Connecticut Medicare Savings Program Denial: How to Appeal a DSS Decision

Common Reasons for MSP Denial in Connecticut

Before filing an appeal, understand why DSS denied the application. The Notice of Action (Form W-409 or ImpaCT-generated notice) states the reason. The most common causes:

Income over the tier limit. DSS calculated gross monthly income above the threshold for the tier applied for. This is the most frequent reason — and the most frequently wrong one, because income disregards may not have been properly applied.

Improper asset test applied. Despite Connecticut law eliminating the MSP asset test, some DSS workers trained primarily on HUSKY C (long-term care Medicaid) mistakenly apply HUSKY C's $1,600/$2,400 asset limits to MSP applications. This is categorically wrong under CGS § 17b-95.

Missing documentation. DSS requested verification documents and did not receive them within the required timeframe. Sometimes the documents were sent but lost at the scanning center; sometimes the applicant didn't realize additional documents were needed.

Medicare Part A not confirmed. The applicant lacks documented Part A entitlement or enrollment. This can happen when an applicant is in the process of obtaining conditional Part A through a buy-in arrangement.

How to Request a Fair Hearing

Connecticut's fair hearing process is managed by OLCRAH — the Office of Legal Counsel, Regulations and Administrative Hearings within DSS.

Read the denial notice for the appeal deadline. For an existing enrollee facing a reduction or termination to continue benefits while the appeal is pending, OLCRAH must receive a written hearing request within 10 days of the notice mailing date. For a fair hearing, OLCRAH must receive the written request within 60 calendar days from the mailing date.

Submit a hearing request in writing. The notice typically includes a tear-off section or instructions for requesting a hearing. Options:

• Mail the request to OLCRAH, 55 Farmington Avenue, 11th Floor, Hartford, CT 06105
• Fax it to 860-424-5729
• Follow any additional filing instructions on the notice

State the specific reason the decision is wrong. If DSS applied an asset test, cite CGS § 17b-95. If the income calculation is incorrect, list the disregards that should have been applied and attach documentation showing the correct gross income.

Continued Benefits During Appeal

For existing MSP enrollees whose benefits are being terminated (not new applicants), OLCRAH must receive the written fair hearing request within 10 days of the notice mailing date to trigger "aid continuing" — benefits remain in place while the hearing is pending. This prevents a gap in Part B premium coverage during the appeal process.

New applicants who are denied don't have existing benefits to continue, but a successful hearing can establish retroactive coverage.

Preparing for the Hearing

Fair hearings are conducted by an OLCRAH hearing officer. They can be held by phone or in person. Preparation matters:

Gather income documentation. Bring the SSA award letter showing gross monthly Social Security, pay stubs, pension statements, and any other income records. Show the math: gross income minus applicable disregards equals countable income, which should fall under the tier limit.

Know the disregards. Connecticut's published MSP income limits already incorporate the state's expanded Section 1902(r)(2) disregards. But if the applicant has earned income, the additional disregard ($65 plus 50% of the remainder) must be applied separately. If the applicant receives VA Aid and Attendance pension benefits, those are entirely excluded under PA 25-95.

Challenge any asset-based denial directly. If the denial involved asset documentation, bring a copy of CGS § 17b-95 and request that the hearing officer confirm the statute prohibits asset testing for MSP.

Getting Help

CHOICES counselors (1-800-994-9422) can help explain the denial reason and advise on whether an appeal is likely to succeed. For complex cases — particularly those involving income calculation disputes or improper procedures — the Center for Medicare Advocacy in Connecticut provides legal assistance.

The Connecticut Medicare Savings & Extra Help Guide includes fair hearing request templates, a checklist of documents to bring, and a reference sheet of the income disregards DSS must apply.

See more Connecticut guides →