How should the phrase “entitled to supplementary security income benefts . . . under subchapter XVI” be interpreted when calculating the Medicare fraction for a hospital's disproportionate share hospital (DSH) adjustment? Specifically, does this include all patients enrolled in the SSI system or only those eligible for a cash payment during their month of hospitalization? The resolution determines the amount of additional funding hospitals receive for treating low-income Medicare patients under 42 U.S.C. § 1395ww(d).

• The phrase "entitled to [SSI] benefits" should encompass all patients enrolled in the SSI system at the time of hospitalization, regardless of whether they were entitled to a cash payment during that specific month.
• SSI benefits include non-cash benefits, such as vocational rehabilitation services and continued Medicaid coverage under 42 U.S.C. § 1382h(b).
• Eligibility for SSI benefits persists from the moment an individual enters the system until they have been ineligible for a cash payment for 12 consecutive months, per 42 U.S.C. § 1383(j)(1)(B).
• A broader interpretation better advances Congress's purpose of providing critical funding to hospitals that serve a disproportionately high percentage of the neediest patients.

• The phrase refers only to patients who are entitled to receive an SSI cash payment during the month in which they were hospitalized.
• SSI benefits under subchapter XVI are fundamentally cash benefits, as evidenced by the statutory language regarding payments and dollar amounts.
• Statutory eligibility for these benefits is determined on a monthly basis based on the individual's income and resources for that specific month.

• The Court held that 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.
• The Court reasoned that SSI benefits are strictly cash benefits, noting that 42 U.S.C. § 1381a states eligible individuals "shall . . . be paid benefts" and 42 U.S.C. § 1382(b)(1) quantifies these benefits in specific dollar amounts.
• The Court determined that eligibility is a monthly inquiry, citing 42 U.S.C. § 1382(c)(1), which mandates that eligibility "for a month shall be determined" based on characteristics "in such month."
• Following *Becerra v. Empire Health Foundation*, the Court treated the term “entitled” as synonymous with “qualifying” or “being eligible.”
• The Court rejected the argument that non-cash benefits count, finding that vocational rehabilitation services are housed under subchapter XI (42 U.S.C. § 1320b–19) rather than subchapter XVI, and Medicaid coverage under 42 U.S.C. § 1382h(b) merely aids in the administration of the Medicaid program (subchapter XIX).
• The Court dismissed the theory that eligibility lasts until a 12-month reapplication period, ruling that 42 U.S.C. § 1383(j)(1)(B) is a housekeeping measure and does not override the monthly determination required by 42 U.S.C. § 1382(c).
• The Court distinguished *Empire Health* by noting that Medicare Part A provides automatic, ongoing insurance, whereas SSI benefits are welfare payments that fluctuate based on monthly income and resources.
• Finally, the Court refused to rewrite the statutory formula to better achieve a policy goal, citing *Bartenwerfer v. Buckley* for the principle that "no statute pursues a single policy at all costs."