ORDERS:
ORDER
STATEMENT OF THE CASE
This case is before the Administrative Law Judge Division (ALJD) as an appeal of a decision rendered by a Hearing Officer
of the Department of Health and Human Services (Department or HHS). Appellant's daughter, Amanda, was afforded
Medicaid coverage under the "Partners for Healthy Children" (PHC) program. PHC provides Medicaid benefits to children
whose families meet specified income guidelines (currently set at 150% of the federal poverty levels, based upon family size).
Coverage under PHC may continue through the end of the month in which the child turns nineteen .
By letter dated February 22, 1999, Appellant was notified that her daughter's Medicaid benefits would be terminated
effective April 1, 1999, because Amanda was turning nineteen on March 13, 1999. Appellant instituted an administrative
appeal, and a fair hearing was held on April 13, 1999. On April 14, 1999, the HHS Hearing Officer issued his decision
affirming the termination of benefits on the basis of Amanda's having reached her nineteenth birthday.
Appellant then sought additional review by the ALJD.
PROCEDURAL POSTURE OF THIS APPEAL
Appellant filed her "Brief of Appellant" dated May 15, 1999. The Department responded on June 4, 1999 with "Motion to
Dismiss, or in the Alternative, for a Dissolution of the Automatic Stay Imposed by ALJD Rule 34." A "Notice of Hearing"
was issued on June 30, 1999 advising that the action on this appeal would be heard at 10:00AM on Tuesday, August 17,
1999.
Early on the morning of August 17, 1999, Appellant contacted the ALJD to advise that she would be unable to attend the
hearing scheduled for later that morning. She explained that she had suffered from insomnia the night before, and was
experiencing heart spasms. Appellant was advised that her doctor would need to contact the ALJD to verify her medical
condition, or that her daughter would need to appear at the scheduled hearing and represent herself. At the time of the
scheduled hearing, no medical professional had contacted the ALJD on behalf of the Appellant, nor had her daughter
indicated her intention to pursue the appeal on her own behalf.
Charles M. Black, Jr., Assistant General Counsel for the Department, appeared at the appointed hearing time. Mr. Black had
previously indicated the Department's willingness to submit to a decision based upon the briefs and other materials filed in
this matter. In light of Appellant's failure to appear at the scheduled hearing, and because the issue presented in this matter
is sufficiently straightforward to be evaluated without oral argument, I find that this case is appropriate for disposition
without oral argument as authorized by ALJD Rule 39.
Furthermore, because I find that the underlying merits in this case can be fully and effectively addressed on the basis of the
materials filed to date, I choose to resolve this matter by ruling directly on the substantive issues of this appeal rather than
simply granting the Department's "Motion to Dismiss." In doing so, I have treated the Department's submissions in support
of its motion as a brief on the underlying merits of the case.
DISCUSSION
Merits of the Eligibility Issue
The sole basis for the termination of Medicaid eligibility for the Appellant's daughter was the fact that the daughter turned
nineteen and was therefore too old to continue receiving benefits under the Partners for Healthy Children (PHC) initiative.
There is absolutely no dispute with respect to this sole issue of material fact. From the earliest stages of this appeal, Ms.
Roberson has repeatedly and consistently conceded that her daughter is now nineteen years of age. Because Ms. Roberson's
daughter is indisputably over the eligibility age limit for qualification under PHC, it is clear that termination of her eligibility
was appropriate. Given the lack of any relevant challenge to the underlying basis of the termination, the Department's action
must be affirmed.
The Automatic Stay Imposed by ALJD Rule 34
Under the provisions of ALJD Rule 34, the filing of an appeal imposes an automatic stay upon the agency's action that is the
subject of the appeal. However, Rule 34 specifically allows a party to apply to the Administrative Law Judge for an order
regarding the effect of the appeal on the agency decision. HHS made such a request in its motion filed on June 4, 1999.
As discussed above, Ms. Roberson has repeatedly admitted that she has no real basis for appealing the Department's action
and that her goal in pursuing this appeal is simply to prolong her daughter's Medicaid benefits for as long as possible. Under
the circumstances, and in light of my ruling in favor of HHS on the underlying merits of this case, a dissolution of any stay
associated with this appeal is clearly appropriate.
ORDER
For the reasons stated above, the April 14, 1999 decision of the HHS Hearing Officer upholding the validity of the
termination of Appellant's daughter's Medicaid eligibility is affirmed. Furthermore, any stay associated with the pursuit of
this appeal before the ALJD is hereby dissolved. Any additional grounds for appeal raised by the Appellant that are not
specifically discussed in this Order are denied.
AND IT IS SO ORDERED.
Ralph King Anderson, III
Administrative Law Judge
August 23, 1999
Columbia, South Carolina |
