Justia Public Benefits Opinion Summaries

Petitioners, a group of hospitals that serve a significant number of elderly, very low-income patients, filed suit challenging the Secretary's issuance of a rule concerning the "disproportionate share percentage" calculation of supplemental payments for low-income Medicare patients. When the Secretary published reimbursement calculations for FY 2007, petitioners learned that their payments would decrease by tens of millions of dollars per year. The rule change had an enormous financial consequence on hospitals. The court held that the Secretary did not provide adequate notice and opportunity to comment before promulgating its 2004 rule, and so affirmed the portion of the district court's opinion vacating the rule. The court reversed only the portion of the district court's opinion directing the Secretary to recalculate the hospitals' reimbursements using the alternate methodology. View "Allina Health Services, et al. v. Sebelius" on Justia Law

In enacting comprehensive welfare reform in 1996, Congress rendered various groups of aliens ineligible for federal benefits and also restricted states' ability to use their own funds to provide benefits to certain aliens. As a condition of receiving federal funds, Congress required states to limit eligibility for federal benefits, such as Medicaid, to citizens and certain aliens. Plaintiffs filed suit claiming that Basic Health Hawai'i violated the Equal Protection Clause of the Fourteenth Amendment because it provided less health coverage to nonimmigrant aliens residing in Hawai'i (COFA Residents) than the health coverage that Hawai'i provided to citizens and qualified aliens who are eligible for federal reimbursements through Medicaid. The court concluded that Congress has plenary power to regulate immigration and the conditions on which aliens remain in the United States, and Congress has authorized states to do exactly what Hawai'i had done here - determine the eligibility for, and terms of, state benefits for aliens in a narrow third category, with regard to whom Congress expressly gave states limited discretion. Hawai'i has no constitutional obligation to fill the gap left by Congress's withdrawal of federal funding for COFA Residents. Accordingly, the court vacated the district court's grant of a preliminary injunction preventing Hawai'i from reducing state-paid health benefits for COFA Residents because Hawai'i is not obligated to backfill the loss of federal funds with state funds and its decision not to do so was subject to rational-basis review. View "Korab v. Fink" on Justia Law

Debtor, a New York City tenant, filed for Chapter 7 bankruptcy and listed the value of her apartment lease on Schedule B as personal property exempt from the bankruptcy estate as a "local public assistance benefit." At issue was whether the value inherent in debtor's rent-stabilized lease as a consequence of the protections afforded by New York's Rent Stabilization Code, N.Y. Comp. Code R. & Regs. tit. 9, 2520.1 et seq., made the lease, or some portion of its value, exempt from debtor's bankruptcy estate as a "local public assistance benefit" within the meaning of New York Debtor and Creditor Law 282(2). The court certified this unsettled issue to the New York Court of Appeals. View "Santiago-Monteverde v. Pereira" on Justia Law

Demyanovich, an employee of Cadon for more than 20 years, was terminated after he requested leave under the Family and Medical Leave Act to treat his congestive heart failure. He had previously taken leave and his condition had gotten worse over the course of about 10 years. He claimed that Cadon and his direct supervisor, Ensign, interfered with his exercise of his FMLA rights, retaliated against him for seeking FMLA leave, and discriminated against him on the basis of disability. Ensign denied the FMLA request because he believed that Cadon did not have enough employees to be subject to the Act, but referred to Demyanovich as a “liability” immediately after the request for FMLA leave. The district court entered summary judgment in favor of Cadon. The Sixth Circuit reversed, noting evidence that establishs a genuine factual dispute as to whether Demyanovich was permanently incapable of working at the time that he was terminated. View "Demyanovich v. Cadon Plating & Coating, L.L.C." on Justia Law

M.L. was born in 2003. At his 15-month well-child visit, his pediatrician noted that M.L. was walking and generally developing normally but did not “want to talk.” In 2005, M.L. received several immunizations, including the DTaP vaccination. Hours later, M.L. allegedly began experiencing an abnormally high fever and swelling. He was admitted to the hospital with a diagnosis of “vaccine adverse reaction with secondary fever, angiodema, and anaphylactoid reaction.” The morning after his discharge, M.L.’s mother called an ambulance because M.L. was exhibiting signs of hypothermia and seizure-like episodes. In the months that followed, M.L.’s vocabulary allegedly decreased. An MRI of M.L.’s brain with and without contrast was normal. After observing M.L.’s developmental delays and repetitive behaviors, a pediatric neurologist placed M.L. in the autism spectrum disorder category. A special master rejected claims under the National Childhood Vaccine Injury Act of 1986, 42 U.S.C. 300aa-1 to -34, and the Claims Court affirmed. The Federal Circuit affirmed. While the DTaP vaccination likely caused the initial anaphylactic reaction, there was no reliable medical theory that the M.L.’s anaphylaxis caused a focal brain injury. View "LaLonde v. Sec'y of Health & Human Servs." on Justia Law

