Justia Public Benefits Opinion Summaries

The California Legislature reduced Medicaid hospital payments 10 percent between 2008-2011; the federal agency administering the Medicaid program approved the rate reductions. Hospitals alleged the reductions violated the Medicaid Act (42 U.S.C. 1396), which sets out procedural and substantive requirements the state must follow when establishing reimbursement rates. Hospitals unsuccessfully sought to have the rates declared void and almost $100 million in recalculated rates. The court of appeal affirmed, concluding that healthcare providers alleging a violation of section 1396a(a)(30)(A) may not obtain a writ of mandate against state officials to contest Medicaid rates approved by the federal agency that administers the program. Their recourse is an administrative action against the federal agency that approved the rates. While plaintiffs may obtain a writ of mandate for violations of the procedural requirements of section 13(A), no such violation occurred here. View "Santa Rosa Memorial Hospital v. Kent" on Justia Law

The Fourth Circuit affirmed the district court's grant of summary judgment to the school district in an action under the Individuals with Disabilities Education Act (IDEA), alleging that the school district failed to provide plaintiff, a former student, with a free appropriate public education (FAPE). The court held that the school district committed a procedural violation of the IDEA by failing to respond to parents' requests and conduct a timely evaluation of whether the student was eligible for special education or related services. Nonetheless, plaintiff failed to show that this defect in the process had an adverse effect on his education. Therefore, plaintiff was not actually deprived of a FAPE. View "T.B. v. Prince George's County Board of Education" on Justia Law

Memorial Hospital at Gulfport and Singing River Health System (“Hospitals”) sought judicial review of a June 24, 2016 administrative decision which found the Division of Medicaid’s (“DOM’s”) 2014 Fiscal Year Methodology “correctly interprets statutes and regulations and is neither arbitrary or capricious.” The chancellor affirmed the decision of DOM. Finding no evidence in the record before it that DOM failed to comply with Sections 43-13-117 and 43-13-145 in allocating and distributing supplemental payments to Mississippi hospitals, the Mississippi Supreme Court affirmed. View "Memorial Hospital at Gulfport v. Dzielak" on Justia Law

On July 11, 2013, the Idaho Department of Labor (“IDOL”) mailed an eligibility determination for unemployment benefits (the “2013 determination”) to William Wittkopf. This determination found Wittkopf underreported his wages for several weeks, which resulted in an overpayment in unemployment benefits. As a result, Wittkopf was: (1) ordered to repay the overpayment; (2) ineligible for any unemployment benefits for a fifty-two week period; and (3) assessed a civil penalty. Additionally, Wittkopf was told that he would remain ineligible for unemployment benefits until all amounts were repaid. Pursuant to Idaho Code section 72– 1368(3) the last day for Wittkopf to file a protest to the 2013 determination was July 25, 2013, which he failed to do. IDOL attempted to collect on the 2013 determination over the next year without success. Subsequently in early 2016, Wittkopf filed for Chapter 7 bankruptcy. The debt he owed to the state of Idaho was included in his bankruptcy and was discharged by order of the Bankruptcy Court. In September 2016, Wittkopf began filing new claims for unemployment benefits with IDOL because he worked a seasonal job and was not receiving any income in the winter months. After not receiving benefits for several weeks, Wittkopf called IDOL which informed him he was ineligible for unemployment benefits because he had failed to pay back his overpayment, civil penalty, and interest he owed IDOL, even though those amounts were discharged in bankruptcy. Wittkopf mailed a letter to IDOL protesting the denial of his unemployment benefits. Wittkopf claimed in this letter that he was eligible for unemployment benefits because his bankruptcy discharged any amount he owed to IDOL. An Appeals Examiner construed Wittkopf’s 2016 letter as a protest of the 2013 determination. Two days later the Appeals Examiner issued a written decision finding there was no jurisdiction to hear Wittkopf’s protest because it was not filed within fourteen days of when it was issued on July 25, 2013, as required by Idaho Code section 72-1368. On November 3, 2016, Wittkopf appealed the Appeals Examiner’s decision to the Industrial Commission. On January 27, 2017, the Industrial Commission affirmed the Appeals Examiner’s decision. The Idaho Supreme Court determined the Industrial Commission erred in affirming the examiner without having determined first whether: (1) the bankruptcy discharge voided IDOL's 2013 determination; (2) whether the discharge operated as an injunction against any effort to collect, recover or offset the 2013 debt; and if yes, (3) why the Department's denial of current benefits on the basis of the 2013 debt wasn't a violation of the injunction. The matter was remanded back to the Industrial Commission for further proceedings. View "Wittkopf v. Idaho Dept of Labor" on Justia Law

