Justia Public Benefits Opinion Summaries

California Education Code 56346(f) requires school districts to initiate a due process hearing if the school district determines that a portion of an Individualized Education Program (IEP) to which a parent does not consent is necessary to provide a child with a Free Appropriate Public Education (FAPE) under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400–1450. The ALJ concluded that the district offered an appropriate placement but Mother's refusal to consent prevented the district from implementing and providing a FAPE. I.R. appealed, but the district court affirmed. The court concluded that the district court erred in concluding that the district could not initiate a due process hearing to address Mother's refusal to the IEP's recommended placement. In this case, the district waited a year and a half before initiating a hearing, which the court determined was too long a period of time. Therefore, to the extent that I.R. lost an educational opportunity and was deprived of educational benefits for an unreasonably prolonged period, the district can be held responsible for denying her a FAPE for that unreasonably prolonged period. The court reversed and remanded. View "I.R. v. L.A. U.S.D." on Justia Law

Legislation, effective in 2004 requires that injured workers’ requests for medical treatment be evaluated through a process called utilization review (UR). Under the UR process, a request for treatment cannot be denied by a claims adjustor and must be approved unless a clinician determines that the treatment is medically unnecessary. Workers can challenge decisions denying requested treatment, but employers cannot challenge decisions approving it. The 2004 legislation called for administrative adoption of uniform standards for physicians to use in evaluating treatment. In 2013, additional reforms went into effect, establishing a new procedure, independent medical review (IMR), to resolve workers’ challenges to UR decisions. Stevens challenged the constitutionality of the IMR process, arguing that it violated the state Constitution’s separation of powers clause, its requirements that workers’ compensation decisions be subject to review and the system “accomplish substantial justice,” and principles of due process. The court of appeal rejected those claims, but remanded Stevens’s request for a home health aid. The Legislature has plenary powers over the workers’ compensation system under article XIV, section 4 of the state Constitution. California’s scheme for evaluating workers’ treatment requests is fundamentally fair and affords workers sufficient opportunities to present evidence and be heard. View "Stevens v. Workers' Comp. Appeals Bd," on Justia Law

Plaintiffs, Medicaid recipients who unsuccessfully sought coverage for prescription drugs, filed suit contending that the District and its officials unlawfully failed to afford them notice of their entitlement to a hearing before denying their prescription drug claims. The court affirmed the district court's dismissal of plaintiffs' claims under Title XIX of the Social Security Act, 42 U.S.C. 1396 et seq., and rejected plaintiffs’ argument that Title XIX’s notice regulations are triggered whenever there has been a denial of a claim for prescription drug coverage at the point-of-sale. However, the court reversed the district court's dismissal of the due process claims because the prescription drug coverage sought by plaintiffs qualifies as a property interest protected by the Fifth Amendment; plaintiffs adequately alleged that Xerox, a private company, determined their eligibility for benefits while acting as an agent of the District; and the court remanded the case to permit the district court to conduct an inquiry in the first instance into what process is due. The court also remanded to the district court to reconsider its jurisdiction over the D.C. -law claims in light of the court's partial reversal. View "NB v. District of Columbia" on Justia Law

Plaintiffs filed suit under 42 U.S.C. 1983 against DSS to enforce the Food Stamp Act's, 7 U.S.C. 2020(e)(3) and (9), time limits for awarding food stamp benefits. The district court certified a class consisting of all past, current, and future Connecticut food stamp applicants whose applications are not processed in a timely manner and the district court issued a preliminary injunction requiring DSS to process food stamp applications within the statutory deadlines. The court concluded that plaintiff can maintain a private lawsuit under 42 U.S.C. 1983 to enforce the statutory time limits in section 2020(e)(3) and (9). The court also concluded that federal regulations do not excuse DSS from processing food stamp applications within the statutory time limits. Accordingly, the court affirmed the judgment. View "Briggs v. Bremby" on Justia Law

Plaintiffs, residents of privately-owned Chicago building, received housing vouchers from the Chicago Housing Authority to enable them to rent apartments. They claimed that the Authority is complicit in and responsible for a deprivation of their constitutionally protected privacy by the building owners. The owners require their tenants to be tested annually for illegal drugs; passing the test is a condition of a tenant’s being allowed to renew his or her lease for another year. The requirement applies to all tenants, not just those who might be suspected of using illegal drugs. The district court denied a preliminary injunction on the ground that the drug-testing policy was private rather than state action. The Seventh Circuit affirmed. None of the plaintiffs had requested transfer from the drug-testing building in which he or she currently resides to a building that does not require drug testing. A CHA representative testified that his agency would have approved such a request. That the CHA may encourage or even request testing does not constitute state action. View "Stubenfield v. Chicago Hous. Auth." on Justia Law

