MICHELS v DEPT OF SOCIAL REHABI

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No. 7 9 - 3 0 IN THE SUPREME COURT OF THE STATE OF MONTAhTA MELANIE MICHELS, Petitioner and Appellant, VS. DEPARTMENT OF SOCIAL AND REHABILITATION SERVICES OF THE STATE OF MONTANA; CASCADE COUNTY, a political subdivision of the State of Montana; and the CASCADE COUNTY WELFARE BOARD, Respondents and Respondents. Appeal from: ~istrict Court of the Fourth Judicial ~istrict, In and For the County of Cascade. Honorable Joel G. Roth, Judge presiding. Counsel of Record: For Appellant: Richard Ganulin, Great Falls, Montana For Respondents: David A. Scott, Helena, Montana J. Fred Bourdeau, County Attorney, Great Falls, Montana Alexander and Baucus, Great Falls, Montana Submitted on briefs: March 24, 1 9 8 0 ~ecided: MAR 2 6 Filed : f'PIflR 2:; 1389 1989 J u s t i c e John Conway H a r r i s o n d e l i v e r e d t h e Opinion of t h e Court. Mr. The a p p e l l a n t s o u g h t a j u d i c i a l r e v i e w of an a d v e r s e d e c i s i o n of t h e S t a t e Board o f S o c i a l and R e h a b i l i t a t i o n S e r v i c e s Appeals c o n c e r n i n g t h e d e n i a l o f m e d i c a l a s s i s t a n c e . The ~ i s t r i c C o u r t a f f i r m e d t h e a d m i n i s t r a t i v e d e c i s i o n , and t a p p e l l a n t brings t h i s appeal. A p p e l l a n t i s a twenty y e a r o l d female. She w a s born i n G r e a t F a l l s , Montana, and h a s l i v e d h e r e n t i r e l i f e t h e r e . I n t h e s p r i n g of 1978 s h e l e f t G r e a t F a l l s t o a t t e n d Western Montana C o l l e g e i n D i l l o n , Montana. During t h e p e r i o d of t i m e s h e a t t e n d e d s c h o o l , s h e r e t u r n e d t o h e r home n e a r l y e v e r y weekend and c o n s i d e r e d G r e a t F a l l s h e r permanent address. The t e s t i m o n y i n d i c a t e s t h a t s h e i n t e n d s t o make G r e a t F a l l s h e r home when s h e f i n i s h e s s c h o o l . I n t h e summer of 1978 a p p e l l a n t found employment w i t h t h e G a l l a t i n N a t i o n a l F o r e s t on a summer job t h a t was t o a s s i s t h e r i n h e r e d u c a t i o n , and s h e i n d i c a t e d t h a t s h e intended t o r e t u r n t o college t h a t f a l l . On August 5, 1978, a p p e l l a n t was i n v o l v e d i n a head-on automobile c o l l i s i o n . The d r i v e r of t h e o t h e r v e h i c l e was k i l l e d , and a p p e l l a n t was s e r i o u s l y i n j u r e d . She was t a k e n t o t h e emergency room o f Bozeman Deaconess H o s p i t a l , was i n t h e i n t e n s i v e c a r e u n i t f o r s e v e r a l d a y s and remained i n t h e h o s p i t a l two weeks b e f o r e b e i n g r e l e a s e d t o r e t u r n t o h e r home i n G r e a t F a l l s . A s a r e s u l t of t h e a c c i d e n t , she w a s i n c a p a c i t a t e d t h r e e months w i t h t h e f o l l o w i n g m e d i c a l and p h y s i c a l problems: compound f r a c t u r e of h e r l e f t l e g , broken c h i n , broken arm, and f o u r m i s s i n g t e e t h . She was u n a b l e t o go o u t on h e r own u n t i l a p p r o x i m a t e l y t h r e e months a f t e r the accident. T o t a l m e d i c a l e x p e n s e s r e s u l t i n g from t h i s a c c i d e n t were $ 6 , 5 0 0 . Neither appellant nor her parents had ever received any welfare assistance prior to the accident. Her family con- sisted of seven members and the income of the family was approximately $9,000. Following the accident, a relative recommended that appellant's mother apply for disability benefits from the social security administration to help defray medical bills. Such an application was made but denied two months after it had been made. No one at the hospital or no medical personnel contacted appellant's family concerning the availability of county medical benefits. They learned that county medical benefits might be available in their notice of denial from the social security administration some two months after applying. Appellant then applied for medical benefits. Her application was denied since she applied later than five days after receiving the medical care. Three issues are presented for our consideration: 1. Is the five-day rule valid? 