that issue.
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435
Opinion of the Court
used in a single statute—and so “entitled” means something
di
fferent from “eligible.” Brief for Respondent 22. To be
“eligible” for a beneft, Empire says, is to be “qualifed” to
seek it; to be “entitled” to a beneft means instead to have
an “absolute right” to its payment. Id., at 4, 30. But that
reading, even if plausible in the abstract, does not work in
the Medicare statute. There, “entitled to benefts” is essen-
tially a term of art, used over and over to mean qualifying
(or, yes, being eligible) for benefts—i. e., being over 65 or
disabled. And in the end, Empire basically concedes that
point. It must devise a way to give “entitled to benefts” a
different meaning in the fraction descriptions than the
phrase has everywhere else in the Medicare law. See Tr. of
Oral Arg. 37–41. So Empire shifts gears, relying now on
the parenthetical phrase “(for such days)” to do its work—to
transform the usual statutory meaning of “entitled to bene-
fts” to something different and novel. See ibid.; § 1395ww
(d)(5)(F)(vi)(I) (“patients who (for such days) were entitled to
[Medicare Part A] benefts”). (The dissent, for its part, fo-
cuses most of its energies on this latter stage of Empire's
argument.) But those three little words do not accomplish
what Empire would like, having the much less radical func-
tion of excluding days of a patient's hospital stay before he
qualifes for Medicare (e. g., turns 65). So contrary to Em-
pire's claim, being “entitled” to Medicare benefts still
means—in the fraction descriptions, as throughout the stat-
ute—meeting the basic statutory criteria, not actually re-
ceiving payment for a given day's treatment.
1
First and foremost, the Medicare statute explicitly identi-
fes which individuals are “entitled to hospital insurance ben-
efts under part A”—all people who meet the basic statutory
criteria. §§ 426(a)–(b). “Every individual,” the law states,
who “has attained age 65” and is entitled to ordinary social
security payments “shall be entitled to” Medicare Part A

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436 BECERRA
v. EMPIRE HEALTH FOUNDATION, FOR
VALLEY HOSPITAL MEDICAL CENTER
Opinion of the Court
benefts. § 426(a). So too, “every individual” under age 65
who
has been entitled to federal disability benefts for at
least 24 months “shall be entitled” to Medicare Part A bene-
fts. § 426(b). The “[e]ntitlement to hospital insurance ben-
efts” (as the section caption reads) is “automatic”: Age or
disability makes a person “entitled” to Part A benefts with-
out an application or anything more. § 426; Hall v. Sebelius,
667 F. 3d 1293, 1294–1296 (CADC 2012). Turn 65 or receive
disability benefts for 24 months, and you have an entitle-
ment to Part A benefts—because the latter is, according to
the statute, simply a legal status arising from the former.
3
That broad meaning of “entitlement” coexists with limi-
tations on payment, as several statutory provisions show.
The entitlement to benefts, the statute repeatedly says, is
an entitlement to payment under specifed conditions. To
quote one provision: “entitlement of an individual” to Medi-
care Part A benefts “consist[s] of entitlement to have pay-
ment made under, and subject to the limitations in, part A.”
§ 426(c)(1); see § 1395d(a) (similarly stating that the entitle-
ment to benefts entails the receipt of “payment[s] . . . subject
to the provisions of this part”). Those limits on payment
include, as described earlier, the 90-day hospital-stay cap.
See supra, at 432. And indeed the statute twice refers
to patients who are “entitled to benefts under part A but
3
Another way of putting the point is to say that the Medicare statute
uses the term “entitled” to benefts in the same way as the Medicaid stat-
ute uses the term “eligible” for benefts. Compare 42 U. S. C. § 426 (“enti-
tled” in Medicare context) with, e. g., §§ 1396, 1396d (“eligible” in Medicaid
context). That difference in overall statutory terminology is mirrored in
the fraction provisions—“entitled to [Medicare Part A] benefts” and “eli-
gible for [Medicaid] assistance.” §§ 1395ww(d)(5)(F)(vi)(I–II). As the
D. C. Circuit put the point: “Congress has, throughout the various Medi-
care and Medicaid statutory provisions, consistently used the words `eligi-
ble' to refer to potential Medicaid benefciaries and `entitled' to refer to
potential Medicare benefciaries.” Northeast Hospital Corp. v. Sebelius,
657 F. 3d 1, 12 (2011). Congress simply followed suit when referring to
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ha[ve] exhausted benefts for inpatient hospital services.”
