Benjamin S. Wright

DHA Case No. MDV 40/18587 (Wis. Div. of Hearings and Appeals Dec. 16, 1997) (DHS)  ↓ Download PDF In general, a transfer for fair market value is not a divestment. In this case, the petitioner spent $52,074 on repairs to his home, in which he had retained a life estate, after he was institutionalized. The […] Read more

DHA Case No. MRA 223077 (Wis. Div. Hearings and Appeals Jul. 22, 2026) (DHS) ↓ Download PDF An ALJ may increase the community spouse income allocation (CSIA) if the community spouse does not have enough income to pay his or her “necessary and basic maintenance needs.” In this case, the petitioner’s community spouse had expenses […] Read more

DHA Case No. CWA 221759 (Wis. Div. Hearings and Appeals Mar. 25, 2026) (DHS) ↓ Download PDF When deciding whether to approve a budget amendment, the Division of Medicaid Services (DMS) considers whether the requested service is necessary, cost-effective, and not duplicative of other services. In this case, the petitioner requested a budget amendment to […] Read more

DHA Case No. CWA 220910 (Wis. Div. Hearings and Appeals Mar. 25, 2026) (DHS) ↓ Download PDF An IRIS participant has a right to a fair hearing only after an adverse action, which is a denial, reduction, termination, or limitation of services or a denial of eligibility. In this case, the petitioner’s AFH received an […] Read more

DHA Case No. FCP 221947 (Wis. Div. Hearings and Appeals Mar. 24, 2026) (DHS) ↓ Download PDF The Family Care program provides residential services only if they are cost-effective or the member’s health and safety cannot be adequately safeguarded in their own home. In this case, the petitioner’s guardian requested he be placed in an […] Read more

DHA Case No. FCP 221463 (Wis. Div. Hearings and Appeals Mar. 24, 2026) (DHS) ↓ Download PDF The Program of All-Inclusive Care for the Elderly (PACE) may provide transportation services to maintain community connections and receive services in the community. In this case, the petitioner requested travel vouchers for the purpose of going to the […] Read more

DHA Case No. CWK 221868 (Wis. Div. Hearings and Appeals Mar. 23, 2026) (DHS) ↓ Download PDF The Children’s Long-Term Support program will not pay for home modifications that are “of a general utility and not of direct or remedial benefit to the CLTS recipient.” In this case, the petitioner asked that her patio be […] Read more

DHA Case No. FCP 220772 (Wis. Div. Hearings and Appeals Mar. 20, 2026) (DHS) ↓ Download PDF In the Family Care program, MCOs may not deny a service that is reasonable and necessary to cost-effectively support the member’s long-term care outcomes. In this case, the petitioner’s Community Support Program services ended when the agency determined […] Read more

DHA Case No. FCP 221245 (Wis. Div. Hearings and Appeals Mar. 19, 2026) (DHS) ↓ Download PDF In the Family Care program, the MCO does not have to provide a service the participant wants if there are less expensive alternatives that achieve the same results. In this case, the MCO terminated the petitioner’s AFH funding […] Read more

DHA Case No. FCP 220220 (Wis. Div. Hearings and Appeals Mar. 19, 2026) (DHS) ↓ Download PDF An MCO may not deny a service that is reasonable and necessary to cost-effectively support a member’s long-term care outcomes. In this case, the petitioner had been living at home and receiving adult day care services. When she […] Read more

DHA Case No. CWK 221052 (Wis. Div. Hearings and Appeals Mar. 19, 2026) (DHS) ↓ Download PDF The CLTS program may pay for adaptive aids, which can include items such as adaptive playground equipment if a qualified professional believes it is appropriate to the needs of the participant. In this case, the petitioner requested coverage […] Read more

DHA Case No. CWA 216742 (Wis. Div. Hearings and Appeals Aug. 4, 2025) (DHS) ↓ Download PDF Under the Wisconsin Equal Access to Justice Act (WEAJA), petitioners who prevail in a fair hearing are entitled to an award of costs unless the agency’s action was “substantially justified.” In this case, the petitioner successfully appealed the […] Read more

DHA Case No. MAP 216925 (Wis. Div. Hearings and Appeals Apr. 24, 2025) (DHS) ↓ Download PDF To be non-financially eligible for MAPP, a person must be working and meet the SSI standard for disability. In this case, the petitioner had laryngeal cancer and was initially determined disabled, but after a year and a half […] Read more

DHA Case No. MGE 217838 (Wis. Div. Hearings and Appeals Jul. 15, 2025) (DHS) ↓ Download PDF Court-ordered support payments are deducted from income for an “institutionalized person,” according to the Medicaid Eligibility Handbook (MEH). In this case, the petitioner paid $4,059 per month in court-ordered spousal support, had monthly income of $12,089.20 ($8,045.98 from a […] Read more