Fair Hearing Decisions

DHA Case No. MDV 206205 (Wis. Div. of Hearings and Appeals December 2, 2022) (DHS) ↓ Download the original decision This case involved two issues. First, did a signed “irrevocable assignment” of $600,000 in assets make the petitioner’s assets unavailable, even though the assets were not actually delivered to the assignee until the next month? […] Read more

DHA Case No. MDV-45/86382 (Wis. Div. of Hearings and Appeals November 19, 2007) (DHS) ↓ Download the original decision In this case, the petitioner owned a home and a commercial property. She created life estates in both and the agency determined these transfers to be divestments. At the fair hearing, the petitioner argued that: (1) […] Read more

DHA Case No. MDV-37/88496 (Wis. Div. of Hearings and Appeals May 16, 2008) (DHS) ↓ Download the original decision Promissory notes are commonly used to reduce countable resources for Medicaid eligibility. The rules require the note to have a repayment term within the applicant’s life expectancy, require equal payments with no balloon payment, prohibit cancellation […] Read more

DHA Case No. MRA 135337 (Wis. Div. of Hearings and Appeals Feb. 10, 2012) (DHS) ↓ Download the original decision This case was about an apparent conflict in the Medicaid Eligibility Handbook rules. On the one hand, revocable annuities are treated as available assets. On the other hand, the retirement accounts of a community spouse are exempt. […] Read more

DHA Case No. MRA-70/110322 (Wis. Div. of Hearings and Appeals May 19, 2010) (DHS) ↓ Download the original decision This case is an example of using the fair hearing process to increase the Community Spouse Resource Allowance (CSRA) beyond the normal limits. At the time of this case, the maximum CSRA would have been something […] Read more

DHA Case No. MGE 117071 (Wis. Div. of Hearings and Appeals Jul. 26, 2011) (DHS) ↓ Download the original decision This case is one example of a marital property avoiding the potential divestment when a community spouse (1) dies, (2) leaves property to someone other than the Medicaid recipient, and (3) the recipient fails to […] Read more

DHA Case No. MDV 144813 (Wis. Div. of Hearings and Appeals Jan. 18, 2013) (DHS) ↓ Download the original decision The petitioner in this case spent $195,000 on life-insurance-funded burial contracts (LIFBCs) to become eligible for Medicaid. She bought 13 of them, all for her children and their spouses, at a cost of $15,000 each. […] Read more

DHA Case No. MGE 143573 (Wis. Div. of Hearings and Appeals March 13, 2013) (DHS) ↓ Download the original decision This unusual case is fact-specific, involving the interplay of Community Waiver benefits, the community spouse asset share, and the timing of getting a functional screen from the Aging and Disability Resource Center (ADRC). The issue […] Read more

DHA Case No. MDV 146580 (Wis. Div. of Hearings and Appeals April 23, 2013) (DHS) ↓ Download the original decision In this divestment case, the petitioner divested $85,000 to relatives. Those same relatives afterward paid about $89,000 for the petitioner’s nursing home care. Despite this, the agency found only a partial cure, arguing that only […] Read more

DHA Case No. MGE 148648 (Wis. Div. of Hearings and Appeals Sep. 4, 2013) (DHS) ↓ Download the original decision In this straightforward case, the issue was simply whether paying a private-rate nursing home bill reduced the petitioner’s countable assets. Unsurprisingly, it did. It appears the issue came up because the county chafed against a […] Read more

DHA Case No. FCP 155113 (Wis. Div. of Hearings and Appeals May 14, 2014) (DHS) ↓ Download the original decision The issue in this case was whether overnight caregiver costs counted as a remedial expense, which could be deducted from income before determining the cost share. The agency argued these could not be a remedial […] Read more

DHA Case No. MGE 170367 (Wis. Div. of Hearings and Appeals March 2, 2016) (DHS) ↓ Download the original decision This decision discussed two issues at some length. First, whether payments to the petitioner’s daughter were divestments; and second, whether the petitioner’s former home, now rented at fair market value, was countable. On the first […] Read more

DHA Case No. MGE 160646 (Wis. Div. Hearings and Appeals January 9, 2015) (DHS) ↓ Download the original decision This case involved two main issues: (1) the date the petitioner transferred ownership of a life insurance policy to her Wispact sub-account, and (2) the effect of a pending disability determination on retroactive eligibility. On the […] Read more

Out-of-state home exempted

DHA Case No. MGE 185074 (Wis. Div. Hearings and Appeals March 14, 2018) (DHS) ↓ Download the original decision In this straightforward decision, the petitioner owned home property in Michigan but was admitted to a Wisconsin nursing home. Her Medicaid application was denied because the agency “did not receive timely verification of any circumstance that […] Read more

DHA Case No. MDV 195771 (Wis. Div. Hearings and Appeals January 9, 2020) (DHS) ↓ Download the original decision In this case, the petitioner’s son bought her multi-family residential property, which had also been her home. A bank evaluation estimated the property’s fair market value at $225,000, and the tax assessment bill estimated it at […] Read more