Advocate Christ Medical Center v. Kennedy

P R E L I M I N A R Y P R I N T
Volume 605 U. S. Part 1
Pages 1–37
OFFICIAL REPORTS
OF
T H E S U P R E M E C O U R T
April 29, 2025
REBECCA A. WOMELDORF
reporter of decisions
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CASES ADJUDGED
IN THE
SUPREME COURT OF THE UNITED STATES
AT
OCTOBER TERM, 2024
ADVOCATE CHRIST MEDICAL CENTER et al. v.
KENNEDY, SECRETARY OF HEALTH AND HUMAN
SERVICES
certiorari to the united states court of appeals for
the district of columbia circuit
No. 23–715. Argued November 5, 2024—Decided April 29, 2025
When hospitals provide inpatient services to Medicare benefciaries, the
Medicare program pays those hospitals a fxed rate for treating each Medi-
care patient. See 42 U. S. C. §§ 1395ww(d)(1)–(4). Congress also pro-
vides various hospital-specifc rate adjustments, including the “dispropor-
tionate share hospital” (DSH) adjustment, which offers additional funding
to hospitals that treat a high percentage of low-income patients. To cal-
culate the DSH adjustment, the Department of Health and Human Serv-
ices (HHS) adds together two statutorily prescribed fractions referred
to as the Medicare fraction and the Medicaid fraction. § 1395ww(d)
(5)(F)(vi). The Medicare fraction “represents the proportion of a hospi-
tal's Medicare patients who have low incomes,” and the Medicaid frac-
tion “represents the proportion of a hospital's patients who are not enti-
tled to Medicare and have low incomes.” Becerra v. Empire Health
Foundation, for Valley Hospital Medical Center, 597 U. S. 424, 429–430.
When the Medicare fraction is expressed as a percentage and added to
the Medicaid fraction's percentage, the sum yields the disproportionate
patient percentage. § 1395ww(d)(5)(F)(vi). That percentage, in turn,
determines whether a hospital will receive a DSH adjustment—and if
so, how much.
1
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2 ADVOCA
TE CHRIST MEDICAL CENTER v. KENNEDY
Syllabus
Relevant here, the numerator of the Medicare fraction is defned by
the
statute as “the number of [a] hospital's patient days” attributable to
patients “who (for such days) were entitled to benefts under [Medicare]
part A” and “entitled to supplementary security income [SSI] benefts
. . . under subchapter XVI.” § 1395ww(d)(5)(F)(vi)(I). This Court in
Empire Health has held that the phrase “ `entitled to [Medicare Part A]
benefts' ” in the Medicare fraction includes “all those qualifying for the
program, regardless of whether they are receiving Medicare payments
for part or all of a hospital stay.” 597 U. S., at 445 (quoting § 1395ww
(d)(5)(F)(vi)(I); alteration in original). But the Court has not addressed
the issue presented in this case—i. e., which patients count as being
“entitled to [SSI] benefts . . . under subchapter XVI.” HHS interprets
the language to mean patients who are entitled to receive an SSI pay-
ment during the month in which they were hospitalized. Petitioners—
a group of more than 200 hospitals—insist that the phrase includes all
patients enrolled in the SSI system at the time of their hospitalization,
even if they were not entitled to an SSI payment during their month of
hospitalization. The hospitals claim that, as a result of HHS's misinter-
pretation of the phrase, HHS miscalculated the hospitals' DSH adjust-
ment and underfunded the hospitals from 2006 to 2009. The hospitals
have lost at every stage of this litigation, including most recently before
the D. C. Circuit. The D. C. Circuit concluded that SSI benefts in “sub-
chapter XVI [are] about cash payments for needy individuals,” and that
“it makes little sense to say that individuals are `entitled' to the beneft
in months when they are not even eligible for [a payment].” Advocate
Christ Medical Center v. Becerra, 80 F. 4th 346, 352–353. The Court
granted certiorari.
Held: In calculating the Medicare fraction, an individual is “entitled to
[SSI] benefts” for purposes of the Medicare fraction when she is eligible
to receive an SSI cash payment during the month of her hospitalization.
Pp. 10–20.
(a) SSI benefts are cash benefts. See 42 U. S. C. ch. 7, subch. XVI.
Section 1381a, which describes the basic entitlement to benefts, pro-
vides that “[e]very . . . individual who is determined . . . to be eligible
on the basis of his income and resources shall . . . be paid benefts.”
(Emphasis added.) The word “paid” connotes cash. Section 1382(b)(1),
which specifes the amount that the Social Security Administration must
pay to eligible individuals, states that the benefts “shall be payable
at the rate of [specifc dollar amounts].” A beneft quantifed in dollar
amounts is plainly a cash beneft. Similarly, subchapter XVI's codifed
statement of purpose is “to provide supplemental security income to
individuals.” § 1381 (emphasis added).

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3
Syllabus
Just as subchapter XVI makes clear that SSI benefts are cash bene-
fts,
it also establishes that eligibility for such benefts is determined
on a monthly basis. Section 1382(c)(1) provides that “[a]n individual's
eligibility for a beneft under this subchapter for a month shall be deter-
mined” based on the individual's “income, resources, and other relevant
characteristics in such month.” The statute's reference to termination
of benefts also refers back to months of ineligibility, stating that an
individual must reapply for the program after she has been “ineligible
for benefts . . . for a period of 12 consecutive months.” § 1383( j)(1)(B).
Finally, although subchapter XVI speaks primarily in terms of eligi-
bility for SSI benefts, the Medicare fraction focuses on whether an
individual is entitled to such benefts. Nothing turns on this difference.
In Empire Health, the Court treated the word “entitled” in the Medi-
care statute as synonymous with “qualifying ” for or “being eligible . . .
for benefts.” 597 U. S., at 435. This case also involves the Medicare
fraction, so the Court follows the same course. Because eligibility for
an SSI payment is determined on a monthly basis, an individual is con-
sidered “entitled to [SSI] benefts” for purposes of the Medicare fraction
when she is eligible for such benefts during the month of her hospital-
ization. Pp. 10–12.
(b) The hospitals' broader reading of “entitled to [SSI] benefts” fails.
Pp. 12–20.
(1) While the hospitals characterize SSI benefts as including non-
cash benefts—e. g., vocational rehabilitation services and continued
Medicaid coverage—these noncash benefts do not ft the description
of a “supplementa[ l] security income” beneft. § 1395ww(d)(5)(F)(vi)(I)
(emphasis added). Further, none of the noncash benefts identifed by
the hospitals is housed “under subchapter XVI.” Ibid. (empha-
sis added). The hospitals' reliance on the Ticket to Work and Self-
Suffciency Program falls short for this reason. Nor do any of subchap-
ter XVI's other references to vocational rehabilitation services confer
an SSI beneft. Rather, § 1382d's references to certain services point
to benefts housed elsewhere, but not within subchapter XVI.
The hospitals' reliance on continued Medicaid coverage pursuant to
§ 1382h(b) also falls fat. In most States, eligibility for SSI benefts
qualifes an individual for Medicaid coverage. While losing SSI benefts
generally means losing Medicaid coverage, § 1382h(b) allows certain peo-
ple ineligible for SSI benefts in a given month to be treated as if they
remain eligible for SSI benefts so that they can continue receiving Med-
icaid. But § 1382h(b), which by its terms applies only to Medicaid (i. e.,
“subchapter XIX”), simply aids in the administration of the Medicaid
program. It does not create an SSI beneft. Pp. 13–15.
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4 ADVOCA
TE CHRIST MEDICAL CENTER v. KENNEDY
Syllabus
(2) The hospitals advance a second argument that eligibility for SSI
benefts—
even for purely cash benefts—begins when a person enters
the SSI system and continues until the individual is ineligible for an SSI
payment for 12 consecutive months. While it is true that a person frst
applying for benefts must disclose her income “rate” “for the calendar
year,” § 1382(a)(1)(A), that “calendar year” income does not render her
eligible for SSI benefts, nor does it establish that SSI benefts operate
in intervals with a duration longer than one month. Instead, the stat-
ute clearly directs eligibility decisions to be made monthly based on “the
individual's . . . income, resources, and other relevant characteristics in
such month.” § 1382(c) (emphasis added). Nor does the reapplication
requirement change the nature of eligibility. Under § 1383( j)(1)(B), a
once-eligible individual must submit a new application after she has
been “ineligible for benefts . . . for a period of 12 consecutive months.”
That provision does not state that a person remains eligible during this
period; it states that a person who “was an eligible individual” at one
poi nt must reapply af ter 12 consecutive months of i nelig ibi lity.
§ 1383( j)(1)(A) (emphasis added).
