MEDICAID-1356-0710 - DHHR

State of West Virginia
DEPARTMENT OF HEALTH AND HUMAN RESOURCES
Office of Inspector General
Board of Review
1400 Virginia Street
Joe Manchin III Oak Hill, WV 25901 Patsy A. Hardy, FACHE, MSN, MBA
Governor
Cabinet Secretary
July 29, 2010
----- RE: -----
----- Action No:-----
-----
-----
Dear -----:
Attached is a copy of the findings of fact and conclusions of law on your hearing held June 23, 2010.
Your hearing request was based on the Department of Health and Human Resources’ proposal to terminate -----
’s AFDC Medicaid due to a loss of income disregards.
In arriving at a decision, the State Hearing Officer is governed by the Public Welfare Laws of West
Virginia and the rules and regulations established by the Department of Health and Human Resources. These
same laws and regulations are used in all cases to assure that all persons are treated alike.
Eligibility for the AFDC Medicaid program is based on current policy and regulations. These
regulations provide that a $30 and 1/3 disregard is applied to earned income for four (4) consecutive months
(WV Income Maintenance Manual § 10.7 B).
The information submitted at your hearing revealed that your client did not receive four (4) months of
the $30 and 1/3 earned income disregard.
It is the decision of the State Hearing Officer to Reverse the proposal of the Department to terminate ---
--’s AFDC Medicaid due to a loss of earned income deductions.
Sincerely,
Kristi Logan
State Hearing Officer
Member, State Board of Review
cc:
Chairman, Board of Review
Emily Shumate, Economic Service Worker

WEST VIRGINIA DEPARTMENT OF HEALTH & HUMAN RESOURCES
BOARD OF REVIEW
-----,
Claimant,
v. Action Number: 10-BOR-1356
West Virginia Department of
Health and Human Resources,
Respondent.
DECISION OF STATE HEARING OFFICER
I. INTRODUCTION:
This is a report of the State Hearing Officer resulting from a fair hearing concluded on June 23,
2010 for -----. This hearing was held in accordance with the provisions found in the Common
Chapters Manual, Chapter 700 of the West Virginia Department of Health and Human
Resources.
II.
PROGRAM PURPOSE:
The Program entitled AFDC Medicaid is administered by the West Virginia Department of
Health & Human Resources.
The Aid to Families with Dependent Children (AFDC, AFDCU for unemployed parents)
Medicaid Program is designed to provide medical assistance to eligible families with children
to age 18. These dependent children must be deprived of parental support due to the death,
continued absence, incapacity, or unemployment of the parents. In addition, the family must
meet financial eligibility criteria.
III.
PARTICIPANTS:
-----, Claimant
-----, Counsel for Claimant
Emily Shumate, Economic Service Worker
Presiding at the Hearing was Kristi Logan, State Hearing Officer and a member of the Board of
Review.
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IV.
QUESTION TO BE DECIDED:
The question to be decided is whether or not the Department’s proposal to terminate Claimant’s
AFDC Medicaid is correct.
V. APPLICABLE POLICY:
WV Income Maintenance Manual § 10.7 B(1)
VI.
LISTING OF DOCUMENTARY EVIDENCE ADMITTED:
Department’s Exhibits:
D-1 Hearing Summary
D-2 Hearing Request received May 25, 2010
D-3 Hearing/Grievance Record Information
D-4 Hearing Appointment Letter
D-5 Termination Notification Letter dated May 19, 2010
D-6 Case Comments (CMCC) from RAPIDS Computer System
D-7 2009 Income Tax Returns Schedule C
D-8 WV Income Maintenance Manual Chapter 10 Appendix A
D-9 WV Income Maintenance Manual § 10.7 B
Claimants’ Exhibits:
C-1 Raleigh County Screening Form dated March 30, 2010
C-2 Individual Participation History Screen (AQIP) from RAPIDS Computer System
C-3 Self-Employment Records for March 2010
VII.
FINDINGS OF FACT:
1) Claimant had been receiving AFDC Medicaid since March 2010. A termination letter
dated May 19, 2010 was issued by the Department which read in pertinent parts (D-5):
Your AFDC Medicaid benefits will stop. You will not receive this
benefit after May 2010. The $30 and 1/3 earned income disregard ends.
2) Emily Shumate, Claimant’s caseworker, testified that the earned income disregard of
$30 and 1/3 for AFDC Medicaid only last for four (4) consecutive months. After the
fourth month, the $30 disregard continues for an additional eight (8) months. With the
loss of the $30 and 1/3 disregard, Claimant’s self-employment income of $1950
monthly was excessive to continue receiving AFDC Medicaid.
3) -----, counsel for Claimant, argued that Claimant had not received four (4) consecutive
months of the $30 and 1/3 disregard when his AFDC Medicaid was terminated.
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Claimant received AFDC Medicaid in March 2010, April 2010 and May 2010 (C-2).
According to policy, ----- contended that Claimant was entitled to one (1) additional
month of the $30 and 1/3 disregard.
Additionally, ----- stated Claimant’s self-employment income was incorrectly
calculated. Claimant testified that he reported at his Supplemental Nutrition Assistance
Program (SNAP) review in March 2010 that his income had been reduced due to the
weather. Claimant reported his self-employment income for March 2010 as $300 (C-1).
Despite this, the income of $1950 monthly derived from Claimant’s 2009 income tax
returns was used in determining his Medicaid eligibility (D-7 and C-3).
4) WV Income Maintenance Manual § 10.7 B(1) a-c states:
The following disregards and deductions are applied to earned income:
Standard Work Deduction
A standard deduction of $90 for work expenses is deducted from the
gross earned income of each employed individual.
$30 + 1/3 Earned Income Disregard
The remaining amount of income for each individual, after the deduction
outlined above, may be subject to the $30 + 1/3 Disregard of the
remainder.
Use of the $30 + 1/3 Disregard is limited to 4 consecutive months. The
individual may not receive it again until the AG has been a non-recipient
of AFDC Medicaid for 12 consecutive months.
After the $30 + 1/3 Disregard has been applied 4 consecutive months,
the $30 disregard continues for 8 consecutive months. At the end of 8
consecutive months, an individual is not eligible to receive the $30
Disregard again until he has been a non-recipient of AFDC Medicaid for
12 consecutive months.
VIII. CONCLUSIONS OF LAW:
1) Policy allows an earned income deduction of $30 and 1/3 for four (4) consecutive
months. After the fourth month, the $30 income deduction is applied for an additional
eight (8) months.
2) Claimant’s AFDC Medicaid began in March 2010. After receiving only three (3)
consecutive months of the $30 and 1/3 disregard, Claimant’s AFDC Medicaid was
terminated as his income was excessive for the program with the loss of the income
deductions.
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2) Claimant is clearly entitled an additional month of the $30 and 1/3 earned income
disregard as dictated by policy. Claimant’s AFDC Medicaid was incorrectly terminated.
IX.
DECISION:
It is the decision of the State Hearing Officer to reverse the proposal of the Department to
terminate Claimant’s AFDC Medicaid due to a loss of the $30 and 1/3 earned income
disregard.
X. RIGHT OF APPEAL:
See Attachment
XI.
ATTACHMENTS:
The Claimant’s Recourse to Hearing Decision
Form IG-BR-29
ENTERED this 29 th day of July 2010.
_______________________________________________
Kristi Logan
State Hearing Officer
Member, Board of Review
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