A “Notice of Action” must be provided to CLTS participants at least fifteen days before a reduction or termination of services, which participants have the right to appeal. In this case, the petitioner’s respite services were terminated effective October 31, 2025, but the agency did not send a notice until November 19, 2025. ALJ Teresa Perez concluded the petitioner’s termination was not proper.
This decision was published with support from the Wisconsin chapter of the National Academy of Elder Law Attorneys and Krause Financial.
Preliminary Recitals
Pursuant to a petition filed on December 3, 2025, under Wis. Admin. Code § HA 3.03(1), to review a decision by the Milwaukee Enrollment Services regarding Medical Assistance (MA), a hearing was held on January 21, 2026, by telephone.
The issue for determination is whether the agency properly terminated respite services.
There appeared at that time the following persons:
PARTIES IN INTEREST:
Petitioner:
—
Respondent:
Department of Health Services
201 E. Washington Ave.
Madison, WI 53703
By: Nancy Duma
Milwaukee Enrollment Services
6055 N. 64th Street
Milwaukee, WI 53218
ADMINISTRATIVE LAW JUDGE:
Teresa A. Perez
Division of Hearings and Appeals
Findings of Fact
- Petitioner is a 19-year old resident of Milwaukee County who is enrolled in the CLTS Program.
- Petitioner received respite through the CLTS Program for at least three years.
- The agency terminated Petitioner’s respite services effective October 31, 2025.
- The agency did not send Petitioner a Notice of Action regarding the termination of respite services until November 19, 2025.
- Petitioner filed a fair hearing request on December 3, 2025.
Discussion
The purpose of Wisconsin’s Children’s Long-Term Support (CLTS) Waiver Program is to provide supports and services to children who have significant disabilities, who require a level of support that would qualify them for institutional care but who reside at home or in the community, and who satisfy Medicaid financial and non-financial requirements. See Medicaid Home and Community-Based Services Waiver Manual for the CLTS Waiver Program (“CLTS Manual”), §§1.1 and 2.1.
The Department of Health Services (DHS) is charged with administering the CLTS Program and developing state-wide policies. See Id. at 1.2. DHS tasks county waiver agencies with authorizing services and supports in accordance with those state-wide policies. See CLTS Manual, Chapters 4 and 7.
The issue in dispute here is whether the agency properly terminated respite services.
All CLTS participants have the right to “contest certain decisions, action, or omissions by using either the state fair hearing process and/or a local grievance process.” CLTS Manual §8.1. Among the actions that participants have the right to appeal through the fair hearing process are service terminations and reductions. CLTS Manual §8.2.2. Waiver agencies must provide participants a “Notice of Action” (NOA) at least fifteen days before the effective date of a reduction or termination of a service that includes the following information: the proposed action, the reason for the proposed action, the effective date of the action, the participant’s right to request a fair hearing including but not limited to “the timeline for filing a fair hearing in order to avoid reduction or termination of services until a hearing is made.” CLTS Manual, § 8.2.2 and § 8.2.3. If a participant files a request for fair hearing prior to the effective date of the intended reduction or termination of services, they are, upon request, entitled to continue receiving unreduced services until a hearing decision is issued. See 42 C.F.R. §431.230 and CLTS Manual §8.2.3.
In the present case, the waiver agency terminated Petitioner’s respite services without sending an advance Notice of Action. Instead, the agency sent a Notice of Action after respite services were already terminated. For that reason alone, I find that the termination of respite services was not proper. If Petitioner received respite after October 31, 2025 from the previously authorized respite provider, the agency must issue payment for those services if requested and if the agency receives any required verification from Petitioner and/or provider.
At hearing, the agency argued why it terminated respite services and Petitioner argued why she believed she continues to need respite services. I am not addressing any of those arguments because the lack of notice by itself rendered the service termination inappropriate. This decision does not, however, prohibit, the waiver agency from now providing appropriate advance notice–assuming that the agency continues to believe that respite is no longer an appropriate waiver service for Petitioner. If the waiver agency takes that action, Petitioner would have the right to file a new fair hearing request.
Conclusions of Law
The agency did not issue the required advance notice of action to Petitioner informing her that her respite services would be terminated; the agency’s termination of respite services was therefore not appropriate.
THEREFORE, it is
Ordered
That the appeal is remanded to the agency to reinstate the prior authorization for respite services retroactive to November 1, 2025, and to inform Petitioner of any steps she must take if she wishes to seek payment for respite services provided on or after November 1, 2025. The agency must comply with these instructions within ten days of the date of this decision.
[Request for a rehearing and appeal to court instructions omitted.]
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