BCS 219604 (09/29/2025)
DHA cannot erase mistaken eligibility, enrollment

Preliminary Recitals

Pursuant to a petition filed August 11, 2025, under Wis. Stat., §49.45(5)(a), to review a decision by the Barron County Dept. of Human Services regarding Medical Assistance (MA), a hearing was held on September 24, 2025, by telephone.

The issue for determination is whether the Division of Hearings and Appeals can order that MA eligibility records be erased.

PARTIES IN INTEREST:

Petitioner:
—

Respondent:
Department of Health Services
1 West Wilson Street, Room 651
Madison, WI 53703
By: Rebecca Arbs
Barron County Dept. of Human Services
335 E Monroe Ave
Barron, WI 54812

ADMINISTRATIVE LAW JUDGE:
Brian C. Schneider
Division of Hearings and Appeals

Findings of Fact

1. Petitioners (CARES # —) are residents of Dunn County. Barron County is a lead county of the Great Rivers IM Consortium.
2. On December 3, 2024, petitioners filed an application for Marketplace insurance. However, the application erroneously omitted mention of their income, making it appear that they had none. The computer system thus forwarded the application to the Great Rivers Consortium to process as an application for BadgerCare Plus (BC+) MA.
3. Within an hour of filing the erroneous Marketplace application, petitioners filed an amended one showing their correct monthly income, which is above the BC+ income limit. It was processed, and they were made eligible for Marketplace insurance beginning January 1, 2025.
4. In the meantime, the BC+ application was processed as a matter of course. Because it showed no income, they were granted eligibility quickly. By a notice dated December 6, 2024, the agency informed petitioners that they were eligible for BC+ effective December 1, 2024.
5. In early January, 2025, petitioners received notice that they were enrolled in the GHC HMO for BC+ purposes. They called the HMO to state that they did not want coverage under the HMO. They did not call the consortium or report a change on-line to request discontinuance of BC+.
6. In July, 2025, they received a letter from the Marketplace inquiring about their having coverage under both the Marketplace and state MA. They then contacted the Consortium to request discontinuance of BC+. BC+ closed effective September 1, 2025.

Discussion

Petitioners filed this appeal asking that BC+ eligibility for the period December 1, 2024 through August 31, 2025, be retroactively terminated and that their eligibility under BC+ be erased. Ms. Arbs reported that she contacted the Department’s Resolution Team and was told that the best the Department could do was to terminate current eligibility, but it could not backdate a termination. MA paid HMO capitation fees to GHC for those months, a fact that cannot be erased.

I have reviewed state law and policy. There is nothing that I can find that gives the Division of Hearings and Appeals authority to retroactively erase eligibility. That petitioners were eligible for BC+ is a fact. They were notified about the eligibility. When they discovered that they were eligible for BC+ in January, 2025, they contacted the HMO, not the agency that could discontinue the eligibility. That is irrelevant, however, because even if petitioners were determined to be eligible for BC+ totally by error of the Department, there still is no mechanism to erase the fact that they had eligibility.

Conclusions of Law

There is no legal mechanism for the Division of Hearings and Appeals to erase retroactively petitioners’ eligibility for BC+ from December, 2024 through August, 2025.

THEREFORE, it is

Ordered

That the petition for review is hereby dismissed.

[Request for a rehearing and appeal to court instructions omitted.]