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SC Administrative Law Court Decisions

Kevin Riffe vs South Carolina Department of Health and Human Service

South Carolina Department of Health and Human Services

Kevin Riffe

South Carolina Department of Health and Human Services





This is an appeal from the Department of Health and Human Services (DHHS).  Appellant Kevin Riffe applied for benefits from Medicaid under the Aged, Blind or Disabled (ABD) program on September 22, 2008.  Upon referral to Respondent’s agent for disability determination, South Carolina Department of Vocational Rehabilitation (VR), no evaluation was done because the Social Security Administration (SSA) had made a disability determination of NOT Disabled within 12 months of the application date and denied Appellant’s application for disability.  VR found that Appellant’s Medicaid application allegations were the same allegations made in his SSA application.  From the decision of the DHHS Hearing Officer finding that Federal law, found at 42 U.S.C. § 435.541 (a) and (b), controlled his decision, Appellant has appealed.

           Respondent argues in its Motion to Dismiss that it is not free to disregard disability determinations made by SSA.  Rather, it argues that when SSA has made a determination of no disability, it may not make an independent finding on that same issue since the SSA determination is binding. 42 C.F.R. § 435.541(a)(2) and (b)(i), see also Sebastian v. Commissioner of Human Services, 1993 WL 642701 (M.D. Tenn. 1993) (“Specifically, if the Social Security Administration (SSA) has made a determination of non-disability for SSI benefits purposes, then the state agency must defer to this decision and cannot redetermine Medicaid eligibility on disability.”).  These same federal regulations have been judged to show an intent “that the federal agency’s determination of nondisability supercedes [even] a previous state agency determination of disability.” Disabled Rights Union v. Kizer, 744 F. Supp. 221, (C.D. Cal. 1990), 42 C.F.R. § 435.541 (b)(ii).  Further, in 1989, the Social Security Administration published, at 54 Fed. Reg. 50,755 (December 1989), the final rule and public comments when adopting 42 C.F.R. § 435.541 containing the following wording:  “SSA has an ongoing process for making disability determinations and has a high level of expertise in this area.  It is not in the interest of program efficiency or in the best interest of recipients for States to perform duplicate tasks, which might arrive at different or conflicting determinations of eligibility.  To do so would be wasteful of Federal tax dollars; and, would subject recipients unnecessarily to application of two separate processes.” 

           Having reviewed both Respondent’s Motion to Dismiss as well as the law on this subject, I find that federal law justifies Respondent’s position.  Since SSA had made a ruling on Appellant’s application within twelve months of his Medicaid application and that the same allegations for disability were made in both applications, the Hearing Officer was without jurisdiction to issue a ruling inconsistent with SSA’s ruling. I find that Appellant’s sole remedy is to appeal his SSA denial and the outcome of that appeal will control his Medicaid application. Appellant has a pending SSA appeal and, therefore, that decision will control.  The Hearing Officer, in Finding 7, has ruled that September 22, 2008 will be the date Medicaid benefits would begin were Appellant to prevail in an SSA appeal and I so find.  In the alternative, Appellant can reapply for Medicaid and allege and prove disability based upon conditions that have not been ruled on by the SSA.

           Because the agency did not acquire subject matter jurisdiction to grant the relief requested pursuant to federal law, this Court, likewise, may not grant the relief requested. This appeal should be dismissed.

IT IS THEREFORE ORDERED that this appeal should be and therefore is dismissed.



May 20, 2009

Columbia, SC


John D. McLeod, Judge

S.C. Administrative Law Court


Brown Bldg.






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