The Department appealed the district court’s order expanding a preliminary injunction forbidding the Department from decreasing the individual budgets of a class of participants in and applicants to Idaho’s Developmental Disabilities Waiver program (DD Waiver program) without adequate notice. The court rejected the Department's ripeness argument and concluded that the dispute is ripe for adjudication where plaintiffs alleged that they have already felt the effects of the Department's actions in a concrete way; the district court reasonably found that participants’ services are capped by their individual budgets under Idaho law; the district court also did not abuse its discretion in holding that plaintiffs were likely to show that the 2011 Budget Notices did not comply with the notice requirements of the Medicaid regulations; the district court did not abuse its discretion in holding that plaintiffs were likely to prevail on their claim that they were denied adequate notice under the Due Process Clause; the Department waived its argument that plaintiffs failed to show that the proposed class was likely to suffer irreparable harm; the court joined a number of its sister circuits in rejecting Eleventh Amendment challenges directed at orders reinstating social assistance benefits prospectively; and the court declined to exercise jurisdiction to review the district court’s order denying the motion to approve the 2013 Proposed Notice. Accordingly, the court affirmed the district court's judgment. View "K.W. v. Armstrong" on Justia Law

Plaintiffs, parents of a disabled student, filed suit under the Individuals with Disabilities Education Act (“IDEA”), 20 U.S.C. 1400 et seq., seeking reimbursement by the DOE for the costs of attending a private program. The hearing officer denied the request for reimbursement, concluding that it was untimely under Haw. Rev. Stat. 302A-443(a). The district court held, however, that the student's placement by the parents was “bilateral,” not “unilateral,” so that the parents’ request was not untimely, and concluded that the parents were entitled to reimbursement. The court agreed and concluded that the student's family is entitled to reimbursement for the 2010–11 school year because the DOE tacitly consented to his enrollment at the private school program by failing to provide an alternative. The court also affirmed the district court's fee award. View "Sam K. v. Hawaii Dept. of Educ." on Justia Law

Since 1996, retired employees of the City and County of San Francisco) have been eligible for a supplemental cost of living allowance (COLA) as part of their pension benefits when the retirement fund’s earnings from the previous year exceeded projected earnings. In 2011, voters passed Proposition C, an initiative measure that conditioned payment of the supplemental COLA on the retirement fund being “fully funded” based on the market value of the assets for the previous year. POB, a political action committee representing the interests of retired city employees, challenged the amendment as an impairment of a vested contractual pension right under the contract clauses of the federal and state Constitutions. The court of appeal held that, with respect to current employees and employees who retired after the supplemental COLA went into effect, the full funding requirement cannot stand. Employees who retired before November 6, 1996 had no vested contractual right in the supplemental COLA; the 2011 amendment may be applied to their pensions. The court rejected POB’s claim that the full funding requirement must be set aside because the Board of Supervisors failed to obtain an adequate actuarial report before placing Proposition C on the ballot. View "Protect Our Benefits v. City & Co. of San Francisco" on Justia Law

In 1996 Ritzhoff was injured while working as a banquet server. He sustained permanent injuries to his ankle and injured his hand and back. His treating psychiatrist initially evaluated Ritzhoff in 2001 and noted that Ritzhoff demonstrated diminished cognitive functioning, had severe depression, suicidal ideation, severe anxiety, and total neuroticism. The doctor found Ritzhoff temporarily totally disabled on a psychiatric basis and in need of emotional treatment. His employer made temporary disability payments until 2006. Ritzhoff admitted working from time-to-time since his injury. At a third hearing in 2013, Ritzhoff refused to respond to cross-examination. The workers’ compensation judge found Ritzhoff totally permanently disabled on a psychiatric basis, originating in the orthopedic injury. The Workers’ Compensation Appeals Board affirmed. The court of appeal annulled the determination. That the decision was supported by substantial evidence is beside the point. The appeals board exceeded its powers when it adopted a decision as its own that was flawed by a denial of due process with respect to cross-examination. View "Ogden Entm't Servs. v. Workers' Comp. Appeals Bd." on Justia Law

Plaintiffs filed a putative class action suit against the Secretary on behalf of Medicare beneficiaries who were placed into "observation status" by their hospitals rather than being admitted as "inpatients." Placement into "observation status" allegedly caused these beneficiaries to pay thousands of dollars more for their medical care. The district court granted the Secretary's motion to dismiss and plaintiffs appealed. The court affirmed the dismissal of plaintiffs' Medicare Act, 42 U.S.C. 1395, claims where plaintiffs lack standing to challenge the adequacy of the notices they received and nothing in the statute entitles plaintiffs to the process changes they seek. However, the court vacated the district court's dismissal of plaintiffs' Due Process claims where the district court erred in concluding that plaintiffs lacked a property interest in being treated as "inpatients," because the district court accepted as true the Secretary's assertion that a hospital's decision to formally admit a patient is "a complex medical judgment" left to the doctor's discretion. The district court's conclusion constituted impermissible factfinding, which in any event is inconsistent with the complaint's allegations that the decision to admit is guided by fixed and objective criteria. View "Barrows v. Burwell" on Justia Law