Fair Hearing Decisions

The Department of Health and Social Services (DHSS) provides an opportunity for a fair hearing to any person who is dissatisfied with a decision to deny, suspend, delay, reduce, or terminate benefits. A fair hearing gives applicants and recipients an opportunity for an impartial, objective review of actions taken by DHSS. When we notify anyone of any action affecting their benefits, we provide a written notice of the opportunity for a fair hearing and the method by which a hearing can be requested. Appellants can appear for a hearing in person or they can be represented by legal counsel or by another person at a hearing.

A request for a hearing must be made in writing. When someone asks for a hearing, we prepare and submit a hearing summary to the State Hearing Office of the Division of Social Services. The fair hearing summary gives the factual and legal reason(s) for the action under appeal. When the hearing summary is received, the Hearing Office sets a date for the hearing and notifies all parties, including witnesses, by certified mail of the date, time, and place of the hearing.

Before the hearing, the applicant or recipient and his/her representative can ask to look at and copy the documents and records the State or its agent (such as a Managed Care Organization) will use at the hearing. Such requests should be made to the office where the action under appeal was taken. There is no charge for copies of records and documents needed to prepare a case for a fair hearing.

At the hearing the individual has the opportunity to:

1. Examine case records and documents;
2. Present his/her case by him/herself or with the aid of a representative or counsel;
3. Bring witnesses;
4. Submit evidence to establish all pertinent facts and circumstances;
5. Advance any argument without interference;
6. Question or refute any testimony or evidence including an opportunity to confront and cross-examine adverse witnesses;
7. Use interpreters or mechanical facilities to overcome language or other communication handicaps;
8. Withdraw the request for a hearing at any time.

Decisions of Hearing Officers are based exclusively on evidence introduced at the hearing. The decision of the Hearing Officer is issued within 30 days from the date of the hearing. The decision of the Hearing Officer is the final decision of the Department of Health and Social Services. If an applicant or recipient disagrees with the decision of the Hearing Officer, he/she may ask for judicial review. In order to have a review of the decision in Superior Court, a notice of appeal must be filed with the clerk (Prothonotary) of the Superior Court within 30 days of the date of the decision. An appeal may result in a reversal of the Hearing Officer’s decision.

Hearing decisions regarding Medical Assistance

Names of appellants have been removed from all hearing decisions posted here, either by being redacted or by substituting a pseudonym.

