Morris v. Williams

433 P.2d 697, 67 Cal. 2d 733, 63 Cal. Rptr. 689, 1967 Cal. LEXIS 261
CourtCalifornia Supreme Court
DecidedNovember 20, 1967
DocketSac. No. 7817
StatusPublished
Cited by249 cases

This text of 433 P.2d 697 (Morris v. Williams) is published on Counsel Stack Legal Research, covering California Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Morris v. Williams, 433 P.2d 697, 67 Cal. 2d 733, 63 Cal. Rptr. 689, 1967 Cal. LEXIS 261 (Cal. 1967).

Opinions

SULLIVAN, J.

— We are called upon to inquire into the validity of certain amended regulations of the Health and Welfare Agency reducing benefits provided under the California Medical Assistance Program, popularly known as MediCal. Accordingly, as required by long established and unassailable California precedents, we here discharge our responsibility to determine whether the Agency has acted in obedience to the mandate of the Legislature or has ignored or violated it. [1] Our function is to inquire into the legality of the regulations, not their wisdom. Nor do we superimpose upon the agency any policy judgments of our own. [2] Administrative regulations that violate acts of the Legislature are void and no protestations that they are merely an exercise of administrative discretion can sanctify them. They must conform to the legislative will if we are to preserve an orderly system of government.

As we shall explain, we have concluded that the regulations under review are violative of the pertinent law in two major respects: (1) by restricting physicians’ services for recipients of public assistance without eliminating the medically indigent from the Medi-Gal program; and (2) by eliminating certain services entirely in the absence of a showing that proportionate reductions were not feasible to some extent. We hold that the trial court properly enjoined their implementation. We therefore affirm the judgment.

Plaintiff, a recipient of welfare assistance eligible for MediCal benefits, commenced the instant class action on behalf of himself and all other persons eligible for assistance under the Medi-Cal program 1 for the purpose of challenging the [738]*738validity of the regulations. Defendants 2 appeal3 from the ensuing judgment declaring the regulations invalid and permanently enjoining their implementation.4

The Medi-Cal program is found in chapters 7 and 8 of part 3 of division 9 of the Welfare and Institutions Code (§ 14000 et seq.).5 6These statutes were enacted by the Legislature at the 1965 Second Extraordinary Session in order to establish a program of basic and extended health care services for recipients of public assistance and for medically indigent persons (§§ 14000 et seq., 14500 et seq.) and, by meeting the requirements of federal law, to qualify California for the receipt of federal funds made available under title XIX of the Social Security Act. An outline of the pertinent provisions of these statutes is essential to a grasp of the issues now presented to us.

The Federal Statute

Title XIX, enacted by Congress in 1965 as Public Law 89-97, authorizes the Secretary of Health, Education and Welfare to make payments to states whose medical assistance programs meet the requirements of the statute. (42 U.S.C.A. § 1396.)° A state plan must cover individuals receiving aid or [739]*739assistance under federally aided state programs for the aged, blind, disabled, and needy families with children; these groups must be treated equally. Persons who do not meet the income requirements for such aid or assistance may also be covered, but in “amount, duration, or scope” no greater than extended to cash recipients. (42 U.S.C.A. § 1396a(a) (10).)7 A state must provide at least five categories of medical assistance : inpatient hospital services; outpatient hospital services; other laboratory and X-ray services; skilled nursing home services; and physicians’ services, wherever furnished. (42 [740]*740U.S.C.A. §§ 1396a(a) (13),8 1396d(a) (1-5).9) The plan may not require any contribution by the individual towards payment for inpatient hospital services. (42 U.S.C.A. § 1396a (a) (14) (A).)

In addition to these and other specific requirements, the federal statute provides that the Secretary “shall not make payments . . . unless the State makes a satisfactory showing that it is making efforts” to broaden “the scope of the care and services made available under the plan” and to liberalize “the eligibility requirements for medical assistance, with a view toward furnishing by July 1, 1975, comprehensive care and services to substantially all individuals who meet the plan’s eligibility standards. . . .” (42 U.S.C.A. § 1396b(e).)

The California Statute

As previously stated, the Medi-Cal program provides for basic health care (eh. 7) and extended health services (ch. 8). It is the purpose of chapter 7 “to afford basic health care and related remedial or preventive services to recipients of public assistance and to medically indigent aged and other persons, including related social services which are necessary for those receiving health care under this chapter and Chapter 8 (commencing with Section 14500).” (§ 14000, 1st par.) The Legislature expressed its intent to provide through chapter 7 “for basic health care for those aged and other persons, including family persons who lack sufficient annual income to meet the costs of health care, and whose other assets are so limited that their application toward the cost of such care would jeopardize the person or family’s future minimum self-maintenance and security.” (§ 14000, 2d par.) It also expressed its intent “that the scope and duration of health services under this chapter and Chapter 8 (commencing with Section 14500) [741]*741shall be at least equivalent to the level provided in 1964-65 under public assistance programs.” (§14000.1.) “Basic health care . . . may include diagnostic, preventive, corrective, and curative services and supplies essential thereto . . . for conditions that cause suffering, endanger life, result in illness or infirmity, interfere with capacity for normal activity including employment, or for conditions which may develop into some significant handicap.” (§14059.) The specific categories of basic health care are those listed in the federal statute. (§ 14053, following 42 U.S.C.A. § 1396d.)

The Legislature authorized the Administrator of the Health and Welfare Agency to administer the program. Section 14105,10 reenacted by chapter 104 of the 1967 statutes, contains the legislative mandate: “The director [the Administrator of the Health and Welfare Agency, as defined in section 14060] shall prescribe the policies to be followed in the administration . . . [of the program] and the scope of the services to be provided, and may limit the rates of [742]*742payment for such services, and shall adopt such rules and regulations as are necessary for carrying out, not inconsistent with, the provisions [of the statute], . . . Insofar as practical, consistent with the efficient and economical administration of this part, the department [the Health and Welfare Agency, as defined in section 14062] shall afford recipients of public assistance free choice of arrangements under which they shall receive basic health care. ...”

Section 14105 further requires that “In establishing the scope of services to be provided, the director shall provide for recipients [of public assistance] at least for a minimum coverage”—defined by section 14056 as the five basic services required by 42 H.S.C.A. § 1396a(a) (13) (see fns.

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Cite This Page — Counsel Stack

Bluebook (online)
433 P.2d 697, 67 Cal. 2d 733, 63 Cal. Rptr. 689, 1967 Cal. LEXIS 261, Counsel Stack Legal Research, https://law.counselstack.com/opinion/morris-v-williams-cal-1967.