§§
1395l(a)(8)(B)(i), 1395l(t)(1)(B)(ii). Under Empire's read-
ing, that statement makes no sense: A patient is not, Empire
argues, “entitled to benefts” when the statute precludes
payment. See supra, at 434–435. But the statute says oth-
erwise. It considers those who have exhausted their cover-
age (and so cannot receive further payments for a hospital
stay) still “entitled to [Part A] benefts.”
In thus describing the Part A entitlement, the Medicare
statute refects the complexity of health insurance. Con-
sider your own health plan (maybe it is Medicare). You
might have hit some limit on coverage as to one medical
service—let's say, eye care. But you're still insured: Your
policy will pay for more eye care in the next coverage period
and meanwhile will pay for your knee replacement. So it
is with Medicare Part A. As the 2004 regulation explains,
patients “who have exhausted their Medicare Part A inpa-
tient coverage may still be entitled to other Part A benefts.”
69 Fed. Reg. 49098. Medicare Part A also covers, “for ex-
ample, certain physician services and skilled nursing serv-
ices” outside the hospital setting. See CMS–1498–R, at 10.
And even as to hospital care, another 90 days of coverage
will be available for another illness. See supra, at 432. For
that reason among others, HHS has noted, the stoppage of
payment for any given service cannot be thought to affect
the broader statutory entitlement to Part A benefts. See
69 Fed. Reg. 49098. That entitlement arises when a person
meets the basic statutory qualifcations and (unless a disabil-
ity diminishes) never goes away.
If “entitled to [Part A] benefts” instead bore Empire's
meaning, Medicare benefciaries would lose important rights
and protections. Perhaps most signifcantly, a patient could
lose his ability to enroll in other Medicare programs when-
ever he lacked a right to Part A payments for hospital care.
As noted earlier, a person's entitlement to Part A benefts is
usually the predicate for his enrollment in Part B (covering

438 BECERRA
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Opinion of the Court
outpatient care), Part C (providing coverage through pri-
vately
managed plans), or Part D (offering prescription-drug
benefts). See §§ 1395o(a), 1395w–21(a)(3), 1395w–101(a)(3)
(A); supra, at 429. So if (as Empire urges) a hospitalized
patient is not “entitled to [Part A] benefts” on any day he
cannot get Part A payments, then he could be locked out of
the benefts of Parts B through D at that time. Consider
what that might mean in the real world: A Medicare patient
in the hospital for longer than 90 days—by defnition, a very
ill person—could not enroll in Part D's prescription-drug
coverage. Congress could not have wanted—and in fact did
not provide for—that result.
Empire's interpretation would also make a hash of provi-
sions designed to inform Medicare benefciaries of their ben-
efts. The statute requires annual notice to individuals
“entitled to benefts under part A” concerning all available
program benefts, including any “limitations on payment.”
§ 1395b–2(a). Under Empire's reading, that notice require-
ment would phase in and out depending on whether Medicare
Part A was currently paying for the individual's hospital
treatment. HHS, for example, would have no obligation to
inform a patient of benefts when a private insurer was pay-
ing for his hospital care, even if that policy would soon run
out and Medicare would assume the coverage. Once again,
Congress would not have drafted such an on-again, off-again
notice requirement.
So too, Empire's reading of “entitled to [Part A] benefts”
would subvert a provision to protect benefciaries from mis-
leading marketing materials. Under the statute, an insurer
offering a Part C (privately managed Medicare) plan may
not distribute advertising materials to eligible benefciaries
unless the materials are frst cleared by HHS. See § 1395w–
21(h)(1). Eligible benefciaries are individuals “entitled to
benefts under Part A” and enrolled in Part B. § 1395w–
21(a)(3). If Empire is right about what the “entitled to”
phrase means, an insurer could send whatever it wanted to
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a patient who at that time lacked a right to Part A payments.
