SC Administrative Law Court Decisions

This matter is before me as the result of Ms. Madison's appeal of a determination that she is not eligible for Medicaid benefits. The South Carolina Department of Health and Human Services (DHHS) has moved to dismiss Ms. Madison's appeal on the grounds that the Administrative Law Judge Division (ALJD) lacks jurisdiction in this matter for the following reasons: (1) Ms. Madison failed to file the appeal in a timely manner; and (2) the appeal request filed by Ms. Madison fails to meet the required level of specificity in order to invoke a review of the agency's decision under the provisions of the Administrative Procedures Act. For the reasons discussed below, I find that the agency's motion should be granted and that this appeal should be dismissed.

This case involves an eligibility determination by the South Carolina Medicaid Program, which is administered by DHHS. Acting on behalf of DHHS, the Aiken County Department of Social Services, and the South Carolina Department of Vocational Rehabilitation (VR) determined that Ms. Madison was not "disabled" under the relevant federal criteria. Because she did not meet the disability criteria, Ms. Madison did not qualify for Medicaid.

Ms. Madison exercised her right to an administrative appeal of this determination. An administrative "fair hearing" was held on January 7, 1997, and was conducted by the Honorable Vastine G. Crouch, Jr., a Hearing Officer in the Appeals Division of DHHS. On Friday, February 14, 1997, an Administrative Decision was issued by Mr. Crouch affirming the finding that Ms. Madison was not eligible for Medicaid.

By letter dated March 25, 1997, Ms. Madison requested an appeal before the ALJD. The entire text of the appeal request reads as follows:

I, Frankie J. Madison, am asking that you'll will [sic.] go back into my case, once again, and reconsider my case again. I need help! In [sic.] getting my Doctors bills paid. I need some insurance to help pay my Doctors bills, when I have appointments for check-ups.

The appeal request makes no allegations regarding any factual or legal errors by DHHS or by the Hearing Officer, nor does it contain any details regarding Ms. Madison's grounds for this appeal. Pursuant to the Department's Motion to Dismiss, the Petitioner filed a letter dated May 17, 1997. In that letter, the Petitioner stated no reason as to why she failed to file an appeal within thirty (30) days. Her letter simply reiterated her desire to receive Medicare and/or Medicaid reimbursements for doctors bills she has incurred but is unable to pay because her employer does not provide her medical insurance.

In order to invoke the jurisdiction of the Administrative Law Judge Division in an appeal of an agency decision, an individual is required to comply with the requirements of S.C. Code Ann. §1-23-380. The petition for appeal must be filed within thirty (30) days of the receipt of the decision being appealed, and the petition must state the specific grounds for the appeal. Id.; see also ALJD Rule 33. DHHS contends that the petition for appeal submitted by Ms. Madison in this case was not filed within the required time period, and does not contain the required level of specificity with respect to the basis for the appeal. Either of these defects is sufficient to deprive the ALJD of jurisdiction and requires the dismissal of this action.

As previously noted, a petition for the appeal of an agency's administrative decision must be filed within thirty (30) days of the receipt of that decision. The decision of the DHHS Hearing Officer and the accompanying cover letter, both dated February 14, 1997, were sent to Ms. Madison by certified mail with a return receipt requested. The signed receipt shows that Ms. Madison received these materials on February 20, 1997. However, Ms. Madison's request for an appeal was dated March 25, 1997 -- thirty-three (33) days after her receipt of the agency's decision. Because this appeal was not instituted within the thirty (30) day period as required by the Administrative Procedures Act, jurisdiction failed to vest with the ALJD and the appeal must be dismissed.

In order for an administrative appeal to be properly instituted, the Administrative Procedures Act (A.P.A.) requires that the basis for the appeal -- i.e., the alleged error(s) of law or the alleged erroneous factual finding(s) -- must be set forth. See, S.C. Code Ann. §1-23-380 (Supp. 1996). The South Carolina Supreme Court has repeatedly held that the failure to do so is fatal to the appeal, since the A.P.A. does not allow jurisdiction to vest in the absence of a sufficient notice of appeal. Pringle v. Builders Transport, 298 S.C. 494, 381 S.E.2d 731 (1989), (citing Smith v. South Carolina Dept. of Social Services, 284 S.C. 469, 327 S.E.2d 348 (1985)).

Furthermore, in both Smith and Pringle, the Supreme Court specifically held that the liberal policy of allowing the amendment of pleadings does not apply to the amendment of a petition for appeal filed under the A.P.A. after the expiration of the thirty (30) day statutory period for filing the appeal. Smith at 471, 327 S.E.2d at 349. Pringle at 495-96, 381 S.E.2d at 732.

The letter requesting this appeal does not allege that any error -- factual or legal -- was committed by DHHS during the agency-level appeal or by DSS or VR in the underlying eligibility determination. Therefore, this appeal has not been perfected as required by the A.P.A., and consequently must be dismissed for lack of jurisdiction.

ORDER

The Motion to Dismiss is GRANTED and this appeal is hereby DISMISSED.

AND IT IS SO ORDERED.

______________________________

Ralph King Anderson, III

Administrative Law Judge

Columbia, South Carolina

June 11, 1997