J.M. v. Garfield Medical Center CA2/1

Filed 8/21/26 J.M. v. Garfield Medical Center CA2/1
NOT TO BE PUBLISHED IN THE OFFICIAL REPORTS

California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions
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has not been certified for publication or ordered published for purposes of rule 8.1115.

IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA

SECOND APPELLATE DISTRICT

DIVISION ONE

J.M., a Minor, etc., B342088

Plaintiff and Respondent, (Los Angeles County
Super. Ct. No. 19STCV15763)
v.

GARFIELD MEDICAL CENTER
et al.,

Defendants;

CALIFORNIA DEPARTMENT OF
HEALTH CARE SERVICES,

Claimant and Appellant.

APPEAL from an order of the Superior Court of
Los Angeles County, Lisa R. Jaskol, Judge. Reversed and
remanded with directions.
Rob Bonta, Attorney General, Cheryl L. Feiner, Assistant
Attorney General, Maureen C. Onyeagbako and Michael E.
Byerts, Deputy Attorneys General, for Claimant and Appellant.
Lew-Stevens and Steven B. Stevens for Plaintiff and
Respondent.
____________________________

Plaintiff Jennifer M., individually and as guardian ad litem
for her minor daughter, plaintiff and respondent J.M., sued a
hospital and two doctors for medical negligence.1 The trial court
later granted J.M.’s petition for an order approving the
settlement of her claims for $7,480,000. In that approval order,
the court determined the value of J.M.’s overall damages,
including the present value of the costs of her future care, and
reserved jurisdiction to decide a claim for the reduction of a
$410,466.68 Medi-Cal lien for past medical costs.
Several years later, J.M. moved for a determination of the
value of the Medi-Cal lien. J.M. asked the trial court to reduce
the lien using the following formula: Reimbursement Due =
[Total Settlement ÷ Full Value of Claim] x Value of the Medi-Cal
Benefits Provided.2 In response, claimant and appellant

1 To protect the minor’s privacy, we identify her by initials
and her mother by first name and last initial. (See Cal. Rules of
Court, rule 8.90(b)(9) & (b)(11).) For the sake of clarity and
consistency, we refer only to J.M. when discussing actions
undertaken by Jennifer M. in her capacity as J.M.’s guardian ad
litem.
2 As we explain in our Applicable Law Regarding Medi-Cal
Liens, post, this equation is designated the Ahlborn formula, in

2
California Department of Health Care Services (the Department)
asked the trial court to exclude a substantial portion of J.M.’s
future medical expenses from the denominator of the ratio used
in the Ahlborn formula, namely, the full value of the claim. The
Department argued this exclusion was proper because Medi-Cal
will cover much of J.M.’s future care. Granting the Department’s
request would have increased the ratio employed in the formula,
thereby allowing the Department a greater recovery on the Medi-
Cal lien.
The trial court employed the Ahlborn formula, declined to
exclude any future medical expenses from the denominator,
further reduced the Medi-Cal lien to account for the
Department’s share of J.M.’s attorney fees and costs, and
awarded the Department $71,974.26 from the settlement. The
court reasoned that in seeking exclusion of certain future
expenses from the formula, the Department was attempting
improperly to relitigate the court’s prior determination of the
present value of the costs of J.M.’s future care.
We reverse the order determining the Medi-Cal lien. The
Department’s request for exclusion of certain future expenses
from the denominator of the Ahlborn computation is not a
challenge to the trial court’s prior finding as to the present value
of future medical care. Rather, the Department merely seeks an
adjustment to the formula based on the Department’s claim that
a subset of J.M.’s future expenses will be covered by Medi-Cal.
Furthermore, J.M. fails to demonstrate that claim or issue
preclusion bars the Department from making this request. On

reference to Arkansas Department of Health and Human Services
v. Ahlborn (2006) 547 U.S. 268 (Ahlborn).

