Court Opinion

ID: 9561509
Source: CourtListenerOpinion
Date Created: 2023-08-21 18:10:54.72392+00
Date Added: 2024-06-11T09:13:50.667418
License: Public Domain

Dore, C.J.
(concurring in part, dissenting in part) — I concur with the majority on two issues: First, I agree that the trial court properly granted summary judgment on the issue that the County is primarily responsible for an inmate's medical costs. Second, I agree that postjudgment interest cannot be imposed on a sovereign without consent. I dissent, however, on the issue of the Department of Social and Health Services' (DSHS) obligation to reimburse the County. The trial court properly granted summary judgment on DSHS's claim that it need only reimburse the County for the medical care costs to the extent it would provide coverage for nonconfined medically indigent persons. It follows that the County was not entitled to summary judgment for full reimbursement from DSHS.
*457On the contrary, to say that DSHS must hilly reimburse the County for the medical costs of its prisoners is to have the State write a blank check for the health care of the County's prisoners. The following brief overview of the law and the applicable health care programs will clarify the issues.
RCW 70.48.130 mandates that the County is primarily responsible for paying the medical costs of its prisoners. That statute further mandates that DSHS reimburse the County "for the cost thereof" where, and only where, "the confined person requires treatment for which such person is eligible under the department of social and health services' public assistance medical program."
DSHS administers three public assistance medical programs. The first program falls under RCW 74.09.510. As amended in 1970, that program provided full medical coverage to inmates. In 1981, however, the Legislature modified RCW 74.09.510 to fall under the Federal Medicaid program which excludes inmates from coverage. The 1981 modification left only the second and third public assistance medical programs. The second program is controlled by RCW 74.04-.005 and provides care for only the unemployed and recipients of drug and alcohol addiction services. The third and final program, falling under RCW 74.09.700, is the Limited Casualty Program for the Medically Indigent (LCPMI).
LCP-MI is the program of last resort for Washington's medically indigent. The Legislature created LCP-MI at the same time that it modified RCW 74.09.510 to fall under the Federal Medicaid program. The Legislature intended LCP-MI to be a spillover program to care for medically indigent persons who did not qualify for Federal Medicaid. The program has several distinct characteristics. First, it operates on very limited funds, and because of this, LCP-MI is only capable of covering a portion of a participant's medical costs. Second, because of the limited funds, the Legislature afforded DSHS total authority to set the amount, scope, and duration of medical coverage under LCP-MI. Pursuant to that author*458ity, DSHS instituted a single rate structure designed to limit program spending "to the extent of available funds" as RCW 74.09.700 requires.
Returning to RCW 70.48.130, the majority postulates that when the Legislature enacted that statute in 1977, it used the term "cost thereof" to mean full cost. If this were the case, the Legislature clearly was referring to RCW 74.09-.510, the first of the three programs described above. That was the only program providing full coverage for inmates' medical costs at that time. Although that program allotted full coverage until 1981, today neither RCW 74.09.510 nor any other program can fully reimburse the County for prisoner medical costs.
The only possible source of any reimbursement is LCP-MI, and the Legislature probably never intended that program to provide full coverage for the medical care of county prisoners. If the Legislature had intended such a large additional expenditure as full reimbursement for prisoner medical costs it would have appropriated funds earmarked for that purpose or it would have designated such coverage in the enabling legislation. No such appropriation took place. In fact, the Legislature did not designate any appropriations whatsoever for LCP-MI, much less for the medical care of medically indigent prisoners. Rather, the Legislature simply granted DSHS the authority to allocate funds out of its general appropriation to LCP-MI. Moreover, although RCW 74.09.700 lists certain medically needy groups covered under LCP-MI, it neither includes nor excludes prisoners from coverage.
