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


In re: DCIS No. Redacted Redacted

Appearances:
Redacted, pro se, Claimant
Lenora Williams, Senior Social Worker/Case Manager, Division of Social Services
Virginia McGonegal, Social Worker Supervisor, Division of Social Services

I.

Redacted (Claimant) opposes a decision by the Division of Social Services (DSS) to deny her Medical Assistance application based upon being over the income limit for a household of three (3).

The Division of Social Services (DSS) contends that the household's income is over the income limit for a household of three (3).

II.

On October 8, 2004, DSS sent to Claimant three (3) Notices to Deny Your Medical Assistance. (Exhibits 5-7)

The Claimant filed three (3) requests for a fair hearing. (Exhibits 2-4). The hearing requests were consolidated as the sole issue was the denial of Medical Assistance for being over the income limit.

The Claimant was notified by certified letter dated November 8, 2004, that a fair hearing would be held on December 6, 2004. A hearing was conducted on that date in New Castle, Delaware.

This is the decision resulting from that hearing.

III.

Ms. Redacted filed a re-determination application for medical assistance benefits. At the time of her application she provided her social worker with two pay stubs - one in the amount of $943.35 and one in the amount of $884.34. She is paid bi-weekly. DSS determined, after applying a 2.16 factor to this earned income as provided in DDSM 16230, that Ms. Redacted had a monthly income in the amount of $1974.23. The household also had unearned income in the form of social security disability income for her husband and son totaling $1870.64. DSS then issued three (3) Notices to Deny Your Medical Assistance. (Exhibits 5-7)

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 Claimant received an earned income deduction (disregard) in the amount of $90.00 because her income was from employment, pursuant to DSSM 16250. This resulted in a countable income of $1884.23 for Ms. Redacted 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 household's earned and unearned monthly countable income after all allowable deductions was $3745.87, well in excess of the income limits for a household of three (3) for medical assistance benefits. As a result, the Claimant was properly sent three (3) Notices to Deny Your Medical Assistance. (Exhibit 5-7)

IV.

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

Date: January 27, 2004

MICHAEL L. STEINBERG
HEARING OFFICER

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

POSTED
MLS/vmd

cc:
Redacted
Lenora Williams, DSS
Virginia McGonegal, DSS

EXHIBITS FILED IN OR FOR THE PROCEEDING

  • EXHIBIT #1 - Copy of DSS Fair Hearing Summary consisting of two (2) pages date-stamped October 12, 2004.
  • EXHIBIT #2 - Copy of the Claimant's request for a fair hearing (MCHL) date-stamped September 27, 2004, consisting of one (1) page.
  • EXHIBIT #3 - Copy of the Claimant's request for a fair hearing (MPVY) date-stamped October 19, 2004, consisting of one (1) page
  • EXHIBIT #4 - Copy of the Claimant's request for a fair hearing (MCHH) dated October 18, 2004, consisting of one (1) page
  • EXHIBIT #5 - Copy of the Notice to Deny Your Medical Assistance (MPVY) dated October 8, 2004, consisting of four (4) pages.
  • EXHIBIT #6 - Copy of the Notice to Deny Your Medical Assistance (MCHH) dated October 8, 2004, consisting of two (2) pages.
  • EXHIBIT #7 - Copy of the Notice to Deny Your Medical Assistance (MCHL) dated September 20, 2004, consisting of four (4) pages.
  • EXHIBIT #8 - Copy of two (2) of Claimant's pay stubs, consisting of one (1) page.


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