DFCS must make eligibility determination when SSA’s 90-day period elapses.

Topic: Medicaid Eligibility, Decided by Judge Miller 
Docket Number: ***** , Decision Date: 2015-10-26 
Attachment: Click here to download the decision. 

When a Medicaid applicant applies for Supplemental Security Income through the Social Security Administration (SSA), DFCS generally does not make an independent determination of blindness or disability. Instead, SSA makes the eligibility determination. Under federal regulations, however, if an applicant has applied for both Medicaid [..] Read More..

Deviation from financial eligibility formula set forth in Medicaid Manual improper.

Topic: Medicaid Eligibility, Decided by Judge Schroer 
Docket Number: ***** , Decision Date: 2015-06-29 
Attachment: Click here to download the decision. 

Petitioner was properly denied Medicaid under the “Qualified Medicare Beneficiary” class of assistance, as her total net income exceeded the income limit for that Medicaid category.  Petitioner is eligible for, and will continue to receive, “Specified Low-Income Medicare Beneficiary” Medicaid.  The Court has no authority [..] Read More..

DFCS cannot toll the transfer of assets penalty period.

Topic: Medicaid Eligibility, Decided by Judge Woodard 
Docket Number: ***** , Decision Date: 2015-06-29 
Attachment: Click here to download the decision. 

The Department of Human Services’ Division of Family and Children Services (“DFCS”) assessed a penalty of 3.43 months against Petitioner for transferring $20,020.46 of her assets without receiving fair market value in return.  This meant that she was ineligible for a nursing home vendor payment [..] Read More..

Transfer of resources penalty improper due to probate court order.

Topic: Medicaid Eligibility, Decided by Judge Woodard 
Docket Number: 1425490 , Decision Date: 2014-03-21 
Attachment: Click here to download the decision. 

The Division of Family and Children Services’ (DFCS) was not authorized to impose a transfer-of-resources penalty, because the probate court had already determined that the Medicaid applicant’s conservators had made expenditures solely for his use and benefit and had received the fair market value.

Cognitively alert applicant eligible for the Independent Care Waiver Program.

Topic: Medicaid Eligibility, Decided by Judge Schroer 
Docket Number: ***** , Decision Date: 2013-10-25 
Attachment: Click here to download the decision. 

Judge reversed and remanded the denial of Petitioner’s application for the Independent Care Waiver Program (ICWP), because he meets both the eligibility criteria for entry and the service specifications for his requested services.  Specifically, he qualifies for Personal Support Services Level III as he is [..] Read More..

Senior Community Service Employment Program stipend constitutes wages for Medicaid eligibility.

Topic: Medicaid Eligibility, Decided by Judge Kennedy 
Docket Number: ***** , Decision Date: 2013-10-22 
Attachment: Click here to download the decision. 

Petitioner’s Medicaid benefits were terminated because a stipend, which she received from the Senior Community Service Employment Program under Title V of the Older Americans Act, put her over the income limit.  The stipend constituted a wage because (1) it is remuneration for personal services; [..] Read More..

Denial of Medicaid assistance proper where applicant’s net income exceeded income limit for assistance.

Topic: Medicaid Eligibility, Decided by Judge Walker-Russell 
Docket Number: ***** , Decision Date: 2013-09-24 
Attachment: Click here to download the decision. 

Petitioner was properly denied Adult Medicaid Assistance because his total net income exceeded the income limit for all Adult Medicaid categories.

Denial of Medicaid assistance proper where applicant’s net income exceeded income limit for assistance.

Topic: Medicaid Eligibility, Decided by Judge Walker-Russell 
Docket Number: ***** , Decision Date: 2013-09-24 
Attachment: Click here to download the decision. 

Petitioner was properly denied Adult Medicaid Assistance because his total net income exceeded the income limit for all Adult Medicaid categories.

Petitioner erroneously denied Medicaid as “over income” need not reapply but DFCS can deny application on other grounds.

Topic: Medicaid Eligibility, Decided by Judge Woodard 
Docket Number: ****** , Decision Date: 2013-06-05 
Attachment: Click here to download the decision. 

Respondent, the Division of Family and Children Services (DFCS), stipulated that its denial of Petitioner’s application for Nursing Home Medicaid was erroneous.  The error was due to a failure to exclude Aid and Attendance Department of Veterans’ Affairs (VA) benefits, which are not counted as [..] Read More..