16 Del. Admin. Code § 5000-5300

Current through Register Vol. 28, No. 7, January 1, 2025

Section 5000-5300 - Providing Adequate and Timely Notices

7 CFR 273.15(f), 42 CFR 431.210, 42 CFR 438.404, 42 CFR 457.340, 45 CFR 205.10

This policy applies to every applicant and recipient under any public assistance program administered by the Division of Social Services (DSS) or the Division of Medicaid and Medical Assistance (DMMA).

1. DSS and DMMA Provide Written Notice of Agency Actions

Written notice of an agency action will contain:

A. A statement of the client's right to a fair hearing as provided under this section.

B. The method by which he or she may request a fair hearing.

C. A statement that he or she may represent him/herself or that he or she may be represented by counsel or by another person.

2. DSS and DMMA Take Action Only Under Certain Conditions

No action may be taken unless the following conditions are met:

A. Written notice is provided to the client that is "adequate."

An adequate notice is a written notice that includes

1. A statement of what action the agency intends to take

2. The reasons for the intended agency action

3. The specific regulations supporting such action

4. Explanation of the individual's right to request a State agency hearing

5. The circumstances under which assistance is continued if a hearing is requested

6. If the agency action is upheld, that such assistance

i. Must be repaid under Title IV-A

ii. Must be repaid under Titles I, X, XIV or XVI (AABD) if the State plan provides for recovery of such payments

iii. May be repaid under Title XIX

B. Written notice is provided to the client that is "timely."

A timely notice is one that is mailed at least 10 days before the date of action.

Exception: For TANF, notice is timely if mailed at least 5 days before the action would become effective when DSS learns of facts indicating that assistance should be discontinued, suspended, terminated, or reduced because of the probable fraud of the recipient, and, where possible, such facts have been verified through secondary sources.

C. Each recipient is advised of his or her potential liability for repayment of benefits received while awaiting a fair hearing if the agency's decision is upheld.

Continue benefits if the hearing request form is unclear as to whether the recipient wants continued benefits or not. Provide continued benefits within 5 working days of the date the agency received the household's request.

Exception: Food Supplement Program households do not have a right to a continuation of benefits while waiting for the fair hearing when the recipient is disputing a reduction, suspension or cancellation of benefits as a result of an order issued by FNS.

During the fair hearing period, the agency will adjust allotments to take into account reported changes except for the factor(s) on which the hearing is based.

D. Each notice contains information needed for the claimant to determine from the notice alone, the accuracy of the Division's action or intended action.

All notices will:

Indicate the action or proposed action to be taken (i.e., approval, denial, reduction, or termination of assistance);

a. Provide citation(s) to the regulation(s) supporting the action being taken;

b. Provide a detailed individualized explanation of the reason(s) for the action being taken which includes, in terms understandable to the claimant:

i. An explanation of why the action is being taken, and

ii. An explanation of what the claimant was required by the regulation to do and why his or her actions fail to meet this standard (if the action is being taken because of the claimant's failure to perform an act required by a regulation)

c. Provide:

i. explanations of what income and/or resources the agency considers available to the claimant

ii. the source or identity of these funds,

iii. the calculations used by the agency,

iv. the relevant eligibility limits and maximum benefit payment levels for a family or assistance unit of the claimant's size.

16 Del. Admin. Code § 5000-5300

15 DE Reg. 86 (07/01/11)
16 DE Reg. 419 (10/01/12)