Justia Government & Administrative Law Opinion Summaries

The issue this case presented for the New Hampshire Supreme Court's review called for the Court to determine the constitutionality of New Hampshire Administrative Rules, He-W 654.04(c). The rule required DHHS to include a child’s federal Supplemental Security Income (SSI) in the calculation of a family’s eligibility for benefits under the federal Temporary Assistance for Needy Families program (TANF), as administered by the State’s Financial Assistance to Needy Families program (FANF). Plaintiffs Carrie Hendrick and Jamie Birmingham were mothers whose children received SSI and FANF benefits, and whose benefits were ultimately cut by the Department of Health and Human Services (DHHS). Plaintiffs brought this lawsuit on behalf of themselves and their children, seeking a declaratory judgment that DHHS’s “inclusion of children’s SSI in FANF assistance group income is unlawful and void” pursuant to applicable federal law. In addition, plaintiffs sought a declaratory judgment that Rule He-W 654.04 “is invalid because it impairs [their] legal rights.” Plaintiffs sought a permanent injunction enjoining DHHS from including children’s SSI in FANF assistance group income and an award of attorney’s fees “because this litigation will result in a substantial benefit to the public.” After requesting that the Solicitor General of the United States file an amicus brief in this matter, and after reviewing that brief, the New Hampshire Supreme Court agreed with the Solicitor General that the Supremacy Clause did not permit the State to redirect federal benefits as required by Rule He-W 654.04(c). The rule, by counting a disabled child’s SSI benefits as income available to the child’s “assistance group,” treated the child’s benefits as a source of income for the entire household. The rule, thereby, reduced a household’s TANF benefit by one dollar for every dollar in SSI that was received by a disabled child in the household. Because the rule “stands as an obstacle to the accomplishment and execution of the full purposes and objectives of Congress,” the New Hampshire Court held that Rule He-W 654.04(c) was preempted by federal law and, thus, invalid to the extent that it required inclusion of children’s SSI as income to the TANF assistance group for the purpose of determining eligibility for TANF benefits. View "Hendrick v. New Hampshire Dept. of Health & Human Svcs." on Justia Law

In 2012, Plaintiff applied for disability insurance benefits under the Social Security Act, alleging a disability onset date of 1995. Plaintiff’s date last insured (DLI) was in 1998. An administrative law judge (ALJ) denied benefits, concluding that Plaintiff was not disabled prior to her DLI and was thus not eligible to receive benefits. The district court vacated the Commissioner’s decision and remanded for further proceedings, ruling that the ALJ failed to comply with Social Security Ruling (SSR) 83-20 and consult a medical advisor before drawing inferences as to whether Plaintiff’s onset date preceded the expiration of her insured status. In making its ruling, the district court relied upon Social Security Ruling (SSR) 83-20, which instructs an ALJ to consult a medical expert when the ALJ must infer a claimant’s date of disability onset on the basis of ambiguous medical evidence. The First Circuit vacated the judgment of the district court, holding that SSR 83-20 did not require the ALJ to consult a medical expert because the medical evidence was not ambiguous, and thus, the ALJ did not need to infer Plaintiff’s date of disability onset. Remanded for consideration of Plaintiff’s remaining claims. View "Fischer v. Colvin" on Justia Law

An ALJ found that Jerry Addison was entitled to benefits under the Black Lung Benefits Act, 30 U.S.C. 901-944, because he had established the existence of clinical and legal pneumoconiosis that resulted in a total respiratory disability. Sea-B, Addison's former employer, filed a petition for review of the ALJ's decision. The court concluded that the ALJ’s decision to exclude the additional CT scan evidence was not harmless. This error affects the determination of both clinical and legal pneumoconiosis and impacts the ALJ’s consideration of the other evidence in this case. The omitted CT scan evidence is unquestionably probative of the central issue in dispute: whether Addison suffered from pneumoconiosis. Furthermore, the court could not determine from the ALJ’s sparse explanation how, or if, he weighed the x-ray readings in light of the readers’ qualifications. Finally, because the proffered explanation for elevating Dr. Forehand’s diagnosis is not supported, the ALJ must reevaluate that opinion to determine the proper weight it should be given. Accordingly, the court granted the petition for review, vacated the order, and remanded for further proceedings. View "Sea "B" Mining Co. v. Addison" on Justia Law

Plaintiff was a registered sex offender when he was admitted to the state rental assistance program. Thereafter, the legislature promulgated section 17b-812-13(9) of the Regulations of Connecticut States Agencies, which makes sex offender registration a ground for termination or denial of rental program assistance. The Commissioner of Housing (Commissioner) subsequently terminated Plaintiff’s rental program benefits. Plaintiff took an administrative appeal of the Commissioner’s decision to the trial court, which concluded that the Commissioner’s application of section 17b-812-13(9) was not retroactive and therefore did not exceed the authority granted to the Commissioner by the legislature. The Supreme Court reversed, holding (1) the Commissioner applied section 17b-812-13(9) of the regulations retroactively in this case by imposing a new obligation on Plaintiff’s sex offender status that terminated his rental program assistance; and (2) such retroactive application of the regulation was not statutorily authorized, and therefore, the trial court erred in dismissing Plaintiff’s administrative appeal. View "Shannon v. Comm’r of Housing" on Justia Law

Relators filed suit against medical laboratory businesses in 2007 in state court, alleging that the labs had submitted false claims to the Commonwealth for Medicaid reimbursement. Defendants removed to federal court. After the Commonwealth entered into a settlement agreement with defendants, the district court awarded relators a share of the settlement proceeds. Relators appealed, contending that the district court's award was insufficient under state law. The court vacated and remanded to the state court, concluding that the district court lacked subject matter jurisdiction over the qui tam action. In this case, by the plain terms of the complaint, relators could have prevailed on their state law claims by proving that defendants contravened the Commonwealth’s Medicaid regulations, without showing any violation of federal law. View "Commonwealth of Virginia ex rel. Hunter Labs. v. Commonwealth of Virginia" on Justia Law

