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Decision to close Medical Assistance


In re:
DCIS No. Redacted
Redacted Redacted

Appearances:
Redacted Redacted, pro se, Appellant
Charlene Smith, Social Worker Supervisor, Division of Social Services
Tony Watson, Senior Social Worker/Case Manager, Division of Social Services

I.

Redacted 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 Division of Social Services (DSS) contends that the Appellant failed to notify them of a new job in a timely, and when DSS finally received wage information, the Appellant was over the income limit for a household of one (1).

II.

On October 6, 2004, DSS sent to Appellant a Notice to Close Your Medical Assistance. (Exhibit 3)

The Appellant filed a request for 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 October 22, 2004, that a fair hearing would be held on November 22, 2004. The hearing was conducted on that date in New Castle, Delaware.

This is the decision resulting from that hearing.

III.

Appellant was receiving Adult Poverty medical assistance benefits. While she began working at Dunkin Donuts on June 23, 2004, this information was not reported to DSS until September 30, 2004. DSS determined that Appellant was receiving $232.64 weekly, including wages and tips. (Exhibit 4) 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 $1007.37. In this case, the Claimant then received an earned income deduction (disregard) in the amount of $90.00 because her income was from employment, pursuant to DSSM 16250, for a total countable income of $917.37. On October 1, 2004, DSS received additional wage information for the Appellant's job at Dunkin Donuts, which showed an even higher gross monthly income.

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. Pursuant to DSSM 16230.1.1, DSS is only permitted to utilize gross income, and not net income (after expenses), for purposes of eligibility. DSS properly utilized the Appellant's gross income in determining eligibility for medical assistance.

Based upon the information provided, DSS correctly determined that the Appellant's earned monthly countable income is $917.37. The income limit for a household of one (1) for adult poverty medical assistance benefits on the date that the notice was issued was $776.00 per month. As a result, the Appellant was properly sent a Notice to Close Your Medical Assistance. (Exhibit 3)

IV.

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

Date: December 24, 2004

MICHAEL L. STEINBERG
HEARING OFFICER

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

POSTED
MLS/vmd

cc:
Redacted Redacted
Charlene Smith, DSS Pool 120
Tony Watson, DSS Pool 120

EXHIBITS FILED IN OR FOR THE PROCEEDING

  • EXHIBIT #1 - DSS Hearing Summary consisting of two (2) pages date-stamped October 19, 2004.
  • EXHIBIT #2 - The Appellant's request for fair hearing date-stamped October 13, 2004, consisting of one (1) page.
  • EXHIBIT #3 - Copy of the Notice to Close Your Medical Assistance dated October 6, 2004, consisting of four (4) pages.
  • EXHIBIT #4 - Copy of Transmittal Form for DSS Adjustments Closings, consisting of three (3) pages.
  • EXHIBIT #5 - Copy of Fax from Appellant including most recent pay stub, dated October 1, 2004, consisting of two (2) pages.


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