Justia Public Benefits Opinion Summaries

Hospitals that are disadvantaged by their geographic location may reclassify to a different wage index area for certain Medicare reimbursement purposes by applying for redesignation to the Medicare Geographic Classification Review Board. Section 401 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999, enacted 10 years after the Board was established, creates a separate mechanism by which qualifying hospitals located in urban areas “shall [be] treat[ed] . . . [as] rural” for the same reimbursement purposes. To avoid possible strategic maneuvering by hospitals, the U.S. Department of Health and Human Services issued a regulation providing that hospitals with Section 401 status cannot receive additional reclassification by the Board on the basis of that status, 42 C.F.R. 412.230(a)(5)(iii) (Reclassification Rule). Geisinger, a hospital located in an urban area, received rural designation under Section 401 but was unable to obtain further reclassification by the Board pursuant to the Reclassification Rule. Geisinger sued. The district court upheld the regulation. The Third Circuit reversed, finding that Section 401 is unambiguous: HHS shall treat Section 401 hospitals as rural for Board reclassification purposes, 42 U.S.C. 1395ww(d)(8)(E)(i) View "Geisinger Cmty. Med. Ctr. v. Sec'y United States Dep't of Health & Human Servs." on Justia Law

In the “NOVA” decision, the Federal Circuit approved a plan requiring the Department of Veterans Affairs (VA) to identify and rectify harms caused by wrongful application of former 38 C.F.R. 3.103. The Plan required that the VA notify every claimant who received a final Board decision during the specified period and did not receive full relief. If a claimant had a case outside of the Board’s jurisdiction, but mandate had not issued and the appellate court’s judgment was not final, the VA was obligated to offer to submit a joint motion for remand. If the mandate had issued, the VA was required to offer to submit a joint motion to recall mandate and a joint motion for remand. Smith served in the Army, 1963-1965. In 2000, Smith filed an unsuccessful claim for compensation for post-traumatic stress disorder (PTSD). In 2008, Smith was awarded service connection for PTSD with a 100% disability rating and a 2006 effective date. Smith appealed to the Board, which, in 2011, denied entitlement to an earlier effective date. The Board did not apply the invalid Rule interpretation. The Veterans Court affirmed and, days before the NOVA decision, entered judgment. In 2013, the parties filed a joint motion to recall that judgment. The decision fit the search terms profile under the Plan and triggered the VA’s obligation to offer to submit a joint motion. Smith did not claim that VA failed to comply with 38 C.F.R. 3.103(c)(2) or any prejudice in the conduct of the Board hearing. The Federal Circuit affirmed denial of the motion, stating that neither its decisions nor the Plan preclude appropriate denial. View "Smith v. McDonald" 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

Engstrand, a former dairy farmer, applied for Disability Insurance Benefits and Supplemental Security Insurance because of pain caused by diabetic neuropathy and osteoarthritis, in July 2010, when he was 47. He alleged an onset of disability in July 2007, more than a year before his date last insured in September 2008. The ALJ concluded that his account of his limitations was not credible, that the opinion of his treating physician was not entitled to deference, and that Engstrand was not disabled. The Seventh Circuit reversed and remanded, stating that the ALJ wrongly evaluated the significance of his daily activities and did not explain his rejection of the doctor's testimony. View "Engstrand v. Colvin" on Justia Law

Papesh had a GED and worked as a bakery helper. She reported long-term, low-back pain, which radiated to her hips and legs. She said the pain “is worse with working” because the bakery has concrete floors. She began treatment in 2009 (the year she turned 50) with Dr. Cash, who observed “tenderness throughout the lumbar spine to palpation, as well as pain with some spasm in the low back.” Papesh was also caring for her mother, who had severe dementia and suffered “worsened depression and anxiety” after her mother’s death. Papesh applied for disability and for supplemental security income in early 2010, alleging she was disabled due to degenerative disc disease, fibromyalgia, depression, anxiety, and other impairments. The Eighth Circuit reversed and remanded the denial of benefits because the record contained two substantially similar residual function capacity opinions from a treating physician and neutral medical expert plus a consistent opinion from a second treating physician—all consistent with Papesh’s descriptions of her daily functioning. The ALJ’s determination that Papesh can perform light work was outside the available zone of choice. The substantial evidence on the record as a whole supports a finding that Papesh is capable of sedentary work only. View "Papesh v. Colvin" on Justia Law

Robles worked collecting food grease from restaurants until his 2010 termination. Robles’s supervisor cited Robles’s attempt to buy shoes at the Red Wing store, where employees can use an annual $150 shoe allowance. Robles asked the clerk to measure his friend’s foot because he “intended to give it to my friend.” Robles reasoned that he had shoes and his friend needed them. The clerk told Robles “that was not possible.” Robles believes there was a misunderstanding of policy but no misconduct. Robles sought unemployment benefits. The Employment Development Department’s record contained no employer information about the incident. The EDD’notice stated that Robles’s claim was denied because he “broke a reasonable employer rule.” Robles appealed, stating his employer did not cite any specific rule, that he was not aware of any such rule, and that he did not obtain an improper benefit or cause his employer any harm. Despite being twice ordered to do by the trial court, EED continued to refuse to award benefits. The court of appeal affirmed the court’s most recent response to Robles’s motion to enforce writ of administrative mandate,ordering EDD “to pay withheld federal extension benefits, costs and interest in the amount of $45,560.39, within 30 days.” View "Robles v. Emp't Dev. Dept." on Justia Law

