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Division of Social Services (DSS) decision to close transitional medical assistance


In re: DCIS No. Redacted

Appearances:
Redacted, Appellant
Redacted, Appellant's Spouse
Donna Rogers, Sr. Social Worker/Case Manager, Division of Social Services
Joanne Friend, Sr. Social Worker/Case Manager, Division of Social Services

I.

Redacted ("Appellant") is appealing the decision to close her Transitional medical assistance case and to deny her application for other medical assistance benefits.

The Division of Social Services ("DSS") contends that Appellant is no longer eligible for Transitional medical assistance coverage because she has exhausted her time-limited benefits under that program. DSS also contends that they properly denied her application for benefits because they have determined that the household is over the income limit for a household of four (4).

II.

By notice dated December 2, 2004, and effective after December 31, 2004, DSS terminated the Appellant's Transitional medical assistance benefits. (Exhibit 3) DSS also denied medical assistance benefits to the Appellant by notice dated December 17, 2004. (Exhibit 4)

On December 27, 2004, 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 January 12, 2005, that a fair hearing would be held on February 8, 2005. The hearing was conducted on that date in Georgetown, Delaware. This is the decision resulting from that hearing.

III.

The Appellant had been receiving transitional medical assistance benefits and was approaching the end of her second year of coverage. On December 2, 2004, DSS issued a Notice To Close Your Medical Assistance citing that Appellant had used up her two years of eligibility under the Transitional medical assistance program. (Exhibit 3)

The Appellant filed her review application. After review of her application, DSS determined that Appellant was no longer eligible for medical assistance benefits because of the household income, and issued a Notice to Deny Your Medical Assistance. (Exhibit 4)

DSS determined that Mr. Redacted receives gross monthly earnings of $2002.25 based upon pay stubs that were submitted with the application for assistance. (Exhibit 4) DSS determined that Appellant's husband was receiving $462.44 weekly. Pursuant to DSSM 16230, this figure was multiplied by a factor of 4.33 to account for months that have five (5) weeks, and resulted in a gross income figure of $2002.35. In this case, the Claimant then received an earned income deduction in the amount of $90.00 because his income was from employment, pursuant to DSSM 16250, for a total countable income of $1912.35.

Pursuant to DSSM 16230, countable income is used to determine eligibility for benefits. DSSM 16230 defines countable income as earned or unearned income minus any disregards, if applicable. In this case, the Appellant household did receive an earned income deduction because all of Mr. Redacted 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.

Based upon the information provided, DSS correctly determined that the Appellant's unearned household monthly countable income is $1912.35. The income limit for a household of four (4) for adult poverty medical assistance benefits on the date that the notice was issued was $1571.00 per month. As a result, the Appellant was properly sent a Notice to Deny Your Medical Assistance. (Exhibit 4)

IV.

For these reasons, the decisions of the Division of Social Services to terminate Appellant's Medical Assistance benefits and deny her application for medical assistance benefits are AFFIRMED.

Date: March 19, 2005

STEVEN A. GREENSPAN
HEARING OFFICER

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

POSTED
SAG/vmd

EXHIBITS FILED IN OR FOR THE PROCEEDING

  • EXHIBIT #1 - Copy of DSS Hearing Summary consisting of two pages, date-stamped January 4, 2005.
  • EXHIBIT #2 - Copy of Appellant's request for a fair hearing date-stamped December 27, 2004, consisting of one (1) page.
  • EXHIBIT #3 - Copy of Notice to Close Your Medical Assistance dated December 2, 2004 consisting of four (4) pages.
  • EXHIBIT #4 -Copy of Notice to Deny Your Medical Assistance dated December 17, 2004 consisting of four (4) pages.
  • EXHIBIT #5 - Copy of pay stubs from Appellant's husband, consisting of two (2) pages


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