No. 13578 

IN THE SUPREME COURT OF THE STATE OF MONTANA 

COUNTY OF BLAINE, STATE OF MONTANA, 

Petition= and Appellant, 

EDWIN S. MOORE and ST. JAMES COMMUNITY 

HOSPITAL, 

Respondent and Respondent. 

Appeal from: District Court of the Twelfth Judicial District, 

Honorable B. W. Thomas, Judge presiding. 

Counsel of Record: 

For Appellant: 

Solem and MacKenzie, Chinook, Montana 

Stuart C. MacKenzie argued, Chinook, Montana 

For Respondent: 

Corette, Smith and Dean, Butte, Montana 

Gerald R. Allen argued, Butte, Montana 

, , 6- 

. :- >. Filed: I 

Submitted: June 1, 1977 

Decided: SEP i/i ;CJT~, 
Mr. Justice Gene B. Daly delivered the Opinion of the Court. 

The County of Blaine, State of Montana, appeals from 

the final judgment and order of the district court, Blaine 

County. The district court affirmed the administrative decisions 

of the Department of Social and Rehabilitation Services (SRS) 

which ordered Blaine County, as the county of financial responsibility, to pay approximately $30,000 in medical debts incurred 

by Edwin S. Moore and his wife. 

Edwin S. Moore and his wife, Marlene Moore, were married 

March 9, 1969. Prior to moving to Montana in the early fall, 1969, 

Mr. Moore was employed in a teaching position in Oklahoma. Moore 

is of Indian descent from the Creek Tribe in Oklahoma. Marlene 

Moore is an enrolled member of the Fort Belknap Indian Reservation. 

Upon their marriage the Moores took up residence on the ranch of 

Marlene's parents located at Lodgepole, Montana, in Blaine County. 

In February, 1970, Moores moved to Denver, Colorado, where 

he was employed as an iron worker on construction jobs until 

December, 1972. Marlene returned to her parents' ranch on December 24, 1972 and Moore joined her the following day. The Moores 

resided on the ranch at Lodgepole until September, 1973 when they 

moved to Havre in Hill County. Both attended Northern Montana 

College and resided in a married student housing unit. The Moores 

returned to the ranch at Lodgepole on weekends and over Christmas 

vacation. In April, 1974, Moores moved out of the married student 

housing unit and transported all their personal property back to 

the ranch at Lodgepole. Neither of the Moores attended classes 

during spring quarter, but during the summer, 1974, Moore commuted 

from the ranch at Lodgepole to Northern Montana College. 

In September, 1974, Moore obtained employment as an 

Indian counsellor with the Anaconda Public School System. The Moores 

moved to Anaconda, Deer Lodge County. Moore was assisted in obtain- 
ing this employment by the Employment Assistance Office of the 

Bureau of Indian Affairs, Fort Belknap Indian Reservation. The 

Bureau of Indian Affairs paid the Moores' moving expenses and 

provided an initial subsistance allowance. On August 2, 1974, 

when the Moores filed the Application for Economic Assistance 

with the Bureau of Indian Affairs, Marlene also filled out a 

statement of medical history stating that she was pregnant. 

On September 27, 1974, Marlene was admitted to Community 

Hospital in Anaconda where she gave birth to a baby girl. She 

was released from Community Hospital on October 3, 1974. Complications from the pregnancy required that she be readmitted 

to Community Hospital on October 7, 1974. She was transferred, 

under emergency conditions, to St. James Community Hospital, 

Butte, Montana, Silver Bow County, on October 23, 1974. Marlene 

was not released from St. James Community Hospital until December 

28, 1974. In the meantime, Moore had been suspended from his 

employment with the Anaconda Public School System. The Moores 

returned to Lodgepole and have resided there since her release. 

The Moores have incurred medical expenses of approximately 

$30,000 and are without funds to pay these medical debts. Marlene 

was insured under the Blue Cross of Montana health care plan 

provided by Moore's employer. However, benefits for obstetrical 

care or complications of pregnancy are available only if child 

birth occurs after nine months of continuous family membership. 

The Moores failed to satisfy the waiting period. 

