No. 13578
I N THE SUPREME COURT OF THE STATE O M N A A
F O T N
C U T O BLAINE, STATE O MONTANA,
O NY F F
P e t i t i o n = and A p p e l l a n t ,
EDWIN S. M O E and ST. JAMES COMMUNITY
OR
HOSPITAL,
Respondent a n d R e s p o n d e n t .
Appeal from: D i s t r i c t Court o f t h e Twelfth J u d i c i a l D i s t r i c t ,
H o n o r a b l e B. W. Thomas, J u d g e p r e s i d i n g .
C o u n s e l o f Record:
For Appellant:
Solem a n d MacKenzie, Chinook, Montana
S t u a r t C. MacKenzie a r g u e d , Chinook, Montana
F o r Respondent:
C o r e t t e , S m i t h and Dean, B u t t e , Montana
G e r a l d R . A l l e n a r g u e d , B u t t e , Montana
Submitted: J u n e 1, 1977
Decided: SEP i/i ;CJT~,
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Filed: I
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 respon-
sibility, 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 Decem-
ber 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. Com-
plications 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 regard-
ing 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 fore-
seeable 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 de-
cision 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 re-
quested by the Board of Social and Rehabilitation Appeals in their
decision of August 29, 1975, the rehearing was limited to a deter-
mination 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 re-
hearing 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, review-
ing 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 ad-
ministrative 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 pur-
sue the Moores' claim for county medical benefits. The depart-
mental rules of the Montana Department of Social and Rehabilita-
tion 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 pur-
poses 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 unsuccess-
ful 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 repre-
sentative withdraws his request for a fair hear-
ing 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 conjunc-
tion 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 justifica-
tion 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 claim-
ant 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 'off-
reservation Indians.'"
MAC 46-2.10(18)-S11490 provides:
"(a) Third party includes an individual, insti-
tution, 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 exam-
ination. 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 avail-
able, 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 juris-
diction.
" (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 jurisdic-
tion 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, ser-
vices 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 con-
cern 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 responsi-
bility 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 responsi-
bility is that county in which the claimant resides at the end
of one year continuous residence in Montana. The statutory lang-
uage would infer that a person, otherwise qualified, who makes
his permanent home in the state of Montana with the intent to be-
come a resident, may migrate from county to county within Montana
and, at the end of the one year period, the county where the per-
son 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 finan-
cially 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 I n i t i a t i n g Date Terminating S i t u s of R e s i d e n c e Approximate p e r i o d
Residence Residence of Residence
Dec. 24, 1972 S e p t . 23, 1973 Lodgepole, B l a i n e 9 months
County
S e p t . 24, 1973 A p r i l 23, 1974 Havre, H i l l 7 months
County
A p r i l 24, 1974 S e p t . ?, 1974 Lodgepole, B l a i n e 5 months
County
S e p t . ?, 1974 Dec. 28, 1974 Anaconda, Deer 3 months
Lodge County
Dec. 29, 1974 present Lodgepole, B l a i n e
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 uni-
versity 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 Col-
lege 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 respon-
sibility for purposes of providing county medical welfare assis-
tance 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 deter-
mination 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 ,?Appealsand
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 / '