Source: http://dhss.delaware.gov/dhss/dss/rfhd2005/fsmedexpense200533.html
Timestamp: 2017-12-13 18:34:04
Document Index: 425761605

Matched Legal Cases: ['§9060', '§9060', '§9060', '§9060', '§9013', '§9013']

FS-MEDEXPENSE-2005.33.doc - Delaware Health and Social Services - State of Delaware
Decision of the Division of Social Services to approve food stamp benefits
Redacted, Appellant
Redacted, Appellant's Sister and Power of Attorney
Nelly Maldonado, Sr. Social Worker/Case Manager, Division of Social Services
Linda Jones, Sr. Social Worker/Case Manager, Division of Social Services
Redacted, ("Appellant"), by and through her sister and Power of Attorney, Redacted, was receiving food stamps and experienced changes to her income and expenses that reduced her food stamp benefit when she re-applied for benefits. Ms. Redacted contends that she has medical expenses that are not taken into consideration, although she receives Medicaid, and believes that her food stamp amount should not be decreased.
The Division of Social Services ("DSS") contends that their calculation of benefits was proper based upon the information they received.
Appellant was receiving food stamp benefits in the amount of $141.00, which were reduced when a re-calculation of benefits was made pursuant to a new application for benefits and information DSS obtained regarding the Appellant's income and expenses.
By notice dated December 27, 2004, DSS approved the Appellant's food stamp benefits in the amount of $17.00, beginning January 1, 2005. (Exhibit 3).
On January 5, 2005, the Appellant filed a request for a fair hearing based upon the amount of her food stamp benefits.
The Appellant was notified by certified letter dated January 14, 2005, that a fair hearing would be held on March 2, 2005. The hearing was conducted on that date in New Castle, Delaware. This is the decision resulting from that hearing.
Ms. Redacted was receiving food stamp benefits in the amount of $141.00 based upon an application that she filed in September 2004. In December 2004, the Appellant filed another application for food stamp benefits. DSS determined that that the Appellant's rent had increased from $745.00 to $790.00, that her social security income for the month of January would be $725.00 instead of $705.00, that her pension income was increasing from $460.00 to $472.00 and that she pays for her utilities.
DSS testified that since the Appellant was also receiving State of Delaware medical assistance she was no longer entitled to a deduction for excess medical expenses. The Appellant testified that notwithstanding her medical assistance coverage, she now pays approximately $45.00 per month for co-payments for medications.
As a result of all of the changes, when DSS approved her food stamp benefit case after recalculating her case based upon the new information, the result was a change in her food stamp benefit reduced from $141.00 to $17.00. (Exhibit 3).
DSSM recalculated the Appellant's benefits pursuant to DSSM §§9060 and 9065, based upon the information they received when the Appellant re-applied for benefits in December 2004. Appellant was provided with the maximum utility deduction and a deduction for her increase in rent. However, DSS removed any deduction for excess medical expense because the Appellant is receiving state medical assistance. This was in error.
Pursuant to DSSM §9060 C. Excess Medical Deductions - That portion of unreimbursed medical expenses in excess of $35 per month, excluding special diets, incurred by any household member who is 60 years of age or over or disabled as defined in DSSM 9013.1 is deducted as well. This coverage includes prescription drugs and over-the-counter medication when approved by a licensed practitioner or other qualified health professional. Nothing in the regulation prohibits a deduction for excess medical expense if the party is receiving state medical assistance.
Appellant testified that under her medical assistance program, she is required to pay co-payments for medications that total approximately $45.00 per month. In addition, DSSM §9060 also provides for deductions stemming from other out of pocket medical costs that Appellant may be paying, but which have not been identified by DSS.
Accordingly, DSS should have inquired as to the medical expenses of the Appellant, which are over and above what is covered by her medical assistance program. Any unreimbursed medical expense in excess of $35.00 per month should be counted as an excess medical deduction pursuant to DSSM §9060.
Therefore, while DSS properly attributed the new income, rent and utility information to the Appellant's case, they failed to investigate the extent of her excess medical deduction, if any. Since there is not ample credible evidence to support the actions taken by DSS, the actions of DSS are not sustained on the record. However, should DSS determine that the Appellant is not at least 60 years old or disabled pursuant to DSSM §9013.1, then they have satisfied their burden and their actions are sustained on the record.
For these reasons, the decision of the Division of Social Services to approve the Appellant's food stamp benefits for $17.00 beginning January 1, 2005 is STAYED.
DSS is directed to determine the Appellant's age, and if needed, disability status under DSSM §9013.1. If Appellant meets the age or disability eligibility requirements for the excess medical deduction, then the case is REVERSED and REMANDED to DSS to recalculate the food stamp benefit, taking into account the Appellant's excess medical costs, if any. In such a case, DSS shall issue a new notice to the Appellant informing her of the food stamp amount.
If the Appellant fails to meet the age or disability criteria for excess medical deductions, the decision by DSS to approve the Appellant's food stamps in the amount of $17.00 is AFFIRMED.
Nelly Maldonado, DSS Pool 235
Linda Jones, DSS Pool 235
EXHIBIT #1 - DSS Hearing Summary consisting of two (2) pages date-stamped June 9, 2004. This is admitted as a business record pursuant to s. 5312 of the Division of Social Services Manual.
EXHIBIT #2 - Copy of Fair Hearing Request date-stamped May 25, 2004, consisting of one (1) page.
EXHIBIT #3 - Copy of Notice To Reduce Your Food Stamps dated May 14, 2004, consisting of six (6) pages.