SHA appealed the district court's grant of summary judgment in favor of plaintiff. The district court concluded that SHA acted arbitrarily and capriciously in terminating plaintiff's rental assistance benefits under the Housing Choice Voucher Program (Section 8) for failure to attend an annual recertification meeting. The court held that plaintiff followed SHA's requirements - including contacting SHA within three days of her receipt of SHA's notice and attempting to reschedule due to her mother's recent death - and that SHA's contrary decision was arbitrary and capricious. Because this conclusion disposed of the case, the court did not address the parties' remaining contentions. Accordingly, the court affirmed the judgment of the district court. View "Cooley v. Housing Auth. of the City of Slidell" on Justia Law

The Federal Grant and Cooperative Agreement Act, 31 U.S.C. 6301, states that an executive agency must use: “a procurement contract . . . when . . . the principal purpose … is to acquire … property or services for the direct benefit or use” of the government and must adhere to the Competition in Contracting Act and the Federal Acquisition Regulation However, an “agency shall use a cooperative agreement . . . when . . . the principal purpose … is to transfer a thing of value … to carry out a public purpose of support or stimulation … instead of acquiring . . . property or service” and can avoid procurement laws. Under Section 8 of the Housing Act, HUD provides rental assistance, including entering Housing Assistance Program (HAP) contracts and paying subsidies directly to private landlords. A 1974 amendment gave HUD the option of entering an Annual Contributions Contract (ACC) with a Public Housing Agency (PHA), which would enter into HAP contracts with owners and pay subsidies with HUD funds. In 1983, HUD’s authority was amended. HUD could administer existing HAP contracts, and enter into new HAP contracts for existing Section 8 dwellings by engaging a PHA if possible, 42 U.S.C. 1437f(b)(1). Later, HUD began outsourcing services and initiated a competition to award a performance-based ACC to a PHA in each state, with the PHA to assume “all contractual rights and responsibilities of HUD.” After making an award, HUD chose to re-compete, seeking greater savings, expressly referring to “cooperative agreements,” outside the scope of procurement law. The Government Accountability Office agreed with protestors that the awards were procurement contracts. HUD disregarded that recommendation. The Claims Court denied a request to set aside the award. The Federal Circuit reversed, finding that the awards are procurement contracts, not cooperative agreements.View "CMS Contract Mgmt. Servs. v. United States" on Justia Law

Plaintiff appealed the district court's decision upholding the Commissioner's determination that he was not entitled to waiver of recovery of overpaid disability benefits. The court concluded that substantial evidence supported the Commissioner's decision where recovery of the overpayment did not defeat the purpose of Title II of the Social Security Act, 42 U.S.C. 301 et seq., and where recovery of the overpayment was not against equity or good conscience because plaintiff's mere receipt of disability benefits after notifying the Commissioner of his work activity did not satisfy 20 C.F.R. 404.510a. Accordingly, the court affirmed the judgment of the district court. View "Rodysill v. Colvin" on Justia Law

Plaintiffs placed their son in a specialized private school designed to educate children with learning disabilities and filed suit against the District for tuition reimbursement under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq. An Impartial Hearing Officer (IHO) awarded tuition reimbursement but the State Review Officer (SRO) reversed. The court held that the SRO's decision was insufficiently reasoned to merit deference and deferred to the IHO's decision, which was more thorough and carefully considered. The court affirmed the dismissal of plaintiff's claim under Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. 794, where the parents had not presented sufficient evidence of bad faith or gross misjudgment. View "C.L. v. Scarsdale Union Free Sch. Dist." on Justia Law

Thomas sought disability benefits in 2009, based on sciatica, diabetes, angina, a trigger thumb in her left hand, and chronic obstructive pulmonary disease. She was morbidly obese. Thomas saw a consultative examiner, who noted a reduced range of motion in Thomas’s lumbar spine, hips, and knees; an x-ray appeared to show narrowed disc space. A state agency doctor determined that Thomas had the residual functional capacity to perform light work. At a hearing, Thomas testified that she could not stand for more than 15 minutes or sit for more than 20 minutes at a time and could only walk about half a block and could not do laundry or vacuum. When the inflammation was bad, she could not use her left hand at all. Thomas used her inhaler four times a day to control asthma. A vocational expert testified about Thomas’s prior work as a phlebotomist as heavy, semiskilled work, requiring lifting and moving patients and drawing their blood. The ALJ denied Thomas’s claim. The Appeals Council denied review. The district court affirmed. The Seventh Circuit reversed, finding that the ALJ improperly discredited Thomas’s testimony and disregarded medical evidence concerning pain. View "Thomas v. Colvin" on Justia Law