ORDERS:
ORDER
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.
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.
AND IT IS SO ORDERED;
_____________________________
Ralph King Anderson, III
Administrative Law Judge
December 7, 2004
Columbia, South Carolina |
