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Administrative Law Court
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SC Administrative Law Court Decisions

CAPTION:
Eunice E. Patterson vs. SCDHHS

AGENCY:
South Carolina Department of Health and Human Services

PARTIES:
Appellant:
Eunice E. Patterson

Respondents:
South Carolina Department of Health and Human Services
 
DOCKET NUMBER:
99-ALJ-08-0621-AP

APPEARANCES:
n/a
 

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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