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

“Entitled to benefits” in 42 U.S.C. § 1395ww(d)(5)(F)(vi)(I) is to be read as meeting the statutory criteria expressed in §§ 426(a)–(b), not actually having used Medicare funds for treatment.

The Medicare program reimburses hospitals who treat lower income patients by the fiscal year based on a statutorily set formula, one portion expressed as the number of “patients who (for such days) were entitled to benefits under part A of [Medicare]” divided by the number of days Medicare patients were treated in total. 42 U.S.C. § 1395ww(d)(5)(F)(vi)(I). Under a 2004 regulation issued by the Department of Health and Human Services (HHS), “entitled to benefits” is to be read as meeting the statutory criteria expressed in §§ 426(a)–(b), not actually having used Medicare funds for treatment. The Ninth Circuit found for Respondent, finding the interpretation to be incompatible with how the fraction is statutorily described. The Supreme Court disagreed on appeal, holding that HHS’ regulation is the appropriate reading of the statutory text. Respondent’s interpretation lacks textual support, as §§426(a)–(b) identifies who is “entitled to benefits . . . under part A:” all who meet the statutory criteria. Under Respondent’s interpretation, many circumstances could exist which would defeat Congress’ purpose in enacting the reimbursement plan to compensate for low-income Medicare patients, such patients who have exhausted their Part A benefits but are still entitled to other Medicare benefits. See §§ 1395l(a)(8)(B)(i), 1395l(t)(1)(B)(ii).  REVERSED AND REMANDED.