South Carolina              
Administrative Law Court
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SC Administrative Law Court Decisions

CAPTION:
Bessie L. Dabbs vs. SCDHHS

AGENCY:
South Carolina Department of Health and Human Services

PARTIES:
Appellant:
Bessie L. Dabbs

Respondents:
South Carolina Department of Health and Human Services
 
DOCKET NUMBER:
96-ALJ-08-0497-AP

APPEARANCES:
For the Appellant, Bessie L. Dabbs: pro se

For the Respondent, S. C. Department of Health and Human Services: Charles M. Black, Jr., Assistant General Counsel
 

ORDERS:

ORDER

This matter is before me pursuant to the appeal of Ms. Bessie L. Dabbs ("Appellant"), from the decision of the South Carolina Department of Health and Human Services ("Respondent" or "Department") pursuant to S. C. Code Ann. § 1-23-380 (Supp. 1996) and S. C. Code Ann. § 44-6-190 (Supp. 1995). After conducting a contested case ("fair") hearing, the hearing officer issued his Order on November 8, 1996, affirming the decision of the Lexington County Department of Social Services that Appellant failed to meet financial eligibility criteria to receive Medicaid benefits through the Aged, Blind and Disabled/Qualified Medicare Beneficiary (ABD/QMB) Program. Appellant is appealing that decision.

A hearing was held at the Administrative Law Judge Division on April 16, 1997, after notice to the parties. As agreed to by the parties, the Appellant was provided the opportunity to present evidence and testimony at the appellate hearing in lieu of the case being remanded, because the Department was unable to provide to this reviewing tribunal a transcript of the contested case proceeding. Upon consideration of the briefs and the arguments and testimony presented at the hearing, together with a review of the applicable law, the order and decision of the hearing officer is affirmed.



STATEMENT OF THE CASE

On appeal, Appellant argues for a reversal of the decision and order of the hearing officer, alleging her entitlement for medical assistance under the Aged, Blind and Disabled program. She argues that, even though her monthly income is approximately $22.00 in excess of the monthly eligibility limit, consideration should be given to her medical problems and her large requirements for medical care and medicines. The Department seeks affirmance of the order and decision of the hearing officer on two grounds: (1) appellant has not alleged any error or erroneous findings in the order and decision of the hearing officer, either in her letter requesting the appeal and review by the Division or in her brief and, thus no jurisdiction is with the Division; (2) the Department properly applied the Medicaid eligibility rules in this case and there are no exceptions to the income limit, which is determined by federal law.

FACTS

On August 14, 1996, the Appellant applied for Medicaid benefits with the Lexington office of the Department of Social Services. Her request for Medicaid ABD benefits was denied by that office on September 9, 1996. In accordance with S. C. Code Regs. 126-152, on September 13, 1996 Appellant appealed that determination to the Department's Appeals Division, requesting a contested case ("fair") hearing. That hearing was held on November 4, 1996. The hearing officer, Lester D. Bockow, issued his final order and decision on November 8, 1996 in which he affirmed the determination of the caseworker, finding that Appellant's income exceeded the allowable limits to qualify for the Medicaid benefits.

On November 25, 1996, Appellant petitioned the Division for a review of the decision of the hearing officer, feeling that she is entitled to benefits because her income is only $22.00 over the maximum of $645.00 per month, and the formula does not account for her medical bills. The Department was unable to provide a transcript of the proceedings before the hearing officer. However, after a conference with both parties at the Division offices on February 11, 1997, the parties agreed to proceed with the hearing and allow Appellant to present testimony in lieu of remanding the case for another proceeding before the hearing officer.

DISCUSSION AND STANDARD OF REVIEW

In appeals involving the South Carolina Department of Health and Human Services, the standard of review is set forth in the Administrative Procedures Act (APA). The APA provides that an Administrative Law Judge may affirm the decision of the agency or remand the case for further proceedings, or may reverse or modify the decision if substantial rights of the appellant have been prejudiced because the administrative findings, inferences, conclusions or decisions are:

(a) in violation of constitutuional 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;

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

S.C. Code Ann. § 1-23-380 (A)(6)(Supp. 1996).

In accordance with the foregoing statutory provision, the order and decision may only be set aside if unsupported by "substantial evidence." " 'Substantial evidence' 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, 276 S.E.2d 304, 306 (1981).

Application of this standard is appropriate only in those cases where a "manifest or gross error of law has been committed by the administrative agency. The statute specifically states; 'The court shall not substitute its judgment for that of the agency as to the weight of the evidence on questions of fact.'" Id. at 307. The party challenging an agency action has the burden of proving convincingly that the agency's decision is unsupported by substantial evidence. Waters v. S. C. Land Resources Conservation Comm'n, ___S. C. ___, 467 S. E. 2d 913 (1996).

In this case, the hearing officer made a factual finding that the Appellant is ineligible for Medicaid benefits because her income, after deducting allowable exclusions, exceeded the allowable limit. Appellant has not alleged that the hearing officer made an error in making such finding, only that there should be some exception in the law to provide Medicaid benefits for individuals such as herself who have large medical expenses. The South Carolina Supreme Court has repeatedly held that the failure to allege proper grounds for appeal, i.e., an alleged error of law or an alleged erroneous finding of fact, is fatal to the appeal. Pringle v. Builders Transport, 298 S. C. 494, 381 S. E. 2d 731 (1989), citing Smith v. DSS, 284 S. C. 469, 327 S. E. 2d 348 (1985). Such failure on the part of the Appellant to allege a proper ground as authorized by the Administrative Procedures Act requires this tribunal to deny the appeal. Further, I find that the law was correctly applied by the hearing officer to the factual situation presented to him at the contested case hearing and that the decision of the hearing officer is supported by the substantial evidence in the record.

ORDER


Based upon the record, the testimony presented at the hearing, and the applicable law, the order and decision of the hearing officer is AFFIRMED.

AND IT IS SO ORDERED.





_________________________________

Marvin F. Kittrell

Chief Judge

Columbia, South Carolina

April 28, 1997


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