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At issue in this case was whether a school district may be permitted to avoid its responsibility to provide special education and related services to an eligible student to fund the placement of a child with severe disabilities in a residential treatment center, where that placement was necessary to enable the child to access a meaningful educational benefit, because the child's adoptive parents happened also to have funding available for that residential placement through a noneducational governmental agency program. The Court of Appeal held that the Los Angeles County Department of Children and Family Services (DCFS) is not a "public agency, other than an educational agency" under Education Code section 56155; DCFS did not "place" the student in the Sonoma facility by providing Adoptive Assistance Program (AAP) assistance; and therefore Education Code section 56156.4, subdivision (a), did not provide the school district with an exception to the rule that the school district of the parents' residence is responsible for the costs of a disabled student's education. The court also disapproved of the Office of Administrative Hearings's decision in Parent v. Elk Grove Unified Sch. Dist., to the extent it is inconsistent with this decision. Therefore, the court held that the school district was responsible for the cost of the parents' transportation relating to the student's placement in the Sonoma facility. The court reversed and remanded. View "B.H. v. Manhattan Beach Unified School District" on Justia Law

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Three plaintiffs' cases were consolidated for review; the plaintiffs were elderly women receiving long-term care in nursing homes. In each case, the “institutionalized spouse,” began receiving long-term care at a nursing home at her own expense. One to two months later, each plaintiff’s husband, a “community spouse,” created an irrevocable trust that was solely for his own benefit (a “solely for the benefit of,” or “SBO,” trust). The couples then transferred a majority of their individual and marital property to each SBO trust or its trustee, giving up any claim of title to that property. Distributions or payments from each SBO trust were to be made on an actuarially sound basis and solely to or for the benefit of the community spouse. The distribution schedule required that each trustee distribute the income and resources held by the trust to each community spouse at a rate that would deplete the trust within the community spouse’s expected lifetime. A short time after each SBO trust was formed, each institutionalized spouse applied for Medicaid benefits. The Department of Health and Human Services and its director (collectively, the Department) determined that each institutionalized spouse did not show the requisite financial need because the value of the trust assets put their countable resources above the monetary threshold, and it denied each application. In each case, the plaintiff unsuccessfully contested the Department’s decision in an administrative appeal, but each decision was then reversed on appeal at the circuit court. On appeal in the Court of Appeals, all three cases were consolidated, and the Department’s denial decisions were reinstated. The Michigan Supreme Court concluded that the Court of Appeals erred in its interpretation of the controlling federal statutes, which caused the Court of Appeals to improperly reinstate the Department’s denial decisions. Because the administrative hearing decision in each case suffered from "the same faulty reasoning" used by the Court of Appeals, the Court surmised that legal error may have caused the administrative law judges (ALJs) to forgo a more thorough review of the Medicaid applications at issue or to disregard other avenues of legal analysis. Therefore, rather than order that the Medicaid applications be approved at this time, the Court vacated the hearing decision of the ALJ in each case and remanded these cases to the appropriate administrative tribunal for any additional proceedings necessary to determine the validity of the Department’s decision to deny plaintiffs’ Medicaid applications. View "Hegadorn v. Dept. of Human Services" on Justia Law

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Jozefyk applied for Disability Insurance Benefits and Supplemental Security Income, claiming disability based on several conditions, including degenerative changes in his cervical spine, lumbar strain, obesity, affective disorder, and anxiety disorder. An ALJ denied benefits. The district court and Seventh Circuit affirmed, rejecting Jozefyk’s arguments that the ALJ did not establish a valid waiver of attorney representation before allowing Jozefyk to proceed pro se and that the residual functional capacity finding did not account for Jozefyk’s moderate limitations in concentration, persistence, or pace. Jozefyk was sent several Social Security Administration communications, including a publication entitled “Your Right to Representation,” explaining his right to an attorney, organizations that could help him find an attorney, the fee structure, and the benefits of representation. In his request for a hearing, Jozefyk certified: “I do not have a representative. I understand that I have a right to be represented and that if I need representation, the Social Security office or hearing office can give me a list of legal referral and service organizations to assist me in locating a representative.” The ALJ offered to continue the hearing to give Jozefyk more time to find an attorney, but Jozefyk again stated that he wanted to proceed. Jozefyk cited self-reported symptoms that doctors, including his own treating physician, could not confirm. View "Jozefyk v. Berryhill" on Justia Law

