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 |