ORDERS:
ORDER
I. STATEMENT OF THE CASE
Rosemarie Knight's (Knight) application for Medicaid benefits through the Aged, Blind and
Disabled Program (ABD) was denied by the Horry County Department of Social Services (DSS)
for failure to meet the ABD's financial eligibility requirements. This matter is before the
Administrative Law Judge Division (ALJD) since Knight has appealed the South Carolina
Department of Health and Human Services's (DHHS) decision upholding the DSS denial of
Medicaid benefits.
On June 17, 1997, Knight applied for ABD Medicaid benefits with DSS in order to assist her in
paying overbearing monthly medical and pharmaceutical expenses. Knight suffers from asthma,
emphysema, depression, and other serious medical conditions. The monthly expenses related to
Knight's medical problems exceed her ability to pay for them.
Knight's monthly income totaled $1,229 (the sum of: Social Security benefits of $100 per month;
retirement benefits of $399 per month; and alimony of $750 per month; minus the "unearned
income disregard" allowable deduction of $20). The ABD eligibility limit was $658 per month for
an individual at the time of Knight's application. Applying the ABD income limitation, DSS denied
Knight's application.
In accordance with S.C. Code Ann. Regs. 126-152, Knight appealed the DSS determination of
ineligibility, requesting a contested case ("fair") hearing before a DHHS hearing officer. The
DHHS hearing was held on July 31, 1997. The hearing officer, Vastine G. Crouch, issued a final
order and decision on September 29, 1997 affirming the denial of benefits based upon the ABD
financial eligibility requirements.
On October 9, 1997, Knight petitioned the ALJD for a review of the decision of the DHHS hearing
officer. While not disputing the fact that her monthly income exceeds the ABD eligibility limit,
Knight appeals seeking an exemption due to the high cost of her medical expenses. DHHS seeks
affirmance of the Hearing Officer's decision based on the fact that the ABD eligibility requirements
were properly applied. In addition, DHHS asserts that there are no exceptions to the ABD income
limit applicable to Knight.
This appeal to the ALJD is pursuant to S.C. Code Ann. § 1-23-380 (Supp. 1997) and S.C. Code
Ann. § 44-6-190 (Supp. 1997). Oral arguments on the appeal of this case were heard on February
5, 1998 at the Horry County Courthouse. Upon consideration of the briefs, the arguments
presented, and a review of the applicable law, the decision of the DHHS hearing officer is affirmed.
II. Issue on Appeal
Does substantial evidence support the DHHS hearing officer's decision to deny Knight's application
for Medicaid benefits through the Aged, Blind, and Disabled Program based upon Knight's failure
to meet the financial eligibility requirements?
III. Law and Analysis
A. Scope of Review
This matter is an appeal under the appellate jurisdiction of the Administrative Procedures Act. S.C.
Code Ann. § 1-23-380(A)(6) (Supp. 1997). As the appellate body, the ALJD must determine if
substantial evidence supports the factual basis of the decision made below with the burden of
establishing a lack of substantial evidence on Knight as the party appealing. See Waters v. S.C.
Land Resources Conservation Comm'n, 321 S.C. 219, 467 S.E.2d 913 (1996). Substantial
evidence is established when the record as a whole allows reasonable minds to reach the same
conclusion reached by the hearing officer. Bilton v. Best Western Royal Motor Lodge, 282 S.C.
634, 321 S.E.2d 63 (Ct. App. 1984). The fact that different conclusions could be reached from the
record does not demonstrate a lack of substantial evidence. Grant v. S.C. Coastal Council, 319
S.C. 348, 461 S.E.2d 388 (1995). Indeed, in reviewing the facts found by the hearing officer, the
appellate body may not substitute its judgment for that of the officer who rendered the decision
below and the appellate body may not reweigh the evidence on questions of fact. Lark v. Bi-Lo,
276 S.C. 130, 276 S.E.2d 304 (1981). On the contrary, the factual findings of the hearing officer
are presumed to be correct. Rodney v. Michelin Tire Co., 320 S.C. 515, 466 S.E.2d 357 (1996).
B. Application of Substantial Evidence Rule
In this case, the DHHS hearing officer made a factual finding that Knight was ineligible for
Medicaid benefits because her monthly income, after deducting allowable exclusions, exceeded the
financial limit of the ABD program. Knight has not alleged, nor does the record indicate, that the
hearing officer made any error in making this finding. Nor has Knight disputed the accuracy of the
income figures or eligibility limits applied by the hearing officer.(1) Rather, Knight seeks an
exemption from the Medicaid income limit due to the high costs of her medical treatment and the
inadequacy of her monthly income to pay for such treatment.
The record indicates that DHHS, in addition to this tribunal, is well aware of the difficult situation
Ms. Knight faces with regard to her high medical costs. Unfortunately, the Medicaid eligibility
rules simply do not allow for any exceptions to the income limit in situations where applicants are
faced with overbearing health care costs. The hearing officer's ruling applied the Medicaid
requirements accurately and with an even hand. To have done otherwise, and grant an exemption
where none was provided for, would have constituted unequal application of the law warranting
appellate reversal.
In sum, the facts in this case as applied to the governing law do not indicate any error on the part
of the DHHS hearing officer that would satisfy the substantial evidence standard of review.
IV. Conclusion
Accordingly, the order and decision of the hearing officer denying Knight ABD Medicare benefits
is affirmed.
AND IT IS SO ORDERED.
RAY N. STEVENS
Administrative Law Judge
This 13th day of February, 1998
Columbia, South Carolina.
1. The ABD Medicaid program imposes an income limit that is set at 100% of the federal poverty limit. At
the time of Knight's application, the ABD limit was $658 per month for an individual. Knight's countable income
(gross income minus any allowable deductions) was $1,229 per month - an amount well in excess of the ABD limit. |