• Reduce Medical Assistance benefits to Family Planning Services based upon being over the income limit (10/28/2011)
• Close/Reduce Medical Assistance benefits based upon being over the income limit (10/21/2011)
• Close Medical Assistance benefits based upon being over the income limit (10/21/2011)  
• Close childrens Medical Assistance benefits based upon being over the income limit (10/21/2011)
• Close Medical Assistance benefits based upon being over the income limit (10/20/2011) 
• Close Medical Assistance after not participating in a case review(10/20/2011)
• Reduce Medical Assistance benefits to Family Planning Services based upon being over the income limit (10/20/2011)
• Close Medical Assistance benefits based upon being over the income limit (10/20/2011)
• Deny application for medical assistance benefits (10/18/2011)
• Deny request for an Ultralightweight manual wheelchair(9/13/2011)
• Close Medical Assistance benefits (9/22/2011) 
• Deny Medical Assistance benefits (9/22/2011)
• Close Medical Assistance benefits based upon being over the income limit (8/26/2010)
• Deny Medical Assistance benefits (9/22/2011)  
• Deny Medical Assistance benefits based upon being over the income limit (9/16/2011)
• Close Medical Assistance benefits based upon being over the income limit (9/16/2011)
• Reduce Medical Assistance benefits for being over the income limit (9/27/2011)
• Approve Prescribed Pediatric Extended Care benefits (9/27/2011)
• Deny request for Medicaid coverage of orthodontic care (9/16/2011)
• Reduce Medical Assistance to Family Planning based upon being over the income limit (9/1/2011)
• Close Medical Assistance benefits based upon being over the income limit (9/1/2011) 
• Close Medical Assistance benefits based upon being over the income limit (9/1/2011)
• Close Medical Assistance benefits based upon being over the income limit (9/1/2011)  
• Deny application for Medicaid for Uninsured Adults based upon being over the income limit (8/4/2011)
• Denied Medical Assistance because non-needs based income was over the limit(8/4/2011)
• Close Medicaid for Uninsured Adults based upon being over the income limit (8/4/2011)
• Close Medical Assistance benefits based upon being over the income limit (7/21/2011) 
• Close Medical Assistance benefits based upon being over the income limit (7/21/2011)
• Deny Medical Assistance benefits based upon being over the income limit (8/26/2010)
• Deny Medical Assistance benefits based upon being over the income limit (8/26/2010) 
• Close Medical Assistance benefits based upon being over the income limit (8/23/2010)
• Deny Medical Assistance benefits based upon being over the income limit (8/26/2010)  
• Reduce Medical Assistance benefits based upon being over the income limit (8/26/2010)
• Change Medicaid Long Term Care patient pay amount (8/10/2010)
• Change Medicaid Long Term Care patient pay amount (8/10/2010) 
• Close Medical Assistance benefits for not cooperating with the Division of Child Support Enforcement (DCSE) (8/10/2010)
• Close Medical Assistance benefits, based upon being over the income (8/10/2010)
• Reduce Medicaid to Family Planning Medicaid, based upon being over the income (8/5/2010)
• Recoupment for unpaid nursing home care bills (8/5/2010)
• Deny coverage for comprehensive orthodontic treatment for the minor Appellant to acquire braces (7/26/2010)
• Reduce Qualified Medicare Beneficiary (" QMB ") benefits to Special Low Income Beneficiary (" SLMB ") benefits based upon being over the income limit (7/22/2010)
• Close family 's Medical Assistance benefits based upon being over the income limit (7/13/2010)
• Change Medical Assistance benefits, removing from Transitional Medicaid via the Extended Medicaid for Wages program, and placing in the Delaware Healthy Children Program and in the Family Planning Services Program. (7/13/2010)
• Close Medical Assistance benefits based upon being over the income limit (6/28/2010)
• Deny Medical Assistance benefits based upon being over the income limit (6/28/2010) 
• Close Medical Assistance for not participating in a case review (6/27/2010)
• Close Medical Assistance benefits based upon being over the income limit (6/22/2010)
• Reduce Medical Assistance benefits to Family Planning Medicaid based upon being over the income limit (6/22/2010)
• Close Medical Assistance for not participating in a case review (6/17/2010)
• Close Medical Assistance benefits based upon being over the income limit (6/16/2010)
• Close Medicaid for Uninsured Adults based upon being over the income limit (6/10/2010)
• Reduce Medical Assistance to Family Planning Medicaid based upon being over the income limit (6/10/2010)
• Close Medical Assistance benefits based upon being over the income limit (6/9/2010)
• Close Medical Assistance benefits based upon being over the income limit (6/9/2010) 
• Deny adult expansion Medicaid benefits based upon being over the income limit (6/9/2010)
• Reduce Medical Assistance to Family Planning Medicaid based upon being over the income limit (6/9/2010)
• Deny adult expansion Medicaid benefits based upon being over the income limit (6/3/2010)
• Close Medical Assistance benefits based upon being over the income limit (6/3/2010)
• Close Medical Assistance benefits based upon being over the income limit (5/27/2010)