3
remand, the trial court shall consider in the first instance
whether the Department met its burden of demonstrating it is
reasonably probable that Medi-Cal will pay for J.M.’s future
health care expenses and, if so, the court shall recalculate the
Department’s recovery accordingly.

PROCEDURAL BACKGROUND3
We summarize only those facts pertinent to our disposition
of this appeal.
In May 2019, plaintiffs filed this action for medical
negligence against defendants Garfield Medical Center; Jamie C.
Lin, M.D.; and Ben Ha, M.D.4 J.M. claims she sustained serious
injuries at birth, “[s]he is severely handicapped due to global
developmental delay,” and she will require around the clock “care
by a licensed vocational nurse . . . at school and at home[ ] for the
rest of her life.” J.M. acknowledges in her appellate brief that
“[s]ome of [J.M.’s] health care costs were paid by Medi-Cal.”
The parties ultimately agreed to settle the action for
$7,480,000. In October 2020, J.M. filed a petition to approve this
compromise of her pending action. The petition included a life
care plan for J.M. and a report calculating the present value of
her future medical care to be $28,185,265. An attachment to the
petition stated: “Medi-Cal claims that it paid $410,466.68, but

3 We derive our Procedural Background in part from
undisputed aspects of the trial court’s orders and admissions
made by the parties in their appellate briefing. (Association for
Los Angeles Deputy Sheriffs v. County of Los Angeles (2023)
94 Cal.App.5th 764, 772, fn. 2 (Association for Los Angeles Deputy
Sheriffs) [employing this approach].)
4 The three defendants are not parties to this appeal.

4
[J.M.] disputes that amount . . . . [J.M.] proposes to hold that
sum in [a] client trust account pending later determination of the
Medi-Cal lien, under Welfare & Institutions Code section
14124.76 (separate motion to determine lien claim).”5 J.M. asked
the trial court to retain jurisdiction of the case pending resolution
of the lien claim.
The Department was served with a copy of the petition for
approval of the compromise of J.M.’s action. The Department
did not object to the petition.
On February 18, 2021, the trial court signed and filed an
order approving the compromise of J.M.’s pending action. In the
order, the court stated: “The Court finds that the overall value of
the minor’s damages are: (1) present value of future care, in the
amount of $28,185,265; (2) present value of loss of earning
capacity in the amount of $3,994,721; [and] (3) Non-economic
damages in an amount greater than $250,000.00 but for purposes
of approval of the settlement, the Court assigns a value of
$250,000.” The court also found, “[T]he settlement is fair and
reasonable and in the best interests of the minor, in light of the
overall value of damages, the cost of further litigation, including
trial, the delay if the parties proceeded to trial, the risks of
prevailing or losing at trial, and the delay and risks of appeal.”
The court reserved jurisdiction to determine a claim for reduction
of the Medi-Cal lien and ordered that $410,466.68 be held in a
client trust account pending resolution of the lien claim.
On April 27, 2021, the trial court dismissed the entire
action with prejudice at plaintiffs’ request.

5 Undesignated statutory citations are to the Welfare and
Institutions Code.

5
On March 21, 2024, J.M. filed a motion under
section 14124.76 to determine the amount of the Department’s
lien. J.M. argued, inter alia, the trial court should employ the
Ahlborn formula to calculate the Medi-Cal lien as follows: (1) the
full case value for the denominator should be $32,840,653; (2) the
settlement amount of $7,480,000 is 22.777 percent of the full case
value; and (3) 22.777 percent of $410,667 is $93,538.6 J.M.
contended the court should further reduce that figure to account
for the Department’s share of attorney fees and costs such that
the final recoverable amount is $66,645.
The Department opposed the motion, contending it
provided Medi-Cal services valued at $501,219.02, and not
merely $410,466.68. Additionally, citing Aguilera v. Loma Linda
University Medical Center (2015) 235 Cal.App.4th 821 (Aguilera),
the Department contended that J.M.’s Ahlborn calculation was
flawed because she did not reduce the full case value used in the
denominator by the amount of future medical expenses that
Medi-Cal is reasonably likely to pay. The Department submitted
declarations to support its position that Medi-Cal will cover most
of the expenses included in J.M.’s life care plan.
In her reply, J.M. argued the Department had not
demonstrated that it will pay for J.M.’s future health care
expenses.
On August 27, 2024, the trial court awarded the
Department $71,974.26 on its lien.7 The court agreed with the

