County of Santa Clara v. Hall

Decision Date09 March 1972
CourtCalifornia Court of Appeals Court of Appeals
PartiesCOUNTY OF SANTA CLARA, Plaintiff and Appellant, v. James M. HALL, substituted as party defendant for Lucian B. Vandegrift, as Secretary of the Human Relations Agency of the State of California, and Earl W. Brian, Jr., M.D., as Director of the Department of Health Care Services of the State of California, Defendants and Respondents. Civ. 13195.

William M. Siegel, County Counsel, by Norman E. Matteoni, Deputy County Counsel, San Jose, for plaintiff-appellant.

Evelle J. Younger, Atty. Gen., by John Fourt, Deputy Atty. Gen., Sacramento, for defendants-respondents.

TAYLOR *, Associate Justice.

This is an action for declaratory and injunctive relief initiated by plaintiff, County of Santa Clara, as a fiscal partner of the State of California under the 'county option' provision of the Medi-Cal Program. It is directed against two State of California agencies, the Human Relations Agency and the Department of Health Care Services, which administer the Medi-Cal Program.

Santa Clara County operates the Santa Clara Valley Medical Center, a licensed general hospital, sometimes known as the 'county hospital.' It seeks to determine its right to coverage of certain health care costs incurred in hospital treatment of county jail prisoners and juvenile court wards under the 'county option' provision of the Medi-Cal Program as found in Welfare and Institutions Code section 14150.1; and, second, to restrain defendants from denying such coverage.

I

Generally, prior to the Medi-Cal Program, the Santa Clara Valley Medical Center provided care to the indigent of Santa Clara County. Upon introduction of the Medi-Cal Program its role changed. It was placed in competition with private hospitals because Medi-Cal patients were allowed a choice of medical facilities for treatment. But, a group of citizens, not covered by Medi-Cal and yet unable to afford medical care, remained the responsibility of plaintiff's hospital. This group of medically indigent persons included prisoners and juvenile court wards admitted for treatment at the hospital.

When the Medi-Cal law was proposed in 1965 there was concern among the counties that the competition of private hospitals with county hospitals would increase the costs of the latter hospitals. The provision establishing the county's contribution or share of cost obligation to the state Health Care Deposit Fund under the Medi-Cal Program was set out in proposed Welfare and Institutions Code section 14150. 1 Generally, it required contribution by the county to the Health Care Deposit Fund of certain specified sums plus an amount equal to 90 percent of the county cost of health care, uncompensated from any source in fiscal year 1964--1965 (the 'base year'), for all categorical aid recipients and other persons age 65 and over in the county medical institutions. Some counties were concerned that this method of contribution to the Health Care Deposit Fund would leave them with insufficient funds to provide hospital care for those persons not eligible for Medi-Cal. 2 To protect those counties, a new provision, section 14150.1, known as the 'county option,' was urged upon the Legislature and was adopted. The option provided, to each county electing its benefits, a plan whereby the county's contribution to the Health Care Deposit Fund would not exceed the total county costs of health care, uncompensated from any source in 1964--1965, for all categorical aid recipients and all other persons in the county hospital, adjusted annually for population increases.

The impetus for the Medi-Cal law was the federal participation available under the 1965 amendments to the Social Security Act. Generally, the financing of the Medi-Cal Program is participated in by the federal, state and county governments. However, under the 'county option' provision, federal participation was not available because the option was not a part of the federal law. Thus, it was financed only by the state and the counties.

The Medi-Cal law became operative March 1, 1966. Sections 14150 and 14150.1 were part of it. As of March 1, 1966, plaintiff elected to pay its share of cost into the program under the 'county option' provision and has operated on this basis at all times involved in this action.

Plaintiff included in its cost of health care, uncompensated from any source in the base year 1964--1965, services provided in its county hospital to inmates of county jails, juvenile halls and other custodial or correctional institutions. The base year calculation for plaintiff under section 14150.1 was the sum of $7,679,410; and each year of its participation plaintiff paid its share of the program based upon that amount as adjusted by a population factor.

Plaintiff has billed and received payment from the Health Care Deposit Fund for services, otherwise uncompensated from any source, furnished in its county hospital to inmates of county jails, juvenile halls and other custodial or correctional institutions from March 1, 1966, through September 30, 1971. 3

The recipients of the services for which plaintiff has billed and received payment from the Health Care Deposit Fund were admitted to its county hospital as patients and classified as 'medically indigent' after a credit check by the hospital. The hospital had no separate ward or wing devoted to county jail prisoners or juvenile court wards; and it accepted no responsibility for insuring that such patients would not escape.

