Justia Public Benefits Opinion Summaries

Petitioner filed to receive food stamp benefits under the Supplemental Nutrition Assistance Program as a separated spouse in a one-person household. The Department of Health and Human Resources (DHHR) determined that Petitioner and her husband (Husband) were living together for seventeen months after Petitioner filed to receive food stamps and sent Petitioner a notice of overpayment. Petitioner requested a hearing, and a hearing examiner affirmed the DHHR's overpayment claim. The circuit court affirmed, finding that Petitioner had not submitted sufficient evidence to support her claim that she and Husband had separate residences. The Supreme Court reversed the judgment of the circuit court and remanded for entry of an order granting Petitioner's petition for a writ of certiorari and dismissing the DHHR's overpayment claim, holding that the DHHR failed to prove that Petitioner and Husband lived together during the seventeen month time period of the overpayment claim, and the claim should have been dismissed at the conclusion of DHHR's evidence.View "Hudson v. Bowling" on Justia Law

The Office of the Medicaid Inspector General (OMIG) terminated a physician's participation in the Medicaid program on the basis of a Bureau of Professional Medical Conduct (BPMC) consent order, in which the physician pleaded no contest to charges of professional misconduct and agreed to probation. Supreme Court annulled the OMIG's determination. The Appellate Division affirmed, concluding (1) the agency acted arbitrarily and capriciously in barring the physician from treating Medicaid patients when the BPMC permitted him to continue to practice; and (2) the OMIG was required to conduct an independent investigation before excluding a physician from Medicaid on the basis of a BPMC consent order. The Court of Appeals affirmed but for another reason, holding (1) the OMIG is authorized to remove a physician from Medicaid in reliance solely on a consent order between the physician and the BMPC, regardless of whether BPMC chooses to suspend the physician's license or OMIG conducts an independent investigation; but (2) because OMIG did not explain why the BPMC consent order caused it to exclude the physician from the Medicaid program, the agency's determination was arbitrary and capricious.View "Koch v. Sheehan" on Justia Law

When an insurance company authorized to transact business in Illinois becomes insolvent and unable to pay claims, the Illinois Insurance Guaranty Fund pays those claims after an order is entered liquidating the company, 215 ILCS 5/532. A cap on individual claims is inapplicable to workers compensation claims under the Workers’ Compensation Act, 820 ILCS 305/1. The plaintiff is the successor to Wells, a manufacturer. A Wells employee was seriously injured on the job in 1985, and, in 1993, the Industrial Commission ordered weekly lifetime benefits for total, permanent disability. Wells began to make the payments directly to the employee. Wells was self-insured, but had excess insurance from Home Insurance. After Wells’ payments to the injured employee reached $200,000, Home paid benefits until Home became insolvent in 2003 and was liquidated. The Illinois Insurance Guaranty Fund took over Home’s obligations, but stopped paying the employee in 2005, arguing that payments to an excess, rather than a primary, insurer were not payments of “workers’ compensation claims” exempted from the cap. Wells continued paying the employee and sought a declaration that the Fund’s payments should continue. The circuit court agreed with Wells, awarding summary judgment, and the appellate court affirmed. The Illinois Supreme Court affirmed, rejecting the distinctions made by the Fund between excess and primary coverage and between payments made directly or indirectly to employees. View "Skokie Castings, Inc. v. IL Ins. Guar. Fund" on Justia Law

Ryan W. entered the care of the Department of Social Services at age nine as a child in need of services (CINA) and was placed in foster care. After Ryan's parents died, the Department was appointed by the Social Security Administration (SSA) as Ryan's representative payee for Old Age and Survivor's Disability Insurance (OASDI) benefits to which Ryan was entitled. The Department received Ryan's benefit payments and applied them to partially reimburse itself for the current cost of Ryan's foster care. The circuit court determined that the Department violated Ryan's due process and equal protection rights by failing to notify him before applying his OASDI benefits toward the current costs incurred by the Department on his behalf. The court of special appeals reversed. The Court of Appeals affirmed in part and reversed in part, holding (1) a local department of social services, acting in the capacity as an institutional representative payee appointed by the SSA, has discretion to apply a CINA foster child's OASDI benefits to reimburse the Department for its costs incurred for the child's current maintenance; but (2) the department must provide notice to the child that the department applied to the SSA and received such benefits on the child's behalf. View "In re Ryan W." on Justia Law