The hospitals also assert that Empire Health supports their theory
that being “entitled to [SSI] benefts” means that a patient is entitled
to SSI benefts even if she does not qualify for a payment during the
month of hospitalization. Not so. Just as Empire Health turned on
the specifc features of Medicare Part A, this case turns on the specifc
features of SSI benefts under subchapter XVI. Unlike Medicare Part
A, which provides automatic, ongoing health insurance that “never goes
away” absent diminished disability, Empire Health, 597 U. S., at 437,
SSI benefts require recipients to apply for and be deemed eligible for
benefts, and recipients can (and do) fuctuate in and out of eligibility
based on monthly income and resources. Consistency with Empire
Health's beneft-focused analysis thus requires the Court to recognize
and give effect to the differences between Medicare Part A and SSI
benefts. Pp. 15–18.
(3) Finally, invoking statutory purpose, the hospitals argue that
their broad reading of “entitled to [SSI] benefts” better advances Con-
gress's goal of providing additional funds to hospitals that serve a dis-
proportionately high percentage of needy Medicare patients. But “[n]o
statute pursues a single policy at all costs,” Bartenwerfer v. Buckley,
598 U. S. 69, 81, and the Court must respect the specifc formula that
Congress prescribed. Pp. 18–20.
80 F. 4th 346, affrmed.
Barrett, J., delivered the opinion of the Court, in which Roberts,
C. J., and Thomas, Alito, Kagan, Gorsuch, and Kavanaugh, JJ., joined.

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5
Opinion of the Court
Jackson, J., fled a dissenting opinion, in which Sotomayor, J., joined,
post
, p. 20.
Melissa Arbus Sherry argued the cause for petitioners.
With her on the briefs were Hyland Hunt, Ruthanne M.
Deutsch, Daniel F. Miller, Sara J. MacCarthy, Heather D.
Mogden, Eric J. Konopka, Jordan R. Goldberg, and Maureen
O'Brien Griffn.
Ephraim A. McDowell argued the cause for respondent.
With him on the brief were Solicitor General Prelogar,
Principal Deputy Assistant Attorney General Boynton,
Deputy Solicitor General Kneedler, Mark B. Stern, and
Stephanie R. Marcus.*
Justice Barrett delivered the opinion of the Court.
The Medicare program, which provides health insurance to
elderly or disabled Americans, is governed by a notoriously
complex statute. Unsurprisingly, then, the provision at
issue in this case is highly technical: It prescribes a percent-
age used to calculate the rate that the Government will pay
a hospital that treats a disproportionate share of low-income
Medicare patients. The percentage is determined by the
sum of two fractions—the so-called Medicare fraction and
Medicaid fraction. Relevant here, the numerator of the
Medicare fraction counts the number of patient days attrib-
utable to Medicare patients who were “entitled to benefts
under [Medicare] part A” and were “entitled to supplemen-
tary security income benefts . . . under subchapter XVI.”
42 U. S. C. § 1395ww(d)(5)(F)(vi)(I).
In Becerra v. Empire Health Foundation, for Valley Hos-
pital Medical Center, we held that the phrase “ `entitled to
*Briefs of amici curiae urging reversal were fled for the American
Hospital Association et al. by Morgan L. Ratner; and for Twenty-Six State
and Regional Hospital Associations by Robert L. Roth, Kelly A. Carroll,
Sven C. Collins, and Lloyd A. Bookman.
Alan J. Sedley fled a brief for the Empire Health Foundation as ami-
cus curiae.
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6 ADVOCA
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Opinion of the Court
[Medicare Part A] benefts' ” includes “all those qualifying
for
the program, regardless of whether they are receiving
Medicare payments for part or all of a hospital stay.” 597
U. S. 424, 445 (2022) (quoting § 1395ww(d)(5)(F)(vi)(I); alter-
ation in original). We did not decide, however, what it
means to be “entitled to supplementary security income ben-
efts . . . under subchapter XVI.” § 1395ww(d)(5)(F)(vi)(I).
Today, we hold that a person is entitled to such benefts when
she is eligible to receive a cash payment during the month
of her hospitalization.
I
The Medicare program reimburses hospitals that pro-
vide inpatient services to Medicare beneficiar ies. See
§ 1395ww(d). As a rule, the “program pays a hospital a fxed
rate for treating each Medicare patient, based on the pa-
tient's diagnosis,” which is “designed to refect the amounts
an effciently run hospital, in the same region, would expend
to treat a patient with the same diagnosis.” Id., at 429 (cit-
ing §§ 1395ww(d)(1)–(4) and 42 CFR § 412.2 (2022)). Because
the fxed-rate payment is provided “regardless of the hospi-
tal's actual costs,” it “gives hospitals an incentive to provide
effcient levels of medical service.” Empire Health, 597
U. S., at 429.
Congress also “provided for various hospital-specifc rate
adjustments—including the one at issue here for treating
low-income patients.” Ibid. That adjustment is called the
“disproportionate share hospital” (DSH) adjustment, which
provides “hospitals serving an `unusually high percentage of
low-income patients' enhanced Medicare payments.” Ibid.
(quoting Sebelius v. Auburn Regional Medical Center, 568
U. S. 145, 150 (2013)). This adjustment accounts for the fact
that “low-income individuals are often more expensive to
treat than higher income ones, even for the same medical
conditions.” Empire Health, 597 U. S., at 429. The en-
hanced payment incentivizes hospitals to treat low-income
patients. See ibid.
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as: 605 U. S. 1 (2025)
7
Opinion of the Court
In Empire Health, we described the DSH adjustment in
great
detail, so here, we will be brief. To calculate a hospi-
tal's DSH adjustment, the Department of Health and Human
Services (HHS) adds together “two statutorily described
fractions, usually called the Medicare fraction and the Medic-
aid fraction.” Ibid.; see § 1395ww(d)(5)(F)(vi). Together,
these fractions are “designed to capture two different low-
income populations that a hospital serves.” Id., at 429.
The “Medicare fraction represents the proportion of a hospi-
tal's Medicare patients who have low incomes, as identifed
by their entitlement to supplementary security income (SSI)
benefts.” Id., at 429–430. And “[t]he 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.” Id., at 430.
Like Empire Health, this case concerns the Medicare frac-
tion, which is defned as:
“the fraction (expressed as a percentage), the numerator
of which is the number of such hospital's patient days
for such period which were made up of patients who (for
such days) were entitled to benefts under part A of this
subchapter and were entitled to supplementary security
income benefts (excluding any State supplementation)
under subchapter XVI of this chapter, and the denomi-
nator 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 part
A of this subchapter.” § 1395ww(d)(5)(F)(vi)(I).
1
In plainer English, the Medicare fraction works like this:
The numerator counts “the number of patient days attribut-
1
Although the Medicare fraction employs the phrase “supplementary
security income,” § 1395ww(d)(5)(F)(vi)(I) (emphasis added), subchapter
XVI refers to this beneft as “supplemental security income,” § 1381 (em-
phasis added). Despite the slight variation in wording, these two phrases
refer to the same beneft.
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Opinion of the Court
able to Medicare patients who are poor”—i. e., those Medi-
care
patients who are entitled to SSI benefts under subchap-
ter XVI. Id., at 430. The denominator counts “the number
of patient days attributable to all Medicare patients.” Ibid.
When the Medicare fraction is expressed as a percentage and
added to the Medicaid fraction's percentage, the sum of
the two yields the “ `disproportionate patient percentage.' ”
§ 1395ww(d)(5)(F)(vi). The resulting percentage “deter-
mines whether a hospital will receive a DSH adjustment”—
and i f so, how much. Id., at 431. “ The h igher the
disproportionate-patient percentage,” the more funding a
hospit a l receives. Id., at 432 (citi ng §§ 1395ww(d)(5)
(F)(vii)–(xiv)).
For purposes of this case, the key phrase in the Medicare
fraction is “entitled to supplementary security income bene-
fts . . . under subchapter XVI.” § 1395ww(d)(5)(F)(vi)(I).
Supplemental security income is “a subsistence allowance”
offered to the country's “needy aged, blind, and disabled.”
Schweiker v. Wilson, 450 U. S. 221, 223 (1981); see also § 1381
(describing subchapter XVI as a “national program to pro-
vide supplemental security income to individuals who have
attained age 65 or are blind or disabled”). HHS interprets
the relevant text to refer to patients who are “entitled to
receive SSI benefts during the month” in which they were
hospitalized. 75 Fed. Reg. 50281 (2010).
2
2
To calculate the number of people eligible for SSI benefts in a particu-
lar month, HHS obtains data from the Social Security Administration
(SSA) that seeks to “captur[e] all SSI-entitled individuals during the
month(s) that they are entitled to receive SSI benefts.” 75 Fed. Reg.
