Grijalva v. Shalala, 119 S. Ct. 1573 (1999).
The U.S. Supreme Court summarily vacated the August 1998 Ninth Circuit judgment in this nationwide class action which had ruled that denial of services by HMO's to Medicare beneficiaries violated due process. The Ninth Circuit had found that denial of services by private Medicare HMO's constituted state action for the purposes of the Fourteenth Amendment. The Supreme Court remanded the case to the Ninth Circuit for further consideration in light of their recent decision, American Manufacturers Mutual Ins. Co. v. Sullivan et al., 119 S. Ct. 977 (1999), .. 4001-4002 of the Balanced Budget Act of 1997 and implementing federal regulations. American Manufacturers held, in part, that a decision by a private insurer, which provides worker's benefits under the Pennsylvania's worker compensation system, to withhold payment for medical expenses pending utilization review does not constitute state action for purposes of the Fourteenth Amendment. Grijalva was previously reported in the September 1998 Welfare Bulletin and American Manufacturers in the March 1999 Welfare Bulletin.
Plaintiffs' attorneys: Sally Hart, Center for Medicare Advocacy, 1730 East River Road, Suite 107, Tucson, AZ 85718, tel. 520-577-1611, fax 520-577-0342, email: slyhart@azstarnet.com; Lenore Gerard, Legal Assistance to the Elderly, 1453 Mission Street, Suite 500, San Francisco, CA 94103, tel. 415-861-0310; and Carol Jimenez, tel. 562-430-0239.
Cleveland v. Policy Management Systems, __ U.S. __ (1999), WL 320795 (U.S., May 24, 1999)(No. 97-1008).
The U.S. Supreme Court unanimously ruled that pursuit and receipt of Social Security Disability Insurance (SSDI) benefits does not automatically preclude the recipient from pursuing an action for discrimination based on disability under the Americans with Disability Act (ADA) of 1990. The Court, in an opinion delivered by Justice Breyer, explained that although pursuing both SSDI benefits and an action under the ADA may seem contradictory, it is not necessarily so. The main difference between the two is that the ADA prohibits covered employers from discriminating against disabled employees as along as they "can perform essential functions" of the job, including employees who can do so only with "reasonable accommodation." SSDI, on the other hand, does not take into consideration whether reasonable accommodations can be made to enable the employee to work. Furthermore, SSDI recipients do not automatically lose their benefits if they return to work, in order to facilitate such reentry into the workforce. In order to survive summary judgment, an ADA plaintiff must offer a sufficient explanation as to why the ADA claim is consistent with the receipt of SSDI. The Court found that summary judgment would be appropriate in these cases when the plaintiff fails to offer such explanation.
Reynolds v. Giuliani, 98 Civ. 8877 (WHP) (S.D.N.Y. May 24, 1999).
In January 1999, after finding that the City's practices illegally denied and deterred needy individuals from applying for Food Stamps, Medicaid, and cash assistance, the court enjoined New York City from converting any more income maintenance centers to job centers and ordered the City to develop a corrective action plan (35 F. Supp. 2d 331 (S.D.N.Y.1999)). After a hearing on the adequacy of New York City's corrective action plan, the Court has now modified the January 25th preliminary injunction to allow the City to convert three more income maintenance centers to job centers and noted that it will consider a further modification of its order after a hearing on the adequacy of the City's monitoring procedures and the data collected as to the results of implementation of its corrective action plan. In its opinion the court noted that the City had made numerous revisions to its corrective action since filing the plan in early February, many in response to plaintiffs' comments. Revisions to forms, procedures, and policies for processing applications are among the changes. Although the City did not respond to all of the plaintiffs' concerns, the court found that on the whole the corrective action plan sufficiently addresses concerns identified in the January order, although it recognized that it is not yet clear what the results of the policy directives will be. The court also concluded that the City's procedures for training agency personnel were sufficient and that experience would show whether the court would have to require revisions. As to the interpretation of early monitoring data, the court noted that the parties interpreted the data differently and that plaintiffs' arguments over the validity of the data raised valid questions which could not be resolved on the current record.
