Mendocino Community Health Clinic v. State Department of Health Care Services

In this appeal, we must determine whether the State Department of Health Care Services (Department), which administers Medi-Cal, may limit payment to federally qualified health centers (FQHC’s) for psychological services to two visits per month per patient. The Department concluded that it can, but the trial court granted the petition of Mendocino Community Health Clinic and other related clinics (the Mendocino Clinics), which are FQHC’s, for a writ requiring payment beyond the two-visit limit. We conclude that the petition was improperly granted. Federal law does not prohibit a state’s application of utilization controls to psychology services rendered at an FQHC, and state law provides for those utilization controls.

BACKGROUND

At the time relevant to this appeal, the Medi-Cal program, which is California’s application of federal Medicaid law, provided coverage of outpatient clinic psychology services. These services, however, are subject to utilization controls. (Cowan v. Myers (1986) 187 Cal.App.3d 968, 973 [ 232 Cal.Rptr. 299 ]; Welf. & Inst. Code, § 14132, subd. (a).)

Welfare and Institutions Code section 14132, subdivision (a) provides that outpatient psychology…