50281. SSA collects this data by identifying certain “status codes” that
indicate whether a person was entitled to SSI benefts during a particular
month. Ibid. As part of a 2010 rulemaking, HHS evaluated various
codes used by SSA and concluded that three codes (C01, M01, and M02)
capture the relevant population of those entitled to a monthly SSI cash
beneft. Ibid. Code C01 represents SSI enrollees who receive an auto-
matic cash payment, and codes M01 and M02 represent SSI enrollees
whose cash payments are managed manually. See Advocate Christ Medi-

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9
Opinion of the Court
Petitioners, a group of more than 200 hospitals, disagree
w
ith this interpretation. They insist that the phrase encom-
passes all patients enrolled in the SSI system at the time of
their hospitalizations, even if those patients were not enti-
tled to an SSI payment during that month. This approach
sweeps more people into the numerator of the Medicare frac-
tion, thereby increasing the amount of funding a hospital
may receive. See §§ 1395ww(d)(5)(F)(vii)–(xiv). The hospi-
tals claim that because HHS misconstrued the Medicare frac-
tion, it underfunded them during the fscal years 2006 to
2009.
The hospitals have lost at every step of this litigation.
The Provider Reimbursement Review Board, a tribunal
within HHS, denied the hospitals' request for additional re-
imbursement on procedural grounds. The Centers for
Medicare & Medicaid Services, which administers Medicare
for HHS, also denied relief, this time on the merits. The
hospitals then sought review in the District Court, which
rejected their claims and granted summary judgment to
HHS. See Advocate Christ Medical Center v. Azar, No. 17–
cv–1519 (D DC, June 8, 2022), App. to Pet. for Cert. 18. The
cal Center v. Becerra, 80 F. 4th 346, 350, n. 1 (CADC 2023). As part of
that rulemaking, HHS rejected a proposal to begin using additional SSA
codes that, according to the commenter, “represent individuals who [are]
eligible for SSI, but not eligible for SSI payments” in a given month, in-
cluding because the individual is in “suspended” status. 75 Fed. Reg.
50280–50281; see 20 CFR §§ 416.1320–416.1330, 416.1339 (2024) (describing
suspension of benefts payments). In rejecting this proposal, HHS ex-
plained that “none of the SSI status codes . . . mentioned would be used
to describe an individual who was entitled to receive SSI benefts during
the month that one of those status codes was used.” 75 Fed. Reg. 50281.
This case does not present the question whether HHS correctly includes
only three SSI status codes as part of its calculation for the Medicare
fraction. Below, the D. C. Circuit declined to consider whether HHS “un-
reasonably excluded from the Medicare fraction individuals assigned codes
`S' and `E02' ” because the hospitals raised the argument for the frst time
in their reply brief. 80 F. 4th, at 354. We too decline to consider this
issue.
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D. C. Circuit also agreed with HHS. See Advocate Christ
Med
ical Center v. Becerra, 80 F. 4th 346 (2023). In explain-
ing that SSI benefts in “subchapter XVI [are] about cash
payments for needy individuals,” the D. C. Circuit observed
that “it makes little sense to say that individuals are `enti-
tled' to the beneft in months when they are not even eligible
for [a payment].” Id., at 352–353. We granted certiorari.
602 U. S. 1021 (2024).
II
To determine when a person is “entitled to supplementary
security income benefts,” § 1395ww(d)(5)(F)(vi)(I), we must
know what the benefts are. See Empire Health, 597 U. S.,
at 435–439. The answer is clear: SSI benefts are cash bene-
fits. See 42 U. S. C. ch. 7, subch. XVI. Secti on 1381a,
which describes the basic entitlement to benefts, provides
that “[e]very . . . individual who is determined . . . to be
eligible on the basis of his income and resources shall . . .
be paid benefts by the Commissioner.” (Emphasis added.)
The word “paid” obviously connotes a cash beneft. Section
1382(b) sings the same tune: It specifes the amount that SSA
is required to pay eligible individuals, stating that “[t]he ben-
eft under this subchapter . . . shall be payable at the rate of
[specifc dollar amounts].” § 1382(b)(1). A beneft quanti-
fed in dollar amounts is plainly a cash beneft. Echoing the
point, other provisions explain how and when the cash bene-
ft is to be paid to recipients. See, e. g., § 1383 (prescribing
procedures for the “payment of benefts” (boldface deleted));
§ 1383(a)(4)(A) (permitting a “cash advance against such ben-
efts” to individuals in limited circumstances).
3
Subchapter
XVI's codifed statement of purpose is of a piece: to “estab-
3
See also § 1382(h) (describing rules for “determining eligibility for, and
the amount of, benefts payable” to individuals who receive other types of
fnancial assistance); § 1382f(a) (providing an “[i]ncrease of dollar amounts”
of SSI benefts based on cost-of-living adjustments (boldface deleted));
§ 1383(b)(1)(A) (providing “appropriate adjustments in future payments”
in the case of overpayments or underpayments of SSI benefts).
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Opinion of the Court
lis[h] a national program to provide supplemental security
inco
me to individuals who have attained age 65 or are blind
or disabled.” § 1381 (emphasis added). “Income” is “a gain
or recurrent beneft that is usu[ally] measured in money and
for a given period of time.” 2 Webster's Third New Inter-
national Dictionary 1143 (1971).
Statutory provisions outside subchapter XVI also under-
stand the phrase “[SSI] benefts . . . under subchapter XVI”
to mean a cash beneft. Take § 1320b–19 in subchapter XI,
which directs the Commissioner of Social Security to estab-
lish the Ticket to Work and Self-Suffciency Program. Sec-
tion 1320b–19 defnes the phrase “supplemental security in-
come beneft” to mean “a cash beneft under section 1382 or
1382h(a) of this title.” § 1320b–19(k)(5); see also § 1320a–
6(b) (defning the term “supplemental security income bene-
fts” to “mea[n] benefts paid or payable by the Commissioner
of Social Security under subchapter XVI”). Same too in
subchapter VIII, which provides special benefts for certain
Wor ld War II veterans. There, Congress defi ned the
“ `[f]ederal beneft rate under subchapter XVI' ” to mean
“with respect to any month, the amount of the supplemental
security income cash beneft.” § 1012(4).
Just as subchapter XVI makes clear that SSI benefts are
cash benefts, it also establishes that eligibility for such bene-
fts is determined on a monthly basis. Section 1382(c)(1)
provides that “[a]n individual's eligibility for a beneft under
this subchapter for a month shall be determined” based on
the individual's “income, resources, and other relevant char-
acteristics in such month.” The statute's reference to termi-
nation of benefts also refers back to months of ineligibility:
An individual must reapply for the program after she has
been “ineligible for benefts . . . for a period of 12 consecutive
months. ” § 1383( j)(1)(B). Other examples similarly con-
frm that eligibility is a month-to-month inquiry. See, e. g.,
§ 1382(e)(1)(A) (providing that “no person shall be an eligible
individual . . . with respect to any month if throughout such
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12 ADVOCA
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Opinion of the Court
month he is an inmate of a public institution”); § 1382(e)(1)(D)
(prov
iding that “[a] person may be an eligible individual . . .
with respect to any month throughout which he is a resident
of a public emergency shelter for the homeless”); §§ 1382(e)
(4)(A)(i)–(ii) (providing that “[n]o person shall be considered
an eligible individual . . . with respect to any month if during
such month the person is . . . feeing to avoid prosecution” or
violating “a condition of probation or parole”).
A note for the sake of completeness: While subchapter
XVI speaks primarily in terms of eligibility for SSI benefts,
the Medicare fraction focuses on whether an individual is
entitled to such benefts. Nothing turns on this difference.
In Empire Health, we treated the word “entitled” in the
Medicare statute (including the Medicare fraction) as synon-
ymous with “qualifying ” for or “being eligible . . . for bene-
fts.” 597 U. S., at 435. See also Webster's Third New In-
ternational Dictionary 758 (1986) (defning “entitle” as “to
give a right or legal title to” or to “qualify (one) for some-
thing ”); id., at 736 (defning “eligible” as “ftted or qualifed
to be chosen or used” or “entitled to something ”). This case
also involves the Medicare fraction, so we follow the same
course. See Brown v. Gardner, 513 U. S. 115, 118 (1994)
(noting that the presumption of consistent usage is “surely
at its most vigorous when a term is repeated within a
given sentence”).
We therefore conclude that an individual is “entitled to
[SSI] benefts . . . under subchapter XVI” when she is eligible
to receive an SSI cash payment. And because eligibility is
determined on a monthly basis, an individual is considered
“entitled to [SSI] benefts” for purposes of the Medicare frac-
tion only if she is eligible for such benefts during the month
of her hospitalization.
III
The hospitals advance two primary arguments for reading
the phrase “entitled to [SSI] benefts . . . under subchapter
XVI” more broadly. First, they characterize SSI benefts
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as encompassing noncash benefts for which eligibility is
not
determined on a monthly basis. Second, the hospitals,
joined by the dissent, argue that eligibility for SSI benefts
persists until a person must reapply for them, which occurs
after 12 consecutive months of ineligibility for a cash pay-
ment. See § 1383( j)(1)(B).