But
such a person might well be interested in eventually
enrolling in a Part C plan—and he is no less vulnerable to
deceptive marketing than anyone else.
And the problems with Empire's interpretation do not stop
there. The Sixth and D. C. Circuits have cataloged several
other statutory provisions that Empire's reading would ren-
der unworkable or unthinkable or both. See Metropolitan
Hospital, 712 F. 3d, at 260; Northeast Hospital Corp. v. Sebe-
lius, 657 F. 3d 1, 6–11 (CADC 2011). We could spell out each
one in painful detail, but we think the above should suffce.
Applying Empire's reading of “entitled to [Part A] benefts”
across the Medicare statute would diminish the benefciary
protections Congress wrote into law. Those safeguards
would apply or not apply, or fuctuate constantly between the
two, based on the happenstance of whether Medicare paid
for hospital care on a given day. Once again, that is not the
statute Congress wrote.
2
Faced with these many provisions, Empire swerves. Em-
pire effectively (if reluctantly) concedes that its reading of
“entitled to [Part A] benefts”—again, to have an “absolute
right” to Part A payments—cannot be applied throughout
the Medicare statute. Brief for Respondent 30; see id., at
41–42; Tr. of Oral Arg. 37–39. There, over and over—and
contra the main thrust of Empire's arguments—the concepts
of entitlement and eligibility are the same. So Empire must
come up with a way of converting the ordinary meaning of
“entitled” in the Medicare law to something different in its
fraction provisions. The lever Empire proposes to use for
that purpose is the parenthetical phrase “(for such days).”
See Tr. of Oral Arg. 38–39 (“[T]he key distinction” is “for
such days,” which is “language that's not found anywhere
else”). Empire argues that when “entitled” is married to
“(for such days)”—recall the whole phrase, “patients who (for
such days) were entitled to [Part A] benefts”—the idea of
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440 BECERRA
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Opinion of the Court
entitlement morphs. § 1395ww(d)(5)(F)(vi)(I). Now it does
not
mean meeting Medicare's statutory (age or disability) cri-
teria on the days in question, but instead means actually re-
ceiving Medicare payments. (The dissent makes much the
same argument.)
But we cannot understand Congress to have changed the
statute's consistent meaning of “entitled to benefts” simply
by adding “(for such days).” That slight phrase is incapable
of bearing so much interpretive weight. If Congress “does
not alter the fundamental[s]” of a statutory scheme “in vague
terms or ancillary provisions,” then it ordinarily does not do
so in parentheticals either. Whitman v. American Truck-
ing Assns., Inc., 531 U. S. 457, 468 (2001). To the contrary,
a parenthetical is “typically used to convey an aside or after-
thought.” Boechler v. Commissioner, 596 U. S. 199, 206
(2022) (internal quotation marks omitted). And nothing
about the “(for such days)” parenthetical signals anything
different. Empire asks us to read it as transforming the
uniform statutory meaning of “entitled to benefts” for the
fraction provisions alone. But if Congress had wanted to
accomplish that unexpected object, it would simply have said
so. Or else, to make only paid-for days count, it would have
dropped the language of entitlement altogether. What it
would not have done is upend the settled meaning of that
language, in this one place, through so subtle, indirect, and
opaque a mechanism.
The “(for such days)” phrase instead works as HHS says:
hand in hand with the ordinary statutory meaning of “enti-
tled to [Part A] benefts.” The parenthetical no doubt tells
HHS to ask about a patient on a given day. But the query
the agency must make is not whether that patient on that
day has received Part A payments; the query is, consistent
with what “entitled” means all over the statute, whether that
patient on that day is qualifed to do so. Suppose, for exam-
ple, that a patient turns 65 halfway through a 30-day hospi-
tal stay. HHS will then count only 15 days of his stay
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when computing the Medicare fraction. Or suppose, simi-
lar
ly, that midway through his stay, a patient begins to qual-
ify as disabled—because, under the statutory defnition, he
has reached his 25th month of federal disability benefts.
