DHA Case No. CWA 219333 (Wis. Div. Hearings and Appeals Oct. 15, 2025) (DHS) ↓ Download PDF Aperson enrolled in IRIS is required to pay a cost share as a condition of eligibility. In this case, the petitioner had more than $4,000 in overdue cost share and had previously entered a repayment agreement, but failed […] Read more

DHA Case No. CWA 219663 (Wis. Div. Hearings and Appeals Oct. 13, 2025) (DHS) ↓ Download PDF An IRIS participant may be involuntarily disenrolled if the program cannot ensure the participant’s health and safety. In this case, the petitioner had 25 critical incidents (a critical incident is a medical emergency, law enforcement contact, or hospitalization) […] Read more

DHA Case No. MGE 219014 (Wis. Div. Hearings and Appeals Oct. 6, 2025) (DHS) ↓ Download PDF IRIS enrollment dates may be revised if the agency is the cause of a wrongful termination of IRIS enrollment. In this case, the agency sent advance notice of the renewal deadline and a notice requiring verification of a […] Read more

DHA Case No. CWA 219176 (Wis. Div. Hearings and Appeals Oct. 1, 2025) (DHS) ↓ Download PDF IRIS enrollment dates may be revised if the agency is the cause of a wrongful termination of IRIS enrollment. In this case, the agency called the petitioner before her renewal deadline but she declined to do the renewal […] Read more

DHA Case No. BCS 219613 (Wis. Div. Hearings and Appeals Sep. 26, 2025) (DHS) ↓ Download PDF To be eligible for Wisconsin Medicaid programs, a person must be a resident of Wisconsin. In this case, the 21-year-old petitioner claimed to be a homeless resident of Wisconsin while attending college in Mississippi, where she had an […] Read more

DHA Case No. CWA 218110 (Wis. Div. Hearings and Appeals Sep. 25, 2025) (DHS) ↓ Download PDF IRIS participants may submit one-time expense requests to pay for goods or services, including adaptive aids such as vehicle modifications. In this case, the petitioner requested a wheelchair and hand-controls conversion after her old vehicle, which had been […] Read more

DHA Case No. CWA 218862 (Wis. Div. Hearings and Appeals Sep. 19, 2025) (DHS) ↓ Download PDF IRIS participants may be disenrolled if they cannot or will not address health and safety concerns. In this case, the petitioner lived with his parents/guardians who themselves were aging and having health problems that were impeding their ability […] Read more

DHA Case No. CWA 218438 (Wis. Div. Hearings and Appeals Sep. 18, 2025) (DHS) ↓ Download PDF Prevocational services may be funded through IRIS, but services in sheltered workshop settings are excluded and the participant must have a goal of community-integrated employment. In this case, the petitioner received prevocational services for 11 years in a […] Read more

DHA Case No. MQB 218814 (Wis. Div. Hearings and Appeals Sep. 12, 2025) (DHS) ↓ Download PDF Rental income is generally countable income for MA eligibility. In this case, the petitioner’s SLMB+ benefits ended when his caregiver moved in and began paying $650/mo. towards his mortgage payment. Although the petitioner claimed the payment was made […] Read more

DHA Case No. CWA 219278 (Wis. Div. Hearings and Appeals Sep. 11, 2025) (DHS) ↓ Download PDF Any negative action regarding a person enrolled in Medicaid must be preceded by proper notice. In this case, the petitioner lost her SSI eligibility but the agency never sent a notice before terminating her from IRIS. ALJ Brian […] Read more

DHA Case No. MGE 218833 (Wis. Div. Hearings and Appeals Sep. 5, 2025) (DHS) ↓ Download PDF For a single person in the Institutional MA program, the items that may be subtracted from income in determining patient liability are limited. In this case, the petitioner asked that his $70/month life insurance premiums be deducted, noting […] Read more

DHA Case No. FCP 218531 (Wis. Div. Hearings and Appeals Sep. 4, 2025) (DHS) ↓ Download PDF The Family Care program must generally cover services that reasonably and effectively address the participant’s long-term needs, but those services must also be cost-effective. In this case, the agency denied the petitioner’s request for coverage of a health […] Read more

DHA Case No. FCP 219093 (Wis. Div. Hearings and Appeals Aug. 25, 2025) (DHS) ↓ Download PDF The Family Care program must generally cover services that reasonably and effectively address the participant’s long-term needs, but those services must also be cost-effective. In this case, the petitioner’s home-delivered meals ended because his plan already included Supportive […] Read more

DHA Case No. CWA 219215 (Wis. Div. Hearings and Appeals Aug. 22, 2025) (DHS) ↓ Download PDF Any negative action regarding a person enrolled in Medicaid must be preceded by proper notice that includes appeal rights. In this case, the petitioner lost her SSI eligibility but the agency never sent a notice with appeal rights […] Read more