Justia Public Benefits Opinion SummariesArticles Posted in Government Law
Cook v. Glover
In this case, the Georgia Department of Human Services, Family and Children Services (DFCS) granted appellee Jerry Glover's application for Medicaid benefits but imposed a multi-month asset transfer penalty on him pursuant to section 2339 of DFCS's Georgia Economic Support Services Manual due to his refusal to name the State as the remainder beneficiary on an annuity. Glover appealed the penalty to an Office of State Administrative Hearings Administrative Law Judge (ALJ) who issued an initial decision reversing the penalty. DFCS then filed a request for agency review by the Georgia Department of Community Health (DCH). DCH issued a final decision upholding the penalty. Pursuant to OCGA 50-13-19 of the Administrative Procedures Act, Glover then sought judicial review from the Superior Court which affirmed the final agency decision. The Court of Appeals granted Glover’s application for discretionary appeal and reversed the superior court, concluding that section 2339 of the Eligibility Manual as applied to Glover was inconsistent with the plain language of the federal Medicaid statute and that pursuant to 42 U. S. C. sections 1396p (c) (1) (F) and (G), Glover's annuity was not an asset to which the asset transfer penalty would apply. Appellants, David Cook in his official capacity as Commissioner of DCH and Clyde Reese in his official capacity as Commissioner of DFCS, appealed to the Georgia Supreme Court arguing that the Court of Appeals improperly interpreted the annuity section of the Medicaid Act and erred in holding that sec. 2339 as applied to Glover violated federal law. Asserting that the statutory provisions at issue was ambiguous, appellants contended that the Court of Appeals was required to defer to CMS's interpretation of the federal statute. Because the Supreme Court found that the federal statutory provisions at issue were ambiguous and the relevant administrative agencies’ interpretations of them were based on a permissible construction of the statutory language, it reversed the Court of Appeals’ decision in this case. View "Cook v. Glover" on Justia Law
Dube v. New Hampshire Dept. of Health & Human Svcs.
This case involved a petition for injunctive and declaratory relief brought by plaintiffs Harbor Homes, Inc. and Gary Dube, Thomas Taylor, Cynthia Washington, and Arthur Furber against defendants the New Hampshire Department of Health and Human Services (DHHS), the Commissioner of DHHS, the Associate Commissioner of DHHS, and the Administrator of the Bureau of Behavioral Health seeking, in part, to enjoin DHHS from denying the individual plaintiffs the right to obtain Medicaid-funded services from their chosen provider, Harbor Homes. The individual plaintiffs received Medicaid-funded rehabilitative services from Harbor Homes. Since 1991, Harbor Homes participated in New Hampshire's Medicaid program pursuant to a Medicaid Provider Enrollment Agreement. On June 23, 2008, Harbor Homes entered into an interagency agreement (IAA) with a community mental health program, Community Council of Nashua, NH, now known as Greater Nashua Mental Health Center (GNMHC), which authorized Harbor Homes to provide certain Medicaid-funded rehabilitative services to GNMHC patients. In February 2011, Harbor Homes learned that GNMHC did not intend to renew its IAA and that the Medicaid reimbursable services provided by Harbor Homes would be transitioned to GNMHC. This was done pursuant to Administrative Rule He-M 426.04(a)(2), which meant that Harbor Homes would no longer have an IAA with a community mental health provider, and it would no longer be permitted to provide Medicaid funded mental health services to approximately one hundred and forty of its clients, including the individual plaintiffs in this case. Plaintiffs filed a petition for injunctive and declaratory relief, seeking a court order enjoining DHHS from "terminating or limiting Harbor Homes' status as a qualified Medicaid provider" and to direct the State to allow the individual plaintiffs to obtain community mental health services from Harbor Homes, the provider of their choice. Following two hearings, the court denied the plaintiffs' request for a preliminary injunction. Thereafter, all parties moved for partial summary judgment on the plaintiffs' claim that DHHS's reliance upon the IAA requirement as a reason to terminate Harbor Homes' status as a qualified Medicaid provider was improper because the requirement was invalid both on its face and as applied in this case. Plaintiffs appealed rulings of the Superior Court that denied their summary judgment motions and granting the defendants' cross-motions for summary judgment on two counts in the plaintiffs' petition. Upon review of the matter, the Supreme Court reversed the Superior Court's ruling that New Hampshire Administrative Rules, He-M 426.04(a)(2) did not violate the federal Medicaid Act. The case was remanded for further proceedings. View "Dube v. New Hampshire Dept. of Health & Human Svcs." on Justia Law
Campbell v. Dep’t of Emp’t Sec.
Robert Campbell quit his job as a school teacher in anticipation of accompanying his wife to Finland on her Fulbright grant. Campbell applied for unemployment benefits for the months between his resignation in June 2010 and his family's planned departure in February 2011. His request was denied because the Department of Employment Security determined that Campbell did not qualify for benefits as claimed under RCW 50.20.050(2)(b)(iii), known as the "quit to follow" provision. On appeal, the superior court reversed, but the Court of Appeals reinstated the agency action. The Supreme Court affirmed the Court of Appeals and held that Campbell's resignation from his job seven months before the planned relocation was not reasonable as contemplated by the statute.View "Campbell v. Dep't of Emp't Sec." on Justia Law
Palomba-Bourke v. Comm’r of Soc. Servs.
