DHA Case No. BCS 219613 (Wis. Div. Hearings and Appeals Sep. 26, 2025) (DHS) ↓ Download PDF To be eligible for Wisconsin Medicaid programs, a person must be a resident of Wisconsin. In this case, the 21-year-old petitioner claimed to be a homeless resident of Wisconsin while attending college in Mississippi, where she had an […] Read more

DHA Case No. MAP 216504 (Wis. Div. Hearings and Appeals Feb. 19, 2025) (DHS) ↓ Download PDF To be eligible for MAPP, an individual must (1) be a disabled adult, (2) meet all nonfinancial Medicaid requirements, (3) satisfy the MAPP work requirement, unless exempt, and (4) pay any required premium payments, unless exempt. In this […] Read more

DHA Case No. BCS 219279 (Wis. Div. Hearings and Appeals Sep. 15, 2025) (DHS) ↓ Download PDF A migrant worker can qualify for Emergency Services MA if he is currently working in Wisconsin and qualifies for BadgerCare Plus under a category other than childless adult. In this case, the petitioner was a migrant working in […] Read more

DHA Case No. MAP 216062 (Wis. Div. Hearings and Appeals Feb. 4, 2025) (DHS) ↓ Download PDF The agency may not require one particular type of verification when various types are adequate and available. In this case, the petitioner owned a newly incorporated business with no previous tax filings. Instead of submitting a self-employment income […] Read more

DHA Case No. MGE 214684 (Wis. Div. Hearings and Appeals Jan. 2, 2025) (DHS) ↓ Download PDF Royalties are considered unearned self-employment income for MA purposes. The monthly countable income is calculated by prorating the previous tax year’s net income over twelve months. In this case, the petitioner complained that the fluctuating amounts received meant […] Read more

DHA Case No. MAP 217949 (Wis. Div. Hearings and Appeals May 13, 2025) (DHS) ↓ Download PDF To qualify as disabled for MAPP eligibility, a person must ultimately be unable to perform any substantial gainful activity. In this case, the petitioner was 28, had autism, anxiety disorder, and mild mental retardation, and had no physical […] Read more

DHA Case No. MAP 216925 (Wis. Div. Hearings and Appeals Apr. 24, 2025) (DHS) ↓ Download PDF To be non-financially eligible for MAPP, a person must be working and meet the SSI standard for disability. In this case, the petitioner had laryngeal cancer and was initially determined disabled, but after a year and a half […] Read more

DHA Case No. MDD 213268 (Wis. Div. Hearings and Appeals Sep. 6, 2024) (DHS) ↓ Download PDF A person is not disabled for Medicaid purposes if they can perform the same work they have done in the past at a substantially gainful level. In this case, the petitioner was ultimately determined not disabled because he […] Read more

DHA Case No. MGE 216109 (Wis. Div. Hearings and Appeals Feb. 14, 2025) (DHS) ↓ Download PDF To be eligible for Community Waivers Medicaid programs, an individual must be elderly, blind, or disabled. In this case, the petitioner was 28 years old and working full time at $15.50 per hour, though he had at some […] Read more

DHA Case No. MGE 215845 (Wis. Div. Hearings and Appeals Feb. 17, 2025) (DHS) ↓ Download PDF Medicaid denials must be appealed within 45 days. In this case, the petitioner received notices dated April 18, 2023 and August 29, 2023 determining that she was over the asset limit in April, May, and June. But because […] Read more

DHA Case No. MKB 212148 (Wis. Div. Hearings and Appeals Jun. 18, 2024) (DHS) ↓ Download PDF To be eligible for the Katie Beckett program, a child must qualify as disabled under the Social Security standards in addition to functionally needing an institutional level of care. That often comes down to whether the child’s condition […] Read more

DHA Case No. MDD 212595 (Wis. Div. Hearings and Appeals May 14, 2024) (DHS) ↓ Download PDF An applicant is not disabled if he or she is still able to perform appropriate types of work. In this case, the petitioner claimed to be disabled because of her diagnoses of extreme social anxiety, bipolar, PTSD, depression, […] Read more

DHA Case No. MKB 211904 (Wis. Div. Hearings and Appeals Mar. 29, 2024) (DHS) ↓ Download PDF To be eligible for the Katie Beckett program, a child must meet the Social Security standards for childhood disability, including “marked and severe functional limitations.” In this case, the petitioner was an eight-year-old child with severe congenital disorders […] Read more

DHA Case No. MDD 214689 (Wis. Div. Hearings and Appeals Oct. 21, 2024) (DHS) ↓ Download PDF If the Social Security Administration finds an applicant not disabled within twelve months of a state MA application, that determination is binding on the state. In this case, the petitioner applied for SSI, SSDI, and state MA. Because […] Read more