Justia Public Benefits Opinion Summaries

This issue this case presented for the Supreme Court's review centered on whether the collateral source rule should apply when Medicaid pays for an injured party’s medical expenses. The Delaware Supreme Court held that, when Medicaid has paid an injured party’s medical expenses, the collateral source rule cannot be used to increase an injured party’s recovery of past medical expenses beyond those actually paid by Medicaid. "As with Medicare, the difference is unnecessary to make the injured party whole because it is paid by no one." Appellant Jennifer Smith, was injured in two car collisions. Although employed when her injuries occurred, Smith qualified for Medicaid coverage. At first, her treating physician sought to recover his standard charges of $22,911 from the proceeds of any personal injury settlement. But later, the treating physician opted to forego his original billed amount, and instead billed Medicaid for his charges. Medicaid paid the treating physician $5,197.71, and asserted a lien in that amount on the proceeds of any recovery by settlement or lawsuit. When all was netted out, the Superior Court entered judgment against the defendants jointly and severally for $49,911. Relying on the applicable case law, the trial court determined that “Delaware case law is clear that the collateral source rule does not apply to Medicaid or Medicare write-offs.” In its decision here, the Delaware Supreme Court refused to extend operation of the collateral source rule and affirmed the superior court's judgment. Also affirmed was the Superior Court’s ruling that future medical expenses were not subject to Medicaid reimbursement limitations. "Unlike Medicare, Medicaid coverage is income dependent, and might not be available if a plaintiff improves her financial position to a living wage and secures other insurance. Because of the uncertainty of future coverage, Medicaid benefits cannot be used to limit a plaintiff’s future medical expenses." View "Smith v. Mahoney" on Justia Law

Jessica Barr appealed an Idaho Industrial Commission (Commission) decision finding her ineligible for unemployment benefits and affirming the decision of an Appeals Examiner for the Idaho Department of Labor’s (IDOL) Appeals Bureau. The Commission found that Barr was discharged by her employer, Citicorp Credit Services, Inc. USA (Citicorp), for misconduct in connection with employment and determined that Barr was not eligible for benefits pursuant to Idaho Code section 72-1366(5). Barr argued that Citicorp representatives provided false information to the Appeals Examiner and her unemployment benefits should have been restored. Finding that the Commission's decision was supported by substantial and competent evidence, the Supreme Court affirmed the IDOL Appeals Examiner's decision. View "Barr v. CitiCorp Credit Svc" on Justia Law

The consolidated appeals in this case involved a dispute between the Secretary of Health and Human Services and a group of Maine hospitals about certain payments - called disproportionate share payments (DSH payments) - the hospitals had received in reimbursement from the federal government for charity care for fiscal years dating as far back as 1993. Generally speaking, the more low-income patients a hospital services, the higher the hospital’s DSH payment. In this case, the Secretary maintained that the Hospitals were overinclusive in their DSH payment calculations. An intermediary reassessed the DSH payments and recouped from the Hospitals approximately $22 million in alleged overpayments. The Provider Reimbursement Review Board, in turn, ordered the intermediary to restore approximately $17 million to the Hospitals. The Secretary reversed. The Hospitals sought judicial review, but neither side was satisfied with the district court’s ruling. On appeal, the First Circuit reversed in part and affirmed in part, holding (1) the Secretary properly reopened the disputed years and adequately demonstrated that the Hospitals had received substantial overpayments of DSH funds; and (2) the Hospitals’ defenses to repayment were unavailing. View "Maine Medical Center v. Burwell" on Justia Law

In the underlying litigation to this appeal, claimants were petitioners or represented petitioners who challenged legislation passed in 2013 that changed the pension benefits paid to certain members of the Public Employee Retirement System (PERS) by limiting the statutory cost-of-living adjustment (COLA) and eliminating a PERS income-tax offset for out-of-state retirees. In "Moro v. Oregon," (351 P.3d 1 (2015) (Moro I)), the Oregon Supreme Court largely agreed with petitioners’ argument that modifications to the COLA formula impaired petitioners’ contractual rights, thus violating Article I, section 21, of the Oregon Constitution. But the Court rejected petitioners’ similar challenge to the elimination of the income-tax offset. Petitioners, who were active and retired members of PERS, were the prevailing parties. Following the decision in Moro I, claimants petitioned for attorney fees and costs. State respondents and county/school district respondents filed objections. The Supreme Court referred those petitions to a special master for recommended findings of fact and conclusions of law. The special master reported his recommendations, and the parties subsequently filed objections and responses to those recommendations. The issues raised in those filings included which legal doctrines justified an award of attorney fees in this case; whether self-represented attorneys were eligible to receive an award of attorney fees; whether the fees sought by claimants were reasonable; and how to pay for an award of fees and costs. After review, the Oregon Supreme Court concluded that fees should be awarded based on the common-fund and substantial-benefit doctrines; that the self-represented attorneys were eligible to receive a fee award under those doctrines; that a reasonable fee award under the lodestar approach had to be based on reasonable hourly rates and reflect reductions to account for duplicative work and work on unsuccessful claims; and that an award in this case should be paid for as determined by the Public Employees Retirement Board (PERB) in a manner that was consistent with its statutory authority and fiduciary obligations. View "Moro v. Oregon" on Justia Law