6 In her calculation, J.M. appears to have rounded the
$410,466.68 Medi-Cal lien identified in the approval order up to
the nearest dollar.
7The judicial officer who made this award is not the trial
judge who had approved the settlement.

6
Department that the reasonable value of past medical costs paid
by Medi-Cal was $501,219.02. On the other hand, the court ruled
that its prior determination of the present value of J.M.’s future
medical care barred the Department from seeking exclusion of
certain future expenses from the denominator used in the
Ahlborn formula.8 Using that equation, the court calculated the
amount recoverable by the Department as follows: “(1) [T]he
settlement amount of $7,480,000.00 is 23.06% of the total case
value [of $32,429,986], and (2) 23.06% of $501,219.02 is
$115,606.53.” To arrive at the $71,974.26 award to the
Department, the court reduced the $115,606.33 figure by
25 percent to account for the Department’s share of attorney fees
($28,901.58), and further reduced the Department’s recovery by
its proportionate share of costs ($14,730.49).
The Department timely appealed from the trial court’s
order determining the Department’s recovery on the Medi-Cal
lien.

APPLICABLE LAW REGARDING MEDI-CAL LIENS
“Medicaid is a medical assistance program for low-income
individuals that is jointly funded by the federal and state
governments. . . . . [¶] California has elected to participate in
Medicaid by establishing the Medi-Cal program. California’s
implementing legislation, known as the Medi-Cal Act, is codified
at section 14000 et seq. [Citation.] [The Department] is the state
agency charged with administering the Medi-Cal program.”
(Daniel C. v. White Memorial Medical Center (2022)
83 Cal.App.5th 789, 795, 800 (Daniel C.).)

8 We describe this aspect of the trial court’s order in
greater detail in Discussion, part A, post.

7
“[W]hen benefits are provided to a Medi-Cal beneficiary
because of an injury for which a third party . . . is liable, [the
Department] has the right to recover from such party . . . the
reasonable value of the Medi-Cal benefits.” (Daniel C., supra,
83 Cal.App.5th at p. 800.) The Department may “fil[e] an action
directly against [the] third party tortfeasor, . . . interven[e] in
[the] Medi-Cal beneficiary’s action against [the] third party,
or . . . fil[e] a lien against [the] beneficiary’s settlement,
judgment, or award.” (Ibid.)
“Recovery of the director’s lien from an injured beneficiary’s
action or claim is limited to that portion of a settlement,
judgment, or award that represents payment for medical
expenses, or medical care, provided on behalf of the
beneficiary. . . . In determining what portion of a settlement,
judgment, or award represents payment for medical expenses, or
medical care, provided on behalf of the beneficiary and as to what
the appropriate reimbursement amount to the director should be,
the court shall be guided by the United States Supreme Court
decision in [Ahlborn, supra,] 547 U.S. 268 and other relevant
statutory and case law.” (§ 14124.76, subd. (a), italics added.)
Ahlborn announced a formula that a trial court may, but
is not obligated to, employ to “determine which portion of the
settlement is attributable to past medical expenses, against
which [the Department] is entitled to collect its lien . . . .” (See
Daniel C., supra, 83 Cal.App.5th at p. 811.) “The Ahlborn
formula is the ratio of the settlement to the total claim, when
applied to the benefits provided by the Department. [Citation.]
Expressed mathematically, the Ahlborn formula calculates the
reimbursement due as the total settlement divided by the full
value of the claim, which is then multiplied by the value of

