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AGO 1950 No. 381 - November 14, 1950
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Smith Troy | 1941-1952 | Attorney General of Washington

SOCIAL SECURITY ‑- STATE DEPARTMENT OF HEALTH ASSUMING HEALTH SERVICES TO RECIPIENTS

1. Section 7 of Initiative 178 transfers the legal responsibility for providing necessary medical care and health services to recipients of public assistance and medical indigents from the Department of Social Security to the State Department of Health.

2. The Department of Social Security is not legally authorized to continue its agreement for medical care with the State Medical Bureau which was entered into under Initiative 172.

3. The Department of Health is legally responsible for medical care under Initiative 178, but until the legislature convenes a dual control arrangement for dismissal of the funds appropriated for the medical aid program should be worked out between the Department of Social Security and the Department of Health.

4. The Department of Health is authorized under Initiative 178, to establish standards for health services to medical indigents and recipients of public assistance.

5. The Department of Health cannot use the county two mill levy funds to provide medical care to medically indigent persons under Initiative 178 either directly or by reimbursement from the Department of Social Security.

6. The Department of Social Security no longer has any responsibility for or control over county hospitals and infirmaries.

                                                                   - - - - - - - - - - - - -

                                                               November 14, 1950

Honorable Roderic Olzendam, Director
Department of Social Security
Olympia, Washington                                                                                                              Cite as:  AGO 49-51 No. 381

Dear Sir:

            You have requested the opinion of this office on the following questions:

             [[Orig. Op. Page 2]]

            1. Do the provisions of section 7, of Initiative 178, which amends section 15, chapter 6, Laws of 1949, mean that after December 7, 1950, the State Department of Health will assume all medical care to public assistance recipients and others unable to meet the costs of such care?

            2. Inasmuch as the State Department of Health has no appropriation with which to provide medical care under Initiative 178, can the Department of Social Security continue its agreement with the Washington State medical Bureau for doctor services and pay directly for other health services after December 7, 1950?

            3. If the answer to the second question is no, can some interim plan for medical care for recipients be worked out between the Department of Social Security and the Department of Health so that no hardships may occur?

            4. Is the Department of Social Security or the Department of Health authorized to set standards for medical care given to medical only cases?

            5. Can the State Department of Health use the county two mill levy funds provided for in chapter 216, Laws of 1939, to care for medical indigents either directly or by reimbursement from the Department of Social Security through the county welfare departments?

            6. What authority, if any, does the Department of Social Security have after December 7, 1950, over county hospitals and infirmaries?

            Our conclusions may be summarized as follows:

            1. Section 7 of Initiative 178 transfers the legal responsibility for providing necessary medical care and health services to recipients of public assistance and medical indigents from the Department of Social Security to the State Department of Health.

            2. The Department of Social Security is not legally authorized to continue its agreement for medical care with the State Medical Bureau which was entered into under Initiative 172.

             [[Orig. Op. Page 3]]

            3. The Department of Health is legally responsible for medical care under Initiative 178, but until the legislature convenes, a dual control arrangement for disbursal of the funds appropriated for the medical care program should be worked out between the Department of Social Security and the Department of Health.

            4. The Department of Health is authorized under Initiative 178, to establish standards for health services to medical only persons and recipients of public assistance.

            5. The Department of Health cannot use the county two mill levy funds to provide medical care to medically indigent persons under Initiative 178 either directly or by reimbursement from the Department of Social Security.

            6. The Department of Social Security has no responsibility for, or control over county hospitals and infirmaries under Initiative 178.

                                                                     ANALYSIS

            Section 7, of Initiative 178, which amends section 15, chapter 6, Laws of 1949, (1949 Rem. Supp. 9998-330) provides in part as follows:

            "(a) On and after the effective date of this amendatory act the State Department of Health shall be responsible for providing necessary medical, dental and related services to recipients of public assistance and other persons without income and resources sufficient to secure them.  Eligibility for such medical service shall be established by the Department of Social Security."

            In addition, it provides:

            "* * *

            "(b) The State Board of Health shall formulate policies, establish standards and rules and regulations to carry out the purposes of this act.  * * *"

             [[Orig. Op. Page 4]]