Appellants, PremierTox, Inc. and PremierTox 2.0 (collectively, PremierTox) filed an action against Kentucky Spirit Health Plan, Inc. and others (collectively, Appellees), alleging that it was owed $1.8 million by Kentucky Spirit for services it had provided to Medicaid patients and for which Kentucky Spirit had allegedly been paid by the Commonwealth. The circuit court ordered Appellees to deposit $1.8 million into an escrow account controlled by the circuit court pending adjudication of the claim. The court of appeals issued a writ to prohibit enforcement of the circuit court's order, concluding that the circuit court lacked the authority to require Appellees to pay the demanded judgment into court in advance of an adjudication that Appellees owed the money. The Supreme Court affirmed the decision of the court of appeals to issue the writ of prohibition, holding (1) the circuit court acted erroneously in ordering Appellees to escrow the disputed funds under Ky. R. Civ. P. 67.02; (2) the circuit court's order was essentially a pre-judgment attachment for which Appellees lacked an adequate remedy on appeal or otherwise; and (3) Appellees satisfied the "irreparable injury" prong of the proper writ analysis. View "PremierTox 2.0 v. Circuit Court" on Justia Law

Mother and Appellant/Cross-Appellee Lisa Kinney Lindstrom sought a ruling as to the number of "occurrences" for which the MCARE Fund is liable based on allegations that her physician failed to diagnose discrete in utero infections suffered by her twins, which caused severe injuries to both children. The Commonwealth Court granted summary judgment in favor of the MCARE Fund, holding that the physician's failure to diagnose Mother's infection constituted the single cause of the children's injuries, and, therefore, there was a single occurrence, limiting MCARE coverage to the statutory limit of one payment of $1 million. Upon review, the Supreme Court reversed, holding that the Commonwealth Court erred by granting summary judgment because there was a genuine issue of material fact as to whether the children's injuries arose from the physician's failure to diagnose a single infection, or whether the children's injuries resulted from the physician's failure to diagnose multiple infections from different organisms that infected each child in utero at different times. View "Kinney-Lindstrom v. MCARE Fund" on Justia Law

The Department of Health and Welfare appealed an order that disallowed its attempt to recover assets in a probate proceeding. The Department sought to recover assets of a dead Medicaid recipient for medical assistance payments made on the decedent's behalf from her widower. The magistrate court held that the Department could not reach the separate property of the decedent's spouse. Upon review, the Supreme Court concluded the Department was permitted to seek recovery from the decedent's community property that was transmuted to her widow as his separate property. View "In re Estate of Wiggins" on Justia Law

The employee alleged that, while at work in 2004, he was involved in an accident that resulted in a condition for which he sought compensation. A Workers’ Compensation Commission arbitrator denied benefits, citing lack of causation, and, in 2009, the Commission adopted the decision. The trial court confirmed the denial. The appellate court vacated, finding that the lower court lacked subject matter jurisdiction. The employee had calculated the 20-day time period for filing, Workers’ Compensation Act, section 19(f)(1), using the date on which required documents were mailed to the court, rather than the date on which the documents were received and file-stamped. The Illinois Supreme Court reversed and remanded, finding that the so-called “mailbox rule,” which has applied to notices of appeal from the trial to the appellate court and to petitions for the Workers’ Compensation Commission’s review of arbitrators’ decisions, also applies to commencement of an action for judicial review of a Commission decision, which is an exercise of special statutory jurisdiction. Notice to the other party and the statute of limitations were not factors in this case and, absent a clear directive from the legislature, allowing the mailbox rule in such a case is most consistent with Illinois law.View "Gruszeczka v. IL Workers' Comp. Comm'n" on Justia Law

Petitioner Ounjaniese Brown appealed a district court judgment that denied her request for review of Burleigh County Housing Authority's ("BCHA") decision to terminate her housing assistance benefits. Brown was a recipient of benefits under a federal housing assistance program. In 2012, BCHA terminated Brown's housing assistance benefits. Brown filed a notice of appeal and specification of error in district court, stating she was appealing BCHA's decision to terminate her housing assistance. Brown alleged BCHA's decision violated her constitutional rights, she did not receive a fair hearing, and BCHA failed to consider evidence she presented. BCHA filed a motion to dismiss, arguing it was not an agency for purposes of the Administrative Agencies Practices Act ("AAPA") and therefore the district court did not have jurisdiction to hear the appeal. Upon review, the Supreme Court concluded the district court lacked jurisdiction over the matter, and vacated the judgment and orders. View "Brown v. Burleigh County Housing Authority" on Justia Law

After Defendants were charged with Medicaid fraud, the Commonwealth obtained search warrants to obtain and search designated e-mail accounts of Defendants' former billing director. Defendants moved for a protective order, claiming that the attorney-client privilege protected many of the e-mails. A motion judge amended the order to permit the Commonwealth to search the e-mails by using a "taint team," assistant attorneys general not involved in the investigation or prosecution of Defendants. Defendants filed a petition seeking relief from the order. The Supreme Court answered reported questions from the county court by holding (1) the Commonwealth may, by means of an ex parte search warrant, search the post-indictment emails of a criminal defendant; and (2) the "taint team" procedure was permissible under the Massachusetts Constitution. View "Preventive Med. Assocs. v. Commonwealth" on Justia Law