Brown v. County Com'rs of Carroll County

• Decision Date: 01 September 1994
• Docket Number: No. 61,61
• Citation: 338 Md. 286,658 A.2d 255
• Parties: Melvin BROWN, v. COUNTY COMMISSIONERS OF CARROLL COUNTY. ,
• Court: Maryland Court of Appeals

Page 286

338 Md. 286

658 A.2d 255

Melvin BROWN, v. COUNTY COMMISSIONERS OF CARROLL COUNTY.

No. 61, Sept. Term, 1994.

Court of Appeals of Maryland.

May 17, 1995.

Franklin M. Johnson, Jr., Legal Aid Bureau, Inc., of Silver Spring (Susan Stauffer, Legal Aid Bureau, Inc. of Frederick), on brief, for appellant.

Charles W. Thompson, Jr., County Atty. for Carroll County (Mary J. Murphy, Asst. County Atty., both on brief), Westminster, for appellee.

Carmen M. Shepard, Asst. Atty. Gen. (Kathleen S. Hoke, Staff Atty., J. Joseph Curran, Jr., Atty. Gen., on brief), Baltimore, amicus curiae.

Argued before MURPHY, C.J., and ELDRIDGE, RODOWSKY, CHASANOW, KARWACKI, BELL, and RAKER, JJ.

CHASANOW, Judge.

In the present case, we must determine whether an indigent pretrial detainee may be held personally liable for the costs of medical treatment received while incarcerated, despite the fact that he may have been covered under the Maryland Medical Assistance Program for most of the period of his detention.

I.

Melvin Brown was arrested on April 28, 1991 as a result of an altercation in which he was injured. Brown was unable to post bail and was therefore held at the Carroll County Detention Center until his release on September 26, 1991. At the time of his incarceration, Brown executed a "Health Services Consent Form," which authorized the provision of medical services to Brown by the Detention Center. The consent form further provided:

"I UNDERSTAND THAT ALL NECESSARY MEDICAL CARE WILL BE PROVIDED, BUT FURTHER

UNDERSTAND THAT ALL MEDICAL CARE PROVIDED OUTSIDE OF THE DETENTION CENTER (i.e. OPTICAL, DENTAL, HOSPITAL, ETC.) WILL BE DONE AT MY OWN EXPENSE. IF THERE IS A BALANCE DUE FOR MEDICAL CARE WHEN I AM TRANSFERRED OR RELEASED FROM CUSTODY, I UNDERSTAND IT IS MY OBLIGATION TO PAY THIS BALANCE. IF THE BALANCE IS NOT SATISFIED WITHIN 30 DAYS, IT MAY BE REFERRED TO THE COUNTY ATTORNEY FOR POSSIBLE CIVIL ACTION AGAINST ME."

At the time Brown entered the Detention Center, Brown had been certified by the Carroll County Department of Social Services as qualified for benefits under the Maryland Medical Assistance Program ("MA"), which provides coverage for indigent persons. ¹ As a recipient of Aid for Families with Dependent Children ("AFDC"), Brown was entitled to receive MA benefits from October 1, 1990 until May 31, 1991. Brown testified that when he entered the Detention Center, he was asked whether he had health insurance and he informed the personnel that he had MA coverage. He stated that he told personnel at the Detention Center that his MA card was in his wallet, which had been confiscated by the Detention Center, and that he was told that the Detention Center "would take care of it."

While incarcerated, Brown received various medical treatments outside of the Detention Center, including treatment at the Carroll County General Hospital on April 29, 1991 and a visit to an ophthalmologist's office on May 3, 1991. Additionally, on June 24, 1991, Brown was taken to a dentist's office to have several teeth extracted. The parties do not dispute that Brown did not qualify for benefits under MA for the dental treatment. The cost of all of the medical treatment Brown received totalled $649.60, which was paid by the Detention Center without seeking reimbursement under MA from the Department of Health and Mental Hygiene ("DHMH").

Subsequent to paying Brown's bills, the County Commissioners of Carroll County ("the County") sought reimbursement from Brown pursuant to Maryland Code (1957, 1991 Repl.Vol.), Article 87, § 46, ² and judgment was entered by the District Court against Brown in the amount of $649.60. Brown appealed to the Circuit Court for Carroll County which, following a de novo trial, granted judgment in favor of the County. We granted Brown's petition for a writ of certiorari to consider whether an indigent pretrial detainee may be held personally liable for medical costs incurred while incarcerated, despite the fact that he might be covered under Maryland MA for some of those charges.

II.

