Pеtitioner Elmer Medina appeals the trial court’s order affirming an agency’s decision to deny Medicaid coverage. Petitioner is an alien who was not lawfully admitted to the United States. In December of 2000, petitioner suffered a one-day fever, and over the next two weeks, he became increasingly fatigued. On the morning of 29 December 2000, petitioner had a fainting spell and passed out. Petitioner went to an urgent care facility and was later admitted to the pediatric floor at Carolinas Medical Center in Charlotte, North Carolina. (CMC)
At that time, petitioner denied any symptoms of upper respiratory infection, nausea, vomiting, or diarrhea. However, doctors believed that petitioner was likely suffering from acute lymphoblastic leukemia. The results of a bone marrow biopsy confirmed this diagnosis, and petitioner began to receive chemotherapy.
On 5 January 2001, petitioner had a fever of 103.7 degrees. He was also suffering abdominal pain that was associated with acute pancre-atitis resulting from the chemotherapy. After being treated in the intensive care unit, petitioner went back to the pediatric floor on 7 January 2001. On 10 January 2001, petitioner had an operative procedure to insert an infusion port because petitioner required chronic venous access for chemotherapy. He was discharged to go home on 13 January 2001, given prophylactic medicatiоns, and directed to follow up with his treating physician.
On 6 January 2001, petitioner submitted an application for Medicaid benefits to the Mecklenburg County Department of Social Services. Respondent Division of Medical Assistance apрroved Medicaid coverage for the care and services petitioner received on 29 December 2000 through 30 December 2000 and 5 January 2001 through 6 January 2001.
*504 On 31 January 2001, petitioner received diagnostic tests. He was readmitted to CMC on 5 February 2001 for scheduled chemotherapy. He was instructed to contact his treating physician if he suffered any problems.
Petitioner underwent additional chemotherapy and diagnostic testing on 13 February 2001 on an outpatient basis. He was dischаrged to go home the following day and had no restrictions. Petitioner had other visits on 27 February 2001 and on 12 March 2001.
On 6 April 2001, petitioner submitted another application for Medicaid services after 13 January 2001. Respondent Division of Medical Assistance denied coverage based on its determination that the care petitioner received was no longer for the treatment of an emergency medical condition. Petitioner appealed this decision to respondent Division of Social Services, but the final agency affirmed the denial of benefits. Petitioner then sought judicial review of the final agency decision. A hearing took place on 20 March 2003, and the Honorable Jesse B. Caldwell, III, affirmed the agency’s denial of Medicaid coverage after 13 January 2003.
Petitioner appeals. On appeal, petitioner argues that the trial court erred by determining that he was not eligible for Medicaid benefits after 13 January 2003. Becausе the trial court failed to make adequate findings of fact to support its conclusions of law, we reverse and remand the decision of the trial court.
I. Standard of Review
Codified at Chapter 150B of the North Carolina General Statutes, the North Carolina Administrative Procedure Act (APA), governs judicial review of administrative agency decisions.
Henderson v. N.C. Dept. of Human Resources,
The present case is not governed by N.C. Gen. Stat. § 150B-51(c) because that section addresses the situation in which an administra *505 tive law judge makes a decision, but the agency declines to adopt that decision. In this case, the Division of Medical Assistance denied coverage for services after 13 January 2001, and the agency affirmed the denial of benefits. Therefore, the correct standard of review is the one used in other civil cases in which the superior court sits without a jury:
[T]he standard of review on appeal is whether there was competent evidence to support the trial court’s findings of fact and whether its conclusions of law were proper in light of such facts. Findings of fact by the trial court in a non-jury trial . . . are conclusive on appeal if there is evidence to support those findings. A trial court’s conclusions of law, howеver, are reviewable de novo.
Shear v. Stevens Building Co.,
II. Legal Background
Medicaid is a federal prоgram designed to provide health care funding for the needy.
Luna v. Div. of Soc. Servs.,
In Luna, this Court outlined the definition of “emergency medical condition” under federal law:
*506 The implementing federal regulation provides, however, that undocumented aliens are entitled to Medicaid coverage for emеrgency services required after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be еxpected to result in: (i) placing the patient’s health in serious jeopardy; (ii) serious impairment to bodily functions; or (iii) serious dysfunction of any bodily organ' or part. A state Medicaid plan must conform to these requirements.
Id.
at 4-5,
III. Issue on Appeal
Petitioner submitted two application's for Medicaid. The first appliсation was approved, and coverage was provided for services rendered 29 December 2000 through 30 December 2000 and 5 January 2001 through 6 January 2001. Therefore, the first application is not the subject of this appeal. Instead, the рarties are disputing petitioner’s second application. The issue is whether the services rendered after 13 January 2001 were for the treatment of an emergency medical condition.
We recognize that this is an evolving issue in North Carоlina. Our appellate courts simply have not had the opportunity to consider cases like this one with great frequency. However, this Court has established that the trial court must make adequate findings of fact to support its conclusions of law. Luna,
(1) whether his condition was mаnifesting itself by acute symptoms, and (2) whether the absence of immediate medical treatment could reasonably] be expected to place his health in serious jeopardy, or result in serious impairment to bodily functions or serious dysfunction of any bodily organ or part.
Id.
at 13,
In this case, the trial court made the following relevant findings of fact:
3. Petitioner was originally admitted to Carolinas Medical Center on December 29, 2000, and subsequently diagnosed as having acute lymphoblastic lеukemia. Following the insertion of a central line for the administration of chemotherapy, a bone marrow aspirate and lumbar puncture, he was discharged home on January 13, 2001.
4. Subsequent admissions were for planned courses of chеmotherapy.
5. An application for Medicaid was submitted on the Petitioner’s behalf on April 6, 2001 to the Mecklenburg County Department of Social Services.
6. The Respondent determined that admissions covering December 29-30, 2000, and January 5-6, 2001, werе for the treatment of an emergency medical condition and approved Medicaid coverage to reimburse Carolinas Medical Center for these periods.
7. The Respondent denied coverage for the admissions subsequent to January 13, 2001, upon its determination that these admissions were not for the treatment of an emergency medical condition.
The trial court also made the following pertinent conclusions of law:
3. Emergency medical conditions are limited to sudden, severe, short-lived illnesses (and injuries) that require immediate treatment to prevent further harm.
*508 4. The care and services for which the Respondent denied Medicaid reimbursement were not for the treatment of an emergenсy medical condition.
5. The Respondent’s final agency decision is consistent with controlling federal statutes and regulations; it is not in violation of' constitutional provisions, nor does it exceed the statutory authority or jurisdiction of the agenсy.
6. The Respondent’s final agency decision was made upon lawful procedure and is not affected by other error of law.
After carefully reviewing the decision in Luna and the findings of fact and conclusions of law in the present case, we are struck by the similarities between thе two cases. Like the trial court in Luna, the trial court in the present case failed to show whether petitioner’s condition was manifesting itself by acute symptoms. The trial court also failed to address whether the absence of immediate mеdical attention after 13 January 2001 could result in any of the consequences listed in the North Carolina rule (health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part). These are the key issuеs required by the regulation, and even if its conclusions of law were accurate, the trial court failed to make sufficient findings to support those conclusions.
Without adequate findings, we are unable to decide whether coverage was proper or not. Therefore, we vacate the conclusions of law, leave standing the findings of fact, and remand for further proceedings. On remand, the trial court should resolve the important factual issues mentioned above аnd then decide the legal issue of coverage.
Reversed and remanded.
Notes
. This standard of review was also applied in a case that considered the same issue on appeal.
Luna v. Div. of Soc. Servs.,