Abney v. State Dept. of Health Care Services

CourtCalifornia Court of Appeal
DecidedJanuary 31, 2024
DocketA164775
StatusPublished

This text of Abney v. State Dept. of Health Care Services (Abney v. State Dept. of Health Care Services) is published on Counsel Stack Legal Research, covering California Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Abney v. State Dept. of Health Care Services, (Cal. Ct. App. 2024).

Opinion

Filed 1/31/24 CERTIFIED FOR PUBLICATION

IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA

FIRST APPELLATE DISTRICT

DIVISION TWO

DEBRA ABNEY, Plaintiff and Appellant, A164775 v. STATE DEPARTMENT OF (San Francisco City & County HEALTH CARE SERVICES et al., Super. Ct. No. CPF20517020) Defendants and Respondents.

In 2018, the Social Security Administration notified appellant Debra Abney that it would begin withholding almost $600 from her Social Security payment each month to satisfy a debt she owed the IRS. The City and County of San Francisco (the County) subsequently notified Abney that it would consider the garnished money as income for the purposes of calculating her eligibility for benefits under Medi-Cal, making her ineligible to receive those benefits without a share of cost. Abney unsuccessfully sought writs of administrative mandate and ordinary mandamus seeking to reverse that decision, the trial court rejecting her argument that the tax garnishment was not income “actually available to meet [her] needs” under the regulations implementing the Medi-Cal program. We also reject the argument, and we affirm.

1 BACKGROUND Medicaid and Medi-Cal Medi–Cal is California’s program under the joint federal-state program known as Medicaid. (Welf. & Inst. Code, § 14000 et seq.) Medicaid provides federal financial assistance to participating states to support the provision of health care services to certain categories of low-income individuals and families, including the aged, blind, and disabled, as well as pregnant women and others. (42 U.S.C. § 1396 et seq.) Because California has opted to participate in the Medicaid program and receive federal matching funds, it must comply with all federal Medicaid requirements. (Conlan v. Bontá (2002) 102 Cal.App.4th 745, 753.) Among other things, the state must administer its Medicaid program through a plan that has been approved by the federal Centers for Medicare and Medicaid Services. (See 42 U.S.C. § 1396a; 42 C.F.R. §§ 430.10, 430.15(b) (2014); Welf. & Inst. Code, § 14100.1.) Respondent, the California Department of Health Care Services (Department), is the state agency that administers Medi-Cal, but counties are responsible for eligibility determinations, subject to the direction of the Department. (Welf. & Inst. Code, § 14100.1; Cal. Code Regs.,1 tit. 22, § 50004, subd. (c).) The federal Medicaid Act requires that a state plan must “include reasonable standards . . . for determining eligibility for and the extent of medical assistance under the plan which . . . provide for taking into account only such income and resources as are, as determined in accordance with standards prescribed by the Secretary [of Health and Human Services], available to the applicant or recipient . . . .” (42 U.S.C. § 1396a(a)(17).) A

1 Further undesignated citations are to Title 22 of the California Code

of Regulations.

2 state’s “methodology to be employed in determining income and resource eligibility for individuals . . . may be less restrictive, and shall be no more restrictive” than the federal Medicaid standard. (42 U.S.C. § 1396a(r)(2)(A); 42 C.F.R. § 435.601(d).) California offers several different Medi–Cal programs, including, as relevant here, the Aged, Blind, and Disabled Federal Poverty Level Program (ABD FPL) and the Aged, Blind and Disabled Medically Needy Program (ABD MN). (42 U.S.C. §§ 1396a(a)(10)(A)(ii)(X), (a)(10)(C); Welf. & Inst. Code, §§ 14005.7, 14005.40.) The ABD FPL program provides medical coverage to eligible California residents with no share of cost, provided that their “[c]ountable income, as determined in accordance with Section 1902(m) of the federal Social Security Act (42 U.S.C. Sec. 1396a(m)), does not exceed” certain limits. (Welf. & Inst. Code, § 14005.40, subd. (c)(1) see id. subd. (c).) The ABD MN program allows individuals to receive Medi–Cal when their income exceeds the limits for the ABD FPL program. (See Welf. & Inst. Code, §§ 14005.7; 14005.) However, under the ABD MN program, recipients are required to pay a share of cost if they incur medical expenses in a given month. (Welf. & Inst. Code, §§ 14005.7, subds. (b), (c); 14005.9.) Under California’s Medi–Cal regulations, “Income includes benefits in cash or in kind” from various sources, but income “shall be considered as income only if it is currently available in accordance with Sections 50513 through 50517.” (Cal. Code Regs., tit. 22, § 50501, subds. (a), (b).) The referenced regulations provide that “[o]nly income which is actually available to meet the needs of a person or family shall be considered in determining that person’s or family’s share of cost,” and similarly, “[i]ncome which is not available to meet current needs of a person or family shall not be considered

3 in determining that person’s or family’s share of cost.” (Cal. Code Regs., tit. 22, § 50513, subd. (a); Cal. Code Regs., tit. 22, § 50515, subd. (a).) Abney’s Medi–Cal Benefits Since at least November 1, 2011, Abney has been receiving Medi–Cal benefits—initially through the ABD FPL program—for a household of one. On November 2, 2018, the Social Security Administration sent Abney an award letter informing her that it would begin withholding $598.20 from her monthly Social Security payment “to pay your debt to the IRS,” leaving her with a monthly Social Security payment of $845.80. On March 19, 2019, the County sent Abney a “Notice of Action,” informing Abney that her Medi–Cal share of cost had changed to $729 per month beginning April 1, 2019. The County determined that Abney had gross unearned income of $1,484.50, and after an income deduction of $155 and a $230 disregard, a net non-exempt income of $1,099, exceeding the ABD FPL income limit of $1,041, and making her ineligible for that program. However, the County calculated that Abney was eligible for “Regular Medi– Cal” with a $729 monthly share of cost, based on an income deduction of $155.50 and a “maintenance need” of $600. On June 10, Abney requested an administrative hearing on the Notice of Action. Abney submitted a statement of position, arguing that the $598.20 withheld from her Social Security payment was not “income which is actually available to meet [her] needs” within the meaning of section 50513, subdivision (a), and should not have been included in determining her Medi– Cal eligibility. A hearing was held on September 26, and on December 3, the administrative law judge denied Abney’s claim, relying on Title 20, section 416.1123, subdivision (a)(2) of the Code of Federal Regulations, which provides: “We also include more [of your unearned income] than you actually

4 receive if amounts are withheld from unearned income because of a garnishment, or to pay a debt or other legal obligation, or to make any other payment such as payment of your Medicare premiums.” The Proceedings Below On February 13, 2020, Abney filed in San Francisco County Superior Court a combined petition for writ of administrative mandate under Code of Civil Procedure sections 1094.5 and ordinary mandamus under Code of Civil Procedure section 1085.

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Abney v. State Dept. of Health Care Services, Counsel Stack Legal Research, https://law.counselstack.com/opinion/abney-v-state-dept-of-health-care-services-calctapp-2024.