State Hearing Decision - Hearing Decisions

OHIO DEPARTMENT OF JOB AND FAMILY SERVICES
BUREAU OF STATE HEARINGS
In the matter of:
Case Number: County:
5093764453 PORTAGE
Appeal: Program: Disposition:
1753253
1753254
No Compliance Required
MED
MED
OVERRULED
OVERRULED
Decision Date:
Request Date:
Hearing Officer:
02/29/2012
01/18/2012
ANN SHANE
State Hearing Decision
ISSUE SECTION
Appeal number 1753253 Medicaid (Low-Income Families)
Appeal number 1753254 Medicaid (Healthy Start)
The Portage County Department of Job and Family Services (Agency) denied the Appellant’s
application for Low-Income Families and Healthy Start for failure to provide requested
verification of income.
The issues are whether the Agency’s denials of Low-Income Families and Healthy Start
Medicaid are correct. After a review of the record and policy I recommend the appeals be
overruled.
PROCEDURAL MATTERS
The Appellant’s authorized representative, First Source, requested a state hearing on January 10,
2012. A state hearing was conducted on February 7, 2012 with the Appellant’s authorized
representative, Kerry Emerick, from First Source and Agency Eligibility Worker Christine
Woodson testifying under oath. An appeal summary was received. All parties participated by
telephone.
FINDINGS OF FACT
1. An application for Medicaid was filed on December 8, 2011 requesting retroactive coverage
to September 2011.
2. Agency issued a JFS 07220 requesting verification of income and when the Appellant’s
boyfriend, who is also the father of the Appellant’s child, left the home.
3. Agency issued a second JFS 07220 again requesting verification of income and when the
boyfriend left the home.
4. Agency testified the information was needed because there were conflicts in the information
and statements provided by the Appellant on the application for assistance and by her
boyfriend.
JFS 04005 (Rev. 6/2002)
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STATE HEARING DECISION CONTINUATION
5. Appellant reported that she and the boyfriend lived together and then that they had never
lived together, that she had not been employed since January 2011 but listed employment
through at least June 30, 2011.
6. Appellant and authorized representative failed to provide the requested verifications.
7. Authorized Representative testified that they have also not been successful in obtaining the
requested information from the Appellant.
8. Agency denied the application by notice mailed January 10, 2012.
CONCLUSIONS OF POLICY
If information needed to determine an individual's initial or continuing eligibility for a medical
assistance program must be verified, but was not submitted with the application the Agency shall
send a verification request checklist to the Appellant and authorized representative. If the
information is not returned, a second notice is sent.
The administrative agency shall deny an application for medical assistance or terminate
eligibility if an individual fails or refuses, without good cause, to cooperate by providing
necessary verifications or by providing consent for the administrative agency to obtain the
verifications. The administrative agency shall:
(a) Allow the individual a reasonable opportunity, not to exceed the time limits for timely
determination of eligibility, to obtain verifications and resolve discrepancies prior to
determining the individual's eligibility.
(b) Deny or terminate medical assistance if:
(i) An individual provides incomplete or inconsistent information, is noncooperative,
or is unable to clarify information; and
(ii) (ii)The administrative agency is unable to verify a required eligibility factor. 1
Analysis
There was no dispute that the Appellant provided conflicting information on her application for
Medicaid and two notices were sent requesting information. The information was not provided
by the Appellant to either the Agency or the authorized representative. The information
requested is necessary to determine eligibility as income and who is to be included in the
assistance group are eligibility factors that must be considered. I find the Appellant has failed to
cooperate with the determination of eligibility for Medicaid and the denial of Low-Income
Families and Healthy Start Medicaid is correct.
HEARING OFFICER’S RECOMMENDATION
Based on the record and policy before me I recommend appeal numbers 1753253 and 1753254
be overruled.
FINAL DECISION AND ADMINISTRATIVE ORDER
Finding the hearing officer’s decision to be supported by the evidence, the recommendation
above is adopted and the appeals are overruled.
