DHA Case No. WFC 213597 (Wis. Div. of Hearings and Appeals June 25, 2024) (DHS) ↓ Download PDF The Wisconsin Funeral and Cemetery Aids Program (WFCAP) pays a portion of the cemetery expenses and funeral and burial expenses of indigent recipients of AFDC, W-2 benefits, SSI, or Medicaid under certain circumstances. In this case, the […] Read more

DHA Case No. BCS 213015 (Wis. Div. of Hearings and Appeals June 24, 2024) (DHS) ↓ Download PDF During the Covid public health emergency unwinding, members who had an increase in earned income could qualify for a 12-month extension starting the month after their renewal. In this case, the petitioner qualified for an extension but […] Read more

DHA Case No. MAP 212440 (Wis. Div. of Hearings and Appeals April 16, 2024) (DHS) ↓ Download PDF Applicants for Medicaid are given at least 20 days from the date of a request to provide verification, and benefits may only be denied if the applicant has the power to produce the verification. In this case, […] Read more

DHA Case No. FCP 211142 (Wis. Div. of Hearings and Appeals March 19, 2024) (DHS) ↓ Download PDF Family Care enrollment can be backdated if agency error by the ADRC or IM causes unreasonable delay. In this case, the petitioner filed an application October 10, but the agency never told his authorized representative of the […] Read more

DHA Case No. CWA 211353 (Wis. Div. of Hearings and Appeals March 14, 2024) (DHS) ↓ Download PDF DHS automatically disenrolls an IRIS participant when he or she loses basic Medicaid eligibility. In this case, the petitioner failed to get his renewal verification in on time and was disenrolled from Medicaid and IRIS. Although he […] Read more

DHA Case No. MGE 162960 (Wis. Div. of Hearings and Appeals March 6, 2015) (DHS) ↓ Download PDF In a spousal impoverishment case, any assets designated for burial purposes are exempt (as long as the amount is reasonable). In this case, the petitioner designated stocks and an insurance policy as burial funds on his November […] Read more

DHA Case No. CWA 210997 (Wis. Div. of Hearings and Appeals January 17, 2024) (DHS) ↓ Download PDF 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 […] Read more

DHA Case No. FCP 210973 (Wis. Div. of Hearings and Appeals January 16, 2024) (DHS) ↓ Download PDF Family Care enrollment can be backdated if agency error by the ADRC or IM causes unreasonable delay. In this case, the petitioner’s authorized representative failed to complete his renewal: she “apparently left employment with her payee company, […] Read more

DHA Case No. FCP 209929 (Wis. Div. of Hearings and Appeals January 12, 2024) (DHS) ↓ Download PDF Family Care enrollment can be backdated if agency error by the ADRC or IM causes unreasonable delay. In this case, the ADRC sent the Community Waivers referral to IM on June 16, but “for reasons unclear” IM […] Read more

DHA Case No. MGE 209925 (Wis. Div. of Hearings and Appeals January 12, 2024) (DHS) ↓ Download PDF Family Care enrollment can be backdated if agency error by the ADRC or IM causes unreasonable delay. In this case, the petitioner was eligibile on July 6 but not enrolled until July 21 because the ADRC mistakenly […] Read more

DHA Case No. FCP 209869 (Wis. Div. of Hearings and Appeals January 12, 2024) (DHS) ↓ Download PDF In general, the ADRC has 30 days from the date of request to determine functional eligibility or provide notice of a delay; IM has 30 days from the date of application to determine financial eligibility. In this […] Read more

DHA Case No. FCP 209037 (Wis. Div. of Hearings and Appeals November 14, 2023) (DHS) ↓ Download PDF The Department may backdate Family Care enrollment when there is an agency error that causes an unreasonable delay. In this case, the petitioner was found eligible in December of 2022 and the MCO received her enrollment form […] Read more

DHA Case No. MGE 209328 (Wis. Div. of Hearings and Appeals December 5, 2023) (DHS) ↓ Download PDF An application for Institutional MA can be backdated up to three months before the month of application. The MEH provides that an application faxed and received by the agency after business hours counts as filed on the […] Read more

DHA Case No. MGE 209372 (Wis. Div. of Hearings and Appeals August 11, 2023) (DHS) ↓ Download PDF In general, a member must have at least ten days to provide required verification during a renewal. In this case, the agency sent a notice on July 3 requesting verification by July 10. Although he should have […] Read more