Justia Public Benefits Opinion Summaries

The Court of Appeals confirmed the determination of a local services agency, confirmed by a state agency, that child support payments a parent receives, made for the benefit of her five children living at home, are included as "household" income in deciding whether the household is eligible for benefits under the Supplemental Nutrition Assistance Program (SNAP), holding that, for the purposes of SNAP, child support directly received by a parent is household income, even if it is used for the benefit of an ineligible college student living at home.The Suffolk County Department of Social Services (DSS) discontinued the household's benefits because its income exceeded the upper limit for the household. Because the two college children were ineligible for SNAP, DSS did not count them as household members but did include the full amount of child support in its calculation of household income. The mother appealed, arguing that the college children's pro rata share of the child support payment should be excluded from household income, rendering the household SNAP-eligible. The Office of Temporary and Disability Assistance (OTDA) upheld the determination. The Appellate Division confirmed the OTDA's determination. The Court of Appeals also confirmed, holding that the OTDA's interpretation of the relevant federal statutes was not irrational and was entitled to deference. View "Leggio v. Devine" on Justia Law

The Supreme Court affirmed the decision of the court of appeals affirming the determination of Scott County that Consumer Directed Community Support (CDCS) money that Cindy Ali, whose son was disabled, had allocated to herself as wages to care for her child was not excluded from the annual income calculation for the purpose of Section 8 eligibility, holding that amounts allocated to a parent to care for her disabled child are not excluded as income under 24 C.F.R. 5.609(c)(16).This dispute arose from the interplay between two public welfare programs, the state CDCS option for families with disabled members, and Section 8, an income-based federal housing program. Ali participated in the Section 8 housing program until Scott County, the local housing administrator, determined that the amounts Ali paid herself under the CDCS option were not excluded from her income when calculating her eligibility for Section 8 housing. As a result, Ali lost her Section 8 eligibility. The court of appeals affirmed. The Supreme Court affirmed, holding that the CDCS amounts Ali received as compensation for her services in caring for her child were correctly included as annual income when calculating Ali's Section 8 eligibility. View "In re Cindi Ali" on Justia Law

Under the Medicaid program, 42 U.S.C. 1396, states must ensure that certain medical assistance is available to all eligible beneficiaries. Illinois administers its Medicaid program through HFS. For managed care programs, HFS contracts with Medicaid managed care organizations (MCOs), which a flat monthly fee per patient. The MCOs pay providers for services rendered to Medicaid beneficiaries. Plaintiffs, consultants who offer business services to Illinois nursing homes and supportive living facilities, sued on behalf of a class of nursing home residents entitled to Medicaid benefits, alleging violations of Title XIX of the Social Security Act, the Americans with Disabilities Act, the Rehabilitation Act, and the Due Process and Equal Protection Clauses. They alleged that the MCOs failed to process timely payments for claims submitted by nursing homes—the plaintiff‐consultants’ clients—to the MCOs, putting the resident‐beneficiaries at risk of being discharged from the facilities. The Seventh Circuit affirmed the dismissal of the case for lack of subject matter jurisdiction. The regulation cited by plaintiffs does not permit authorized representatives to bring civil lawsuits on behalf of Medicaid beneficiaries so the plaintiffs lacked standing. The residents would be unlikely to benefit if the plaintiffs won; they apparently filed suit in an effort to push the state to pay outstanding bills owed to the consultants’ clients. View "Bria Health Services, LLC v. Eagleson" on Justia Law

Stacey Janssen alleged Lawrence Memorial Hospital ("LMH") engaged in two healthcare schemes to fraudulently receive money from the United States. Janssen first contended LMH falsified patients’ arrival times in order to increase its Medicare reimbursement under certain pay-for-reporting and pay-for-performance programs the Government used to study and improve hospitals’ quality of care. Second, Janssen contended LMH falsely certified compliance with the Deficit Reduction Act in order to receive Medicare reimbursements to which it was otherwise not entitled. LMH moved for summary judgment below, arguing Janssen failed to show her allegations satisfied the Act’s materiality requirement - that the alleged falsehoods influenced the Government’s payment decision as required under the FCA. The district court granted LMH summary judgment on all of Janssen’s claims on this basis, and finding no reversible error, the Tenth Circuit affirmed. View "United States ex rel. Janssen v. Lawrence Memorial Hospital" on Justia Law

Martin, a 67-year-old woman, sought Social Security Disability benefits. Her persistent back pain stems from two car accidents; she also suffers from depression, anxiety, bipolar disorder, panic disorder, and PTSD. These conditions caused Martin to stop working in 2009. Before then she had worked as a home health aide, data entry clerk, and administrative assistant. An ALJ determined that Martin’s severe impairments left her capable of performing only a limited range of sedentary jobs. The district court remanded for a more thorough consideration of Martin’s mental health problems. A new ALJ then found that Martin had no physical limitations whatsoever and declined to award benefits.The Seventh Circuit reversed, finding the second ALJ’s decision not supported by substantial evidence, and took “the rare step of ordering the award of benefits.” The court rejected Martin’s argument that the ALJ’s residual functional capacity determination failed to translate her mental health symptoms into limitations related to concentration, persistence, and pace but the record is clear that Martin’s physical limitations leave her unable to perform any work above the light level. Given her restricted range of motion and symptoms of pain, light exertion would likely be a challenge for Martin because it requires “a good deal of walking or standing.” View "Martin v. Saul" on Justia Law

