Justia Public Benefits Opinion Summaries

A group of Black farmers and their association, along with several individual members, sought to file claims with the U.S. Department of Agriculture (USDA) for financial assistance under a program created by the Inflation Reduction Act of 2022. They wished to submit applications on behalf of deceased relatives who had allegedly experienced discrimination in USDA farm lending programs. The USDA, however, had a policy that excluded applications reporting only discrimination against individuals who were deceased at the time of application, making such claims ineligible for the program.The plaintiffs filed suit in the United States District Court for the Western District of Tennessee, seeking an injunction to require the USDA to accept these “legacy claims.” The district court denied their motion for a preliminary injunction and granted the government’s motion to dismiss under Rule 12(b)(6), holding that the relevant statute only authorized financial assistance to living farmers. The plaintiffs appealed this decision to the United States Court of Appeals for the Sixth Circuit and also sought an emergency injunction pending appeal, which was denied.The United States Court of Appeals for the Sixth Circuit reviewed the district court’s dismissal de novo. The appellate court held that the statutory language of § 22007(e) of the Inflation Reduction Act required the USDA to provide “assistance” to farmers who experienced discrimination, and that “assistance” was forward-looking and could not be provided to deceased individuals. The court found that the statute did not authorize compensation for past harm to deceased farmers, distinguishing “assistance” from “compensation.” The court affirmed the district court’s judgment and denied the motion for an injunction pending appeal as moot, holding that the USDA was required to reject applications filed on behalf of deceased farmers. View "Black Farmers & Agriculturalists Ass'n v. Rollins" on Justia Law

Horace Meredith worked as a coal miner for several decades, with his last employment at Hobet Mining, Inc. During Meredith’s tenure at Hobet, Arch Coal Company, Inc. was Hobet’s parent company and provided self-insurance for black lung liabilities. Years after Meredith left Hobet and after Arch had sold Hobet to Magnum Coal (which was later acquired by Patriot Coal Company), Meredith filed a claim for black lung benefits. By the time of his claim, both Patriot and Hobet were defunct, and the Department of Labor sought to hold Arch liable for Meredith’s benefits, despite Arch no longer owning or insuring Hobet.After Meredith filed his claim, the district director designated Hobet as the responsible operator and Arch as the insurance carrier. Arch and Hobet contested this designation, arguing that Arch was no longer responsible for Hobet’s liabilities and that the Black Lung Disability Trust Fund should cover the claim. The Administrative Law Judge (ALJ) found Hobet to be the responsible operator and Arch liable as its self-insurer at the time of Meredith’s last employment. The Department of Labor’s Benefits Review Board affirmed the ALJ’s decision, holding Hobet and Arch liable for the claim.The United States Court of Appeals for the Fourth Circuit reviewed the Board’s decision. The court held that neither the Black Lung Benefits Act nor its regulations imposed liability on Arch under these circumstances. Specifically, the court found that Hobet did not meet the regulatory requirements to be a financially capable responsible operator, and Arch could not be held liable as a self-insurer for claims filed long after it ceased to own or insure Hobet. The Fourth Circuit granted the petition for review, vacated the Board’s decision, and remanded for further proceedings consistent with its opinion. View "Hobet Mining, Inc. v. Director, Office of Workers' Compensation Programs" on Justia Law

Catherine Baker was employed by San Mateo County as a Social Worker III but went on medical leave in 2009 due to back pain. In 2015, she returned to work in a different position as a screener trainee, which involved different duties but was compensated at the same pay rate as her original position. Her last paycheck was issued in January 2016. In 2017, Baker applied for a service-connected disability retirement, and the San Mateo County Employees Retirement Association (SamCERA) determined that the effective date for her retirement benefits should be January 22, 2016, the day after her last receipt of “regular compensation.”After SamCERA’s Board approved her application and set the effective date, Baker sought administrative review, arguing that her compensation as a screener trainee did not qualify as “regular compensation” under Government Code section 31724 because she had not returned to her original job. An administrative law judge recommended denial of her request to change the effective date, and the Board adopted this recommendation. Baker then filed a petition for writ of administrative mandamus in the Superior Court of San Mateo County, which denied the petition and confirmed the January 22, 2016 effective date.On appeal, the California Court of Appeal, First Appellate District, Division One, reviewed whether “regular compensation” under section 31724 included Baker’s pay as a screener trainee. Exercising independent judgment on statutory interpretation, the court held that “regular compensation” refers to regular salary or full wages, regardless of whether the position is the employee’s original job. Because Baker’s screener trainee pay matched her original position’s rate, it qualified as “regular compensation.” The court affirmed the trial court’s judgment, upholding the effective date set by SamCERA. View "Baker v. San Mateo County Employees Retirement Assn." on Justia Law

