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SC Administrative Law Court Decisions

Nellie H. Roberson vs. SCDHHS

South Carolina Department of Health and Human Services

Nellie H. Roberson

South Carolina Department of Health and Human Services




This matter is before me on an appeal filed by Nellie Roberson. Effective January 1, 2004, the Respondent made certain changes to the Medicaid program by instituting cost sharing pursuant to 42 CFR 447.50, et seq. Medicaid Cost Sharing is a procedure under which Medicaid recipients are required to assume some degree of responsibility for their medical care by making a minimal co-payment toward each bill for covered services they receive. Under these changes, all Medicaid recipients with certain exceptions are required to make a co-payment before receiving medical services.

A number of recipients appealed this action and a group hearing was held pursuant to 42 CFR 431.222 on June 2, 2004. The majority of appellants failed to appear for the hearing but Appellant Roberson presented her case on behalf of the group. Afterwards, the Hearing Officer entered his Order on June 14, 2004, denying Ms. Roberson’s request to carve out additional exceptions to the federal law. This appeal followed.

In her appeal dated June 29, 2004, Ms. Roberson, who does not fall into one of the excluded groups, urged this Court to reverse the Respondent’s decision to impose “cost sharing” because the limited exclusion of certain groups of Medicaid recipients is discriminatory. The Respondent moved to dismiss the appeal asserting that Ms. Roberson had neither complied with the Rules of Procedure for the Administrative Law Court nor stated sufficient grounds in her Notice of Appeal upon which relief can be granted.

Having read Appellant’s Notice of Appeal and Respondent’s Motion to Dismiss, I dismiss this appeal for failure to state sufficient grounds upon which relief can be granted. Footnote

Generally, a Notice of Appeal must specifically direct the reviewing Court’s attention to errors or abuses committed by the lower tribunal. A mere expression of dissatisfaction with the ruling is not sufficient. Smith v. SC DSS, 284 S.C. 469, 327 S.E. 2nd 348 (1985). Moreover, the Appellant’s arguments must set forth grounds upon which relief can be granted. Id.; Rowe v. City of West Columbia, 334 S.C. 400, 513 S.E.2d 379 (S.C. App. 1999) (“Lack of subject matter jurisdiction may not be waived, even by consent of the parties, and should be taken notice of by this Court.”).

Ms. Roberson's allegations only point to a general dissatisfaction with the Department’s Order. She merely states: “I am being discriminated against because I am not young/pregnant, etc. but [59 yrs] old and sickly.” Furthermore, it is clear from the Respondent’s Motion and the Transcript of Record that Respondent was simply following the constraints of the federal Medicaid law on cost sharing found at 42 CFR 447.50, et seq. That law clearly and unambiguously sets forth groups and services that were exempt from cost sharing. Specifically, 42 CFR 447.53 excludes children, pregnant women, institutionalized individuals and emergency services from cost sharing. The Appellant does not allege that she is in one of the specifically enumerated groups but rather simply argues that the law setting forth those groups is discriminatory.

Since Ms. Roberson’s general assertion of discrimination is expressly provided for in federal law and she has provided no basis upon which the Administrative Law Court could reverse the Agency’s decision, I therefore uphold the Agency’s determination in this matter and dismiss this appeal.



Ralph King Anderson, III

Administrative Law Judge

December 7, 2004

Columbia, South Carolina

Brown Bldg.






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