A
As the hospitals see it, SSI benefts include both cash and
noncash benefts—specifcally, vocational rehabilitation serv-
ices and continued Medicaid coverage.
4
And a patient re-
mains eligible for these benefts, the hospitals assert, even
in months when the patient does not receive a cash payment.
The hospitals' theory stumbles out of the gate, because
neither vocational rehabilitation services nor continued Med-
icaid coverage fts the description of a “supplementa[l] se-
curity income” benefit. § 1395ww(d)(5)(F)(vi)(I) (emphasis
added). And even beyond that self-evident point, none of
these benefts is housed “under subchapter XVI.” Ibid.
(emphasis added).
Begin with the hospitals' reliance on the Ticket to Work
and Self-Suffciency Program. This program, which is avail-
able to people eligible for SSI benefts based on disability or
blindness, provides career development support and ex-
panded employment opportunities through state agencies or
private employment networks. See § 1320b–19. Because
subchapter XI establishes the Ticket to Work program, it
is not a beneft “under subchapter XVI.” § 1395ww(d)(5)
(F)(vi)(I).
Nor do any of subchapter XVI's other references to voca-
tional rehabilitation services confer an SSI beneft. Section
1382d(a), for example, requires the Commissioner to refer
blind or disabled minors who receive SSI monthly cash pay-
4
In the court below, the hospitals pressed Medicare Part D's prescrip-
tion drug subsidy as another noncash SSI beneft. Because the hospitals
have abandoned their reliance on that program, we do not address it.
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ments to the “appropriate State agency administering [a]
St
ate program under subchapter V” of the Social Security
Act. The remainder of § 1382d authorizes SSA to “reim-
burse” state agencies that administer or supervise “vo-
cational rehabilitation services approved under title I of
the Rehabilitation Act of 1973.” § 1382d(d). These express
cross-references to subchapter V of the Social Security Act
and title I of the Rehabilitation Act point to benefts housed
elsewhere—not within subchapter XVI.
The hospitals' reliance on continued Medicaid coverage
also fails. In most States, eligibility for SSI benefts quali-
fies an i ndiv idua l for Medicaid hea lth coverage. See
§ 1396a(a)(10)(A)(i)(II). Thus, if a person earns excess in-
come and loses her eligibility for SSI payments, she gener-
ally also loses access to Medicaid. See ibid.; Baystate Medi-
cal Center v. Leavitt, 545 F. Supp. 2d 20, 37, n. 24 (DC 2008).
Section 1382h(b) creates a limited exception to that default
rule. It provides that “for purposes of subchapter XIX
[governing Medicaid], any individual who was determined to
be a blind or disabled individual eligible to receive [an SSI]
beneft under section 1382” and “who in a subsequent month
is ineligible for benefts under this subchapter” due to excess
“income” is still “considered to be receiving [SSI] benefts.”
§ 1382h(b). According to the hospitals, the beneft of contin-
ued Medicaid coverage “arises solely out of section 1382h(b)”
and therefore counts as an SSI beneft. Brief for Petition-
ers 37.
The hospitals are mistaken. Section 1382h(b) does not
create a supplemental security income beneft—it aids in the
administration of the Medicaid program. (Hence the open-
ing phrase of § 1382h(b) states that the provision is “for pur-
poses of subchapter XIX,” which governs Medicaid.) The
provision merely allows certain blind or disabled people who
are not eligible to receive SSI benefts in a given month to
be treated as if they remain eligible for SSI benefts so that
they can continue receiving Medicaid benefts. If continued
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Medicaid coverage is an SSI beneft under subchapter XVI,
th
is is a very odd way of establishing it. Under the hospi-
tals' theory, this provision confers an SSI beneft on people
it simultaneously describes as “ineligible for [SSI] benefts.”
§ 1382h(b). That defes common sense.
B
The hospitals, joined by the dissent, advance a second ar-
gument: Eligibility, even for purely cash benefts, begins
when a person enters the SSI system and continues until she
has been ineligible for 12 consecutive months, at which point
she must submit a new application for benefts. See post,
at 26, 29–32 (opinion of Jackson, J.).
To support this theory, the hospitals and the dissent em-
phasize that when a person frst applies for benefts, she
must disclose her income “rate” “for the calendar year.”
§ 1382(a)(1)(A); see post, at 30. True enough. But her “cal-
endar year” income does not render her eligible for SSI ben-
efts, nor does it establish that SSI benefts operate in inter-
vals with a duration longer than one month. For that, she
must still show that she meets the requirements for a given
month. In fact, a nearby provision of the statute directs
eligibility determinations “for a month” to be made “on the
basis of the individual's . . . income, resources, and other rele-
vant characteristics in such month.” § 1382(c) (emphasis
added). And while the dissent looks to § 1383(a)(2)(B)(viii)
for help, none is forthcoming. That the Commissioner may
“defer (in the case of initial entitlement) or suspend (in the
case of existi ng entitlement)” a payment of a benefit,
§ 1383(a)(2)(B)(viii), merely addresses a question of timing—
it does not, as the dissent suggests, “contemplate a long-term
benefts relationship,” post, at 30.
Nor does the reapplication requirement change the nature
of eligibility. Under § 1383( j)(1)(B), a once-eligible individ-
ual must submit a new application after she has been “ineli-
gible for benefts . . . for a period of 12 consecutive months.”
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Note that this provision does not say that an individual re-
mai
ns eligible until this 12-month period has lapsed. On the
contrary: It states that a person who “was an eligible in-
dividual” at one point must reapply after 12 consecutive
months of ineligibility. § 1383( j)(1)(A) (emphasis added).
As the D. C. Circuit observed, “it makes little sense to say
that individuals are `entitled' to the beneft in months when
they are not even eligible for it.” 80 F. 4th, at 353.
5
Leaning on Empire Health, which dealt with Medicare
Part A, the hospitals and the dissent urge us to think of
SSI benefts as an “income-insurance program.” Brief for
Petitioners 41; see post, at 35. The shoe does not ft. In-
surance programs generally “provid[e] basic protection
against [certain future] costs,” including, in the case of Medi-
care Part A, “the costs of hospital, related post-hospital,
home health services, and hospice care.” § 1395c (describing
Medicare Part A as an “insurance program”). SSI benefts,
by contrast, do not provide an ongoing backstop against un-
expected costs—they operate as a welfare payment that
directly subsidizes recipients' income. See Schweiker, 450
U. S., at 223 (describing SSI as “provid[ing] a subsistence
allowance”); Bowen v. Galbreath, 485 U. S. 74, 75 (1988) (de-
scribing SSI as a “welfare program”).
5
Moreover, this provision appears to be a housekeeping measure: Added
roughly 14 years after SSI benefts were established, it ties the reapplica-
tion process to SSA's longstanding practice of removing people from its
database after 12 months of ineligibility. See 101 Stat. 3576; Tr. of Oral
Arg. 60. Nor do other housekeeping provisions demonstrate that eligibil-
ity for SSI benefts is determined on something other than a monthly
basis. See, e. g., § 1383(e)(1)(B)(ii)(II)(bb) (ensuring SSA's access to bene-
ft recipient's fnancial information until “the cessation of the recipient's
eligibility for benefts under this subchapter”); § 1382c(a)(3)(H)(ii)(I) (re-
quiring SSA to review, at least “once every 3 years,” “the continued eligi-
bility for benefts under this subchapter of each individual who has not
attained 18 years of age and is eligible for such benefts by reason of an
impairment . . . likely to improve”).
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Notwithstanding these differences, the hospitals and the
dissent
insist that consistency with Empire Health requires
us to reject HHS's interpretation. See Brief for Petitioners
19–21; post, at 33–36. Recall that in Empire Health, we in-
terpreted “ `entitled to [Medicare Part A] benefts' ” to mean
“all those qualifying for the program, regardless of whether
they are receiving Medicare payments for part or all of a
hospital stay.” 597 U. S., at 445 (quoting § 1395ww(d)(5)(F)
(vi)(I); alteration in original). So too here, the hospitals and
the dissent assert: Being “entitled to [SSI] benefts” means
that a patient is entitled to SSI benefts even if she does not
qualify for a payment during the month of hospitalization.
6
Yet rather than supporting this interpretation, Empire
Health cuts against it. We defned the entitlement to bene-
fts under Medicare Part A after carefully examining the
prerequisites and characteristics of that particular beneft.
