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. |
