Justia Public Benefits Opinion Summaries

Plaintiff, on behalf of herself and her son, K.T., filed suit under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq., against the DOE. At issue is the adequacy of three individualized education programs (IEP), which were characterized by a pattern of procedural violations of the IDEA committed by the DOE, and whether these errors deprived K.T. of a free appropriate public education (FAPE) for a period of three consecutive years. The court concluded that the procedural violations in formulating each IEP, when taken together, deprived K.T. of a FAPE for each school year. The DOE displayed a pattern of indifference to the procedural requirements of the IDEA and carelessness in formulating K.T.’s IEPs over the period of many years, repeatedly violating its obligations under the statute, which consequently resulted in the deprivation of important educational benefits to which K.T. was entitled by law. Accordingly, the court reversed the judgment of the district court and remanded for further proceedings. On remand, the district court is directed to consider, in the first instance, what, if any, relief plaintiff is entitled to as an award for K.T.'s FAPE deprivations. View "L.O. ex rel. K.T. v. N.Y.C. Dep’t of Educ." on Justia Law

Plaintiff filed a class action against the Commissioner, challenging New York’s coverage restrictions on certain medical services provided under its Medicaid plan. Plaintiffs argued that New York’s 2011 plan amendments, which restrict coverage of orthopedic footwear and compression stockings to patients with certain enumerated medical conditions, violate the Medicaid Act’s, 42 U.S.C. 1396 et seq., reasonable standards, home health services, due process, and comparability provisions, as well as the anti‐discrimination provision and integration mandate of Title II of the Americans with Disabilities Act (ADA), 42 U.S.C. 12131 et seq., and section 504 of the Rehabilitation Act, 29 U.S.C. 794. Because neither the Medicaid Act nor the Supremacy Clause confers a private cause of action to enforce the reasonable standards provision, the court vacated the district court’s grant of summary judgment to plaintiffs on that claim; the court declined to reach plaintiffs’ unequal treatment claim under the ADA and Rehabilitation Act as largely duplicative of their integration mandate claim; and the court affirmed the summary judgment rulings with respect to the remaining claims. Defendant is entitled to summary judgment on plaintiffs' home health services plan because orthopedic footwear and compression stockings constitute optional “prosthetics” rather than mandatory “home health services” under the Medicaid Act; defendant is entitled to summary judgment on the hearing element and plaintiffs are entitled to summary judgment on the notice element of plaintiffs’ due process claim, because the due process provision required New York to provide plaintiffs with written notice – though not evidentiary hearings – prior to terminating their benefits; plaintiffs are entitled to summary judgment on their comparability provision claim because New York’s coverage restrictions deny some categorically needy individuals access to the same scope of medically necessary services made available to others; and plaintiffs are entitled to summary judgment on their anti‐discrimination claims because New York’s restrictions violate the integration mandate of the ADA and Rehabilitation Act. Finally, the court vacated the injunction and remanded for further consideration on the appropriate relief because the injunction is broader than is warranted by the court's liability conclusions. View "Davis v. Shah" on Justia Law

Binder, a law firm representing claimants before the SSA, appealed from summary judgment in two related cases where Binder seeks past attorney's fees. When Binder sought to hold the SSA liable for the fees, the district courts granted summary judgment to the SSA on the basis of sovereign immunity. The court affirmed the judgments and held that, regardless of the SSA’s statutory duties to withhold attorney’s fees from payments to successful claimants, there is no waiver of sovereign immunity in 42 U.S.C. 406(a) that would permit Binder’s lawsuits for money damages. View "Binder & Binder v. Colvin" on Justia Law

The Department appealed a judgment awarding plaintiffs reimbursement under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq., for one year of private school education for their daughter, L.K. The court concluded that the Department’s refusal to discuss the bullying of L.K. with her parents during the process of developing L.K.’s individualized education program (IEP), violated the IDEA. The court also concluded that plaintiffs have met their burden to show that their choice of a private placement for L.K. was appropriate and that the equities favored reimbursing them. Accordingly, the court affirmed the judgment. View "T.K. v. N.Y.C. Dept. of Educ." on Justia Law

Plaintiff appealed the denial of social security disability benefits, alleging that the Appeals Council erred by failing to provide an explanation for why it disregarded the treating physician’s opinion and that the ALJ’s decision is not supported by substantial evidence in light of a treating physician’s opinion. The court agreed and held that, based on the record, including the physician's opinion, the ALJ's determination is not supported by substantial evidence in the record. Accordingly, the court vacated the judgment and remanded for further proceedings. View "Lesterhuis v. Colvin" on Justia Law