Justia Public Benefits Opinion Summaries

An employee, Matthew I. Ortega, voluntarily quit his job as an office manager at Island Towing after 17 years, citing work-related stress from interactions with law enforcement as the reason. Ortega applied for unemployment benefits, stating that the stress affected his mental health and ability to perform his job. The Nebraska Department of Labor denied his application, finding that he did not have good cause to quit.Ortega appealed to the Nebraska Department of Labor’s Appeal Tribunal, where both he and his supervisor, Chloe Aguilar, testified. Ortega described two specific incidents involving law enforcement that caused him significant stress, one of which occurred 2½ years prior to his resignation. Aguilar confirmed the ongoing negative interactions with law enforcement but stated that there was no way to alleviate the stress. The Appeal Tribunal upheld the denial, stating that Ortega did not provide sufficient evidence, such as medical documentation, to prove that his stress constituted good cause for quitting.Ortega then appealed to the district court for Hall County, which affirmed the Appeal Tribunal’s decision. The district court agreed that Ortega’s stress was a health concern requiring medical evidence and noted that Ortega had not pursued alternative solutions to preserve the employment relationship, such as seeking a leave of absence or modifying his job duties.The Nebraska Supreme Court reviewed the case and affirmed the district court’s judgment. The court held that Ortega failed to meet his burden of proof to show good cause for voluntarily leaving his employment. The court found that the evidence provided, including the details of only one specific negative interaction with law enforcement, was insufficient to establish that Ortega’s work conditions were an increasingly unreasonable burden affecting his health or sense of well-being. View "Ortega v. Albin" on Justia Law

In these consolidated appeals, the Supreme Court affirmed the district court's dismissal of separate actions challenging the Nebraska Department of Health and Human Services' (DHHS) denial of an administrative appeal hearing, holding that the district court correctly determined that the hearing request was untimely submitted to DHHS under the governing regulation.Robert Colwell, DDS, P.C., was a Nebraska corporation through which Colwell (collectively, Colwell) provided medical services. Colwell entered into an agreement with Managed Care of North America (MCNA), which provided managed care services to Nebraska's Medicaid program, agreeing to provide dental services for individuals enrolled in Nebraska Medicaid. When MCNA allegedly failed to compensate Colwell for covered services, Colwell filed one action challenging the MCNA's decision to terminate the Medicaid provider agreement with Colwell. In this action, Colwell filed a request for a fair hearing with DHHS, which DHHS denied and dismissed. Colwell then filed another action challenging the DHHS order of dismissal. The district court dismissed both appeals for lack of subject matter jurisdiction. The Supreme Court affirmed, holding that Colwell's request for a hearing before DHHS was not timely filed within ninety days of the "date of the action." View "Colwell v. Managed Care of North America" on Justia Law

The Supreme Court affirmed the district court's judgment affirming a state agency's denial of Medicaid eligibility after J.S., a noncitizen who was admitted into the bridge to independence program (B2I), reached age nineteen, holding that the statutes and regulations cited by J.S. did not authorize her participation despite her immigration status and age.B2I, Nebraska's extended foster care program, was created by the Young Adult Bridge to Independence Act (YABI), Neb. Rev. Stat. 43-4501 to 43-4514. J.S., a citizen of El Salvador who fled to Nebraska as a minor, was adjudicated in juvenile court and placed into foster care. Upon turning nineteen years old, J.S. was accepted into B2I but was denied Medicaid coverage after her nineteenth birthday. The Nebraska Department of Health and Human Services (DHHS) upheld the denial of Medicaid benefits. At issue on appeal was whether J.S. could receive Medicaid under B2I. The district court concluded that because the Nebraska Legislature did not affirmatively provide for unlawful aliens to receive Medicaid benefits under B2I, J.S. was not entitled to Medicaid benefits. The Supreme Court affirmed, holding that the district court did not err in determining that J.S. was not eligible for Medicaid. View "J.S. v. Nebraska Department of Health & Human Services" on Justia Law

The Supreme Court affirmed the district court's order affirming the denial of LeVeta Winslow's 2016 application for Medicaid benefits, holding that Nebraska's Department of Health and Human Services (DHHS), Division of Medicaid and Long-Term Care properly determined that Winslow was ineligible for Medicaid due to excess resources.DHHS determined that Winslow was ineligible for Medicaid because her resources, which included a house, were above $4,000. The district court affirmed the denial of benefits, finding that the house did not qualify for Winslow's home and thus was not exempt from consideration as an available resource as Winslow's home. The Supreme Court affirmed, holding (1) the district court correctly determined that the house was not subject to the home exemption for Winslow's Medicaid application; (2) the district court erred in determining that the property was not eligible for the other real property exception because Winslow lacked authority to liquidate while it was held by a revocable trust; and (3) Winslow failed to provide sufficient documentation that she was under the available resource limit if she could exclude the house, and therefore, the district court did not err in failing to find that DHHS was required to provide Winslow an IM-1 form for the house while it was held by the trust. View "Winslow v. State ex rel. Peterson" on Justia Law

