DHA Case No. MDV 143690 (Wis. Div. Hearings and Appeals Nov. 23, 2012) (DHS) ↓ Download PDF A divestment occurs when a Medicaid applicant transfers resources and receives less than fair market value in return; exempt business assets must be used in a business “for the self-support of the individual.” In this case, the petitioner […] Read more

DHA Case No. MED 36/91877 (Wis. Div. Hearings and Appeals Jun. 4, 2008) (DHS) ↓ Download PDF An institutionalized person’s home is exempt if the person expresses an intent to return there. In this case, the petitioner was admitted to a nursing home and a doctor opined that she “cannot realistically expect to return home,” […] Read more

DHA Case No. MDV 5/105182 (Wis. Div. Hearings and Appeals 2009) (DHS) ↓ Download PDF Agift that occurred during the lookback period and was made by either the institutionalized person or his or her spouse is a divestment. In this case, the petitioner’s husband amended their revocable trust to transfer their home to a new […] Read more

DHA Case No. MDV 59/60290 (Wis. Div. Hearings and Appeals Jan. 20, 2004) (DHS) ↓ Download PDF A gift that occurred during the lookback period and was made by either the institutionalized person or his or her spouse is a divestment. In this case, the petitioner’s husband disinherited her and then died a year before […] Read more

DHA Case No. FCP 220397 (Wis. Div. Hearings and Appeals Dec. 29, 2025) (DHS) ↓ Download PDF The Family Care program, through MCOs, must generally provide services that reasonably and effectively address all of the recipient’s long-term needs and outcomes, assist the recipient to be as self-reliant and autonomous as possible, and are cost effective. […] Read more

DHA Case No. MAP 219778 (Wis. Div. Hearings and Appeals Dec. 23, 2025) (DHS) ↓ Download PDF Medical Assistance policy requires applicants and recipients to verify self-employment income. In this case, the petitioner was enrolled in MAPP and a Medicare savings program when she applied for FoodShare and reported rental income from billboards she owned. […] Read more

DHA Case No. CWK 220665 (Wis. Div. Hearings and Appeals Dec. 22, 2025) (DHS) ↓ Download PDF Children may be functionally eligible for the CLTS program automatically if they meet certain age and diagnosis requirements. In this case, the petitioner was a five-year-old with autism whose was determined functionally ineligible after an updated functional screen. […] Read more

DHA Case No. MLL 220239 (Wis. Div. Hearings and Appeals Dec. 10, 2025) (DHS) ↓ Download PDF A request for a hardship waiver of estate recovery must be mailed within 45 days of the Department’s claim. In this case, the petitioner “was under the mistaken understanding that his oral communications with department representatives were sufficient” […] Read more

DHA Case No. MDD 219941 (Wis. Div. Hearings and Appeals Dec. 10, 2025) (DHS) ↓ Download PDF If the Social Security Administration finds that a person is not disabled for social security or SSI purposes, that decision is generally binding on any state agency making a medical assistance disability determination—but there is an exception if […] Read more

DHA Case No. CWA 219952 (Wis. Div. Hearings and Appeals Dec. 10, 2025) (DHS) ↓ Download PDF The Department may deny enrollment in the IRIS program for substantiated fraud during a previous enrollment, living in an ineligible residential setting, or inability or unwillingness to develop an Individual Support and Service Plan (ISSP) that ensures the […] Read more

DHA Case No. FCP 220016 (Wis. Div. Hearings and Appeals Dec. 8, 2025) (DHS) ↓ Download PDF Medicaid appeals must be filed within 45 days of the date of the notice of action. In this case, the petitioner was sent a cost share notice on April 11 but did not file an appeal until September […] Read more

DHA Case No. CWA 219262 (Wis. Div. Hearings and Appeals Dec. 29, 2025) (DHS) ↓ Download PDF IRIS enrollment and services generally require the participant to reside in a permanent living arrangement, though the participant can apply while in transitional housing and there is an exception for temporary absences up to 90 days. In this […] Read more

DHA Case No. HMO 220155 (Wis. Div. Hearings and Appeals Dec. 26, 2025) (DHS) ↓ Download PDF Wisconsin Medicaid does not cover experimental services, a determination the Department makes on its own. In this case, the petitioner requested an Occipital Nerve Block, which was denied as experimental. While recognizing that past decisions have considered experimental […] Read more

DHA Case No. CWK 219225 (Wis. Div. Hearings and Appeals Dec. 26, 2025) (DHS) ↓ Download PDF For the Children’s Community Options Program, the right to appeal is limited to the denial of eligibility for services, or a reduction or termination of services. In this case, the petitioner requested coverage of a safety wagon. ALJ […] Read more