Facts

Petitioner Patrick Kelley, a 67-year-old married man who has multiple sclerosis and Petitioner Matthew Reed, a 62-year-old married man who has multiple sclerosis, Bell's Palsy, and Vascular Dementia, petitioned for a writ of mandate and writ of administrative mandamus against respondents the California Department of Health Care Services and its Director Jennifer Kent, and California Department of Social Services and its Acting Director Pat Leary. Petitioners are disabled married couples who lacked the income and resources to pay for home and community-based care and should have been eligible for Medicaid services, but for respondents' alleged refusal to implement the Affordable Care Act's mandatory expansion of the Medicaid spousal impoverishment protection to ensure eligible individuals received access to Medicaid-funded services. The federal Medicaid Act's mandatory spousal impoverishment protection program allows married couples, where one spouse is a person with a disability, to access home and community-based Medi-Cal services, and to stay at home with their spouse, as opposed to going to a nursing facility to receive care.

PETITIONERS' CONTENTIONS: Petitioners contended that respondents refused to implement the federal Medicaid Act's mandatory spousal impoverishment protections which resulted in petitioners being unable to afford their care and placed them at risk of institutionalization or exhausting their savings. For example, Petitioner Kelley contended he was required to pay more than $1,500 per month for care when respondents' refused to implement the protection, which he contended he could not afford. Petitioners lastly contended respondents violated federal spousal protection laws and discriminated against petitioners based on their disabilities.

RESPONDENTS' CONTENTIONS: Respondents denied the contentions and contended they properly implemented the expanded spousal impoverishment rule for determining Medi-Cal eligibility. Respondents argued that DHCS satisfied its ministerial duties by exercising its discretion as to how implement the new rule by issuing guidance to the counties and other state agencies, providing trainings and technical assistance to the counties, and providing information to newly eligible beneficiaries in the ways it deemed most effective.

Result

The petition was granted in part and denied in part after the court determined that, as the single state Medicaid agency, the Department of Health Care Services was required to fully implement federal law: the expanded spousal impoverishment rule. The court noted the Act was part of the Affordable Care Act in 2014. Specifically, the court directed DHCS to provide further notice of the benefits and to implement rules for retroactive in-home supportive services benefits. However, Reed's petition for administrative mandamus was denied.