Advocate Christ Medical Center v. Kennedy (605 U.S. 1, 2025)

PRELIMINARY PRINT Volume 605 U. S. Part 1 Pages 1–37 OFFICIAL REPORTS OF THE SUPREME COURT April 29, 2025 Page Proof Pending Publication REBECCA A. WOMELDORF reporter of decisions NOTICE: This preliminary print is subject to formal revision before the bound volume is published. Users are requested to notify the Reporter of Decisions, Supreme Court of the United States, Washington, D. C. 20543, pio@supremecourt.gov, of any typographical or other formal errors. 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 Page Proof Pending Publication 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 2 ADVOCATE 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 Page Proof Pending Publication 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). Cite as: 605 U. S. 1 (2025) 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. Page Proof Pending Publication (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. 4 ADVOCATE 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 point must reapply after 12 consecutive months of ineligibility. § 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 Page Proof Pending Publication 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. Cite as: 605 U. S. 1 (2025) 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 Page Proof Pending Publication 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. 6 ADVOCATE CHRIST MEDICAL CENTER v. KENNEDY 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 beneficiaries. 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 Page Proof Pending Publication 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. Cite 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: Page Proof “the fraction Pending (expressed Publication 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. 8 ADVOCATE CHRIST MEDICAL CENTER v. KENNEDY 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 if so, how much. Id., at 431. “The higher the disproportionate-patient percentage,” the more funding a hospital receives. Id., at 432 (citing §§ 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.” Page Proof Pending Publication 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- Cite as: 605 U. S. 1 (2025) 9 Opinion of the Court Petitioners, a group of more than 200 hospitals, disagree with 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 Page Proof Pending Publication 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. 10 ADVOCATE CHRIST MEDICAL CENTER v. KENNEDY Opinion of the Court D. C. Circuit also agreed with HHS. See Advocate Christ Medical 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. Section 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 . . . Page Proof Pending Publication 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). Cite as: 605 U. S. 1 (2025) 11 Opinion of the Court lis[h] a national program to provide supplemental security income 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 Page Proof Pending Publication subchapter VIII, which provides special benefts for certain World War II veterans. There, Congress defined 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 12 ADVOCATE CHRIST MEDICAL CENTER v. KENNEDY Opinion of the Court month he is an inmate of a public institution”); § 1382(e)(1)(D) (providing 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- Page Proof Pending Publication 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 Cite as: 605 U. S. 1 (2025) 13 Opinion of the Court 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 Page Proof Pending Publication 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. 14 ADVOCATE CHRIST MEDICAL CENTER v. KENNEDY Opinion of the Court ments to the “appropriate State agency administering [a] State 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 individual for Medicaid health 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 Page Proof Pending Publication 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 Cite as: 605 U. S. 1 (2025) 15 Opinion of the Court Medicaid coverage is an SSI beneft under subchapter XVI, this 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- Page Proof Pending Publication 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 existing 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.” 16 ADVOCATE CHRIST MEDICAL CENTER v. KENNEDY Opinion of the Court Note that this provision does not say that an individual re- mains 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, Page Proof Pending Publication 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”). Cite as: 605 U. S. 1 (2025) 17 Opinion of the Court 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- Page Proof Pending Publication 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. 18 ADVOCATE CHRIST MEDICAL CENTER v. KENNEDY Opinion of the Court 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. Page Proof Pending Publication 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. Cite as: 605 U. S. 1 (2025) 19 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 Page Proof Pending Publication 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 20 ADVOCATE CHRIST MEDICAL CENTER v. KENNEDY Jackson, J., dissenting of compromise, the limitations expressed in statutory terms often 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- Page Proof Pending Publication 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- Cite as: 605 U. S. 1 (2025) 21 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 Page Proof Pending Publication the wrong conclusion. To be specific: When 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 22 ADVOCATE CHRIST MEDICAL CENTER v. KENNEDY 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 beneficiaries. 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- Page Proof Pending Publication 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 reimbursements. Empire 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- Cite as: 605 U. S. 1 (2025) 23 Jackson, J., dissenting 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. Page Proof Pending Publication 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 ADVOCATE CHRIST MEDICAL CENTER v. KENNEDY Jackson, J., dissenting 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 Page Proof Pending Publication 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 participants with meaning ful reassurance. Poverty in America is a plague of uncertainty marked by persistent in- stability—what others have called “the constant fear that it Cite as: 605 U. S. 1 (2025) 25 Jackson, J., dissenting 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 bills paid? If one extra thing 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 Page Proof Pending Publication 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 the basis of his income and resources shall, in accordance 26 ADVOCATE CHRIST MEDICAL CENTER v. KENNEDY Jackson, J., dissenting 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 “shall be an eligible individual for purposes of this 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- ual's countable income 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 Page Proof Pending Publication 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 Cite as: 605 U. S. 1 (2025) 27 Jackson, J., dissenting 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. Page Proof Pending Publication 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 ADVOCATE CHRIST MEDICAL CENTER v. KENNEDY 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 fo