Crespin v. Kizer

• Decision Date: 20 December 1990
• Docket Number: No. A044596,A044596
• Citation: 226 Cal.App.3d 498,276 Cal.Rptr. 571
• Court: California Court of Appeals Court of Appeals
• Parties: Father George CRESPIN, et al., Plaintiffs and Respondents, v. Kenneth KIZER, Director of State Department of Health Services, et al., Defendants and Appellants.

Page 571

276 Cal.Rptr. 571

226 Cal.App.3d 498

Father George CRESPIN, et al., Plaintiffs and Respondents, v. Kenneth KIZER, Director of State Department of Health Services, et al., Defendants and Appellants.

No. A044596.

Court of Appeal, First District, Division 1, California.

Dec. 20, 1990.

As Modified on Denial of Rehearing

Jan. 22, 1991.

Review Denied March 28, 1991.

John K. Van de Kamp, Atty. Gen., Richard Martland, Chief Asst. Atty. Gen., Charlton G. Holland, III, Asst. Atty. Gen., San Francisco, for defendants and appellants.

Stephen Ronfeldt, Legal Aid Soc. of Alameda County, Oakland, Susan Drake, Vibiana Andrade, National Immigration

Law Center, Stanley Dorn, Jane Perkins, National Health Law Program, Inc., Los Angeles, Lucy Quacinella, Legal Services Northern California, Butte Regional Office, Chico, James Carroll, San Fernando Valley Neighborhood Legal Services, Pacoima, Melinda Bird, Western Center of Law & Poverty, Inc., Los Angeles, for plaintiffs and respondents except for Alameda Health Consortium and Father George Crespin.

Stephen Schear, East Oakland Community Law Office, Oakland, for Alameda Health Consortium.

Carole Raimondi-Pineda, Oakland, for Father George Crespin.

STEIN, Associate Justice.

Respondents ¹ challenged the State Department of Health Services proposed interpretation and implementation of S.B. 175 which was enacted in response to changes in federal law extending new Medicaid benefits to certain classes of aliens previously excluded from federal financial participation.

The issues raised in this appeal are whether the trial court abused its discretion by enjoining the State Department of Health Services ² from: (1) denying Medi-Cal coverage for undocumented aliens having medical needs for long-term care or kidney dialysis, except to those aliens who were receiving these services under the Medi-Cal program as of October 1, 1988, the effective date of S.B. 175; and (2) requiring aliens applying for Medi-Cal coverage for emergency and pregnancy-related services, which is available regardless of immigration status, to disclose extensive information regarding their immigration status or that of members of his or her family or household.

We affirm the preliminary injunction order and remand for further proceedings.

I. STATUTORY BACKGROUND

A. Federal Law

The Medicaid program, established by Title XIX of the Social Security Act, 42 United States Code sections 1396-1396g, is a medical assistance program jointly funded by the federal and state governments. The California program is known as Medi-Cal. (Welf. & Inst.Code, § 14000 et seq.) Under the Medicaid program, states receive federal financial participation (FFP) for services specified under federal law. The state may provide services that are not provided for under federal law, but they do so entirely at their own expense.

Section 9406 of the Omnibus Budget Reconciliation Act of 1986 (Budget Act) amended the Medicaid statute to provide that, with respect to aliens, federal financial participation was available for the full range of Medicaid services only if those services are provided to aliens with status as permanent residents under color of law (PRUCOL), ³ or to legal permanent residents. (42 U.S.C. § 1396b(v).) We shall refer to these Medicaid services as "full-scope" services or benefits.

Prior to the enactment of the Budget Act, 42 Code of Federal Regulations section 435.402(b) provided that federal financial participation was available only for medical assistance provided to "[a]liens lawfully admitted for permanent residence or permanently residing in the United States under color of law, including any In the same year, Congress also enacted the Immigration Reform and Control Act (IRCA). IRCA did not expand the scope of federal financial participation available to illegal aliens but rather disqualified from Medicaid and several other public assistance programs for five years aliens who are granted legalized status as amnesty aliens. ⁴ IRCA did, however, furnish federal funding for emergency and pregnancy-related services to aliens seeking amnesty, and also provided federal financial participation for full-scope Medicaid services to certain classes of amnesty aliens such as the blind and disabled. (8 U.S.C. § 1255a(b).) IRCA also authorized additional federal funding to states providing Medicaid or other benefits to amnesty aliens. (Pub.L. 99-603 § 204.) This federal funding is known as State Legalization Impact Assistance Grants, or SLIAG.

                alien who is lawfully present in the United States under section 203(a)(7) or section 212(d)(5) of the Immigration and Nationality Act."   The Budget Act, however, created a new category of "restricted" benefits for which federal financial participation was available even if the alien recipient is not a legal resident or PRUCOL.  Specifically, the Budget Act provided that federal financial participation would be available for treatment of emergency medical conditions, even for aliens not qualifying as PRUCOL or lawful residents, as long as the alien is "otherwise eligible" for Medicaid.  (42 U.S.C. § 1396b(v)(2)(B).)
                

