Justia Public Benefits Opinion Summaries

The Court of Appeal affirmed the probate court's order denying plaintiffs' request, following the death of their daughter, that the remainder of their daughter's special needs trust be distributed to them rather than to the Department of Health Care Services as reimbursement for Medi-Cal payments for their daughter's medical care.The court held that the mandatory recovery rules for special needs trusts apply to the trust remainder; plaintiffs' interpretation of Probate Code section 3605 conflicts with federal law; the Centers for Medicare & Medicaid Services' opinion letter supports the Department's position that section 3605 permits the Department to recover for the daughter's Medi-Cal expenses; public policy considerations weigh in favor of permitting reimbursement to the Department; and the trust itself requires reimbursement to the Department. The court also held that plaintiffs failed to show that the Department's claim impermissibly included services under the Individuals with Disabilities Education Act and Lanterman Act. View "Gonzalez v. City National Bank" on Justia Law

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

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

After plaintiff's administrative claim for an increase in the family's adoption assistance program (AAP) payments based on California State Foster Parent Assn. v. Wagner, (9th Cir. 2010) 624 F.3d 974, 978, was denied, the trial court granted his petition for writ of mandate.The Court of Appeal reversed and held that the foster care maintenance payment rate increases mandated by Wagner and California State Foster Parent Assn. v. Lightbourne, (N.D. Cal., May 27, 2011, No. C 07-05086 WHA) 2011 U.S.Dist. Lexis 57483, *8, do not apply retroactively to plaintiff's adopted children. The court explained that the California Legislature specifically amended Welfare and Institutions Code section 16121 to confirm that initial adoption assistance agreements that predated Lighthouse were not subject to the new rate structure. View "California Department of Social Services v. Marin" on Justia Law

The Public Employees Retirement Law, Government Code section 21156, defines disability as being “incapacitated physically or mentally.” A governmental employee loses the right to claim disability benefits if terminated for cause. The Third Appellate District identified exceptions: under “Haywood,” a terminated-for-cause employee can qualify for disability retirement when the conduct which prompted the termination was the result of the disability; under “Smith,” a terminated employee may qualify for disability retirement if he had a “matured right” to a disability retirement before that conduct; Smith further recognized that “a court, applying principles of equity,” could deem an employee’s right to a disability retirement to be matured to survive a dismissal for cause. The Board of Administration of the California Public Employees Retirement System (CalPERS) adopted a precedential decision (Vandergoot) that an employee settling a pending termination for cause and agreeing not to seek reemployment is “tantamount to a dismissal,” precluding a disability retirement. Martinez, a former state employee, settled the termination for cause action against her and agreed to resign and not re-apply for employment. CalPERS denied her application for disability retirement. The trial court and court of appeal concluded that Haywood and Smith were binding as stare decisis and that “Vandergoot is a reasonable extension.” The courts rejected an argument that a 2008 enactment tacitly “superseded” Haywood and Smith. View "Martinez v. Public Employees' Retirement System" on Justia Law

Darrin, age 81, filed a Request for Elder or Dependent Adult Abuse Restraining Orders, alleging that her next-door neighbor Miller and Miller’s boyfriend harassed and intimidated her by taunting her, threatening her, twice removing a wire boundary fence between the properties, and trespassing onto her property where they destroyed a hedge and defaced and damaged a barrier fence. Miller argued that Darrin had no standing to seek an order against her under the Act because Miller had no care or custody arrangement with Darrin and no control over Darrin’s real or personal property. The court of appeal reversed the dismissal of the suit. The plain language of the Elder Abuse Act authorizes a trial court to issue a restraining order against any individual who has engaged in abusive conduct, as defined by statute, toward a person age 65 or older regardless of the relationship between the alleged abuser and victim, Welfare and Institutions Code 15610.07(a)(1). View "Darrin v. Miller" on Justia Law

Lindh, a law enforcement officer, took blows to the head during training. He subsequently had severe headaches lasting between several hours and two days. A month later, Lindh suddenly lost most of the vision in his left eye. Two treating physicians did not believe the vision loss was related to the blows. Dr. Kaye, a neuro-ophthalmologist, the Qualified Medical Examiner (QME), agreed with the other physicians, that Lindh’s “blood circulation to his left eye was defective,” absent the injury,” Lindh likely would have retained a lot of his vision. He agreed that even had Lindh not suffered the blows, he could have lost his vision due to this underlying condition; it was “unlikely” Lindh would have suffered a vision loss if he had not had the underlying “vascular spasticity,” a rare condition. His professional opinion was that: 85% of the permanent disability was due to his old condition and 15% was due to the work injury. The ALJ rejected that analysis and found Lindh had 40 percent permanent disability without apportionment between his underlying condition and the work-related injury. The Board affirmed, concluding that the preexisting conditions were mere risk factors for an injury entirely caused by industrial factors; the QME had “confused causation of injury with causation of disability.” The court of appeal ordered an apportioned award. Dr. Kaye’s opinion was consistent with the other physicians' opinions, that it was unlikely the trauma caused the loss of vision. Whether an asymptomatic preexisting condition that contributed to the disability would, alone, have inevitably resulted in disability, is immaterial. View "City of Petaluma v. Workers' Compensation Appeals Board" on Justia Law

