DHA Case No. CWA 216762 (Wis. Div. Hearings and Appeals Mar. 19, 2025) (DHS) ↓ Download PDF Around 2017 DHS instituted a policy that a caregiver should not be approved for more than 40 hours per week of paid services, including SHC covered by IRIS and other forms of caregiving such as personal care worker […] Read more

DHA Case No. CWA 216860 (Wis. Div. Hearings and Appeals Mar. 18, 2025) (DHS) ↓ Download PDF IRIS participants must pay their providers a “usual and customary rate.” In this case, the petitioner sought an increase in the daily rate of his adult day services provider from $157.50 to $168.50. Noting the difference between the customary […] Read more

DHA Case No. MPA 216849 (Wis. Div. Hearings and Appeals Mar. 14, 2025) (DHS) ↓ Download PDF Orthodontia is generally not an MA-covered service, but must be covered for recipients under age 21 if the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) health assessment and evaluation indicates that it is needed. Finding exceptional circumstances […] Read more

DHA Case No. BCS 216544 (Wis. Div. Hearings and Appeals Mar. 14, 2025) (DHS) ↓ Download PDF Certain payments to live-in care providers under the Family Care and IRIS programs do not counts as income for BadgerCare Plus eligibility. In this case, the petitioner argued his $2,797 monthly income should not be counted under these […] Read more

DHA Case No. CWK 216266 (Wis. Div. Hearings and Appeals Mar. 12, 2025) (DHS) ↓ Download PDF Achild in the Children’s Long-Term Support (CLTS) program must be recertified annually, including an updated functional screen. In this case, the petitioner was found functionally ineligible at her recertification, based on the criteria for the psychiatric hospital level […] Read more

DHA Case No. MRA 216768 (Wis. Div. Hearings and Appeals Mar. 6, 2025) (DHS) ↓ Download PDF An ALJ may increase the community spouse income allocation (CSIA) if the community spouse does not have enough income to pay his or her “necessary and basic maintenance needs.” In this case, a previous fair hearing decision had […] Read more

DHA Case No. CWK 216100 (Wis. Div. Hearings and Appeals Mar. 6, 2025) (DHS) ↓ Download PDF A child in the Children’s Long-Term Support (CLTS) program must be recertified annually, including an updated functional screen. In this case, the agency tried many times to schedule a home visit with the petitioner’s mother, but she repeatedly […] Read more

DHA Case No. MGE 216362 (Wis. Div. Hearings and Appeals Mar. 4, 2025) (DHS) ↓ Download PDF An individual is financially eligible for EBD Medicaid if the total value of all non-exempt liquid assets does not exceed $2,000 at the end of the month. In this case, the petitioner owned countable assets of $2,015.27 as […] Read more

DHA Case No. MGE 216433 (Wis. Div. Hearings and Appeals Mar. 3, 2025) (DHS) ↓ Download PDF Medicaid eligibility requires verifying income, assets, and other information as part of the application or renewal process, and on an ongoing basis. In this case, the county agency noticed during a quality control review that it never fully […] Read more

DHA Case No. MGE 216346 (Wis. Div. Hearings and Appeals Feb. 28, 2025) (DHS) ↓ Download PDF An individual is financially eligible for EBD Medicaid if the total value of all non-exempt liquid assets does not exceed $2,000. In this case, the petitioner’s daughter and representative failed to complete a renewal and then, months later, […] Read more

DHA Case No. FCP 216638 (Wis. Div. Hearings and Appeals Feb. 20, 2025) (DHS) ↓ Download PDF Aperson is functionally eligible for Community Waivers long-term care programs if, among other criteria, the person cannot safely or appropriately perform 5 or more IADLs. In this case, the petitioner’s functional screen clearly indicated she needed help with […] Read more

DHA Case No. MAP 216504 (Wis. Div. Hearings and Appeals Feb. 19, 2025) (DHS) ↓ Download PDF To be eligible for MAPP, an individual must (1) be a disabled adult, (2) meet all nonfinancial Medicaid requirements, (3) satisfy the MAPP work requirement, unless exempt, and (4) pay any required premium payments, unless exempt. In this […] Read more

DHA Case No. CWA 216647 (Wis. Div. Hearings and Appeals Feb. 17, 2025) (DHS) ↓ Download PDF An IRIS participant may be disenrolled if the agency is unable to ensure the participant’s health and safety. In this case, the petitioner lived with her daughter, who was also her caregiver and guardian. The petitioner eloped from […] Read more

DHA Case No. CWA 216141 (Wis. Div. Hearings and Appeals Feb. 13, 2025) (DHS) ↓ Download PDF IRIS participants may be involuntarily disenrolled for failure to spend the funds in their budget. In this case, the petitioner was repeatedly warned that her failure to spend her IRIS budget could result in disenrollment, and she ultimately […] Read more