ORDERS:
FINAL ORDER AND DECISION
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 ("DHHS"). Appellant Eunice Patterson appealed a determination
by the Greenville County Department of Social Services ("DSS") that she was ineligible for Medicaid benefits because her
income exceeds the applicable limit. A "fair Hearing" was conducted on September 21, 1999. The DHHS Hearing Officer
issued his written decision on November 5, 1999, in which he agreed with DSS that Appellant's income exceeded the
applicable eligibility limits. Appellant has now appealed that decision to the ALJD.
Because the record before the ALJD is complete with respect to the basis for the DHHS Hearing Officer's decision,
pursuant to ALJD Rule 39, this matter is being decided without oral argument.
STATEMENT OF ISSUES ON APPEAL
The sole issue presented in this appeal is whether the DHHS Hearing Officer erred in finding that the Appellant is ineligible
for Medicaid benefits because her income (after deducting allowable exclusions) exceeds the applicable limit. The only
question before the ALJD is whether the DHHS Hearing Officer committed an error of law that would require a reversal or
remand for additional consideration.
DISCUSSION
When Appellant applied for Medicaid, she reported that she receives monthly Social Security benefits of $799.00.
(Administrative Decision at "Finding of Fact #1," citing testimony of the Appellant). After applying a standard "unearned
income disregard" of $20.00, the Appellant's countable income for Medicaid eligibility purposes was determined to be
$779.00 per month. (Finding of Fact #3). Appellant has not disputed these income figures at any stage of the process thus
far, including her submissions to the ALJD.
In Appellant's case, eligibility was sought under the "Aged, Blind, or Disabled" ("ABD") category, which imposes an
income limit that is set at 100% of the federal poverty limit, as calculated by the federal government each year. At the time
of the Appellant's application, this limit was $687.00 per month for an individual. The Appellant's countable income of
$779.00 per month surpasses this $687.00 limit.
Although Appellant's income appears to be insufficient to meet her significant medical needs and expenses, it exceeds the
limit, even when applying the appropriate disregard of $20.00. The Medicaid eligibility rules do not allow for any
exceptions to the income limit, even in situations where applicants, such as Appellant, are faced with high medical expenses.
Appellant has not alleged any error of law by either DHHS in its conduct of the initial appeal, or by DSS in the underlying
eligibility determination.
DHHS (formerly known as the "State Health and Human Services Finance Commission") administers the South Carolina
Medicaid Program under a specific grant of authority by the South Carolina General Assembly [S.C. Code Ann. § 44-6-30
(Supp. 1999)] and conducts its administrative appeals pursuant to duly-promulgated regulations [27 S.C. Code Ann Regs.
126-150 (1976 & Supp. 1999)]. Thus, DHHS was acting within the scope of its authority in conducting the fair hearing.
DSS was acting within its authority as a contracted agent for DHHS in making eligibility determinations [S.C. Code Ann. §
44-6-50 (Supp. 1999)] when it denied Appellant's Medicaid
application. No challenge has been raised regarding the appropriateness of the eligibility rules used by DSS in reaching its
determination.
This tribunal understands and is sympathetic to the high cost of the Appellant's monthly medications; however, this tribunal
cannot 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. 130, at 134, 276 S.E.2d 304, at 307 (1981). No such error has
been established in the instant case. Furthermore, the record supports the Hearing Officer's findings of fact and conclusions
of law.
ORDER
Based upon the record and the applicable law, I find that the November 5, 1999 Order and
Decision of the DHHS Hearing Officer is AFFIRMED.
_____________________________
C. DUKES SCOTT
ADMINISTRATIVE LAW JUDGE
April 10, 2000
Columbia, South Carolina
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