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Division of Social Services (DSS) to deny application for Medical Assistance


In re: DCIS No. Redacted Redacted

Appearances:
Redacted, pro se, Claimant
Iva Durham, Sr. Social Worker/Case Manager, Division of Social Services
Valerie Turner, Social Worker Supervisor, Division of Social Services

I.

Redacted ("Claimant") opposes a decision by the Division of Social Services ("DSS") to deny her application for Medical Assistance benefits based upon being over the income limit for a household of two (2). Claimant contends that because of her medical condition and her need for medications, she should be entitled to medical assistance.

The Division of Social Services ("DSS") contends that the Claimant is over the income limit for a household of two (2). DSS maintains that Claimant is eligible for benefits from the Family Planning Only Medicaid program and that the CHIPS program is covering her son.

II.

On December 14, 2004, DSS sent to Claimant a Notice to Deny Your Medical Assistance. (Exhibit 3)

On December 9, 2004, the Claimant filed a request for a fair hearing. (Exhibit 2).

The Claimant was notified by certified letter dated January 24, 2005, that a fair hearing would be held on March 10, 2005. The hearing was conducted on that date in New Castle, Delaware.

This is the decision resulting from that hearing.

III.

Appellant applied for medical assistance in December 2004. At that time, she provided DSS with Direct Deposit Advices from the YMCA of Delaware showing her part-time income. I find that DSS correctly determined that the Claimant was earning $585.79 per month from the YMCA of Delaware. She also advised DSS that she was receiving unemployment compensation, which was verified by DSS on a Delaware Department of Labor Unemployment Claims History Payment History screen print. (Exhibit 4). That document showed unemployment compensation income in the amount of $330.00 per week. When this figure was multiplied by a factor of 4.33, pursuant to DSSM 16230 to account for months that have five (5) weeks, DSS determined an unemployment compensation figure of $1428.90 per month. The Claimant testified that she has high blood pressure and allergies, and is taking medications for both, as well as birth control pills. DSS testified that Claimant is eligible for Family Planning Only Medicaid.

Pursuant to DSSM 16230, countable income is used to determine eligibility for benefits under the Adult Poverty medical assistance program. DSSM 16230 defines countable income as earned or unearned income minus any disregards, if applicable. In this case, the Claimant received an earned income deduction (disregard) of $90.00 because some of her income is considered earned under DSSM 16250. Pursuant to DSSM 16230.1.1, DSS is only permitted to utilize gross income, and not net income (after expenses), for purposes of eligibility. As this benefit is based solely on income, there are no deductions made for expenses and a person's medical condition is not taken into consideration.

Based upon the information provided, I find that DSS correctly determined that the Claimant's monthly countable income is $1924.69 after application of the earned income deduction. The income limit for a household of two (2) for adult poverty medical assistance benefits on the date that the notice was issued was $1041.00 per month. As a result, the Claimant was properly sent a Notice to Deny Your Medical Assistance. (Exhibit 3)

IV.

For these reasons, the decision of the Division of Social Services to deny Claimant's application for Adult Poverty Medical Assistance case is AFFIRMED.

Date: March 23, 2005

MICHAEL L. STEINBERG
HEARING OFFICER

THE FOREGOING IS THE FINAL DECISION OF THE DIVISION OF SOCIAL SERVICES

POSTED
MLS/vmd

cc:
Redacted
Iva Durham, DSS Pool 730
Valerie Turner, DSS Pool 730

EXHIBITS FILED IN OR FOR THE PROCEEDING

  • EXHIBIT #1 - Copy of DSS Hearing Summary consisting of two (2) pages date-stamped January 14, 2005.
  • EXHIBIT #2 - Copy of the Claimant's request for a fair hearing date-stamped December 29, 2004, consisting of three (3) pages.
  • EXHIBIT #3 - Copy of the Notice to Deny Your Medical Assistance dated December 14, 2004, consisting of four (4) pages.
  • EXHIBIT #4 - Copy of Delaware Department of Labor Unemployment Claims History Payment History dated November 9, 2004, consisting of one (1) page.
  • EXHIBIT #5 - Copy of YMCA of Delaware Direct Deposit Advices, consisting of five (5) pages.


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