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Administrative Law Court
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SC Administrative Law Court Decisions

CAPTION:
David E. Smith, Jr. vs. SCDHHS

AGENCY:
South Carolina Department of Health and Human Services

PARTIES:
Appellant:
David E. Smith, Jr.

Respondents:
South Carolina Department of Health and Human Services
 
DOCKET NUMBER:
02-ALJ-08-0312-AP

APPEARANCES:
n/a
 

ORDERS:

ORDER

STATEMENT OF THE CASE

This matter is before the Administrative Law Judge Division (ALJD or Division) pursuant to S.C. Code Ann. § 44-6-190 (Supp. 2000) and S.C. Code Ann. §§ 1-23-310 et seq. (1986 & Supp. 2001). Appellant David E. Smith, Jr., seeks review of a decision of the South Carolina Department of Health and Human Services (DHHS or Department) that affirmed the termination of his Medicaid benefits by the Chesterfield County Department of Social Services (DSS). The Chesterfield County DSS determined that Appellant no longer met the financial eligibility requirements of the Aged, Blind or Disabled (ABD) Medicaid program through which he was receiving benefits. In response, Appellant contends that his monthly income is such that he should be eligible to receive ABD Medicaid benefits. Upon careful consideration of the record, the briefs filed, (1) and the applicable law, I find that the Department's decision to approve the termination of Appellant's Medicaid benefits must be affirmed.

BACKGROUND

On March 15, 2002, during a routine review of its files, the Chesterfield County DSS determined that Appellant no longer met the financial eligibility requirements of the ABD Medicaid program through which he was receiving benefits. Specifically, the Chesterfield County DSS found that Appellant's countable monthly income of $1324 exceeded the $739 allowable monthly income limit for ABD benefits. DSS calculated Appellant's countable monthly income by subtracting a $50 "general disregard" from Appellant's $1374 monthly income from Social Security benefits to arrive at a monthly income of $1324. The income limit for eligibility for ABD Medicaid benefits is set at 100% of the federal poverty level; at the time of the termination of Appellant's benefits, the ABD limit was $739 per month for an individual. Because Appellant's monthly income exceeded the income limit for ABD benefits by nearly $600, the Chesterfield County DSS discontinued Appellant's eligibility for those benefits effective April 1, 2002.

On March 22, 2002, Appellant made a request for a "fair hearing" before a DHHS hearing officer to challenge the decision to terminate his Medicaid benefits. The fair hearing was held on June 12, 2002, before DHHS hearing officer Kimberly B. Burrell. Appellant appeared at the hearing on his own behalf. Following the hearing, the hearing officer issued a decision on June 24, 2002, affirming the termination of Appellant's Medicaid benefits based upon the ABD financial eligibility requirements. By letter dated July 16, 2002, Appellant appealed that decision to this tribunal.

STANDARD OF REVIEW

When sitting in its appellate capacity, the ALJD reviews agency decisions under the standard of review set up in S.C. Code Ann. § 1-23-380(A)(6) (Supp. 2001). Under that standard, this tribunal is not entitled to "substitute its judgment for that of the agency as to the weight of the evidence on questions of fact." Id. However, this tribunal may reverse or modify the agency's decision if substantial rights of the appellant have been prejudiced because

the administrative findings, inferences, conclusions or decisions are:



(a) in violation of constitutional or statutory provisions;

(b) in excess of the statutory authority of the agency;

(c) made upon unlawful procedure;

(d) affected by other error of law;

(e) clearly erroneous in view of the reliable, probative and substantial evidence on the whole record; or

(f) arbitrary or capricious or characterized by abuse of discretion or clearly unwarranted exercise of discretion.



Id. "Substantial evidence" as used under this standard of review "is not a mere scintilla of evidence nor the evidence viewed blindly from one side of the case, but is evidence which, considering the record as a whole, would allow reasonable minds to reach the conclusion that the administrative agency reached or must have reached in order to justify its action." Lark v. Bi-Lo, Inc., 276 S.C. 130, 135, 276 S.E.2d 304, 306 (1981). This substantial evidence "is something less than the weight of the evidence, and the possibility of drawing two inconsistent conclusions from the evidence does not prevent an administrative agency's finding from being supported by substantial evidence." Id. at 136, 276 S.E.2d at 306. Accordingly, "[t]he findings of an administrative agency are presumed correct and will be set aside only if unsupported by substantial evidence." Rodney v. Michelin Tire Co., 320 S.C. 515, 519, 466 S.E.2d 357, 359 (1996).

DISCUSSION

In this appeal, Appellant does not dispute the fact that his monthly income from Social Security benefits is $1374 or that the appropriate eligibility limit for ABD benefits is a monthly income of $739. Rather, Appellant contends that his monthly child support payment of $206 and his monthly medical expenses of $435.10 should be deducted from his gross monthly income to determine his eligibility for the ABD program. The deduction of these expenses would place Appellant's income below the $739 limit for ABD eligibility. In response, DHHS argues that the ABD eligibility guidelines were properly applied by DSS and that the Department's decision affirming the termination of Appellant's benefits should be upheld.

While this tribunal, like the Department, is well aware of and greatly sympathetic to the difficult financial situation faced by Appellant, the Department's decision to uphold the termination of Appellant's ABD Medicaid benefits must be affirmed. All parties acknowledge that Appellant has a limited income from which to pay his child support obligations, his significant medical costs, and his other living expenses. However, the eligibility standards for the ABD Medicaid program simply do not allow for an exemption to the income limit or a reduction in an applicant's countable monthly income based upon such costs. And, there is no dispute that, without a reduction in his monthly income for those child support and medical costs, Appellant's countable monthly income far exceeds the eligibility limit for ABD benefits. Therefore, the Department's decision to approve the termination of Appellant's benefits must be upheld.

ORDER

In the case at hand, the DHHS hearing officer applied the Medicaid eligibility guidelines accurately and with an even hand, and her findings are supported by substantial evidence. Therefore, IT IS HEREBY ORDERED that the decision of DHHS to approve the termination of Appellant's ABD Medicaid benefits is AFFIRMED.

AND IT IS SO ORDERED.





______________________________

JOHN D. GEATHERS

Administrative Law Judge

Post Office Box 11667

Columbia, South Carolina 29211-1667



September 23, 2002

Columbia, South Carolina

1. Pursuant to the discretion granted under ALJD Rule 39, this tribunal determined that it was not necessary to hear oral arguments in this appeal.


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