796 N.W.2d 158
Minn. Ct. App.2011Background
- Harold Young, 80, with Alzheimer’s, receives elderly-waiver services at Valleyview of Owatonna under Minnesota’s 1915(c) waiver.
- Steele County (county) notified guardians that it would terminate its contract with Valleyview and would not cover services there after June 30, 2008.
- Young’s appeal to DHS challenged the county’s decision to restrict his choice of provider under federal and state waiver requirements.
- A managed-care plan later paid for Young’s services at Valleyview retroactively to July 1, 2008, but Young became ineligible for that plan and the county again denied elderly-waiver services in January 2009.
- The Steele County contract with Valleyview had previously indicated Valleyview was a contracted provider; county officials framed the issue as whether a provider must have a county contract to be “qualified.”
- The district court and commissioners held that a “qualified provider” must have a county contract, restricting Young’s free choice; the appellate court reverses on authority and reasonings, remanding for contract with Valleyview.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the commissioner may review the county’s contract decision | Young asserts county action is reviewable as a county agency action. | County argues no review because it’s not a county agency decision. | The commissioner may review the county's contracting decision. |
| Whether the county could restrict free choice by declining to contract with Valleyview | Free choice requires provider qualification; Valleyview is qualified despite lack of a county contract. | County may restrict providers by not contracting with them, citing lead-agency procedures. | County lacked authority to restrict free choice by terminating Valleyview’s contract. |
Key Cases Cited
- St. Otto’s Home v. Minn. Dept. of Human Servs., 437 N.W.2d 35 (Minn.1989) (statutory-review and agency review standards (de novo))
- Martin ex rel. Hoff v. City of Rochester, 642 N.W.2d 1 (Minn.2002) (Medicaid plan conformity to federal requirements)
- Shagalow v. State, Dep’t of Human Servs., 725 N.W.2d 380 (Minn.App.2006) (waiver terms and provider access)
- Occhino v. Grover, 640 N.W.2d 357 (Minn.App.2002) (free choice of qualified providers under waiver)
- Premier Bank v. Becker Dev., LLC, 785 N.W.2d 753 (Minn.2010) (statutory interpretation and implied limits)
- Ball v. Rodgers, 492 F.3d 1094 (9th Cir.2007) (free-choice in waivers; access and choice)
- Harris v. McRae, 448 U.S. 297 (U.S.1980) (federal requirements for Medicaid programs)
- O’Bannon v. Town Court Nursing Ctr., 447 U.S. 773 (U.S.1980) (free choice right under Medicaid)