ORDERS:
ORDER
In
the above-captioned matter, Appellant Phyllis McFadden appeals the Order of
Dismissal issued by Respondent South Carolina Department of Health and Human
Services (HHS or Department) on November 6, 2006, in which the Department
denied her application for Medicaid disability benefits under the aged, blind
or disabled (ABD) program. For the reasons set forth below, the Department’s
decision to deny Appellant’s application for disability benefits must be
affirmed.
BACKGROUND
On June 23,
2006, Appellant filed an application for Medicaid disability benefits under the
ABD Program with the Department. By a determination made on September 8, 2006,
a disability examiner with the South Carolina Department of Vocational
Rehabilitation denied Appellant's application for disability benefits because she was denied
disability benefits for the same condition by the federal Social Security
Administration (SSA) within the past year (September 6, 2006). Appellant was
notified of the denial by a letter dated September 18, 2006, and, on September
20, 2006, she submitted a request for a hearing before the Department on the
denial. On November 6, 2006, Barry W. Streeter, a hearing officer with the
Department, issued an Order of Dismissal in which he upheld the disability examiner's
determination that Appellant's application for ABD Medicaid benefits must be
denied under federal law based upon her prior denial for social security
disability benefits by the SSA. Appellant now appeals the Department's denial
of her application for ABD Medicaid benefits before the Administrative Law
Court (ALC or Court).
On
appeal, Appellant does not challenge the Department's finding that the
Department was precluded by federal law from independently evaluating her
disability because she was denied disability benefits by the SSA within one
year preceding her application for ABD benefits with the Department, but
rather, she simply argues that her medical conditions have, in fact, rendered
her disabled, such that she should receive disability benefits from the
Department under the ABD Program.
DISCUSSION
By federal
regulation, a state agency, like the Department, may not make an independent
determination on a claim for Medicaid disability benefits if the SSA has made a
disability determination on the same issues presented in the Medicaid
application, unless at least twelve months have passed since the SSA
determination was made, the claimant alleges a different disabling condition
from that reviewed by the SSA, or the claimant satisfies another regulatory
exemption. See 42 C.F.R. § 435.541(a)-(c). In the case at hand,
Appellant does not contest the Department's finding that the SSA had made a
disability determination based upon the same condition she raises in her
application for ABD Medicaid benefits within one year of the date of her
application for the ABD benefits. Nor does Appellant contend that she satisfies
one of the other regulatory exemptions from the general provision precluding
the Department from issuing a disability determination independent of the
determination made by the SSA. Therefore, while this Court is sympathetic to
the medical concerns raised by Appellant, I must affirm the Department's
determination that federal law precluded the Department from independently
reviewing her disability claim because of the prior disability determination
issued by the SSA regarding her condition.
ORDER
For the reasons
set forth above,
IT
IS HEREBY ORDERED that the Department's denial of Appellant's application
for Medicaid disability benefits under the ABD Program must be AFFIRMED.
AND
IT IS SO ORDERED.
__________________________________
JOHN D. MCLEOD
Administrative
Law Judge
March 15, 2007
Columbia, South Carolina
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