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Administrative Law Court
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SC Administrative Law Court Decisions

CAPTION:
Phyllis McFadden vs. SCDHHS

AGENCY:
South Carolina Department of Health and Human Services

PARTIES:
Appellant:
Phyllis McFadden

Respondent:
South Carolina Department of Health and Human Services
 
DOCKET NUMBER:
06-ALJ-08-0951-AP

APPEARANCES:
n/a
 

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[1] 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



[1] The Department of Health and Human Services contracts with the Department of Vocational Rehabilitation to conduct disability determinations for applicants for disability benefits.


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