8
benefits provided. (Reimbursement Due = [Total Settlement ÷
Full Value of Claim] x Value of Benefits Provided.)” (Aguilera,
supra, 235 Cal.App.4th at p. 828.)
If a trial court elects to “apply[ ] the Ahlborn formula to
reduce the Department’s lien” and “future benefits . . . will be
paid by Med-Cal” in connection with the injury to the beneficiary,
then the court must, “as a matter of law,” “exclude” those future
costs “from its Ahlborn calculation.” (See Aguilera, supra,
235 Cal.App.4th at pp. 831–833.) Specifically, these future
expenses must be subtracted from the full value of the
beneficiary’s claim (i.e., the denominator in the Ahlborn formula),
thereby “result[ing] in a . . . higher ratio, and thus, a . . . higher
recovery by the Department.” (See id. at pp. 829–830, 833.)
“[E]xcluding such expenses is contingent on the Department
presenting sufficient evidence” that “it is reasonably probable
Medi-Cal will pay . . . th[ose] expenses in the future.” (See id. at
pp. 831–832.)
After the trial court determines which portion of the
settlement is attributable to past medical expenses (e.g., by resort
to the Ahlborn formula), the Department’s “claim for
reimbursement [on its lien] is [further] reduced by 25 percent,
representing its share of attorney fees, as well as by its statutory
share of litigation costs. [Citation.] A final determination of
rights and obligations with respect to a Medi-Cal lien is
appealable . . . .” (See Daniel C., supra, 83 Cal.App.5th at
pp. 800–801, 814.)

DISCUSSION
On appeal, neither side contests the trial court’s selection of
the Ahlborn formula to determine the Department’s recovery.
Rather, the Department challenges the court’s ruling that in

9
requesting exclusion of certain future health care costs from the
Ahlborn calculation pursuant to Aguilera, the Department was,
in essence, attempting to relitigate a prior finding in the court’s
order approving the settlement, namely that $28,185,265 is the
present value of J.M.’s future medical care. J.M. likewise
characterizes the Department’s request for exclusion of future
expenses from the Ahlborn formula as an effort to “relitigate the
amount of [J.M.]’s overall damages.” J.M. further argues res
judicata precludes the Department from seeking a reduction of
“the overall value of damages . . . to account for its promise to pay
for medical care in the future.”9
Because our resolution of these issues does not turn on
disputed facts, our review is de novo. (Shewry v. Begil (2005)
128 Cal.App.4th 639, 642.) We reverse the order determining the
value of the Medi-Cal lien because the trial court erred in failing
to determine whether, and if so to what extent, J.M.’s future
medical expenses should be excluded from the Ahlborn
computation. (Discussion, parts A–B, post.) On remand, the
court must determine in the first instance whether the

9 J.M. also argues, in passing, that the trial court erred by
failing to add the Department’s gross lien of $501,219.02 to the
denominator of the Ahlborn equation, which adjustment J.M.
claims would have reduced the Department’s net recovery from
$71,974.26 to $70,640. In asserting the Department’s gross lien
is not already accounted for in the denominator, J.M. apparently
takes issue with the trial court’s rejection of her contention that
she “could not pursue damages based on [past medical] expenses
in [the] lawsuit” “because she was required to assign her claim
for [those] expenses to the Department . . . .” Because J.M. states
she is “not pursuing [this alleged] error,” we do not address it
further.

10
Department satisfied its burden of showing “it is reasonably
probable the Department will pay [J.M.’s] future health care
expenses,” and, if so, recalculate the Medi-Cal lien accordingly.
(See Aguilera, supra, 235 Cal.App.4th at pp. 831–833 [indicating
that a trial court is charged with making this factual
determination based on the evidence presented].) Our disposition
moots the Department’s arguments that (1) the order
determining the Medi-Cal lien violated the Department’s right to
due process, and (2) requiring the Department to raise the
Aguilera issue in response to a petition to approve a minor’s
compromise would “impose additional costs and delays on the
parties and the trial courts.” (Boldface & some capitalization
omitted.)

