DHA Case No. MGE 196854 (Wis. Div. of Hearings and Appeals February 14, 2020) (DHS) ↓ Download PDF
For EBD Medicaid programs, a couple’s income is only counted together if they are legally married and living together. In this case, the petitioner lived with his partner, had children with her, had a commitment ceremony, and she took his last name—but they were never legally married. ALJ Michael O’Brien quickly concluded the partner’s income was not countable.
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Pursuant to a petition filed on November 20, 2019, under Wis. Stat. § 49.45(5), and Wis. Admin. Code § HA 3.03(1), to review a decision by the Wood County Human Services – WI Rapids regarding Medical Assistance (MA), a hearing was held on January 6, 2020, by telephone. A hearing scheduled for December 9, 2019, was rescheduled at the petitioner’s request.
The issue for determination is whether the department correctly counted the income of the mother of the petitioner’s children when determining his eligibility for medical assistance.
There appeared at that time the following persons:
PARTIES IN INTEREST:
Department of Health Services
1 West Wilson Street, Room 651
Madison, WI 53703
Wood County Human Services – WI Rapids
111 W Jackson St
Wisconsin Rapids, WI 54495
ADMINISTRATIVE LAW JUDGE:
Michael D. O’Brien
Division of Hearings and Appeals
Findings of Fact
- The petitioner (CARES # —) is a resident of Ashland County.
- —, the mother of the petitioner’s children, has lived with him and his children since at least 2015. They have never been married.
- The petitioner’s income is under $900 per month. —’s countable income is $3,478.50 per month.
- The department seeks to end the petitioner’s Elderly, Blind, and Disabled Medicaid benefits because it determined that his household income exceeded the program’s income limit.
The petitioner receives Elderly, Blind, or Disabled Medicaid benefits. The program has low income limit that varies with whether the household is considered to have one or two members and with shelter costs. See Medical Eligibility Handbook, § 39.4. The department seeks to end the petitioner’s benefits because it contends that —, the mother of his children, is married to and lives with him. As a result, her income is included when determining he is financially eligible for benefits. The parties agree that his continued eligibility depends upon whether her income is counted.
The preponderance of the evidence establishes that petitioner is not married to —. Both testified that they have never been married, and the department has not submitted a marriage license or any other documentation of their marriage. They did have a commitment ceremony about two decades ago, and — took the petitioner’s last name soon after that, but neither makes them legally married.
—’s income only counts when determining the petitioner’s eligibility if she is his spouse or legally responsible for him. See Medical Eligibility Handbook, § 15.1.1. Because she is not his spouse or guardian, her income does not count; because the department seeks to end his benefits solely because her income would put him over the program’s limit, he remains eligible for Medicaid.
Conclusions of Law
- The income of the mother of the petitioner’s children does not count when determining the petitioner’s eligibility for the Elderly, Blind, and Disabled Medicaid benefits because they are not married and she is not legally responsible for him.
- The petitioner remains eligible for Elderly, Blind, and Disabled Medicaid benefits.
THEREFORE, it is
That this matter is remanded to the county agency with instructions that within 10 days of the date of this decision it reinstate the petitioner’s Elderly, Blind, and Disabled Medicaid benefits retroactive to December 1, 2019.[Request for a rehearing and appeal to court instructions omitted.]