Justia Public Benefits Opinion Summaries

A per diem judge had been credited with retirement service by the Employee Retirement System (ERS) for years under a 1990 memorandum that set eligibility criteria. In 2017, the ERS discovered that the Judiciary had not updated personnel forms as the memorandum appeared to require. Without notice or a hearing, ERS issued a new memorandum rescinding the 1990 policy and retroactively stripped the judge’s retirement credits for service after October 1, 2017. The ERS did not follow rulemaking procedures required by Hawaii’s Administrative Procedure Act.The judge administratively challenged the ERS decision. A hearing officer partially sided with her, but the Board of Trustees of the ERS overruled that recommendation and dismissed all claims. The judge appealed to the Circuit Court of the First Circuit, which reversed the ERS Board, finding that both the 1990 and 2017 memoranda were rules under HRS § 91-1 and invalid because they had not been properly promulgated. On appeal, the Intermediate Court of Appeals (ICA) reversed, agreeing that the memoranda were improperly issued but holding that the circuit court’s reasoning did not support the relief granted.The Supreme Court of the State of Hawai‘i reviewed the case. It held that both the 1990 and 2017 memoranda were rules affecting private rights, not mere internal management or intra-agency communications, and thus subject to statutory rulemaking procedures. The 2017 memorandum and its implementing letter were void as to the judge because they were not lawfully adopted and she had timely challenged them. However, because no timely challenge was made to the 1990 memorandum, it remained valid and controlled her eligibility. The Supreme Court vacated the ICA’s decision, reinstated the circuit court’s judgment, and ordered the ERS to credit the judge for eligible service. View "Martel v. Employee Retirement System" on Justia Law

A skilled nursing facility accepted a new resident who was receiving Medicaid benefits. The resident's husband was designated as her authorized representative. Nearly two years later, the Department of Human Services (DHS) terminated the resident's Medicaid benefits due to excess assets. Both the resident and her husband were incapacitated, and the resident's public guardian submitted a new Medicaid application, which was denied. The nursing facility continued to care for the resident without compensation until her death. The facility later sought an administrative hearing to challenge the eligibility decision, but the request was denied because the facility was not an authorized representative and the appeal was late.The circuit court and the Intermediate Court of Appeals (ICA) affirmed the denial, holding that the nursing home lacked standing to challenge the eligibility determination under Hawai'i Revised Statutes (HRS) § 346-12, which limits appeals to the applicant or recipient. The courts concluded that the nursing home did not have a close relationship with the resident for third-party standing purposes.The Supreme Court of the State of Hawai'i reviewed the case and disagreed with the lower courts regarding standing. The court held that skilled nursing facilities have constitutionally protected property interests in compensation for medical services performed for residents based on DHS eligibility determinations. The court ruled that these facilities have due process rights under the Hawai'i Constitution, including notice and the opportunity to appeal Medicaid eligibility determinations when the beneficiary is incapacitated and no authorized representative is available or willing to appeal. The court vacated the ICA's judgment and the circuit court's order, remanding the case for a new administrative hearing on the merits of the resident's Medicaid eligibility. View "In re FT" on Justia Law

In this case arising out of the Department of Human Services' attempt to recover payments made to Dr. Frederick Nitta from its Medicaid Primary Care Physician Program the Supreme Court vacated the judgment of the intermediate court of appeals (ICA) to the extent it remanded the case and otherwise affirmed, holding that DHS's claims largely lacked merit.The Program at issue was established by 42 U.S.C. 1396a(a)(13)(C) of the Affordable Care Act (ACA) and enabled certain physicians to temporarily receive increased payments for primary care services provided in 2013 and 2014 to Medicaid patients. In this case, DHS demanded repayment of more than $200,000 in enhanced payments received by Nitta through the program after it determined that Nitta was ineligible for participation in the Program because he did not meet specialty requirements as set forth in a federal administrative rule. While Nitta's appeal was pending, the Court of Appeals for the Sixth Circuit invalidated the rule and remanded the case. The ICA adopted the Sixth's Circuit's analysis. The Supreme Court largely affirmed, (1) the rule is invalid because it contravenes the statute; and (2) Nitta was entitled to enhanced payments under the statute. View "Nitta v. Department of Human Services" on Justia Law