2. Was the finding of a lack of good cause for extend- ing the five-day limit proper? 3. Was appellant a resident of Cascade County for the purposes of county medical insurance? Section 53-3-103, MCA, provides broad coverage of medical assistance for those persons who, finding themselves under calamitous circumstances because of medical costs, look to the county to obtain coverage. That section pro- vides for medical aid and hospitalization for indigents: " (1) Except as provided in other parts of this title, medical aid and hospitalization for county residents and nonresidents within the county unable to provide these necessities for themselves are the legal and financial responsibility of the county commissioners and are payable from the county poor fund. . ." C o u n t i e s o f t h i s s t a t e have t h e o b l i g a t i o n t o p r o v i d e medi- c a l a s s i s t a n c e t o i n d i g e n t s under t h i s s e c t i o n . See, F l a t - head H e a l t h C e n t e r v . Cty. o f F l a t h e a d ( 1 9 7 9 ) , Mont , 598 P.2d 1 1 , 36 St.Rep. 1 1 . 1465, 1469; Wheatland County v. B l e e k e r ( 1 9 7 8 ) , 175 Mont. 478, 575 P.2d 48, 35 St.Rep. 166, 169; S a i n t P a t r i c k H o s p i t a l v . Powell County ( 1 9 7 0 ) , 156 Mont. 153, 477 P.2d 340. I t s h o u l d be n o t e d t h a t i n S a i n t P a t r i c k H o s p i t a l , this C o u r t s a i d t h a t under t h e w e l f a r e s t a t u t e , a n i n d i g e n t person ". . . i n c l u d e [ s l t h o s e p e r s o n s who do n o t have t h e p r e s e n t o r f u t u r e hope o f r e s o u r c e s s u f f i c i e n t t o pay f o r a l l t h e m e d i c a l and h o s p i t a l s e r v i c e s r e q u i r e d i n emergency instances." 477 P.2d a t 343. I n S a i n t P a t r i c k Hospital t h i s Court a l s o held t h a t . . t h e S t a t e W e l f a r e Department h a s t h e r i g h t t o s e t up standards so long a s they a r e reasonable. 343. ". . ." 477 P.2d a t I n i n t e r p r e t i n g t h e above r e g u l a t i o n s , t h e Department a d o p t e d a n a d m i n i s t r a t i v e r e g u l a t i o n , ARM §46-2.10(38)S101950, which p r o v i d e s : "GENERAL (1) M e d i c a l l y Needy p e r s o n s may a p p l y t o county w e l f a r e departments i n t h e county i n which t h e y are r e s i d i n g f o r m e d i c a l a i d and hosp i t a l i z a t i o n care. " ( a ) A p p l i c a t i o n by a r e c i p i e n t f o r payment of m e d i c a l s e r v i c e s r e n d e r e d t o him s h a l l b e e f f e c t i v e r e t r o a c t i v e l y i n t h e minimum amount o f f i v e d a y s p r i o r t o d a t e of n o t i f i c a t i o n t o t h e c o u n t y of t h e i n t e n t o f t h e r e c i p i e n t t o a p p l y f o r payment o f s a i d m e d i c a l s e r v i c e s . "(i) R e t r o a c t i v i t y beyond t h e above f i v e - d a y l i m i t s h a l l be a l l o w e d a t t h e d i s c r e t i o n of t h e c o u n t y w e l f a r e board upon good c a u s e shown f o r f a i l u r e t o meet s a i d f i v e - d a y l i m i t . " ( 2 ) ' M e d i c a l l y Needy P e r s o n s ' f o r t h e p u r p o s e s of t h i s Sub-chapter 38 o f t h e Economic A s s i s t a n c e D i v i s i o n a r e t h o s e p e r s o n s who a r e e l i g i b l e f o r G e n e r a l R e l i e f a s p r o v i d e d i n R.C.M. 1947, T i t l e 71, C h a p t e r 3 , and m e e t t h e r e q u i r e ments a s s e t f o r t h i n t h i s S u b - c h a p t e r . " it i s w e l l established i n t h i s A s previously noted, j u r i s d i c t i o n t h a t i n d i g e n t s have t h e r i g h t t o c o u n t y m e d i c a l assistance. A p p e l l a n t h e r e a p p l i e d f o r s u c h a s s i s t a n c e two months a f t e r b e i n g r e l e a s e d from t h e h o s p i t a l . She was d e n i e d a s s i s t a n c e s i m p l y because s h e a p p l i e d l a t e r t h a n f i v e days a f t e r receiving medical services. A t no t i m e was h e r indigency an i s s u e i n t h e case. I t h a s been h e l d t h a t where a s t a t u t e makes i t t h e d u t y of t h e s t a t e o r l o c a l a u t h o r i t i e s t o p r o v i d e f o r i n d i g e n t p e r s o n s , t h a t d u t y i s mandatory and must be s t r i c t l y complied with. S e e , Wayne Township v . L u t h e r a n H o s p i t a l ( 1 9 7 4 ) , 160 1nd.App. 427, 312 N.E.2d 120; S t a t e e x r e l . A r t e a g a v . S i l v e r m a n ( 1 9 7 2 ) r 56 Wis.2d 110, 2 0 1 N.W.2d P i c k e t t ( 1 9 7 1 ) , 94 C a l . R p t r . S h u a r t ( 1 9 7 1 ) , 323 N.Y.S.2d 4 Conn.Cir. 449, 538; Mooney v . 