The California Legislature reduced Medicaid hospital payments 10 percent between 2008-2011; the federal agency administering the Medicaid program approved the rate reductions. Hospitals alleged the reductions violated the Medicaid Act (42 U.S.C. 1396), which sets out procedural and substantive requirements the state must follow when establishing reimbursement rates. Hospitals unsuccessfully sought to have the rates declared void and almost $100 million in recalculated rates. The court of appeal affirmed, concluding that healthcare providers alleging a violation of section 1396a(a)(30)(A) may not obtain a writ of mandate against state officials to contest Medicaid rates approved by the federal agency that administers the program. Their recourse is an administrative action against the federal agency that approved the rates. While plaintiffs may obtain a writ of mandate for violations of the procedural requirements of section 13(A), no such violation occurred here. View "Santa Rosa Memorial Hospital v. Kent" on Justia Law

In an issue of first impression, the Court of Appeals addressed whether Family Code section 4504(b) required derivative benefits received by the child of a disabled parent to be credited against a noncustodial obligor's child support. In this case, the Social Security Administration (SSA) took six years to approve Father's application. In 2015, it made a lump-sum payment for past-due derivative benefits to custodial parent Y.H. (Mother), as Daughter's representative payee. In the intervening six years, Father had continued to pay child support and was not in arrears. The Court of Appeals held section 4504 (b) indeed permitted retroactive child support credit from Daughter's lump-sum payment where there was no child support arrearage. View "Y.H. v. M.H." on Justia Law

Plaintiffs were 23 federally qualified health centers (FQHC’s) and rural health clinics (RHC’s) that served medically underserved populations (the Clinics). The dispute before the Court of Appeal centered on coverage for adult dental, chiropractic, and podiatric services the FQHC’s and RHC’s provided to Medi-Cal patients for a period between 2009 and 2013. Prior to July 1, 2009, the Department processed and paid claims for these services. In 2009, in a cost-cutting measure due to budget problems, the Legislature enacted Welfare and Institutions Code section 14131.101 to exclude coverage for these services (and others) “to the extent permitted by federal law.” After the Department stopped paying claims for these services, various FQHC’s and RHC’s challenged the validity of section 14131.10, claiming it conflicted with federal Medicaid law. In California Assn. of Rural Health Clinics v. Douglas, 738 F.3d 1007 (9th Cir. 2013), the Ninth Circuit held section 14131.10 was invalid to the extent it eliminated coverage for these services when provided by FQHC’s and RHC’s because the federal Medicaid Act imposed on participating states the obligation to cover these services by these providers. In response to CARHC, the Department announced it would reimburse FQHC’s and RHC’s for these services for dates of service only on or after September 26, 2013, the date of the Ninth Circuit’s mandate. Seeking reimbursement for services provided prior to September 26, 2103, the Clinics petitioned for a writ of mandate to compel the Department to accept, process, and pay claims for these services for the period July 1, 2009, to September 26, 2013. The trial court granted the petition in part and entered judgment for the Clinics. The Department appeals. Characterizing the Clinics’ writ petition as a suit for damages, it contended: (1) sovereign immunity barred the Clinics’ claims for retroactive payment; (2) the CARHC decision was retroactive because the Medicaid Act is spending clause legislation and its terms were not sufficiently clear as to the requirement to cover adult dental, chiropractic, and podiatric services provided by FQHC’s and RHC’s; and (3) retroactive relief violated the separation of powers doctrine because it forces the Legislature to appropriate money. The Court of Appeal disagreed with the Department’s characterization of the Clinics’ lawsuit. "Rather than a suit for damages, the lawsuit seeks an order to compel performance of a mandatory duty and did not result in a money judgment. Under well-settled California law, such a mandamus proceeding is not barred by sovereign immunity. The Department’s contentions based on spending clause legislation and separation of powers are new arguments raised for the first time on appeal. We exercise our discretion to consider only the spending clause argument. We reject it because the Department has not shown its obligations under Medicaid law, as determined by CARHC, came as a surprise. The separation of powers argument raises factual issues about appropriations that should have been presented in the trial court and we decline to consider this new argument." Accordingly, the Court affirmed the judgment. View "American Indian Health etc. v. Kent" on Justia Law