See id., at 435–439. Medicare Part A, we observed, pro-
vides automatic and ongoing health insurance to individuals
over the age of 65 or who have a chronic disability. Id., at
435–436. And we explained that the Medicare Part A enti-
tlement “never goes away” unless a benefciary's chronic
“disability diminishes,” and that “the stoppage of payment
for any given service cannot be thought to affect the broader
statutory entitlement to Part A benefts.” Id., at 437. For
example, even if a patient “hit some limit on coverage” for
eye care under Part A, the “policy [would] pay for more eye
6
The dissent also criticizes our reading of the statute on the ground that
it excludes from the Medicare fraction's numerator certain patients who
fail to receive payment during their month of hospitalization due to rea-
sons unrelated to income. See post, at 28. But Congress's decision to
exclude certain individuals from eligibility for SSI benefts under subchap-
ter XVI refects that “the SSI program is broad in its reach, [but] its
coverage is not complete.” Schweiker v. Wilson, 450 U. S. 221, 224 (1981).
And again, we take no position on whether HHS has unreasonably ex-
cluded particular codes from the Medicare fraction.
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care in the next coverage period and meanwhile will pay for
[
a] knee replacement.” Ibid.
Just as our decision in Empire Health turned on the spe-
cifc features of Medicare Part A, this case turns on the spe-
cifc features of SSI benefts under subchapter XVI. And a
comparison of the two programs reveals critical distinctions.
Again, while Medicare Part A benefts extend beyond spe-
cifc payments for any given medical need, SSI benefts
under subchapter XVI consist of monthly cash payments and
nothing more. And while Medicare Part A's entitlement is
automatic and ongoing (with the exception of a disability that
diminishes), the SSI beneft is neither: Recipients must apply
for and be deemed eligible for benefts, and recipients can
(and do) fuctuate in and out of eligibility depending on their
income and resources from one month to the next. Consist-
ency with Empire Health's beneft-focused analysis thus
requires us to recognize and give effect to the differences
between Medicare Part A and SSI benefts.
C
Finally, invoking statutory purpose, the hospitals and the
dissent insist that their interpretation of “entitled to [SSI]
benefts . . . under subchapter XVI” best accords with “Con-
gress's ultimate goal [of] provid[ing] hospitals that serve
the neediest among us with the appropriate level of critical
funds.” Post, at 21. (Indeed, the dissent frames its argu-
ment as one primarily about the statute's purpose and only
secondarily about its text.) They regard our reading as in-
consistent with the overall purpose of the Medicare fraction
and DSH adjustment, because people who happen not to
qualify for an SSI cash payment in a given month are un-
likely to be any healthier or less costly to treat from one
month to the next. As they see it, including these patients
in the numerator of the Medicare fraction better measures a
hospital's burden, ensuring that the hospital receives “the
appropriate level of critical funds.” Ibid.
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Opinion of the Court
This argument overlooks that Congress chose a specifc
means
to advance its end of better funding hospitals that
care for a disproportionate percentage of needy Medicare pa-
tients. It could have chosen another. For instance, it could
have captured the number of poor Medicare patients by rely-
ing on proof of annual income. (That measure might in-
crease the numerator and therefore the reimbursement rate.)
Alternatively, it could have more precisely isolated the
expensive-to-treat Medicare patients by using not only their
annual incomes, but also their health histories. (That meas-
ure might decrease the numerator and therefore the reim-
bursement rate.) But instead of choosing one of these (or
some other) option, Congress decided to approximate a hos-
pital's share of expensive-to-treat Medicare patients by using
the patient's entitlement to SSI benefts under subchapter
XVI. That is not a perfect measure of income—but neither
is income a perfect measure of whether a patient is more
costly to treat. In the end, the Medicare fraction and ulti-
mate DSH adjustment refect a balance of multiple compet-
ing interests, including increased funding for hospitals, ad-
ministrability, effciency, and allocation of fnite resources.
So yes, Congress sought to increase the reimbursement
rate for hospitals that care for a disproportionate share of
low-income Medicare patients. But as we have explained
many times before, “[n]o statute pursues a single policy at
all costs, and we are not free to rewrite this statute (or any
other) as if it did.” Bartenwerfer v. Buckley, 598 U. S. 69,
81 (2023); Luna Perez v. Sturgis Public Schools, 598 U. S.
142, 150 (2023) (“no law ` “pursues its . . . purpose[s] at all
costs” ' ” (alterations in original)); American Express Co. v.
Italian Colors Restaurant, 570 U. S. 228, 234 (2013) (same);
Kucana v. Holder, 558 U. S. 233, 252 (2010) (same); Rodri-
guez v. United States, 480 U. S. 522, 525–526 (1987) (per cu-
riam) (same). We must determine how Congress chose to
pursue its objective. Henson v. Santander Consumer USA
Inc., 582 U. S. 79, 89 (2017) (“Legislation is, after all, the art
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of compromise, the limitations expressed in statutory terms
of
ten the price of passage”). And here, Congress made a
specifc choice: For purposes of the Medicare fraction, an in-
dividual is “entitled to [SSI] benefts” when she is eligible to
receive an SSI cash payment during the month of her hospi-
talization. § 1395ww(d)(5)(F)(vi)(I). We must respect the
formula that Congress prescribed.
***
For the foregoing reasons, we affrm the judgment of the
Court of Appeals.
It is so ordered.
Justice Jackson, with whom Justice Sotomayor joins,
dissenting.
Providing quality healthcare to low-income patients can
be costly. When Congress established Medicare's hospital-
reimbursement system, it recognized that people with low
incomes tend to have comparatively worse health conditions
and health outcomes than wealthier people, and was clear
eyed about the fact that, as a result, “[h]ospitals that serve
a disproportionate share of low-income patients have higher
medicare costs.” H. R. Rep. No. 99–241, pt. 1, p. 16 (1985).
To account for the variable costs attributable to the health-
care needs of different socioeconomic populations, Congress
opted to reimburse hospitals that have a “disproportionate
share” of low-income patients at a different (greater) rate
than other hospitals.
This case concerns the formula that Congress uses to iden-
tify and compensate those hospitals. The majority and I are
in considerable agreement about key aspects of the statutory
provision at issue. We agree that the point of the “dispro-
portionate share” Medicare formula is to identify hospitals
that serve a disproportionate number of low-income patients.
We agree that the formula looks to the Supplemental Secu-
rity Income (SSI) program—a benefts program for low-
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Jackson, J., dissenting
income Americans that entitles certain individuals to receive
cash
payments from the Government—and counts the num-
ber of a hospital's Medicare-eligible patients who are also
“entitled to” SSI. We agree that, under the SSI program,
eligibility for a cash payment in a given month turns on a
person's monthly income. And we agree that, if the SSI
program operates like Medicare Part A, our decision in Be-
cerra v. Empire Health Foundation, for Valley Hospital
Medical Center, 597 U. S. 424 (2022), would control the out-
come of this case, and would require us to rule for the
hospitals.
All that said, the majority's interpretation of Medicare's
disproportionate-share formula is based upon a fundamental
misunderstanding of how SSI's cash-beneft program works.
And that misunderstanding has led the majority to evaluate
the Medicare statute without regard to the function of the
formula's reference to the SSI program, causing it to reach
the wrong conclusion.
To be speci fic: W hen Congress created Medicare's
disproportionate-share formula, it looked to SSI's cash-
benefts program for a reason. No one disputes that Con-
gress's ultimate goal was to provide hospitals that serve the
neediest among us with the appropriate level of critical
funds. The only logical basis for the formula's reliance on
SSI, then, is to draw from that program's pre-existing pool
of individuals that have already been designated as our soci-
ety's neediest—not to assess the wholly irrelevant fact of
whether any such individual actually received a cash pay-
ment under the SSI program during the month of their hos-
pitalization. The majority's interpretation both ignores this
critical context and endorses an interpretation of the Medi-
care formula that arbitrarily undercounts a hospital's low-
income patients.
In short, under the majority's reading, Congress's refer-
ence to the SSI scheme in the Medicare statute serves no
rational purpose. Worse still, the majority seems to think
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Jackson, J., dissenting
that a statutory formula specifcally designed to authorize
payments
to certain hospitals in greater amounts is best read
to affect the arbitrary denial of those additional funds. Re-
spectfully, I dissent.
I
“ The Medicare program provides Government-funded
health insurance to over 64 million elderly or disabled
Americans.” Empire Health, 597 U. S., at 428. The pro-
gram generally works by reimbursing hospitals for their
treatment of Medicare beneficiar ies. See 42 U. S. C.
§ 1395ww(d). To incentivize hospitals to treat patients in
the most effcient manner, Congress reimburses hospitals for
the services they provide at a fxed rate that turns on a
patient's diagnosis rather than the hospital's actual costs.
Empire Health, 597 U. S., at 429.
But Congress also recognized that some hospitals have it
harder than others. Based on empirical research, it specif-
cally observed that “[h]ospitals that serve a disproportionate
share of low-income patients have higher medicare costs,”
and that this was so for two primary reasons. H. R. Rep.