Brown and the County differ in their interpretations of the scope of benefits provided by MA. The MA program has both federal and state aspects. Also known as Medicaid, MA is funded by both the federal and state governments and is subject to regulations and statutes from both authorities. The federal Medicaid program is codified at 42 U.S.C. § 1396 et seq. (1988 & Supp. V 1993). Because Maryland participates in the Medicaid program through the MA program, it must comply with the governing federal statutes and regulations. Alexander v. Choate, 469 U.S. 287, 289 n. 1, 105 S.Ct. 712, 714 n. 1, 83 L.Ed.2d 661, 664 n. 1 (1985); Harris v. McRae, 448 U.S. 297, 301, 100 S.Ct. 2671, 2680, 65 L.Ed.2d 784, 794 (1980). Eligibility for individuals under MA is therefore governed by both federal and state statutes and regulations. We find no indication that Maryland's MA program is intended to be more restrictive or broader than the federal Medicaid regulations with regard to the issues in the instant case.

Brown and the County each rely on different interpretations of Art. 87, § 46 and Md.Code (1982, 1994 Repl.Vol.), Health-General Art., § 15-113 ³ to support their arguments regarding Brown's liability for the costs of his medical treatment. Article 87, § 46 provides in pertinent part:

"(b) The sheriff shall provide food and board for all prisoners committed to the sheriff's charge and food and other articles for the comfort of sick prisoners as the physician attending the prisoners may deem necessary, the expense of which shall be paid by the county or Baltimore City.

(c) Sick, injured, or disabled prisoners including those committed to the Commissioner of Pretrial Detention and Services shall be responsible for reimbursing the county or the State, as appropriate for the payment of all medical care, and shall furnish the sheriff with the following information:

(1) The existence of any health insurance, group health plan, or prepaid medical care coverage under which the prisoner is insured;

(2) The eligibility for benefits under the Maryland Medical Assistance Program to which the prisoner is entitled;

(3) The name and address of the third party payor; and

(4) The policy or other identifying number.

* * * * * *

(e) The liability for payment for medical care described under subsection[ ] (c) ... of this section may not be construed as requiring payment by any person or entity, except by a prisoner personally or through coverage or benefits described under subsection (c) of this section." (Emphasis added).

Section 15-113 of the Health-General Article provides:

"(a) 'Inmate of a public institution' defined.--In this section, 'inmate of a public institution' has the meaning stated in Title 42, § 435.1009 of the Code of Federal Regulations (1978 edition).

(b) Payment required.--(1) If an inmate of a public institution is eligible for federally funded Medicaid benefits, the Department [of Health and Mental Hygiene] shall pay the custodial authority for any medical care that is provided to the inmate during the month when the individual became an inmate.

(2) Payments under this subsection shall be made in accordance with applicable rules and regulations for the [Medical Assistance] Program.

(c) Reimbursement.--The Department shall be reimbursed for the nonfederal cost of medical care by either the State or local authority that is responsible for the inmate of a public institution."

Brown argues that he should not be held liable for any of the medical costs incurred on his behalf. He asserts that the Detention Center was not permitted to seek reimbursement from him before submitting a claim to DHMH for those costs which were covered under MA. Brown argues that reimbursement was available to the County during the first month of his incarceration under § 15-113. He further asserts that Art. 87, § 46(c)(2) would be meaningless if it required inmates or pretrial detainees to provide information regarding insurance and MA coverage, but did not require the County to utilize this information to seek reimbursement from these sources. Brown maintains that the consent form he signed is not a binding contract and that because, under the County's and the lower courts' interpretation, he would have been eligible for MA benefits had he been able to post bail, the denial of MA benefits only to those pretrial detainees who are unable to make bail is a violation of equal protection. Additionally, Brown claims that, even with regard to the dental bill for which he was not eligible for MA benefits, imposing the expense of medical treatment upon him without first establishing his ability to pay those costs is a violation of due process.

Relying on an opinion of the Attorney General that responded to an inquiry from the Baltimore City Solicitor regarding the exclusion of MA coverage for persons incarcerated in detention centers, see 75 Op. Att'y Gen. 1101 (1990), the County argues that pretrial detainees are not eligible for MA coverage. As set forth in the Attorney General's advisory opinion, the federal Medicaid program excludes inmates of public institutions from coverage. See 75 Op. Att'y Gen. at 1102. Under the federal system, Medicaid is denied to a person who is an inmate of a public institution, which is defined as "a person who is living in a public institution." 42 C.F.R. § 435.1009 (1993). Under the federal regulations, a person who might otherwise fall within the definition of an inmate is not considered an inmate if:

"(a) He is in a public educational or vocational training institution for purposes of securing education or vocational training; or

(b) He is in a public institution for a temporary period pending other arrangements appropriate to his needs." (Emphasis added).

Id. This second exception, the Attorney General and the County assert, does not apply to pretrial detainees because "there is nothing 'inappropriate' in...