On October 8, 1974, Donald Martin, Service Unit Director 

of the Fort Belknap Public Health Service, denied Indian Health 

Service coverage for maternity care to Mrs. Moore on the ground 

"our contract medical care funds are limited to only those persons 

who are permanent residents of this service unit delivery system 

area. " 
The Moores subsequently filed in Deer Lodge County an 

Application for General Assistance County Medical Benefits. 

The welfare department, Deer Lodge County, on the basis of the 

application submitted, determined that Blaine County was the 

place of Moores' residence. Deer Lodge County forwarded the 

application to Blaine County by letter dated December 10, 1974. 

Blaine County denied Moores' application on March 7, 1975, on 

the grounds the Public Health Service was the resource responsible 

for satisfying the medical debts of the Moores and Mr. Moore's 

income exceeded Blaine County's standard for determining eligibility 

for general assistance. On April 14, 1975, Moore requested a fair 

hearing before a hearings officer of the Department of Social 

and Rehabilitation Services, State of Montana, because of Blaine 

County's denial of county medical assistance. Additionally, on 

April 15, 1975, St. James Community Hospital requested a fair 

hearing for Moore. 

On June 19, 1975, a hearing on the matter was held in 

Blaine County, Chinook, Montana. Moores were not present at the 

hearing. Blaine County objected to SRS granting a fair hearing 

to St. James Community Hospital on the grounds St. James Community 

Hospital lacked standing to request a fair hearing and the hospital 

failed to obtain written authorization to act on behalf of the 

Moores. Blaine County sought a continuance of the fair hearing 

on the ground the Moores failed to satisfy residency requirements, 

a condition precedent for submitting to Blaine County an Application 

for General Assistance County Medical Benefits. The hearings 

officer denied Blaine County's motions and proceeded with the 

hearing while allowing Blaine County to introduce evidence regarding the issue of Moores' residence. 

On July 1, 1975, the SRS hearings officer issued Fair 

Hearing Decision No. 163, which concluded as a matter of law: 
"Mr. and Mrs. Moore must be classified as 

indigent persons entitled to medical aid and 

hospitalization, who were unable to provide 

such necessities for themselves because of a 

catastrophic misfortune resulting in a medical 

debt of approximately $30,000.00. Section 71- 

308, R.C.M. 1947, indicatels that 'Medical aid 

and hospitalization for persons unable to provide 

such necessities for themselves are hereby 

declared to be the legal and financial duty and 

responsibility of the Board of County Commissioners.' 

In this particular case, Hill County becomes the 

county of financial responsibility * * *." 

The hearings officer ordered: 

"That Blaine County be upheld in their denial of 

General Assistance County Medical to Edwin and 

Marlene Moore since the county of financial 

responsibility is Hill County and that the Hill 

County Board of Commissioners be directed to pay 

Mr. and Mrs. Moore's medical claims resulting in 

approximately $30,000.00." 

The hearings officer based his order on the finding that the 

Moores, while residing in the married student housing unit at 

Northern Montana College in Hill County, were residents of Hill 

County pursuant to the provisions of section 71-302.2, R.C.M. 

On July 9, 1975, St. James Community Hospital appealed 

from Fair Hearing Decision No. 163 so far as it related to the 

finding that Moore was a resident of Hill County for purposes of 

determining eligibility to receive aid. Hill County also filed 

an appeal claiming Hill County was not notified of the fair 

hearing, as required by section 82-4209, R.C.M. 1947; Hill County 

was denied due process of law; and Moore was a resident of Blaine 

County. 

On August 29, 1975, the Board of Social and Rehabilitation 

Appeals issued its decision holding: 

"1. St. James Community Hospital is properly a 

party to the action; 

"2. That Mr. Moore does not now have, nor is it 

reasonably expected that he will have in the foreseeable future, resources which will enable him to 

pay the medical debts relating to his wife's 

illness; 
"3. That a separate hearing be held to determine 

residence and the county of financial responsibility 

and that all parties involved be present and be 

given an opportunity to be heard. Based upon the 

information presented at the hearing, the ~earings 

Officer shall determine the county of residence." 

On October 2, 1975, Blaine and Hill Counties petitioned 

the district court, Blaine County, for review of the findings 

of the hearings officer in Fair Hearing Decision No. 163 and 

review of the administrative order and decision of the Board 

of Social and Rehabilitation Appeals. St. James Community 

Hospital moved to dismiss the petition on the ground Blaine and 

Hill Counties had failed to exhaust all administrative remedies 

available to them. On November 10, 1975, the district court 

issued an order dismissing Blaine and Hill counties' petition for 

review of administrative proceedings on the grounds a final decision on all issues before the administrative agency had not 

been rendered and the appeal of the petitioners was premature. 