The Supreme Court affirmed the order of the district court affirming the decision of the Nebraska Department of Health and Human Services (DHHS) terminating Appellant's status as a Medicaid service provider, holding that the district court's affirmance of the sanction imposed by DHHS was not arbitrary, capricious, or unreasonable.Based on Appellant's failures to adhere to the standards for participation in Medicaid, DHHS terminated Appellant's provider agreements for good cause and then informed Appellant of her permanent exclusion from the Medicaid program. The DHHS director of the Division of Medicaid and Long-Term Care ruled that DHHS' decision to terminate Appellant as a Medicaid service provider was proper. The district court affirmed. The Supreme Court affirmed, holding (1) the court's finding that Appellant billed for overlapping services was based on competent evidence; and (2) DHHS' sanction to permanently exclude Appellant from the Medicaid program was not arbitrary or capricious. View "Tran v. State" on Justia Law

The Supreme Court reversed the order of the district court on remand in this case involving a claimant’s eligibility for Medicaid funding, holding that the district court erred in its instructions on remand.The Nebraska Department of Health and Human Services determined that Paige V. was ineligible for Medicaid funding through he Nebraska Medicaid Assistance Program and, thus, ineligible for “assistance to the aged, blind, or disabled” (AABD) Medicaid waiver services. Paige’s parents sought review. The district court (1) found that the evidence showed that Paige was disabled for purposes of determining Medicaid benefits, and (2) remanded the matter with directions to award Page AABD waiver services and to reimburse her parents for medical expenses. The Supreme Court (1) affirmed the portion of the district court’s order finding that Paige was disabled, but (2) reversed the district court’s order of remanded that awarded Medicaid waiver services because the district court exceeded its scope of review in determining that Paige was eligible for Medicaid waiver services. The Court remanded the case. View "Leon V. v. Nebraska Department of Health & Human Services" on Justia Law

The Supreme Court reversed the opinion of the district court affirming the decision of the Nebraska Department of Health and Human Services (DHHS) terminating the Medicaid benefits of Eric S., holding that the corpus of a trust was not available to Eric for purposes of determining his Medicaid eligibility.Specifically, the Court held (1) the trust at issue was properly characterized as a testamentary trust; (2) applying Pohlmann v. Nebraska Department of Health & Human Services, 710 N.W.2d 639 (Neb. 2006), the trust was a discretionary trust, and Eric did not have the ability to compel distribution of the entire corpus; and (3) therefore, it was error to find the entire trust corpus was an available resource in evaluating Eric’s eligibility for Medicaid. View "Donna G. v. Nebraska Department of Health & Human Services" on Justia Law

At issue in this appeal was whether the district court lacked subject matter jurisdiction to consider Azar Webb’s 42 U.S.C. 1983 claim in the same lawsuit in which the court considered an appeal from a contested case under the Administrative Procedure Act (APA) and whether, as a result, the court lacked the authority to award Webb attorney fees.After the Nebraska Department of Health and Human Services (DHHS) ended Webb’s Medicaid benefits and denied his petition for reinstatement, Webb filed a claim in the district court under the APA for unlawful termination of Medicaid eligibility, adding a claim of violation of his federal rights under section 1983. The district court reversed DHHS’ decision and ordered reinstatement of Webb’s coverage and reimbursement of medical expenses that should have been covered. The court further found in favor of Webb as to his 1983 claim and enjoined DHHS officials from denying Webb Medicaid eligibility. The Supreme Court affirmed, holding that once the district court resolved Webb’s APA claim, the court had the authority to grant Webb relief under section 1983 and his request for attorney fees pursuant to 42 U.S.C. 1988. View "Webb v. Nebraska Department of Health & Human Services" on Justia Law

In this challenge to an initiative petition seeking to expand Medicaid coverage the Supreme Court affirmed the judgment of the district court granting summary judgment in favor of Defendants, the named sponsors of the petition and the Secretary of State, holding that Appellants’ statutory and constitutional arguments were unavailing.Appellants sought to invalidate an initiative petition that received enough signatures to be placed on the November 2018 ballot. The district dismissed the complaint with prejudice. The Supreme Court affirmed, holding that the district court did not err by (1) dismissing as unripe and failing to find merit to Appellant’s claims that the ballot measure was an unconstitutional delegation of legislative authority and did not meet the statutory criteria for appropriations; (2) finding that the initiative did not violate the single subject rule; and (3) excluding a challenged exhibit from the evidence. View "Christensen v. Gale" on Justia Law

The Supreme Court held that “medical assistance” provided to Medicaid recipients includes costs for room and board and other “nonmedical” expenses at nursing facilities, and therefore, those costs can be recovered from the recipient’s estate. In this case, the Nebraska Department of Health and Human Services (DHHS) filed a petition for allowance of a claim for services provided to the decedent while he resided at two different nursing homes. The county court sustained DHHS’ motion for summary judgment, concluding that the services defined as room and board fell within the parameters of services provided under the Medical Assistance Act. The Supreme Court affirmed, holding that DHHS was statutorily authorized to recover the sums it paid for room and board costs and other expenses from the decedent’s estate. View "In re Estate of Vollmann" on Justia Law