Justia Public Benefits Opinion Summaries

Articles Posted in US Court of Appeals for the Fifth Circuit
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This dispute is about whether Texas must provide around-the-clock nursing services to a disabled individuals even though the expense of doing so exceeds the cost cap in the state’s Medicaid program. Plaintiff contends that the Americans with Disabilities Act and Rehabilitation Act require this service because the alternative of institutionalization would amount to discrimination. The district court issued a preliminary injunction requiring Texas to provide the nursing services.   The Fifth Circuit vacated the injunction. The court explained that with the scorecard lopsided in favor of exercising jurisdiction, it is unlikely the district court abused its discretion in declining to abstain. Further, although Plaintiff has shown that the district court should hear her claims, we conclude she is unlikely to succeed on one of them: her due process claim. The court found that because it is unlikely that Plaintiff has a property interest in the treatment she is seeking, a preliminary injunction was not warranted on her due process claim. Finally, on the current record, Plaintiff has not shown that she can prevail on an Olmstead claim seeking services that exceed the cost cap in Texas’s Medicaid waiver program. View "Harrison v. Young" on Justia Law

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D&G, a Medicare service provider for nursing homes and homebound individuals, filed suit against the H.H.S. Secretary in federal court seeking repayment of recouped funds, which then amounted to $4,136,258.19 in principal and $593,294.54 in accrued interest. The district court dismissed D&G's case for lack of subject matter jurisdiction, holding that there was no federal court jurisdiction pursuant to 42 U.S.C. 405(g), as applied to Medicare appeals by 42 U.S.C. 1395ff(b)(1)(A).The Fifth Circuit held that "effectuations" of final agency decisions when sought to liquidate the amount of repayment owed, are reviewable under 42 U.S.C. 405(g) as continuous aspects of the initial, properly exhausted, administrative decision. The court concluded that the district court had jurisdiction under section 405(g) to resolve this dispute because "effectuations" are inextricably intertwined with the initial exhausted agency action. Therefore, the district court committed reversible error when it granted the Secretary' motion to dismiss. Furthermore, the Secretary's attempted reopening of the "effectuation" was untimely and the purported reopening was void ab initio. The court reversed and remanded for further proceedings. View "D&G Holdings, LLC v. Becerra" on Justia Law

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The Fifth Circuit affirmed the denial of social security disability benefits to plaintiff, concluding that the ALJ's residual function capacity (RFC) determination was supported by substantial evidence. The court also concluded that a consultive exam was not required where the ALJ's decision was based upon substantial evidence in a sufficiently developed record. Finally, the court concluded that plaintiff's remaining arguments were waived because he failed to raise them in the district court. View "Webster v. Kijakazi" on Justia Law

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Plaintiff and her now-adult son K.S., a former high school student with a specific learning disability, filed suit under the Individuals with Disabilities in Education Act (IDEA), alleging that the school district neither provided K.S. with a free appropriate public education (FAPE) nor complied with procedural safeguards meant to ensure such.The Fifth Circuit affirmed the district court's decision affirming two administrative decisions concluding that the school district did not violate the IDEA's substantive and procedural requirements. The court reviewed the voluminous record and the magistrate judge's thorough report that the district court adopted, discerning no reversible error in the district court's holding that: (1) the school district did not violate its obligation to identify and evaluate K.S. as a student with a suspected disability; (2) the individualized education programs and transition plan created for K.S. complied with IDEA's substantive requirements; and (3) the school district's procedural foot-faults in failing to include K.S. for the first manifestation determination review and failing to consider certain relevant information were not actionable. View "H v. Riesel Independent School District" on Justia Law

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Family Rehab brought a procedural due process claim arguing that it is entitled to third step review before recoupment of Medicare overpayments. The district court granted summary judgment in favor of Family Rehab, and entered a permanent injunction barring HHS from recouping the disputed funds until the completion of third step review under 42 C.F.R. 405.1036(c)–(d).However, in reaching its decision, the district court did not have the benefit of the Fifth Circuit's decision in Sahara Health Care Inc. v. Azar, 975 F.3d 523 (5th Cir. 2020), in which the court rejected a similar due process claim under nearly identical facts. In this case, Family Rehab's claims all involve documentation issues that do not require cross-examination and credibility determinations. The court explained that Family Rehab's claims could have been resolved in the first two steps of administrative review by producing the relevant documents. Accordingly, the court reversed the district court's judgment. View "Family Rehabilitation, Inc. v. Becerra" on Justia Law