279, 483 P.2d 1231; Lawson v. 488; W i l l i a m s v . S h a p i r o ( 1 9 6 7 ) , 234 A.2d 376. W e f i n d t h a t t h e p r o v i s i o n of a f i v e - d a y l i m i t f o r t h e a p p l i c a t i o n f o r f u n d s i n c a s e s such a s t h i s f o r m e d i c a l insurance are i n v a l i d , f o r u n l e s s r e g u l a t i o n s e f f e c t i v e l y e f f e c t u a t e t h e p u r p o s e of t h e s t a t u t e , t h e y a r e i n v a l i d . S e e , D e s e r t Environmental Con. A s s ' n v . P u b l i c U t i l . ( 1 9 7 3 ) , 106 C a l . R p t r . 31, 505 P.2d 223. Com'n Whatever f o r c e and e f f e c t t h e r e g u l a t i o n h a s must d e r i v e from t h e s t a t u t e under which i t i s e n a c t e d , and a r e g u l a t i o n i n c o n f l i c t w i t h t h a t s t a t u t e i s without e f f e c t . S e e , 2 Am.Jur.2d ~dministrative Law 8289, and B e l l v . Dept. of L i c e n s i n g (19791, , 594 P.2d 331, 36 St.Rep. 880. - Mont. " I t i s axiomatic t h a t a s t a t u t e c a n n o t b e changed by a d m i n i s t r a t i v e r e g u l a t i o n , " S t a t e e x r e l . S w a r t v . Casne ( 1 9 7 7 ) , 172 Mont, 302, 308, 564 P.2d 983. Clearly i n t h i s case the administrative regulation p r o v i d i n g t h a t t h e a p p l i c a t i o n be made w i t h i n f i v e d a y s o f t h e p r o v i s i o n o f m e d i c a l s e r v i c e s changes t h e s t a t u t e which does n o t r e q u i r e an i n d i g e n t person t o apply f o r b e n e f i t s i n any p a r t i c u l a r time. The s p i r i t and t h e p u r p o s e f o r p u b l i c a s s i s t a n c e s t a t u t e s i s t o p r o v i d e f o r t h o s e c i t i z e n s who a r e i n "need." One must a s k h i m s e l f , i n what way i s t h i s i d e a l f u r t h e r e d by d i s t i n g u i s h i n g between t h o s e who a p p l y f o r t h e b e n e f i t s w i t h i n f i v e d a y s o f r e c e i v i n g m e d i c a l s e r v i c e s and t h o s e who a p p l y a f t e r f i v e d a y s ? The v e r y i n j u s t i c e i s a p p a r e n t i n such a c a s e a s h e r e , where a p p e l l a n t was w i t h o u t knowledge o f t h e c o u n t y m e d i c a l program, always a c t e d i n good f a i t h , was f o r two weeks i n a h o s p i t a l away from t h e c o u n t y of h e r home and o n l y a p p l i e d a f t e r two months o f h o s p i t a l and home c a r e . On i t s f a c e , t h e f i v e - d a y r u l e h e r e i s p a t e n t l y unreasonable. While t h e D i s t r i c t C o u r t r u l e d t h a t t h e f i v e - d a y r u l e d i d n o t e n g r a f t " a n a d d i t i o n a l r e q u i r e m e n t on t h e s t a t u t o r y p r o v i s i o n , b u t r a t h e r i s a r e a s o n a b l e and n e c e s s a r y e x e r c i s e of t h e a g e n c y ' s r u l e making power t o e s t a b l i s h a more s p e c i f i c g u i d e l i n e f o r t h e b e n e f i t of b o t h t h e agency and t h e a p p l i c a n t , " we f i n d t h a t i n s o r u l i n g i t e r r e d and t h a t a p p e l l a n t w a s d e p r i v e d of m e d i c a l b e n e f i t s . The n e x t i s s u e r a i s e d i s whether o r n o t a p p e l l a n t f a i l e d t o show good c a u s e f o r w a i v i n g t h e f i v e - d a y r u l e . ( Again, ARM 546-2.10 ( 3 8 ) -S101950 (1) a ) ( i )p r o v i d e s : " R e t r o a c t i v i t y beyond t h e above f i v e - d a y l i m i t s h a l l be a l l o w e d a t t h e d i s c r e t i o n o f t h e c o u n t y w e l f a r e board upon good c a u s e shown f o r f a i l u r e t o meet s a i d f i v e - d a y l i m i t . " The h e a r i n g s o f f i c e r , t h e board and t h e D i s t r i c t C o u r t a l l found t h a t a p p e l l a n t d i d n o t g i v e good c a u s e f o r f a i l u r e t o meet the five-day limit, noting that her parents or she could have telephoned or that the medical vendor or some other person could have made application for the aid within the five-day period. Appellant argues that as a matter of law she has shown good cause for failure to apply for the medical