Petitioners were active and retired members of the Public Employee Retirement System (PERS) who challenged two legislative amendments aimed at reducing the cost of retirement benefits: Senate Bill (SB) 822 (2013), and SB 861 (2013). Petitioners raised numerous challenges to the amendments but primarily argued that the amendments impaired their contractual rights and therefore violated the state Contract Clause, Article I, section 21, of the Oregon Constitution, and the federal Contract Clause, Article I, section 10, clause 1, of the United States Constitution. "Although there is no doubt that the legislature passed SB 822 and SB 861 to address legitimate public policy concerns and with an appropriate sensitivity to the impact that the amendments would have on retirees, those concerns do not establish a defense to the contractual impairment that the amendments effect. The public purpose defense that respondents ask [the Oregon Supreme Court] to recognize imposes a high bar to justify the state’s impairment of a state contract, like PERS, and the record in this case does not meet that standard. We therefore hold that respondents constitutionally may cease the income tax offset payments to nonresidents as set out in SB 822 and that respondents also constitutionally may apply the COLA amendments as set out in SB 822 and SB 861 prospectively to benefits earned on or after the effective dates of those laws, but not retrospectively to benefits earned before those effective dates." View "Moro v. Oregon" on Justia Law

In 2013, Emma Reiger entered the Good Samaritan Society's basic care facility. She executed a general durable power of attorney appointing two women "to be my attorneys-in-fact and co-agents in my name and for my benefit." Rieger signed a "Designation of Authorized Representative" authorizing the Society to "(i) initiate an application for Medicaid benefits on my behalf, (ii) participate in all reviews of my eligibility for Medicaid benefits and (iii) take such action as may be necessary to establish my eligibility for Medicaid." On the same date, Rieger signed a separate document titled, "Assignment of Medicaid Benefits," which assigned to the Society her right to obtain Medicaid benefits for services provided to her by the Society, and an "Authorization for Release of Health Information." These documents were provided to the Department of Human Services. The Department oappealed a judgment reversing the Department's dismissal of Rieger's appeal challenging its denial of her Medicaid application and remanding for a fair hearing on the application. Because the law allowed The Evangelical Good Samaritan Society, doing business as the Good Samaritan Society - Mott ("Society"), to act as Rieger's authorized representative for purposes of appealing the Department's denial of her Medicaid application, the Court affirmed the judgment. View "Evangelical Good Samaritan Society v. N.D. Dep't of Human Services" on Justia Law

Petitioner Rachel Parks appealed an administrative law judge's denial of her application for supplemental security income on behalf of her minor son, D.P. D.P. suffered from attention deficit hyperactivity disorder and borderline intellectual functioning. An administrative law judge denied Parks’s application because D.P. did not suffer from a condition that entitled him to supplemental security income. Parks filed a request for review with the Appeals Council, and she submitted new evidence of D.P.’s academic struggles. The Appeals Council supplemented the record with the new evidence, but denied review. Parks then filed a complaint in the district court, which affirmed the denial of her application. She argued on appeal to the Eleventh Circuit: (1) the administrative law judge's denial of Parks's application was not supported by substantial evidence; and (2) the Social Security Appeals Council needed to make explicit findings of fact about new evidence that it added to the record when it denied review. Because the administrative law judge’s decision was supported by substantial evidence and the Appeals Council was not required to make specific findings about Parks’s new evidence, the Eleventh Circuit affirmed. View "Parks v. Commissioner, Social Security Administration" on Justia Law

Zakarzecka worked as a home healthcare provider for Meuse, an elderly blind man. He required Zakarzecka to wear special shoes inside the house and to change into street shoes when answering the door or going outside. When Zakarzecka heard a deliveryman on May 10, she hurriedly attempted to change her shoes at the top of the stairwell. She fell down the stairs, breaking both wrists and suffering partial loss of the use of both hands. She sought compensation under the Workers’ Compensation Act (820 ILCS 305/1). Because Meuse lacked workers’ compensation insurance, Zakarzecka named the custodian of the Injured Workers’ Benefit Fund, the Illinois State Treasurer. An arbitrator awarded temporary total disability benefits and compensation for the permanent and partial loss of her hands to Zakarzecka, against the Fund. The Commission affirmed. As custodian , the Treasurer sought judicial review. The circuit court confirmed the ruling. The appellate court initially reversed. On rehearing, Zakarzecka argued, for the first time, that judicial review was barred because the Treasurer had not filed an appeal bond, a statutory prerequisite for invoking the circuit court’s jurisdiction, 820 ILCS 305/19(f)(2). Agreeing that a bond was required, the appellate court dismissed for lack of jurisdiction. The Illinois Supreme Court affirmed. View "Ill. State Treasurer v. Ill. Workers' Comp. Comm'n" on Justia Law