Justia Public Benefits Opinion Summaries

Plaintiffs, a class of children eligible for Texas's Early and Periodic Screening, Diagnosis, and Treatment program, filed suit under 42 U.S.C. 1983 for violations of federal Medicaid law. Plaintiffs subsequently entered into a consent decree with various Texas state officials (defendants) calculated to improve implementation of the Program. In 2007, the parties agreed to a "Corrective Action Order." In 2013, defendants moved to terminate a portion of the Order and associated consent decree paragraphs under Rule 60(b)(5). The district court granted the motion and plaintiffs appealed. Determining that plaintiffs have not forfeited their appeal, the court concluded that the district court properly terminated the portion of bullet points 8-10 concerning the completion of the four assessments at issue. The court relied on certain district court decisions to interpret the proper interpretation of "shortage" - which compares the provider-to-class-member ratio with the average client load of the relevant class of provider - and concluded that the district court erred in terminating the portion of bullet points 8-10 that orders defendants to develop plans to address “shortage[s]” identified by the assessments. Accordingly, the court vacated the district court's order in part and remanded for further proceedings. The court affirmed the portion of the district court’s order terminating bullet points 6-7 and consent decree paragraph 93, and the court vacated the portion of the district court's order terminating the challenged sentence of bullet point 5. View "Frew v. Janek" on Justia Law

In 2012, Illinois enacted legislation requiring prior approval for reimbursement for more than four prescriptions for one Medicaid patient within a 30‐day period. 305 ILCS 5/5‐5.12(j). Ciarpaglini is an Illinois Medicaid recipient and suffers from chronic conditions, including bipolar disorder, attention deficit hyperactivity disorder, panic disorder, and generalized anxiety disorder. Doctors have prescribed at least seven medications to manage these conditions. Ciarpaglini alleges that after the prior‐approval requirement took effect, he could not, at least at times, obtain medications he needed and that he has contemplated committing suicide, committing petty crimes so that he would be jailed, or checking himself into hospitals just to get medications. He challenged the requirement under federal Medicaid law, the Americans with Disabilities Act, the Rehabilitation Act, and the Constitution. Illinois subsequently moved Ciarpaglini from the general fee‐for‐service Medicaid program to a new managed care program, under which the requirement does not apply. The district court dismissed the matter as moot. The Seventh Circuit remanded, finding insufficient evidence to determine whether the claims were moot, given Ciarpaglini’s stated desire to move to another county and the lack of information about whether the change in his program was individual or part of a change in policy. View "Ciarpaglini v. Norwood" on Justia Law

Plaintiff filed a class action against the Commissioner, challenging New York’s coverage restrictions on certain medical services provided under its Medicaid plan. Plaintiffs argued that New York’s 2011 plan amendments, which restrict coverage of orthopedic footwear and compression stockings to patients with certain enumerated medical conditions, violate the Medicaid Act’s, 42 U.S.C. 1396 et seq., reasonable standards, home health services, due process, and comparability provisions, as well as the anti‐discrimination provision and integration mandate of Title II of the Americans with Disabilities Act (ADA), 42 U.S.C. 12131 et seq., and section 504 of the Rehabilitation Act, 29 U.S.C. 794. Because neither the Medicaid Act nor the Supremacy Clause confers a private cause of action to enforce the reasonable standards provision, the court vacated the district court’s grant of summary judgment to plaintiffs on that claim; the court declined to reach plaintiffs’ unequal treatment claim under the ADA and Rehabilitation Act as largely duplicative of their integration mandate claim; and the court affirmed the summary judgment rulings with respect to the remaining claims. Defendant is entitled to summary judgment on plaintiffs' home health services plan because orthopedic footwear and compression stockings constitute optional “prosthetics” rather than mandatory “home health services” under the Medicaid Act; defendant is entitled to summary judgment on the hearing element and plaintiffs are entitled to summary judgment on the notice element of plaintiffs’ due process claim, because the due process provision required New York to provide plaintiffs with written notice – though not evidentiary hearings – prior to terminating their benefits; plaintiffs are entitled to summary judgment on their comparability provision claim because New York’s coverage restrictions deny some categorically needy individuals access to the same scope of medically necessary services made available to others; and plaintiffs are entitled to summary judgment on their anti‐discrimination claims because New York’s restrictions violate the integration mandate of the ADA and Rehabilitation Act. Finally, the court vacated the injunction and remanded for further consideration on the appropriate relief because the injunction is broader than is warranted by the court's liability conclusions. View "Davis v. Shah" on Justia Law

Plaintiffs, including many with disabilities, had cases pending in state courts and were represented by an attorney who uses a wheelchair. They claimed that the St. Joseph County Courthouse and the Mishawaka County Services Building did not comply with the Americans with Disabilities Act and the Rehabilitation Act, particularly with respect to restrooms, elevators, witness stands, jury boxes, jury deliberation rooms, attorney podiums, spectator seating, entrance ramps, clerk counters, services for the blind, water fountains, and parking. While the case was pending, defendants remodeled the courthouse restrooms, which are now accessible. Defendants presented evidence that their facilities complied with the statutes. Plaintiffs offered little evidence in rebuttal. The district court granted defendants summary judgment. The court dismissed the claims of non-disabled plaintiffs represented by a disabled lawyer and claims relating to jury facilities, saying that the ADA did not provide for “associational” standing. The court found no evidence that other plaintiffs had suffered past injuries that would support standing for damages, and that the prospect of future injury was too speculative to support an injunction. Some plaintiffs had died; some were no longer in litigation. The Seventh Circuit affirmed, without finding the facilities compliant and without expressing an opinion on possible future claims. View "Hummel v. St. Joseph Cnty. Bd. of Comm'rs" on Justia Law

