Maresh v. State, Dept. of Health and Welfare ex rel. Caballero

Citation970 P.2d 14,132 Idaho 221
Decision Date24 November 1998
Docket NumberNo. 23964,23964
PartiesJudy MARESH, Plaintiff-Appellant, v. STATE of Idaho, DEPARTMENT OF HEALTH AND WELFARE, by and through its Director, Linda CABALLERO, Defendant-Respondent. Moscow, September 1998 Term
CourtUnited States State Supreme Court of Idaho

J. Carl Mickelsen, Moscow, for appellant.

Alan G. Lance, Attorney General; Marcy J. Spilker, Deputy Attorney General, Lewiston, for respondent. Marcy J. Spilker argued.

SILAK, Justice.

NATURE OF THE CASE

This is an appeal to determine whether respondent Department of Health and Welfare (the Department) was required to follow the procedures which govern contested cases as established in the Idaho Administrative Procedure Act (IDAPA) when the Department denied the application of appellant Judy Maresh to participate in a day treatment group conducted by the Department. For the reasons explained below, we affirm the judgment of the district court.

I. FACTS AND PROCEDURAL BACKGROUND

On June 19, 1995, Judy Maresh applied for mental health services from the Department by requesting that she be allowed to participate in the Division of Mental Health's Moscow Positive Action Club (MPAC), a day treatment group. Maresh went through the normal screening process conducted by the group's organizer, a Department employee.

In a letter dated July 10, 1995, Maresh was informed by the Department that she would not be allowed to join the MPAC group because the services provided by the MPAC group did not fit her needs, and would not be clinically appropriate. The Department did not inform Maresh of any available procedures or time limits for reconsideration, or other administrative relief pertaining to the denial of her request to join the MPAC treatment group.

Maresh filed a complaint for declaratory judgment claiming that a process for appeal of the Department's denial of her application for access to the MPAC group is required under the IDAPA. In granting the Department's motion for summary judgment, the district court held that the Department's denial of group treatment is not an "order" which triggers the contested case provisions of the IDAPA, and that the right to participate in the MPAC group is not a property interest protected by due process under either the Idaho or United States Constitutions. Maresh appeals from the district court's order granting the Department's motion for summary judgment.

II. ISSUES ON APPEAL

Maresh raises the following issues on appeal:

1. Whether the district court erred in holding that the Department was not required to follow the contested case provisions of the IDAPA;

2. Whether the district court erred in holding that Maresh was not entitled to the protection of procedural due process pursuant to the Fourteenth Amendment of the United States Constitution.

3. Whether the district court erred in holding that Maresh was not entitled to the protection of procedural due process pursuant to Article I, Section 13 of the Constitution of the State of Idaho.

III. STANDARD OF REVIEW

The parties do not controvert any material facts involved in this case. Indeed, the parties entered into a Stipulation of Facts before the district court. Thus, only questions of law are presented on this appeal.

This Court exercises free review over a district court's conclusions of law. Marshall v. Blair, 130 Idaho 675, 679, 946 P.2d 975, 979 (1997). Hence, this Court may substitute its view for that of the district court on the issues of law presented by this appeal. Id.; Standards of Appellate Review in State and Federal Courts, Idaho Appellate Handbook § 4.2 (1996).

IV. ANALYSIS
A. The District Court Correctly Held That The Department Was Not Required to Follow The Provisions of The IDAPA Governing Contested Cases.

Maresh contends that the Department failed to comply with the procedures required by IDAPA when it denied her request to participate in the MPAC group therapy treatment. In particular, she contends that the Department was required to follow the provisions of the IDAPA which govern contested cases.

With regard to contested cases, Section 67-5240 of the Idaho Code states, in pertinent part, that, "[a] proceeding by an agency, ... that may result in the issuance of an order is a contested case and is governed by the provisions of this chapter." I.C. § 67-5240. Consequently, the provisions of IDAPA governing contested cases must be followed when an agency engages in a proceeding that may result in the issuance of an order. I.C. § 67-5240 (1995).

