Justia Government & Administrative Law Opinion Summaries

A class of Tennessee residents who applied for Medicaid sought declaratory and injunctive relief, alleging that the delays they have experienced in receiving eligibility determinations on their applications violate 42 U.S.C. 1396a(a)(8) of the Medicaid statute, and that the state’s failure to provide a fair hearing on their delayed applications violates that statute and the Due Process Clause. Regulations implementing the statute provide that “the determination of eligibility for any applicant may not exceed” 90 days for those “who apply for Medicaid on the basis of disability” and 45 days for all other applicants. The district court certified a class and granted a preliminary injunction, which requires the state to grant a fair hearing on delayed applications to class members who request one. The Sixth Circuit affirmed the preliminary injunction, holding that the matter is not moot and that the federal government is not a required party. The court noted that the federal government submitted an amicus brief, supporting plaintiffs’ position. Despite the passage of the Affordable Care Act, states remain ultimately responsible for ensuring their Medicaid programs comply with federal law. View "Wilson v.Gordon" on Justia Law

Plaintiff-appellant Laurie Smith sought review when her Social Security disability benefit claims were denied. She alleged disability based in part on: impingement of her left shoulder; restrictions on her ability to: (1) reach and (2) handle and finger objects; and moderate nonexertional limitations. The administrative law judge concluded that Smith could work as a telequotation clerk, surveillance systems monitor, or call-out operator. As a result, the judge concluded that Smith was not disabled. Ms. Smith appealed to the district court, which upheld the administrative law judge’s determination. After its review, the Tenth Circuit found no reason to disturb the ALJ's or the district court's judgments and affirmed. View "Smith v. Colvin" on Justia Law

Plaintiff, the beneficiary of a testamentary trust, entered a long-term care facility in 2012, at which time she applied for financial and medical assistance under Medicaid. The Department of Social Services denied the application for Medical benefits, finding that Plaintiff’s assets, including the trust, exceeded the relevant asset limits. A hearing officer upheld the department’s denial. Plaintiff appealed, arguing that the trust was not an asset available to her as defined by relevant Medicaid regulations. The trial court dismissed Plaintiff’s appeal. The Supreme Court reversed, holding that the testator intended to create a discretionary, supplemental needs trust and, therefore, the trust corpus and income may not be considered to be available to Plaintiff for the purpose of determining eligibility for Medicaid benefits. View "Pikula v. Dep’t of Social Servs." on Justia Law

Via Christi seeks an upward adjustment of the capital-asset depreciation reimbursement paid to its predecessor hospitals under a since curtailed Medicare regulation. Via Christi argues that it received St. Francis’s and St. Joseph’s assets at a lower value, i.e., more depreciated, than was reflected in the Secretary’s earlier depreciation reimbursements. As the hospitals’ successor-in-interest, Via Christi thus seeks additional reimbursements to cover the proportional Medicare share of the depreciation. The court concluded that the Secretary reasonably interpreted the bona fide sale requirement as limited to arm’s length transactions between economically self-interested parties. The Secretary concluded that St. Francis’s transfer of its assets to Via Christi was not an arm’s-length transaction in which each party sought to maximize its economic benefit. The court concluded that the Secretary's determination was supported by substantial evidence, and was not arbitrary, capricious or otherwise unlawful. In this case, Via Christi is not entitled to additional depreciation reimbursement in the absence of a qualifying transaction. View "Via Christi Hosp. Wichita v. Burwell" on Justia Law

Hensley, born in 1949, was employed as a coal miner for 13 years, before leaving in 1988 after seriously injuring his hand and arm in an accident. He has not worked since. Hensley also smoked cigarettes for 10-12 years, averaging half a pack a day before quitting 29 years ago. Hensley first noticed issues with his breathing in 1987. In 1990, he filed an unsuccessful claim for benefits under the Black Lung Benefits Act, 30 U.S.C. 901. He filed a second claim in 2003. The claim was denied, despite a finding of pneumoconiosis, because Hensley did not prove that he was totally disabled by the disease. Hensley filed another claim 2006. The Department of Labor recommended awarding benefits.The evidence, which consisted of chest x-rays, biopsy results, CT scans, pulmonary function studies, arterial blood-gas studies, treatment records and several medical opinions, was forwarded to the ALJ, who awarded benefits in 2010, initially holding that Hensley’s x-ray evidence alone was sufficient to establish the existence of pneumoconiosis.. On remand, the ALJ again concluded that Hensley was entitled to benefits. The Sixth Circuit upheld the award as supported by substantial evidence. View "Dixie Fuel Co. v. Office Workers' Comp. Progams" on Justia Law