Parents of B.D. filed suit against the District, challenging the adequacy of a compensatory education award and seeking to enforce other portions of the Hearing Officer's Decision, as well as to require the District to secure a therapeutic residential placement. The district court granted summary judgment in favor of the District. The court concluded that the parents have met their burden of demonstrating that the Hearing Officer, affirmed by the district court, was “wrong,” as he failed to award sufficient compensatory education to put B.D. in the position he would be in absent the free appropriate public education (FAPE) denial; neither 20 U.S.C. 1415(i)(2)(A) nor 28 U.S.C. 1331 provides a cause of action for parents seeking to enforce a favorable hearing officer decision; and the district court correctly held that the request for an injunction - the only relief count three specifically sought - had become moot. Accordingly, the court affirmed in part, reversed in part, and remanded in part. View "B.D. v. District of Columbia" on Justia Law

Parents of B.D. filed suit against the District, challenging the adequacy of a compensatory education award and seeking to enforce other portions of the Hearing Officer's Decision, as well as to require the District to secure a therapeutic residential placement. The district court granted summary judgment in favor of the District. The court concluded that the parents have met their burden of demonstrating that the Hearing Officer, affirmed by the district court, was “wrong,” as he failed to award sufficient compensatory education to put B.D. in the position he would be in absent the free appropriate public education (FAPE) denial; neither 20 U.S.C. 1415(i)(2)(A) nor 28 U.S.C. 1331 provides a cause of action for parents seeking to enforce a favorable hearing officer decision; and the district court correctly held that the request for an injunction - the only relief count three specifically sought - had become moot. Accordingly, the court affirmed in part, reversed in part, and remanded in part. View "B.D. v. District of Columbia" on Justia Law

Binder, a law firm representing claimants before the SSA, appealed from summary judgment in two related cases where Binder seeks past attorney's fees. When Binder sought to hold the SSA liable for the fees, the district courts granted summary judgment to the SSA on the basis of sovereign immunity. The court affirmed the judgments and held that, regardless of the SSA’s statutory duties to withhold attorney’s fees from payments to successful claimants, there is no waiver of sovereign immunity in 42 U.S.C. 406(a) that would permit Binder’s lawsuits for money damages. View "Binder & Binder v. Colvin" on Justia Law

Robert Dean Carter appealed the denial of his application for disability insurance benefits and supplemental security income. The ALJ concluded that Carter was not disabled because he did not have an impairment or combination of impairments that met or medically equaled one of the listed impairments for chronic heart failure and because Carter had the residual functional capacity (RFC) to perform a limited range of sedentary work. After Carter died, Carter's daughter, KKC, appealed the denial of benefits. The court concluded that substantial evidence supports the ALJ’s finding that Carter’s impairment did not meet section 4.02(B)(1) and 4.02(B)(3); the ALJ did not err by refusing to give controlling weight to the opinion of Carter's treating physician where the physician's statement at issue did not resolve the legal issue of whether Carter was disabled; and the ALJ’s RFC assessment was supported by substantial evidence on the record as a whole. Accordingly, the court affirmed the judgment. View "KKC v. Colvin" on Justia Law

Petitioner and her son prevailed at both hearings concerning their due process complaint against the District. At issue on appeal is the district court's award of attorney fees, pursuant to the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1415, to petitioner's attorney, Tania Whiteleather. The district court awarded $7,780 in fees, substantially less than the $66,420 requested. The court concluded that the outcome of the administrative hearing was not more favorable to petitioner than the District's settlement offer and petitioner was not substantially justified in rejecting the settlement offer. The court concluded that it was not an abuse of discretion for the district court to apply the $400 rate without seeking additional rebuttal evidence from the District. Finally, the court concluded that petitioner's claim for paralegal fees was barred by collateral estoppel because the district court had already concluded that Dr. Susan Burnett was an education consultant in the expedited hearing appeal. Accordingly, the court affirmed the judgment. View "Beauchamp v. Anaheim Union High Sch. Dist." on Justia Law

The plaintiff, now 62 years old, applied in 2011 to the Social Security Administration for disability benefits, citing ailments including asthma, chronic obstructive pulmonary disease (COPD), asbestosis, and a heel spur in his right foot. He had been a sheet metal journeyman for 33 years; the job requires physical strength and he had been given accommodations on the job for several years. The Social Security Appeals Council declined to review the administrative law judge’s denial and the district judge affirmed. The Seventh Circuit reversed and remanded, referring to the ALJ’s “seemingly inconsistent conclusions” and stating that the denial was “not a reasoned analysis of the plaintiff’s claim.” View "Dimmett v. Colvin" on Justia Law