It is undisputed that the Department is an agency as defined by IDAPA. As defined by IDAPA, " '[o]rder' means an agency action of particular applicability that determines the legal rights, duties, privileges, immunities, or other legal interests of one or more specific persons." I.C. § 67-5201(12) (Supp.1998). Whether there was a determination of the "legal rights, duties, privileges, immunities, or other legal interests" of Maresh turns on the interpretation of both the Regional Mental Health Services Act, I.C. §§ 39-3123 to 3139, and Title XIX of the Social Security Act, 42 U.S.C. §§ 1396-1396v. Maresh contends these statutes are sources of her legal right or other legal interest in the particular treatment for which she applied. For the reasons discussed hereafter Maresh's contentions are unpersuasive.

1. The Regional Mental Health Services Act.

The stated purpose of the Regional Mental Health Services Act (the Act) is to delegate the "responsibility and authority to establish and maintain regional comprehensive mental health services in order to extend appropriate mental health services." I.C. § 39-3123 (1998) (emphasis added). The Act recognizes that "it is the policy of the state to provide mental health services to all citizens in need of such care." Id. (emphasis added). It further recognizes that citizens have a right to "the best mental health services that the state is able to provide." I.C. § 39-3125 (emphasis added). These several parts of the Act indicate that no legal right, privilege or other legal interest is established absolutely in any particular type of treatment for any individual.

Moreover, Section 39-3127 does not mandate that every service be provided. Section 39-3127 of the Idaho Code merely lists services that may be offered in a comprehensive health center; it does not require that any particular services be provided nor that every service must be available to every applicant. I.C. § 39-3127 (1998). Section 39-3127 states in pertinent part as follows:

"A regional mental health service shall include one (1) or more of the services leading to the establishment of a regional comprehensive mental health center. A comprehensive mental health center may include such services as:

(1) Short-term hospitalization for psychiatric treatment in an approved medical facility within the region;

(2) Partial hospitalization;

(3) Outpatient diagnosis and treatment;

(4) 24-hour emergency psychiatric services;

(5) Community consultation and education;

(6) Diagnostic services for other agencies;

(7) Rehabilitative services;

(8) Precare and postcare services in cooperation with a state mental hospital;

(9) Training of mental health personnel;

(10) Research and evaluation. [1969, ch. 202, § 5, p. 589.]"

I.C. § 39-3127. By its terms, this section does not establish a legal right, privilege, or other legal interest in any particular treatment in favor of any individual. Section 39-3127 does not establish a legal right, privilege, or other legal interest of Maresh in participating in the MPAC treatment.

The statutory scheme of the Act allows for the type of clinical determination at issue in the instant case. The Department's denial of Maresh's application to participate in the MPAC group did not determine that Maresh had no right to any treatment; rather it determined that the particular treatment she applied for was not appropriate. In fact, the Department determined that the MPAC treatment services were not clinically appropriate because Maresh's needs would not be met through the group and that her disruptive behavior in past interactions caused concern for the welfare of the other clients in the group.

2. Title XIX of the Social Security Act.

"Title XIX of the Social Security Act establishes Medicaid and authorizes grants to states in order to finance medical care for indigent Americans." McCoy v. State, 127 Idaho 792, 794, 907 P.2d 110, 112 (1995); 42 U.S.C. §§ 1396-1396v (1992). Although states participating in the Medicaid program are required to give care to eligible individuals in at least seven general categories, they are given considerable flexibility in determining the scope of coverage they must provide. McCoy v. State, 127 Idaho at 794, 907 P.2d at 112. Title XIX does not require that a state provide funding for all medical treatment falling within one of these general service categories. Id. (citing Beal v. Doe, 432 U.S. 438, 444, 97 S.Ct. 2366, 2371, 53 L.Ed.2d 464 (1977)).

Further, neither Title XIX nor the federal regulations explicitly provide that coverage of every procedure that a physician deems medically necessary is required. McCoy v. State, 127 Idaho at 794, 907 P.2d at 112. "The Medicaid program is not intended to meet all the medical needs of recipients. Rather, the goal is to provide medical assistance 'as far as practicable under the conditions in [each] state.' " Bumpus v. Clark, 702 F.2d 826, 827 (9th Cir.1983). There is no indication in the Medicaid statutes upon which Maresh relies that Congress intended to establish legal rights or other legal interests in the particular type of treatment services which Maresh requested. Consequently, the Medicaid provisions relied upon by Maresh do not confer upon her a legal right or interest in the particular treatment she sought. See, e.g., O'Bannon v. Town Court Nursing Center, 447 U.S. 773, 100 S.Ct. 2467, 65 L.Ed.2d 506 (1980) (holding that similar Medicaid provisions upon which the...

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