The plaintiff, a Nebraska resident, received Medicaid benefits administered by the Nebraska Department of Health and Human Services (NDHHS). In April 2024, she was sent a notice stating her Medicaid eligibility was ending due to income exceeding program standards. The notice informed her of her rights to request a conference or appeal and outlined the process for a fair hearing. She did not appeal the termination, and her coverage ended on May 1, 2024. Subsequently, she filed a federal lawsuit on behalf of herself and similarly situated individuals, alleging that the termination notices failed to meet due process requirements and seeking class certification, declaratory and injunctive relief, including reinstatement of benefits until proper notice was provided.The United States District Court for the District of Nebraska considered only her individual claims, as she did not challenge the court’s decision to exclude class claims on appeal. The district court denied her request for a temporary restraining order, finding she was unlikely to succeed because her claims sought retroactive relief barred by sovereign immunity and because the notices likely satisfied due process. The court then dismissed her complaint for lack of subject matter jurisdiction, concluding she had not alleged an ongoing violation of federal law and was not seeking prospective relief, as required to invoke the Ex parte Young exception to Eleventh Amendment immunity.The United States Court of Appeals for the Eighth Circuit reviewed the case and affirmed the district court’s dismissal. The Eighth Circuit held that the plaintiff’s alleged due process violation was a discrete past event—the issuance of the notice and termination of benefits—not an ongoing violation. The court further held that the relief sought was retrospective, not prospective, and thus barred by the Eleventh Amendment. The court concluded that the Ex parte Young exception did not apply, and affirmed the dismissal. View "Filyaw v. Corsi" on Justia Law

An Army veteran serving a lengthy prison sentence in Florida applied for and received disability benefits for service-related post-traumatic stress disorder. Initially, the Veterans Benefits Administration approved his claim at a 70 percent rate, later increasing it to 80 percent. However, after his felony conviction and incarceration, the Administration reduced his monthly benefits to a 10 percent rate pursuant to 38 U.S.C. § 5313, which limits disability payments for veterans incarcerated for more than 60 days due to a felony.The veteran filed a pro se complaint in the United States District Court for the Middle District of Florida, naming the United States Congress as defendant. He alleged that the statute reducing his benefits violated the Bill of Attainder Clause and the Equal Protection component of the Fifth Amendment, seeking both prospective and retroactive relief. A magistrate judge recommended dismissal, assuming without deciding that the court had jurisdiction over facial constitutional challenges, but finding the claims frivolous. The district court adopted this recommendation, dismissing the complaint and declining to address the plaintiff’s general objections.On appeal, the United States Court of Appeals for the Eleventh Circuit reviewed the case. The court held that sovereign immunity barred the suit against Congress, as Congress has not waived immunity for constitutional claims arising from its enactment of legislation. The court further held that any amendment to name a different defendant would be futile because the Veterans’ Judicial Review Act provides an exclusive review scheme for challenges to veterans’ benefits decisions, channeling all such claims—including constitutional challenges—through the administrative process and ultimately to the Court of Appeals for Veterans Claims and the Federal Circuit. The Eleventh Circuit vacated the district court’s judgment and remanded with instructions to dismiss the case without prejudice for lack of jurisdiction. View "Johnson v. United States Congress" on Justia Law

A childcare provider operating two centers in Vermont participated in the federal Child and Adult Care Food Program (CACFP), which reimburses centers for meals provided to children if certain regulatory requirements are met. The provider had previously been cited for noncompliance in 2019, but the matter was resolved after corrective action. In 2022, the Vermont Agency of Education (AOE) again found serious deficiencies, including inadequate recordkeeping, improper meal claims, and failure to monitor facilities. The provider submitted a corrective-action plan, and AOE initially determined the deficiencies were fully and permanently corrected. However, a subsequent unannounced review in 2023 revealed recurring deficiencies, such as missing enrollment forms, incorrect eligibility determinations, and incomplete documentation.Following these findings, AOE issued a notice proposing to terminate the provider’s participation in CACFP and to disqualify the provider and two employees from future participation. The provider requested an administrative review. At the hearing, the provider acknowledged some paperwork was not in compliance but argued the errors were minor and unintentional. Due to time constraints, the hearing officer allowed both parties to submit post-hearing written arguments and documentation, to which the provider did not initially object but later challenged as a violation of due process and agency procedures.The Vermont Supreme Court reviewed the case after the hearing officer affirmed AOE’s decision to terminate and disqualify the provider. The Court held that the hearing officer applied the correct legal standard and that the record supported the findings of persistent serious deficiencies. The Court also determined that the provider had not properly preserved its objection to post-hearing submissions and, regardless, was not prejudiced by the procedure. The Court affirmed the termination and disqualification from the CACFP. View "In re Butterfly Kisses Child Care Center, Inc." on Justia Law