Then, too, only the second half of the patient's stay would go
into the fraction—because only then has he met the criteria
for benefts.
Empire complai ns that the phrase “(for such days), ”
viewed in that way, does too “little work.” Brief for Re-
spondent 38; Tr. of Oral Arg. 40–41. But it does more than
enough. Some 10,000 people turn 65 in this country every
day, thus qualifying for Medicare coverage. See American
Assn. of Retired Persons, The Aging Readiness & Competi-
tiveness Repor t: United States 2, https://arc.aar pi nter
n a t i o n a l . o r g/ F i l e % 2 0 L i b r a r y / F u l l % 2 0 R e p o r t s /A R C-
Report-United-States.pdf. Many other individuals daily at-
tain their 25th month on federal disability benefts. It is
natural for Congress to have thought of those facts when
devising the fractions. By the way, said Congress (in what
truly is an “aside or afterthought”): If someone turns 65 dur-
ing the year the fraction covers, make sure to exclude his
pre-birthday hospital days. Boechler, 596 U. S., at 206 (in-
ternal quotation marks omitted). Only count the days after
he qualifes for Medicare Part A—when, under the statute's
constant meaning, he is “entitled to [Part A] benefts.”
4
4
The dissent has another complaint: that from 1986 until 2003 HHS read
the “for such days” phrase in the Medicare fraction just as Empire does,
and that the Department changed its view merely to reduce payments to
hospitals. See post, at 446–447 (opinion of Kavanaugh, J.). But that is
an incomplete—leading to an inaccurate—picture. From 1986 to 1997,
HHS read both the Medicare and the Medicaid fractions as counting only
days actually paid for. The effect on the Medicaid side was to substan-
tially depress payments to hospitals (because many low-income patients
were excluded from the numerator, while the denominator remained the
same, see supra, at 431, and n. 1). Hospitals sued, and four Circuit Courts
found that HHS's understanding of the “for such days” language in the
Medicaid fraction was wrong. See Brief for United States 12–13 (collect-

442 BECERRA
v. EMPIRE HEALTH FOUNDATION, FOR
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Opinion of the Court
B
The
structure of the relevant statutory provisions rein-
forces our conclusion that “entitled to [Part A] benefts”
means qualifying for those benefts, and nothing more. As
earlier explained, the statute is designed to recompense hos-
pitals for serving low-income patients, who are compar-
atively more expensive to treat. See supra, at 429. The
st atute deter mines the appropr iate payment ( if any) by
measuring, through two separate fractions, two separate
populations: the low-income Medicare population and the low-
income non-Medicare population. See supra, at 429–430.
5
(Because the vast majority of Medicare patients are over 65,
that roughly translates into the low-income senior population
and the low-income non-senior population.) Those popula-
tions, taken together, account for all the low-income patients a
hospital treats.
HHS's reading of “entitled” comports with the statute's
two-population structure. A low-income Medicare patient
always counts in the Medicare fraction. That is so regard-
less of whether the Medicare program is actually paying for
a day of his care—because that fact has no relationship to
his fnancial status. The Medicare fraction, as calculated by
HHS, thus captures the entire low-income Medicare (i. e., se-
nior) population. And correlatively, the Medicaid fraction
captures the entire low-income non-Medicare (i. e., non-
senior) population. The binary dividing line HHS uses—do
ing citations). In response, HHS immediately corrected its approach to
the Medicaid fraction—which signifcantly raised payments to hospitals.
Some fve years later, HHS issued a rule to bring its reading of the same
language in the Medicare fraction into line. The history shows, then, that
HHS “changed course” not “to save money” but to comply with the law.
Post, at 446.
5
As noted earlier, see supra, at 431, n. 1, the two populations (because
of their fractions' different denominators) are differently weighted in cal-
culating DSH payments. All else equal, a hospital receives greater com-
pensation for low-income individuals in the Medicare population than for
low-income individuals in the non-Medicare population.
