Justia Government & Administrative Law Opinion Summaries

Kristin Anton appealed a district court judgment affirming an order by Job Service North Dakota denying Anton pandemic unemployment assistance benefits. Anton stopped working on March 12, 2020 when the public schools closed due to the COVID-19 pandemic. Anton stopped working because she relied on the school system to provide childcare for at least one of her children. Her employer, Heart River Cleaning, did not close and did not hold Anton’s position for her while she stayed home to watch her children. Anton challenged the finding that she had failed to prove she was entitled to pandemic unemployment benefits under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). Finding no reversible error, the North Dakota Supreme Court affirmed the district court. View "Anton v. Klipfel, et. al." on Justia Law

Claimant an Arizona woman in her forties filed an application for Social Security disability insurance benefits and supplemental security income. The agency repeatedly denied the claimant’s claims. The district court affirmed the ALJ’s decision, concluding that the ALJ reached a reasonable determination based on substantial evidence in the record. On appeal, the claimant argues that the ALJ erred by insufficiently supporting his analysis, failing to account for the claimant’s symptoms and limitations in the residual functional capacity (RFC) assessment, improperly discounting the opinion of one medical provider while giving undue weight to the opinion of another, and failing to satisfy the “clear and convincing” standard for rejecting subjective symptom testimony.   The Ninth Circuit affirmed. The court held that the ALJ did not err in discounting the opinion of the claimant’s treating physician because the “extreme limitations” described by the physician were incompatible with the rest of the objective medical evidence. Likewise, the ALJ did not err in giving significant weight to the opinion of the consultative examiner because the examiner’s determination that the claimant could perform light-exertion work was consistent with the objective medical evidence. Finally, the ALJ provided “clear and convincing” reasons for discounting Claimant’s subjective pain testimony. The claimant’s self-reported limitations were inconsistent with (1) the objective medical evidence, (2) her self-reported daily activities, and (3) her generally conservative treatment plan. View "MISTY SMARTT V. KILOLO KIJAKAZI" on Justia Law

Claimant argued that the administrative law judge (“ALJ”) erred by rejecting the uncontested opinion of a non-examining physician, that supported her claim. Under the pre-2017 regulations that apply to the claim, ALJs are required to give greater weight to certain medical opinions. To reject the uncontested opinion of an examining or treating doctor, an ALJ must provide “clear and convincing” reasons supported by substantial evidence.   The Ninth Circuit affirmed the district court’s decision affirming the denial of claimant’s application for disability benefits under Title II of the Social Security Act. The panel held that the “clear and convincing” standard did not apply to the physician’s opinion because he never treated or examined claimant. Rather his opinion was based solely on a review of claimant’s medical records. The panel held that nothing in the relevant regulations required an ALJ to defer to an opinion from a non-treating, non-examining medical source. In rejecting the physician’s opinion, the ALJ cited specific contradictive medical evidence in the record. In making these findings, the ALJ cited the record at length. The panel concluded that this satisfied the requirements of Sousa v. Callahan, 143 F.3d 1240, 1244 (9th Cir. 1998), the relevant regulations, and the substantial evidence standard. Further, the panel concluded that the district court properly concluded that the ALJ’s denial of benefits was supported by substantial evidence View "RUTH FARLOW V. KILOLO KIJAKAZI" on Justia Law

In this case arising out of the Department of Human Services' attempt to recover payments made to Dr. Frederick Nitta from its Medicaid Primary Care Physician Program the Supreme Court vacated the judgment of the intermediate court of appeals (ICA) to the extent it remanded the case and otherwise affirmed, holding that DHS's claims largely lacked merit.The Program at issue was established by 42 U.S.C. 1396a(a)(13)(C) of the Affordable Care Act (ACA) and enabled certain physicians to temporarily receive increased payments for primary care services provided in 2013 and 2014 to Medicaid patients. In this case, DHS demanded repayment of more than $200,000 in enhanced payments received by Nitta through the program after it determined that Nitta was ineligible for participation in the Program because he did not meet specialty requirements as set forth in a federal administrative rule. While Nitta's appeal was pending, the Court of Appeals for the Sixth Circuit invalidated the rule and remanded the case. The ICA adopted the Sixth's Circuit's analysis. The Supreme Court largely affirmed, (1) the rule is invalid because it contravenes the statute; and (2) Nitta was entitled to enhanced payments under the statute. View "Nitta v. Department of Human Services" on Justia Law

The First Circuit affirmed the judgment of the district court denying Appellant's motion for attorneys' fees, which he filed more than two years after successfully representing Appellee before both the Social Security Administration (SSA) and the district court, holding that the district court properly denied the motion as untimely.In his motion requesting attorneys' fees under 42 U.S.C. 406(b), Appellant argued that the statute does not contain a fixed time for filing a section 406(b) petition. The district court denied the fee request as untimely, concluding that such a motion must be filed within a reasonable time of the SSA's decision awarding benefits. The First Circuit affirmed, holding that, given that Appellant failed to file his section 406(b) petition in a timely manner, the district court did not err in denying his request for attorneys' fees. View "Pais v. Kijakazi" on Justia Law

The Mississippi Division of Medicaid (DOM) and Yalobusha County Nursing Home (YNH) dispute four costs submitted for reimbursement by YNH in its fiscal year 2013 Medicaid cost report. The DOM appeals the Hinds County Chancery Court’s judgment ordering the DOM to reverse the four adjustments at issue. Because the DOM correctly interpreted the appropriate statutes and because its decisions were supported by substantial evidence, the Mississippi Supreme Court reversed the chancery court’s order and rendered judgment reinstating the decisions of the DOM. View "Mississippi Division of Medicaid v. Yalobusha County Nursing Home" on Justia Law