No. 99–241, pt. 1, at 16; see also Empire Health, 597 U. S., at
429. First, low-income patients tend to be in poorer health
to begin with, and have more complications after medical
procedures than patients who are wealthier. H. R. Rep. No.
99–241, pt. 1, at 16. Second, hospitals that see a signifcant
number of low-income patients often have to employ extra
personnel, such as social workers and interpreters, in order to
serve this population, adding to a hospital's fxed costs. Ibid.
Congress thus reasonably decided that those hospitals that
have a disproportionate share of low-income patients should
receive enhanced Medicare rei mbursements. Emp ire
Health, 597 U. S., at 429. And, notably, by compensating for
the disparity in treatment costs, Congress hoped to “encour-
ag[e] hospitals to treat low-income patients.” Ibid.
To accomplish Congress's fair-reimbursement objectives,
the hospitals with a disproportionate share of low-income pa-
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tients frst had to be identifed. One option would have been
to
require all hospitals to track their patients' incomes and
report them to the Government. H. R. Rep. No. 99–241,
pt. 1, at 17. But this would have added administrative over-
head to already burdened hospitals. Ibid. So, instead,
Congress devised a formula that could be used to calculate
the percentage of a hospital's patients who are low income
using administrative data already in the Government's pos-
session. See § 1395ww(d)(5)(F)(vi).
As the majority helpfully explains, part of that formula—
referred to herein as the “Medicare fraction”—calculates
the percentage of a hospital's Medicare-eligible patients who
have low incomes. The base of that fraction counts the total
number of days Medicare patients spent in the hospital.
Ante, at 8. The numerator counts the number of days “ `at-
tributable to Medicare patients who are poor,' ” as deter-
mined by their entitlement to SSI benefts. Ante, at 7–8.
We took this case to decide who falls within the numerator.
That is, which hospital patients are “entitled to [SSI] bene-
fts” for purposes of the disproportionate-share formula?
§ 1395ww(d)(5)(F)(vi)(I). This seems like a narrow, technical
question. But the stakes of the answer are quite high for
hospitals because the greater the number of a hospital's pa-
tients who fall within the numerator, the more Medicare-
reimbursement money that hospital will receive.
II
The majority starts off on the right foot. “To determine
when a person is `entitled to supplementary security income
benefts,' ” “we must know what the benefts are.” Ante, at
10 (quoting § 1395ww(d)(5)(F)(vi)(I)). But it quickly mis-
steps. According to the majority, because SSI entitles indi-
viduals to “cash benefts,” and the eligibility for those benefts
“is determined on a monthly basis,” ante, at 11, the Medicare
fraction counts only those patients who are eligible for a cash
payment under SSI during the month of their hospitaliza-

24 ADVOCA
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tion. This conclusion misunderstands both the beneft that
SSI
provides and also, importantly, the reason why Congress
used SSI as its proxy for identifying low-income patients.
A
The regulations accompanying the SSI statute state that
“[t]he basic purpose underlying the [SSI] program is to as-
sure a minimum level of income for people who are age 65 or
over, or who are blind or disabled and who do not have suff-
cient income and resources to maintain a standard of living
at the established Federal minimum income level.” 20 CFR
§ 416.110 (2024). We have likewise explained elsewhere that
“[t]he SSI program establishes a federally guaranteed mini-
mum income for the aged, blind, and disabled.” Schweiker
v. Hogan, 457 U. S. 569, 581–582 (1982).
At a high level, the SSI program works as follows. Per-
sons who are over 65, blind, or disabled may apply and will
be enrolled in the SSI program if their annual income and
fnancial resources are below a certain designated level. 42
U. S. C. §§ 1381, 1382(a)(1), (c)(7). Once approved—and until
that enrollment is terminated—an individual who is enrolled
in the SSI program is guaranteed an annual income above
the federal minimum. See § 1382(b). This does not neces-
sarily mean such an enrollee will receive a check from the
Government each month (or even at all)—that depends on
other specifed factors. See § 1382(c). But if in any month
an enrollee's income drops below the rate required to hit the
federal minimum, the Government will pick up the slack by
sending them a check. See ibid.
I pause here to note that participation in the SSI program
is thus highly benefcial to enrollees, regardless of whether
they happen to need and receive a check in any particular
month. This is so because being enrolled in SSI provides
par ticipants w ith meaning fu l reassurance. Pover ty in
America is a plague of uncertainty marked by persistent in-
stability—what others have called “the constant fear that it
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will get even worse.” M. Desmond, Poverty, By America 17
(2023).
The problem is not just that one's income is too low;
it is that one's income, such as it is, is highly volatile. “For
scores of American workers, wages are . . . wobbly, fuctuat-
ing wildly not only year to year but month to month, even
week to week.” Id., at 16. As one woman living on the
edge of poverty described her situation: “ `[E]very day and
every night when I'm trying to fall asleep, there's this worry
hanging. . . . How am I gonna get it done? How am I gonna
stretch to get these bi l ls paid? If one extra th i ng
happens—.' ” D. Shipler, The Working Poor 25 (2004).
Congress understood this reality when it set out to con-
struct an income-related social safety net for the population
SSI covers. Indeed, the SSI program was specifcally de-
signed to address the often debilitating state of low-income
volatility. If a person hovering at the poverty threshold is
enrolled in the SSI program, she has peace of mind that if
she misses work because her car breaks down, her child falls
ill, or her work hours are suddenly slashed, she will still be
able to pay the bills because the Government will provide
her with some cash, if needed. That is the true “beneft” of
SSI—one less thing to worry about.
This basic understanding of the SSI program also helps to
clarify the benefciaries (i. e., it explains who is “entitled to”
SSI benefts for purposes of that statutory scheme): anyone
who, per the threshold statutory criteria, is protected by
SSI's safety net in the frst place. In other words, an “enti-
tled” person is any individual who has a right to receive SSI
payments when his income falls below the federal minimum.
The text and structure of the SSI statute plainly comport
with this understanding of both the SSI beneft and what it
means to be “entitled” thereto. The frst substantive provi-
sion of the SSI subchapter—notably titled “Basic entitle-
ment to benefts”—makes a promise: “Every aged, blind, or
disabled individual who is determined . . . to be eligible on
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with and subject to the provisions of this subchapter, be
paid
benefts.” § 1381a (emphasis added; boldface deleted).
That is clear enough. But which individuals are “eligible on
the basis of [their] income and resources”? That question is
answered by the subsequent provision, § 1382(a), which ex-
plains that any “aged, blind, or disabled individual” with an
annual income and fnancial resources below a certain thresh-
old “sha ll be an elig ible i ndiv idua l for purposes of th is
subchapter.”
Section 1382 then goes on to explain what an eligible indi-
vidual is eligible for under this program. Subsection (b)
guarantees each eligible individual payments from the Gov-
ernment up to the statutorily defned federal minimum in-
come level over the course of a year, reduced by that individ-
ua l's count able i ncome for that year. § 1382( b). And
subsection (c) provides that eligible individuals will receive
a cash payment in any month in which their monthly income
falls below the amount that would be required for them
to earn the federal minimum over the course of a year.
§ 1382(c)(1).
Putting it all together: The SSI statute distinguishes be-
tween an entitlement to be enrolled in the SSI program—
promised in § 1381a with eligibility criteria laid out in
§ 1382(a)—and the right to receive a payment under the pro-
gram. Anyone who is in the former bucket gets the quite
valuable safety-net beneft of being enrolled in SSI (and the
peace of mind that comes with it), whether or not they actu-
ally receive a check from the Government in any particular
month.
B
Because the majority fails to appreciate the programmatic
nature of SSI, it reduces SSI's beneft to the monthly check—
and nothing more. From that premise, the majority con-
cludes that all Congress cared about when measuring a hos-
pital's low-income population for purposes of Medicare's

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disproportionate-share formula was the number of patients
who
received a check during the month of their hospital stay.
But the majority also admits that the point of Medicare's
disproportionate-share formula is to identify “ `hospitals
serving an “unusually high percentage of low-income pa-
tients.” ' ” Ante, at 6. And whether an individual received
a check from the Government in a given month does not
track—and, indeed, has little to do with—the broader “low-
income” category of patients. The result is an interpreta-
tion of the formula that not only strangely excludes indisput-
ably low-income patients, but does so arbitrarily.
Imagine a woman who has been eligible for SSI payments
for years and works at a retail store—I will call her Ann.
In January, Ann picks up a few night shifts, which pay more
than her usual day shifts. Cf. Shipler, The Working Poor,
at 65. That extra income bumps her above the SSI cash-
payment threshold so she does not get a payment in January.
But in February (and March, and April, and May), when her
schedule returns to normal, her income falls back below the
threshold. In the majority's view, whether Ann counts as a
low-income patient for purposes of the disproportionate-
share formula depends on the happenstance of her hospital-
ization. If she has a heart attack in February, she's in. But
if her heart fails in January, she's out.
