Ashtabula County Medical Center v. Sebelius, 762 F. Supp. 2d 1

Plaintiffs are five Medicare-participating hospitals in Ohio seeking additional Medicare DSH payments for services to beneficiaries.
They challenge the Secretary of Health and Human Services' interpretation of the Medicare statute's DSH formula as applied to HCAP.
DSH payments are based, in part, on counting patients eligible for medical assistance under a State plan approved under Medicaid but not entitled to Medicare.
Ohio's HCAP requires indigent patients to receive basic hospital services at no charge, but Ohio does not reimburse hospitals for HCAP costs.
Plaintiffs argue HCAP patients should be included in DSH calculations; Secretary argues HCAP patients are not eligible for Medicaid and thus not counted.
The court denies plaintiffs' summary judgment and grants the Secretary's summary judgment based on Adena precedent.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether HCAP patients are eligible for medical assistance under Medicaid for DSH.	Adena-like inclusion of HCAP.	HCAP not Medicaid-eligible; not within DSH statute.	HCAP not eligible; not included in DSH.
Whether the Secretary's interpretation of 'medical assistance' in the DSH provision aligns with the Medicaid statute.	Term should include HCAP as medical assistance.	Medical assistance mirrors Medicaid; excludes HCAP.	Consistent with Medicaid meaning; excludes HCAP.
Whether Adena controls the outcome of the case.	Adena supports including HCAP.	Adena supports excluding HCAP.	Adena controls; favor Secretary.
Whether the court should adopt a statutory reading different from the Secretary's interpretation.	Statutory language is plain and favors inclusion.	Statutory language, as read by Adena, supports exclusion.	Court adopts Adena-based interpretation; favorable to Secretary.

Adena Reg'l Med. Ctr. v. Leavitt, 527 F.3d 176 (D.C. Cir. 2008) (HCAP not part of Medicaid state plan; 'medical assistance' has Medicaid meaning in DSH provision)