Herrera, SFUSD Sue State for Refusing to Reimburse Health Care for School Kids

Defiant state bureaucracy continues to stiff local schools for health care costs for children covered by Medi-Cal, lawsuit alleges

SAN FRANCISCO (May 21, 2009) — Defiant state officials are violating California law by refusing to reimburse local schools for the costs of providing diagnostic and treatment services to school children covered by Medi-Cal, according to a lawsuit filed today by City Attorney Dennis Herrera on behalf of the San Francisco Unified School District.

Medi-Cal, which is California’s version of the state- and federally-funded program that provides medical services to low-income individuals and families, is obligated under state law to reimburse local educational agencies’ costs for providing basic health care and screenings to school children covered by the program. Yet despite the unambiguous legal requirements — and despite published admissions by a senior state health official that the state’s refusal to reimburse is illegal — the California Department of Health Care Services has continued to shift its Medi-Cal responsibilities to school districts already struggling with chronic budget shortfalls. Without the state reimbursements rightfully owed to school districts through Medi-Cal, the complaint argues, San Francisco’s public schools will be irreparably harmed by having to withhold basic medical services, or to reduce vital educational programs and services.

“San Francisco schools are already grappling with enormous challenges in the current budget environment, and it is simply unconscionable for a defiant state bureaucracy to be stiffing local school districts over basic health care services,” said Herrera. “Without the state reimbursements to which our schools are rightfully entitled, it will be school children who ultimately pay the price. I’m grateful to Superintendant Carlos Garcia and others from the San Francisco Unified School District who are working to ensure that the state follows the law, and to get our schools the funding they’re owed.”

“At the end of the day, this case is about protecting the interests of San Francisco school children,” said Carlos Garcia, superintendent of the San Francisco Unified School District. “SFUSD officials have worked hard to reach a resolution with the California Department of Health Care Services over Medi-Cal reimbursements, but the department has not been responsive. I’m thankful to the City Attorney’s office for being capable and aggressive partners with us to make sure justice is done, and to get San Francisco schools the funding they deserve for the health services they have provided.”

According to the complaint filed in San Francisco Superior Court this morning, state officials have attempted to justify their non-reimbursement practice under the “Free Care Principle,” a long-defunct federal policy that once denied financial assistance if services provided to Medicaid-eligible individuals were also provided to others free of charge. That principle was formally invalidated in 2004 after administrators from the Bush Administration’s Department of Health and Human Services found it unsupported by federal law or regulation. Repeated efforts by officials of the San Francisco Unified School District to reach an agreement with the state over its reimbursement obligations have been either ignored or tersely rebuffed.

The civil complaint names the State of California, the California Department of Health Care Services and its director, as defendants. Because of the ongoing irreparable harm caused by the state’s illegal non-reimbursement policy, the civil action seeks a judicial determination of the legality of that policy as soon as possible. While the lawsuit will ultimately seek to recover money that the state has unlawfully withheld from the school district in past years, the school district’s petition for a writ of mandate applies only to prospective relief. The school district estimates that it spends well over $100,000 per year on these services. A favorable ruling could benefit school districts across the state, which are also being unlawfully denied reimbursement for provision of these vital health services.

The case is San Francisco Unified School District v. the State of California et al, San Francisco Superior Court, filed May 21, 2009.