Cooper University Hospital v. Sebelius, No. 08-3781; U.S. District Court (DNJ); opinion by Simandle, U.S.D.J.; filed September 28, 2009.
Plaintiff Cooper University Hospital requests judicial review of the decision of the administrator of the Centers for Medicare and Medicaid Services (CMMS) of the Department of Health and Human Services, which indirectly limits the amount of additional Medicare funding plaintiff may receive as a hospital serving a significantly disproportionate number of low-income patients. Cooper University Hospital seeks to count its New Jersey Charity Care Program (NJCCP) patients in its Medicare disproportionate share hosptial (DSH) calculation. The NJCCP is a state program that covers some or all of the costs for uninsured hospital patients who are “ineligible for any private or governmental sponsored coverage (such as Medicaid).” Hospitals are reimbursed for their NJCCP costs through the Health Care Subsidy Fund, which itself receives partial funding through Medicaid DSH payments. NJCCP patients are included in the calculation of Medicaid DSH payments under New Jersey’s Medicaid plan, and charity-care subsidy payments are described in the approved New Jersey state Medicaid plan.
