Clark v. Coye, 92-15131
| Citation | 1992 WL 140278,967 F.2d 585 |
| Decision Date | 23 June 1992 |
| Docket Number | No. 92-15131,92-15131 |
| Parties | NOTICE: Ninth Circuit Rule 36-3 provides that dispositions other than opinions or orders designated for publication are not precedential and should not be cited except when relevant under the doctrines of law of the case, res judicata, or collateral estoppel. Virginia CLARK, Plaintiff-Appellee, v. Molly Joel COYE, M.D., M.P.H., Director, State Department of Health Services Defendant-Appellant |
| Court | United States Courts of Appeals. United States Court of Appeals (9th Circuit) |
Before REINHARDT and KOZINSKI, Circuit Judges, and EZRA, District Judge *
The Medicaid program is designed to provide necessary medical services to individuals who otherwise could not afford them. California is not required to participate in the program, but because it has chosen to do so through the California Medicaid Assistance Program ["Medi-Cal"], Medi-Cal must be operated in compliance with federal law.
Appellees filed a lawsuit in December of 1987 that asserted, inter alia, that inadequate reimbursement rates paid to dentists who participated in the dental component of Medi-Cal ["Denti-Cal"] severely hindered the ability of Medi-Cal recipients to obtain necessary dental care and violated federal law. On October 28, 1988, the district court certified plaintiffs as the representatives of a subclass consisting of:
All persons who are eligible or will be found eligible for the California Medical Assistance Program ("Medi-Cal"), who seek or will seek dental care on a fee-for-service basis under the program, and who:
(1) do not or will not have available to them such services to the extent that those services are available to the general population by virtue of the Department of Health Services ("DHS") provider rates and claims processing procedures; and/or (2) are or will be unable to obtain in their respective counties the full range of dental care covered by the Medi-Cal program.
Appellees' motion for partial summary judgment was heard on August 27, 1990. On October 3, 1990, the district court granted the motion in part and denied it in part. The district court found that Denti-Cal dentists were being reimbursed at rates 50% below their actual cost of providing services, that only half of the dentists in California had treated any Denti-Cal patients, that only 12.5% of dentists would accept any such new patients, and that Denti-Cal patients faced great difficulty in obtaining dental treatment under the program. See Clark v. Kizer, 754 F.Supp. 572, 576-78 (E.D.Cal.1990). The court also found that the manner in which the Medi-Cal program was operated violated the equal access, statewide availability, timely care, and comparable services provisions of the Medicaid Act, 42 U.S.C. § 1396a et. seq. See id. at 573-78.
On November 13, 1990, the district court filed an Order Granting Summary Judgment and a Permanent Injunction that resolved the liability issue and required the appellants to file "a plan for complying with 42 U.S.C. § 1396a(a)(30)(A), that significantly increases payment rates to dentists so that dental care and services will be available to Medi-Cal recipients at least to the extent these services are available to the general population with insurance in the same geographic areas." The Order required appellants to develop a plan to remedy its violations of Medi-Cal recipients' rights under 42 U.S.C. § 1396a to equal access to dental care, statewide availability of care, timely receipt of care, and comparability of services in the Medi-Cal program.
The parties thereafter elected to proceed before a magistrate judge on the issue of remedies. In late 1990 and early 1991, appellants submitted a plan which they contended met the requirements of the district court's order. Appellees claimed that the plan would not bring the Denti-Cal program into compliance either with the order or with federal law, and, in response, proposed an alternate plan of their own. The key difference in the two plans was the differing reimbursement levels paid to Denti-Cal dentists: appellants' plan provided for payments of only 55% of the average amount billed by Denti-Cal providers, while appellees' plan provided for 80% of that average amount. In September of 1991, appellants--although they were not required to do so--voluntarily implemented the principal components of their proposal including the 55% reimbursement level.
After extensive hearings in late 1991, the magistrate concluded that under appellants' plan "most dentists will lose money by treating Medi-Cal recipients" and that the plan "d[id] not meet the requirement of 42 U.S.C. § 1396a(30)(A) that care and services [be] available to the extent that such care and services are available to the general population with insurance in the same geographic areas." The magistrate further found that the appellees' 80% reimbursement figure "allows a reasonable compensation to a dentist providing service" under the Denti-Cal program and "is reasonably calculated to make dental services available in each geographic area to the extent that they are available to the general public with insurance." The magistrate then accepted the appellants' plan, but with a single--though critical--modification: he adopted the appellees' suggestion of an 80% reimbursement level instead of the 55% level proposed by the state. In a final judgment entered on January 13, 1992, the magistrate ordered the modified plan--including the 80% reimbursement rate--to be put into effect on or before February 1, 1992. The magistrate also ordered appellants to prepare various reports on the implementation and results of the newly-ordered plan: the reports were to begin on March 15, 1992 and end on September 15, 1992. 1
On January 17, 1992--four days after the...
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