IRCA also established a new system of verifying alien eligibility for public benefits, including Medicaid. (42 U.S.C. § 1320b-7.) This system is called Systematic Alien Verification for Entitlements, or SAVE.

In sum, after these changes took effect, federal financial participation would be available for the provision of full-scope Medicaid benefits only to United States citizens and aliens who were either PRUCOL or lawfully admitted for permanent residence. With respect to aliens who were neither PRUCOL nor lawfully admitted as permanent residents, federal financial participation would be available only for restricted Medicaid benefits, i.e., treatment of an emergency medical condition. In addition, in order to receive federal financial participation, the states were to condition eligibility for full-scope benefits on status as a United States citizen or national, or verification of satisfactory immigration status. Aliens seeking only restricted benefits were exempt from the SAVE program.

B. Senate Bill No. 175

In response to these changes in federal law, S.B. 175 repealed former Welfare and Institutions Code section 14007.5 and enacted a new section 14007.5, which created two categories of Medi-Cal eligibility. Except in certain important respects, these new categories track those created by federal law: Full-scope Medi-Cal benefits were granted only to aliens lawfully admitted for permanent residence, or qualifying as PRUCOL. (Welf. & Inst.Code, § 14007.5, subds. (b) and (c).) All other aliens would be eligible only for restricted Medi-Cal benefits. (Welf. & Inst.Code, § 14007.5, subd. (d).)

S.B. 175 also expanded the category of restricted benefits beyond those for which federal financial participation would be available. Specifically, Medi-Cal covers nonemergency pregnancy-related care. (Welf. & Inst.Code, § 14007.5, subd. (d).)

In addition to these amendments to the Welfare and Institutions Code, section 1, subdivision (f), S.B. 175 specifically addressed how the state would handle coverage for aliens needing long-term care or renal dialysis.

S.B. 175 also established a state procedure for identification and verification of alien status and for the provision of benefits pending verification of alien status. (Welf. & Inst.Code, § 14007.5.)

C. The Department's Proposed Implementation of S.B. 175

In September of 1988, the Department, which is the state agency responsible for Under the Department's interpretation, aliens needing long-term care or renal dialysis who applied after October 1, 1988, would not receive any assistance seeking PRUCOL status and were entitled only to restricted benefits unless they could provide proof of satisfactory immigration status.

administering the Medi-Cal program, sent instructions on how to implement the new statute to the county welfare departments. With respect to aliens having medical needs for long-term care or renal dialysis, the Department instructed county welfare departments to verify PRUCOL status with the INS for all otherwise eligible aliens who were "receiving long-term care or dialysis benefits on October 1, 1988 [the effective date of S.B. 175]." The Department stated that these aliens would be eligible for full benefits during the verification period, and, if PRUCOL status was denied, these aliens would continue to receive limited coverage for long-term care or renal dialysis.

The Department also told the county welfare departments that all applicants for Medi-Cal were required to fill out a form entitled, "Statement of Citizenship, Alienage and Immigration Status," which asked whether the applicant is a citizen or alien, whether the applicant received amnesty, and, if so, the applicant's social security number, date of entry into the United States, and the country of the applicant's birth and citizenship. Even applicants for restricted benefits were required to fill out this form, but nonamnesty applicants for restricted benefits were not required to state, under penalty of perjury, that their answers were true. In addition, the Department's MC-210 form, which is the application form that all Medi-Cal applicants must complete under penalty of perjury, asks all applicants for restricted benefits whether they are aliens and to identify their birthplace and social security number, as well as the social security number, birthplace and immigration status of all family members.

Respondents sought and obtained a preliminary injunction against these aspects of the Department's proposed implementation of S.B. 175.

II. DOES S.B. 175 RESTRICT COVERAGE FOR KIDNEY DIALYSIS AND LONG-TERM CARE TO PATIENTS RECEIVING SUCH CARE ON OR BEFORE OCTOBER 1, 1988?

The Department requests that this court finally decide the legal issues presented in this appeal instead of merely determining the likelihood of success...