Justia Public Benefits Opinion Summaries

A.M. received a human papillomavirus vaccine in 2007. Shortly thereafter, she developed autoimmune limbic encephalitis and an intractable seizure disorder, resulting in cognitive impairment. Her mother (McCulloch) sought compensation under the Vaccine Act, 42 U.S.C. 300aa. A special master awarded compensation for A.M.’s injury and accepted the parties' agreement on the amounts and mechanisms of compensation. Neither party sought review. Months later McCulloch sought an award of attorneys’ fees and costs under section 300aa15(e)(1). A special master awarded fees and costs and included amounts to cover the expenses, under Florida guardianship law, of maintaining the guardianship for A.M,-- a required condition for receiving the full payments under the merits judgment. The Claims Court upheld inclusion of those amounts, but cited section 300aa-15(a), the provision governing merits awards of compensation, instead of 300aa-15(e), the fees/costs provision on which the special master relied. The Federal Circuit affirmed while acknowledging that the Claims Court improperly reopened a final merits judgment by awarding money under section 300aa-15(a). Nonetheless, it was appropriate for the special master to award guardianship-maintenance expenses under that section because McCulloch incurred a continuing liability to pay such expenses as a condition of receiving, for her daughter, the compensation awarded on the merits in this proceeding. View "McCulloch v. Secretary of Health and 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

Plaintiff, a civilly committed sexually violent predator, had to pay for GPS monitoring or be prosecuted under a now-repealed Texas law. Plaintiff filed suit alleging that the pay-or-be-prosecuted penalty violated the Social Security Act's anti-attachment provision, 42 U.S.C. 407(a), which protects benefits from execution, levy, attachment, garnishment, or other legal process.The Fifth Circuit affirmed the district court's grant of summary judgment to officials based on qualified immunity, holding that plaintiff's Social Security benefits were not executed on, levied, attached, or garnished. Furthermore, criminalizing a sexually violent predator's failure to pay for GPS monitoring is not "other legal process" under section 407(a). Therefore, the district court correctly interpreted the anti-attachment provision and the officials were entitled to qualified immunity. View "Reed v. Taylor" on Justia Law

Goldstein worked until March 2013. The Employment Development Department (EDD) granted him unemployment insurance benefits, which he received in March 2013 through August 10, 2013. In August 2013, he successfully applied for disability benefits, which he received until he exhausted his maximum benefit amount in September 2014. Goldstein filed another unemployment claim, which had an effective date of March 23, 2014. EDD determined that Goldstein’s second claim was invalid under Unemployment Insurance Code section 1277 because during the benefit year of his first claim he neither was paid sufficient wages nor performed any work. An ALJ and the Appeals Board agreed while acknowledging that disability benefits qualify as wages under section 1277.5. The court of appeal affirmed, finding that the Board erred, but the error was not prejudicial. A claimant can establish a valid claim under section 1277(a) even if he received unemployment insurance benefits during the benefit year of the prior valid claim if both the earnings and work requirements are satisfied. Goldstein satisfied the earnings requirement and the Board erred in ruling otherwise but there is no evidence Goldstein performed services for pay during that time. View "Goldstein v. California Unemployment Insurance Appeals Board" on Justia Law

The Pennsylvania Supreme Court granted discretionary review to determine whether the Commonwealth Court erred in holding appellant Daniel Harmon was disqualified from receiving unemployment compensation benefits pursuant to Section 402.6 of the Unemployment Compensation Law. Appellant was a part-time employee at Brown’s Shop Rite beginning February 14, 2013. By December, he was convicted of driving with a suspended license and sentenced to a term of 60 days’ imprisonment to be served on 30 consecutive weekends, beginning March 14, 2014 and ending August 7, 2014. Appellant’s employment with Brown’s Shop Rite was terminated on March 24, 2014 due to a violation of company policy, which was unrelated to his incarceration. He then filed for benefits and received them for the week ending March 29, 2014 through the week ending July 26, 2014. This period included weeks when appellant was serving his sentence of weekend incarceration. The Supreme Court held appellant was not disqualified from receiving unemployment compensation benefits, and therefore reversed the order of the Commonwealth Court. View "Harmon v. UCBR" on Justia Law

