Opinion ID: 2180470
Heading Depth: 3
Heading Rank: 2

Heading: Medicaid

Text: [¶ 12] Medicaid is a federal program that assists states in providing medical benefits to low-income persons. 42 U.S.C.A. § 1396 (2003). The federal agency that administers the Medicaid program and promulgates implementing regulations is contained within the United States Department of Health and Human Services (USDHHS). In order to receive federal dollars under the Medicaid program, Maine is required, as are all states, to designate a single state agency to administer the state Medicaid program. 42 U.S.C.A. § 1396a(a)(5). The single state agency requirement has been described as a structural programmatic requirement that facilitates federal oversight of state Medicaid programs. San Lazaro Ass'n, Inc. v. Connell, 286 F.3d 1088, 1099 (9th Cir.2002). The legislative history of section 1396a, as described in Sobky v. Smoley, 855 F.Supp. 1123, 1145 (E.D.Cal.1994), demonstrates that administrative efficiency was a primary purpose behind the single state agency requirement. [¶ 13] The single state agency in Maine that administers the Medicaid program is DHS. As the single state agency, DHS is prohibited from delegating authority to [e]xercise administrative discretion in the administration or supervision of the [state Medicaid] plan. 42 C.F.R. § 431.10(e)(1). Although federal regulations permit other state or local agencies to perform services for the single state agency, the other agencies must not have the authority to change or disapprove any administrative decision of the single state agency, nor can other agencies substitute their judgment for that of the single state agency, regarding the application of policies, rules and regulations issued by the agency. 42 C.F.R. § 431.10(e)(3) (2004). The predecessor federal agency to USDHHS interpreted the single state agency to be subject to the ordinary relationships of the agency to the executive and legislative branches of state government, including budget and audit procedures. See RCJ Med. Servs., Inc. v. Bonta, 91 Cal.App.4th 986, 111 Cal.Rptr.2d 223, 230 (2001). The salient feature of the single state agency requirement is that the agency retains the ultimate authority to assure that the Medicaid program is administered according to the federal statutes and regulations. Id.