Justia Public Benefits Opinion Summaries

Johnathan Bertsch was charged with two counts of deliberate homicide and two counts of attempted deliberate homicide after shooting at a vehicle, killing one person and injuring two others, and subsequently shooting a highway patrol officer. He pleaded guilty to one count of deliberate homicide and three counts of attempted deliberate homicide. The State requested $34,728.14 in restitution based on payments made to the victims by Montana’s Crime Victim Compensation Program. Bertsch, who relied on Social Security payments and had not maintained employment, objected to the restitution due to his indigent status.The Fourth Judicial District Court sentenced Bertsch to four consecutive life terms without parole and imposed the requested restitution amount plus a 10% administrative fee. The court reasoned that any funds Bertsch earned through prison work should go towards restitution. Bertsch appealed the restitution order, arguing that it should be waived as unjust given his financial inability to pay.The Supreme Court of the State of Montana reviewed the case. The court held that the restitution statutes require courts to determine restitution amounts without considering an offender’s ability to pay. Bertsch did not adequately request a waiver or present sufficient evidence to show that restitution was unjust under § 46-18-246, MCA. The court found that a general objection based on indigence did not meet the burden of proof required to waive restitution. The court affirmed the District Court’s order, noting that Bertsch could petition for a waiver or adjustment of restitution if his circumstances changed. View "State v. Bertsch" on Justia Law

The case involves a challenge to two Montana laws, HB 544 and HB 862, and a rule adopted by the Montana Department of Public Health and Human Services (DPHHS) regarding Medicaid funding for abortions. The plaintiffs, including Planned Parenthood of Montana and other healthcare providers, argue that these provisions infringe on the constitutional rights of their patients by imposing restrictions on Medicaid coverage for abortions. Specifically, the laws and rule bar Medicaid from covering abortions provided by non-physicians, require prior authorization for abortion services, and limit Medicaid coverage to abortions deemed "medically necessary" under a restrictive definition.The First Judicial District Court of Lewis and Clark County issued a preliminary injunction to halt the enforcement of HB 544, HB 862, and the DPHHS rule. The court found that the plaintiffs were likely to succeed on the merits of their claims, which included violations of the right to privacy and equal protection under the Montana Constitution. The court applied strict scrutiny, determining that the laws and rule were not narrowly tailored to serve a compelling state interest. The court also found that the plaintiffs would suffer irreparable harm without the injunction and that the balance of equities and public interest favored granting the injunction.The Montana Supreme Court reviewed the case and affirmed the District Court's decision to grant the preliminary injunction. The Supreme Court agreed that the plaintiffs were likely to succeed on the merits, as the challenged provisions infringed on the fundamental right to privacy and equal protection. The court held that the state failed to demonstrate that the laws and rule were narrowly tailored to address a medically acknowledged, bona fide health risk. The Supreme Court also found that the plaintiffs would suffer irreparable harm without the injunction and that the balance of equities and public interest supported maintaining the injunction. View "Planned Parenthood v. State" on Justia Law

The Supreme Court reversed an order of the district court affirming an administrative law judge's proposed order that trust principal consisting of a jointly owned home constituted a countable asset for the purpose of the Medicaid eligibility of Marilyn Scheidecker, holding that there were no circumstances under which payment from the trust's corpus could be made for Marilyn's benefit.The Montana Department of Public Health and Human Services denied Marilyn's application for Medicaid, concluding that Marilyn's one-half interest in the trust's principal was a countable resource placing her over Medicaid's resource limit. The ALJ upheld the denial. The district court affirmed the ALJ's ultimate conclusion that the trust was a countable asset pursuant to 42 U.S.C. 1396p(d)(3), holding that circumstances existed by which payments form the trust's corpus could be made to or for Marilyn's benefit. The Supreme Court reversed, holding that the district court was incorrect in its application of the federal statute. View "Estate of Scheidecker v. Montana Department of Public Health & Human Services" on Justia Law

