ORDERS:
ORDER
This matter is before me pursuant to the appeal of Alva O. Humphries, Personal Representative for the Estate of Hazel
Humphries (Appellant), from a final decision of the Respondent, South Carolina Department of Health and Human Services
(Department), denying Appellant's application for a hardship waiver or exemption from the Department's claim against
Appellant's mother's estate for reimbursement of Medicaid expenses. The Administrative Law Judge Division (Division) has
jurisdiction to hear this matter pursuant to S.C. Code Ann. §§ 1-23-380 and 44-6-190 (Supp. 1999). A hearing on the
appeal was held on March 27, 2000 at the offices of the Division in Columbia, South Carolina, after notice to the parties.
Upon consideration of the briefs and the arguments presented at the hearing, together with a review of the applicable law,
the decision of the Department is affirmed.
STATEMENT OF THE CASE
The Appellant's mother, Hazel Humphries, received home-based nursing services through Community Long Term Care
which were covered by Medicaid. After Mrs. Humphries' death on December 17, 1997, the Department, which administers
the Medicaid program in South Carolina, filed a claim in the Florence County Probate Court against her estate in the amount
of $22,219.35. The estate as listed with the Probate Court consists of a house valued at approximately $65,000 and some
household goods.
The Appellant contested the claim with the Department, asserting that he had purchased the house from his mother sometime
in the 1970's, and although the house was still in his mother's name at the time of her death, it was not properly part of the
estate. Appellant further requested a hardship waiver of the claim against the estate, based on his assertion that his sister was
disabled and that he wished to move her into the house. Appellant's request for a waiver was denied in April, 1999, on the
grounds that neither Appellant nor his sister met the statutory requirements for a waiver. In accordance with S.C. Code
Ann. Regs. 126-152, Appellant requested a contested case hearing ("fair hearing") before a hearing officer of the
Department. That hearing was held on June 24, 1999. On September 14, 1999, Hearing Officer Debra J. Stevens issued her
final order and decision, in which she affirmed the Department's determination that Appellant did not qualify for a hardship
waiver. This appeal followed.
ISSUES ON APPEAL
The Appellant raises a number of issues on appeal. His central contentions are that the hearing officer applied the statutory
guidelines too narrowly in denying his request for a hardship waiver; that the hearing officer should not have excluded issues
relating to the ownership of his mother's house from consideration at the hearing; and that the amount of the claim is
unsubstantiated.
STANDARD OF REVIEW
Jurisdiction on appeal is vested in the Administrative Law Judge Division (Division) pursuant to S.C. Code Ann. § 44-6-190
(Supp. 1999). The provisions of the South Carolina Administrative Procedures Act (APA) govern an appeal from a final
order of the Department. Under the APA, the Division "shall not substitute its judgment for that of the agency as to the
weight of the evidence on questions of fact." S.C. Code Ann. § 1-23-380(A)(6) (Supp. 1999). However, the Administrative
Law Judge may reverse or modify the decision of the Department if substantial rights of the appellant have been prejudiced
because the administrative findings or decisions are "clearly erroneous in view of the reliable, probative and substantial
evidence on the whole record," "affected
by . . . error of law," or "arbitrary or capricious." Id; see also Lark v. Bi-Lo, 276 S.C. 130, 276 S.E.2d 304 (1981).
Substantial evidence is that evidence which, in considering the record as a whole, would allow reasonable minds to reach the
conclusion that the administrative agency reached. See, e.g., Jennings v. Chambers Development Co., 335 S.C. 249, 516
S.E.2d 453 (Ct. App. 1999). The possibility of drawing two inconsistent conclusions from the evidence does not prevent an
administrative agency's finding from being supported by substantial evidence. Id. Where there is a conflict in the evidence,
the agency's findings of fact are conclusive. Id.; see also Harbin v. Owens-Corning Fiberglas, 316 S.C. 423, 450 S.E.2d 112
(Ct. App. 1994). 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). This tribunal cannot substitute its judgment for that of the Department upon a question as to which there is room for
a difference of intelligent opinion. See, e.g., Chemical Leamen Tank Lines v. S.C. Pub. Serv. Comm'n, 258 S.C. 518, 189
S.E.2d 296 (1972).
DISCUSSION
Background
The Department is charged with the administration of the Medicaid program in South Carolina. Medicaid is a joint state and
federal program designed to assist with the medical needs of persons meeting certain financial and other criteria. As part of
the Medicaid program, states are required to recover from the estates of certain Medicaid recipients costs properly incurred
for those persons' medical care. The Medicaid Estate Recovery program was mandated by the federal Omnibus Budget
Reconciliation Act of 1993, as codified at 42 U.S.C. § 1396p(b). This legislation requires the states to set up procedures
which conform to guidelines issued by the Secretary of the federal Department of Health and Human Services to waive
certain claims against estates of Medicaid recipients in instances of undue hardship. To date, the Secretary has not issued
any guidelines for determining undue hardship. However, in order to comply with the congressional mandate to promulgate
undue hardship procedures, South Carolina has enacted undue hardship
criteria. Those criteria are codified at S.C. Code Ann. § 43-7-460 (Supp. 1999). That statute provides in pertinent part:
(A) The State Department of Health and Human Services shall seek recovery of medical assistance paid under the Title XIX
State Plan for Medical Assistance from the estate of an individual who:
* * *
(2) was fifty-five years of age or older when the individual received medical assistance, but only for medical assistance
consisting of nursing facility services, home and community-based services, and hospital and prescription drug services
provided to individuals in nursing facilities or receiving home and community-based services.
