Justia Public Benefits Opinion Summaries

On October 11, 2013, the Ohio Department of Medicaid (Department) submitted an application to the Ohio Controlling Board (Board) for an increase in its appropriation authority from the accounts holding federal Medicaid funds. The Board approved the Department's request on October 21, 2013, the effect of which was to provide medical services to Group VIII members under the Patient Protection and Affordable Care Act. The following day, Relators filed a request for writ of mandamus. Relators claimed that the Board violated Ohio Rev. Code 127.17, which provides that the Board shall take no action which does not carry out the legislative intent of the general assembly, by approving the Department's request for increased appropriation authority for the Hospital Care Assurance Match Fund. The Supreme Court denied the writ, concluding that Relators failed to establish a clear legal right to the requested relief and a clear legal duty on the part of the Board to undo the authorization of the expenditure of additional federal funds to provide medical insurance for Group VIII members.View "State ex rel. Cleveland Right to Life v. State of Ohio Controlling Bd." on Justia Law

Two Chicago firefighters suffered duty-related injuries in the 1980s and later died. Their widows each received an ordinary widow’s pension from the Retirement Board of the Firemen’s Annuity and Retirement Benefit Fund of Chicago. The two widows were later awarded annuities available to widows of firemen who died in the line of duty, retroactive to the date of death of each spouse, with interest, because the injuries were permanent and had prevented them from ever returning to active duty. The widows claimed that the calculation of their annuities (based on the current salary of the position last held by the deceased) should include duty availability pay, which is generally intended to compensate firefighters for being available for duty. This type of compensation was created in the 1990s, after these firemen’s accidents, and neither ever received it. Their argument, based on Pension Code language added in 2004, was rejected by the Board and the trial court. The appellate court reversed. The Illinois Supreme Court reinstated the denial. If duty availability pay may be used for pension calculation, it must be pay that was actually received by the firemen.View "Hooker v. Ret. Bd. of the Firemen's Annuity & Benefit Fund of Chicago" on Justia Law

The worker was injured in a 2006 automobile accident near Cordova, where he was working temporarily for Venture. Cordova is 200 miles from Springfield, where he lived and where his plumbers’ and pipefitters’ union was. He was living a motel 30 miles from the worksite with a coworker, also from Springfield, who was driving when the accident occurred. An arbitrator denied his workers’ compensation claim. The Workers’ Compensation Commission reversed; the trial court set aside the Commission’s finding. The Workers’ Compensation Division of the Appellate Court granted relief to the worker. The Illinois Supreme Court reversed, holding that the worker was not a “traveling employee” and could not be compensated. An injury incurred by an employee in going to or returning from the place of employment is not compensable, because it is not arising out of or in the course of employment, unless the worker can be categorized as a “traveling employee.” The employer did not direct the worker to accept the position at the Cordova location; he accepted it with full knowledge of the commute involved. His course or method of travel was not determined by the demands and exigencies of the job. He was not reimbursed for travel time or expenses or told what route to take.View "The Venture-Newberg Perini Stone v. IL Workers' Compensation Comm'n" on Justia Law

The Jackson County Board of Supervisors terminated June Seaman, and she applied to the Mississippi Employment Security Commission (MESC) for unemployment benefits. A claims examiner, an administrative-law judge, and the Board of Review all determined that Seaman was entitled to unemployment benefits because Jackson County had failed to prove by clear and convincing, substantial evidence that Seaman had been terminated for misconduct. The circuit court affirmed the agency’s decision, but the Court of Appeals reversed, finding that the employer had proven misconduct by substantial evidence. After its review, the Supreme Court concluded the Court of Appeals improperly reweighed the evidence before the MESC. Therefore, the Supreme Court reversed the Court of Appeals and reinstated and affirmed the circuit court's judgment. View "Jackson County Board of Supervisors v. Mississippi Employment Security Commission" on Justia Law

A member of the military moved to a new post in Alaska in 2005. Two months later, he was deployed to Iraq. After 16 months of service in Iraq, he returned to Alaska in December of 2006. Shortly thereafter, he applied for the 2007 Permanent Fund Dividend (PFD), for his eligibility for 2006. The Department of Revenue denied his application. The service member filed an informal appeal and later a formal appeal with the Department, both of which were denied. The superior court affirmed the denial, concluding that the relevant statute required him to reside in Alaska for six months before claiming an allowable absence for military service and that the statute did not violate equal protection under the U.S. and Alaska Constitutions. After its review, the Supreme Court concluded that because the service member was not eligible for the 2007 PFD, the Court affirmed the superior court's judgment. View "Heller v. Alaska Dept. of Revenue" on Justia Law

