DHA Case No. CWA 220811 (Wis. Div. Hearings and Appeals Mar. 16, 2026) (DHS) ↓ Download PDF IRIS policy provides that a budget amendment (BA) may only be used for costs that exceed a recipient’s base budget and may not be transferred to a different service or service type. In this case, the agency reduced […] Read more

DHA Case No. CWA 220073 (Wis. Div. Hearings and Appeals Mar. 3, 2026) (DHS) (decision after rehearing) ↓ Download PDF IRIS participants must treat the people who are part of the program with respect, including having a safe space in the participant’s home for meetings. In this case, the agency sought disenrollment after a meeting […] Read more

DHA Case No. MRA 13/99632 (Wis. Div. Hearings and Appeals Feb. 3, 2009) (DHS) ↓ Download PDF An ALJ may increase the community spouse income allocation (CSIA) above the minimum monthly maintenance needs allowance (MMMNA) determined by the agency if the MMMNA is insufficient to meet the community spouse’s basic maintenance needs. In this case, […] Read more

DHA Case No. CWA 221689 (Wis. Div. Hearings and Appeals Apr. 28, 2026) (DHS) ↓ Download PDF An IRIS participant who receives Daily Living Skills Training services (now called Life Skills Training and Education services) must generally demonstrate skill development within a year, or longer if reasonably needed to acquire the skill. Also, as skills […] Read more

DHA Case No. CWA 221317 (Wis. Div. Hearings and Appeals Feb. 27, 2026) (DHS) ↓ Download PDF Every IRIS participant enrolled in the self-directed personal cares (SDPC) program must have a care plan signed annually by the participant’s SDPC nurse and physician. In this case, the petitioner’s SDPC nurse attempted to visit multiple times to […] Read more

DHA Case No. FCP 221117 (Wis. Div. Hearings and Appeals Feb. 23, 2026) (DHS) ↓ Download PDF Residential care services provided through Family Care MCOs may be authorized only when a member’s long-term care outcomes cannot be cost-effectively supported in the member’s home, or when a member’s health and safety cannot be adequately safe guarded […] Read more

DHA Case No. MGE 221661 (Wis. Div. Hearings and Appeals Feb. 20, 2026) (DHS) ↓ Download PDF The state must maintain Medicaid coverage while completing regularly scheduled renewals as long as the renewal is received before the end of the month the renewal is due. In this case, the petitioner was enrolled in Family Care […] Read more

DHA Case No. MPA 220854 (Wis. Div. Hearings and Appeals Feb. 17, 2026) (DHS) ↓ Download PDF When considering a prior authorization request, DHS must consider medical necessity, appropriateness, cost, alternatives, and whether the service is an effective and appropriate use of available services. In this case, the petitioner requested prior authorization for a power […] Read more

DHA Case No. MKB 221000 (Wis. Div. Hearings and Appeals Feb. 17, 2026) (DHS) ↓ Download PDF To qualify as disabled for the Katie Beckett program, a child must have an impairment that causes “marked and severe functional limitations.” In this case, the petitioner had autism and ADHD, was in an age-appropriate grade in school, […] Read more

DHA Case No. CWA 220576 (Wis. Div. Hearings and Appeals Feb. 17, 2026) (DHS) ↓ Download PDF DHS has an obligation to ensure the IRIS program meets certain federal standards, such as the requirement that settings where home and community-based services are provided have the qualities listed in 42 C.F.R. §441.301(c)(4). In this case, the […] Read more

DHA Case No. MDV 221203 (Wis. Div. Hearings and Appeals Feb. 9, 2026) (DHS) ↓ Download PDF One exception to the usual divestment rule is if the transfer was made without the intent to qualify for Medicaid. In this case, the petitioner transferred about $110,000 to her son over the five-year look-back, but because he […] Read more

DHA Case No. CWK 221161 (Wis. Div. Hearings and Appeals Feb. 9, 2026) (DHS) ↓ Download PDF Respite care is a service covered by the Children’s Long-Term Support Program (CLTS), but respite care payments are not allowed to a parent or a primary caregiver in the participant’s household. In this case, the agency discovered that […] Read more

DHA Case No. CWK 220881 (Wis. Div. Hearings and Appeals Feb. 6, 2026) (DHS) ↓ Download PDF To be functionally eligible for the Children’s Long-Term Support Program, a child with a developmental disability who needs intermediate care must demonstrate substantial functional limitations in three areas. In this case, the petitioner was a 7-year-old with autism who […] Read more

DHA Case No. BCS 221175 (Wis. Div. Hearings and Appeals Feb. 4, 2026) (DHS) ↓ Download PDF When applying for MAPP, an applicant may be determined presumptively disabled. A presumptive disability decision stands until the DDB makes a final disability determination, at which point IM must send a manual notice. In this case, the petitioner […] Read more