Clearly, the majority's application of RCW 70.48.130 to LCP-MI creates a statutory conflict. In resolving statutory conflicts, the court's role is to defer to legislative intent while attempting to give effect to each statute, harmonizing them with each other. Draper Mach. Works, Inc. v. Department of Natural Resources, 117 Wn.2d 306, 311, 815 P.2d 770 (1991). The majority opinion, however, gives full effect to RCW 70.48.130 while gutting the LCP-MI program.
*459The majority reconciles these two conflicting statutes by modifying LCP-MI to create full coverage singularly for the medical costs of county prisoners. The majority then dispenses with DSHS authority over the scope of LCP-MI by simply rationalizing that DSHS has that authority except with regard to prison inmates. Finally, the majority ignores the enabling legislation's fundamental requirement that LCP-MI spending not exceed "the extent of available funds". The majority's rewriting of LCP-MI ignores at least these mandates of RCW 74.09.700. In doing so, the majority creates a public assistance medical program that grants inmates full state medical coverage despite very limited funds and limited coverage. Nothing in the faGts suggests that the Legislature intended this to happen.
Rather, the facts persuasively suggest that if the Legislature had intended more reimbursement than allotted by LCP-MTs rate schedule, then it-would not have made reimbursement dependent upon the terms of the public assistance medical program. As noted, the Legislature did not designate any appropriations whatsoever for LCP-MI, much less for the medical care of medically indigent prisoners. Rather, the Legislature granted DSHS authority to set the amount, scope and duration of LCP-MI "to the extent of available funds". DSHS has used this authority to implement a rate schedule which provides partial coverage only. Charity care has historically been reimbursed at a rate less than customary fee schedules, and this court has viewed discounted rate schedules as a legislative "fact of life". Pannell v. Thompson, 91 Wn.2d 591, 589 P.2d 1235 (1979). The discounted rate schedule was authorized by the Legislature to help DSHS meet budgetary constraints. Meeting these constraints has become especially important since the Legislature enacted the budget and accounting act (Budget Act), RCW 43.88.260-.300. The Budget Act imposes fines on agencies that spend more than they are appropriated. The legislative history and circumstances, thus, suggest that the Legislature did not intend RCW 74.09.700 to exist as the majority construes it.
*460Like the legislative circumstances leading up to LCP-MI, public policy does not support the majority's interpretation of the issue. As noted, DSHS cannot afford fines under the Budget Act. If fined, LCP-MI would be the first program to experience DSHS cuts because its funding is based on available funds. In turn, if forced to maintain LCP-MI in order to pay the medical costs of prisoners, DSHS would have no choice but to cut coverage for other needy persons under LCP-MI or to cut back on other DSHS services. The program of last resort for Washington's most vulnerable citizens would become a program for medically indigent prisoners only. Thus, any interpretation of RCW 70.48.130 requiring full reimbursement jeopardizes the LCP-MI program as well as threatens the viability of other delicately funded DSHS programs. Still, an alternative exists.
The majority could have avoided crippling LCP-MI by holding that RCW 70.48.130 requires DSHS to reimburse the County for the "fioll costs" for which it is accountable under the limited coverage of LCP-MI. This is a more plausible reading of the statute than the majority's. First, it is consistent with the language of the statute. Second, it justifies partial reimbursement and maintains the integrity of LCP-MI. Third, it treats confined and nonconfined medically indigent persons equally. Fourth, it maintains DSHS's authority to govern the scope and coverage of the LCP-MI program. Fifth, it arguably gives full effect to both statutes. Sixth and finally, it encourages the County to administer its courts and prison system prudently, keeping medical costs in check.
Conclusion
In sum, I disagree with the majority on the issue of DSHS's obligation to reimburse the County. I hold that the trial court was correct, and that DSHS is requested only to reimburse the County to the dollar amount it would provide coverage for nonconfined medically indigent persons. The Legislature simply did not appropriate the funds necessary to fiilly reimburse counties for the medical costs of their *461prisoners. Besides essentially rewriting the law, the majority's rationalization flirts with the financial destruction of the LCP-MI program and jeopardizes the delicate framework of other DSHS services. I dissent.