Why would Congress have intended to exclude Ann from
the hospital's count of low-income patients in January but
include her in February? The answer is simple: It didn't.
After all, the disproportionate-share formula is not about
Ann's own personal cash fow—Congress was not trying to
identify those patients who lack cash on hand. Instead, as
all agree, the formula is trying to count those patients who
will be costlier to treat due to the health impacts of poverty.
From the hospital's (and society's) perspective, there is no
cost difference between treating Ann in January (when she
had a bit more cash) or treating her in February (when she

28 ADVOCA
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Jackson, J., dissenting
had a bit less). In either month, in terms of the hospital's
comparatively
greater treatment costs, Ann qualifes as a
low-income patient.
The irrationality of the majority's reading does not end
there. Under the majority's view, also falling outside the
Medicare formula's numerator are patients who happen to be
hospitalized during the frst month they are eligible for SSI,
because, by statute, SSI payments do not kick in until the
second month of eligibility. See § 1382(c)(7). Other quirks
of SSI's statutory scheme—such as a provision preventing
persons in Medicaid-funded nursing homes from getting an
SSI payment in any month in which they have more than
$30 in income, § 1382(e)(1)(B)—likewise mean that many
of the lowest income patients are arbitrarily excluded from
the disproportionate-share formula's count. Neither of these
circumstances has anything whatsoever to do with how
costly it will be to provide such patients with quality
healthcare.
1
The majority does not mention these incongruities, let
alone justify them. Instead, it shrugs away all of the appar-
ent oddities of its interpretation, blithely noting that “ `no
statute pursues a single policy at all costs.' ” Ante, at 19
(brackets omitted). I would think the People's representa-
tives deserve more credit than to have this Court conclude
they intentionally enacted a statute that does not reach its
aims and operates so arbitrarily that it makes no sense.
1
The Government has at least conceded that its interpretation is not
an “actual receipt” rule—a patient will be counted, the Government has
promised, even if he doesn't actually receive an SSI payment in a given
month (e. g., because the enrollee moves or the post offce loses the check),
so long as he “satisfes the statutory requirements for a cash payment
during the relevant month in question.” Tr. of Oral Arg. 51. The Gov-
ernment also assured the Court that it would “retroactively” count pa-
tients who initially failed to receive a payment in a given month due to
an administrative error (such as an erroneous address on fle) that was
subsequently cured. Id., at 52.
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In the majority's view, my way of analyzing the relevant
st
atutes impermissibly elevates purpose over text, because
it “overlooks that Congress chose a specifc means to advance
its end.” Ibid. But that contention simply begs the ques-
tion before us; what we are doing now is trying to discern
what it was that Congress “chose” when it referenced the
SSI program while crafting the Medicare fraction. The ma-
jority apparently believes it can fgure that out without con-
sidering what the Medicare fraction was designed to accom-
plish—it just insists, largely by ipse dixit, that Congress
“chose” a proxy for low-income status that asks whether a
patient received an SSI check during the month of their hos-
pital stay. Ante, at 12, 19. My response is simply, why
would Congress possibly make that choice? The illogic of
the majority's interpretation strongly signals that what the
majority believes Congress “chose” is not actually what Con-
gress intended or accomplished.
There is also no need to conclude that Congress intention-
ally selected such an irrational and arbitrary measurement
when there is another equally (if not more) plausible inter-
pretation available: that Congress intended to count those
patients who were enrolled in the SSI program at the time
the hospital served them. Statutes “are not inert exercises
in literary composition,” but “instruments of government.”
United States v. Shirey, 359 U. S. 255, 260 (1959). We disre-
spect that instrument—and the coequal branch of Govern-
ment that has enacted it—when we fail to understand, or
appreciate, the logic of the laws Congress designs.
C
There is yet another reason the majority's myopic ap-
proach to interpreting statutes has yielded the wrong result
in this case. As the majority envisions the SSI program, a
patient's entitlement to SSI toggles off and on each month,
depending on her cash fow. That view of how the program
operates is fatly inconsistent with the fully contextualized
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reading that I have laid out in Part II–A. It also conficts
w
ith the statute's plain text, which clearly contemplates an
SSI entitlement that extends beyond a single month.
To understand how the majority goes awry on this point,
st ar t where the major ity does: w ith the lang uage of
§ 1382(c)—a provision that explains how and when SSI cash
benefts will be paid. See ante, at 11. By starting there,
the majority essentially ignores §§ 1382(a) and (b), which
plainly address who is entitled to SSI benefts and what they
are qualifed to receive due to that entitlement. See also
Schweiker v. Wilson, 450 U. S. 221, 223, n. 2 (1981) (“To be
eligible for SSI benefts,” a person's “income and resources
must be below the levels specifed in . . . 42 U. S. C.
§ 1382(a)”); Sullivan v. Zebley, 493 U. S. 521, 524 (1990) (“A
person is eligible for SSI benefts if his income and fnancial
resources are below a certain level, § 1382(a), and if he is
`disabled' ”). Moreover, and importantly for present pur-
poses, subsection (a) eligibility looks to an individual's in-
come over the course of a “calendar year”—not her income
in any particular month. § 1382(a)(1)(A). Thus, the text of
this statute, read as a whole, plainly establishes that eligibil-
ity for SSI benefts operates on a longer time horizon than
the majority acknowledges.
Other provisions further demonstrate that whether some-
one is “entitled to” SSI benefts does not turn on their income
in a single month. After an individual applies for SSI and
is deemed eligible under § 1382(a), she need not apply again
the next month—or, actually, any month thereafter—because
her eligibility for benefts lasts until her income is too high
for one full year, § 1383( j)(1); 20 CFR § 416.1335, or until
her enrol lment is ter mi nated for some other reason,
§ 1383(e)(1)(A); 20 CFR §§ 416.1331, 416.1333–416.1334. The
statute also seems to contemplate a long-term benefts rela-
tionship, insofar as it permits the Department of Health and
Human Services (HHS) in certain circumstances to “defer (in
the case of initial entitlement) or suspend (in the case of
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existing entitlement)” SSI benefts—a distinction that only
makes
sense if an individual's entitlement to SSI lasts be-
yond a single month. § 1383(a)(2)(B)(viii) (emphasis added);
see also § 1382c(a)(3)(H)(ii)(I) (referring to an individual's
“continued eligibility” for benefts over the course of multi-
ple years).
If all that is still not enough to permit the majority to
accurately discern the broader confnes of this program, con-
sider the fact that HHS requires SSI applicants to grant
the agency permission to access their fnancial records
so that HHS can automatica l ly monitor their i ncome.
§ 1383(e)(1)(B)(ii); 20 CFR § 416.207. That authorization
lasts until “the cessation of the recipient's eligibility for
benefts under this subchapter.” § 1383(e)(1)(B)(ii)(II)(bb).
But if eligibility for SSI benefts were a monthly determina-
tion, the give-us-your-records provision would accomplish
nothing. It would do the agency no good to have permission
to access those records for one month and one month only.
The practical realities of SSI administration further dem-
onstrate that the SSI entitlement is not determined month
by month. For example, SSI benefts are paid on the frst
day of the month—an individual receives his February pay-
ment on February 1st. 20 CFR § 416.502. With its month-
only entitlement perspective, the majority thus apparently
surmises that HHS regularly pays benefts without knowing
whether the recipient is eligible for SSI at all. Any such
policy would be surprisingly irresponsible. But if SSI is a
program that lasts beyond a single month, day-one payments
are both rational and administratively feasible. Recall that
we are talking about people who are desperately in need of
cash to pay their monthly bills; this explains the agency's
practice of providing prompt, prospective payments, which
the aforementioned income monitoring facilitates. More-
over, as I have explained, once an individual is approved for
SSI, he is entitled to receive such prospective payments, as
needed, until his enrollment is terminated. By adopting a

32 ADVOCA
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broader time horizon than the single month in which the pay-
ment
is made, the agency can get the money out to the needy
individual and then subsequently smooth out any over- (or
under-) payments it makes, by checking the person's actual
salary for the month in question and, if necessary, adjusting
the amount it pays in later months. See § 1383(b).
The majority simply ignores these kinds of programmatic
features that cut against its reading. And the unhelpful
statutory provisions that the majority does acknowledge get
short shrift in its opinion; in a footnote, the majority bats
them away as mere legislative “housekeeping.” Ante, at 16,
n. 5. I grant that it is easier to duck Congress's handiwork
than to explain the implications of its various policy choices.
But if the majority is going to base its interpretation exclu-
sively on what Congress “chose” when it used the term “eli-
gibility,” it must grapple with all such usages of that term
in the statute in question—not just those that support its
preferred reading.
