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

In re:DCIS No. Redacted Redacted

Redacted, pro se, Appellant
Mahlon Wise, Senior Social Worker/Case Manager, Division of Social Services
Sandra Brooks, Senior Social Worker/Case Manager, Division of Social Services


Redacted ("Appellant") opposes a decision by the Division of Social Services ("DSS") to close her Medical Assistance case based upon being over the income limit for a household of one (1). The Appellant contends that she has extenuating circumstances and medical expenses that should be taken into consideration.

The Division of Social Services ("DSS") contends that the Appellant is over the income limit for a household of one (1).


On December 11, 2004, DSS sent to Appellant a Notice to Close Your Medical Assistance, effective after December 31, 2004. (Exhibit 3)

The Appellant filed a request for a fair hearing on January 5, 2005, and requested that benefits continue until a hearing decision was issued. (Exhibit 2). According to the Fair Hearing Summary benefits have continued. (Exhibit 1)

(It is unknown why benefits were continued, as the request for the hearing came after the effective date of the action. (See, DSSM §5305))

The Appellant was notified by certified letter dated February 4, 2005, that a fair hearing would be held on March 1, 2005. The hearing was conducted on that date in Georgetown, Delaware.

This is the decision resulting from that hearing.


In January 2004, Appellant was receiving $716.00 per month in social security income as a divorced wife. Because of her status and income, she was receiving benefits under the Qualified Medicare Beneficiary ("QMB") program (Administrative Notice A-04-2004). In March 2004, unbeknownst to DSS, the Appellant began receiving $1795.00 per month from social security income as her status had changed to a surviving divorced wife. This information was never communicated to DSS. In December 2004, when the Social Security Administration issued its mass change, DSS learned, through the State Data Exchange ("SDX") that the Appellant was to begin receiving $1844.00 per month in social security benefits as of January 1, 2005. Accordingly, DSS re-determined the Appellant's eligibility. (DSSM §17300.6)

Pursuant to DSSM §17300.3.2.6, countable income is used to determine eligibility for benefits. Countable income is earned or unearned income minus appropriate deductions (disregards). In this case, the Appellant received a standard $20.00 deduction. In addition, pursuant to DSSM 17300.3.1, DSS is also authorized to provide a Cost of Living Adjustment ("COLA") deduction, which reduces the income by the amount of the COLA amount. A Qualified Medicare Beneficiary must have countable income that does not exceed 100% of the official poverty line. (DSSM §17300.3) As this benefit is based solely on being entitled to Medicare and income, there are no deductions made for expenses.

A QMB is someone who is entitled to hospital insurance benefits under Part A Medicare, whose income does not exceed the Federal Poverty Level. QMB's qualify for Medicaid to pay their Medicare Part A and B premiums, deductibles, and co-insurance expenses. They do not receive any Medicaid services. (DSSM §17300)

Based upon the information provided, I find that DSS correctly determined that the Appellant's unearned monthly countable income is $1774.22. The Appellant had $1844.00 in unearned social security income, a standard $20.00 deduction, and a COLA deduction of $49.78. The income limit for a household of one (1) for the QMB program was $798.00 per month on the date that the notice was issued. As a result, the Appellant was properly sent a Notice to Close Your Medical Assistance. (Exhibit 3)


For these reasons, the decision of the Division of Social Services to close Appellant's QMB benefit case is AFFIRMED.

Date: March 22, 2005




Mahlon Wise, DSS Pool 131
Sandra Brooks, DSS Pool 131


  • EXHIBIT #1 - DSS Hearing Summary consisting of two (2) pages date-stamped January 18, 2005.
  • EXHIBIT #2 - The Appellant's request for a fair hearing date-stamped January 5, 2005, consisting of one (1) page.
  • EXHIBIT #3 - Copy of the Notice to Close Your Medical Assistance dated December 11, 2004, consisting of three (3) pages.