A. The Trial Court Erred In Concluding the
Department’s Invocation of Aguilera Was an Attempt
To Relitigate the Present Value of J.M.’s Future Care
Although the Department offered evidence in support of its
position that it will pay most of J.M.’s future health care
expenses (see Procedural Background, ante), the trial court
did not decide whether the Department satisfied its evidentiary
burden under Aguilera. The court instead concluded that a
previous finding in the order approving the settlement barred the
Department from seeking exclusion of future health care
expenses from the full value of the claim used in the Ahlborn
equation. Specifically, the court observed that in approving the
settlement, the court (1) found, without objection from the
Department, that the present value of future care was
$28,185,265; and (2) “did not reserve jurisdiction to determine the
present value of [J.M.’s] future medical care.” In concluding the
Department was seeking to relitigate the present value of future

11
care, the court rejected the Department’s contention that, “under
Aguilera, supra, 235 Cal.App.4th 821, determining case value for
purposes of a petition to approve a minor’s compromise is
different from determining case value for purposes of
determining the Department’s lien.” (Italics added.)
In its order approving the settlement, the trial court had
determined the overall value of J.M.’s damages, including the
present value of future medical care, compared that overall value
to the $7,480,000 settlement amount, and found that “the
settlement [was] fair and reasonable and in the best interests of
the minor . . . .” By invoking Aguilera, the Department was not
disputing the factual finding that the present value of J.M.’s
future care is $28,185,265. Although we acknowledge that
Aguilera requires a court to subtract certain costs of future care
from the full value of the claim (the denominator in the Ahlborn
formula) (see Aguilera, supra, 235 Cal.App.4th at pp. 829–833),
that is merely a mathematical adjustment to the lien calculation
to account for the future health care costs “it is reasonably
probable the Department will pay” (see id. at p. 833). The
purpose of this adjustment is to ensure “the Department [is not]
forced to accept a[n otherwise] lower percentage of its total lien”
that does not take into consideration the future expenses “it will
in fact pay . . . .” (See id. at pp. 831–832.) Thus, allowing the
Department to make its case under Aguilera would not disturb
the court’s prior valuation of future care costs. The court would
simply be permitting the Department to show that it will pay a

12
subset of those future costs, thereby potentially attaining a
higher recovery on the lien.10
Further, although we agree with the trial court that it
did not retain jurisdiction to redetermine the present value of
J.M.’s future medical care, the order approving the settlement did
reserve jurisdiction to “determine a claim for a reduction of a
Medi-Cal lien under . . . section 14124.76.” Because the Aguilera
adjustment is made in the course of reducing the Department’s
Medi-Cal lien under the Ahlborn formula (see Applicable Law
Regarding Medi-Cal Liens, ante), the court had jurisdiction to
address the Department’s request to exclude certain future
health care costs from the calculation.
In sum, the trial court erred in barring the Department
from invoking Aguilera to increase potentially the Department’s
recovery on its lien.

B. We Reject J.M.’s Contention Res Judicata Barred the
Department From Seeking Exclusion of Certain
Future Medical Expenses from the Ahlborn
Calculation
“ ‘Claim preclusion arises if a second suit involves (1) the
same cause of action (2) between the same parties [or parties in
privity with them] (3) after a final judgment on the merits in the
first suit.’ . . . [Citation.]” (See Parkford Owners for a Better

10 Although J.M. insists one of the Department’s
declarants had opined that J.M. does not need care from a
licensed vocational nurse, the Department represents in its
appellate briefing that it does not challenge the trial court’s
finding that “the present value of future medical care is
$28,185,265.00.”

