To be eligible for Wisconsin Medicaid, a person must be a Wisconsin resident. In this case, the petitioner initially resided in an nursing home in Wisconsin and attempted to exempt more than $1,500 in burial funds. When the agency discovered it had erroneously allowed him to do this, it sent a disenrollment notice, which the petitioner appealed. ALJ Teresa Perez concluded, however, that she had no authority to continue his Medical Assistance because the petitioner was no longer a Wisconsin resident—he had moved to New York and intended to stay there. (Though even if he were still a resident of Wisconsin, $1,500 is the maximum exemption for burial funds.)
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 October 2, 2025, under Wis. Stat. § 49.45(5), and 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 November 19, 2025, by telephone.
The issue is whether the Division of Hearings and Appeals has present jurisdiction.
There appeared at that time the following persons:
PARTIES IN INTEREST:
Petitioner:
—
Petitioner’s Representative:
—
Respondent:
Department of Health Services
201 E. Washington Ave.
Madison, WI 53703
By: Kyra Oberg
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 (CARES # —) is a former resident of Kenosha County.
- Petitioner relocated to New York in late October 2025 where he now resides in a skilled nursing facility. He does not intend to return to Wisconsin.
- In July 2025, Petitioner was residing in a skilled nursing facility in Wisconsin. At that time, he had approximately $7,998 of funds held in bank accounts. Of that, he intended more than $1,500 to be used for burial expenses.
- Petitioner applied for and received Institutional Medical Assistance in Wisconsin from July 8, 2025 through October 31, 2025.
- In September 2025, the agency discovered that it had opened Petitioner’s Medical Assistance in error by failing to note that Petitioner owned more than $2,000 in countable, available assets.
- Via notice dated September 26, 2025, the agency informed Petitioner that his Medical Assistance would close as of November 1, 2025 because his countable assets exceeded the program limit.
- Petitioner filed an appeal with the Division of Hearings and Appeals because he believes that he should be allowed to designate more than $1,500 as a burial fund.
Discussion
To be eligible for Institutional Medical Assistance (also referred to as Nursing Home Long Term Care), an unmarried individual may not own countable, available assets in excess of $2,000. Medicaid Eligibility Handbook (MEH) §§16.1, 27.5.1, and 39.4.1. And, those assets must be verified.
There are several types of burial assets that are considered exempt and thus do not count towards the $2,000 asset limit. For example, $1,500 of “burial funds”, as described and under the conditions set forth in Medicaid Eligibility Handbook, Sec. 16.5.5, may be exempt. Consistent with that policy, the agency correctly determined that Petitioner could not designate more than $1,500 of the funds in his bank account as a “burial fund” and that the remaining countable funds in his bank accounts exceeded the $2,000 program limit.
Petitioner’s daughter appeared at hearing and argued that the agency was not properly applying Medicaid policy or statute. Specifically, she argued that the amount her father had set aside for burial was a reasonable amount and that the agency’s decision frustrated the intent of setting aside money for burial. However, as the agency’s representative stated at hearing, Medicaid policy provides ways for a person to protect more than $1,500 for burial expenses; for example, by setting up an irrevocable life insurance funded burial contract. See, Medicaid Eligibility Handbook Sec. 16.5.1, et. seq. Petitioner also explained that her father has incurred significant medical bills and moving expenses. That is not, however, relevant to the issue here.
During the hearing, Petitioner’s daughter testified that her father moved to New York in late October 2025 and does not intend to return. Under these circumstances, the Division of Hearings and Appeals has no authority to continue his Institutional Medical Assistance. He must apply with the State of New York. Even if the Division of Hearings and Appeals did have jurisdiction, I would find that the agency properly terminated Petitioner’s eligibility because it never received verification showing that his bank account funds, less a $1,500 burial fund designation, had been sufficiently reduced.
Conclusions of Law
The Division of Hearings and Appeals does not have jurisdiction to continue Petitioner’s Institutional Medical Assistance beyond November 1, 2025 because he no longer resides in Wisconsin.
THEREFORE, it is
Ordered
Petitioner’s appeal is dismissed.
[Request for a rehearing and appeal to court instructions omitted.]
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