Justia Public Benefits Opinion Summaries

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John F. Murphy Homes, Inc. operates a private school that offers medical services that are paid for by MaineCare, a State Medicaid program. The State pays one-third of costs for MaineCare, a contribution commonly referred to as the Seed. In 2013, Murphy Homes filed a complaint that, as construed by the trial court, stated claims for breach of contract, quantum meruit, and an equitable claim for unjust enrichment or equitable estoppel, alleging that it was owed $7.5 million for Seed payments not paid between 2001 and 2011. The trial court granted summary judgment for the State on all claims. The Supreme Judicial Court affirmed, holding (1) the breach of contract and quantum meruit claims were not legally viable; and (2) Murphy Homes failed to allege facts to generate a trial worthy issue of fact on the reliance element of its equitable estoppel claim. View "John F. Murphy Homes, Inc. v. State" on Justia Law

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While implementing changes required by the Patient Protection and Affordable Care Act of 2010, Michigan experienced a systemic computer problem that erroneously assigned thousands of non-citizens, who may have been eligible for comprehensive Medicaid coverage, to Emergency Services Only (ESO) Medicaid. Plaintiffs, two eligible noncitizen residents of Michigan who were erroneously assigned ESO coverage, filed a class action complaint against the Director of the Michigan Department of Health and Human Services, alleging violations of the Medicaid statute and the Due Process Clause. The district court found that actions taken by the state since the complaint was filed had resolved all systemic errors, so that plaintiffs’ claims were moot. The Sixth Circuit reversed the summary judgment, noting that not one of the individuals identified as a named plaintiff or potential named plaintiff was granted relief on the basis of a systemic fix and that that it is not “absolutely clear the allegedly wrongful behavior could not reasonably be expected to recur.” Material questions of fact remain regarding claims that the state failed to provide comprehensive Medicaid coverage and a reasonable opportunity to verify immigration status, precluding summary judgment. View "Unan v. Lyon" on Justia Law

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Boyd worked for the Postal Service, 1985-2010. In 2011, she sought disability retirement benefits under the Federal Employees Retirement System (FERS). The Office of Personnel Management (OPM) approved her application, stating it would provide interim FERS benefits; that she would not receive FERS benefits until OPM received confirmation that she had applied for Social Security disability (SSDI) benefits; that her FERS benefits would be offset by SSDI benefits; and that Social Security checks should not be negotiated until the FERS benefit had been reduced. Boyd provided OPM with notice of her SSDI award but cashed the SSDI checks. Five months later, OPM notified Boyd that she had been overpaid by $3,322, which it would recover by offsetting 36 monthly FERS benefits by $92.27. Boyd requested a waiver or a reduced payment based on financial hardship. Boyd completed a Financial Resources Questionnaire but did not provide a later-requested update. OPM denied a waiver but reduced the monthly offset to $40. Boyd appealed to the Merit Systems Protection Board, pro se, but did not file evidence nor respond to a show-cause order. The ALJ affirmed, finding that she was “not without fault” and did not refute the reasonableness of the reduced payment schedule. The Board affirmed. The Federal Circuit vacated, citing erroneous application of the overpayment recovery statute, 5 U.S.C. 8346(b), and remanded for determination of whether Boyd knew or suspected that she had been overpaid, and, if not, whether the recovery would be against equity and good conscience. View "Boyd v. Office of Personnel Management" on Justia Law

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In 2014, the Board of Veterans Appeals denied Parrott’s claims for benefits on account of her veteran husband’s esophageal adenocarcinoma, with liver and peritoneal metastasis, and his ensuing death. The Veterans Court vacated and remanded. Parrott then timely sought attorney fees and expenses under the Equal Access to Justice Act (EAJA), 28 U.S.C. 2412. The Veterans Court awarded her $4,050. The Federal Circuit affirmed, rejecting arguments that, in arriving at its award of attorney fees, the Veterans Court misinterpreted EAJA and adopted an incorrect approach for determining the cost of living adjustment to be used in calculating her attorney’s hourly rate and that the court then abused its discretion by not allowing her to resubmit her application using the approach the court had adopted. EAJA states that “attorney fees shall not be awarded in excess of $125 per hour unless the court determines that an increase in the cost of living . . . justifies a higher fee.” The court properly rejected Parrott’s request for a cost of living increase, based on Washington D.C., based on the location of the Veterans Court and applied rates based on the locations of her attorney’s offices in San Francisco, Dallas, and Little Rock. View "Parrott v. Shulkin" on Justia Law

