Justia U.S. 2nd Circuit Court of Appeals Opinion Summaries

Plaintiff filed a class action against the Commissioner, challenging New York’s coverage restrictions on certain medical services provided under its Medicaid plan. Plaintiffs argued that New York’s 2011 plan amendments, which restrict coverage of orthopedic footwear and compression stockings to patients with certain enumerated medical conditions, violate the Medicaid Act’s, 42 U.S.C. 1396 et seq., reasonable standards, home health services, due process, and comparability provisions, as well as the anti‐discrimination provision and integration mandate of Title II of the Americans with Disabilities Act (ADA), 42 U.S.C. 12131 et seq., and section 504 of the Rehabilitation Act, 29 U.S.C. 794. Because neither the Medicaid Act nor the Supremacy Clause confers a private cause of action to enforce the reasonable standards provision, the court vacated the district court’s grant of summary judgment to plaintiffs on that claim; the court declined to reach plaintiffs’ unequal treatment claim under the ADA and Rehabilitation Act as largely duplicative of their integration mandate claim; and the court affirmed the summary judgment rulings with respect to the remaining claims. Defendant is entitled to summary judgment on plaintiffs' home health services plan because orthopedic footwear and compression stockings constitute optional “prosthetics” rather than mandatory “home health services” under the Medicaid Act; defendant is entitled to summary judgment on the hearing element and plaintiffs are entitled to summary judgment on the notice element of plaintiffs’ due process claim, because the due process provision required New York to provide plaintiffs with written notice – though not evidentiary hearings – prior to terminating their benefits; plaintiffs are entitled to summary judgment on their comparability provision claim because New York’s coverage restrictions deny some categorically needy individuals access to the same scope of medically necessary services made available to others; and plaintiffs are entitled to summary judgment on their anti‐discrimination claims because New York’s restrictions violate the integration mandate of the ADA and Rehabilitation Act. Finally, the court vacated the injunction and remanded for further consideration on the appropriate relief because the injunction is broader than is warranted by the court's liability conclusions. View "Davis v. Shah" 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 Department appealed a judgment awarding plaintiffs reimbursement under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq., for one year of private school education for their daughter, L.K. The court concluded that the Department’s refusal to discuss the bullying of L.K. with her parents during the process of developing L.K.’s individualized education program (IEP), violated the IDEA. The court also concluded that plaintiffs have met their burden to show that their choice of a private placement for L.K. was appropriate and that the equities favored reimbursing them. Accordingly, the court affirmed the judgment. View "T.K. v. N.Y.C. Dept. of Educ." on Justia Law

Plaintiff appealed the denial of social security disability benefits, alleging that the Appeals Council erred by failing to provide an explanation for why it disregarded the treating physician’s opinion and that the ALJ’s decision is not supported by substantial evidence in light of a treating physician’s opinion. The court agreed and held that, based on the record, including the physician's opinion, the ALJ's determination is not supported by substantial evidence in the record. Accordingly, the court vacated the judgment and remanded for further proceedings. View "Lesterhuis v. Colvin" on Justia Law

Plaintiff appealed the denial of his application for Social Security disability benefits (SSI). The district court granted defendant's motion for judgment on the pleadings. The court concluded, however, that the ALJ erred by failing to provide “good reasons” for giving little weight to the treating physician's opinion, and that this error was not harmless. Accordingly, the court vacated the district court's judgment and remanded for further proceedings. View "Greek v. Colvin" on Justia Law

Plaintiffs filed suit under 42 U.S.C. 1983 against DSS to enforce the Food Stamp Act's, 7 U.S.C. 2020(e)(3) and (9), time limits for awarding food stamp benefits. The district court certified a class consisting of all past, current, and future Connecticut food stamp applicants whose applications are not processed in a timely manner and the district court issued a preliminary injunction requiring DSS to process food stamp applications within the statutory deadlines. The court concluded that plaintiff can maintain a private lawsuit under 42 U.S.C. 1983 to enforce the statutory time limits in section 2020(e)(3) and (9). The court also concluded that federal regulations do not excuse DSS from processing food stamp applications within the statutory time limits. Accordingly, the court affirmed the judgment. View "Briggs v. Bremby" on Justia Law

Robinson worked for Concentra as a medical assistant from 2003 until she was terminated in 2010. Robinson applied for Social Security disability benefits four days after being terminated, claiming that she had multiple sclerosis that rendered her unable to work. The initial application was denied. An ALJ reversed, summarizing Robinson’s statements that: she must use a cane to walk because of leg numbness; she has poor vision; her hands frequently cramp and she has difficulty holding objects; and she needs help with all household chores. Robinson then filed suit against Concentra under Title VII, 42 U.S.C. 1981, and the Family and Medical Leave Act, claiming that she had been terminated on the basis of her race and color and in retaliation for filing a complaint with the EEOC and taking FMLA leave and that Concentra had interfered with her ability to take FMLA leave. The court entered summary judgment, finding that Robinson was estopped from showing that she was qualified for her position when she was terminated in September 2010, because she received disability benefits based on her statement that she was fully disabled as of June 2010. The Second Circuit affirmed, noting that Robinson failed to “proffer a sufficient explanation” for the contradictory statements. View "Robinson v. Concentra Health Servs.,Inc." 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, 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, which held that a rent‐stabilized lease qualified as a local public assistance benefit. Rejecting the Trustee’s argument that “benefits” should be limited to cash payments, the court noted that the rent‐stabilization program had “all of the characteristics of a local 10 public assistance benefit” under the statute and that an exemption was consistent with the purpose of protecting a debtor’s essential needs, including housing. The Second Circuit then reversed and remanded to allow Debtor to claim the exemption from her bankruptcy estate. View "Santiago-Monteverde v. Pereira" on Justia Law

Plaintiffs filed a putative class action suit against the Secretary on behalf of Medicare beneficiaries who were placed into "observation status" by their hospitals rather than being admitted as "inpatients." Placement into "observation status" allegedly caused these beneficiaries to pay thousands of dollars more for their medical care. The district court granted the Secretary's motion to dismiss and plaintiffs appealed. The court affirmed the dismissal of plaintiffs' Medicare Act, 42 U.S.C. 1395, claims where plaintiffs lack standing to challenge the adequacy of the notices they received and nothing in the statute entitles plaintiffs to the process changes they seek. However, the court vacated the district court's dismissal of plaintiffs' Due Process claims where the district court erred in concluding that plaintiffs lacked a property interest in being treated as "inpatients," because the district court accepted as true the Secretary's assertion that a hospital's decision to formally admit a patient is "a complex medical judgment" left to the doctor's discretion. The district court's conclusion constituted impermissible factfinding, which in any event is inconsistent with the complaint's allegations that the decision to admit is guided by fixed and objective criteria. View "Barrows v. Burwell" on Justia Law

This case stemmed from plaintiffs' request for tuition assistance for their daughter under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq. Plaintiffs filed suit challenging the State Review Officer's (SRO) decision to deny reimbursement for private schooling and the district court reversed in part and ordered the school district to reimburse plaintiffs for May 1, 2009 to May 31, 2009, and for the 2009-2010 school year. Because the court deferred to the SRO's determination that plaintiffs did not meet their obligation to demonstrate the appropriateness of their daughter's placement, plaintiffs cannot recover under the IDEA for any portion of the time she was placed at Family Foundation. Accordingly, the court reversed the judgment of the district court and remanded for entry of an order affirming the SRO's decision. View "Hardison v. Bd. of Ed. Oneonta City Sch. Dist." on Justia Law