Articles Posted in Public Benefits

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Seven entities under contract to provide residential services to youth in the state (collectively, Petitioners) filed a petition for writ of mandamus requiring the West Virginia Department of Health and Human Services (DHHR), its Cabinet Secretary, the West Virginia Bureau for Medical Services (BMS), its Acting Commissioner, the Bureau for Children and Families (BCF), and its Commissioner (collectively, Respondents) to promulgate new or amended legislative rules prior to implementing changes to existing residential child care services policies. The Supreme Court granted a writ as moulded, finding it most appropriate to order this matter to be docketed in this circuit court as if it were an original proceeding in mandamus in that court. Remanded for further proceedings. View "State ex rel. Pressley Ridge v. W. Va. Department of Health & Human Resources" on Justia Law

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Petitioner has been employed by the Raleigh County Board of Education as a physical therapist since 1987. Her initial “Teacher’s Probationary Contract of Employment” provided that she would be paid an annual salary “for an annual employment term of 120 days.” In 1989, petitioner executed a “Continuing Contract of Employment,” which likewise provided that she was to be employed “for an employment term of 120 days.” She requested enrollment in the Teachers’ Retirement System (TRS). Contributions on petitioner’s behalf were made to TRS continuously from 1987 through 1991, when she enrolled in the newly-created Teachers’ Defined Contribution System and froze her TRS contributions. In 1999, she transferred her TRS funds and service credit into TDC. In 2008, petitioner transferred back to the TRS. The Board ascertained that petitioner was ineligible to participate in either plan because she was only working 120 days a year and indicated that the money contributed would be returned to her and her employer. Petitioner testified that she believed that those working less than 200 days were not ineligible, but would merely receive fractional service credit for the year. The hearing examiner determined that West Virginia Code 18-7A-3 requires a 200-day contract before one may participate in TRS, but that there was no such 200-day requirement to participate in TDC. The circuit court affirmed. The Supreme Court of Appeals affirmed, stating that it was “sympathetic," but could not confer statutory eligibility where none exists. View "Ringel-Williams v. W.V. Consol. Pub. Retirement Bd." on Justia Law

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Beckley Appalachian Regional Hospital (Beckley ARH) was a voluntary provider of medical services through the Medicaid program pursuant to an agreement executed between it and the West Virginia Bureau for Medical Services (BMS). Beckley ARH filed a lawsuit against the West Virginia Department of Health and Human Resources and its secretary and the BMS and its commissioner (collectively, Respondents), seeking a remedy for inadequate Medicaid reimbursement rates. The circuit court dismissed the complaint for failure to state a claim upon which relief could be granted. The Supreme Court affirmed, holding that W. Va. Code 9-15-16 and 16-29B-20 do not provide for an express or implied private cause of action by a Medicaid provider for judicial review of reimbursement rates for medical services.View "Appalachian Reg'l Healthcare v. W. Va. Dep't of Health & Human Res." on Justia Law

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Petitioner filed to receive food stamp benefits under the Supplemental Nutrition Assistance Program as a separated spouse in a one-person household. The Department of Health and Human Resources (DHHR) determined that Petitioner and her husband (Husband) were living together for seventeen months after Petitioner filed to receive food stamps and sent Petitioner a notice of overpayment. Petitioner requested a hearing, and a hearing examiner affirmed the DHHR's overpayment claim. The circuit court affirmed, finding that Petitioner had not submitted sufficient evidence to support her claim that she and Husband had separate residences. The Supreme Court reversed the judgment of the circuit court and remanded for entry of an order granting Petitioner's petition for a writ of certiorari and dismissing the DHHR's overpayment claim, holding that the DHHR failed to prove that Petitioner and Husband lived together during the seventeen month time period of the overpayment claim, and the claim should have been dismissed at the conclusion of DHHR's evidence. View "Hudson v. Bowling" on Justia Law

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Infant was born with severe brain damage. Respondent, Infant's mother, on behalf of Infant, applied for and received Medicaid benefits from the West Virginia Department of Health and Human Resources (DHHR). Respondent later filed a medical malpractice lawsuit on behalf of Infant. Subsequently, Respondent petitioned the circuit court for approval of the settlement, requesting that Medicaid not be reimbursed. DHHR intervened. The court granted the motion of Respondent for allocation of the $3,600,000 settlement, holding that, pursuant to Arkansas Department of Health and Human Services v. Ahlborn, a proportional reduction of DHHR's recovery was required based on the ratio of the settlement to the "full value" of the case among the various damages categories. Using this allocation method, the court reduced DHHR's statutory reimbursement from the requested amount of $289,075 to $79,040 and directed that the net settlement proceeds be placed in a special needs trust for the benefit of Infant. The Supreme Court reversed in part and affirmed in part, holding (1) a $500,000 cap on noneconomic damages was applicable in this case; and (2) under the formula applied in Ahlborn, the DHHR was entitled to approximately $98,080, less its pro rata share of attorney's fees and costs. Remanded. View "In re E.B." on Justia Law

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Petitioner, J.S., was a thirteen-year-old boy who suffered from cerebral policy. Through his mother, J.S. submitted an authorization request for a power wheelchair with fifty-five accessories to the respondent, the state department of health and human resources (DHHR), which administers the Medicaid program in West Virginia. DHHR denied Petitioner's request on the basis that it exceeded the Medicaid policy of providing only the most economical equipment to meet a recipient's basic health care needs. The DHHR board of review upheld the denial. The circuit court upheld the decision. The Supreme Court reversed, holding that the circuit court applied an erroneous standard of review to the decision of the DHHR board of review. Remanded to the circuit court with direction to make an independent review of both the law and the facts of this case. View "J.S. v. Hardy" on Justia Law

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Upon granting Husband and Wife a divorce, the family court directed Husband to pay $1,000 per month in spousal support. The court found that the award did not need to be paid out of Husband's veteran's disability benefits. The circuit court set aside the award of permanent spousal support and directed Husband to pay supposal support in the amount of $500 per month for eighteen months. The Supreme Court reversed, holding (1) in determining the amount of spousal support to be awarded, federal service-connected veterans disability benefits received by the payor spouse may be considered by the family court as a resource, along with the payor's other income, in assessing the ability of the payor to pay spousal support; and (2) because the circuit court, among other things, (i) failed to address with any specificity Husband's veterans benefits or the parties' Social Security awards, (ii) failed to address with specificity how those disability benefits were taken into account in setting aside the family court decision, and (iii) did not determine that any of the factual findings of the family court were clearly erroneous, the action was remanded to the circuit court for further proceedings. View "Zickefoose v. Zickefoose" on Justia Law