On September 28, the District Court for the District of New Jersey ruled that Cooper University Hospital was not permitted to include patient days relating to "charity care" patients served under the New Jersey Charity Care Program (NJCCP) when calculating the Medicaid proxy portion of the hospital's Medicare disproportionate share hospital (DSH) patient percentage calculation. See Cooper University Hospital v. Sebelius, 2009 WL 3234625 (D.N.J. 2009). The NJCCP was part of New Jersey's Medicaid state plan, but the patient days at issue related to patients who were not eligible for traditional Medicaid. The hospital argued that because the NJCCP was part of the Medicaid state plan and the patient days at issue were counted for purposes of the Medicaid DSH payment calculation, the patient days also should be included in the Medicare DSH calculation. The court ruled against the hospital, holding that because the individual patients at issue were not eligible for "traditional Medicaid," the Secretary of HHS's interpretation that such patient days do not meet the Medicare DSH statute's requirement that patients be "eligible for medical assistance under a State plan approved under subchapter XIX" is permissible. This New Jersey district court ruling joins the D.C. Court of Appeals decision in Adena Regional Medical Center v. Leavitt, 527 F.3d 176 (D.C. Cir. 2008) in holding that inclusion of charity care patient days in the Medicaid DSH fraction does not necessarily equate to inclusion of those days in the Medicare DSH fraction. Adena Regional involved Ohio's Hospital Care Assurance Program, which covered similar non-Medicaid eligible patient populations to those covered by the New Jersey program at issue in Cooper University Hospital.