SC Administrative Law Court Decisions

This is an appeal from a final decision of the South Carolina Department of Health and Human Services Division of Appeals and Hearings dated January 5, 1998. Appellant challenges the decision of the DHHS Hearing Officer, which affirmed the determination of the Berkeley County Department of Social Services, to terminate her Medicaid benefits through the Aged, Blind and Disabled Program (ABD). Calculations prepared by DSS showed that Appellant's countable monthly income exceeded the allowable limit for ABD benefits. These calculations were verified by the DHHS Hearing Officer. An appeals hearing was conducted on May 26, 1998 at the Administrative Law Judge Division (ALJD) in Columbia, South Carolina, for the presentation of oral arguments. However, Appellant failed to appear at the hearing.

STANDARD OF REVIEW

The Administrative Procedures Act, S.C. Code Ann. §§ 1-23-310 et seq. (Rev. 1986 and Supp. 1997) establishes the standard of review for appeals of agency decisions. In reviewing the evidence in an appeal of a contested case, the ALJD is limited to determining whether substantial rights of the Appellant have been prejudiced because the administrative findings, inferences, conclusions, or decisions are clearly erroneous in view of the reliable, probative, and substantial evidence on the whole record. S.C. Code Ann. § 1-23-380 (A)(6)(e) (Supp. 1997). In accordance with the foregoing provision, the Hearing Officer's 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, 134, 276 S.E.2d 304, 306 (1981).

DISCUSSION

DHHS administers the Medicaid program in South Carolina. Under contract with DHHS, the Department of Social Services acts as DHHS's agent in processing applications for Medicaid eligibility and rendering eligibility determinations. An applicant who disagrees with the determination of DSS may request a "fair hearing" before the DHHS Division of Appeals and Hearings. Appellant participated in a "fair hearing" on December 18, 1997. Based on her letter filed with this tribunal on March 20, 1998, Appellant generally challenges being denied Medicaid benefits, especially in light of her costly medical expenses incurred each month.

Appellant received Medicaid assistance from March 1990 to December 1997, at which time the benefits were terminated. She began working in June of 1997 at Charleston Lincoln Mercury in North Charleston, and her gross earned income increased to $1,231.36 per month. This earned income was verified by the DSS agent who performed Appellant's annual review. In determining Appellant's countable earned and unearned income for purposes of ABD eligibility, DSS used the following formula:

Gross Monthly Earned Income (avg.) $1231.36

Standard Earned Income disregard - $ 65.00

$1166.36

Divide remainder by 2 ÷ 2

Countable Monthly Earned Income $ 583.18 (A)

Gross Monthly Social Security Benefit $ 507.00

Unearned disregard - $ 20.00

Countable Monthly Unearned Income $ 487.00 (B)

Total Countable Monthly Income (A + B) $1070.18

In order to be eligible, an individual's countable monthly income cannot exceed $658.00. Appellant's Medicaid benefits were terminated because her countable monthly income was correctly determined to be $1,070.18, which exceeded the ABD limit.

Appellant contends that because she has significant medical expenses, her Medicaid benefits should not have been terminated. A letter from Dr. Charles Bounds confirmed that Appellant had been suffering from panic attacks, high blood pressure, dyspepsia, allergic rhinitis, and asthma. While it is not disputed that Appellant suffers from these illnesses which generate substantial medication costs, no provision is made to consider these costs in the ABD eligibility calculation.⁽¹⁾

This tribunal understands and is sympathetic to the high cost of Appellant's monthly medications. However, this tribunal will not substitute its judgment for that of the agency except where a "manifest or gross error of law has been committed by the administrative agency." Lark v. Bi-Lo, Inc., 276 S.C. at 134, 276 S.E.2d at 307 (1981). No such error has been established here. Further, the record supports the Hearing Officer's findings of fact and conclusions of law.

Based upon the record and the applicable law, the Order and Decision of the Hearing Officer is AFFIRMED.

_____________________________

JOHN D. GEATHERS

Administrative Law Judge

Post Office Box 11667

Columbia, South Carolina 29211-1667

June 30, 1998

Columbia, South Carolina

1. Pursuant to 42 U.S.C. § 1396a(a)(17) (1998), a state may elect to provide medical benefits to the "medically needy," defined as persons who meet the nonfinancial eligibility requirements but exceed the financial eligibility standards under AFDC or SSI. Atkins v. Rivera, 477 U.S. 154, 159 (1986). The record does not indicate that South Carolina has elected to participate in this program.