Justia Public Benefits Opinion Summaries

Mowlana, a native of Somalia, was admitted to the United States as a refugee in 2000 and became a lawful permanent resident in 2002. He was ordered removed from the U.S. after the Board of Immigration Appeals concluded that he had been convicted of an aggravated felony. The Board cited Mowlana’s prior conviction under 7 U.S.C. 2024(b), which forbids the knowing use, transfer, acquisition, alteration, or possession of benefits in a manner contrary to the statutes and regulations of the Supplemental Nutrition Assistance Program (food stamps). The Eighth Circuit dismissed his petition for review, agreeing that his offense was an aggravated felony, 8 U.S.C. 1227(a)(2)(A)(iii). View "Mowlana v. Holder" on Justia Law

In December, 2009, Heelan, a Vernon Hills police officer for approximately 20 years, responded to an emergency call, slipped on ice, and fell. He was ultimately diagnosed with significant osteoarthritis in both hips, aggravated by the fall, and had two hip replacement surgeries. He did not return to work. The Village Police Pension Board awarded a line-of-duty disability pension, 40 ILCS 5/3-114.1. The Village sought a declaration that it was not obligated to pay Heelan’s health insurance premium under the Public Safety Employee Benefits Act (the Act), 820 ILCS 320/10. The circuit court entered judgment in favor of Heelan. The appellate court and Illinois Supreme Court affirmed, Proof of a line-of-duty disability pension establishes a catastrophic injury under section 10(a) of the Act as a matter of law; a public safety officer’s employer-sponsored health insurance coverage expires upon the termination of the officer’s employment by the award of the line-of-duty disability pension. The Act lengthens such health insurance coverage beyond the termination of the officer’s employment. View "Village of Vernon Hills v. Heelan" on Justia Law

Defendant Christopher Boisvert appealed his conviction for welfare fraud. Defendant was the father of Carrie Gray's two children. He and Gray moved into a Bristol apartment in 2009 or 2010. Defendant's name was removed from the lease at some point prior to late 2010. On December 31, 2010, defendant filed an application for public assistance. On January 14, 2011, he met with a department of health and human services representative and stated that he was homeless and had no resources; he was certified to receive benefits. Defendant was recertified for benefits at six-month intervals, and again reported in June 2011 and December 2011 that he was homeless. Between December 2010 and March 2012, Gray received medical, food stamp, and cash public assistance. The total amount of assistance that she received was calculated based upon a household consisting only of Gray and her children. She would not have been eligible for the same level of benefits if defendant had disclosed that he was living in the apartment. At some point, the special investigations unit of the department of health and human services received an allegation of welfare fraud concerning Gray. After interviewing witnesses and reviewing records provided by Gray and defendant, the investigator concluded that the case should be referred to the county attorney's office. Defendant was subsequently indicted on one count of welfare fraud. Because it was alleged that the value of the fraudulently obtained payments exceeded $1,000, the offense was classified as a class A felony. The case went to trial, and at the close of the State's case, defendant moved to dismiss the charge, arguing that the State had failed to present sufficient evidence that he was living with Gray during the relevant time period. The trial court denied the motion, and the jury found defendant guilty. This appeal followed. He argued on appeal to the Supreme Court that the Superior Court erred by denying: (1) defendant's motion to dismiss that challenged the sufficiency of the evidence; and (2) his request to give an accomplice liability jury instruction. Finding no reversible error, the Supreme Court affirmed. View "New Hampshire v. Boisvert" on Justia Law

Plaintiff appealed the denial of his application for Social Security disability benefits (SSI). The district court granted defendant's motion for judgment on the pleadings. The court concluded, however, that the ALJ erred by failing to provide “good reasons” for giving little weight to the treating physician's opinion, and that this error was not harmless. Accordingly, the court vacated the district court's judgment and remanded for further proceedings. View "Greek v. Colvin" on Justia Law

Pursuant to federal law, California’s Medi-Cal program requires beneficiaries to use other health coverage (OHC) they may have before accessing Medi-Cal benefits. The state Department of Health Care Services (DHCS) maintains a database with codes that indicate whether a Medi-Cal beneficiary has OHC and, to some extent, the scope of that coverage. The codes are available to providers when a beneficiary seeks services. Medi-Cal beneficiaries filed suit. Because DHCS allegedly permits Medi-Cal providers to refuse nonemergency services to beneficiaries with OHC, and because the codes are not always correct and the information is limited, beneficiaries may be improperly denied service and referred to other providers even when there is no OHC available for the requested service; beneficiaries may experience delays in receiving nonemergency care and may be subject to a higher copayment than permitted under Medi-Cal. Plaintiffs argued that the assignment of an OHC code should trigger notice and a hearing. The trial and appeals courts rejected their arguments. Neither Welfare and Institutions Code 10950 nor regulation 50951 nor the California Constitution requires DHCS to provide a hearing or notice when it assigns an OHC code. Plaintiffs did not establish any violation of a ministerial duty subject to enforcement by a writ of mandate. View "Marquez v. Dept. of Health Care Servs." on Justia Law

