PRISONERS ‑- MEDICAL AID ‑- MEDICAL ASSISTANCE FOR CITY OR COUNTY JAIL PRISONERS

PRISONERS ‑- MEDICAL AID ‑- MEDICAL ASSISTANCE FOR CITY OR COUNTY JAIL PRISONERS

(1) In view of § 1, chapter 60, Laws of 1971, 1st Ex. Sess., amending RCW 74.09.510, inmates of a city or county jail or other penal or detention facility are no longer ineligible to receive medical assistance from the state during the period of their incarceration.

(2) The provision of medical assistance by the Department of Social and Health Services to city or county jail inmates remains, however, subject to the discretion of the Department of Social and Health Services.

(3) To the extent that a county or city jail inmate is eligible for medical assistance under RCW 74.09.510 and WAC 388-86-060, there is nothing in either the statute or the regulation which purports to limit the period of time during incarceration with respect to which medical assistance is to be provided.

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                                                                  March 20, 1979

Honorable Jim McDermott
State Senator, 43rd Dist.
105 Public Lands Building
Olympia, Washington 98504                                                                                                               Cite as:  AGLO 1979 No. 14

Dear Senator McDermott:

            By recent letter you requested our opinion on the following three questions:

            "1.  Are inmates of city and county penal or detention facilities in Washington State eligible to receive Medicaid benefits for medical services provided them during their incarceration?

             [[Orig. Op. Page 2]]

            "2.  If inmates are Medicaid-eligible, is the State required to provide such benefits, or is provision of benefits subject to the discretion of the Department of Social and Health Services?

            "3.  If inmates are Medicaid-eligible, are they entitled to benefits for the duration of their incarceration or for a limited portion thereof?"

            We respond to the foregoing questions in the manner set forth in our analysis.

                                                                     ANALYSIS

            First, let us clarify certain terminology used in all three of your questions.  The term "medicaid" is a term used by the United States Department of Health, Education and Welfare in its regulations pertaining to the medical assistance program provided for under Title XIX of the Federal Social Security Act.  The applicable state law, on the other hand, does not use the word "medicaid" but, instead, speaks of "medical assistance."  See, RCW 74.09.500 which codifies the provisions of § 3, chapter 30, Laws of 1967, Ex. Sess. and reads as follows:

            "There is hereby established a new program of federal-aid assistance to be known as medical assistance to be administered by the state department of public assistance.  The department of public assistance is authorized to comply with the federal requirements for the medical assistance program provided in the Social Security Act and particularly Title XIX of Public Law (89-97) in order to secure federal matching funds for such program."

            Section 4 of this same 1967 enactment, later codified as RCW 74.09.510, in turn, originally provided (in material part) as follows:

             [[Orig. Op. Page 3]]

            "Medical assistance may be provided in accordance with eligibility requirements established by the department of public assistance to an applicant:  (1) Who is in need; (2) who has not made a voluntary assignment of property or cash for the purpose of qualifying for an assistance grant; (3) who is not an inmate of a public institution except as a patient in a medical institution. . ."  (Emphasis supplied)

            On the basis of the above‑underscored portion of this statute, the attorney general, in a letter opinion dated October 22, 1969, to the then director of the State Department of Public Assistance (copy enclosed), advised that medical assistance wasnot legally available to city or county jail inmates ". . . whether or not [their] physical or mental condition requires hospitalization in a medical institution."  In so concluding we reasoned, in essence, as follows:

            "We read this statute to mean that the only inmate of a public institution who may receive medical assistance is one whose only contact with such an institution is as a patient in a medical institution. However, in the case of the question at hand, this is not the only contact between applicant and a public institution, instead, he is both a patient in a medical institution and an inmate in a county or city jail."

            Thereafter, however, the provisions of RCW 74.09.510, supra, were significantly amended.  By § 1, chapter 60, Laws of 1971, Ex. Sess., the legislature rewrote the disqualifying language of subsection (3) of that statute so as to cause it now to read as follows:

            ". . . (3) who is not an inmate of a public institution except as a patient in a medical institutionor except as an inmate in a county or city jail or juvenile detention facility, . . ."  (Emphasis supplied)

             [[Orig. Op. Page 4]]

            By corresponding administrative regulation, now codified as WAC 388-86-060, the Department of Public Assistance (now a part of the Department of Social and Health Services) then implemented this statutory amendment by providing as follows:

            "The department shall provide medical care under the appropriate program for an inmate of a city or county jail or of a juvenile detention facility, unless the local jurisdiction accepts responsibility to provide such care, provided the inmate is financially and medically eligible."

            What all of this means, in direct answer to your first question, is that inmates of a city or county jail or other penal or detention facility are no longer ineligible to receive medical assistance from the state during the period of their incarceration.  It does not, however, mean that all such inmates are entitled to such assistance for, in response to your second question, we must advise you that the provision of medical assistance by the Department of Social and Health Services to county or city jail inmates is (in the words of the question) ". . . subject to the discretion of the Department of Social and Health Services."  Simply stated, the operative word in the statute is "may" and not "shall."  Once again, here set forth in full for ease of reference, RCW 74.09.510,supra, now reads as follows:

            "Medical assistancemay be provided in accordance with eligibility requirements established by the department of social and health services to an applicant:  (1) Who is in need; (2) who has not made a voluntary assignment of property or cash for the purpose of qualifying for an assistance grant; (3) who is not an inmate of a public institution except as a patient in a medical institution or except as an inmate in a county or city jail or juvenile detention facility, or except as an inmate in a public institution who could qualify for federal aid assistance; and (4) who is a resident of the state of Washington."  (Emphasis supplied)

             [[Orig. Op. Page 5]]

            Conversely, WAC 388-86-060, supra, contains the mandatory word "shall."  Repeated for ease of reference, this regulation reads, in full, as follows:

            "The departmentshall provide medical care under the appropriate program for an inmate of a city or county jail or of a juvenile detention facility, unless the local jurisdiction accepts responsibility to provide such care, provided the inmate is financially and medically eligible." (Emphasis supplied)

            Notably, however, this mandatory administrative regulation contains two expressly stated, built in, qualifications; i.e., the department is to provide medical care ". . . unless the local jurisdiction accepts responsibility to provide such care, . . ." and, secondly, the department in any event is only to provide medical care to an inmate who ". . . is financially and medically eligible. . . ."

            Finally, in response to your third question our opinion is as follows:  To the extent that a county or city jail inmate may be said to be either eligible for medical assistance or, by reason of WAC 388-86-060, entitled to such assistance, neither the statute nor the regulation involved purports to limit the period of time during incarceration with respect to which medical assistance is to be provided.

            It is hoped that the foregoing will be of assistance to you.

Very truly yours,

SLADE GORTON
Attorney General

PHILIP H. AUSTIN
Deputy Attorney General