The Supreme Court affirmed in part and reversed in part a district court order granting in part and denying in part judicial review of the Montana Department of Public Health and Human Services (DPHHS) fair hearing proposed decision that DPHHS overpaid IMS under the Medicaid program and was entitled to reimbursement in the amount of $670,152 from Independence Medical Supply, Inc. (IMS). IMS appealed, and DPHHS cross appealed the district court’s order. The Supreme Court held (1) the district court did not abuse its discretion by affirming the hearing officer’s determination that physician affidavits introduced by IMS did not cure technical violations of the supply orders submitted to DPHHS; and (2) the district court erred in holding that a letter sent by DPHHS on January 8, 2014 commenced an action for recovery of the overpayment because DPHHS did not commence an action within the meaning of Mont. Code Ann. 27-2-102(1)(b) and Mont. R. Civ. P. 3. View "Independence Medical Supply, Inc. v. Montana Department of Public Health & Human Services" on Justia Law

Dawn McGee, who was receiving public assistance in the form of SNAP benefits, and Helge Naber were an unmarried couple living together with their five collective children. When the Department of Health and Human Services learned that Naber was living with McGee it sent McGee a notice requesting income information for Naber. McGee did not send the requested information, and the Department terminated McGee’s benefits. The Board of Public Assistance and district court upheld the Department’s determination. The Supreme Court affirmed, holding that the Department was required to terminate McGee’s SNAP benefits when the household, including Naber, refused to provide the income information that the Department requested. View "McGee v. State Department of Public Health & Human Services" on Justia Law

In 2003, Joshua Micone applied for Medicaid benefits for himself and his family. In his applications, Joshua did not report his wife Jennifer's interest in a family limited partnership. The Department of Public Health and Human Services approved Joshua's application, and the Micone family received Medicaid benefits from 2003 to 2006. Subsequently, the Department notified Joshua that his household was ineligible for benefits paid over the past three years because of Jennifer's interest in the partnership and demanded repayment. Joshua contested the demand of benefits paid. The State Board of Public Assistance upheld a hearing officer's findings that Jennifer's interest in the partnership was a countable and available resource. The district court affirmed. On appeal, the Supreme Court affirmed, holding (1) the district court correctly concluded that that the hearing officer did not violate Mont. Code Ann. 2-4-623 when he did not issue a decision within ninety days after the case was deemed submitted; and (2) the district court correctly determined that substantial credible evidence supported the Department's finding that Jennifer's interest in the partnership was an available resource.

Donovan Donald (Don) was incapacitated in an accident and received several treatment in Kalispell Regional Medical Center (KRMC). Later, a dispute arose between Don's estate and KRMC over KRMC's acceptance or rejection of Medicaid's payments for Don's care. KRMC filed liens against the Estate. The Estate, in turn, sued KRMC and MASH, a company that had provided Medicaid application forms to the Estate, under several theories of liability. The district court granted Defendants' motions for summary judgment. The Supreme Court affirmed, holding the district court (1) did not err in granting summary judgment to KRMC and MASH; (2) correctly interpreted and applied the Montana Medicaid Act; (3) correctly awarded KRMC prejudgment interest but incorrectly included interest KRMC received from its interest-bearing account; and (4) did not abuse its discretion by awarding KRMC attorney fees and costs. Remanded with instructions to offset the prejudgment interest award by the amount of interest KRMC received from the interest-bearing account.

Plaintiff, on behalf of a class of similarly situated plaintiffs who received Medicaid assistance and were subject to a Medicaid lien pursuant to 53-2-612, MCA, sued defendant alleging that defendant had collected a greater amount than it was entitled from plaintiffs' recoveries from other sources. The parties raised several issues on appeal. The court held that Ark. Dept. of Health & Human Servs. v. Ahlborn applied retroactively to all class members' claims and that defendant must raise affirmative defenses with respect to individual class members to avoid Ahlborn's effect. The court held that the applicable statute of limitations to be 27-2-231, MCA, which provided for a five-year limitations period. The court declined to disturb the district court's order requiring defendant to compile data on individual class members' claims. The court reversed the district court's determination as to interest assessed against defendant, and concluded that no interest could be assessed until two years after any judgment had been entered, under 2-9-317, MCA. The court concluded that the term "third party" in the Medicaid reimbursement statutes included all other sources of medical assistance available to Medicaid recipients, including private health or automobile insurance obtained by the Medicaid recipient. The court reversed the district court's grant of summary judgment to the class on its proffered distinction between "first party" and "third party" sources. The court affirmed the district court's conclusion that plaintiffs' "made whole" claim was immaterial in light of Ahlborn.