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 1989
Filed : f'PIflR 2:; 1389
Mr. 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.
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 con-
tacted 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 respon-
sibility 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. . ." 477 P.2d a t
343. 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 hos-
p 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 . "
A s previously noted, it i s w e l l established i n t h i s
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 538; Mooney v .
P i c k e t t ( 1 9 7 1 ) , 94 C a l . R p t r . 279, 483 P.2d 1231; Lawson v.
S h u a r t ( 1 9 7 1 ) , 323 N.Y.S.2d 488; W i l l i a m s v . S h a p i r o ( 1 9 6 7 ) ,
4 Conn.Cir. 449, 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 . Com'n
( 1 9 7 3 ) , 106 C a l . R p t r . 31, 505 P.2d 223. 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, - Mont.
, 594 P.2d 331, 36 St.Rep. 880. " 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 re-
leased from the hospital in a county several hundred miles
away from her home.
What the hearings officer, the board of county commis-
sioners, and the District Court failed to take into considera-
tion in the fact situation here is that appellant was involved
in an accident where one person was killed; was in an inten-
sive 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 au-
thority. 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 wel-
fare 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 respon-
s 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 cus-
tomary 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