A rehearing of Fair Hearing Decision No. 163 was held in 

Blaine County, Chinook, Montana on November 18, 1975. As requested by the Board of Social and Rehabilitation Appeals in their 

decision of August 29, 1975, the rehearing was limited to a determination of the Moores' county of residence and the county of 

financial responsibility. Moores were present at the rehearing. 

St. James Community Hospital presented a written authorization, 

signed by Moores, allowing St. James Community Hospital to act in 

behalf of the Moores, in connection with the rehearing. The 

authorization was dated November 18, 1975. 

On November 20, 1975, the SRS hearings officer issued rehearing of Fair Decision No. 163 which concluded as a matter of 

law: 

"In conclusion, Mr. and Mrs. Moore are residents 

of Blaine County. When returning to Montana from 

Colorado, they became new residents of the State 

beginning December 24, 1972. From this date on, 

they considered Blaine County as their residence 
until actually moving to Anaconda, Montana, in 

September 1974. However, the Moores, for 

welfare purposes, would remain residents of 

Blaine County, even though residing in Deer 

Lodge County, for up to one (1) year but, in 

this case, they chose to return to Blaine 

County in December 1974." 

The hearings officer ordered: 

"That the original order of July 1, 1975, 

upholding Blaine County's action to deny General 

Assistance County Medical and directing Hill County 

to pay Mr. and Mrs. Moore's medical claims be hereby 

amended and it is hereto ordered that Blaine County 

is the county of financial responsibility based 

on evidence of residency provided by Mr. and Mrs. 

P4oore at the rehearing held on November 18, 1975. 

Blaine County is, therefore, the county of financial 

responsibility and is directed to pay Mr. and Mrs. 

Moore's medical debts incurred during the time in 

question of approximately $30,000.00." 

Blaine County appealed the rehearing of Fair Hearing 

Decision No. 163 to the Board of Social and Rehabilitation Appeals. 

The Board issued its decision on January 28, 1976, affirming the 

revised order of the hearings officer. 

On February 27, 1976, Blaine County filed a petition in 

the district court, Blaine County, seeking judicial review of the 

SRS administrative proceedings, pursuant to section 82-4217, R.C.M. 

1947. The district court, after hearing oral arguments, reviewing and considering the administrative proceedings and briefs of 

counsel, affirmed the administrative decisions of SRS, having 

failed to find a basis for reversal or modification of those administrative decisions under the provisions of section 82-4217, 

R.C.M. 1947. Judgment was accordingly entered for respondents 

on July 13, 1976. Blaine County appeals to this Court from the 

final order and judgment of the district court, Blaine County. 

Blaine County raises the following issues for review: 

1. Whether the hearings officer erred when he denied 

Blaine County's motions for dismissal or continuance in Fair 

Hearing No. 163 when the claimants (Moores) failed to appear? 

2. Whether the hearings officer and the Board of Social 
and Rehabilitation Appeals erred when they concluded St. James 

Community Hospital was a proper party which had standing to 

pursue the Moores' claim for county medical benefits and had 

standing to appeal Fair Hearing Decision No. 163? 

3. Whether the hearings officer erred in failing to 

find the Indian Health Service the resource responsible for 

satisfying the medical debts of the Moores? 

4. Whether the Board of Social and Rehabilitation Appeals 

erred in limiting the scope of rehearing of Fair Hearing Decision 

No. 163 to a determination of the Moores' county of residence? 

5. Whether the hearings officer, Board of Social and 

Rehabilitation Appeals and district court erred in finding Blaine 

County the resource financially responsible for paying the medical 

debts of the Moores? 

The first two issues raised by Blaine County challenge 

St. James Community Hospital's standing as a proper party to pursue the Moores' claim for county medical benefits. The departmental rules of the Montana Department of Social and Rehabilitation Service provide: 

"46-2.2(2)-P240 CONTESTED CASES, REPRESENTATION 

(1) A claimant may be represented by legal counsel, 

or by a relative, friend, or other spokesman, or 

he may represent himself. A departmental employee 

may not represent a claimant. 

