Medicaid Managed Care Open Enrollment Extended through Dec. 15
Current Suspected Overdose Deaths in Delaware for 2017: 227
DCIS No Redacted
Redacted, pro se, Appellant
John Porch, Sr. Social Worker/Case Manager, Division of Social Services
Redacted ("Appellant") contends that she was never asked to complete an application and provide it to the Division of Social Services ("DSS") in order for them to re-determine her eligibility for benefits.
DSS contends that the Appellant failed to return her application for re-determination of eligibility and therefore, her Medical Assistance and ABC cases were closed.
Ms. Redacted received notices to terminate her Medical Assistance and ABC benefits dated October 5, 2004, and her benefits were to be terminated effective after October 31, 2004. (See, Exhibits 3-5)
The Appellant filed three (3) requests for a fair hearing. Because the requests were made before the effective date of the action benefits were continued. (Exhibit 2)
The Appellant was notified by letter dated October 28, 2004, that a fair hearing would be held on December 2, 2004. The hearing was conducted on that date in New Castle, DE. This is the decision resulting from that hearing.
Ms. Redacted was receiving Medical Assistance and ABC benefits. Ms Redacted was instructed to complete applications for re-determination and return the applications by September 30, 2004. Those applications were never received by DSS and as of the hearing date, no new applications were submitted. The Appellant testified that she never received any new applications to be completed; however the DSS worker testified that those applications were mailed to her.
Appellant argues that she was not aware of how to proceed, and that when she called into her worker after receiving the closure notices, she was never instructed to complete any new applications. Despite her insistence that she was never instructed to return an application, the very notices closing her case instruct the Appellant that in order to get benefits she must reapply. She never requested a new application and never re- applied for benefits.
DSSM 14100.6 - Re-determination of Eligibility, mandates that when a re-determination is due, the recipient is required to complete and return a new DSS application form. Failure to complete and return a DSS application form will result in termination of eligibility. (See also, DSSM 200 and 200.1).
Since DSS did not receive the Appellant's applications in a timely manner, DSS was correct in its decision to terminate Ms. Redacted Medicaid and ABC coverage.
For these reasons, DSS's decision to terminate the Appellant's Medicaid and ABC benefits is AFFIRMED.
Date: January 25, 2004
THE FOREGOING IS THE FINAL DECISION OF THE DIVISION OF SOCIAL SERVICES
John Porch, Pool 120
EXHIBITS FILED IN OR FOR THE PROCEEDING