A healthcare provider participated in Kentucky’s Medicaid program, offering in-home services to recipients in rural areas under the Home and Community Based (HCB) Waiver program. The Department for Medicaid Services had, for several years, reimbursed the provider at enhanced rates for “case management” services, even though the relevant administrative regulation did not list “case management” as a reimbursable “revenue code service.” In 2016, the Department determined that these payments were made in error and sought to recoup over $1 million from the provider for services rendered between 2011 and 2013.After the Department initiated recoupment, the provider contested the action through the Cabinet’s administrative process, arguing that the omission of “case management” from the regulation was a drafting error and that the Department should be estopped from recouping the funds due to its prior representations and delay. The administrative hearing officer rejected these arguments, finding the regulation’s text unambiguous and concluding that neither equitable estoppel nor laches applied. The Secretary of the Cabinet adopted this decision. The provider then sought judicial review in the Franklin Circuit Court, which affirmed the agency’s decision. The Kentucky Court of Appeals also affirmed.The Supreme Court of Kentucky reviewed the case and affirmed the Court of Appeals. The Court held that the Department’s regulation unambiguously excluded “case management” from the list of services eligible for enhanced reimbursement, and the Department was within its authority to recoup the overpaid funds. The Court declined to read omitted language into the regulation, found no basis for equitable estoppel or laches against the Department, and rejected the provider’s arguments regarding the sufficiency of the Department’s audit. View "PROFESSIONAL HOME HEALTH CARE V. COMMONWEALTH OF KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES" on Justia Law

A skilled nursing facility accepted a new resident who was receiving Medicaid benefits. The resident's husband was designated as her authorized representative. Nearly two years later, the Department of Human Services (DHS) terminated the resident's Medicaid benefits due to excess assets. Both the resident and her husband were incapacitated, and the resident's public guardian submitted a new Medicaid application, which was denied. The nursing facility continued to care for the resident without compensation until her death. The facility later sought an administrative hearing to challenge the eligibility decision, but the request was denied because the facility was not an authorized representative and the appeal was late.The circuit court and the Intermediate Court of Appeals (ICA) affirmed the denial, holding that the nursing home lacked standing to challenge the eligibility determination under Hawai'i Revised Statutes (HRS) § 346-12, which limits appeals to the applicant or recipient. The courts concluded that the nursing home did not have a close relationship with the resident for third-party standing purposes.The Supreme Court of the State of Hawai'i reviewed the case and disagreed with the lower courts regarding standing. The court held that skilled nursing facilities have constitutionally protected property interests in compensation for medical services performed for residents based on DHS eligibility determinations. The court ruled that these facilities have due process rights under the Hawai'i Constitution, including notice and the opportunity to appeal Medicaid eligibility determinations when the beneficiary is incapacitated and no authorized representative is available or willing to appeal. The court vacated the ICA's judgment and the circuit court's order, remanding the case for a new administrative hearing on the merits of the resident's Medicaid eligibility. View "In re FT" on Justia Law

Rachael Gorecki applied for disability benefits and received a hearing before an administrative law judge (ALJ) whose appointment was ratified by Nancy Berryhill during her second tenure as Acting Commissioner of the Social Security Administration. The ALJ denied Gorecki's benefits application, and the Social Security Administration's Appeals Council denied review, making the decision final. Gorecki then sued, arguing that the ALJ had no constitutional authority to issue a decision because Berryhill's second stint as Acting Commissioner violated the Federal Vacancies Reform Act (FVRA).The United States District Court for the Northern District of Alabama rejected Gorecki's argument, aligning with other appellate courts that had ruled on similar issues. The district court found that Berryhill's second tenure as Acting Commissioner was lawful under the FVRA.The United States Court of Appeals for the Eleventh Circuit reviewed the case and joined five other circuits in holding that the FVRA authorized Berryhill's second stint as Acting Commissioner. The court found that the plain text of the FVRA allowed Berryhill to serve again as Acting Commissioner once a nomination for the office was submitted to the Senate, regardless of whether the nomination occurred during the initial 210-day period. The court affirmed the district court's judgment, concluding that Berryhill's ratification of the ALJ's appointment was valid and that the ALJ had the authority to deny Gorecki's benefits application. The Eleventh Circuit thus affirmed the lower court's decision. View "Gorecki v. Commissioner, Social Security Administration" on Justia Law

Plaintiff-Appellant Mollie Marie Flinton applied for Social Security disability insurance and supplemental security income benefits in August 2015, citing mental health disabilities. Her application was initially denied, and she requested an administrative hearing. ALJ Mark Solomon, who was not properly appointed at the time, conducted the hearing and denied her benefits in March 2018. Flinton appealed, and the United States District Court for the Southern District of New York remanded the case for a new hearing in 2020. Despite the remand, Flinton appeared again before ALJ Solomon in August 2021, whose appointment had been ratified by then.The United States District Court for the Southern District of New York, presided over by Magistrate Judge Gary R. Jones, granted a motion for judgment on the pleadings in favor of the Commissioner of Social Security in September 2023. The court found that the ALJ’s decision was supported by substantial evidence and that remanding the case to a new ALJ was unnecessary, despite acknowledging the Appointments Clause challenge.The United States Court of Appeals for the Second Circuit reviewed the case and held that, pursuant to Lucia v. SEC, Flinton was entitled to a new hearing before a different, properly appointed ALJ. The court found that ALJ Solomon’s initial decision was invalid due to his improper appointment and that the subsequent hearing before the same ALJ did not cure the constitutional violation. The court vacated the district court’s decision and remanded the case to the Commissioner for a de novo hearing before a different, validly appointed ALJ. View "Flinton v. Comm'r of Soc. Sec." on Justia Law