Plaintiffs each applied for Medicaid institutional care coverage shortly after purchasing a short-term annuity. The Pennsylvania Department of Human Services (DHS) classified each of their annuities as a resource when determining Medicaid eligibility. This classification meant that the value of each annuity precluded them from receiving Medicaid assistance and resulted in a penalty period of ineligibility. The district court held that the plaintiffs’ purchases of the short-term annuities were sham transactions intended only to shield resources from Medicaid calculations, and affirmed DHS’s imposition of a period of Medicaid ineligibility, but held that, contrary to DHS’s arguments, a Pennsylvania statute that purported to make all annuities assignable was preempted by federal law. The Third Circuit affirmed in part, finding that the statute was preempted, but reversed in part, citing “safe harbor” provisions, under which, certain annuities are not considered resources for purposes of Medicaid eligibility, 42 U.S.C. 1396p(c)(1)(F). The court noted the qualifications for safe-harbor protection: the annuity must name the state as the remainder beneficiary, be irrevocable and nonassignable, be actuarially sound, and provide for payments in equal amounts during its term, with no deferral and no balloon payments. The court rejected the state’s argument that the annuities were “trust-like.” View "Zahner v. Sec'y Pa. Dept. of Human Servs." on Justia Law

Most Medicare recipients must pay monthly premiums in addition to various co-payments and deductibles, 42 U.S.C. 1395. States that receive federal Medicaid funds must assist certain low-income Medicare beneficiaries with payment of their out-of-pocket expenses related to the Medicare program. To be eligible for such assistance, a Medicare beneficiary must have income less than or equal to certain percentages of the federal poverty line “for a family of the size involved[.]” In calculating 74-year-old Turner’s family size to determine eligibility for assistance, the Ohio Department of Medicaid did not include Turner’s wife, who lives with him, and denied benefits. Ohio generally does not count a Medicare beneficiary’s spouse as a member of his “family.” The Sixth Circuit held that the Department’s use of an individual-need standard to deny applications and the state’s exclusion spouses in determining the size of a family, was contrary to federal law View "Wheaton v. McCarthy" on Justia Law

On April 25, 2011, Marcella Atkinson entered a long-term care facility. On June 16, 2011, Marcella and her husband Raymond submitted a Medicaid application for Marcella’s care. On August 9, 2011, Marcella transferred title to the house to Raymond. On September 28, 2011 the Knox County Department of Job and Family Services approved Marcella for Medicaid. The agency, however, delayed Medicaid benefits for Marcella until April 2012, asserting that the transfer of the home to Raymond was improper because it exceed the community-spouse resource allowance (CSRA) and was for less than fair market value. The Ohio Department of Job and Family Services upheld the determination. The Fifth District Court of Appeals affirmed. The Supreme Court affirmed, holding (1) during the period between an application for Medicaid benefits and the notice of Medicaid approval, Medicaid law allows an institutionalized spouse to transfer a home or equivalent assets to a spouse living in the community to the extent that it does not exceed the CSRA; and (2) in this case, the state may have imposed a penalty on Raymond that was not authorized by law. Remanded. View "Estate of Atkinson v. Ohio Dep’t of Job & Family Servs." on Justia Law

Hesseltine is “within the Borderline range of mental functioning.” She graduated from high school in 2003, reading at a sixth grade level. Hesseltine underwent several childhood surgeries to treat a leg impairment caused by Perthes disease, which cuts off blood flow to the hip. From 2004 to 2005, Hesseltine worked irregularly as a cook’s helper. From 2005 to 2007, Hesseltine worked part-time at a laundry business with the help of a job coach. In 2009, Hesseltine worked briefly as a casino housekeeper. In 2006, Hesseltine was diagnosed with polycystic ovarian syndrome, she manages her syndrome with medication. In 2007, a doctor observed limitation in flexion of her left hip and knee, “probably due to obesity.” Hesseltine lives with her husband and performs some household tasks, but reported that she could not walk more than a block without needing to rest and could lift a gallon of milk at a maximum. Hesseltine applied for disability insurance benefits. An ALJ denied the application, finding that her combination of impairments did not meet or medically equal a listed impairment in 20 C.F.R. 404, and that there were jobs in the economy that Hesseltine could perform. The Eighth Circuit remanded; the ALJ failed to sufficiently address whether her impairments medically equal Listing 12.05C. View "Hesseltine v. Colvin" on Justia Law

Alaura, age 22, was struck in the back of his head by an assailant wielding a bar stool. The blow shattered his skull, necessitating emergency surgery to remove part of his brain and place a metal plate in his skull. During this craniotomy Alaura had a seizure. Alaura has repeatedly seen neurologists, complaining of headaches, dizziness, and confusion, and has been diagnosed with post-traumatic headaches, cognitive impairment, and occipital neuralgia, an injury to or inflammation of nerves that run from the spinal cord at the base of the neck up through the scalp. It causes piercing or throbbing pain in the neck, the back of the head, and the front of the head behind the eyes. A year later, Alaura still complained of daily headaches, “absence-type” seizures several times a week, and back and neck pain. The Seventh Circuit reversed denial of Alaura’s claim for social security disability benefits as premature, stating that the “long list” of severe impairments “don’t sound like trivial obstacles to being able to hold full-time employment.” The administrative law judge’s explanations were “thin,” he made no effort to consider the combined effects on Alaura’s ability to work of all his impairments and limitations. View "Alaura v. Colvin" on Justia Law