* * *
(C) Recovery under this section must be waived by the department upon proof of undue hardship, asserted by an heir or
devisee of the property claimed pursuant to 42 U.S.C. 1396p(b)(3). Until conflicting hardship standards and criteria are
issued by the Secretary of the United States Department of Health and Human Services, the following are considered
instances of undue hardship in which recovery must be waived:
(1) with respect to the decedent's home property, if the decedent could have transferred the home property on or after the
date of his or her Medicaid application without incurring a penalty under 42 U.S.C. 1396p(c), if the property could have
been transferred without a penalty to a:
(b) surviving child of the decedent who was under age twenty-one or blind or totally disabled;
(d) surviving child of the deceased who lived in the home for a period of at least two years immediately before the decedent
became institutionalized and who provided care which allowed the decedent to delay institutionalization.
However, hardship under this item only applies if the individual to whom the property could have been transferred without
penalty is actually residing in the home at the time the hardship is claimed. . . .
(2) with respect to the decedent's home and one acre of land surrounding the house, if an immediate family member:
(a) has resided in the home for at least two years immediately prior to the recipient's death;
(b) is actually residing in the home at the time the hardship is claimed;
(c) owns no other real property or agrees to sell all other interest in real property and give the proceeds to the department;
and
(d) has annual gross family income that does not exceed one hundred eighty-five percent of the federal poverty guidelines.
(Emphasis added).
Application of the Undue Hardship Criteria
Appellant argues that the hearing officer erred in denying his request for an undue hardship waiver on behalf of his sister.
The hearing officer determined that Appellant's sister was not currently living in the house, nor had she lived there for the
two year time period set forth in Section 43-7-460(C), and was thus ineligible to receive an undue hardship waiver.
Furthermore, the hearing officer determined that the sister was not disabled, as there was no evidence that she had applied
for or was receiving Social Security disability benefits. These findings are amply supported by the substantial evidence in the
record.
Notwithstanding the fact that neither Appellant nor his sister had ever lived in the house and thus did not meet the undue
hardship criteria specified in the statute, Appellant contends that the hearing officer erred in determining that the listed
statutory criteria constitute the only instances in which a finding of undue hardship may be made. Appellant's argument is
without merit. First, the statute lists only three instances of undue hardship, none of which apply to the Appellant's situation.
Moreover, a generally recognized rule of statutory construction is expressio unius est exclusio alterius, which means that the
enumeration of particular things excludes the idea of something else not mentioned. Under this rule, exceptions made in a
statute give rise to a strong inference that no other exceptions were intended. Pennsylvania Nat. Mut. Cas. Ins. Co. v.
Parker, 282 S.C. 546, 320 S.E.2d 458 (Ct. App. 1984). Accordingly, the hearing officer properly applied the requirements
for an undue hardship waiver in Appellant's case.
Amount of the Claim
Appellant contends that there is insufficient documentation to support the Department's claim that it furnished services to his
mother in the amount of $22,219.35. A review of the hearing transcript indicates that Appellant did not contest the amount
of the claim at the hearing. Having failed to raise this issue below, Appellant may not raise it on appeal. See, e.g., Doe v.
S.B.M., 327 S.C. 352, 488 S.E.2d 878 (Ct. App. 1997).
Exclusion of Issues Relating to the House
Finally, Appellant argues that the hearing officer erred in holding that she did not have jurisdiction to rule on any issues
relating to the inclusion of his mother's house in the estate. He argues that, although the house was still in his mother's
name and although it was left to Appellant in her will, he had purchased the house from his mother some time ago and it was
not properly a part of the estate. The hearing officer correctly found that this issue properly belonged before the Probate
Court. S.C. Code Ann. § 62-1-302 (Supp. 1999) (the Probate Court has exclusive original jurisdiction over all subject
matter related to estates of decedents). In this case, Appellant's argument has been rendered moot by a decision of the
Florence County Probate Court, issued on April 25, 2000, which found that the house was properly included in the
decedent's estate.
ORDER
For all the foregoing reasons, the Department's decision to deny Appellant's request for a hardship waiver is hereby
AFFIRMED. Any arguments not addressed in this Order are dismissed as being without merit.
AND IT IS SO ORDERED.
______________________________
Marvin F. Kittrell
Chief Judge
Columbia, South Carolina
July 5, 2000 |