Plaintiff appealed the district court’s1 order upholding the Commissioner of the Social Security Administration’s (Commissioner) denial of Social Security disability insurance benefits, arguing that the Commissioner’s decision was not supported by substantial evidence. Plaintiff challenged two aspects of the Commissioner’s decision. First, Plaintiff argued that the ALJ committed legal error by improperly evaluating the medical evidence. Second, Plaintiff argued that the ALJ’s RFC assessment was unsupported by substantial evidence. 
 The Eighth Circuit affirmed. The court explained that the ALJ found that Plaintiff had the RFC to “perform light work . . . ; except, she should avoid extreme cold and wetness, avoid work in direct sunlight, and avoid loud noises.” Central to this finding was the ALJ’s conclusion that Plaintiff’s surgically implanted neurostimulator resulted in “on-going symptom control without a consistent description of debilitating pain or the inability to function.” A lack of evidence of treatment in the months prior to the hearing undermines Plaintiff’s claim of disabling headaches. The court ultimately concluded that the ALJ’s RFC assessment is within the “available zone of choice” provided by the whole record. View "Lisa Austin v. Kilolo Kijakazi" on Justia Law

The underlying dispute before the Pennsylvania Supreme Court in this case involved the adequacy of state funding for community participation support ("CPS") services, which were designed to help individuals with autism or intellectual disabilities live independently. The primary issue on appeal related to the exhaustion requirement. The Pennsylvania Department of Human Services ("DHS") issued ODP Announcement 19-024, indicating it intended to change the rate structure for CPS services provided under the Home and Community Based Services (“HCBS”) waivers. Petitioners filed an action for declaratory and injunctive relief, challenging the legality of the new fee schedule and alleged the new reimbursement rates were too low to sustain the provision of CPS services to eligible recipients. Pertinent here, the Commonwealth Court agreed with one of DHS' preliminary objections that Petitioners failed to exhaust their administrative remedies, as required by case precedent, before seeking judicial review. The court acknowledged a narrow exception to the exhaustion requirement whereby a court may consider the merits of a claim for declaratory or injunctive relief if a substantial constitutional question is raised and the administrative remedy is inadequate. It clarified, however, that the exception only applied where the plaintiff raises a facial constitutional challenge to the statute or regulation in question, as opposed to its application in a particular case. Here, the court concluded, the Petitioners were attacking the fee schedule in the Final Notice, which was produced by application of the legal authority cited in that notice, and not advancing a facial constitutional challenge. The court also found Petitioners failed to demonstrate the administrative remedy was inadequate. The Supreme Court affirmed the Commonwealth Court’s order insofar as it sustained the preliminary objection asserting that the Petitioners failed to exhaust their administrative remedies, and dismissed the Petition as to those parties. The order was vacated in all other respects, and the matter was remanded for further proceedings. View "Rehabilitation & Community Providers Association, et al. v. Dept. Human Svcs" on Justia Law

In 1993, Kastman was charged with misdemeanor offenses based on acts of public indecency involving children and disorderly conduct. The state’s attorney initiated a civil commitment proceeding against Kastman under the Sexually Dangerous Persons Act (725 ILCS 205/0.01). Evidence indicated that Kastman suffered from pedophilia, antisocial personality disorder, exhibitionism, and alcohol dependency. Kastman was found to be a sexually dangerous person, and the circuit court granted the petition. In 2016, Kastman was granted conditional release from institutional care.In 2020, he sought financial assistance. Kastman asserted that he was unemployed, disabled, and could not afford his $300 monthly treatment costs and the $1800 monthly rent for housing that complied with the Sex Offender Registration Act. The circuit court of Lake County ordered the Department of Corrections to pay a portion of Kastman’s monthly expenses. The appellate court and Illinois Supreme Court affirmed. The statutes indicate that a sex offender’s ability to pay is a relevant consideration in deciding who should bear the expense of treatment costs; without a clear statutory directive, the legislature is not presumed to have intended that only financially stable individuals are eligible for conditional release. Financial instability and the need for supervision to protect the public are not the same things. View "People v. Kastman" on Justia Law

Under the Social Security Act’s Title IV-E program, states receive reimbursements for foster care maintenance payments (FCMPs), 42 U.S.C. 670–676. Title IV-E’s conditions include having a state plan approved by the Secretary of Health and Human Services (HHS); the removed child’s placement and care must be the responsibility of the state agency administering that plan. Kentucky's approved plan is administered by the Kentucky Cabinet for Health and Family Services. Under Kentucky law, a court may remove a child from her home “to the custody of an adult relative, fictive kin,” or other person or facility or can commit the child to the custody of the Cabinet. The Cabinet does not provide FCMPs to children placed by courts into the care of a relative or fictive kin, although that is a preferred outcome for the child.Caregivers brought a class action, accusing the Cabinet of denying FCMPs to eligible children without notice or a fair hearing, in a way that discriminated against relative caregivers. The district court certified a Children’s Class, a Caregivers’ Class, a Cabinet Custody Class, and a Notice and Hearing Class. The Sixth Circuit affirmed the dismissal of the suit except as to the Cabinet Custody Class. Under Kentucky law, the Cabinet did not have placement and care responsibility over children not in their custody; the Cabinet cannot change a child’s placement without a court order. Only Cabinet Custody Class members were eligible for FCMPs. View "J. B-K. v. Kentucky Cabinet for Health and Family Services" on Justia Law