Cardew, a wheelchair-bound quadriplegic, had a summer internship with Lear Corporation thanks to his cousin, a Lear vice president. Over about three months, Cardew earned $5,502.75. Lear allowed Cardew a 30-hour work week, rather than the typical 40-hour week; exempted him from tasks typically assigned interns that involved traveling and from clerical tasks because of his difficulty with typing; and allowed more frequent breaks to adjust his position to avoid skin ulcers and use the restroom. Lear also paid $4,0000 to modify doors to be wheelchair-accessible. After the internship, Cardew applied for child disability benefits retroactive to age 15, when an accident rendered him, quadriplegic. Having applied after his eighteenth birthday, he had to prove that he has lived with a continuous disability since the accident. An ALJ denied Cardew’s application based on the income he received from Lear, reasoning that because Cardew’s earnings over three months exceeded a “bright line” threshold in the regulations, he had been “able to work at the substantial gainful activity level.” The Sixth Circuit vacated, finding the legal analysis incomplete and more rigid than the regulations require. Even assuming Cardew engaged in “gainful” activity, the ALJ failed to consider all the special conditions attendant to Cardew’s internship that could rebut the presumption, created by his income, that he had engaged in “substantial” activity. View "Cardew v. Commissioner of Social Security" on Justia Law

Lambert applied for Disability Insurance Benefits in 2012 at age 41 alleging disabling lower back pain. In 2004 discs in his lumbar spine had been surgically fused with a rod. In 2008 surgeons repaired the rod. In 2010 Lambert began experiencing back pain “most of the time” and had “intermittent” pain down his left leg that often caused him to fall. By late 2012 Lambert had tried steroid injections in his spine and pelvis, chiropractic care, medication, and physical therapy. Several neurosurgeons found the cause unclear; three said further surgery was not an option. In denying Lambert’s application, an ALJ concluded that Lambert suffers from degenerative disc disease that is severely impairing but not disabling, giving little weight to the most recent opinions of his treating neurosurgeon and discrediting Lambert’s own testimony about the severity of his pain and extent of his limitations. The Seventh Circuit reversed. The ALJ failed to explain why the treating neurosurgeon’s opinions were entitled to less weight than those of the agency physicians, rendered before some key medical evidence was compiled. The ALJ improperly relied on Lambert’s application for unemployment compensation to discount his credibility in seeking disability benefits; a claimant’s desire to work is not evidence that the claimant has embellished his limitations. View "Lambert v. Berryhill" on Justia Law

In 2007, Chavez, then 21, was diagnosed with a brain tumor and underwent five surgeries. Chavez experienced depression and anxiety. She struggled to maintain concentration to complete simple household tasks and suffered from migraine headaches, back pain (caused by degenerative disc disease), and numbness in her feet and hands. Chavez had no prior work experience. In 2010 Chavez applied for Social Security supplemental security income. Chavez could perform only simple, routine tasks with significant restrictions on how much she could lift. The vocational expert enlisted by the agency to estimate the number of jobs suitable for Chavez testified that for one particular job there were either 800 or 108,000 existing positions but preferred the larger estimate. The administrative law judge agreed and denied Chavez’s claim. The district court affirmed. The Seventh Circuit vacated. The decision was not supported by substantial evidence; the ALJ failed to ensure that the vocational expert’s job estimates were reliable. The vocational expert offered no explanation for why his estimates (or his method) were reliable, instead reaching a conclusion by determining that the estimates yielded by an alternative method seemed too low. By affording such broad deference to the vocational expert’s chosen estimates, the ALJ relieved the agency of its evidentiary burden at the final step of the analysis, impermissibly shifting the burden to Chavez. View "Chavez v. Berryhill" on Justia Law

