Justia California Supreme Court Opinion Summaries

The Supreme Court reversed the decision of the court of appeal affirming the conclusion of the State Department of Health Care Services that the costs of outreach and education activities aimed at Medicaid-eligible patients were categorically nonreimbursable, holding that the chief administrative law judge's ruling was an abuse of discretion.Health care providers entitled to government reimbursement, including federally qualified health centers (FQHCs), for reasonable costs related to the care of Medicaid beneficiaries are required to offer outreach and education activities to members of underserved communities. The FQHC operator in this case sought reimbursement for the outreach and education costs, but the Department determined that the costs were nonreimbursable. The court of appeal affirmed. The Supreme Court reversed, holding that the Department's determination rested on a misunderstanding of relevant legal principles governing the reimbursement of medical provider costs. View "Family Health Centers of San Diego v. State Dep't of Health Care Services" on Justia Law

The Supreme Court held that because Plaintiff's state-law claims were based on allegations that his father's health maintenance organization (HMO) plan and healthcare services administrator that managed his father's benefits (collectively, Defendants) breached state-law duties that incorporated and duplicated standards established under Medicare Part C, Part C's preemption provision preempted them.Plaintiff brought this action alleging a state statutory claim under the Elder Abuse Act and common law claims of negligence and wrongful death for the alleged maltreatment of his father, a Medicare Advantage (MA) enrollee who died after being discharged from a skilled nursing facility. Plaintiff alleged that the MA HMO and healthcare services administrator breached a duty to ensure his father received skilled nursing benefits to which he was entitled under his MA plan. Defendants demurred, arguing that the claims were preempted by Part C's preemption provision. The trial court sustained the demurrers, and the court of appeal affirmed. The Supreme Court affirmed, holding that because Plaintiff's state-law claims were based on allegations that Defendants breached state-law duties that incorporate and duplicate standards established under Part C, the claims were expressly preempted. View "Quishenberry v. UnitedHealthcare, Inc." on Justia Law

The Supreme Court held that a claim for reimbursement of emergency medical services may be maintained against a health care service plan when the plan is operated by a public entity and that the Government Claims Act, Cal. Gov. Code 810 et seq., did not immunize the County of Santa Clara from such a claim in this case.Two hospitals submitted reimbursement claims for the emergency medical services they provided to three individuals enrolled in a County-operated health care service plan. The hospitals sued for the remaining amounts based on the reimbursement provision of the Knox-Keene Act, and the trial court concluded that the hospitals could state a quantum merit claim against the County. The court of appeal reversed, determining that the County was immune from suit under the Government Claims Act. The Supreme Court reversed, holding that the County was not immune from suit under the circumstances of this case and that the hospitals' claims may proceed. View "County of Santa Clara v. Superior Court" on Justia Law

In this case involving the In-Home Supportive Services (IHSS) program the Supreme Court affirmed the judgment of the court of appeal concluding that sections 631 and 683 of the Unemployment Insurance Code exclude from coverage a provider who is the recipient's minor child, parent, or spouse under the state's unemployment insurance program, holding that the court of appeal did not err.The IHSS program authorized certain Californias, who were disabled or elderly, to receive in-home services from third parties or family members paid for with public funds. Under one program option, service recipients hire their own providers and the providers are paid either by a public entity or by the recipients with funds they have received from a public entity. At issue was whether such a provider qualified for unemployment benefits. The Supreme Court answered the question in the negative, holding that provider who is the recipient's minor child, parent, or spouse is not covered by the state's unemployment insurance program. View "Skidgel v. California Unemployment Insurance Appeals Board" on Justia Law

The Supreme Court held that a Section 8 beneficiary's compensation for providing in-home care for a severely disabled adult daughter should be excluded from income in calculating the rental subsidy.Plaintiff had an adult daughter who was severally disabled and required constant supervision. Plaintiff and her daughters received housing assistance through Section 8 of the United States Housing Act, 42 U.S.C. 1437 et seq., and Plaintiff received compensation to provide in-home supportive care for her disabled daughter through the In-Home Supportive Services (IHSS) program. Plaintiff asked that the Marine Housing Authority (MHA) exclude her IHSS compensation from "income" under the federal regulations. MHA did not respond to the request and then terminated Plaintiff's housing voucher. Plaintiff filed a petition for writ of mandate seeking an order requiring MHA to reinstitute her Section 8 voucher. The trial court sustained MHA's demurrer, and the court of appeals affirmed. The Supreme Court reversed, concluding that a parent's IHSS compensation to provide care to keep a developmentally disabled child at home is excluded from income under 24 Code of Federal Regulations part 5.609(c)(16). View "Reilly v. Marin Housing Authority" on Justia Law

The Supreme Court held that the determination of the California Department of Social Services (the Department) that a household member's income that is used to pay child support for a child living in another household counts as income "reasonably anticipated" to be "received" by the paying household within the meaning of Cal. Welf. & Inst. Code 11265.2 for the purposes of determining eligibility for state welfare benefits was reasonable and therefore valid.Plaintiff applied for California Work Opportunity and Responsibility to Kids (CalWORKs) aid to support herself and her family. The Director of the Department denied the claim, concluding that child support payments garnished from Plaintiff's husband's earned income and unemployment insurance benefits was correctly included as nonexempt available income in determining eligibility for CalWORKs benefits. The superior court declared the department's policy of counting court-ordered child support payments as available income of CalWORKs applicants invalid. The court of appeal reversed. The Supreme Court affirmed, holding that the Department’s determination that funds garnished to pay child support for the benefit of a child living in another household are not exempt from the paying household’s income for purposes of determining its eligibility for or amount of CalWORKs aid was a reasonable exercise of its lawmaking authority and was therefore valid. View "Christensen v. Lightbourne" on Justia Law

In this case, the court construed Labor Code section 4659(c), which provided for the annual indexing of two categories of workers' compensation benefits, total permanent disability and life pension payments, to yearly increases in the state's average weekly wage (SAWW), so that lifetime disability payments made to the most seriously injured workers would keep pace with inflation. The indexing procedure was sometimes referred to as an "escalator," or one providing for "cost of living adjustments" (COLA's). At issue was whether the operative language of section 4659(c) required the annual COLA's for total permanent disability and life pension payments to be calculated (1) prospectively from the January 1 following the year in which the worker became "entitled to receive a life pension or total disability indemnity," (when the payments actually commenced); (2) retroactively to January 1 following the year in which the worker sustained the industrial injury; or (3) retroactively to January 2004, in every case involving a qualifying industrial injury, regardless of the date of injury or the date the first benefit payment became due. Applying fundamental rules of statutory construction, the court held that the Legislature intended that COLA's be calculated and applied prospectively commencing on the January 1 following the date on which the injured worker first became entitled to receive, and actually began receiving, such benefits payments, i.e., the permanent and stationary date in the case of total permanent disability benefits, and the date on which partial permanent disability benefits became exhausted in the case of life pension payments. View "Baker v. Workers' Comp. App. Bd." on Justia Law