Plaintiff’s spouse (Spouse) applied to the Commissioner of Social Services (Department) for Medicaid benefits. After a review of the combined assets of both Spouse and Plaintiff, the Department concluded that Spouse was not eligible to receive Medicaid benefits. A hearing officer denied Plaintiff’s appeal, as did the superior court. The Supreme Court affirmed, holding that the trial court correctly concluded that the Department did not act arbitrarily or abuse its discretion in finding that the Department applied the correct eligibility and availability of assets criteria when evaluating the application for Medicaid benefits submitted by Spouse. View "Palomba-Bourke v. Comm’r of Soc. Servs." on Justia Law
Martin H. Handler, M.D., P.C. v. DiNapoli
Petitioners were two medical providers whose patients included individuals insured by the State’s primary health benefit plan. The State Comptroller reviewed Petitioners’ billing records as part of an audit of billing practices in the health care industry for claims paid by the State. While Petitioners conceded that the State paid eighty percent of the costs of their services, Petitioners challenged the Comptroller’s authority to audit their books. Supreme Court concluded that the Comptroller lacked constitutional authority to audit Petitioners because Petitioners were “not a political subdivision of the State.” The Appellate Division modified Supreme Court’s orders to reinstate the audits. The Court of Appeals affirmed, holding that the State Constitution does not limit the Comptroller’s authority to audit, as part of its audit of State expenditures, the billing records of private companies that provide health care to beneficiaries of a State insurance program.View "Martin H. Handler, M.D., P.C. v. DiNapoli" on Justia Law
Risovi v. Job Service
A Job Service claims deputy issued an initial determination that Kenneth Risovi misrepresented facts in order to obtain unemployment benefits, which he was not eligible to receive. Job Service disqualified Risovi from receiving unemployment benefits from November 4, 2012, to October 26, 2013. Risovi appealed the determination. Finding no reversible error, the Supreme Court affirmed. View "Risovi v. Job Service" on Justia Law
Doe, et al. v. Wilmington Housing Authority, et al.
Two certified questions came before the Delaware Supreme Court in this case. The questions centered on whether lease provisions for apartments of a public housing authority that restrict when residents, their household members, and guests may carry and possess firearms in the common areas violate the right to keep and bear arms guaranteed by Article I, Section 20 of the Delaware Constitution. The United States Court of Appeals for the Third Circuit found no violation of the Second Amendment or the Delaware Constitution. The certified questions were: (1) whether, under the Delaware Constitution, a public housing agency such as the WHA could adopt a firearms policy; and (2) whether under the Delaware Constitution, a public housing agency could require its residents, household members, and guests to have available for inspection a copy of any permit, license, or other documentation required by state, local, or federal law for the ownership, possession, or transportation of any firearm or other weapon, including a license to carry a concealed weapon. The Delaware court answered both questions in the negative.View "Doe, et al. v. Wilmington Housing Authority, et al." on Justia Law
Bell v. Commonwealth
Mary Bell was a disabled person who drew Social Security Insurance benefits and participated in a federally-funded, community-based program operated by the Cabinet for Health and Family Services. When Thomas Bell, Mary’s father, retired and began to draw his Social Security benefits, Mary became eligible for Old Age, Survivor and Disability Insurance. Consequently, Mary was charged $60 per month for her continued program participation. Thomas filed an administrative appeal on Mary’s behalf. The matter ultimately reached the circuit court, which held that Mary could not be charged to participate in the program. Thereafter, the circuit court (1) awarded attorney’s fees against the Cabinet due to the Cabinet’s “egregious government behavior,” and (2) ordered the Cabinet to disclose the personal information of all other participants in the program. The court of appeals reversed. The Supreme Court affirmed, holding that the trial court erred by (1) ordering the payment of attorney’s fees solely for egregious conduct without statutory authorization or a contract providing for such fees; and (2) ordering the disclosure of records of all persons participating in the program without the other persons having filed claims and no class action being certified.View "Bell v. Commonwealth" on Justia Law
In re Brett
In consolidated appeals, petitioners, both recipients of home-based long-term care benefits through Vermont's Medicaid-funded Choices for Care (Choices) program, appealed decisions of the Human Services Board disallowing deductions for personal care services from their patient-share obligation under federal and state Medicaid laws. Upon review of the cases, the Supreme Court concluded that to the extent the services in question were medically necessary, expenses for those services must be deducted from petitioners’ patient-share obligation even if they are of a type generally covered by Medicaid. Furthermore, the Court rejected the State’s claim that the decision of the Department of Disabilities, Aging and Independent Living not to provide the personal care services in question under the Choices program constituted a conclusive finding that the services were not medically necessary. View "In re Brett" on Justia Law
Caldwell v. Janssen Pharmaceutical, Inc.
The Attorney General for the State of Louisiana brought an action against the defendant pharmaceutical companies alleging, among other things, violations of the Louisiana Medical Assistance Programs Integrity Law (MAPIL). The district court entered a judgment upon the jury's verdict in favor of the Attorney General, finding the defendants' alleged misconduct in marketing certain drugs had violated provisions of MAPIL as it read in November 2003, and awarding civil penalties of $257,679,500.00, $70,000,000.00 in attorney fees, and $3,000,200.00 in costs. The court of appeal affirmed the district court's judgment. After its review, the Supreme Court found the Attorney General failed to establish sufficient facts to prove a cause of action against the defendants under MAPIL because no evidence was presented that any defendant made or attempted to make a fraudulent claim for payment against any Louisiana medical assistance program within the scope of MAPIL. Accordingly, the Court reversed the district court's judgment in favor of the Attorney General.View "Caldwell v. Janssen Pharmaceutical, Inc." on Justia Law