2
Notably, the design of the statute that creates the SSI pro-
gram—basic criteria establishing an entitlement to a beneft,
pursuant to which individuals are eligible for a payment
under certain conditions that are delineated elsewhere—is
not unique to SSI. Consider veterans benefts, for example.
A veteran “with the requisite period of military service be-
comes `entitled to' ” certain educational benefts, “typically
in the form of a stipend or tuition payments.” Rudisill v.
McDonough, 601 U. S. 294, 299 (2024) (emphasis added).
But just because a person is entitled to those benefts does
not mean she will ever receive them; there are hoops through
which she must jump and conditions she must satisfy to be
eligible to receive a payment. Id., at 300–301.
2
For my part, I do not deny that the SSI statute discusses an individu-
al's “ `eligibility for a beneft . . . for a month.' ” Ante, at 11 (quoting
§ 1382(c)(1)). But, as I've explained, that monthly eligibility is meant only
to describe the beneft (i. e., the cash payment) that an individual who is
entitled to SSI is eligible to receive. Supra, at 26.
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Or consider Medicare Part A. “When a person turns 65,”
she
“becomes `entitled' to” Medicare Part A benefts. Em-
pire Health, 597 U. S., at 428 (quoting 42 U. S. C. §§ 426(a)–
(b)). There, too, entitlement does not guarantee payment—
a person may be entitled to Medicare Part A benefts yet
never receive a single cent, perhaps because he is covered
by private health insurance, or because he has hit some stat-
utory cap on care. 597 U. S., at 432. As this Court has rec-
ognized, “[t]he entitlement to [Medicare Part A] benefts” is
simply “an entitlement to payment under specifed condi-
tions.” Id., at 436 (some emphasis deleted). The same is
true of SSI. Compare § 426(c)(1) (explaining that “entitle-
ment of an individual” to Medicare Part A benefts “consist[s]
of entitlement to have payment made under, and subject to
the limitations in, part A”) with § 1381a (stating that “[b]asic
entitlement to [SSI] benefts” consists of a promise to certain
individuals of payment “in accordance with and subject to
the provisions of th[e SSI] subchapter” (boldface deleted)).
III
It was precisely this distinction—between a threshold en-
titlement to participate in a beneft program, on the one
hand, and a subsequent right to a payment under that pro-
gram, on the other—that was the linchpin of our interpreta-
tion of another part of the disproportionate-share formula
just three Terms ago. In Empire Health, we faced a ques-
tion that is substantially similar to the one the Court decides
today: Which patients are “ `entitled to' ” Medicare Part A
benefts for purposes of the disproportionate-share formula?
597 U. S., at 428. What is more, the arguments in that case
mirrored the arguments we consider now. One side main-
tained that a patient is “entitled to” such benefts only if she
had actually received a Medicare payment; the other insisted
that a patient is so entitled if he was eligible for the Medicare
Part A program, no payment necessary. See id., at 432–
433. Notably, however, the valence of the arguments was
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fipped—in Empire Health, it was the hospitals that insisted
payment
was required, while the Government asserted pro-
gram eligibility suffced. Ibid.
We sided with the Government. A patient is “ `entitled
to' ” Medicare Part A benefts, we held, if she “meet[s] the
basic statutory criteria” for the Medicare Part A program,
whether or not she “actually receiv[ed] payment for a given
day's treatment. ” Id., at 435. For pur poses of the
disproportionate-share formula, we said, a patient's receipt
of payment is beside the point. All the formula cares about
is whether a patient qualifes for the program that entitles
her to payment under specifed conditions. Id., at 436.
Exactly that same logic should have carried the day here.
A patient is “entitled to” SSI benefts for purposes of the
disproportionate-share formula if she “meets the basic statu-
tory criteria” for the SSI program, whether or not she “actu-
ally receiv[ed an SSI] payment” in the relevant month. Id.,
at 432, 435. In other words, just as with Medicare Part A,
statutory entitlement to SSI “coexists with limitations on
payment.” Id., at 436.
Our reasoning in Empire Health resulted in hospitals re-
ceiving less money by operation of the Medicare fraction.
Id., at 444. Applied here, that same logic requires them to
receive more, because it places more patients in the numera-
tor of the Medicare fraction. But instead of simply follow-
ing Empire Health where it leads, the majority diverges
from its clear and plainly applicable holding. In the majori-
ty's view, although a patient need not receive a Medicare
Part A payment to be “entitled to” Medicare Part A for pur-
poses of the disproportionate-share formula, she must re-
ceive an SSI payment to be “entitled to” SSI under that
same calculation.
To justify this puzzling departure, the majority identifes
two “critical distinctions” that it says distinguish SSI from
Medicare Part A and thus make this case different from Em-
pire Health. Ante, at 18. First, the majority says that
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Medicare Part A benefts “extend beyond specifc payments
for
any given medical need,” whereas SSI benefts “consist
of monthly cash payments and nothing more.” Ibid. I've
already explained why that characterization of SSI is wrong:
The SSI beneft is not simply the payment itself, but the
promise of a payment in one's time of need. Supra, at 24–
25. SSI thus operates just like income insurance. Enrolled
individuals are promised a payout, should the relevant trig-
gering event—monthly income below the threshold—occur.
The majority rejects this commonsense conclusion based
on superfcial mischaracterizations of the SSI program and
what it means to the people who rely on it. So, SSI is com-
monly described as a “ `welfare program,' ” ante, at 16—so
what? That label does not change the fact that this welfare
program operates more like insurance than a subsidy. The
majority also seems to believe that insurance programs may
protect benefciaries only against increased costs—not de-
creased income. Ibid. But why is that the case? Eco-
nomically speaking, increased costs and decreased income
are two sides of the same coin. The only difference is the
precipit ati ng fac tor, and, of course, the fac t that the
decreased-income species of insurance acknowledges the re-
ality of income insecurity.
The second declared distinction is the majority's conten-
tion that Medicare Part A is “automatic and ongoing ” while
SSI is not. Ante, at 18. This seems faulty from the start,
since the majority concedes that disabled individuals can lose
their entitlement to Medicare Part A if their disability dimin-
ishes. Ibid. Thus, it is questionable whether Medicare
Part A is, in fact, “ongoing.” In any event, the majority
fails to explain why this “ongoing ” distinction makes any dif-
ference. The question before us is whether a person is
“entitled to” SSI for purposes of the disproportionate-share
formula, not whether a person must reapply to become so
entitled, or whether it is possible to be excised from this
beneft program's rolls.
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Ultimately, then, neither of the “critical” distinctions that
the
majority identifes between Medicare Part A and SSI are
critical at all. So, in the absence of any principled basis for
distinguishing this case from Empire Health, the majority
falls back on pithy rhetoric, quipping that “ `it makes little
sense to say that individuals are “entitled” to the beneft in
months when they are not even eligible for it.' ” Ante, at 16.
Again, this characterization misrepresents the real beneft of
SSI. It is also noteworthy that, while some on this Court
embraced a similar argument in Empire Health, they did so
in dissent. See 597 U. S., at 447–448 (opinion of Kava-
naugh, J.) (arguing that a patient could not be considered
“entitled to” a Medicare Part A beneft “if the patient by
statute could not” receive a payment). The majority view
in Empire Health fully appreciated the insurance-like nature
of the Medicare program, and its reasoning applies full bore
to the question we address today.
***
The decision the majority has made in this case will de-
prive hospitals serving the neediest among us of critical fed-
eral funds that Congress plainly attempted to provide. Hos-
pitals that have a disproportionate share of low-income
patients are struggling. Indeed, it is undisputed that sys-
temically undercounting low-income patients for the pur-
poses of the disproportionate-share formula might cause
many such hospitals to close their doors entirely, such that
patients from our Nation's poorest communities may not be
served at all. Brief for American Hospital Association et al.
as Amici Curiae 27–28; Tr. of Oral Arg. 36–38.
This outcome is not compelled by the text of the Medicare
statute or the circumstances that surround it. Rather, it is,
unfortunately, directly attributable to the majority's incuri-
ous and context-free method of statutory analysis. Con-
gress's reference to the SSI program in the Medicare formula
has confused the majority into thinking that Congress meant
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Jackson, J., dissenting
for hospitals serving low-income patients to be reimbursed
at
lower rates than if their patient population was fully taken
into account. So it will now be up to Congress to restate its
intention that low-income people have access to quality medi-
cal care and that hospitals be compensated accordingly.
I suspect that such a legislative fx would not be too diff-
cult to craft. But Congress would not need to go that extra
mile if this Court's interpretive practices would just take
care to evaluate the text of a statute alongside any indis-
putable legislative objectives. Here, we should have easily
concluded that, for purposes of the disproportionate-share
formula used to reimburse hospitals, patients are “entitled
to” SSI benefts when they are eligible for and enrolled in
the SSI program, as Congress undoubtedly intended.
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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:
p. 2, line 1: “faction” is inserted before “Medicare”