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Decision by the Division of Social Services to deny application for Medical Assistance


In re: DCIS No. Redacted Redacted

Appearances:
Redacted, pro se, Claimant
Marcella Nichols, Sr. Social Worker/Case Manager, Division of Social Services
Sabrina Taylor, Sr. Medical Social Worker Supervisor, Div. of Social Services

I.

Redacted ("Claimant") opposes a decision by the Division of Social Services ("DSS") to deny her application for Medical Assistance benefits based upon being over the income limit for a household of one (1). Claimant contends that because of her medical condition and her need for medications, she should be entitled to medical assistance.

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

II.

On October 25, 2004, DSS sent to Claimant a Notice to Deny Your Medical Assistance. (Exhibit 3)

On November 15, 2004, the Claimant 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 did not continue. (Exhibit 1)

The Claimant was notified by certified letter dated December 3, 2004, that a fair hearing would be held on January 13, 2005. The Claimant requested a re-scheduled hearing and the hearing was rescheduled to March 2, 2005. The hearing was conducted on that date in New Castle, Delaware.

This is the decision resulting from that hearing.

III.

Appellant applied for medical assistance on September 8, 2004. At that time, she provided an Awards Letter from the Social Security Administration ("SSA") stating that she receives $833.00 per month in Title II Disability payments. Claimant has multiple medical problems that require her to see physicians on a regular basis and take medications regularly.

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 did not receive an earned income deduction (disregard) because all of her income is considered unearned 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. As this benefit is based solely on income, there are no deductions made for expenses and a person's medical condition is not taken into consideration.

Based upon the information provided, I find that DSS correctly determined that the Claimant's unearned monthly countable income is $833.00. 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 Claimant was properly sent a Notice to Deny Your Medical Assistance. (Exhibit 3)

IV.

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

Date: March 22, 2005
MICHAEL L. STEINBERG
HEARING OFFICER

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

POSTED
MLS/vmd

cc:
Redacted
Marcella Nichols, DSS Pool 034
Sabrina Taylor, DSS Pool 034

EXHIBITS FILED IN OR FOR THE PROCEEDING

  • EXHIBIT #1 - Copy of DSS Hearing Summary consisting of two (2) pages dated November 29, 2004.
  • EXHIBIT #2 - Copy of the Claimant's request for a fair hearing dated November 15, 2004, consisting of two (2) pages.
  • EXHIBIT #3 - Copy of the Notice to Deny Your Medical Assistance dated October 25, 2004, consisting of two (2) pages.


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