Farmacia San Jose v. Dept. of Health Care Services CA3

BACKGROUND

A. Statutory and regulatory framework Medicaid is a cooperative federal-state program under which the federal government and participating state governments share the costs of providing health care services to qualified low-income persons. (County of Colusa v. Douglas (2014) 227 Cal.App.4th 1123, 1126.) California participates in the Medicaid program through its California Medical Assistance Program, or “Medi-Cal,” which is administered by the Department pursuant to the Medi-Cal Act (Welf. & Inst. Code, § 14000 et seq.) and the Department’s Medi-Cal regulations. (Cal. Code Regs., tit. 22, § 50000 et seq.)1 (County of Colusa, supra, at p. 1126; Oroville Hospital v. Department of Health Services (2006) 146 Cal.App.4th 468, 471-472.) To obtain reimbursement for Medi-Cal services, a medical professional must enroll as a “provider” in the Medi-Cal program. (Marvin Lieblein, Inc. v. Shewry (2006) 137 Cal.App.4th 700, 707; Golden Drugs Co., Inc. v. Maxwell-Jolly (2009) 179 Cal.App.4th 1455, 1458 (Golden Drugs); Welf. & Inst. Code, § 14043.1, subds. (h), (o); § 51000.7.) An applicant seeking enrollment must follow the procedures and requirements specified in the Medi-Cal…