DETERMINATION OF ELIGIBILITY OF PERSONS FOR MEDICAL ASSISTANCE UNDER SECTION 7, CHAPTER 1, LAWS OF 1951

DETERMINATION OF ELIGIBILITY OF PERSONS FOR MEDICAL ASSISTANCE UNDER SECTION 7, CHAPTER 1, LAWS OF 1951.

1. The state department of health cannot accept responsibility for providing medical service to persons not certified as eligible by the state department of social security under section 7, chapter 1, Laws of 1951.

2. The state department of health cannot honor claims for payment of services given to persons not certified as eligible by the state department of social security under section 7, chapter 1, Laws of 1951.

3. The state department of health cannot honor claims for payments of persons treated as emergencies at King County Hospital until such persons are certified as eligible for receiving medical services by the state department of social security under section 7, chapter 1, Laws of 1951.

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                                                                   May 23, 1951

Honorable J. A. Kahl, M.D.
Acting Director, State Department of Health
Smith Tower
Seattle 4, Washington                                                                                                Cite as:  AGO 51-53 No. 47

Dear Sir:

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

            1. Can the State Department of Health accept the responsibility for providing health services to persons not certified as eligible by the State Department of Social Security or one of its agencies?

            2. Can the State Department of Health honor claims for payment for services given to persons not certified as eligible by the State Department of Social Security or one of its agencies?

            3. Can the State Department of Health honor for payment from its appropriation the cost of care at King County Hospital for patients admitted as emergencies who have contagious diseases or who are under psychiatric  [[Orig. Op. Page 2]] observation without respect to their financial situation, even though income from those patients collected at a later date may be deducted from the operating cost of the hospital system during a subsequent month and therefore deducted from that month's obligation against the hospital?

            Our conclusions may be summarized as follows:

            1. Under section 7, chapter 1, Laws of 1951, the state department of health cannot accept the responsibility for providing health services to persons not certified as eligible by the state department of social security.

            2. The state department of health cannot honor claims for payment for services given to persons not certified as eligible by the state department of social security.

            3. The state department of health cannot honor for payment the cost of care at King County Hospital for patients admitted as emergencies who have contagious diseases or who are under psychiatric observation until the patients have been certified as eligible by the state department of social security.

                                                                     ANALYSIS

            Section 7, chapter 1, Laws of 1951, which amends section 15, chapter 6, Laws of 1949, reads in part as follows:

            "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."  (Emphasis supplied)

            It is clear beyond question by the above quoted portion of the Citizens' Security Act that eligibility of people for necessary medical, dental and related services is determined by the state department of social security.  This cannot mean that King County Hospital determines the eligibility of patients admitted there for state medical assistance, unless the King County  [[Orig. Op. Page 3]] Hospital has certified as authorized agents of the state department of social security.  The state department of health cannot accept responsibility for providing health services to persons not certified by the state department of social security.  It follows, logically, therefore, that the state department of health cannot honor claims for payment for medical services rendered to not properly certified persons.

            This reasoning is also applicable to cases where King County Hospital has admitted patients as emergencies, who have contagious diseases or who are under psychiatric observation without respect to those patients' financial situation.  Even though payment from those patients may be forthcoming at a future date and the amount deducted from a month's obligation against the department, the state department of health cannot honor for payment claims for the care of such patients unless they are certified as eligible by the state department of social security.

Very truly yours,

SMITH TROY
Attorney General

BARBARA L. OHNICK
Assistant Attorney General