• Close Medical Assistance benefits based upon being over the income limit (5/24/2010)
• Deny adult expansion Medicaid benefits based upon being over the income limit (5/24/2010)
• Decision to deny Long Term Care Medicaid (5/24/2010)
• Terminate Medicaid due household income exceeding the income limit (5/24/2010)
• Close Medical Assistance for not participating in a case review (5/17/2010)
• Denied for Medicaid Long Term Care because requested information was not provided by the requested dates (5/17/2010)
• Close Medicaid based upon being over the income limit (5/3/2010)
• Deny Medicaid based upon being over the income limit (5/3/2010)
• Deny Medical Assistance benefits based upon being over the income limit (5/3/2010)
• Deny Medicaid re-application based upon being over the income limit (5/3/2010)
• Deny Medical Assistance benefits application based upon being over the income limit (5/3/2010)
• Deny Medical Assistance benefits application based upon being over the income limit (5/3/2010) 
• Close Medical Assistance benefits, based upon being over the income limit (4/19/2010)
• Reduce Medical Assistance benefits to Family Planning Medicaid based upon being over the income limit (4/14/2010)
• Reduce Medical Assistance to Family Planning Medicaid and Medical Assistance to Delaware Healthy Children ' s Program based upon being over the income limit (4/12/2010)
• Close Medical Assistance benefits based upon being over the income limit (4/12/2010)
• Reduce Medical Assistance benefits to Family Planning Medicaid based upon being over the income limit (4/12/2010)
• Close Medical Assistance benefits based upon being over the income limit (4/12/2010) 
• Close Medical Assistance benefits based upon being over the income limit (3/16/2010)
• Close Medical Assistance benefits based upon being over the income limit (3/16/2010) 
• Close Medical Assistance benefits based upon being over the income limit (3/16/2010)  
• Close Medical Assistance benefits based upon being over the income limit (3/10/2010)
• Close Medical Assistance benefits based upon being over the income limit (3/10/2010) 
• Close Medical Assistance case based upon being over the income limit (3/1/2010)
• Close Medical Assistance for not participating in a case review (2/22/2010)
• Reduce Medical Assistance benefits to Family Planning Medicaid based upon being over the income limit (2/22/2010)
• Deny Medicaid Long Term Care benefits, effective from March 1, 2009 to April 30, 2009 (2/22/2010)
• Decision to close Medical Assistance (12/24/2004)
• Decision by the Division of Social Services to terminate Medical Assistance benefits (12/29/2004)
• Decision to deny services offered by the Delaware Division of Developmental Disabilities (1/5/2005)
• Application for Long Term Care denied for over resource (1/5/2005)
• Decision by the Division of Social Services (DSS) to deny application for Long Term Care (1/24/2005)
• Decision by the Division of Social Services (DSS) to close Medical Assistance (1/26/2005)
• Decision by the Division of Social Services (DSS) to deny Medical Assistance (1/27/2004)
• Decision of the Division of Social Services to deny request for prescription drug coverage (2/21/2005)
• Decision of Delaware Physicians Care, Incorporated ("DPCI") to not provide service (3/1/2005)
• Decision by the Division of Social Services ("DSS") to close Medical Assistance (3/4/2005)
• Decision by the Division of Public Health to deny request for Medicaid coverage (3/14/2005)
• Decision to deny application for Medical Assistance (3/15/2005)
• Decision by the Division of Social Services ("DSS") to close Medical Assistance (3/15/2005)
• Decision by the Division of Social Services ("DSS") to terminate Medical Assistance (3/16/2005)
• Decision by the Division of Social Services ("DSS") to terminate Medical Assistance (3/19/2005)
• Decision by the Division of Social Services ("DSS") to close Medical Assistance (3/19/2005)a
• Decision by the Division of Social Services ("DSS") to close Medical Assistance (3/19/2005)b
• Decision by the Division of Social Services ("DSS") to close Medical Assistance (3/19/2005)c
• Decision by the Division of Social Services ("DSS") to close Medical Assistance (3/19/2005)d
• Division of Social Services ("DSS") decision to close transitional Medical Assistance (3/19/2005)
• Decision by the Division of Social Services ("DSS") to close Medical Assistance (3/22/2005)
• Decision by the Division of Social Services to deny application for Medical Assistance (3/22/2005)
• Medicaid Long Term Care ("LTC") resources over the $2000.00 limit (3/22/2005)
• Division of Social Services ("DSS") to deny application for Medical Assistance (3/23/2005)
• Decision of the Division of Social Services to discontinue Medicaid Program benefits (3/24/2005)
• Decision by the Division of Social Services to terminate Medical Assistance benefits (3/24/2005)
• Decision of the Division of Social Services to terminate Medicaid Program benefits (4/1/2005)
• Decision by the Division of Social Services to deny application for Medical Assistance (4/12/2004)
• Decision by the Division of Social Services to deny re-application for Medical Assistance (4/12/2005)
• Decision by the Division of Social Services ("DSS") to discontinue Medical Assistance (4/26/2005)
• Decision by DMMA to deny claim for Durable Medical Equipment (9/2/2006)