Plaintiff has neither billed the Health Care Deposit Fund nor received payment for, and does not seek payment for, health care services provided in its county jail or juvenile halls by nurses and physicians employed by the county.

Defendant Human Relations Agency (at that time the Health and Welfare Agency) in April 1967, after extensive discussions with the counties, issued its directive 'PRINCIPLES GOVERNING OPTION COVERAGE SECTION 14150.1, W&I CODE.' These principles furnished a definition and interpretation of the option coverage for those counties that elected to place themselves under section 14150.1. Specifically, paragraph II G stated: 'Medical services provided to inmates of the county jail, juvenile hall or other custodial or correctional institutions are not included.' No distinction was made between inmates who received medical attention within the correctional institution and those who were transferred to county hospitals for medical treatment.

On December 5, 1969, defendant Department of Health Care Services demanded: (1) Plaintiff recompute its base year of 1964--1965 to exclude from its share of cost obligation to the Health Care Deposit Fund an amount representing the services provided in its hospital to inmates of public, nonmedical institutions, and (2) plaintiff reimburse the defendants for that portion of state monies received by plaintiff for those excluded services.

The trial court held that the Medi-Cal Act excludes from the plaintiff's share of cost obligation to the Health Care Deposit Fund under section 14150.1 et seq., the cost of medical care provided in fiscal year 1964--1965 by plaintiff's hospital to inmates of the county jail, juvenile hall and other county public institutions. The trial court further held that the Medi-Cal Act excludes from plaintiff's billings to the Health Care Deposit Fund, under section 14150.1 et seq., for the period March 1, 1966, to May 10, 1971, the cost of medical care provided by plaintiff through its hospital to the inmates of the county jail, juvenile hall and other county public institutions. 4

Plaintiff has appealed, contending that the 'county option' provision is a state-county health care program completely separated from the general Medi-Cal Program.

II

The California Medi-Cal Act was introduced in the Second Extraordinary Session of 1965. Prior to its enactment it went through a series of amendments. The relevant provisions, other than sections 14150 and 14150.1, heretofore discussed, are section 14050, which provides: 'Unless the context otherwise requires, the definitions set forth in this article (§§ 14050--14062) govern the construction of this chapter (§§ 14000--14160).' and section 14053, which read in pertinent part: "Health care and related remedial or preventive services' means:

'15. Except that such term shall not include

'a. Any care or services for any individual who is an inmate of a public institution (except as a patient in a medical institution); . . .' 5

There seemingly is an inconsistency between section 14150.1, in its provision for payment by the county of 100 percent of the cost 'uncompensated from any source in 1964--65 for all categorical aid recipients, and all other persons in the county hospital,' and section 14053 which, in defining 'health care,' excludes service to prisoners and juvenile hall wards. The trial court concluded that when section 14150.1 refers to the county costs of 'Health care . . . for . . . all other persons' it means such care as defined in section 14053, which excludes health care to prisoners and juvenile hall wards, because section 14050 provides that the definitions in section 14053 govern unless the context otherwise requires. The trial court said: 'The context does not otherwise require, despite the legislative history. When the Legislature chose to go beyond the scope of Federal Medicaid, it was free to go as far as it wished, and stop wherever it reasonably wished. It is not logical to assume that the insertion of an amendment to pending legislation was intended to modify other portions thereof so as to make them inapplicable to the amendment. Pending legislation is constantly being amended before passage, and it is not reasonable to assume that the proponent of the amendment does not have in mind the legislation in its entirety and how it affects this amendment; particularly is this so with specific definitions which must...

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2 cases
  • County of San Diego v. State of California
    • United States
    • California Supreme Court
    • March 3, 1997
    ...by Medi-Cal and yet unable to afford medical care, remained the responsibility of" the counties. (County of Santa Clara v. Hall (1972) 23 Cal.App.3d 1059, 1061, 100 Cal.Rptr. 629 (Hall ).) In establishing Medi-Cal, the Legislature expressly recognized this fact by enacting former section 14......
  • Kemp v. Schultz
    • United States
    • California Superior Court
    • May 29, 1981
    ...to know what it was saying and to have meant what it said when it enacts or amends legislation (County of Santa Clara v. Hall (1972) 23 Cal.App.3d 1059, 1065 (100 Cal.Rptr. 629); People v. Pina (1977) 72 Cal.App.3d Supp. 35, 39 (140 Cal.Rptr. 270)). Indeed, we are required to give effect to......

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