A California appeals court orders the state Department of Health Services to bring years of delay to an end and comply with its earlier order to put in place a plan for reimbursing Medi-Cal (Medicaid) beneficiaries for medical services they received and paid for during the three months prior to the date of their Medicaid application. In the process, the court makes two qualifications to the earlier order.
In 2002, the Court of Appeal of California, First District, ordered the state Department of Health Services to provide a means by which Medi-Cal (Medicaid) recipients who incur covered expenses during the three-month period before they apply for assistance may either obtain reimbursement directly from the Department or compel their providers to obtain reimbursement on their behalf. (See Conlan v. Bontá (2002) 102 Cal.App.4th 745. Nearly three years later, and more than eight years since the petition in the case was filed, the Department has not yet begun to implement the decision. Although in the interim the California legislature amended the governing statute to incorporate the substance of the court's ruling, the Department has resisted petitioners' efforts to enforce compliance, pleading poverty, reasserting contentions rejected in the earlier ruling, and proposing an alternative plan that the trial court rejected.
The Department appealed once more, claiming, inter alia, that implementing the court's order could cost it as much as $8.04 billion, that it had no duty to provide reimbursement to those who were enrolled in Medi-Cal prior to this court's decision (the trial court ordered reimbursement retroactive to June 27, 1997), that it could not give notice to potential claimants who are no longer Medi-Cal recipients, and that it should not be required to provide reimbursement for medical services supplied by providers that are not Medi-Cal providers.
In a 37-page opinion that does not try to conceal its exasperation (for example, the Department's cost estimate is termed "preposterous"), the Court of Appeal of California rejects virtually all of the Department's arguments. The court gives the Department 30 days to submit to the trial court a revised implementation plan and proposed notice in conformity with an earlier order of the trial court, with two qualifications: services of non-Medicaid-certified providers should be reimbursed at the Medicaid rate, not the higher private-pay rate; and in the time period between the filing of an application and the granting of eligibility, beneficiaries could gain reimbursement oly for Medicaid-certified providers provided that the Medicaid program had notified the beneficiary during the application process that use of a Medicaid-certified provider was required.
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