"(2) In the discretion of the Fair Hearing Officer, 

a hospital, nursing home, physician or other vendor 

may act in a representational capacity for the purposes of requesting a fair hearing and acting as 

spokesman for a claimant where a hardship exists 

which impedes the obtainability of a written 

authorization from the claimant to act in such a 

capacity." 

Although St. James Community Hospital obtained written 

authorization from the Moores in time for the rehearing, the 

hospital lacked such written authorization at the time of the 
initial fair hearing. Two months lapsed between the date St. 

James Community Hospital petitioned for a fair hearing and the 

date of the fair hearing. The hospital contends it made good 

faith efforts to contact Moore in Lodgepole, but were unsuccessful in obtaining a response. The good faith efforts of the 

hospital are supported by evidence that the Blaine County Welfare 

Department was also unsuccessful in contacting Moore. Once the 

hospital did obtain written authorization on November 18, 1975, 

Moore ratified all previous actions of the hospital in the Moores' 

behalf and authorized the hospital to further pursue the Moores' 

claim. 

Blaine County contends the absence of the Moores at the 

fair hearing is fatal to any force or effect given the hearings 

officer's findings of fact and conclusions of law and decision. 

In support of its argument Blaine County cites the SRS departmental 

rules, MAC 46-2.2 (2) -P2040 (6) , which provides: 

"(6) A hearing may otherwise be considered as 

concluded when the claimant or authorized representative withdraws his request for a fair hearing in writing or fails to attend a properly 

noticed hearing without good cause. The hearing 

officer shall inform the claimant by letter of 

the date his claim shall become a closed issue 

as a result of said failure to attend. A second 

hearing may be scheduled at the discretion of 

the hearing officer for good cause. A hearing 

may also be concluded by stipulation, consent 

order, or settlement." 

We believe this departmental rule must be read in conjunction with MAC 46-2.2(2)-P240(2) which places in the discretion of 

the fair hearings officer the determination of whether a hospital 

may act in a representational capacity for purposes of requesting 

a fair hearing and acting as spokesman for the claimant. In the 

instant case the hearings officer concluded there was justification for the hospital's failing to obtain written authorization 

from the claimant in time for the fair hearing. We fail to find 

substantial evidence which would indicate the hearings officer abused 
his discretion in arriving at this determination. 

This Court held in Montana Deaconess Hospital v. Lewis 

and Clark County, 149 Mont. 206, 210, 425 P.2d 316, a hospital 

has standing, as a real party in interest, to bring a cause of 

action to collect county welfare medical benefits for emergency 

medical care rendered by the hospital for an individual eligible 

to receive county welfare medical assistance. In Montana Deaconess 

Hospital v. Lewis and Clark County we stated: 

" * * * If hospitals were to reject admission of 

emergency cases until the legal settlement is 

established, or until one who is responsible 

accepts the obligation to care for such indigent, 

much harm could result." 

Similarly, much harm could result if hospitals, under the facts 

of the present case, could be denied a vehicle for recovering the 

costs expended for emergency medical care merely because a claimant fails to appear at a fair hearing. We conclude the hearings 

officer in the instant case did not abuse his discretion when he 

determined the hospital was a proper party which had standing to 

request a fair hearing and pursue the Moores' claim for county 

welfare medical assistance in the Moores' absence. Nor did the 

Board of Social and Rehabilitation Appeals err when it determined 

the hospital had standing to appeal Fair Hearing Decision No. 

163. 

The third issue raised by Blaine County challenges the 

hearings officer's failure to find the Indian Health Service the 

resource responsible for satisfying the medical debts of the 

Moores. Blaine County contends the Moores should be denied county 

welfare assistance since the Indian Health Service is responsible 

for providing the Moores medical care. Blaine County refers to 

specific provisions of the Bureau of Indian Affairs manual, which 

purportedly provides maternity care benefits up to eleven months 

after relocation when the claimant receives relocation assistance 
from the Bureau of Indian Affairs, and the existence of past 

and pending federal cases which address the issue of the Indian 

Health Service "responsibility to provide medical care to 'offreservation Indians.'" 

