County of Colusa v. Douglas

227 Cal. App. 4th 1123, 174 Cal. Rptr. 3d 421, 2014 Cal. App. LEXIS 599
CourtCalifornia Court of Appeal
DecidedJuly 9, 2014
DocketC073624
StatusPublished
Cited by4 cases

This text of 227 Cal. App. 4th 1123 (County of Colusa v. Douglas) 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
County of Colusa v. Douglas, 227 Cal. App. 4th 1123, 174 Cal. Rptr. 3d 421, 2014 Cal. App. LEXIS 599 (Cal. Ct. App. 2014).

Opinion

Opinion

BUTZ, Acting P. J.

We conclude that Welfare and Institutions Code section 14053.1—under which the State of California, rather than its counties, pays for ancillary outpatient services for Medi-Cal eligible patients ages 21 to 64 in an “institution for mental diseases” (IMD)—remains a valid law. 1

In reaching this conclusion, we find that section 14053.1’s presence in the California statutes is not the result of a legislative amendment to a repealed act, which is a legislative action proscribed under Government Code section 9609, and further find that Welfare and Institutions Code section 14053.3 (which requires the state to recover from counties payments for certain ancillary services, when Medi-Cal coverage is unavailable) did not shift funding from the state to the counties for ancillary outpatient services, to Medi-Cal eligible IMD patients ages 21 to 64, and did not impliedly repeal section 14053.1. Accordingly, we shall reverse the judgment.

FACTUAL AND PROCEDURAL BACKGROUND

We draw much of our background from the able summary of facts and procedure the trial court provided in its ruling.

Medicaid, Medi-Cal, and Payment of Services for IMD Patients

Medicaid is a cooperative federal-state program under which the federal government and participating state governments share the costs of medical treatment generally for low-income individuals. (42 U.S.C. § 1396 et seq.) California’s Medicaid program is known as Medi-Cal. (§ 14000 et seq.)

IMD’s are hospitals, nursing facilities, and other institutions that primarily treat and care for patients with mental diseases. (42 U.S.C. § 1396d(i).) Nearly all individuals placed within IMD’s are gravely disabled by mental disease and unable to provide for themselves; most IMD patients qualify for Medi-Cal.

*1127 Under federal Medicaid law, the federal government does not pay for services to IMD patients between the ages of 21 and 65. (42 U.S.C. § 1396d(a)(xvii)(29)(B); Connecticut Dept. of Income Maint. v. Heckler (1985) 471 U.S. 524, 525 [85 L.Ed.2d 577, 579, 105 S.Ct. 2210].) The federal government deems long-term care in mental institutions a state responsibility; this policy is known as the “IMD exclusion” (hereafter, federal IMD exclusion). (Heckler, supra, 471 U.S. at p. 533, fn. 24 [85 L.Ed.2d at p. 584, fn. 24].) As to that exclusion, federal Medicaid law does not prohibit states from paying for IMD services as a “state-only” Medicaid benefit.

Statutory Scheme Involving State Medi-Cal Funding of IMD Ancillary Services

In 1999, California (the State) added a state-only Medi-Cal benefit by enacting section 14053.1. That section provides that the State will pay for “ancillary outpatient services” for IMD patients ages 21 to 64 (i.e., the patients within the federal IMD exclusion). “Ancillary outpatient services” generally constitute physician services, prescription drugs, x-rays, and laboratory, dental, vision, psychiatric and psychological services, performed outside the IMD.

After section 14053.1’s enactment in 1999, the State and the counties divided financial responsibility for IMD patients as follows: (1) For a patient within the federal IMD exclusion who is eligible for Medi-Cal, counties pay for the patient’s “core” (i.e., basic, institutional) IMD services, and the State pays for “ancillary outpatient” services and (2) for a patient within the federal IMD exclusion who is not eligible for Medi-Cal, counties generally pay for both the “core” services and the “ancillary outpatient” services (generally, persons who are not Medi-Cal eligible are undocumented persons). (§§ 5600 et seq., 5900-5912, 14053.1.)

Shortly after section 14053.1 was enacted in 1999, the Legislature amended it to include a one-year sunset provision. (Stats. 1999, ch. 146, § 39, p. 1917; Stats. 1999, ch. 148, § 2, p. 2028.)

The specific focus of this appeal involves two Assembly bills: Assembly Bill No. 2877 (1999-2000 Reg. Sess.) (hereafter, Assembly Bill 2877) and Assembly Bill No. 430 (2001-2002 Reg. Sess.) (hereafter, Assembly Bill 430) (collectively, Assembly Bills 2877 and 430), that concern subsequent sunsetting legislation regarding section 14053.1. Assembly Bill 2877, enacted in 2000, sought to extend the original sunset provision an additional year. (Stats. 2000, ch. 93, § 65, pp. 1463-1464.) And Assembly Bill 430, enacted in 2001, sought to eliminate the sunset provision altogether, thereby making section 14053.1 effective indefinitely. (Stats. 2001, ch. 171, § 38, p. 1859.) *1128 Assembly Bills 2877 and 430 each were enacted as urgency legislation budget trailer bills during fiscal year-end budget disputes that were typical at the time of their enactments. We will set forth the specific language of these two bills when we discuss them in detail later.

All parties agree that, at least until section 14053.3 was enacted in 2008, the State paid for ancillary outpatient services, in line with section 14053.1, for Medi-Cal eligible IMD patients within the federal IMD exclusion. Section 14053.3 requires the State Department of Mental Health (DMH) (now the State Department of Health Care Services or DHCS) 2 to recover IMD ancillary payments that were made to counties by the State (when Medi-Cal coverage is unavailable) or by the federal government (given the federal IMD exclusion).

Following section 14053.3’s enactment, the State—through a DHCS memorandum in 2009 (hereafter, DHCS 2009 Memorandum), and a DMH letter in 2010 (hereafter, DMH 2010 Letter)—(1) informed IMD’s that Medi-Cal (i.e., state funding) does not cover the costs of ancillary outpatient services for Medi-Cal eligible IMD patients within the federal IMD exclusion, and (2) directed health care providers of those services to bill counties, rather than the State, for such services. We will set forth section 14053.3’s language when we discuss it later.

Procedural Background

Twenty California counties (the Counties) have been plaintiffs in the lawsuit at issue here—a petition for writ of mandate and complaint for declaratory and injunctive relief against defendants the State and its pertinent officials (DHCS and DMH). 3

In their petition, the Counties allege that the DHCS 2009 Memorandum and the DMH 2010 Letter are invalid because (1) they are inconsistent with section 14053.1, which requires the State to pay for ancillary outpatient services for Medi-Cal eligible IMD patients within the federal IMD exclusion, and (2) they constitute underground regulations adopted in violation of the state Administrative Procedure Act (Gov. Code, § 11340.5, subd. (a)).

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Crestwood Behavioral Health, Inc. v. Baass
California Court of Appeal, 2023
City of Sunnyvale v. Bosler CA3
California Court of Appeal, 2021

Cite This Page — Counsel Stack

Bluebook (online)
227 Cal. App. 4th 1123, 174 Cal. Rptr. 3d 421, 2014 Cal. App. LEXIS 599, Counsel Stack Legal Research, https://law.counselstack.com/opinion/county-of-colusa-v-douglas-calctapp-2014.