Justia U.S. 5th Circuit Court of Appeals Opinion Summaries

Plantiff filed suit challenging the denial of his claim for disability benefits under Title II of the Social Security Act, 42 U.S.C. 423. Because the ALJ based his decision on a credibility assessment of plaintiff's testimony without holding an additional hearing as required by the Hearings, Appeals, and Litigation Law Manual (HALLEX), the court held that defendant was prejudiced by the HALLEX violation. Accordingly, the court reversed and remanded with instructions that the case be remanded to the Commissioner for further proceedings. View "Morgan, Jr. v. Colvin" on Justia Law

Plaintiff appealed the denial of her claims for disability insurance benefits (DIB) and supplemental security income benefits (SSI) based on a fractured ankle in 2011. The ALJ denied her claim, concluding that plaintiff's impairment did not equal the medical severity of an impairment listed in the C.F.R., which required plaintiff to show that her ankle injury rendered her unable to ambulate effectively for a full year after the May 2011 onset. Plaintiff requested review of her claim and submitted additional medical records. The Appeals Council made this additional evidence part of the record but denied the review without providing discussion of the newly submitted evidence. The court reversed and remanded for further proceedings because the court was unable to determine, from review of the record as a whole, if substantial evidence supports the Commissioner’s denial of benefits. View "Sun v. Colvin" on Justia Law

This action began in 1993 when Plaintiffs, representatives of a class of over 1.5 million Texas children eligible for Medicaid’s Early and Periodic Screening, Diagnosis, and Treatment program ("EPSDT"), sued various Texas state officials under 42 U.S.C. 1983 for violations of federal Medicaid law in the state’s implementation of the Program. The parties concluded a consent decree in 1996 in which Defendants promised to implement a number of changes, among which was a training program for participating health care providers. A few years later, after little progress had been made, the district court found Defendants in violation of the Decree. The Fifth Circuit reversed solely on Defendants' challenge to the Decree's validity under the Eleventh Amendment. In 2007, the parties agreed on a corrective action order to resolve Plaintiffs’ concerns with one part of the Decree. Defendants, believing their obligations to be satisfied, moved to dissolve that order and the associated Decree provisions under Rule 60(b)(5). The district court granted their motion. Plaintiffs appealed the district court’s termination of several provisions of the Decree decree and the dissolution of a related corrective action order pursuant to the first clause of Federal Rule of Civil Procedure 60(b)(5), that the judgment has been “satisfied, released, or discharged.” Finding no reversible error, the Fifth Circuit affirmed. View "Frew v. Suehs" on Justia Law

Plaintiff appealed the denial of her application for disability insurance benefits (DIB) and supplemental security income (SSI) benefits. The court vacated the district court's dismissal of plaintiff's complaint and remanded, holding that a rebuttable presumption against substantial gainful activity arises where a disability claimant's earnings are below the threshold set by the relevant statutory regulations. In this case, the Commissioner's failure to address plaintiff's earnings and apply the presumption is grounds for reversal. View "Copeland v. Colvin" on Justia Law

UT filed suit against the United States, seeking refund of the Social Security component of FICA taxes it paid with respect to the service of medical residents in 2005. The court affirmed the district court's denial of UT's motion for summary judgment and grant of the United States' motion for summary judgment, concluding that UT's residents are not "students" within the meaning of the student exclusion in Texas's 42 U.S.C. 418 agreement. Section 418 allows states to voluntarily opt-in to the Social Security system by entering into an agreement with the Commissioner of Social Security.View "University of Texas System, et al. v. United States" on Justia Law

Plaintiffs, Medicaid beneficiaries with near total disabilities, filed suit after being denied coverage for ceiling lifts under a categorical exclusion in the state's implementing Medicaid regulations. The district court granted summary judgment for the state. The court concluded that, under binding precedent, plaintiffs have an implied private cause of action under the Supremacy Clause to pursue their challenge; the state must comply with the requirements of the Medicaid Act, 42 U.S.C. 1396 et seq., but the Act does not preempt the state's categorical exclusions; and therefore, the court affirmed the grant of summary judgment and denied the motion to vacate. View "Detgen, et al. v. Janek" on Justia Law

SHA appealed the district court's grant of summary judgment in favor of plaintiff. The district court concluded that SHA acted arbitrarily and capriciously in terminating plaintiff's rental assistance benefits under the Housing Choice Voucher Program (Section 8) for failure to attend an annual recertification meeting. The court held that plaintiff followed SHA's requirements - including contacting SHA within three days of her receipt of SHA's notice and attempting to reschedule due to her mother's recent death - and that SHA's contrary decision was arbitrary and capricious. Because this conclusion disposed of the case, the court did not address the parties' remaining contentions. Accordingly, the court affirmed the judgment of the district court. View "Cooley v. Housing Auth. of the City of Slidell" on Justia Law

Oaks, a nursing facility, initiated contempt proceedings against the government because the government failed to abide by the district court's order enjoining the government from acting in accordance with a Notice of Termination relative to Oak's Medicare and Medicaid Provider Agreement. The court vacated the finding of contempt and reversed the judgment of the district court, concluding that the government complied with the injunction by delaying effectuation of the termination notice. View "Oaks of Mid City Resident Council v. Sebelius, et al." on Justia Law

After Hermann Hospital merged with Memorial Hospital System, creating the Memorial Herman Hospital System (MHHS), the Administrator denied MHHS's request for a Medicare loss payment under 42 C.F.R. 413.134(l). The court joined all other circuits that have ruled on the issue by holding that statutory mergers must be bona fide sales in order to be eligible for a depreciation adjustment under 42 U.S.C. 413.134(l). The court found that substantial evidence supported the Administrator's conclusion that the merger at issue failed to constitute a bona fide sale and, therefore, affirmed the judgment of the district court. View "Memorial Hermann Hospital v. Sebelius" on Justia Law

Plaintiff appealed the termination of her Medicaid benefits. At issue was the enforceability of a provision of the Medicaid Act, 42 U.S.C. 1396a(a)(8), under 42 U.S.C. 1983. The court concluded that section 1396a(a)(8) created a right enforceable under section 1983, and that exhaustion of Louisiana's procedure for judicial review was not required before a Medicaid claimant filed suit in federal court. Accordingly, the court affirmed the judgment of the district court denying DHH's motion to dismiss because plaintiff's claims were properly before the district court. View "Romano v. Greenstein" on Justia Law