MAC 46-2.10(18)-S11490 provides: 

"(a) Third party includes an individual, institution, corporation, public or private agency 

who is or may be liable to pay all or part of 

the medical cost of injury, disease or disability 

of an applicant or recipient of medical assistance. 

" (b) Referrals shall be made to the Legal Unit, 

Department of Social and Rehabilitation Services, 

P. 0. Box 1723, Helena, Montana 59601, for examination. The Legal Unit shall make referrals to 

the Department of Revenue for recovery.'' (Emphasis 

added. ) 

The evidence clearly establishes that the Indian Health 

Service refuses to give medical assistance to the Moores. 42 

CFR 36.12 indicates there may be regulatory justification for 

the Indian Health Service's denial of medical assistance to the 

Moores : 

"836.12 Persons to whom services will be provided. 

"(a) In general. (1) Services will be made available, as medically indicated, to persons of Indian 

descent belonging to the Indian community served 

by the local facilities and program, and non-Indian 

wives of such persons. 

"(2) Generally, an individual may be regarded as 

within the scope of the Indian health and medical 

service program if he is regarded as an Indian by 

the community in which he lives as evidenced by 

such factors as tribal membership, enrollment, 

residence on tax-exempt land, ownership of restricted 

property, active participation in tribal affairs, 

or other relevant factors in keeping with general 

Bureau of Indian Affairs practices in the jurisdiction. 
" (b) Doubtful cases. (1) In case of doubt as 

to whether an individual applying for care is 

within the scope of the program, the Medical 

Officer in Charge shall obtain from the appropriate 

Bureau of Indian Affairs officials in the jurisdiction information pertinent to his determination of 

the individual's continuing relationship to the 

Indian population group served by the local program. 

"(2) If the applicant's condition is such that 

immediate care and treatment are necessary, services shall be provided pending identification as 

an Indian beneficiary. 

"(c) Priorities when funds, facilities, or personnel 

are insufficient to provide the indicated volume of 

services. Priorities for care and treatment, as 

among individuals who are within the scope of the 

program, will be determined on the basis of relative 

medical need and access to other arrangements for 

obtaining the necessary care." (Emphasis added.) 

In any event, we fail to find merit in Blaine County's argument 

that the Moores must litigate a potential right to federal resources 

prior to seeking county welfare medical assistance. Upon being 

denied federal assistance, the Moores elected to apply for county 

welfare medical assistance and under the circumstances they are 

entitled to such assistance. 

The fourth and fifth issues raised by Blaine County concern the problem of determining the Moore's residence as it applied 

to the finding that Blaine County was the county of financial 

responsibility for purposes of paying the medical debts of the 

Moores. It should be noted that BlaireCounty does not contest 

SRS's finding that the Moores are indigent persons entitled to 

county welfare medical assistance. See State ex rel. Hendrickson 

v. Gallatin County, 165 Mont. 135, 526 P.2d 354; Saint Patrick 

Hospital v. Powell County, 156 Mont. 153, 477 P.2d 340. The 

difficulty arises when one attempts to determine the county of 

financial responsibility under Montana's statutory scheme. 

Section 71-305, R.C.M. 1947, in pertinent part provides: 

"Medical aid and hospitalization. (1) Medical aid 

and hospitalization for nonresidents within the 

county and county residents unable to provide 

such necessities for themselves are the legal and 
financial duty and responsibility of the board of 

county commissioners, except as otherwise provided 

in other parts of this act, payable from the 

county poor fund." 

MAC 46-2.10(38)-S101970 provides: 

"46-2.10(38)-S101970 COUNTY RESIDENCY (1) 

For determination of applicant's county residency 

requirements, reference is made to R.C.M. 1947, 

Section 71-302.2." 

Finally, section 71-302.2, R.C.M. 1947, sets forth the criteria 

to be utilized in determining the county of financial responsibility on the basis of the claimant's residency: 

