SC Administrative Law Court Decisions

James E. Beasley (Beasley) filed an appeal challenging the denial of medicaid benefits by the South Carolina Department of Health and Human Services (DHHS). On December 16, 2002, DHHS filed a Motion to Dismiss Beasley's appeal on two grounds. First, the appeal was filed untimely. Second, the appeal is improper since a previous holding by the Social Security Administration (SSA) of "no disability" is binding upon DHHS so that no medicaid benefits can be paid until the SSA determination is changed by SSA.

Beasley responded to the motion to dismiss by a written response filed on December 26, 2002. After considering the arguments presented, the motion must be granted.

A late filing of an appeal is fatal since one who fails to timely file an appeal fails to invoke the jurisdiction of the reviewing entity. Mears v. Mears, 287 S.C. 168, 337 S.E.2d 206 (1985); Burnett v. S.C. Highway Dep't, 252 S.C. 568, 167 S.E.2d 571 (1969); Stroup v. Duke Power Co., 216 S.C. 79, 56 S.E.2d 745 (1949). To determine if a filing is timely, one must "file" the document, and one must do so timely.

Deciding when a document is filed is fairly straight forward: a filing is complete when mailed. ALJD Rule 4(C). However, deciding when a document is timely filed is slightly more involved. Like filing, timeliness is also decided by ALJD Rules.

A filing is timely if filed with the ALJD within 30 days "of receipt of the decision from which the appeal is taken." ALJD Rule 33. Further, the 30 day period for a timely appeal is calculated by excluding the first day and counting the last day in which action is required. ALJD Rule 3. In addition, if the last day falls on a Saturday, Sunday, or legal holiday, an extension exists until the next day that is not a Saturday, Sunday, or legal holiday. ALJD Rule 3.

Here, Beasley received the order of denial of medicaid benefits on October 25, 2002. In seeking his appeal, Beasley chose to mail the appeal to the ALJD via the United States Postal Service. Since the date of mailing is established by the postmarked envelope containing the appeal, the appeal was filed on November 25, 2002.

With an appeal filing date of November 25, 2002, and with a receipt date of the DHHS denial order of October 25, 2002, the appeal here is timely filed since the last day of the filing period is November 25, 2002. (The last day of the thirty day filing period fell on a Sunday, November 24, 2002, so that the time for filing extended to Monday, November 25, 2002). Accordingly, the appeal cannot be dismissed for a lack of timely filing.

DHHS is not free to disregard disability determinations made by the SSA. Rather, when SSA has made a determination of either disability or no disability, DHHS may not make an independent finding on that same issue since the SSA determination is binding on DHHS. 42 CFR §435.541(b)(1)(I). See Sebastian v. Commissioner of Human Services, 1993 WL 642701 (M.D.Tenn. 1993) ("Specifically, if the Social Security Administration (SSA) has made a determination of non-disability for SSI benefits purposes, then the state agency must defer to this decision and cannot redetermine Medicaid eligibility on disability grounds if SSA and the state have a section 1634 agreement, as Tennessee and the SSA do."). Indeed, these same federal regulations have been judged to show an intent "that the federal agency's determination of nondisability supersedes [even] a previous state agency determination of disability." Disabled Rights Union v. Kizer 744 F.Supp. 221 (Cal. 1990). Thus, if even the more basic matter of a prior state adjudication of disability is not immune from a later federal veto, how much more so is a current "no disability" federal decision controlling on a yet to be litigated state decision. Instead, whether for ill or gain, the federal regulations deny the state the decision making authority in the instant case. ⁽¹⁾ Thus, this matter must be dismissed due to controlling federal regulations.

AND IT IS SO ORDERED.

__________________________________

RAY N. STEVENS

Administrative Law Judge

Dated: January 7, 2003

Columbia, South Carolina

1. In this case, the record below establishes that SSA determined Beasley was not disabled for SSI purposes. (Order below, FOF 1.). Further, while not explicitly found by the hearing officer, the conclusion reached below is inherently premised on a holding that South Carolina has "a section 1634 agreement" with the SSA. Moreover, nothing in the opposition brief establishes a contrary position.