The question underlying these proceedings was whether the State must consider and pay claims submitted after the effective date of the legislative deadline for pre-2006 reimbursement claims set forth in Section 61 of the 2012 amendment to the Medicaid Cap Statute, which provides that no reimbursement claims shall be made for a category of Medicaid disability expenses paid by counties to the State prior to 2006. In these appeals, the latest round in a decade-long struggle between the counties and the State over Medicaid payments, several counties challenged the constitutionality of Section 61. The Court of Appeals held (1) Section 61 is constitutional; and (2) the State is under no obligation to address outstanding county reimbursement claims filed after April 1, 2012, and the State is not required to initiate an administrative review of its records to identify and pay for any pre-2006 claims. View "County of Chemung v. Shah" on Justia Law

In 2001, Israel injured his back while digging posts for a porch. He worked while receiving treatments but his pain worsened; he stopped working in February 2003. He underwent a lumbar laminectomy and diskectomy, which did not resolve his pain Two surgeons determined that further surgery was not an option. Under the care of various doctors, Israel tried physical therapy, transcutaneous electrical nerve stimulation (TENS), a dorsal column stimulator, epidural injections, narcotic pain medications including Methadone and morphine, lidocaine patches, a muscle relaxer, an anti‐depressant, and drugs for nerve pain. Diagnosed with lumbar radiculopathy and post‐laminectomy pain syndrome, Israel continues to experience severely limiting pain. His doctor sought approval to implement an “intrathecal drug delivery system,” a pain pump that delivers medication directly to the spinal cord. Israel’s insurer refused to cover the cost. Israel sought Disability Insurance Benefits and Supplemental Security Income benefits in 2007. On remand, the Social Security Administration repeatedly denied benefits.The Commissioner conceded in the district court that her decision was not supported by substantial evidence and requested remand. Israel, frustrated with years of delay, sought a direct award of benefits. The district court remanded. The Seventh Circuit affirmed, finding that the district court did not abuse its discretion in ordering a remand; the agency should expedite proceedings so that the matter may be resolved. View "Israel v. Colvin" on Justia Law

W.C. was born in Guatemala in 1997. He lived with his grandparents because his mother was dead and his father missing. W.C. left Guatemala because of threats to his safety and came to the U.S. alone, in 2014. At the border, W.C. was taken into protective custody and placed with a distant relative in Oakland. The relative agreed to sponsor W.C. for asylum, but their relationship deteriorated. W.C. became homeless in October 2014. He started using drugs. Taken to a hospital for assessment after cutting himself at school, he was denied treatment because he lacked insurance. W.C. lived at a youth shelter for a while, then told social services he was living with a friend. Eventually, W.C. was suspended from school because he was under the influence of drugs, possessed a knife, and engaged in theft. W.C. requested protective custody. The court ordered him detained, with temporary placement and care provided by the agency. On May 1, 2015, W.C. turned 18. At a May 26 hearing, the agency recommended the dependency be dismissed because the juvenile court had made no legal determination on dependency. On July 7, the juvenile court dismissed the Welfare and Institutions Code section 300 petition. In February 2016, W.C. filed a Request to Return to Juvenile Court Jurisdiction and Foster Care, hoping to participate in job training. The court denied the request. The court of appeal affirmed, holding that a nonminor who was never found a dependent of the court could not reenter and be subject to juvenile court jurisdiction. View "In re W.C." on Justia Law

Plaintiff challenged the denial of his application for disability insurance benefits. Plaintiff claims that he is disabled as a result of osteoarthritis and degenerative joint disease of the hips, degenerative disc disease of the lumbar and cervical spines, sensory and motor neuropathies, chronic shoulder pain and osteoarthritis, and carpal tunnel syndrome. The court concluded that the ALJ did not err in failing to find that plaintiff's impairments met or equaled the criteria of Listing 1.02A; substantial evidence in the record as a whole supports the ALJ’s finding that plaintiff had the residual functional capacity to perform his past relevant work as a receptionist and thus was not disabled; and the denial of disability insurance benefits is supported by substantial evidence on the record as a whole. Accordingly, the court affirmed the judgment. View "Igo v. Colvin" on Justia Law

The focus of this appeal centered on the validity of HB 2630; 2014 Okla. Sess. Laws c. 375 (effective November 1, 2014). HB 2630 created the Retirement Freedom Act (74 O.S. Supp. 2014, sec. 935.1 et seq.), with the stated purpose as creating a new defined contribution system within the Oklahoma Public Employees Retirement System (OPERS) for persons who initially became a member of OPERS on or after November 1, 2015 (this included most state employees hired on or after this date). Plaintiffs-appellants filed a Petition for Declaratory and Supplemental Relief challenging the validity of HB 2630, claiming HB 2630 was void because it was passed by the Legislature in violation of the Oklahoma Pension Legislation Actuarial Analysis Act (OPLAA). Both parties filed a motion for summary judgment. The trial court granted defendants-appellees' motion for summary judgment and the appellants appealed. Agreeing with the trial court that the OPLAA had not been violated, the Supreme Court affirmed the grant of summary judgment in defendants' favor. View "Stevens v. Fox" on Justia Law

Plaintiff appealed the denial of Social Security disability insurance benefits. The ALJ concluded that she suffered from severe but not listed impairments – mood disorder, anxiety disorder, residuals of brain tumor with surgical resection, degenerative disc disease of the thoracic and cervical spine, and scoliosis – but that plaintiff was not disabled because, while she could not perform her past relevant work, she retained the residual functional capacity (RFC) to perform a limited range of light work. In this case, the ALJ expressly incorporated into the RFC work-related limitations suggested by medical source opinions regarding plaintiff's slow pace; the cumulative evidence submitted did not undermine the ALJ's RFC determination; and the ALJ properly weighed and considered the extensive medical evidence in the record in making the RFC determination. Therefore, the court concluded that substantial evidence on the record as a whole supports the ALJ’s decision and the court affirmed the judgment. View "Harvey v. Colvin" on Justia Law