ORDERS:
FINAL ORDER AND DECISION
I. Introduction
This case is an appeal of a decision by the South Carolina Department of Health and Human
Services (DHHS) concluding that Preston Jack White (Mr. White) is ineligible for Medicaid
benefits due to his wife’s transfer on June 18, 2003, of property worth $63,500 to her son for
$5.00. The sole issue is whether the transfer renders Mr. White ineligible for Medicaid benefits.
II. Analysis
In addressing this issue, the Administrative Law Court sits not as a fact-finder, but rather as an
appellate body reviewing the factual findings made below. S.C. Code Ann. §1-23-380(A)(6)
(Supp. 2003). In reviewing those factual findings, the Court must begin with the presumption that
the factual findings are correct. Rodney v. Michelin Tire Co., 320 S.C. 515, 466 S.E.2d 357
(1996). Further, for any disputed question of fact, the ALC is prohibited from re-weighing the
evidence and must not substitute its judgment for that of the agency. Grant v. South Carolina
Coastal Council 319 S.C. 348,461 S.E.2d 388 (1995). Rather than the Court having the authority
to re-weigh the evidence presented below, the duty falls on Mr. White, the party challenging the
agency’s factual decisions, to convincingly establish that the decision below is unsupported by
substantial evidence. Waters v. South Carolina Land Resources Conservation Comm̓n, 321
S.C. 219,467 S.E.2d913 (1996).
Mr. White cannot show a lack of substantial evidence by seeking to show that the evidence
presented below could have produced a different result. Rather, the mere fact that reasonable
minds could differ on the judgment made by the agency does not establish the absence of
substantial evidence. Lark v. Bi-Lo, 276 S.C. 130, 276 S.E.2d 304 (1981). Indeed, the fact that
the record, when considered as a whole, presents the possibility of drawing two inconsistent
conclusions from the evidence does not establish that the decision below is unsupported by
substantial evidence. Grant v. South Carolina Coastal Council, 319 S.C. 348, 461 S.E.2d 388
(1995).
Here, the evidence presented below shows that on June 18, 2003, Mrs. White transferred property
worth $63,000 to her son for $5.00. On the next day, June 19, 2003, she applied on Mr. White’s
behalf for Nursing Home Medicaid benefits for her husband. On June 25, 2003, Mr. White was
admitted for nursing home services.
Given these facts, the applicable statute is 42 USC § 1396p(c)(1)(A):
In order to meet the requirements of this subsection for purposes of section
1396a(a)(18) of this title, the State plan must provide that if an institutionalized
individual or the spouse of such an individual (or, at the option of a State, a
noninstitutionalized individual or the spouse of such an individual) disposes of
assets for less than fair market value on or after the look-back date specified in
subparagraph (B)(i), the individual is ineligible for medical assistance for
services described in subparagraph (C)(i) (or, in the case of a noninstitutionalized
individual, for the services described in subparagraph (C)(ii)) during the period
beginning on the date specified in subparagraph (D) and equal to the number of
months specified in subparagraph (E). (emphasis added).
This case presents two arguments. Mr. White asserts he should not be penalized for a transfer of
property made by his spouse. Such an argument is unavailing. 42 USC § 1396p(c)(1)(A) looks
not only to transfers by the individual seeking medical assistance but also to transfers by the
individual’s spouse.
Likewise, Mr. White’s equitable argument that the property was not transferred in contemplation
of attaining Medicaid eligibility for her husband is also to no avail. The statute does not look to
the motive for the transfer but rather to the fact of a transfer for less than fair market value. The
facts here establish a transfer for less than fair market value. Further, the fact-finder below found
that the timing and sequence of the events did not show convincing evidence that Medicaid
eligibility was not a consideration. Such a finding is supported by substantial evidence and will not
be reversed.
III. Conclusion
The decision below is supported by substantial evidence and is not affected by any error of law.
Therefore, the decision of DHHS is AFFIRMED.
AND IT IS SO DECIDED
_________________________________
RAY N. STEVENS
Administrative Law Judge
Dated: July15, 2004
Columbia, South Carolina |
