Justia Public Benefits Opinion Summaries

The District of Columbia filed this suit to recover its attorneys' fees from a lawyer who brought an administrative complaint against the District on behalf of a student with special educational needs under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400(d)(1)(A). At issue was whether the District was a "prevailing party" under the IDEA in this suit. The court held that the facts in this case followed closely in the wake of the court's precedent in District of Columbia v. Straus where that court held that the district was not a "prevailing party" where its own change of position was what had mooted the dispute, causing the case to be dismissed. Therefore, the court held that the District, in this case, was not a "prevailing party" where the District of Columbia Public Schools (DCPS) authorized an independent comprehensive psychological evaluation for the student, which mooted the only issue before the hearing officer. Accordingly, the district court's grant of summary judgment ordering the lawyer to pay attorneys' fees was reversed.

Plaintiffs, married couples who worked as house parents to children who were "severely emotionally disturbed" in defendants' homes, sued defendants for overtime pay under the Fair Labor Standards Act ("FLSA"), 29 U.S.C. 203(r)(2)(A). The children attended local public schools and participated in other activities away from the homes. Although, the children participated in group therapy conducted by clinicians in the homes, they received most of their medical and psychological treatment outside the homes. Plaintiffs were not licensed medical or social service professionals. Defendants filed an interlocutory appeal challenging the district court's conclusion that defendants' homes were covered by the FLSA and were subject to its overtime provisions. The court held that defendants' homes were not covered by the FLSA because they were not an "institution primarily engaged in the care of the sick, the aged, mentally ill or defective who resided on the premises of such institution." Accordingly, the court reversed and remanded for further proceedings.

Appellants, on behalf of their disabled daughter, appealed the district court's finding that the Fort Osage R-1 School District ("school district") offered the daughter a free appropriate public education ("FAPE") within the meaning of the Individuals with Disabilities Education Act ("IDEA"), 20 U.S.C. 1400, et seq., for the 2006-2007 school year. Appellants sought reimbursement for their costs of placing their daughter at a private facility during the school year. The court held that the district court did not err in concluding that the school district offered the daughter a FAPE and that the Individualized Education Plan put forward by the school district did not suffer from any procedural error. Accordingly, the court affirmed the judgment of the district court.

Plaintiff received disability insurance benefits under the Social Security Act 42 U.S.C. 301 et seq., between September 1994 and March 2004. After an investigation, the Social Security Administration ("SSA") notified plaintiff that she was ineligible for disability benefits because her employment income had exceeded SSA limits and determined that she was required to repay more than $60,000 in over paid benefits. At issue was whether the district court properly entered judgment for the SSA and denied plaintiff's waiver of over payment recovery and affirmed the ALJ's conclusion that it lacked authority to consider plaintiff's new argument contesting the amount of the overpayment itself. The court held that plaintiff failed to meet the administrative exhaustion requirement because she did not timely challenge her overpayment. Accordingly, since no final decision was made, the district court lacked jurisdiction under 42 U.S.C. 405(g) to consider plaintiff's challenge to the overpayment. The court also held that plaintiff was not entitled to a waiver of overpayment recovery because substantial evidence showed that she was not without fault in causing the overpayment and that the ALJ properly found that plaintiff knew or should have known that her work information was material because of her agreement to report such work in her benefit applications. Accordingly, the court affirmed the judgment of the district court.

Claimant appealed the district court's judgment upholding the Commissioner of Social Security's denial of her application for disability insurance. Appellant raised several issues of error on appeal. The court held that a certain physician's post-hearing letter did not contain any additional information and was not relied upon in the decision making process, and its receipt did not violate claimant's due process rights; that the ALJ did not err in finding claimant retained the residual functional capacity to perform certain kinds of low-stress work; that there was no error in the decision not to order a consultative examination regarding claimant's mental impairments; and that a hypothetical question posed to the Vocation Expert adequately addressed impairments supported by the record. Accordingly, the court affirmed the judgment where substantial evidence on the record as a whole supported the ALJ's decision.

