Opinion
C.A. No. 00A-02-010 RRC.
Submitted: July 21, 2000.
Decided: August 23, 2000.
Upon Appeal From a Decision of the Delaware Department of Health and Social Services, Division of Social Services. AFFIRMED.
ORDER
This 23rd day of August, 2000, upon Appellant's pro se appeal from a decision of the Delaware Department of Health and Social Services, it appears to this Court that:
1. Sylvester J. Zdziech (Appellant) has filed an appeal from a January 19, 2000 decision of the Division of Social Services (DSS). For the reasons stated below, the decision of DSS is AFFIRMED.
2. This dispute arises from the decision of DSS to terminate Appellant's Medicaid benefits because Appellant was no longer receiving Supplemental Security Income (SSI). As a recipient of SSI, Appellant had received Medicaid benefits to help pay medical and pharmaceutical costs resulting from several serious medical problems. Appellant stopped receiving SSI and since Appellant's eligibility for Medicaid was conditioned on his receipt of SSI, DSS investigated as to whether it was obligated to terminate Appellant's Medicaid benefits. DSS determined that Appellant was not eligible through any other program that would enable him to receive Medicaid benefits. DSS also specifically found that Appellant did not satisfy the financial threshold for the Adult Expansion Poverty program because his monthly income of $761 exceeded the limit of $687 by $74.
On July 29, 1999 DSS notified Appellant that, since he was no longer receiving SSI, his Medicaid benefits would end August 31, 1999. Appellant opposed the termination and requested a hearing on this matter which was held on December 30, 1999. In its decision, the DSS Hearing Officer stated
[t]he first issue I must decide is whether, having learned Appellant is no longer eligible for Medicaid following the end of his receipt of 551, the Division appropriately assessed Appellant's eligibility under other programs. If the Division properly deemed him ineligible, then I must determine what authority, if any, I have to extend Medicaid benefits pending his receipt of medical benefits as part of the Social Security Disability program.
Decision of Division of Social Services at 1.
The DSS Hearing Officer noted that
[e]ligibility in Delaware turns largely on certain financial criteria. Unfortunately for some applicants, medical necessity or need, even dire medical need, does not confer eligibility.
Id at 3.
Having found that Appellant was no longer receiving SSI, that his income exceeded the threshold level for the Adult Expansion Poverty program, and the absence of any nile permitting the hearing officer to extend the State's Medicaid program beyond the terms of the Approved Plan, the decision of DSS to terminate Appellant's Medicaid benefits was affirmed.
3. Appellant filed an appeal with this Court and DSS subsequently filed a motion to dismiss. This is the Court's decision on Appellant's appeal. This Court deems DDS' motion to dismiss to be an answering brief. See Super. Ct. Civ. R. 72(g) and (i).
4. The Court's authority to review a DSS decision is granted pursuant to 31 Del. C. § 520 which provides, in pertinent part that
[a]ny applicant for or recipient of public assistance benefits under this chapter or Chapter 6 of this title against who an administrative hearing decision has been decided may appeal such a decision to the Superior Court if the decision would result in financial harm to the appellant. The appeal shall be filed within 30 days of the day of the final administrative decision. . . . The appeal shall be on the record without a trial de novo. The Court shall decide all relevant questions and all other matters involved, and shall sustain any factual findings of the administrative hearing decision that are supported by substantial evidence on the record as a whole. . . .
The Court's review of DSS decisions is limited to an "examination of the record for substantial evidence to support the findings of fact made by the Hearing Officer and the absence of any errors of law." Furthermore, as noted by the Bowden Court
Bowden v. Delaware Dept. of Health and Social Services., Div. of Social Services., Del. Super., C.A. No. 92A-08-001, Graves, J. (Aug. 25, 1993) (Letter OP.) at 4, aff'd sub nom. Parsons v. Delaware Dept. of Health and Social Services., Div. of Social Services, Del. Supr., 642 A.2d 837, cert. denied, 513 U.S. 875 (1994).
[o]ur review is necessarily aimed at the potential for misapplication of governing law by a State when determining the qualifications of applicants for assistance through the Medicaid program. Only if the procedure of eligibility determination is legally sound do we proceed to the question of sufficiency of evidence to support the decision.
Id.
Thus, this Court begins its analysis by determining whether the Hearing Officer committed any legal error in making his decision and then by determining whether the decision was supported by substantial evidence in the record. Substantial evidence means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.
See Oceanport Ind v. Wilmington Stevedores, Del. Supr., 636 A.2d 892, 899 (1994); Battista v. Chrysler corp., Del. Super., 517 A.2d 295, 297 (1986), appeal dismissed, Del. Supr. 515 A.2d 397 (1986).
5. Under federal law, Medicaid eligibility in Delaware is automatic upon the determination by the federal Social Security Administration of SSI eligibility. Once Appellant was no longer receiving SSI he was not eligible to receive Medicaid unless DSS found an alternate basis to continue the MedMedicaid benefits. DSS considered Appellant for the only program applicable, the Adult Expansion Poverty program but determined that Appellant was above the financial threshold by $74 per month.
6. This Court finds that the decision of the Hearing Officer is supported by substantial evidence in the record. An investigation was made to find an alternative basis to provide Appellant with Medicaid benefits. Appellant does not apparently qualify for Medicaid through any other program. The decision by the Hearing Officer to affirm the decision of DSS and terminate Medicaid benefits is supported by substantial evidence in the record. The Hearing Officer did not otherwise commit an error of law.
7. For the reasons stated above, the decision of the Division of Social Services is AFFIRMED.
IT IS SO ORDERED.