Plaintiffs' attorneys: Marc Cohan and Rebecca Scharf, Welfare Law Center, 275 Seventh Avenue, Suite 1205, New York, NY 10001-6708, tel. 212-633-6967, fax 212-633-6371, email cohan@welfarelaw.org or scharf@welfarelaw.org; Christopher D. Lamb, Hwan-Hui Helen Lee, Anne K. Callagy, et al., Legal Aid Society, Civil Division, New York City; Constance P. Carden and Randal S. Jeffrey, New York Legal Assistance Group, New York City; and Kenneth Rosenfeld, Northern Manhattan Improvement Corp., New York City.
Aliessa, et al. v. Whalen, Index No. 403748/98 (N.Y. Sup. Ct., N.Y. Cty., May 17, 1999).
The court has ruled for plaintiffs in this challenge to a state law provision, adopted following the lead of the 1996 federal welfare law, that excludes from state-funded Medicaid many lawful immigrants, including "persons residing under color of law" (PRUCOLs), who are no longer entitled to federally-funded Medicaid. (The state provision uses the strict definition of qualified alien under the federal welfare law, thereby eliminating PRUCOLs who do not fit the definition.) The plaintiffs in this case were found by the Court to meet the Medicaid program's financial eligibility requirements and were only being denied Medicaid due to their immigration status. The Court agreed with the Plaintiffs that the state law violates their constitutional rights under sections One and Three of Article XVII of the New York State Constitution which requires the state to provide aid, care, and support for the needy, and the equal protection clauses of the United States and New York State Constitutions. With respect to equal protection, the court applied the strict scrutiny test, relying on Graham v. Richardson. In the eyes of the court, the state statute discriminates against legal immigrants by placing necessary public assistance beyond their grasp. It rejected the state's argument that a rational basis test should apply because the state was acting pursuant to the federal policy of excluding many lawful immigrants from federally-funded Medicaid. The court noted that the federal government has broader powers with respect to immigration and that Congress cannot authorize the states to violate the equal protection clause. Since strict scrutiny applies, the court also rejected fiscal concerns as a justification for the discrimination. With respect to Article XVII of the State Constitution, the court rejected the state's arguments that it was meeting its obligations to plaintiffs through other programs, such as the Safety Net Program and emergency Medicaid. Those programs do not provide for the ongoing health care needs of plaintiffs. The court granted a permanent injunction and ordered defendant to reimburse the plaintiffs for covered expenses. It noted that the defendant will be able to respond to the motion for class certification, which had been held in abeyance pending decision on the merits.
Plaintiffs' attorneys: Elizabeth Benjamin and Janet Sabel, Legal Aid Society, 90 Church Street, New York, NY 10007, 212-577-3386, email ebenjamin@legal-aid.org; Ellen Yacknin, Greater Upstate Law Center, 80 St. Paul Street, Suite 660, Rochester, NY 14604, tel. 716-454-6500, x654, email eyacknin@wnylc.com; Connie Carden, New York Legal Assistance Group, 130 East 59th Street, New York, NY 10022, tel. 212-750-0800, x123.
Weston v. Hammons, Case No. 99CV0412 (CO Dist. Ct., Denver, May 28, 1999) (ruling from the bench)
This class action, brought against state and Denver and Adams County welfare officials, claims that inadequate TANF sanction notices violate federal and state due process and state statutory and regulatory requirements. Plaintiffs also claim that the state has failed in its duty to supervise county welfare administration. On May 28th the court, in a bench ruling, denied the defendants' motion to dismiss and granted class certification. The court concluded that despite state statutory language providing "no entitlement" to TANF, the plaintiffs have a property interest to which due process applies because under the state's welfare program benefits must be provided to those who meet the state's requirements. The statutory scheme creates an expectation of benefits for those who meet the requirements and does not allow unfettered agency discretion in determining who gets benefits. The court also ruled that plaintiffs did not have to exhaust administrative remedies because the case involves a question of law and the relief they seek, namely a systemic change in the notices used by the counties as opposed to relief for individuals, could not be granted by an administrative law judge. A hearing on plaintiffs' preliminary injunction motion is set for September. At the May 28th hearing, the court also approved a settlement agreement between plaintiffs and the Denver County defendants in which the county agreed to revised notices and informational material (which will also be provided in translation), reinstatement of class members who wish to claims such restitution after counseling regarding its effects, restitution according to a formula, protection against adverse consequences from any invalidly imposed sanctions, and subject to budget limitations, a transition team program to review each sanction that could result in case closure to ensure that proper procedures have been followed.