"Residency requirements. Any person otherwise 

qualified who makes his home in the state of 

Montana with the intent to become a resident shall 

be eligible for general relief. Upon the filing 

of his application in the county of residence, 

his assistance shall be paid entirely from state 

funds until he has resided for one (1) continuous 

year in the state of Montana, at which time he 

shall become a financial responsibility of the 

county in which he resides at the expiration of 

the one (1) year period. A person who leaves the 

state of Montana with the intent to reside in 

another state, and later returns to reside in the 

state of Montana, shall be deemed a new resident 

for the purposes of this act. If a recipient moves 

from his original county of residence to reside 

in another county, he shall continue to be a 

financial responsibility of the original county 

of residence for one (1) year from the date of his 

change of residence. If during this one (1) year 

period, the individual resides in several counties, 

he shall become a financial responsibility of the 

county in which he resides at the expiration of 

the one (1) year period. County medical assistance 

under section 71-308 shall not be entitled to be 

paid from state funds. " 

The plain and clear meaning of the language in section 

71-302.2, R.C.M. 1947, indicates the county of financial responsibility is that county in which the claimant resides at the end 

of one year continuous residence in Montana. The statutory language would infer that a person, otherwise qualified, who makes 

his permanent home in the state of Montana with the intent to become a resident, may migrate from county to county within Montana 

and, at the end of the one year period, the county where the person is found is the county of financial responsibility for the 
purpose of paying county welfare medical benefits. Furthermore, 

if the new resident continues his migration after the one year 

period, the "original county of residence" continues to be financially responsible for county welfare benefits for one year from 

the date of the new residents change of county residence. 

The effect of section 71-302.2, R.C.M. 1947, and the 

complications arising out of the present fact situation are best 

demonstrated by a chart depicting the Moores' migration patterns. 

Date Initiating Date Terminating Situs of Residence Approximate period 

Residence Residence of Residence 

Dec. 24, 1972 Sept. 23, 1973 Lodgepole, Blaine 9 months 

County 

Sept. 24, 1973 April 23, 1974 Havre, Hill 7 months 

County 

April 24, 1974 Sept. ?, 1974 Lodgepole, Blaine 5 months 

County 

Sept. ?, 1974 Dec. 28, 1974 Anaconda, Deer 3 months 

Lodge County 

Dec. 29, 1974 present Lodgepole, Blaine 

County 

At the end of the Ploores' year of residence in Montana, 

subsequent to returning from Colorado, the Moores were residing 

at Havre, in Hill County, attending Northern Montana College 

and living in the married couples housing unit. Under a strict 

interpretation of section 71-302.2, one would conclude that 

Hill County is the county of financial responsibility. However, 

a presumption arises that the county wherein a college or university lies is not the resident county of the attendant students. 

Generally, students travel from the residence of their parents, 

attending college only during the academic year, and return to 

their parents' residence on weekends, holidays and summer breaks. 

For this reason, it is customary to look to the parents' residence 

in order to determine the residence of the student. Otherwise, 

the county in which the college lies would be unduly burdened 
with providing for the social welfare of students. 

As oftentimes occurs, the facts of the present case do 

not readily fall within the guidelines of the presumption. The 

Moores are not of the tender age often associated with college 

students. Furthermore, there is an absence of the parental 

ties often associated with the student leaving his parents' home 

to attend college. Therefore, we must look closer to determine 

the county having the most significant contacts with the Moores. 

The Moores resided in Blaine County for nine months prior 

to their attending Northern Montana College. During the Moore's 

stay in Hill County, they returned to Blaine County on weekends 

and holidays to aid Mrs. Moore's parents by helping with the work 

on their ranch. Upon leaving Hill County, the Moores returned 

to Blaine County, and resided on the ranch while continuing to 

help with the work. Moore then commuted to Northern Montana College where he continued his course work during the summer, 1974. 

Moore testified that he at all times considered Lodgepole to be 

the situs of his permanent residence. 

The facts clearly indicate that Blaine County was the 

county having the most significant contacts with the Moores. Under 

such an analyses Blaine County is the county of financial responsibility for purposes of providing county medical welfare assistance to the Moores. We conclude the hearings officer and Board 

of Social and Rehabilitation Appeals did not err in limiting the 

scope of rehearing of Fair Hearing Decision No. 163 to a determination of the Moores' county of residence since that was the 

sole issue being legitimately contested at the time. Nor did the 

hearings officer, Board of Social and Rehabilitation ,?Appeals and 

district court err in finding Blaine County the county financially 

responsible for providing county welfare medical assistance to 

the Moores. 
The order and judgment of the district court, affirming 

the administrative decisions of SRS are affirmed, consistent with 

this opinion. 

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Justice 

Chief Justice n 

Justices / '