DHA Case No. MDD 199954 (Wis. Div. of Hearings and Appeals January 14, 2021) (DHS) ↓ Download PDF If the Social Security Administration makes a finding of no disability for an SSI or SSDI application within 12 months of a state Medicaid application, that finding is generally binding on the state. In this case, the […] Read more
2 Nonfinancial Eligibility
DHA Case No. MDD 200680 (Wis. Div. of Hearings and Appeals February 10, 2021) (DHS) ↓ Download PDF In making a disability determination, the Disability Determination Bureau (DDB) applies a 5-step test. Step 5 considers whether the individual can adjust to types of work the individual has not performed in the past, considering his or […] Read more
DHA Case No. MOP 200346 (Wis. Div. of Hearings and Appeals February 10, 2021) (DHS) ↓ Download PDF In an overpayment hearing, the agency has the burden to prove, by the preponderance of the evidence, both that the petitioner failed to provide accurate or complete information and that the petitioner was not eligible during the […] Read more
DHA Case No. MDD 201432 (Wis. Div. of Hearings and Appeals April 9, 2021) (DHS) ↓ Download PDF To determine if an applicant can engage in substantial gainful activity, the Disability Determination Bureau applies a 5-step test. In the fifth step, the DDB must determine if the person can do any kind of work that […] Read more
DHA Case No. MDD 203616 (Wis. Div. of Hearings and Appeals January 19, 2022) (DHS) ↓ Download PDF Even if a person cannot engage in any substantial gainful activity, he must still pass a 5-step test to be determined disabled. If he can perform work he has done in the past, Step 4 requires a […] Read more
DHA Case No. MOP 204371 (Wis. Div. of Hearings and Appeals May 2, 2022) (DHS) ↓ Download PDF A person must be a resident of Wisconsin to receive Medicaid benefits, and residency ends if another state determines the person to be a resident for its own Medicaid programs. In this case, the petitioner applied for […] Read more
DHA Case No. 204650 (Wis. Div. of Hearings and Appeals May 3, 2022) (DHS) ↓ Download PDF A resident alien is generally not eligible for public assistance benefits for five years after his or her date of entry. In this case, the petitioner had entered the country less than five years before applying for SeniorCare […] Read more
DHA Case No. MGE 160646 (Wis. Div. Hearings and Appeals January 9, 2015) (DHS) ↓ Download PDF This case involved two main issues: (1) the date the petitioner transferred ownership of a life insurance policy to her Wispact sub-account, and (2) the effect of a pending disability determination on retroactive eligibility. On the first issue, […] Read more
DHA Case No. MGE 185074 (Wis. Div. Hearings and Appeals March 14, 2018) (DHS) ↓ Download PDF In this straightforward decision, the petitioner owned home property in Michigan but was admitted to a Wisconsin nursing home. Her Medicaid application was denied because the agency “did not receive timely verification of any circumstance that would exempt […] Read more
DHA Case No. MED 67/53178 (Wis. Div. Hearings and Appeals Feb. 28, 2003) (DHS) ↓ Download PDF In this case, a Medicaid recipient failed to report a divestment that occurred after her initial application was approved and benefits had started. The ALJ held that, despite the failure to report, the overpayment of benefits was not […] Read more