DHA Case No. CWA 221163 (Wis. Div. Hearings and Appeals Mar. 19, 2026) (DHS) ↓ Download PDF Services provided by IRIS must be cost-effective. In this case, the petitioner requested a budget amendment to pay for an increased hourly rate by the supported employment provider, whose rate had increased substantially over the past several years. […] Read more
Category: Fair Hearing Decisions
DHA Case No. FCP 220856 (Wis. Div. Hearings and Appeals Mar. 9, 2026) (DHS) ↓ Download PDF All individuals, including family members, who provide paid care to Family Care participants must undergo a background check. In this case, the petitioner was enrolled in Family Care July 1, but his guardian and caregiver did not complete […] Read more
DHA Case No. CWA 220532 (Wis. Div. Hearings and Appeals Mar. 6, 2026) (DHS) ↓ Download PDF Personal care services must be provided consistent with a written physician’s order and according to state regulations. In this case, the petitioner’s plan of care, which was signed by a physician, ordered 47.5 hour per week for a […] Read more
CWA 220664 (03/04/2026)
IRIS disenrollment for failure to talk and meet with ICA over several months
DHA Case No. CWA 220664 (Wis. Div. Hearings and Appeals Mar. 4, 2026) (DHS) ↓ Download PDF After a service plan is implemented, IRIS consultant agencies (ICAs) must contact the participant monthly and meet in person at least every 90 days. Participants may be involuntarily disenrolled if the ICA is unable to reach the participant […] Read more
DHA Case No. CWA 221054 (Wis. Div. Hearings and Appeals Mar. 3, 2026) (DHS) ↓ Download PDF The IRIS program may include support broker services. A support broker “supports a participant in directing personal assistance services and services budgets” and “assists the participant in planning, securing, and directing self-supports” (essentially, helping a person maintain public […] Read more
DHA Case No. CWA 220503 (Wis. Div. Hearings and Appeals Mar. 9, 2026) (DHS) ↓ Download PDF Services provided through the IRIS program must generally be cost-effective and necessary to achieve a long-term care outcome. In this case, the petitioner had been receiving daily living skills training since 2019 but still required 24-hour support, and […] Read more
DHA Case No. FCP 220671 (Wis. Div. Hearings and Appeals Mar. 31, 2026) (DHS) ↓ Download PDF An individual’s functional eligibility for Family Care is determined by a functional screen, an interview that scores the person’s ability to perform tasks independently. In this case, the petitioner was determined functionally ineligible after a yearly renewal screen […] Read more
DHA Case No. MGE 221598 (Wis. Div. Hearings and Appeals Mar. 27, 2026) (DHS) ↓ Download PDF Medicaid applicants are required to verify all countable assets. In this case, the petitioner failed to verify a prepaid debit card and whether her home had been sold. Although this failure was apparently due to past financial abuse […] Read more
DHA Case No. FCP 221429 (Wis. Div. Hearings and Appeals Mar. 26, 2026) (DHS) ↓ Download PDF Community Waivers members in Group A have no cost share. In this case, the petitioner moved from Group A to Group B when she lost her eligibility for the Widow/Widower Group (a special status class of full-benefit Medicaid) […] Read more
DHA Case No. CWA 220447 (Wis. Div. Hearings and Appeals Mar. 25, 2026) (DHS) ↓ Download PDF IRIS participants are generally entitled to a fair hearing appeal of adverse actions, defined as a denial, reduction, termination or limitation of previously authorized services, a denial of requested services, or a determination of ineligibility. In this case, […] Read more
DHA Case No. FCP 221622 (Wis. Div. Hearings and Appeals Mar. 19, 2026) (DHS) ↓ Download PDF In the Family Care program, the services provided must reasonably and effectively address all long-term needs to assist the client to be as self-reliant and autonomous as possible, but it must also be cost-effective. In this case, the […] Read more
DHA Case No. MGE 220677 (Wis. Div. Hearings and Appeals Mar. 17, 2026) (DHS) ↓ Download PDF Enrollment in Family Care may be backdated if an unreasonable delay was caused by agency error. In this case, the petitioner applied for Medicaid, requested Community Waivers, and was financially eligible on July 15, 2025. But, due to […] Read more
DHA Case No. FCP 220337 (Wis. Div. Hearings and Appeals Mar. 17, 2026) (DHS) ↓ Download PDF Enrollment in Family Care may be backdated if an unreasonable delay was caused by agency error. In this Milwaukee County case, the ADRC took four months to complete a functional screen and another three months to complete enrollment. […] Read more
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