It is the guardian’s responsibility to complete a Medicaid renewal and to keep DHS informed when circumstances change. In this case, the petitioner changed guardians but neither guardian informed the agency, which then sent the renewal notices to the old guardian. The renewal was missed and the petitioner ended up with a gap in his coverage. While noting the unfortunate circumstance, ALJ John Tedesco concluded he had no authority to backdate because the problem was not caused by the agency but by the petitioner’s representatives.
This decision was published with support from the Elder Law & Special Needs Section of the State Bar of Wisconsin and the Wisconsin chapter of the National Academy of Elder Law Attorneys.
Preliminary Recitals
Pursuant to a petition filed on November 14, 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 December 27, 2023, by telephone.
The issue for determination is whether the agency erred in its termination of petitioner’s IRIS eligibility after he failed to complete a periodic renewal.
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: J. Madera
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 Barron County.
- Petitioner was enrolled in the IRIS Program.
- Petitioner was due to complete a periodic eligibility renewal on 8/31/23.
- Notices requiring the renewal were sent to petitioner’s prior guardian.
- Petitioner’s guardian changed in August 2023. The new guardian, —, was not aware of the need to complete the renewal.
- Petitioner, by —, completed a renewal on 9/21/23. This resulted in a gap in IRIS enrollment from 8/31/23 to 9/21/23.
- Petitioner appealed the 8/31/23 termination.
Discussion
The facts are not in dispute. Petitioner was required to complete a MA renewal by 8/31/23. He did not do so. Thus, his MA lapsed. The petitioner and the respondent are in agreement that this happened because petitioner changed guardians prior to the renewal. The agency was not aware of this and sent the renewal notices to the old guardian.
Apparently, the new guardian had not provided new contact information for MA related notices. And the previous guardian did not forward the notices received to the new guardian.
At hearing, both parties pleaded for some relief. The problem here, however, was caused by petitioner’s representatives not completing the required renewal. Petitioner’s representative explained that “we all love him and want the best for him,” but she offered no legal basis for why the termination should be determined to be incorrect.
This is an unfortunate circumstance. Petitioner did not complete the renewal. He relies on his representatives to handle such matters and it seems that one or both of the guardians failed to handle the renewal. This does not make the termination incorrect, however. The IRIS representative explained that she thought that backdating the case could be accomplished through a proposed decision process that is occasionally done in Family Care and Iris eligibility cases. But, that process is used when an eligibility determination is unreasonable delayed as a result of an agency error. In this case the delay was the result of a failure by petitioner or his representatives. As an ALJ I have no authority to simply change things because the result is sad or unfortunate. I see no error here by the agency and have no authority to alter the termination.
Conclusions of Law
The agency did not err in its termination of MA on 8/31/23 based on petitioner’s failure to complete the required renewal.
THEREFORE, it is
Ordered
That this appeal is dismissed.
[Request for a rehearing and appeal to court instructions omitted.]