13
Community v. Windeshausen (2022) 81 Cal.App.5th 216, 225
(Parkford Owners for a Better Community).) Conversely, “[i]ssue
preclusion applies . . . : ‘ “(1) after final adjudication (2) of an
identical issue (3) actually litigated and necessarily decided in
the first suit and (4) asserted against one who was a party in the
first suit or one in privity with that party.” ’ [Citations.]” (Ibid.)
Although claim preclusion has “historically [been] referred to as
res judicata” and issue preclusion has “historically [been] referred
to as collateral estoppel” (see 7 Witkin, Cal. Procedure (6th ed.
2026) Judgments, § 361), “[c]ourts have at times used ‘res
judicata’ . . . as an umbrella term, encompassing both” doctrines
(see Parkford Owners for a Better Community, at p. 225).
J.M. attempts to salvage the trial court’s determination of
the Medi-Cal lien by resorting to a legal theory not discussed in
the court’s order. Specifically, J.M. argues the prior order
approving the settlement has “res judicata implications,” that is,
the approval order barred the Department from requesting
exclusion of certain future medical costs from the Ahlborn
formula.
As for issue preclusion, J.M. seems to argue the trial court
had “necessarily decided” not to reduce the full case value used
for the Ahlborn calculation when the court determined the
present value of J.M.’s future medical care in the order approving
the settlement. (See Parkford Owners for a Better Community,
supra, 81 Cal.App.5th at p. 225; see also ibid. [noting that an
essential element of issue preclusion is that the issue sought to
be precluded necessarily was decided in the first suit].) The
court’s determination of the present value of J.M.’s future
medical expenses, however, is an issue distinct from whether the
court should exclude certain of those future medical expenses

14
from the Ahlborn formula. (See Discussion, part A, ante
[explaining the latter question turns on whether the Department
shows it is reasonably probable Medi-Cal will pay those future
expenses].) Accordingly, issue preclusion has no application here.
Turning to claim preclusion, “Two proceedings are on the
same cause of action if they are based on the same ‘primary
right.’ [Citations.] Under this theory, a cause of action is
‘ “comprised of a ‘primary right’ of the plaintiff, a corresponding
‘primary duty’ of the defendant, and a wrongful act by the
defendant constituting a breach of that duty. [Citation.] . . .
[Citation.] . . . ” ’ [Citation.]” (Association of Irritated Residents
v. Department of Conservation (2017) 11 Cal.App.5th 1202, 1228,
fn. 24.) J.M. does not argue — let alone demonstrate — that
under the primary rights theory, the Department sought to
relitigate a cause of action that the trial court adjudicated when
it approved the settlement of J.M.’s medical negligence action.
Thus, insofar as J.M. contends claim preclusion bars the
Department from seeking an adjustment to the lien calculation
under Aguilera, J.M. fails to provide any analysis to support that
contention. (See Association for Los Angeles Deputy Sheriffs,
supra, 94 Cal.App.5th at pp. 787, fn. 19, 792 [noting that the
respondent has a duty to aid the appellate court in sustaining the
judgment, and that “ ‘[w]e do not serve as “backup appellate
counsel,” or make the parties’ arguments for them’ ”].)
We thus reject J.M.’s invocation of “res judicata.” In light
of our analysis above, we do not address the Department’s
arguments that (1) claim and issue preclusion are inapplicable
because the Department was not a party to the petition to
approve the settlement, (2) issue preclusion is inapposite because
the petition for approval and the motion to determine the

15
Department’s lien did not address identical factual allegations,
and (3) claim preclusion does not apply because “[t]he petition
[for approval] could not have litigated the Aguilera issue . . . .”
(Boldface omitted.)

DISPOSITION
We reverse the trial court’s order determining that
claimant and appellant California Department of Health Care
Services shall recover only $71,974.26 on its Medi-Cal lien, and
remand this matter for further proceedings consistent with this
opinion. In the interests of justice, we order each party to bear
its own costs on appeal. (Cal. Rules of Court, rule 8.278(a)(5).)
NOT TO BE PUBLISHED.

BENDIX, Acting P. J.

We concur:

WEINGART, J.

M. KIM, J.

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