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Plaintiff suffers from physical, cognitive, and psychological impairments. In this appeal, plaintiff challenged the denial of her social security disability benefits. The court concluded that the ALJ legally erred by rejecting an examining physician's opinion without explanation. In this case, the physician opined that plaintiff could not work any job that entailed standing for longer than 30 minutes or walking farther than 50 years. Accordingly, the court vacated and remanded for the ALJ to consider plaintiff's impairments, taking into account the examining physician's opinion. View "Kneeland v. Berryhill" on Justia Law

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The Acting Commissioner of the Social Security Administration appealed a district court order reversing her decision to deny Marla Vallejo’s application for supplemental security income benefits and remanding the case for further administrative proceedings. Because the district court’s order rested on a misapplication of controlling law, the Tenth Circuit reversed and remanded to the district court for further proceedings. View "Vallejo v. Berryhill" on Justia Law

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In the underlying action, JCHCC sought to permanently enjoin the Parish from evicting it from two Parish-owned facilities in which JCHCC currently provides medical services to medically underserved populations. The district court granted JCHCC's motion for a preliminary injunction, enjoining the Parish from evicting JCHCC but allowing it to terminate the injunction by establishing that the medical needs of the population currently served by the relevant JCHCC facilities would be met if JCHCC were evicted. The court reversed, concluding that JCHCC has not established a substantial likelihood of success on the merits of the only claim that was properly before the court. In this case, JCHCC failed to establish a likelihood of success on the merits of its Medicaid violation claim where JCHCC does not point to any authority suggesting that every local government in every participating state must provide the relevant medical services, nor does it point to authority establishing that the Parish has any obligation under Louisiana state law to provide such services on behalf of the state. View "Jefferson Community Health Care Centers v. Jefferson Parish Government" on Justia Law

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Brayden O. was a seventeen-year-old girl who suffered from Coffin-Lowry Syndrome and other disabilities. Brayden had been receiving home and community-based waiver services through the Medicaid division of the Nebraska Department of Health and Human Services (DHHS) for almost a dozen years before the DHHS determined that Brayden no longer met the necessary qualifications for such services. Merie B., Brayden’s mother, appealed DHHS’ determination, which was affirmed after an administrative appeal hearing. The district court affirmed. On appeal, the Supreme Court reversed and remanded with directions that the district court order DHHS to reinstate waiver services to Brayden, effective as of the date services were originally terminated. On remand, Merie requested reimbursement for expenses she incurred due to the wrongful termination of Brayden’s services, along with attorney fees. The district court granted the request and entered judgment against DHHS in the amount of $76,260.48. The Supreme Court reversed, holding that the district court was without authority to expand the mandate in Merie B. I and hold an evidentiary hearing on Merie’s “Motion to Determine Expenses.” View "Merie B. on behalf of Brayden O. v. State" on Justia Law

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In 2005, while serving in the Army National Guard, Bird injured a tendon in his right shoulder. He was operated on in 2006. He reported to Veterans Affairs doctors that he suffered hearing loss, migraines, and stiffness and pain in his hands, back and right shoulder, as well as anxiety, weakness in gripping objects, and ringing in his ears. The medical records include contradictory opinions from treating physicians. The Department of Veterans Affairs gave Bird a 70% service-connected disability rating but pays him at the 100% rate because they found him unemployable. The Social Security Administration denied Douglas Bird’s application for disability insurance benefits. The district court remanded. The Seventh Circuit affirmed. The VA’s finding that Bird is 70% disabled and unemployable does not establish that he is entitled to SSA benefits. There are differences in how the agencies evaluate claims: the VA’s evaluation is pro-claimant rather than neutral. The grounds for the VA’s decision finding Bird to be 70% disabled and unemployable were not available to the ALJ and neither were the results of Bird’s x-ray and MRI. The record even includes evidence conflicting with a finding of disability. View "Bird v. Berryhill" on Justia Law

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The trial court denied appellant's petition for writ of administrative mandamus seeking to overturn the denial of his claim for services under the Lanterman Developmental Disabilities Services Act (Lanterman Act), Welf. & Inst. Code, 4500 et seq. The trial court denied the petition based on the doctrine of res judicata because his ineligibility for services had been previously adjudicated in two prior proceedings. The court agreed, and rejected appellant's claim that res judicata does not apply because the court’s decision in Samantha C. v. State Dept. of Developmental Services and a 2003 amendment to the Lanterman Act constitute an intervening change in the law or a doctrinal change that precludes application of the doctrine. In this case, the court concluded that neither the Samantha C. decision nor the 2003 amendment to section 4512 bars application of res judicata. Accordingly, the court affirmed the judgment. View "Ronald F. v. Department of Developmental Services" on Justia Law