benefits within five days of receiving the services. Neither she nor her family had ever received any welfare benefits in the past. They had no knowledge of the county medical program until two months after appellant was released from the hospital in a county several hundred miles away from her home. What the hearings officer, the board of county commissioners, and the District Court failed to take into consideration in the fact situation here is that appellant was involved in an accident where one person was killed; was in an intensive care situation for a matter of days; remained in the hospital away from her home for over two weeks; and was unable to go out of her home for nearly three months. Under these facts, this Court can and has reversed administrative decisions that are arbitrary or capricious or constitute abuse of discretion on the part of the administrative authority. Here the administrative decision was arbitrary and capricious. No reason was provided for the agency's decision that appellant did not have good cause for applying more than five days after receiving the medical services. The Cascade County welfare department is obliged to assist indigents in paying for medical services. In light of this we find that appellant has made a good faith and reasonably diligent effort to get this assistance from the county and that it was an abuse of discretion for the welfare department to determine that she did not have good c a u s e f o r a p p l y i n g more t h a n f i v e d a y s a f t e r r e c e i v i n g t h e medical a s s i s t a n c e . The t h i r d i s s u e p r e s e n t e d f o r o u r c o n s i d e r a t i o n i s whether a p p e l l a n t i s a r e s i d e n t of Cascade County f o r t h e p u r p o s e s of c o u n t y m e d i c a l a s s i s t a n c e . This Court i n a r e c e n t c a s e , County of B l a i n e v. Moore ( 1 9 7 7 ) , 174 Mont. 1 1 4 , 568 P.2d 1216, 3 4 St.Rep. 1051, c o n s i d e r e d t h e q u e s t i o n of t h e r e s i d e n c y of c o l l e g e s t u d e n t s a s t o r e c e i v i n g p u b l i c assistance. There t h e C o u r t n o t e d : "At t h e end of t h e Moores' y e a r of r e s i d e n c e i n Montana, s u b s e q u e n t t o r e t u r n i n g from Colorado, t h e Moores were r e s i d i n g a t Havre, i n H i l l County, a t t e n d i n g N o r t h e r n Montana C o l l e g e and l i v i n g i n t h e married couples housing u n i t . Under a s t r i c t i n t e r p r e t a t i o n of s e c t i o n 7 1 302.2 [R.C.M. 19471, one would c o n c l u d e t h a t H i l l County i s t h e c o u n t y o f f i n a n c i a l respons i b i l i t y . However, a presumption arises t h a t t h e county wherein a c o l l e g e o r u n i v e r s i t y l i e s i s n o t t h e r e s i d e n t c o u n t y of t h e a t t e n d a n t students. G e n e r a l l y , s t u d e n t s t r a v e l from t h e r e s i d e n c e of t h e i r p a r e n t s , a t t e n d i n g c o l l e g e o n l y d u r i n g t h e academic y e a r , and r e t u r n t o t h e i r p a r e n t s ' r e s i d e n c e on weekends, h o l i d a y s and summer b r e a k s . F o r t h i s r e a s o n , i t i s customary t o l o o k t o t h e p a r e n t s ' r e s i d e n c e i n order t o determine t h e residence of t h e student. O t h e r w i s e , t h e c o u n t y i n which t h e c o l l e g e l i e s would b e unduly burdened w i t h p r o v i d i n g f o r t h e s o c i a l w e l f a r e of s t u d e n t s . " 568 P.2d a t 1224. Here a p p e l l a n t was born and r a i s e d i n Cascade County. Her p a r e n t s and f a m i l y l i v e i n Cascade County. She g i v e s Cascade County a s h e r permanent a d d r e s s and i n t e n d s t o r e s i d e t h e r e a f t e r she f i n i s h e s school. The f a c t t h a t s h e a c c e p t e d temporary summer employment i n G a l l a t i n County d o e s n o t change h e r p l a c e of r e s i d e n c e . Under t h e r u l e e s t a b - l i s h e d i n County of B l a i n e v . Moore, s u p r a , a p p e l l a n t i s found t o be a r e s i d e n t of Cascade County f o r p u r p o s e s of county medical a s s i s t a n c e . The judgment of t h e D i s t r i c t C o u r t i s r e v e r s e d . W e concur: 74f J u4..k w , -h i e- s t i c e C c Justices

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