Justia Public Benefits Opinion Summaries

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

Serban worked as a massage therapist at Voda Spa. Serban and Voda Spa disagree as to why he left that work, but the trial court found Serban had good cause to leave and that finding was not challenged. They also disputed whether Serban was an employee or independent contractor. The California Unemployment Insurance Appeals Board found that he was an employee, not an independent contractor, and the trial court agreed with the Board that its decision was not subject to judicial review because both the California Constitution and the Unemployment Insurance Code bar actions whose purpose is to prevent the collection of state taxes. The court of appeal reversed, agreeing that the case does not challenge the imposition of a tax. View "W. Hollywood Cmty. Health & Fitness Ctr. v. CA Unemp. Ins. Appeals Bd." on Justia Law

For more than twenty years, the Maine Department of Health and Human Services (DHHS) provided Medicaid coverage for nineteen- and twenty-year-old children whose families met low-income requirements. In 2012, Maine DHHS submitted a state plan amendment to the federal DHHS plan seeking to drop that coverage. The federal DHHS Secretary declined to approve the amendment because it did not comply with 42 U.S.C. 1396a(gg), which requires states accepting Medicaid funds to maintain their Medicaid eligibility standards for children until October 1, 2019. Maine DHHS petitioned for review, contending that the statute is unconstitutional under the Spending Clause and violates the doctrine of equal sovereignty as articulated in Shelby County v. Holder. The First Circuit affirmed, holding that the statute is constitutional as applied in this case, as (1) application of section 1396a(gg) in these circumstances does not exceed Congress’s power under the Spending Clause; and (2) the equal sovereignty doctrine of Shelby County is not applicable in this case, and any disparate treatment caused by section 1396a(gg) is sufficiently related to the problem the statute was designed to address. View "Mayhew v. Burwell" on Justia Law

Plaintiff, a mother with limited financial means raising a severely disabled child, withdrew her daughter from public school and enrolled her in a private learning center, alleging that the Department failed to provide her child with the free appropriate public education (FAPE) required by the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq. The court concluded that, in light of the contractual obligation to pay tuition, plaintiff had standing under Article III to pursue her challenge to the Individualized Education Program (IEP) and to seek direct retroactive tuition payment. The court also concluded that, in light of intervening authority, the district court erred in affirming the SRO's determination that the December 2008 IEP provided a FAPE. Because the court could not resolve the merits of plaintiff's challenge to the IEP, the court remanded for further proceedings.View "E.M. v. NYC Dept. of Educ." on Justia Law

The Board challenged the district court's decision to award O.L.'s parents reimbursement for one-on-one instruction outside the school setting as well as some of their attorney's fees. The parents cross-appealed the district court's decision not to award O.L. compensatory education. The court concluded that the parents were eligible for reimbursement; the district court was right to find that the alternative program was proper under the standard set forth in Bd. of Educ. of Hendrick Hudson Centr. Sch. Dist., Westchester Cnty. v. Rowley; even if the alternative program has its shortcomings, it was reasonably calculated to permit the child to obtain some educational benefit; the district court's reimbursement award was appropriate; the district court did not abuse its discretion when it took the quality of the chosen alternative into consideration; it was clear on the record that the district court properly weighed the evidence and did not abuse its considerable discretion when it denied the request for compensatory education; and there was no need to reverse the attorney's fee award since the court affirmed the district court's decision in all respects.View "R.L., et al. v. Miami-Dade Cty. Sch. Bd." on Justia Law

Plaintiffs, Medicaid beneficiaries with near total disabilities, filed suit after being denied coverage for ceiling lifts under a categorical exclusion in the state's implementing Medicaid regulations. The district court granted summary judgment for the state. The court concluded that, under binding precedent, plaintiffs have an implied private cause of action under the Supremacy Clause to pursue their challenge; the state must comply with the requirements of the Medicaid Act, 42 U.S.C. 1396 et seq., but the Act does not preempt the state's categorical exclusions; and therefore, the court affirmed the grant of summary judgment and denied the motion to vacate.View "Detgen, et al. v. Janek" on Justia Law