Plaintiffs, including many with disabilities, had cases pending in state courts and were represented by an attorney who uses a wheelchair. They claimed that the St. Joseph County Courthouse and the Mishawaka County Services Building did not comply with the Americans with Disabilities Act and the Rehabilitation Act, particularly with respect to restrooms, elevators, witness stands, jury boxes, jury deliberation rooms, attorney podiums, spectator seating, entrance ramps, clerk counters, services for the blind, water fountains, and parking. While the case was pending, defendants remodeled the courthouse restrooms, which are now accessible. Defendants presented evidence that their facilities complied with the statutes. Plaintiffs offered little evidence in rebuttal. The district court granted defendants summary judgment. The court dismissed the claims of non-disabled plaintiffs represented by a disabled lawyer and claims relating to jury facilities, saying that the ADA did not provide for “associational” standing. The court found no evidence that other plaintiffs had suffered past injuries that would support standing for damages, and that the prospect of future injury was too speculative to support an injunction. Some plaintiffs had died; some were no longer in litigation. The Seventh Circuit affirmed, without finding the facilities compliant and without expressing an opinion on possible future claims. View "Hummel v. St. Joseph Cnty. Bd. of Comm'rs" 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 plaintiff, now 62 years old, applied in 2011 to the Social Security Administration for disability benefits, citing ailments including asthma, chronic obstructive pulmonary disease (COPD), asbestosis, and a heel spur in his right foot. He had been a sheet metal journeyman for 33 years; the job requires physical strength and he had been given accommodations on the job for several years. The Social Security Appeals Council declined to review the administrative law judge’s denial and the district judge affirmed. The Seventh Circuit reversed and remanded, referring to the ALJ’s “seemingly inconsistent conclusions” and stating that the denial was “not a reasoned analysis of the plaintiff’s claim.” View "Dimmett v. Colvin" on Justia Law

The Hospital system filed suit seeking to obtain a writ of mandamus compelling HHS to adjudicate immediately its administrative appeals on claims for Medicare reimbursement. The parties agree that, as of February 2014, the Secretary had 480,000 appeals awaiting assignment to an ALJ, and the Secretary conceded in her brief that the number had by then climbed to more than 800,000 appeals, creating a ten-year backlog. The court concluded that the Medicare Act, 42 U.S.C. 1395 et seq., does not guarantee a healthcare provider a hearing before an ALJ within 90 days, as the Hospital System claims. Rather, it provides a comprehensive administrative process that a healthcare provider must exhaust before ultimately obtaining review in a United States district court. The court further concluded that the issuance of a judicial order now, however, directing the Secretary to hear the Hospital System’s claims in the middle of the administrative process, would unduly interfere with the process and, at a larger scale, the work of the political branches. Moreover, such intervention would invite other healthcare providers suffering similar delays to likewise seek a mandamus order, thereby effectively causing the judicial process to replace and distort the agency process. Accordingly, the court affirmed the district court's dismissal of the complaint. View "Cumberland Cnty. Hosp. v. Burwell" on Justia Law

In 2011, the California Legislature adopted legislation which dissolved the redevelopment agencies (RA's) that had been formed by municipalities throughout the state under the provisions of the Community Redevelopment Law (CRL). Before their dissolution, the operations of RA's were funded by way of so-called "tax increment" financing. Shortly before the Legislature dissolved RA's, plaintiffs-appellants Virginia Macy, a low-income resident of the city; Libreria Del Pueblo, Inc.; and California Partnership filed a petition for a writ of mandate against the Fontana Redevelopment Agency alleging the agency failed to provide the low- and moderate-income housing required under the CRL. Plaintiffs asked for relief in the form of the payment of $27 million into the agency's low- and moderate-income housing fund (LMIHF). AB 26 created successor agencies that were given responsibility over certain obligations of each dissolved RA. Importantly, under the dissolution legislation, the liability of successor agencies was limited to the value of the assets those agencies received from their respective predecessor RA's. After enactment of AB 26, plaintiffs amended their petition and added defendant and respondent City of Fontana (the city), initially in its role as the successor agency provided by AB 26, and later also in its separate capacity as a municipal corporation. In its capacity as a municipal corporation, the city filed a demurrer to the petition, arguing that under AB 26 only a successor agency may be held liable for the preexisting obligations of an RA. The trial court sustained the demurrer without leave to amend. Plaintiffs appealed, but the Court of Appeal affirmed: the low- and moderate-income housing were never the liabilities of municipalities and their general funds. "An extension of RA statutory liabilities to municipalities and their general funds would require a very clear expression of the Legislature's intention to depart from the historical treatment of low- and moderate-income housing obligations; no such expression appears in AB 26 or later amendments to the dissolution legislation." View "Macy v. City of Fontana" on Justia Law