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Decision by the Division of Social Services (DSS) to close Medical Assistance


In re: DCIS No. Redacted Redacted

Appearances:
Redacted, pro se, Appellant
Melissa Leeper, Social Worker/Case Manager, Division of Social Services
Donna Rogers, Social Worker/Case Manager, Division of Social Services

I.

Redacted ("Appellant") opposes a decision by the Division of Social Services ("DSS") to close his Medical Assistance case based upon being over the income limit for a household of two (2).

The Division of Social Services ("DSS") contends that the Appellant is over the income limit for a household of two (2) and is therefore ineligible to continue to receive Transitional Medicaid or CHIPS services.

II.

On October 27, 2004, DSS sent to Appellant a Notice to Close Your Medical Assistance. (Exhibit 3)

The Appellant filed a request for a fair hearing and requested that benefits continue until a hearing decision was issued. (Exhibit 2). According to the Fair Hearing summary benefits have continued. (Exhibit 1)

The Appellant was notified by certified letter dated December 6, 2004, that a fair hearing would be held on January 31, 2005. The hearing was conducted on that date in Georgetown, Delaware.

This is the decision resulting from that hearing.

III.

In October 2004, the Appellant filed a re-determination form to continue Transitional Medicaid benefits. He provided DSS with four (4) stubs. Based upon these pay stubs, DSS determined that Mr. Redacted was receiving $2,598 per month in earned income, which represented an increase of approximately $1500.00 from his income as calculated in August 2003. The pay stubs were not presented at the hearing.

Pursuant to DSSM 15200.6.3, for Transitional Medicaid, the family's gross monthly earnings (less the monthly costs of necessary dependent care) must be at or below 200% of the Federal Poverty Level (FPL).

Based upon the information provided to them, DSS determined that the Appellant had $433.00 in allowable dependent care costs, and earned monthly income in the amount of $2,598.00. After subtracting the dependant care costs, DSS determined that Mr. Redacted had a gross monthly countable income of $2165.00, $83.00 over the limit of $2082.

In this case, however, the Appellant disputed the calculation of his income in his request for fair hearing, and DSS provided no pay stubs to substantiate their income calculation. Accordingly, the action by DSS to close the Appellant's Transitional Medical Assistance case cannot be substantiated on the record before me.

IV.

For these reasons, the decision of the Division of Social Services to close Appellant's Transitional Medical Assistance case is REVERSED.

Date: March 4, 2005

MICHAEL L. STEINBERG
HEARING OFFICER

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

POSTED
MLS/vmd

cc:
Redacted
Melissa Leeper, DSS Pool 430
Donna Rogers, DSS Pool 430

EXHIBITS FILED IN OR FOR THE PROCEEDING

  • EXHIBIT #1 - Copy of DSS Hearing Summary consisting of two (2) pages date-stamped November 24, 2004.
  • EXHIBIT #2 - Copy of the Appellant's request for a fair hearing date-stamped November 16, 2004, consisting of two (2) pages.
  • EXHIBIT #3 - Copy of the Notice to Close Your Medical Assistance dated October 27, 2004, consisting of four (4) pages.


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