Conlan v. Shewry

No. A106278 (Cal. Ct. App. Aug. 15, 2005) ; Clearinghouse Number: 54953

Description

California Must Comply with Previous Order to Reimburse Medicaid Recipients for Out-of-Pocket Expenses Incurred During Retroactivity Period

Abstract

The California Court of Appeal ordered the Department of Health Services to enforce a court order to enable certain Medi-Cal beneficiaries to obtain reimbursement. These are beneficiaries who incur out-of-pocket expenses for covered services during the three-month retroactivity period before they apply for assistance or during the period between applying and being found eligible for benefits. Exasperated with department’s intransigence, the court described department’s positions variously as “preposterous” and “nonsensical.” Beneficiaries sought reimbursement directly from the state but under department’s process were entitled only to reimbursement from their health care providers, who could in turn seek reimbursement from the state. Providers had little incentive, nor could they be compelled, to do so. In 2002 the court of appeal ordered department to establish a process that would enable beneficiaries actually to receive reimbursement, as guaranteed under the Medicaid Act, 42 U.S.C. § 1396a(a)(34). In 2003 beneficiaries moved for enforcement; the trial court ordered department to file a compliance plan. Subsequent hearings addressed various issues, including notice to beneficiaries of their right to reimbursement. In March 2004 department cast a trial court order as a denial of department’s motion to approve its compliance plan and filed a notice of appeal. The court of appeal said that the order was not appealable and that department, contrary to court rules, did not explain in its brief why the order was appealable. Nonetheless, given the passage of time during which “Department’s procedures remain out of compliance with the requirements of federal law,” and to avoid further prolongation of the proceedings, the court of appeal treated the “purported appeal” as a petition for extraordinary relief. With minor qualifications, the court of appeal concluded that the trial court properly interpreted its earlier opinion and ordered department to comply without delay.

Additional Information

Attorney Information
Respondent represented by Richard Rothschild, Robert Newman, Catherine Murphy, Western Center on Law and Poverty, 3701 Wilshire Blvd., Suite 208, Los Angeles, CA 90010 (213.487.7211).
Docket Date
2005-08-15 00:00:00+00:00
Attorney Email
rrothschild@wclp.org