Thomas applied for Supplemental Security Income in 2010 when she was 55 years old. An administrative law judge identified her medically determinable impairments as degenerative changes in her back and left shoulder, Graves’ disease, and dysthymic disorder (a form of chronic depression), but concluded that the impairments did not impose more than minimal limitations on Thomas’s ability to work and denied her application. The Seventh Circuit reversed and remanded. The ALJ’s omission of fibromyalgia from Thomas’s medically determinable impairments and his conclusion that she has no severe impairments were not supported by substantial evidence. Thomas’s doctors’ lack of specialization in rheumatology was not an acceptable basis for discounting their assessments. View "Thomas v. Colvin" on Justia Law

The issue before the New Jersey Supreme Court in this case was whether the 2011 suspension of State pension cost-of-living adjustments (COLAs) contravened a term of the contract right granted under the earlier enacted non-forfeitable right statute, L.1997, c.113 (codified as N.J.S.A.43:3C-9.5). Qualifying members of the State's public pension systems or funds were granted a non-forfeitable right to receive benefits as provided under the laws governing the retirement system or fund. By codifying that non-forfeitable right to receive benefits, the Legislature provided that the benefits program, for any employee for whom the right has attached, could not be reduced. Whether COLAs were part of the benefits program protected by N.J.S.A. 43:3C-9.5 depended on whether the Legislature, in enacting N.J.S.A. 43:3C-9.5(a) and (b), intended to create a contractual right to COLAs. The Supreme Court found in this instance, proof of unequivocal intent to create a non-forfeitable right to yet-unreceived COLAs was lacking. Although both plaintiff retirees and the State advanced plausible arguments on that question, "the lack of such unmistakable legislative intent dooms plaintiffs' position." The Court concluded that the Legislature retained its inherent sovereign right to act in its best judgment of the public interest and to pass legislation suspending further COLAs. Having determined that there was no contract violation, and because the additional arguments advanced by plaintiffs were not meritorious, the Court reversed the Appellate Division's judgment holding to the contrary. View "Berg v. Christie" on Justia Law

Caring Hearts Personal Home Services, Inc. provided physical therapy and skilled nursing services to “homebound” Medicare patients. It sought reimbursement from Medicare for services provided. The definition of who qualified as "homebound" or what services qualified as "reasonable and necessary" was unclear, even to the Centers for Medicare & Medicaid Services (CMS). CMS has developed its own rules on both subjects that had been repeatedly revised and expanded over time. In an audit, CMS purported to find that Caring Hearts provided services to at least a handful of patients who didn’t qualify as “homebound” or for whom the services rendered weren’t “reasonable and necessary.” As a result, CMS ordered Caring Hearts to repay the government over $800,000. It was later found that in reaching its conclusions CMS applied the wrong law: the agency did not apply the regulations in force in 2008 when Caring Hearts provided the services in dispute. Instead, it applied considerably more onerous regulations the agency adopted years later, "[r]egulations that Caring Hearts couldn’t have known about at the time it provided its services." The Tenth Circuit found that Caring Hearts "[made] out a pretty good case that its services were entirely consistent with the law as it was at the time they were rendered" when CMS denied Caring Hearts' request for reconsideration. The Tenth Circuit reversed the district court's judgment affirming CMS' denial to Caring Hearts for reimbursement, and remanded for further proceedings. View "Caring Hearts v. Burwell" on Justia Law

In 2008, Joseph Gerdon was seriously injured in a motor vehicle accident that arose out of and in the course of his employment. He was a passenger in a vehicle being driven by a coworker, who drove off the road. The Industrial Commission awarded Gerdon benefits. Gerdon requested a hearing to determine whether he was also entitled to benefits for a compensable psychological injury. That issue was heard before a referee, who issued proposed findings of fact, conclusions of law, and a recommendation that Gerdon had failed to prove that he was entitled to additional psychological care. The Commission adopted the referee’s proposed findings of fact and conclusions of law and issued an order. Gerdon appealed to the Idaho Supreme Court. Because the Commission’s decision was based upon its constitutional right to weigh the evidence and determine the credibility of conflicting expert opinions, the Supreme Court affirmed the Commission's order. View "Gerdon v. Con Paulos, Inc." on Justia Law

Attorneys employed by the Franklin County Public Defender sought membership and service credit in the Ohio Public Employees Retirement System for their years of service prior to January 1999, and challenged a decision the Ohio Public Employees Retirement Board’s denial of service credit. Persons hired by the Franklin County Public Defender on or before December 31, 1984, are public employees entitled to PERS benefits; effective January 1, 1999, the Franklin County Public Defender’s employees have been enrolled in and considered to be members of PERS. During the intervening years, pursuant to the Ohio Public Defender Act (R.C. Chapter 120), the Franklin County Public Defender Commission and its employees paid Social Security taxes on wages and did not consider the office to be a county agency. The Court of Appeals denied relief. The Supreme Court of Ohio granted a writ of mandamus to compel the board to award service credit, rejecting an argument that “there was no person holding the office of Franklin County Public Defender between 1985 and 1999 because a person was appointed as the ‘Director’ of the corporation. The plain language in R.C. 120.14(A)(1) indicates that the attorneys were employed by a public official, and hence, were public employees. View "Altman-Bates v. Pub. Emps. Retirement Bd." on Justia Law