There’s a quiet shift happening in hospital finance, and if your team hasn’t felt it yet, you likely will soon.

The recent Supreme Court decision in Advocate Christ Medical Center v. Kennedy didn’t make national headlines, but the implications are real and immediate for hospitals that rely on DSH support. The Court ruled that only Medicare patients who received a cash SSI payment during their hospital stay can be included in DSH calculations. It’s a narrower definition than many hospitals were counting on.

On paper, it might seem like a technical clarification. But in practice, it means millions, if not billions of dollars, will no longer show up on cost reports for hospitals serving many dual-eligible patients. For many, this isn’t a theoretical concern; it’s a line item that has just vanished from the budget.

Still, this isn’t the first time Washington has shifted the goalposts. Anyone who’s worked in hospital finance knows these moments come in waves. What tends to separate those who weather the storm from those who feel it hardest isn’t who lobbies hardest; it’s who adapts fastest.

We’ve seen this firsthand. Over the past three decades, our team at RCA has worked with hospitals through policy swings, funding cuts, and program sunsets. The organizations that come out stronger are the ones that double down on what they can control. That usually starts with getting to patients sooner, meeting them before discharge, and uncovering eligibility that otherwise would’ve gone unnoticed. There’s often more there than meets the eye, such as Medicaid, SSI, and old insurance plans, but only if someone is looking. Plans that focus on revenue capture will be necessary.

We built our platform and tools around that challenge, like our conversational AI bot, Elly. Technology can’t replace your team but can massively expand its reach. That’s how we think: augment staff time, more captured revenue, better patient outcomes.

And while this Supreme Court ruling is final, the policy environment isn’t frozen. States like Texas and Illinois are experimenting with funding models to ease the pressure on safety-net hospitals. Some programs are already in motion, and more are on the table. We’re tracking them closely and helping our clients navigate what’s available.

If you’re leading a hospital that’s bracing for this change or trying to figure out what it means for your next fiscal year, you’re not alone. This is the kind of inflection point that rewards preparation overreaction.

We’re happy to share what we see, walk through potential exposure, or even run a scenario based on your specific payer mix. Just reach out. This isn’t the end of the road; it’s just a bend, and we need to slow down and plan…together.