The Ninth Circuit affirmed the district court's dismissal of a negligence action brought by plaintiff under the Federal Tort Claims Act (FTCA), alleging that he received improper treatment at a VA facility. In this case, after plaintiff presented a claim to the VA, the VA issued a final denial. The panel held that plaintiff's appeal was time-barred, because he failed to file the action within six months after the VA mailed a notice of final denial of plaintiff's initial claim, and the statute of limitations did not restart when the VA declined to consider plaintiff's second attempt to file the same claim. View "Redlin v. United States" on Justia Law

Sucic served on active duty 1973-1979 and 1982-1984. In 2007, he was granted service connection for post-traumatic stress disorder (PTSD), effective January 2003. In 2008, Sucic requested an effective date of June 1992. After remand by the Federal Circuit, the Veterans Court entered judgment in June 2016 and issued its mandate in August 2016. Sucic died five days after the Federal Circuit’s mandate issued but before the Veterans Court vacated the Board’s decision. Sucic’s counsel did not notify the Veterans Court of his death until after the Veterans Court issued its mandate. Sucic’s counsel filed an unopposed motion to recall the Veterans Court’s judgment and remand decision and a motion to substitute Sucic’s three adult children as claimants. The Veterans Court concluded, and the Federal Circuit affirmed, that the non-dependent adult children were not eligible accrued benefits beneficiaries under 38 U.S.C. 5121(a), qualified for substitution. View "Sucic v. Wilkie" on Justia Law

The Coalition filed suit on behalf of its foster parent members, alleging that the State pays foster parents members inadequate rates to cover the costs of caring for their foster children, in violation of the Adoption Assistance and Child Welfare Act of 1980. The Second Circuit affirmed the district court's finding that the Coalition has standing to sue on behalf of its members under Nnebe v. Daus, 644 10 F.3d 147 (2d Cir. 2011) and rejected the State's argument that the Coalition was barred by the third‐party standing rule.However, the court reversed the district court's dismissal of the Coalition's claims and joined the Sixth and Ninth Circuits in holding that the Act creates a specific entitlement for foster parents to receive foster care maintenance payments, and that this entitlement was enforceable through 42 U.S.C. 1983. Accordingly, the court vacated the order dismissing the case and remanded for further proceedings. View "New York State Citizens' Coalition for Children v. Poole" on Justia Law

Genesis Hospice LLC provided outpatient hospice care to Medicaid beneficiaries in the Mississippi Delta. Claims Genesis submitted outside the norm, prompting a Mississippi Division of Medicaid audit. A statistical sample of 75 of the 808 billed claims were reviewed, and of that 75, 68 claims were not substantiated by the patients’ records and thus not eligible for payment. The auditing physicians specifically found that the patient records for the 68 rejected claims lacked sufficient documentation to support the given terminal-illness diagnosis and/or lacked documentation of disease progression. Medicaid’s statistician extrapolated that 68 of 75 unsupported claims represented a total overpayment of $1,941,285 for the 808 claims Genesis billed during the relevant time period. And Medicaid demanded Genesis repay this amount. Medicaid’s decision has been affirmed in an administrative appeal before Medicaid and by the Hinds County Chancery Court, sitting as an appellate court. On further appeal to the Mississippi Supreme Court, Genesis essentially argued Medicaid unfairly imposed documentation requirements not found in the federal or state Medicaid regulations. Genesis insisted the only requirement was a physician’s certification that in his or her subjective clinical judgment the patient was terminally ill, which Genesis provided. The Supreme Court found the regulations were clear: a physician’s certification of terminal illness is indeed required, but so is documentation that substantiates the physician’s certification. Because Genesis’ records failed to support 90 percent of its hospice claims, Medicaid had the administrative discretion to demand these unsupported claims be repaid. Therefore, the Supreme Court affirmed. View "Genesis Hospice Care, LLC v. Mississippi Division of Medicaid" on Justia Law