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Louisiana, represented by its Attorney General, filed this lawsuit in 2014 against defendants, Molina Healthcare, Inc., Molina Information Systems, L.L.C. d/b/a Molina Medicaid Solutions, and Unisys Corporation. As described in the state’s petition, “[o]ver the last thirty (“30”) years, the Defendants have been the fiscal agent responsible for processing Louisiana’s Medical pharmacy provider reimbursement claims.” Pursuant to a contract to which the state itself was allegedly a party, “the Defendants assumed operational liability” of a “customizable” computerized system known as the Louisiana Medicare Management Information System (“LMMIS”). As part of defendants’ duties, they were “responsible for the operation and maintenance of LMMIS, as well as creating and implementing design changes to the LMMIS that comply with State and federal mandates.” The crux of the state’s allegations in this lawsuit is that Unisys caused the Louisiana Department of Health (“LDH”) to overpay Medicaid pharmacy providers through Unisys’ improper operation and management of LMMIS. The Louisiana Supreme Court granted certiorari review in this case to review the correctness of the appellate court’s ruling, sustaining an exception of no right of action for the Attorney General’s lawsuit against the defendants. By statute, the Louisiana Department of Health had the capacity to sue and be sued for programs that it administered, such as Medicaid. However, because the Louisiana Department of Health delegated–and defendants allegedly contractually accepted–some of the administrative functions of the state’s Medicaid program, the Supreme Court found the Attorney General had the capacity, and hence a right of action, to prosecute this lawsuit. View "Louisiana ex rel. Caldwell v. Molina Healthcare, Inc." on Justia Law

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A.M. received a human papillomavirus vaccine in 2007. Shortly thereafter, she developed autoimmune limbic encephalitis and an intractable seizure disorder, resulting in cognitive impairment. Her mother (McCulloch) sought compensation under the Vaccine Act, 42 U.S.C. 300aa. A special master awarded compensation for A.M.’s injury and accepted the parties' agreement on the amounts and mechanisms of compensation. Neither party sought review. Months later McCulloch sought an award of attorneys’ fees and costs under section 300aa15(e)(1). A special master awarded fees and costs and included amounts to cover the expenses, under Florida guardianship law, of maintaining the guardianship for A.M,-- a required condition for receiving the full payments under the merits judgment. The Claims Court upheld inclusion of those amounts, but cited section 300aa-15(a), the provision governing merits awards of compensation, instead of 300aa-15(e), the fees/costs provision on which the special master relied. The Federal Circuit affirmed while acknowledging that the Claims Court improperly reopened a final merits judgment by awarding money under section 300aa-15(a). Nonetheless, it was appropriate for the special master to award guardianship-maintenance expenses under that section because McCulloch incurred a continuing liability to pay such expenses as a condition of receiving, for her daughter, the compensation awarded on the merits in this proceeding. View "McCulloch v. Secretary of Health and Human Services" on Justia Law

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The Supreme Court affirmed the district court's order affirming the denial of LeVeta Winslow's 2016 application for Medicaid benefits, holding that Nebraska's Department of Health and Human Services (DHHS), Division of Medicaid and Long-Term Care properly determined that Winslow was ineligible for Medicaid due to excess resources. DHHS determined that Winslow was ineligible for Medicaid because her resources, which included a house, were above $4,000. The district court affirmed the denial of benefits, finding that the house did not qualify for Winslow's home and thus was not exempt from consideration as an available resource as Winslow's home. The Supreme Court affirmed, holding (1) the district court correctly determined that the house was not subject to the home exemption for Winslow's Medicaid application; (2) the district court erred in determining that the property was not eligible for the other real property exception because Winslow lacked authority to liquidate while it was held by a revocable trust; and (3) Winslow failed to provide sufficient documentation that she was under the available resource limit if she could exclude the house, and therefore, the district court did not err in failing to find that DHHS was required to provide Winslow an IM-1 form for the house while it was held by the trust. View "Winslow v. State ex rel. Peterson" on Justia Law

