Doe v. South Carolina Department of Health & Human Services, 727 S.E.2d 605

Medicaid HCBS waiver program in SC permits waivers substituting community-based services for institutional care.
Doe has intellectual and adaptive deficits with long-standing cognitive impairment.
SC DDSN adopted an age-18 onset criterion for mental retardation via policy, conflicting with SSA/SSI definitions.
Waiver eligibility criteria rely on the waiver application, not the SSA disability determination.
ALC and Hearing Officer terminated Doe’s waiver eligibility based on age-18 onset; majority reverses.
Court remands to apply proper standard: onset before age 22 under SSI definition; DDSN policy disallowed.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Is DDSN bound by SSA disability determination for waiver eligibility?	Doe—SSA disability binding applies.	HHS/DDSN—waiver must be separately defined by state.	No; SSA disability not binding for waiver eligibility.
May SC impose an age-18 onset restriction for mental retardation in waiver eligibility?	Doe—18 onset requirement invalid.	DDSN policy supports 18 onset.	Error to impose 18 onset; apply 22 onset standard.
Does Regulation 88-210(F) control the developmental period for waiver eligibility?	Regulation controls applicability.	Policy guidelines may guide interpretation.	Regulation controls; DDSN policy guidelines disregard; remand.

Wilder v. Virginia Hosp. Assoc., 496 U.S. 498 (U.S. (1990)) (Medicaid funding and plan requirements for states)
Pharm. Research & Mfrs. of Am. v. Walsh, 538 U.S. 644 (U.S. (2003)) (Regulatory interpretation of Medicaid-related provisions)
Olmstead v. L.C., 527 U.S. 581 (U.S. (1999)) (Right to community-based treatment where appropriate)
Doe v. Kidd, 501 F.3d 348 (4th Cir. 2007) (Fourth Circuit on disability/benefits context for Doe)
Byerly Hosp. v. S.C. State Health & Human Servs. Fin. Comm’n, 319 S.C. 225 (S.C. 1995) (Deference to agency Medicaid interpretations)