ORDERS:
ORDER
In
the above-captioned matter, Appellant Ruth Tyler appeals the Order of Dismissal
issued by Respondent South Carolina Department of Health and Human Services
(Department) on July 14, 2006, in which the Department denied her application
for Medicaid disability benefits under the Aged, Blind or Disabled (ABD)
Program. For the reasons set forth below, the Department’s decision to deny
Appellant’s application for disability benefits must be affirmed.
BACKGROUND
On April
28, 2006, Appellant filed an application for Medicaid disability benefits under
the Aged, Blind or Disabled (ABD) Program with Respondent South Carolina
Department of Health and Human Services (Department). By a determination made
on May 30, 2006, a disability examiner with the South Carolina Department of
Vocational Rehabilitation, denied Appellant’s
application for disability benefits because she had previously been denied disability
benefits for the same condition by the federal Social Security Administration
(SSA) within the past year. Appellant was notified of the denial by a letter
dated June 20, 2006, and, on June 27, 2006, she submitted a request for a
hearing before the Department on the denial. On July 14, 2006, Kimberly
Burrell, a hearing officer with the Department, issued an Order of Dismissal in
which she upheld the disability examiner’s determination that Appellant’s
application for ABD Medicaid benefits must be denied under federal law based
upon her prior denial for social security disability benefits by the SSA.
Appellant now appeals the Department’s denial of her application for ABD
Medicaid benefits before this Court. On appeal, Appellant does not challenge
the Department’s finding that the Department was precluded by federal law from
independently evaluating her disability because she was denied disability benefits
by the SSA within one year preceding her application for ABD benefits with the
Department, but rather, she simply argues that her medical conditions have, in
fact, rendered her disabled, such that she should receive disability benefits
from the Department under the ABD Program.
DISCUSSION
By
federal regulation, a state agency, like the Department, may not make an
independent determination on a claim for Medicaid disability benefits if the
SSA has made a disability determination on the same issues presented in the
Medicaid application, unless at least twelve months have passed since the SSA
determination was made, the claimant alleges a different disabling condition
from that reviewed by the SSA, or the claimant satisfies another regulatory
exemption. See 42 C.F.R. § 435.541(a)-(c) (2005). In the case at hand,
Appellant does not contest the Department’s finding that the SSA had made a
disability determination based upon the same condition she raises in her
application for ABD Medicaid benefits within one year of the date of her
application for the ABD benefits. Nor does Appellant contend that she
satisfies one of the other regulatory exemptions from the general provision
precluding the Department from issuing a disability determination independent
of the determination made by the SSA. Therefore, while this Court is
sympathetic to the medical concerns raised by Appellant, I must affirm the
Department’s determination that federal law precluded the Department from
independently reviewing her disability claim because of the prior disability
determination issued by the SSA regarding her condition.
ORDER
For
the reasons set forth above,
IT
IS HEREBY ORDERED that the Department’s denial of Appellant’s application
for Medicaid disability benefits under the ABD Program must be AFFIRMED.
AND
IT IS SO ORDERED.
______________________________
JOHN D.
GEATHERS
Administrative
Law Judge
1205 Pendleton
Street, Suite 224
Columbia, South
Carolina 29201-3731
November 29, 2006
Columbia, South Carolina
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