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The Supreme Court affirmed the order of the district court affirming the decision of the Nebraska Department of Health and Human Services (DHHS) terminating Appellant's status as a Medicaid service provider, holding that the district court's affirmance of the sanction imposed by DHHS was not arbitrary, capricious, or unreasonable. Based on Appellant's failures to adhere to the standards for participation in Medicaid, DHHS terminated Appellant's provider agreements for good cause and then informed Appellant of her permanent exclusion from the Medicaid program. The DHHS director of the Division of Medicaid and Long-Term Care ruled that DHHS' decision to terminate Appellant as a Medicaid service provider was proper. The district court affirmed. The Supreme Court affirmed, holding (1) the court's finding that Appellant billed for overlapping services was based on competent evidence; and (2) DHHS' sanction to permanently exclude Appellant from the Medicaid program was not arbitrary or capricious. View "Tran v. State" on Justia Law

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Plaintiff, a civilly committed sexually violent predator, had to pay for GPS monitoring or be prosecuted under a now-repealed Texas law. Plaintiff filed suit alleging that the pay-or-be-prosecuted penalty violated the Social Security Act's anti-attachment provision, 42 U.S.C. 407(a), which protects benefits from execution, levy, attachment, garnishment, or other legal process. The Fifth Circuit affirmed the district court's grant of summary judgment to officials based on qualified immunity, holding that plaintiff's Social Security benefits were not executed on, levied, attached, or garnished. Furthermore, criminalizing a sexually violent predator's failure to pay for GPS monitoring is not "other legal process" under section 407(a). Therefore, the district court correctly interpreted the anti-attachment provision and the officials were entitled to qualified immunity. View "Reed v. Taylor" on Justia Law

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Goldstein worked until March 2013. The Employment Development Department (EDD) granted him unemployment insurance benefits, which he received in March 2013 through August 10, 2013. In August 2013, he successfully applied for disability benefits, which he received until he exhausted his maximum benefit amount in September 2014. Goldstein filed another unemployment claim, which had an effective date of March 23, 2014. EDD determined that Goldstein’s second claim was invalid under Unemployment Insurance Code section 1277 because during the benefit year of his first claim he neither was paid sufficient wages nor performed any work. An ALJ and the Appeals Board agreed while acknowledging that disability benefits qualify as wages under section 1277.5. The court of appeal affirmed, finding that the Board erred, but the error was not prejudicial. A claimant can establish a valid claim under section 1277(a) even if he received unemployment insurance benefits during the benefit year of the prior valid claim if both the earnings and work requirements are satisfied. Goldstein satisfied the earnings requirement and the Board erred in ruling otherwise but there is no evidence Goldstein performed services for pay during that time. View "Goldstein v. California Unemployment Insurance Appeals Board" on Justia Law

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The Pennsylvania Supreme Court granted discretionary review to determine whether the Commonwealth Court erred in holding appellant Daniel Harmon was disqualified from receiving unemployment compensation benefits pursuant to Section 402.6 of the Unemployment Compensation Law. Appellant was a part-time employee at Brown’s Shop Rite beginning February 14, 2013. By December, he was convicted of driving with a suspended license and sentenced to a term of 60 days’ imprisonment to be served on 30 consecutive weekends, beginning March 14, 2014 and ending August 7, 2014. Appellant’s employment with Brown’s Shop Rite was terminated on March 24, 2014 due to a violation of company policy, which was unrelated to his incarceration. He then filed for benefits and received them for the week ending March 29, 2014 through the week ending July 26, 2014. This period included weeks when appellant was serving his sentence of weekend incarceration. The Supreme Court held appellant was not disqualified from receiving unemployment compensation benefits, and therefore reversed the order of the Commonwealth Court. View "Harmon v. UCBR" on Justia Law