Parents who adopted special needs children challenged decision by the Department of Human Services (DHS) to provide a lower assistance subsidy for the children than the assistance subsidy that would be paid if the children were in a foster placement. The decision was upheld upon administrative review by DHS and sustained by the district court and Court of Civil Appeals. Parents filed a petition for certiorari, seeking review of the Court of Civil Appeals' decision. The Supreme Court concluded DHS was attempting to apply a predetermined fixed amount of subsidy without allowing adoptive parents to show greater need up to the amount provided for special needs children in foster care. This was contrary to the policy and purpose of the statutory law providing and regulating financial assistance to people who undertake parental responsibility and care of special needs children. The opinion of the Court of Civil Appeals was therefore vacated and the district court order sustaining the decision of the Department of Human Services was reversed. The case was remanded to the Department of Human Services for redetermination of the monthly subsidy amount.View "Troxell v. Oklahoma Dept. of Human Services" on Justia Law

Beckley Appalachian Regional Hospital (Beckley ARH) was a voluntary provider of medical services through the Medicaid program pursuant to an agreement executed between it and the West Virginia Bureau for Medical Services (BMS). Beckley ARH filed a lawsuit against the West Virginia Department of Health and Human Resources and its secretary and the BMS and its commissioner (collectively, Respondents), seeking a remedy for inadequate Medicaid reimbursement rates. The circuit court dismissed the complaint for failure to state a claim upon which relief could be granted. The Supreme Court affirmed, holding that W. Va. Code 9-15-16 and 16-29B-20 do not provide for an express or implied private cause of action by a Medicaid provider for judicial review of reimbursement rates for medical services.View "Appalachian Reg'l Healthcare v. W. Va. Dep't of Health & Human Res." on Justia Law

The City of Gadsden and certain members of the State Employees' Insurance Board appealed two circuit court orders that granted injunctive relief to John Boman. Boman worked as a Gadsden police officer from 1965 until he retired in 1991. In 2000, Gadsden elected to join the 'Local Government Health Insurance Plan,' a health benefit plan administered by the Board. When Boman turned 65 in 2011, he was receiving medical care for congestive heart failure and other ailments. After his 65th birthday, Blue Cross began denying his claims for medical treatment based on the failure to provide Blue Cross with a 'record of the Medicare payment.' However, Boman had no Medicare credits. When the dispute over coverage arose, Boman sought review by the Board. The Board denied Boman's request for an appeal. Boman and 18 other active and retired Gadsden police officers sued Gadsden, alleging, among other things, that they had 'been deprived of Social Security and Medicare protection which other police officers have been provided' and that, after 20 years of service, they were being required to pay a higher pension charge or percentage of base pay than their counterparts who were hired after April 1, 1986. In 2011, Boman filed a 'motion for immediate relief for medical care.' The Supreme Court found that the circuit court issued preliminary injunctive relief against Gadsden without requiring Boman to give security and without making any specific findings. As such, the Supreme Court had "no alternative but to reverse" the preliminary injunction issued against Gadsden and remanded the case for further proceedings.View "City of Gadsden v. Boman " on Justia Law

Petitioner filed to receive food stamp benefits under the Supplemental Nutrition Assistance Program as a separated spouse in a one-person household. The Department of Health and Human Resources (DHHR) determined that Petitioner and her husband (Husband) were living together for seventeen months after Petitioner filed to receive food stamps and sent Petitioner a notice of overpayment. Petitioner requested a hearing, and a hearing examiner affirmed the DHHR's overpayment claim. The circuit court affirmed, finding that Petitioner had not submitted sufficient evidence to support her claim that she and Husband had separate residences. The Supreme Court reversed the judgment of the circuit court and remanded for entry of an order granting Petitioner's petition for a writ of certiorari and dismissing the DHHR's overpayment claim, holding that the DHHR failed to prove that Petitioner and Husband lived together during the seventeen month time period of the overpayment claim, and the claim should have been dismissed at the conclusion of DHHR's evidence.View "Hudson v. Bowling" on Justia Law

The Office of the Medicaid Inspector General (OMIG) terminated a physician's participation in the Medicaid program on the basis of a Bureau of Professional Medical Conduct (BPMC) consent order, in which the physician pleaded no contest to charges of professional misconduct and agreed to probation. Supreme Court annulled the OMIG's determination. The Appellate Division affirmed, concluding (1) the agency acted arbitrarily and capriciously in barring the physician from treating Medicaid patients when the BPMC permitted him to continue to practice; and (2) the OMIG was required to conduct an independent investigation before excluding a physician from Medicaid on the basis of a BPMC consent order. The Court of Appeals affirmed but for another reason, holding (1) the OMIG is authorized to remove a physician from Medicaid in reliance solely on a consent order between the physician and the BMPC, regardless of whether BPMC chooses to suspend the physician's license or OMIG conducts an independent investigation; but (2) because OMIG did not explain why the BPMC consent order caused it to exclude the physician from the Medicaid program, the agency's determination was arbitrary and capricious.View "Koch v. Sheehan" on Justia Law