O’Brien is a Vietnam veteran whose service-connected disabilities make him eligible to receive compensation for himself and for certain “dependents,” 38 U.S.C. 1115. Section 1115 does not define “dependents,” but lists specific allotments for veterans with “a spouse but no child,” “a spouse and one or more children,” “no spouse but one or more children,” and “a parent dependent upon such veteran for support.” Under title 38, a “child” is an unmarried person who meets certain age restrictions “and who is a legitimate child, a legally adopted child, a stepchild who is a member of a veteran’s household or was a member at the time of the veteran’s death, or an illegitimate child [in certain circumstances].” O’Brien took legal guardianship of D.B., his stepdaughter’s minor son, then requested dependency compensation. He and his late wife were D.B.’s caretakers since D.B.’s mother was in a nursing home and his father was absent. The VA denied compensation for D.B., indicating that O’Brien could reopen his claim with proof of D.B.’s adoption. The Board of Veterans’ Appeals, Veterans Court, and Federal Circuit upheld the denial as a matter of first impression. Despite not expressly defining “dependents,” Congress unambiguously limited that term to “spouses, children, and dependent parents” by specifying the amount payable for each. View "O'Brien v. Wilkie" on Justia Law

In 2009-2011, Hernandez sustained on-the-job injuries and received medical treatment. In 2016, she filed a voluntary Chapter 7 bankruptcy petition and reported unsecured claims held by three health care providers to whom she owed $28,709.60, $58,901.20, and $50,161.26 respectively. She reported minimal assets: $1300 in bank accounts and her pending workers’ compensation claim, valued at $31,000. Two days after filing her petition, Hernandez settled her workers’ compensation claim for $30,566.33 without consulting the bankruptcy trustee. She believed the settlement was exempt under section 21 of the Workers’ Compensation Act (820 ILCS 305/21). That statute provides: “No payment, claim, award or decision under this Act shall be assignable or subject to any lien, attachment or garnishment, or be held liable in any way for any lien, debt, penalty or damages….” The health care providers objected; the district court ruled in their favor.The Illinois Supreme Court answered a question of Illinois law certified by the Seventh Circuit: After the 2005 amendments to section 8 of the Workers’ Compensation Act and the enactment of section 8.2 of the Act, section 21 of the Act does exempt the proceeds of a workers’ compensation settlement from the claims of medical-care providers who treated the illness associated with that settlement or injury. View "In re Hernandez" on Justia Law

After the plaintiffs’ disability claims were denied by ALJs employed by the Social Security Administration (SSA), the Supreme Court held in Lucia v. SEC (2018), that ALJs in the Securities and Exchange Commission (SEC) exercised “significant discretion” in carrying out “important functions” and were required, under the Appointments Clause, to be appointed by the President, a court of law, or the head of a department. Because the SEC ALJs were not so appointed, the petitioner there was entitled to a new hearing. When Lucia was decided, the plaintiffs were already in the process of challenging the SSA’s denial of their claims in the district court and demanded new hearings on the ground that the SSA ALJs were unconstitutionally appointed. The Acting Commissioner of SSA quickly reappointed the administrative judges but argued that the plaintiffs were not entitled to relief because they had not previously presented their Appointments Clause challenges to their ALJs or the Appeals Council and had not exhausted those claims before the agency. The district court declined to require exhaustion, vacated the agency’s decisions, and remanded for new hearings. The Third Circuit affirmed. Both the characteristics of the SSA review process and the rights protected by the Appointments Clause favor resolution of these claims on the merits, so exhaustion is not required in this context. View "Cirko v. Commissioner Social Security" on Justia Law

Young, diagnosed with emphysema in 2002, had worked in coal mines for 19 years, retiring from Island Creek Coal in 1999. During and after work, Young would often cough up coal dust. For 35 years, Young smoked at least a pack of cigarettes a day. Young sought benefits under the Black Lung Benefits Act, 30 U.S.C. 902(b). Because Young had worked for at least 15 years as a coal miner and was totally disabled by his lung impairment, he enjoyed a statutory presumption that his disability was due to pneumoconiosis. If Young was entitled to benefits, Island Creek, Young’s last coal-mine employer, would be liable. After reviewing medical reports, the ALJ awarded benefits. The Benefits Review Board affirmed, noting that if there was any error in the ALJ’s recitation of the standard, that error was harmless. The Sixth Circuit denied a petition for review, first rejecting an Appointments Clause challenge as waived. The ALJ did not err by applying an “in part” standard in determining whether Island Creek rebutted the presumption that Young has legal pneumoconiosis. To rebut the “in part” standard, an employer must show that coal-mine exposure had no more than a de minimis impact on a miner’s lung impairment. The ALJ reasonably weighed the medical opinions and provided thorough explanations for his credibility determinations. View "Island Creek Coal Co. v. Young" on Justia Law

In 2010 San Diego Sherriff’s Deputy Collier died following an accident while on duty. Collier owned a house together with his fiance, Li, who was also designated as Collier’s beneficiary for his retirement benefits and as a dependent for purposes of workers’ compensation. The two were to have been married three months after the date of Collier’s death; Collier had repeatedly stated, including on a video, that he had made arrangements for Li to be taken care of in the event of his death. Stamp, Collier’s former girlfriend, was named as the beneficiary of his life insurance. Stamp and Li agreed to split the proceeds; Li received $560,920 and Stamp received $25,000. The Bureau of Justice Assistance denied Li’s claim for benefits under the Public Safety Officers’ Benefits Act, 34 U.S.C. 10281, because Li was not the designated beneficiary on Collier’s life insurance policy. The Federal Circuit affirmed. Rejecting Li’s argument that the Bureau should have considered the “totality of the circumstances,” the court stated that Li was not the designated life insurance beneficiary. California law requires strict compliance with the requirement of a policy to change the beneficiary; Collier’s policy required a written designation. There was no written designation and none of the exceptions apply. View "Li v. Department of Justice" on Justia Law