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you qualify for Medicare?—mirrors the statute's binary,
popu
lation-focused framework. All low-income people ft
naturally into one or the other box, with the sum of the two
leaving no one out.
By contrast, Empire's view fts poorly with the bifurcated,
population-based statutory structure. Again, its who-paid-
for-a-day-of-care test has no relationship to a patient's fnan-
cial status. So on Empire's view, a patient could phase in
and out of the Medicare fraction even though his income re-
mains the same. Empire responds by asserting that any
low-income person excluded from the Medicare fraction (say,
because of exhaustion of benefts) would get counted instead
in the Medicaid fraction. See Brief for Respondent 15–16,
50–51. But even if that is true—we express our doubts
below—Empire's scheme would result in patients ping-
ponging back and forth between the two fractions based on
the happenstance of actual Medicare payments, sometimes
during a single hospital stay. That scheme is of course
harder to administer than HHS's. And still more, it does
not refect the statute's dichotomy between two discrete low-
income populations, each of which counts (but counts differ-
ently) toward setting a hospital's DSH rate. See supra, at
431, n. 1, 442, n. 5.
In any event, Empire is too quick to claim that those who
(on its view) are tossed from the Medicare fraction for non-
income-based reasons would still wind up in the Medicaid
fraction. Recall here the role Empire says the phrase “(for
such days)” plays. See supra, at 439–441. According to
Empire's ultimate argument, that phrase is what converts
the ordinary statutory meaning of “entitled to benefts” (i. e.,
qualifying for Medicare) to a special meaning (i. e., actually
receiving payments). So where the phrase “(for such days)”
does not appear, the usual meaning of “entitled” should gov-
ern. Now look again at the description of the Medicaid frac-
tion. It counts “patients [i] who (for such days) were eligi-
ble for [Medicaid], but [ii] who were not entitled to benefts
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444 BECERRA
v. EMPIRE HEALTH FOUNDATION, FOR
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Opinion of the Court
under part A [of Medicare].” § 1395ww(d)(5)(F)(vi)(II). In
that
description, “for such days” does not modify clause [ii].
So the “not entitled” phrase in that clause should mean (con-
sistent with the rest of the statute) not qualifying for Medi-
care. But those whom Empire's view would oust from the
Medicare fraction—say, because of exhaustion—do qualify
for Medicare. They thus fall outside clause [ii]—and outside
the Medicaid fraction. The upshot is that, under Empire's
reading, a low-income patient who, say, has exhausted his
coverage will not get counted at all. But that person re-
mains just as low income as he ever was, imposing just as
high costs on the hospital treating him. His exclusion dem-
onstrates, if anything more needs to, the error of Empire's
reading.
Empire's only response is to insist that its interpretation
has to be right because it usually (though not always) leads
to higher DSH payments for hospitals. See Brief for Re-
spondent 33–35; supra, at 432–433. But the point of the DSH
provisions is not to pay hospitals the most money possible;
it is instead to compensate hospitals for serving a dispropor-
tionate share of low-income patients. And Empire's reading
excels only by the former measure, not by the latter one.
As just shown, Empire's actual-payment test counts fewer,
not more, of the low-income patients the DSH provisions
care about. The reason that approach still benefts many
hospitals is that it defates the denominator of the Medicare
fraction. Consider a wealthy 70-year-old patient who has
exhausted Medicare benefts—or, as is often true, has a pri-
vate insurance policy. HHS's view would exclude him from
the Medicare fraction's numerator (because he is wealthy)
but keep him in the denominator (because he is over 65).
By contrast, Empire's view would exclude him from both the
numerator and the denominator—the latter because he is not
actually receiving Medicare payments. That move in-
creases payments to hospitals—but only because it fails to
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445
Kavanaugh, J., dissenting
capture high-income Medicare patients, not because it better
captures
low-income ones. Or said otherwise, it increases
payments because it distorts what the Medicare fraction is
designed to measure—the share of low-income Medicare pa-
tients relative to the total.