Plaintiffs' attorneys: Thomas Nichols, Davis, Graham & Stubbs, LLP; Natalie Hanlon-Leh, Steven Zansberg and Christopher Beall, Faegre & Benson, LLP; Barbara Blumenthal, McKenna & Cuneo, LLP; Kimberley Ghiselli, Silver & Deboskey. For additional information contact Maureen Farrell, Colorado Center on Law & Policy, 623 Fox St #205, Denver, CO 80204-4503, tel. (303) 573-5669; e-mail: msfarrell@uswest.net.
Rotondo v. Ferguson, C.A. No. 98-1497 (R.I. Superior Court, Providence, June 3, 1999).
The parties have settled this case which challenged the agency's failure in Medicaid disability cases to determine eligibility within the time required by federal and state law and its failure to take final action on hearing requests within 90 days. The settlement sets out in detail the defendant's agreement to comply with the relevant standards and exceptions to the timeliness requirements. The case was brought as an individual action and plaintiff's counsel reports that with respect to eligibility determination, before the lawsuit delays were often 5-6 months and sometimes 12 months.
Plaintiff's attorney: Gretchen Bath, Rhode Island Legal Services, 56 Pine St., 4th Fl., Providence, RI 02903, tel. 401-274-2652.
Matter of Rivera v. DeBuono, QDS: 22701062. N.Y. Supreme Court, May 6, 1999 (www.nylj.com/decisions).
This case challenged a Fair Hearing decision that resulted in the discontinuation of petitioner's Medicaid-funded twenty-four-hour personal in-home care services and referral of petitioner to a residential care facility. Petitioner claimed that the hearing officer's determination violated State and Federal law and due process when he failed to provide petitioner an opportunity to testify and a Spanish interpreter. Upon notification that her personal care services would be discontinued, petitioner, a 79-year-old woman whose primary language is Spanish, requested a fair hearing which was held in two portions, one at the City office and one in her home. The first portion, at the City office, was attended only by the petitioner's niece because the petitioner was homebound. The second portion was conducted in the petitioner's living room while she remained in bed in another room. Again, the hearing officer only spoke with the petitioner's niece and did not provide an interpreter to speak directly to the petitioner. After both portions of the hearing, the hearing officer affirmed the termination of the personal care services. On appeal, the court agreed that petitioner's Due Process rights were violated. The court noted that because the hearing officer did not interview petitioner in either English or Spanish, the hearing was not "fair," and cannot properly be termed a "hearing." It further concluded that through these actions, the hearing officer did not afford the petitioner an opportunity to hear or be heard. The termination of the petitioner's personal care services was reversed and a new fair hearing was ordered. The court found that the petitioner is entitled to a Spanish interpreter to assist in her challenge to the termination.
In re C.B., Case No. 230271504-001 (Commonwealth of Pennsylvania Department of Public Welfare, Feb. 11, 1999 and March 18, 1999).
The appellant sought to challenge a work-related sanction and the agency's failure to provide various supportive services for various periods. In response to the CAO's argument that the appeal was untimely, appellant contended that the CAO never sent a written notice of the sanction. Since the CAO did not have any written record regarding the CA sanction and denial of supportive services, the hearing officer concluded that written notices had not been provided and that the appeal was timely. In the subsequent hearing on the merits, appellant prevailed in part on her claim for supportive services. The hearing officer concluded that she had not documented child care expenses for part of the period in issue and that with respect to her request for child care and transportation for another period, the agency had not recorded her request or notified her of its decision. Allowances were ordered for periods for which documentation was presented. The hearing officer also ordered benefits reinstated for the sanction period because the agency had not given the appellant written notice of its decision to sanction her.
In re T.W. (Commonwealth of Pennsylvania Department of Public Welfare, March 10, 1999).
The appellant appealed the County Assistance Office's (CAO) failure to provide her with an assessment and opportunity for training to become employable and its failure to provide written, as opposed to oral, notices of its decisions. After the CAO failed to participate in a telephone hearing without an explanation (either before or after the scheduled meeting), the appeal was automatically sustained and the CAO was directed to provide appellant with the assessment and opportunity for training and written notices of its decisions.
Appellants' attorney: Anne Vaughan, Delaware County Legal Assistance, 410 Welsh St., Chester, PA 19103, tel. 610-874-8421, fax 610-874-2171.