In this brief case, the petitioner appealed the termination of her IRIS benefits due to losing functional eligibility. Because she did not appear at the hearing, ALJ John Tedesco dismissed the case and the IRIS termination was finalized. But then she asked for a rehearing, saying that she never received the hearing notice. Before the rehearing she was rescreened, determined functionally eligible, and re-enrolled in IRIS. ALJ John Tedesco concluded that, because of the lack of notice, the IRIS eligibility and enrollment should be reinstated back to the original date of termination:
Had she received the hearing notice I have no question that the re-screen would have taken place and the matter would have been resolved with no lapse in enrollment and eligibility.
Preliminary Recitals
Pursuant to a petition filed on June 8, 2023, under Wis. Admin. Code § HA 3.03, to review a decision by the Bureau of Long-Term Support regarding Medical Assistance (MA), a hearing was held on October 4, 2023, by telephone.
The issue for determination is whether petitioner’s IRIS enrollment should be reinstated as of 6/21/23 without a lapse.
There appeared at that time the following persons:
PARTIES IN INTEREST:
Petitioner:
—
Respondent:
Department of Health Services
1 West Wilson Street, Room 651
Madison, WI 53703
By:
Bureau of Long-Term Support
PO Box 7851
Madison, WI 53707-7851
ADMINISTRATIVE LAW JUDGE:
John P. Tedesco
Division of Hearings and Appeals
Findings of Fact
- Petitioner is a resident of Juneau County.
- Petitioner was terminated from IRIS effective 6/21/23 for no longer meeting the required level of care.
- Notice dated 6/6/23 was sent to petitioner informing her of the termination.
- Petitioner appealed timely.
- DHA set a hearing date and issued notice to petitioner by mail.
- Petitioner did not appear and the case was dismissed by this ALJ.
- As a result of that dismissal the IRIS program finalized the termination.
- Petitioner requested rehearing on the basis that she did not receive the hearing notice.
- Rehearing was granted.
- Prior to rehearing petitioner was determined to meet the required level of care and was re-enrolled in IRIS.
Discussion
Petitioner did not appear at the initial hearing based on her not receiving the hearing notice. Had she received the hearing notice I have no question that the re-screen would have taken place and the matter would have been resolved with no lapse in enrollment and eligibility. It is not clear that her failure to appear was the fault of any party or DHA. Regardless, petitioner should not bear a burden due to what may be the fault of DHA or the US Postal Service.
For this reason, IRIS eligibility and enrollment should be reinstated with no lapse back to the 6/21/23 date of termination.
Conclusions of Law
IRIS eligibility and enrollment should be reinstated with no lapse back to the 6/21/23 date of termination.
THEREFORE, it is
Ordered
That this matter is remanded to the IRIS agency with instruction to reinstate IRIS eligibility and enrollment with no lapse back to the 6/21/23 date of termination. This action should be completed within 10 days of this Decision.
[Request for a rehearing and appeal to court instructions omitted.]