III
Text, context, and structure all support calculating the
Medicare fraction HHS's way. In that fraction, individuals
“entitled to [Medicare Part A] benefts” are all those qualify-
ing for the program, regardless of whether they are receiv-
ing Medicare payments for part or all of a hospital stay.
That reading gives the “entitled” phrase the same meaning
it has throughout the Medicare statute. And it best imple-
ments the statute's bifurcated framework by capturing low-
income individuals in each of two distinct populations a
hospital serves.
For those reasons, we reverse the judgment of the Court
of Appeals and remand the case for further proceedings con-
sistent with this opinion.
It is so ordered.
Justice Kavanaugh, with whom The Chief Justice,
Justice Alito, and Justice Gorsuch join, dissenting.
Under the Medicare statute, HHS pays higher reimburse-
ments to hospitals that serve a signifcant number of low-
income patients. The statutory formula for determining
exactly how much HHS will pay to those hospitals is mind-
numbingly complex. But embedded within the complicated
overall formula are various subsidiary calculations, some of
which are relatively straightforward.
This case concerns one of those straightforward subsidiary
calculations. Consistent with traditional insurance and
coordination-of-benefts principles, Medicare by statute can-
not pay for a patient's hospital care if, for example, the pa-
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446 BECERRA
v. EMPIRE HEALTH FOUNDATION, FOR
VALLEY HOSPITAL MEDICAL CENTER
Kavanaugh, J., dissenting
tient is covered by private insurance, the patient has ex-
hausted
her Medicare benefts, or a third-party tortfeasor is
liable for the patient's care. The retrospective reimburse-
ment question raised by the statutory provision in this case
is this: Was a patient “entitled to” have payment made by
Medicare for a particular day in the hospital if the patient
by statute could not (and did not) have payment made by
Medicare for that day? In my view, the answer to that nar-
row question is straightforward and commonsensical: No.
Importantly, from the time the statute was enacted in 1986
until 2003, HHS interpreted this statutory provision in
the exact same way that I do. See 51 Fed. Reg. 31460−
31461 (1986); Brief for Petitioner 32−33. Then in 2004,
HHS abruptly changed course. Why? Presumably to save
money. HHS was trying hard to fnd ways to contain Medi-
care costs in light of increasing Medicare expenditures and
the country's fscal situation. To that end, HHS's new 2004
interpretation of this statutory provision had the down-
stream effect of signifcantly reducing HHS's reimburse-
ments to hospitals that serve low-income patients.
Whatever HHS's precise motivations for the 2004 change,
we now must focus on the statutory text and HHS's current
interpretation of it. To begin, both parties offer a dog 's
breakfast of arguments about broad statutory purposes, real-
world effects, surplusage, structure, consistent usage, incon-
sistent usage, agency deference, and the like. But this case
is resolved by the most fundamental principle of statutory
interpretation: Read the statute.
The relevant text of this reimbursement provision refers
to “the number of . . . patient days . . . which were made up
of patients who (for such days) were entitled to benefts
under part A.” 42 U. S. C. § 1395ww(d)(5)(F)(vi)(I). Impor-
tantly, the statute elsewhere says that “[t]he benefts pro-
vided” under Medicare Part A consist of a patient's “entitle-
ment to have payment made on his behalf . . . (subject to the
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447
Kavanaugh, J., dissenting
provisions of this part).” § 1395d(a) (emphasis added); see
a
lso § 426(c) (“entitlement” means “entitlement to have pay-
ment made under, and subject to the limitations in, part A”
(emphasis added)).
Zero in on the phrases “entitlement to have payment
made” and “for such days.” In my view (and in HHS's view
from 1986 to 2003), a patient was entitled to have payment
made by Medicare for particular days in the hospital if Medi-
care was obligated to pay for the patient's care for those
days. Stated the other way, a patient was not entitled to
have payment made by Medicare for particular days in the
hospital if the patient by statute could not (and did not) have
payment made by Medicare for those days—for example, be-
cause the patient had other insurance, the patient had ex-
hausted his Medicare benefts, or a third-party tortfeasor
was paying. Simple enough.