Plaintiff applied for disability benefits based on combined impairments including bullous emphysema, depression, anxiety, and bipolar disorder and alleged that her disability began when her right lung collapsed. Plaintiff appealed the district court's decision affirming the Commissioner of Social Security's denial of her application for disability insurance benefits and supplemental security income benefits under Titles II and XVI of the Social Security Act, 42 U.S.C. et seq. The court held that the administrative law judge ("ALJ") erred by failing to follow the requirements of 20 C.F.R. 404.1520(a) in determining whether plaintiff's mental impairments were severe and, if severe, whether they met or equaled a listed impairment. Accordingly, the court reversed the judgment of the district court with instructions to remand to the ALJ to conduct a proper review of plaintiff's mental impairments.

Plaintiff, on behalf of a class of similarly situated plaintiffs who received Medicaid assistance and were subject to a Medicaid lien pursuant to 53-2-612, MCA, sued defendant alleging that defendant had collected a greater amount than it was entitled from plaintiffs' recoveries from other sources. The parties raised several issues on appeal. The court held that Ark. Dept. of Health & Human Servs. v. Ahlborn applied retroactively to all class members' claims and that defendant must raise affirmative defenses with respect to individual class members to avoid Ahlborn's effect. The court held that the applicable statute of limitations to be 27-2-231, MCA, which provided for a five-year limitations period. The court declined to disturb the district court's order requiring defendant to compile data on individual class members' claims. The court reversed the district court's determination as to interest assessed against defendant, and concluded that no interest could be assessed until two years after any judgment had been entered, under 2-9-317, MCA. The court concluded that the term "third party" in the Medicaid reimbursement statutes included all other sources of medical assistance available to Medicaid recipients, including private health or automobile insurance obtained by the Medicaid recipient. The court reversed the district court's grant of summary judgment to the class on its proffered distinction between "first party" and "third party" sources. The court affirmed the district court's conclusion that plaintiffs' "made whole" claim was immaterial in light of Ahlborn.

Samantha A. is a 15-year-old with a wide range of medical maladies. Samantha is unable to perform a many activities necessary for independent living. The Department of Social and Health Services (DSHS) determined that Samantha is eligible for 24-hour institutional care because of the extreme nature of her needs. Because Samantha is cared for by a single mother, Samantha qualified for the Medicaid Home and Community Based Waiver Program so that she can receive benefits at home and not be institutionalized. As part of the in-home benefits, Samantha receives Medicaid Personal Care (MPC). DSHS assessed Samantha as needing 90 hours of MPC per month. In 2005, DSHS adopted changes to its assessment formula pertaining to MPC. Under the new rules, Samantha's MPC hours were reduced. Samantha petitioned the Superior Court for review of the DSHS reassessment. The court invalidated some of the DSHS rule changes. DSHS appealed to the Supreme Court, arguing that the rule changes were valid. The Supreme Court agreed with the lower court, finding the rule changes invalid under the Medicaid laws. The Court affirmed the superior court's decision.

Plaintiffs, a class of indigent children who suffered from severe emotional and mental disabilities, sued Idaho state officials more than three decades ago, alleging that the officials were providing them with inadequate care in violation of their constitutional and statutory rights. The parties reached agreements intended to remedy deficiencies in care and those agreements were embodied in three consent decrees entered and monitored by the district court. Plaintiffs appealed the 2007 order of the district court finding that defendants had substantially complied with the remaining Action Items, which were specified in an Implementation Plan that resulted from the third consent decree, asserting that it was error for the district court to apply the standard for civil contempt in determining whether to vacate the decrees. Plaintiffs further contended that the district court committed errors in fact and law in issuing protective orders barring them from taking supplemental depositions of appellee and two non-parties. The court held that the district court's application of the contempt standard with the imposition of the burden of proof on plaintiffs was error where the district court accepted the Action Items as the entire measure of compliance with the consent decree. Accordingly, the court reversed the order of the district court. The court also held that the district court committed no errors in upholding the assertion of the deliberative process privilege to one non-party and appellee, as well as the legislative privilege to the second non-party. Accordingly, the court did not abuse its discretion in issuing the protective orders.

A.S., a California minor, filed a request for a special education due process hearing where he was eligible for special education services under the Individuals with Disabilities Education Act ("IDEA"), 20 U.S.C. 1400 et seq., as an emotionally disturbed child. At issue was which California agency was responsible for funding a special education student's placement in an out-of-state residential treatment facility. The court requested the California Supreme Court exercise its discretion and decide the following certified question, "Whether under California law the school district responsible for the costs of a special education student's education while the student is placed at an out-of-state residential treatment facility is the district in which the student's de facto parent, who is authorized to make educational decisions on behalf of the student, resides."