            It seems clear from the provisions of section 7 of the Initiative,supra, that after the effective date of the Act, December 7, 1950, all legal responsibility for providing necessary medical, dental and related services to recipients of public assistance and medically indigent persons is transferred from the Department of Social Security to the Department of Health.  Accordingly, since the Department of Social Security is no longer legally responsible for providing medical care, it has no authority to continue its contract with the Washington State Medical Bureau for doctor services and to pay directly for medical services after December 7, 1950.  However, no provision was made in Initiative 178 for the transfer of monies appropriated for medical care from the Department of Social Security to the Department of Health after December 7, 1950.  Section 7 provides in subsection (h) that the medical service program shall be financed from funds appropriated to the Department of Health.  In addition, it provides that the Department of Health shall allocate the total appropriation by the legislature so that funds shall be available for the period designated.  The Department of Social Security, however, still has money available which was appropriated to it by the legislature to provide for medical care for recipients of public assistance under the provisions of Initiative 172 during the biennium, although it no longer has responsibility for such medical care under Initiative 178.  The 1949 legislature appropriated from the General Fund to the Department of Social Security the sum of twenty-two million dollars to be used to provide "medical services."  Clearly the intent of the legislature was that such money should be used to provide medical care under our public assistance laws.  The question then is whether or not the Department of Health can provide health services and medical care under section 7 of Initiative 178 and the Department of Social Security pay the cost of such services and care out of the appropriation for their medical services until the legislature convenes in January, at which time the situation can be remedied.  Clearly there would be no violation of the constitutional provision found in Article VIII, section 4, to the effect that no monies may be expended out of the treasury except in pursuance of an appropriation.  The legislature intended that the twenty-two million dollars appropriated should be spent during the biennium to provide medical care under the provisions of the public assistance laws of this state.

            We have been unable to find any specific statutory or case authority which would allow the transfer of an appropriation from one department of a state to another where there has been a transfer of duties and where there was no specific act authorizing such a transfer.  As a practical matter, however, it would obviously work undue and unnecessary hardships on many needy persons if they were denied medical care between December 7, 1950, and the convening of the legislature merely because no provision was made in  [[Orig. Op. Page 5]] the law for a new appropriation or the transfer of the 1949 appropriation to the Department of Health.  It is our opinion, therefore, that some method of dual control by both departments should be worked out so that they are in agreement as to the medical care to be provided and paid for under section 7, since the Department of Social Security should not be required to sign vouchers for payment of medical care unless they are working in close cooperation with the Department of Health and know what care has been provided.  This method of dual control should be in effect only until the legislature convenes in January, and at that time the matter should be brought to the attention of the legislators for immediate action by them.  In answer to your third question, therefore, it is the opinion of this office that the Department of Health and the Department of Social Security can work out a method of dual control over the medical care problem under Initiative 178 until the legislature convenes in January.

            This does not mean, however, that the Department of Social Security has any legal authority to actually administer the medical care program or provide medical services.  Its sole responsibility under the Initiative is to determine eligibility for medical care of recipients of public assistance and medically indigent persons.  As was pointed out,supra, the State Board of Health is to formulate policies, establish standards and rules and regulations to carry out the purposes of the act.  In addition, subsection (a) provides such eligibility for medical service shall be established by the Department of Social Security.  In answer to your fourth question, therefore, it is the opinion of this office that the Department of Social Security is to determine whether or not a medically indigent person is eligible for medical care, and the State Board of Health is to determine the standard for medical care provided for such persons.

            The county two mill levy funds to which you refer are provided for in section 10, chapter 216, Laws of 1939, as amended by chapter 172, Laws of 1943.  (1943 Rem. Supp. 10007-110a).  Under that provision, each county annually levies a tax of two mills, the proceeds of which are to be used primarily for general assistance purposes.  General assistance is defined under that act as assistance and/or services of any character provided to needy persons.  Under Rem. Rev. Stat. 9986, the last remnant of the old poor laws, each county through its county commissioners was responsible for medical care of indigent persons within its territory.  In a series of Attorney General's opinions, this office has ruled that such responsibility was assumed by the Department of Social Security under our public assistance laws.  The monies used for such care of indigent persons during the past have been those of the  [[Orig. Op. Page 6]] county two mill levy.  Now, however, section 7 of Initiative 178, specifically provides that the Department of Health shall be responsible for providing such medical care and an appropriation shall be made to cover the costs of such care, and repealing, by implication at least, Rem. Rev. Stat. 9986, supra. Therefore, since the county commissioners are no longer legally responsible for the medical care of indigents in their county and the Department of Health is now responsible for such care, it is the opinion of this office that monies from the counties' two mill levies cannot be used either directly by the Department of Health or be paid by the Department of Social Security through the county welfare departments to reimburse the Health Department for the cost of providing medical or related services to medically indigent persons.

            In answer to your last question, section 7 of Initiative 178 provides that the Department of Health in providing medical care:

            "(4) shall make full use of all existing public and free facilities and services,"

            and provides further in subsection (g) that:

            "the local health officer shall have supervision over county hospitals and other public institutions utilized in providing medical service to the eligible persons.  The local Health Department shall make full use of public, free and voluntary facilities and services in the administration of this program."

            It is therefore the opinion of this office that under the provisions of Initiative 178,supra, the Department of Social Security no longer has any responsibility for financing hospitals or infirmaries; nor does it have any control over or supervision of the personnel or physical plants of such county hospitals or infirmaries.  This opinion is not to be construed however, as determinative of the control to be exercised by the Department of Health over county hospitals under the provisions of section 7 of Initiative 178.

Very truly yours,

SMITH TROY
Attorney General

JANE DOWDLE
Assistant Attorney General

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