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Plaintiffs, tenants living in substandard conditions in a "Section 8" housing project, filed suit seeking to compel HUD to provide relocation assistance vouchers. The Fifth Circuit held that, because 24 C.F.R. 886.323(e) mandates that HUD provide relocation assistance, its alleged decision not to provide relocation vouchers to plaintiffs is not a decision committed to agency discretion by law and is therefore reviewable. Furthermore, the agency's inaction here constitutes a final agency action because it prevents or unreasonably delays the tenants from receiving the relief to which they are entitled by law. Therefore, the district court has jurisdiction over plaintiffs' Administrative Procedure Act (APA) and Fair Housing Act (FHA) claims and erred in dismissing those claims.However, the court agreed with the district court that plaintiffs failed to state a claim for which relief can be granted on their Fifth Amendment equal protection claim. In this case, plaintiffs failed to state a plausible claim of intentional race discrimination. Accordingly, the court reversed in part, affirmed in part, and remanded for further proceedings. View "Hawkins v. United States Department of Housing and Urban Development" on Justia Law

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The Fifth Circuit affirmed the district court's decision upholding the Commissioner's denial of supplemental security income and disability insurance benefits to plaintiff. The court explained that, although the ALJ did not mention the Stone standard, it did cite Social Security Ruling (SSR) 85-28, 1985 WL 56856 (Jan. 1, 1985), a policy statement issued to clarify the agency’s process for determining non-severe impairments. The court held that SSR 85-28 comports with the Stone standard. The court also held that, even if the ALJ failed to properly apply the Stone standard, the error is harmless. In this case, plaintiff does not meaningfully address how the ALJ's application of SSR 85-28 (instead of citing Stone) produced a different outcome in her case. View "Keel v. Saul" on Justia Law

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The Fifth Circuit affirmed the district court's denial of a parent's motion for summary judgment against the school district for alleged procedural and substantive violations of the Individuals with Disabilities Education Act (IDEA). The court held that the district court did not err in finding that the parent failed to meet her burden of showing that the school district violated the procedural requirements of the IDEA. In this case, none of the incidents the parent claimed amounted to a procedural violation and the court was not convinced that the student was denied a free and appropriate public education.The court also held that there were no substantive IDEA violations. The court was satisfied that the school district took the necessary steps to ensure that the student was being properly serviced under this individualized education plan, despite his absences. Accordingly, the court affirmed the district court's grant of the school district's motion for summary judgment. View "A. A. v. Northside Independent School District" on Justia Law

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Plaintiff filed suit alleging that the school district violated the Individuals with Disabilities Education Act (IDEA) by failing to develop and implement an Individual Education Plan (IEP) that was reasonably calculated to provide him with educational benefits appropriate to his circumstances.Assuming arguendo that plaintiff was able to challenge all of the IEPs that the school district designed and implemented, the Fifth Circuit ultimately held that there was no IDEA violation. The court held that the district court properly considered the four factor test articulated in Cypress-Fairbanks lndep. Sch. Dist. v. Michael ex rel. Barry F., 118 F.3d 245, 247 (5th Cir. 1997), and concluded that all factors weighed in favor of the school district. In this case, the school district expended a great amount of time and resources developing and implementing an IEP that was based on multiple in-depth evaluations of plaintiff's unique needs and abilities with significant input from plaintiff's parents and expert consultants, and plaintiff achieved at least some academic and nonacademic benefits as a result of his plan. Accordingly, the court affirmed the district court's grant of summary judgment against plaintiff on his IDEA claim and dismissal of his remaining claims. View "R. S. v. Highland Park Independent School District" on Justia Law

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The Fifth Circuit reversed the denial of social security disability benefits to plaintiff. The court held that the denial of benefits was not supported by substantial evidence, because the ALJ failed to apply the SSA's rules regarding borderline-age situations and did not provide any explanation for putting her in a lower age category. Accordingly, the court remanded for further proceedings. View "Schofield v. Saul" on Justia Law