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Case Study: State Fair Hearing

Satisfactory Essays

On July 7, 2017, a State Fair Hearing was held at the request of Ms. Kenetria N. Carter. The hearing was requested to appeal the denial of Medicaid benefits due to an unfavorable disability decision. Background Ms. Carter submitted an application on April 17, 2017, to the Philadelphia Regional Office (RO) for Medicaid benefits through the Working Disabled program. On the same day, the RO forwarded the medical records for Ms. Carter to Disability Determination Services (DDS), who has the responsibility of making disability decisions for the Division of Medicaid (DOM). DDS notified the RO on May 24, 2017, that Ms. Carter was not disabled for Medicaid purposes. The RO issued a Notice of Adverse Action on May 26, 2017. The RO received a State …show more content…

Carter represented herself at the hearing. Her sister Ms. Mignan Johnson was present at the hearing. Ms. Martha Myers served as the Hearing Facilitator and Ms. Louise Mack was the Hearing Officer. Prior to the taking of testimony, the Hearing Facilitator informed all parties that the hearing would be recorded, and that a CD of the proceedings would be made available upon request. Further, the Hearing Officer explained the beneficiary’s rights, which were also included in the notification letter that the beneficiary received from DOM. These rights were reiterated as follows: 1. The beneficiary has the right to examine at a reasonable time before the date of the hearing and during the hearing the content of the beneficiary’s case record; 2. The beneficiary has the right to have legal representation and witnesses at the hearing; 3. The beneficiary has the right to produce documentary evidence and establish all factors and circumstances why the service should not be denied; Hearing Officer’s Recommendation Re: Kenetria N. Carter; MID #306-05-9815 August 15, …show more content…

Carter that the Working Disabled program is limited to individuals who are working at least 40 hours each month at some type of paid activity, and who meet the disability criteria. Findings According to Section 4733 of the Balanced Budget Act of 1997, the Working Disabled program is limited to individuals who are working and also meet the Supplemental Security Income (SSI) disability criteria, except for the application of “substantial gainful activity” (SGA) criteria. Although an individual must be working for purposes of the Working Disabled program, the fact that the individual is working is not to be considered in making the disability decision. After the hearing, Ms. Carter’s case was forwarded to DDS for review. DDS adopted the federal decision dated July 20, 2017, stating that Ms. Carter was not disabled for Medicaid purposes. Until this unfavorable disability finding is changed by DDS, DOM must abide by the DDS decision. Accordingly, the RO’s decision is supported by substantial evidence.

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