Three disabled individuals who formerly received cash general assistance benefits from the Pennsylvania Department of Public Welfare filed a complaint alleging that the manner in which the Pennsylvania General Assembly enacted Act 80 of 2012, a piece of legislation which, inter alia, made sweeping changes to the administration of the state's human services programs, violated Article III, Sections 1, 3 and 4 of the Pennsylvania Constitution. The Pennsylvania Supreme Court determined the Act was in violation of Section 4. The provisions of H.B 1261, P.N. 1385 were entirely removed from the bill by the Senate, inasmuch as they had been enacted by another piece of legislation, Act 22 of 2011. Since the original provisions were gone when the new provisions were added by the Senate, it was factually and legally impossible for the new provisions to work together with the deleted provisions to accomplish a single purpose. The Court held the amendments "to such enfeebled legislation" were not germane as a matter of law. Consequently, the Senate amendments were not germane to the provisions of H.B. 1261, P.N. 1385, and, accordingly, the three times that H.B. 1261, P.N. 1385 was passed by the House in 2011 could not count towards the requirements of Article III, Section 4. View "Washington, et al. v. Dept. of Pub. Welfare" on Justia Law

In an issue of first impression, the Court of Appeals addressed whether Family Code section 4504(b) required derivative benefits received by the child of a disabled parent to be credited against a noncustodial obligor's child support. In this case, the Social Security Administration (SSA) took six years to approve Father's application. In 2015, it made a lump-sum payment for past-due derivative benefits to custodial parent Y.H. (Mother), as Daughter's representative payee. In the intervening six years, Father had continued to pay child support and was not in arrears. The Court of Appeals held section 4504 (b) indeed permitted retroactive child support credit from Daughter's lump-sum payment where there was no child support arrearage. View "Y.H. v. M.H." on Justia Law

Jason Lillie appeals the Employment Security Board’s denial of his claim for unemployment benefits. In July 2014, Lillie was an employee of Amerigas Propane, Inc. and suffered an injury while working. He reported the injury to his employer, which in turn reported it to its worker’s compensation insurer. He sought medical attention for his injury shortly after being hurt but was able to continue working for several weeks, most of it on modified or light duty. In October, Amerigas fired Lillie for an alleged safety violation. A few days later, Lillie’s doctor indicated he was medically unable to work. Lillie expressed concern that he was ineligible for unemployment benefits because he was not able to work but was told he must apply in order to receive economic benefits. Lillie then sought workers’ compensation temporary disability benefits, which were initially denied by the insurer. Without any income or compensation disability benefits for several weeks, Lillie sought economic assistance from the Vermont Economic Services Division of the Department for Children and Families. Lillie was told by Economic Services that in order to be eligible for economic assistance he would have to file for unemployment benefits, even if he felt he would not qualify for them. With his workers’ compensation claim still in dispute, and based upon the information he had received from Economic Services, Lillie filed a claim for unemployment benefits. The Unemployment Division found him to be monetarily eligible for unemployment benefits when he sought them in December 2014. While he had the necessary base period wages to make him monetarily eligible for benefits, Lillie was not able to work and available for work, as required by 21 V.S.A. 1343(a)(3), because he was medically unable to work. He was, therefore, denied unemployment compensation. "At a minimum, coordination of the important information between the Unemployment Division and Economic Services concerning monetary eligibility, the establishment of a benefit year, and the use of wages and the use of wages prior to disability in connection therewith in the case of a worker injured on the job may have avoided this quagmire. Following the advice given by Economic Services, which we do not doubt was provided in good faith to Lillie, resulted in the unintended consequence of his loss of unemployment benefits once he regained his ability to work in 2017." The Vermont Supreme Court affirmed the denial of unemployment benefits; the Unemployment Division applied the law properly, and the Court was "not at liberty to rewrite the applicable statutes to obtain a different outcome." View "Lillie v. Department of Labor" on Justia Law