1 OAC 5101:1-38-01.2 Medicaid: Application, Determination, and Redetermination Processes (2009)
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STATE HEARING DECISION CONTINUATION
Hearing Authority
February 29, 2012
Notice to Appellant
This is the official report of your hearing and is to inform you of the decision and order in your case. All papers and materials
introduced at the hearing or otherwise filed in the proceeding make up the hearing record. The hearing record will be maintained
by the Ohio Department of Job and Family Services. If you would like a copy of the official record, please telephone the hearing
supervisor at the CANTON District hearing section at 1-866-635-3748.
If you believe this state hearing decision is wrong, you may request an administrative appeal by writing to: Ohio Department of
Job and Family Services, Bureau of State Hearings, P.O.BOX 182825, Columbus, OH 43218-2825 or fax: (614) 728-9574.
Your request should include a copy of this hearing decision and an explanation of why you think it is wrong. Your written
request must be received by the Bureau of State Hearings within 15 calendar days from the date this decision is issued. (If the
15th day falls on a weekend or holiday, this deadline is extended to the next work day.) During the 15-day administrative appeal
period you may request a free copy of the tape recording of the hearing by contacting the district hearings section.
If you want information on free legal services but don't know the number of your local legal aid office, you can call the Ohio
State Legal Services Association, toll free, at 1-800-589-5888, for the local number.
Aviso a la Apelante
Esta es la decisión estatal administrativa de su caso. Todos los documentos y materiales presentados como prueba en la vista o de
otra manera radicados componen el récord administrativo. El récord administrativo será mantenido por el Ohio Department of
Job and Family Services.
Si usted cree que esta decisión estatal administrativa es erronea, usted puede solicitar una apelación administrativa escribiendo al:
Ohio Department of Job and Family Services, Bureau of State Hearings, P.O. Box 182825, Columbus, Ohio 43218-2825 o
facsímil (614) 728-9574. Su solicitud debe indicar por qué usted piensa que la decisión administrativa es erronea. Usted puede
completar la solicitud de apelación incluida con esta decisión. Su solicitud escrita o formulario de apelación tiene que ser
recibido por el Bureau of State Hearings dentro de los 15 días calendario desde la fecha en que esta decisión es expedida. (Si el
15to. día recae sobre un fin de semana o un día feriado, esta fecha límite es extendida al próximo día laborable). Durante el
período de 15 días de apelación administrativa, usted o su representante pueden solicitar una copia gratuita del récord
administrativo y de la grabación de la vista llamando al Bureau of State Hearings al 1-866-635-3748 (seleccione la opción 1 del
menú principal).
Si usted quiere información sobre servicios legales gratuitos pero no sabe el número de su oficina local de servicios legales, usted
puede llamar al Ohio State Legal Services Association, gratuitamente, al 1-800-589-5888, para el número local.
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STATE HEARING DECISION CONTINUATION
Appellant’s Exhibits
1. State hearing request, 2 pages
2. Authorization to represent
3. Miscellaneous documents, 32 pages
Appendix
Agency’s Exhibits
A. Appeal summary
B. Statewide online computer system screen (CRISE) Update Fair Hearing Request
C. CRISE Notice History and Detail, 3 pages
D. CRISE Individual Demographics
E. CRISE Running Record Comments, 8 pages
F. Returned mail, 4 pages
G. Returned mail, 2 pages
H. Returned mail, 3 pages
I. Notice of Denial mailed January 10, 2012,7 pages
J. Statement from Appellant’s boyfriend dated December 23, 2011
K. JFS 07220 Verification Request Checklist dated December 13, 2011
L. Fax pages from Authorized Representative, 3 pages
M. CRISE Data Linkage Inquiry State Wage Information
N. JFS 07110 Retroactive Medicaid Worksheet, 2 pages
O. JFS 07216 Combined Programs Application dated stamped December 8, 2011
P. JFS 07200 Request for Cash, Food, and Medical Assistance dated stamped May 26, 2011, 4
pages
Q. Handwritten statement from Appellant dated October 5, 2011
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