Benjamin S. Wright

DHA Case No. MGE 209343 (Wis. Div. of Hearings and Appeals October 2, 2023) (DHS) ↓ Download PDF The balance of a land contract is counted as an available asset unless its terms prohibit transfer or no one is willing to purchase it. In this case, the petitioner was selling non-homestead real estate under a […] Read more

DHA Case No. MGE 209372 (Wis. Div. of Hearings and Appeals August 11, 2023) (DHS) ↓ Download PDF In general, a member must have at least ten days to provide required verification during a renewal. In this case, the agency sent a notice on July 3 requesting verification by July 10. Although he should have […] Read more

DHA Case No. CWA 208861 (Wis. Div. of Hearings and Appeals November 10, 2023) (DHS) ↓ Download PDF In general, a service covered by IRIS must be necessary and cost-effective. In this case, the petitioner sought an increase in the rate paid to his AFH from $194.37 per day to $309.20 per day. Thanks largely […] Read more

DHA Case No. CWA 208719 (Wis. Div. of Hearings and Appeals October 23, 2023) (DHS) ↓ Download PDF An IRIS participant may be involuntarily disenrolled for loss of functional eligibility. In this case, the agency attempted to disenroll the petitioner from the IRIS self-directed personal care (SDPC) program only, not IRIS itself, for loss of functional […] Read more

DHA Case No. FCP 207790 (Wis. Div. of Hearings and Appeals May 19, 2023) (DHS) ↓ Download PDF In the Family Care program, the MCO must develop an Individual Service Plan (ISP) that reasonably and effectively addresses long-term care needs and outcomes and is cost-effective. In this case, the petitioner had extreme and violent behaviors […] Read more

DHA Case No. MLL 209268 (Wis. Div. of Hearings and Appeals September 29, 2023) (DHS) ↓ Download PDF An applicant for an estate recovery waiver must file his or her application within 45 days of the Department’s notice. In this case, the petitioner filed it a month after the deadline, then appealed when the waiver […] Read more

DHA Case No. MGE 209206 (Wis. Div. of Hearings and Appeals November 8, 2023) (DHS) ↓ Download PDF DHA Case No. CWA 209207 (Wis. Div. of Hearings and Appeals November 8, 2023) (DHS) ↓ Download PDF The principal or income of an irrevocable trust funded with a Medicaid applicant’s resources is countable if there are […] Read more

DHA Case No. FCP 209188 (Wis. Div. of Hearings and Appeals September 5, 2023) (DHS) ↓ Download PDF An appeal of a negative MA decision must be filed, at most, within 90 days (for most decisions it’s 45 days). In this case, the petitioner’s cost share was increased by notices effective September 1, 2022 and […] Read more

DHA Case No. HMO 209172 (Wis. Div. of Hearings and Appeals July 27, 2023) (DHS) ↓ Download PDF When a member disagrees with a Medicaid HMO’s decision, the member must first appeal to the HMO. The Division of Hearings and Appeals does not have jurisdiction until there is a final determination by the HMO’s internal […] Read more

DHA Case No. MDV 209022 (Wis. Div. of Hearings and Appeals August 25, 2023) (DHS) ↓ Download PDF An appeal of a divestment penalty must be filed within 45 days; an appeal of a hardship waiver denial must also be filed within 45 days. In this case, the agency imposed a divestment penalty when the […] Read more

DHA Case No. MPA 208980 (Wis. Div. of Hearings and Appeals November 9, 2023) (DHS) ↓ Download PDF Wisconsin Medicaid covers gender-affirming medical and surgical treatments when medically necessary. In this case, the petitioner sought a prior authorization for six sessions of laser hair removal from the face as part of gender-affirming care. The Department […] Read more

DHA Case No. MGE 207999 (Wis. Div. of Hearings and Appeals May 10, 2023) (DHS) ↓ Download PDF When a consumer is discharged from the Comprehensive Community Services (CCS) program and receives MA, they must first exhaust the grievance procedure at the local level before appealing to a fair hearing. The notice of discharge, however, […] Read more

DHA Case No. MGE 210503 (Wis. Div. of Hearings and Appeals December 19, 2023) (DHS) ↓ Download PDF After enrollment in a long-term care Medicaid program, the institutionalized spouse must spend down or transfer resources to the community spouse to get below $2,000 by the first renewal. In this case, the petitioner failed to do […] Read more

DHA Case No. FCP 210574 (Wis. Div. of Hearings and Appeals November 30, 2023) (DHS) ↓ Download PDF An MCO must give ten days’ notice of any adverse benefit determination. In this case, the petitioner’s MCO issued a notice on September 29 disenrolling her retroactive to August 21. ALJ Brian Schneider concluded the MCO had not […] Read more