DHA Case No. CWA 216919 (Wis. Div. Hearings and Appeals May 30, 2025) (DHS) ↓ Download PDF An IRIS participant’s budget is based in their long-term care functional screen. In this case, the petitioner’s Supportive Home Care (SHC) hours were reduced from 22.25 to 5 hour per week, even though his most recent functional screen […] Read more
Category: Fair Hearing Decisions
DHA Case No. MGE 216220 (Wis. Div. Hearings and Appeals May 27, 2025) (DHS) ↓ Download PDF A participant in Institutional MA may have their patient liability reduced to allow them to pay medical or remedial expenses. In this case, the petitioner was given a medical/remedial expense deduction to pay an outstanding nursing home bill, […] Read more
DHA Case No. CWA 217205 (Wis. Div. Hearings and Appeals May 13, 2025) (DHS) ↓ Download PDF To be functionally eligible for home and community based long term care services, an individual must require a “nursing home” level of care. In this case, the petitioner’s condition improved after a bone marrow transplant; an updated functional […] Read more
DHA Case No. MGE 216321 (Wis. Div. Hearings and Appeals May 9, 2025) (DHS) ↓ Download PDF An MA recipient has a right to a fair hearing when aggrieved by an action or inaction of the Department or a county when the county is acting as the agency which administers an income maintenance program. In […] Read more
DHA Case No. CWA 216858 (Wis. Div. Hearings and Appeals May 9, 2025) (DHS) ↓ Download PDF A person is functionally eligible for IRIS if, among other criteria, the person cannot safely or appropriately perform one or more ADL and 3 or more IADLs and has cognitive impairment. In this case, the petitioner was a […] Read more
DHA Case No. CWK 216983 (Wis. Div. Hearings and Appeals Apr. 28, 2025) (DHS) ↓ Download PDF For a CLTS participant age 12 or older, covered “child care” can include school and community-based settings such as after school programs and 4-H. In this case, the petitioner requested funding for two three-week camp programs at the […] Read more
DHA Case No. MLL 216729 (Wis. Div. Hearings and Appeals Apr. 21, 2025) (DHS) ↓ Download PDF When estate recovery makes a claim, Wisconsin law gives a right to appeal the issues of the value of the property and the extent of the decedent’s interest in it. In this case, the petitioner disputed the Department’s […] Read more
DHA Case No. FCP 216785 (Wis. Div. Hearings and Appeals Apr. 14, 2025) (DHS) ↓ Download PDF To be functionally eligible for home and community based long term care services through the PACE program, an individual must require a “nursing home” level of care. In this case, the petitioner required assistance with one ADL and […] Read more
DHA Case No. FCP 216652 (Wis. Div. Hearings and Appeals Apr. 14, 2025) (DHS) ↓ Download PDF Aservice that is “duplicative with respect to other services being provided” is not medically necessary. In this case, the petitioner lived in an Adult Family Home (AFH) and attended adult day services at a community provider. The MCO […] Read more
DHA Case No. FCP 217068 (Wis. Div. Hearings and Appeals Apr. 7, 2025) (DHS) ↓ Download PDF Aservice that is “duplicative with respect to other services being provided” is not medically necessary. In this case, the petitioner attended adult day services with a certain provider while living with her siblings for several years. But when […] Read more
DHA Case No. BCS 216832 (Wis. Div. Hearings and Appeals Apr. 7, 2025) (DHS) ↓ Download PDF The agency must mail a notice of adverse action at least 10 days prior to the effective date. In this case, the petitioner never received a notice that her BadgerCare Plus renewal was due, but the agency did […] Read more
DHA Case No. FCP 216051 (Wis. Div. Hearings and Appeals Mar. 28, 2025) (DHS) ↓ Download PDF Whether Family Care must cover placement in an Adult Family Home (AFH) or other group home setting depends on the general criteria of medical necessity and cost-effectivness, among others. In this case, the petitioner lived in an apartment […] Read more
DHA Case No. WFC 215794 (Wis. Div. Hearings and Appeals Mar. 27, 2025) (DHS) ↓ Download PDF The Wisconsin Funeral and Cemetery Aids Program (WFCAP) pays up to $1,500 of the funeral and burial expenses and up to $1,000 of the cemetery expenses of certain indigent recipients of public benefits. However, the program does not […] Read more
DHA Case No. FCP 216227 (Wis. Div. Hearings and Appeals Mar. 27, 2025) (DHS) ↓ Download PDF A participant in Family Care cannot be disenrolled without proper advance notice. In this case, the petitioner apparently missed a yearly renewal due in August and had difficulty navigating the re-enrollment process with the ADRC (“sometime in December […] Read more
DHA Case No. CWA 216153 (Wis. Div. Hearings and Appeals Mar. 26, 2025) (DHS) ↓ Download PDF When a petitioner is disenrolled due to agency error, ALJs often correct the error by ordering continued enrollment. In this case, the petitioner made numerous attempts to timely complete a renewal but was unable to due to agency […] Read more