To be sure, patients who satisfy certain criteria (for exam-
ple, those who are age 65 or older) are generally “entitled”
to Medicare hospitalization benefts. No one disputes that
point. But this reimbursement provision looks to whether
the patient was entitled to have payment made by Medicare
for a particular day in the hospital. And the answer to that
question is no if Medicare by statute could not (and did not)
pay for that day in the hospital.
Suppose that a college says that your academic record enti-
tles you to a scholarship for next year if your family's income
is under $60,000, unless you have received another scholar-
ship. And suppose that your family's income is under
$60,000, but you have received another scholarship. Are
you still entitled to the frst scholarship? Of course not. So
too here.
The Court concludes otherwise, mainly by (i) saying that
“entitled to benefts” is a term of art in the Medicare statute,
(ii) diminishing the value of the statutory phrase “(for such
days),” in part because the phrase appears in a parenthetical,
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448 BECERRA
v. EMPIRE HEALTH FOUNDATION, FOR
VALLEY HOSPITAL MEDICAL CENTER
Kavanaugh, J., dissenting
and (iii) invoking a parade of horribles about what could hap-
pen
to other provisions of the Medicare statute if the Court
were to read this provision as I would.
With respect, none of that adds up. First, although the
Medicare statute generally uses “entitled” to refer to those
who meet the basic statutory criteria for Medicare benefts,
the retrospective reimbursement provision at issue here fo-
cuses laser-like on whether the patient was actually entitled
to have payment made by Medicare for particular days in
the hospital. A patient cannot be simultaneously entitled
and disentitled to have payment made by Medicare for a par-
ticular day in the hospital.
Second, contrary to the Court's suggestion, we cannot
brush aside the statutory phrase “(for such days)” simply
because that phrase appears in a parenthetical. See Dun-
can v. Walker, 533 U. S. 167, 174 (2001). Parentheticals can
be important, as the Constitution itself makes clear. See,
e. g., Art. I, § 7 (counting days for bill to become law with
“(Sundays excepted)”); Art. IV, § 4 (affording federal protec-
tion to States on application by the Executive but only
“(when the Legislature cannot be convened)”).
Third, properly interpreting this specifc reimbursement
provision will not “make a hash” of other provisions or ren-
der the Medicare statute “unworkable.” Ante, at 438−439.
We need not speculate about that point: For nearly two dec-
ades from the time that the statute was enacted in 1986
through 2003, HHS interpreted this reimbursement provi-
sion in the same way that I do. And HHS did so without
any noted problems for other provisions in the Medicare
statute.
To sum up: A patient was not entitled to have payment
made by Medicare “for such days” in the hospital if the pa-
tient by statute could not (and thus did not) have payment
made by Medicare for those days—for example, because pri-
vate insurance was already covering the patient's care, or
the patient had exhausted his Medicare benefts. Both stat-
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449
Kavanaugh, J., dissenting
utory text and common sense point to that conclusion.
HHS'
s contrary interpretation boils down to the proposition
that a patient can be simultaneously entitled and disentitled
to have payment made by Medicare for a particular day in
the hospital. That interpretation does not work. And
HHS's misreading of the statute has signifcant real-world
effects: It fnancially harms hospitals that serve low-income
patients, thereby hamstringing those hospitals' ability to
provide needed care to low-income communities.
In my view, HHS's 2004 interpretation is not the best
reading of this statutory reimbursement provision. I re-
spectfully dissent.
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Reporter’s Note
The attached opinion has been revised to refect the usual publication
and citation style of the United States Reports. The revised pagination
makes available the offcial United States Reports citation in advance of
publication. The syllabus has been prepared by the Reporter of Decisions
for the convenience of the reader and constitutes no part of the opinion of
the Court. A list of counsel who argued or fled briefs in this case, and
who were members of the bar of this Court at the time this case was
argued, has been inserted following the syllabus. Other revisions may
include adjustments to formatting, captions, citation form, and any errant
punctuation. The following additional edits were made:
None