DHA Case No. MGE 221661 (Wis. Div. Hearings and Appeals Feb. 20, 2026) (DHS) ↓ Download PDF The state must maintain Medicaid coverage while completing regularly scheduled renewals as long as the renewal is received before the end of the month the renewal is due. In this case, the petitioner was enrolled in Family Care […] Read more
Tag: 1 Applications and Renewals
DHA Case No. MGE 220385 (Wis. Div. Hearings and Appeals Jan. 26, 2026) (DHS) ↓ Download PDF Enrollment in Family Care may be backdated if an unreasonable delay was caused by agency error. In this case, the petitioner was disenrolled when she failed to complete her renewal, then reapplied and was enrolled again eight months […] Read more
DHA Case No. MGE 220307 (Wis. Div. Hearings and Appeals Jan. 12, 2026) (DHS) ↓ Download PDF To be eligible for Family Care, an applicant must have a long-term care functional screen to determine his or her functional eligibility. In this case, the petitioner submitted an online ACCESS application indicating that she needed help with […] Read more
DHA Case No. BCS 220537 (Wis. Div. Hearings and Appeals Jan. 9, 2026) (DHS) ↓ Download PDF Neither the administrative code nor the federal regulations include a right to a fair hearing regarding an agency’s failure to close a case promptly when asked to do so by a benefit recipient. In this case, the petitioner […] Read more
DHA Case No. MGE 220918 (Wis. Div. Hearings and Appeals Feb. 6, 2026) (DHS) ↓ Download PDF The MEH says a faxed application received after business hours is considered filed on the next business day, but a 2023 fair hearing decision—adopted as final by the DHS secretary—concluded it should be considered filed the day it […] Read more
DHA Case No. MGE 220701 (Wis. Div. Hearings and Appeals Feb. 3, 2026) (DHS) ↓ Download PDF A person’s income and assets are mandatory verification items at the time of a Medicaid application and at annual renewals. In this case, the petitioner provided, over several rounds of requests, verification of her various assets and spend-down; […] Read more
DHA Case No. MRA 220384 (Wis. Div. Hearings and Appeals Jan. 7, 2026) (DHS) ↓ Download PDF In general, all gross income is counted when determining eligibility and cost share for Family Care. In this case, the petitioner was enrolled in Institutional MA and allocated the maximum amount of income to her community spouse, who […] Read more
DHA Case No. CWA 219687 (Wis. Div. Hearings and Appeals Nov. 13, 2025) (DHS) ↓ Download PDF While ADRCs do not have primary responsibility for assisting people with Medicaid applications, they are contracted to provide general assistance, including assistance with obtaining verification. In this case, the ADRC faxed verification documents for the petitioner to Income […] Read more
DHA Case No. MGE 219014 (Wis. Div. Hearings and Appeals Oct. 6, 2025) (DHS) ↓ Download PDF IRIS enrollment dates may be revised if the agency is the cause of a wrongful termination of IRIS enrollment. In this case, the agency sent advance notice of the renewal deadline and a notice requiring verification of a […] Read more
DHA Case No. CWA 219176 (Wis. Div. Hearings and Appeals Oct. 1, 2025) (DHS) ↓ Download PDF IRIS enrollment dates may be revised if the agency is the cause of a wrongful termination of IRIS enrollment. In this case, the agency called the petitioner before her renewal deadline but she declined to do the renewal […] Read more
DHA Case No. MGE 218652 (Wis. Div. Hearings and Appeals Jul. 30, 2025) (DHS) ↓ Download PDF A participant must maintain MA eligibility to remain enrolled in the Family Care program. In this case, the petitioner submitted his renewal and all verification timely, but the agency mistakenly disenrolled him. ALJ Jason Grace ordered Family Care […] Read more
DHA Case No. CWA 218446 (Wis. Div. Hearings and Appeals Jul. 17, 2025) (DHS) ↓ Download PDF A participant in IRIS may be disenrolled if they lose their Medicaid eligibility after a renewal. In this case, the petitioner completed a FoodShare renewal that the agency mistakenly processed as a Medicaid renewal, even though her Medicaid […] Read more
DHA Case No. BCS 216832 (Wis. Div. Hearings and Appeals Apr. 7, 2025) (DHS) ↓ Download PDF The agency must mail a notice of adverse action at least 10 days prior to the effective date. In this case, the petitioner never received a notice that her BadgerCare Plus renewal was due, but the agency did […] Read more
DHA Case No. FCP 216227 (Wis. Div. Hearings and Appeals Mar. 27, 2025) (DHS) ↓ Download PDF A participant in Family Care cannot be disenrolled without proper advance notice. In this case, the petitioner apparently missed a yearly renewal due in August and had difficulty navigating the re-enrollment process with the ADRC (“sometime in December […] Read more
DHA Case No. CWA 216153 (Wis. Div. Hearings and Appeals Mar. 26, 2025) (DHS) ↓ Download PDF When a petitioner is disenrolled due to agency error, ALJs often correct the error by ordering continued enrollment. In this case, the petitioner made numerous attempts to timely complete a renewal but was unable to due to agency […] Read more